Medicinal plants, widely used in traditional medicine, contain bioactive compounds such as phenolics and flavonoids that exhibit antioxidant and anti-inflammatory properties relevant to skin health. Recently, medicinal plant-derived nanovesicles (MPDNVs) have emerged as natural nanocarriers that combine intrinsic bioactivity with drug delivery potential. This review provides a comprehensive overview of MPDNVs for dermatological and cosmetic applications, including the management of inflammatory skin disorders, wound healing, and anti-aging care. We critically examine current isolation and characterization techniques, emphasizing challenges related to standardization, reproducibility, and nomenclature. For the first time, particular attention is given to topical formulation strategies and their impact on MPDNV stability, integrity, and rational for therapeutic performance. Educational sections are integrated throughout the review to clarify complex concepts, including vesicle classification, analytical methodologies, and formulation design, offering expert perspectives on technical and regulatory hurdles. Finally, we highlight the dual role of MPDNVs as active agents and drug carriers, and outline opportunities for clinical translation and regulatory harmonization. By combining mechanistic insights with formulation considerations, this review aims to guide future research towards safe, effective, and scalable MPDNV based therapies for skin drug delivery and cosmetic applications.