This review provides an in-depth analysis of the potential benefits of cell-free therapy based on adipose-derived exosomes (ADSC-Exos) in inhibiting scar formation. The review highlights the advantages of using ADSC-Exos. It also explores the complex mechanisms by which ADSC-Exos inhibit scar formation, including their role in hemostasis, inflammation, cell proliferation, tissue remodeling, and their regulation of critical molecules (platelets, inflammatory factors, extracellular matrix molecules, collagen molecules) and crucial cells (macrophages, endothelial cells, fibroblasts), as well as their modulation of epithelial-mesenchymal transition. Additionally, the article examines different delivery methods and engineering approaches for optimizing the targeting of adipose stem cell-derived exosomes in traumatic scarring. It points out the potential of using liposomes to construct molecular-targeted exosomes in precision medicine. Finally, the review summarizes current research and provides insights into the future development of exosomes in scar treatment. In conclusion, this article reveals the potential of cell-free therapy based on ADSC-Exos as a promising treatment for inhibiting scar formation.