Everything We Know So Far About Micro-Coring

Though it gained FDA approval last summer, a major in-office innovation called Micro-Coring—it’s touted as a skin-tightening superstar with nonsurgical results rivaling a facelift, and no scarring—is still largely under the radar because “there are very few devices available around the world, so very few people have used it,” says Boston dermatologist Mathew Avram, MD. Here’s everything we know.

What It Is
A proprietary technology created by a company called Cytrellis (the formal name is the Ellacor System with Micro-Coring technology), Micro-Coring is a minimally invasive method for removing skin to produce a tightening effect and reduce moderate-to-severe wrinkles in the mid and lower face. As of now, the treatment is only indicated to be used on the cheeks and along the jawline, and a little bit right underneath the chin. Based on the initial research and forward-thinking of its founders, Boston plastic surgeon William G. Austen, Jr., MD, and dermatologist Rox Anderson, MD (he invented CoolSculpting), Cytrellis was able to bring this innovative idea to life. “The novel system [the first of its kind] can remove as much skin as some surgical procedures without scarring,” says Dr. Austen, Jr.

How It Works
According to New York dermatologist Doris Day, MD, the device uses hollow needles to remove full thickness micro cores of dermal and epidermal tissue, resulting in an improved appearance of wrinkles and a reduction in sagging skin associated with aging. It’s also an alternative to some energy-based ablative lasers that require a significant downtime in exchange for skin tightening.

And that’s an important differentiator: Micro-Coring is not an energy-based device or laser treatment, or facelift surgery. “This device is basically mechanically extracting skin,” says Dr. Avram. “When you do a facelift, you remove a certain amount of skin by the ear and pull the remaining skin back and suture it in. Then you have an area of ​​wound healing there and you get a tightening effect. This isn’t making one large incision. What it’s actually doing is taking between 10,000 and 12,000 tiny little micro-cores of skin—tiny little touch biopsies, if you will—and removing 4 to 8 percent of the skin in the area you’re treating, but there’s no perceptible scarring. The reason for that is because the tissue removals are small enough—less than 500 micrometers in width—that they don’t create scars. If you look under a microscope on a histology slide, you won’t see a scar, and you certainly won’t see one looking at a patient.”

Dr. Day agrees: “The holes are teeny, teeny tiny, but just the right size to work without leaving a visible scar. In studies, when they did a biopsy of the skin, they found that even looking under a microscope, you couldn’t find any damaged collagen—there was no scarring at all.”

Who It’s Best For
“I think it provides a niche for patients who have some laxity, some jowls or some facial laxity that creates marionette lines,” says Dr. Avram. “It can soften some of the lines on the cheeks that are closer to the chin and lips, as well as tighten the jowls and face a little bit. And in that way, it does something that fillers and lasers can’t do. Fillers can fill lines and provide volume for areas that need it, but they can’t tighten. Lasers can soften lines, but they’re not great at tightening. I think that’s why we’re seeing good results and good patient satisfaction so far, in line with what the study showed.”

As far as which skin tones it’s suitable for, unfortunately the studies were only done on Fitzpatrick Types 1-4, so it remains unclear as to whether or not it is safe for darker skin tones. “I was not involved in the studies, so I can’t speak authoritatively on this because I don’t know the answer,” says Dr. Avram, “but it would have been great if they studied skin types 5 and 6. However, given the fact there isn’t a lot of energy or heat being used with this treatment, it’s reasonable to expect that there won’t be a great difference in the degree of hyperpigmentation or complications, but until patients are treated, we can’t be definitive.”

Pain Factor
Local anesthesia is a must: “We do nerve blocks with lidocaine and epinephrine [injections of numbing medication in the treatment area] for anesthesia because without anesthesia, it would be very painful,” Dr. Avram explains. “You get good pain control this way.” Dr. Day adds that the healing time is about three days, which is faster than the downtime associated with many energy-based procedures.

Number of Treatments Needed
If a patient has mild laxity, Dr. Avram says one treatment can be more than sufficient for a good result and significant improvement. But if a patient has moderate-to-severe laxity, they may need several treatments. “It takes three months to see the full benefits of treatment, and if doing a series, I’d wait at least six weeks in between treatments,” he adds.

If you’ve recently had filler injections, be sure to let your doctor know before undergoing treatment because it could negatively impact your results. “Micro-Coring is only removing up to 8 percent of skin, so it’s not going to remove a lot of filler, but it will really depend on where the filler was placed, where it’s concentrated and what you’re trying to do for the patient,” Dr. Avram explains. “I think the better order would be to do the filler after Micro-Coring because you’ll get some tightening and some lines may improve, but you may want to top that off with filler. There’s no reason you can’t do a combination treatment with this.”

How It’s Different Than Microneedling
Though it’s totally understandable to assume a similarity when you hear “micro” and “needles” in the same sentence, but this technology is completely different. “Microneedling doesn’t take out any skin,” says Dr. Day. “Micro-Coring does create channels in the skin, so it’s like a microneedle, but microneedles aren’t hollow with the goal of creating a hole in the skin like a cookie cutter. When you push it through the skin, the skin goes into the hole, or hollow of the needle.”

Why It’s Not a Substitute for Surgery
La Jolla, CA plastic surgeon Robert Singer, MD says it’s important to note that Micro-Coring is not a substitute for a facelift because it does not manipulate the facial musculature the way surgery does, which is often necessary to achieve a more youthful result overall (rather than tightening the skin).

Eugene, OR plastic surgeon Mark Jewell, MD agrees. “I believe it only addresses skin laxness, not the supporting SMAS layer that supports the skin. Facial aging is complex from a biomechanical perspective, as the skin ages differently that the underlying SMAS. Skin tightening with laser, radio-frequency or threads does not produce a lasting effect. It takes deep layer tightening of the SMAS as part of a comprehensive facial rejuvenation process, and tightening of the skin is of less importance. SMAS tightening can be achieved with surgery or Ultherapy on the 4.5 millimeter depth.”

Either way, it’s a significant innovation for the aesthetic community and we can’t wait to learn more. Click here to watch a video of Dr. Avram performing a Micro-Coring treatment on a patient at Mass General (note: it may be too graphic for some, so proceed with caution).

The Future of Micro-Coring
If top doctors continue seeing the results they’re seeing right now, this could be a complete game changer for skin-tightening treatments, but also the aesthetic industry as a whole. And of course we wanted to know when this will be available to use on parts of the body below the neck, such as the arms and above the knees where loose skin can be incredibly bothersome. “Though we’re not going off of the FDA indications at this time, we’re hopeful that in the future, given the benefits we’re seeing on the face, it’s entirely logical to think this will be available for treatments off the face for loose and lax skin elsewhere,” says Dr. Avram. “As time goes on, I think it will be safe and effective, but we haven’t done that yet and we’re going to proceed cautiously.”

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