Last year in July 2021, the US FDA cleared Ellacor by Cytrellis Inc., a new medical device for minimally invasive skin tightening and rejuvenation through micro-coring technology (MCT). The team behind this new device is from the Massachusetts General Dermatology Laser and Cosmetic Center, led by Dr. Mathew M Avram, MD JD, associate professor of dermatology at Harvard Medical School.
This is something of a big deal as most of the times we see improvements in old technologies or variations of old technologies being marketed as new aesthetic medicine devices, but in this case, we are looking at something completely new, a total innovation.
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How does Ellacor work?
Ellacor is the first medical device to employ micro-coring, also called fractional micro-coring, to rejuvenate the skin. This device has three hollow stainless-steel needles moving rapidly in a 10 mm x 10 mm (about 0.4 x 0.4 inches) area of the skin. The needles punch the skin, and a vacuum allows for the removal of a column of skin (a “micro-core”) from the needle. The 10×10 mm area is treated in less than 3 seconds and each micro-core is about 0.5 mm in diameter (0,02 inches or 20 thou). By doing this, Ellacor can remove up to 8% of the total surface area treated which results in shrinking and tightening the skin and stimulating collagen and elastin synthesis. The micro-cores are so small that there is no scar left behind not just to the naked eye, but also when looking at the skin with a microscope.
Removing the micro-cores of skin with Ellacor overall produces skin contraction and a lifting effect once the treated area is fully healed. The fractional nature of this treatment, leaving healthy columns of skin between the micro-cores, allows for a faster healing process than it would be if there were just large chunks of skin removed.
The physicians can change some settings in the machine to tailor the treatment to each patient such as the percentage of skin to remove (up to 8%), and the depth of the micro-cores to adjust it according to the dermal thickness of the area treated and of the patient (from 0 to 5 mm).
The micro-coring treatment not only removes skin, effectively treating sagging, but it has also been proven effective at increasing epidermal and papillary dermal thickness, increase collagen synthesis, promote skin remodeling, and increase elastin content in the dermis. It is likely that the controlled injury caused by Ellacor allows for the release of plasma growth factors leading to a cascade of effects that promote tissue rejuvenation.
According to OCT (optical coherence tomography) imaging studies, the holes close within 10 minutes post treatment following the area’s natural tension lines.
How is Ellacor treatment performed?
Before starting the treatment, your doctor will either apply a numbing cream or will inject a local anesthesia to minimize discomfort. Sometimes, epinephrine is added to minimize bleeding as well. According to the clinical trial data, patients reported pain while undergoing the procedure as less than 2 on a 0 to 10 scale.
Once the anesthesia kicks in, the practitioner will treat the area one square centimeter at a time moving the handpiece in a grid-like pattern. Treatment takes between 15-30 minutes to be completed with some extra time needed to anesthetize the area.
Post micro-coring treatment care
After treatment you are advised to use a petrolatum jelly or other ointment as specified by your physician for up to a few days to restore the skin’s barrier function and prevent infections. Make-up and other skincare products may be best avoided for up to a week after treatment. There is minimal pain or discomfort post-procedure which can be managed with OTC medications and according to your treatment provider’s advice.
According to the clinical trial most patients (70%) felt comfortable going out in public or resuming work 3 days after the procedure, while in some patients recovery may take a bit longer, usually not more than a week.
Results after Ellacor treatment
After just a single treatment you can already experience improvement in the look of wrinkles and sagging skin and multiple treatments may be advised in patients with more severe skin laxity or to further improve the look of wrinkles. Most patients in the clinical trials underwent 3 treatments spaced 30 days apart. Your skin will keep healing and the aesthetic changes will take weeks to be fully appreciated, with most of the results being visible at the 90-day mark post-treatment and full and final results after around 6 months.
According to data from the producer, 90% of patients show improvement and 86% of patients are satisfied with the treatment when also considering the side effect they experienced.
How does Ellacor compare to other aesthetic treatments?
The micro-coring technology is a first-of-its-kind type of cosmetic treatment, so unlike other popular minimally invasive procedures Ellacor currently has no competitor brands on the market. Here below I’ll compare it to other surgical and non-surgical aesthetic procedures that aim at achieving facial rejuvenation.
Micro-coring vs surgical face lift
Ellacor produces significant reduction in skin sagging and smooths wrinkles, reason why it is already being called a non-surgical face lift alternative. While the results may be very good in selected patients, it can’t of course match the results of a traditional face lift surgery.
The micro-cores include portion of the epidermis, the outermost layer of skin, and the dermis that sits above the subcutaneous fat layer; a face lift instead addresses not only the skin but also the fascia and the muscle layer underneath it. On the other hand, there is no long recovery, less risk of complications and less side effects when comparing Ellacor to a traditional surgery: the downtime of the MCT is just around 3 days and treatment time is less than 30 minutes without need for a general anesthesia. Moreover, while with facelifts there is always going to be a scar that the surgeon will try and hide strategically, with the micro-coring technology there seems to be no scar not even at a histological level when looking at the tissues through a microscope. Finally, since there is no skin pulling involved, there is no risk of unnatural looking results or of face features being slightly displaced, like the eyebrows, or of having asymmetrical results.
According to some plastic surgeons, this may be a good alternative in 40-60 years old individuals to address the initial signs of aging and to avoid or at least delay an invasive surgical procedure for a while.
Micro-coring vs micro-needling
Besides the obvious difference that micro-needles do not remove any tissue from the treatment area, unlike Ellacor removing 10-12,000 micro-cores over the course of 10 to 15 minutes of treatment, the micro-needles are also much smaller and penetrate to a much shallower depth: micro-needles diameters are generally around 100 microns, while Ellacor stainless steel needles have an internal diameter of 500 microns. Microneedles are often designed to penetrate only the epidermal layer of the skin with 0.5 to 1.5 mm in length while the micro-coring needles reach the upper portion of the hypodermis which sits much deeper. Microneedles work by producing a controlled minimal injury to the tissue which will cause a cascade of growth factor release as well as breaking down old collagen fibers overall stimulating the fibroblast to produce new extracellular matrix and cause tissue rejuvenation. Ellacor goes beyond that with a much powerful rejuvenation stimuli and adding to that the skin shrinkage due to the thousands of tissue columns removed during the treatment.
Micro-coring vs fractional laser
One might think that both the Ellacor device and a Fraxel laser work the same way, so what would be the benefit of choosing a mechanical device over the energy-based one? Well, they are actually quite different and the only thing they have in common is the fractional pattern used to treat the skin.
With Ellacor there is no thermal damage to the surrounding skin, while with the laser there’s inevitably some energy dispersion in the surrounding leftover tissue. Moreover, while the Ellacor device leaves a clean core behind that closes immediately due to the applied vacuum and starts to heal, the fractional lasers leave a cuff of hard damaged tissue that does not allow the wound to close: this cuff is thicker when using CO2 lasers and thinner when using an Er:YAG laser, but anyway there’s not skin shrinkage with fractional lasers unlike with the micro-coring device.
While the fractional lasers are effective at improving skin texture, photodamaged skin and the look of scars, the skin tightening effect is minimal and non-significant making Ellacor superior in terms of aesthetic results and rejuvenation.
Ellacor indications
The FDA has currently cleared Ellacor for “the treatment of moderate to severe wrinkles in the mid to lower face”, but it is already being used to treat skin laxity and wrinkles in other body areas and it is likely they will expand the indications for treatment. It is available for patients 22 years or older and is only indicated in Fitzpatrick skin type I-IV and has yet to be evaluated in darker skin tones.
In the future it is likely that the applications will be expanded as it is already being investigated for tattoo removal, to treat scars (surgical and acne related, not hypertrophic or keloids) and striae and to treat more areas like the thighs, neck, abdomen, upper arms, knees and elbows.
Ellacor contraindications
Micro-coring treatment is contraindicated in pregnant and nursing women, in those with bleeding disorders or taking anticoagulant medications, and in areas with active infections or skin conditions. For a comprehensive list of contraindications ask your treating physician.
Micro-coring treatment precautions
Some plastic surgeons and dermatologists have been less enthusiastic than other in welcoming this novel skin rejuvenation device and believe that Ellacor has the potential to cause hyperpigmentation issues in a wide range of patients, even those with lighter skin tones. While Ellacor has been studied in clinical trials on human subjects and has been cleared by the FDA for use, the number of patients treated to date is still quite low, in the order of several hundreds to a few thousands, and this is a very low number for statistical analysis when compared to other aesthetic treatments performed on millions of patients all over the world each year. Patients with a tendency to develop hyperpigmentation are advised to be cautious; broad spectrum SPF is always advised regardless of the procedure, and it may be best to avoid sun exposure prior and after treatment.
Another concern is that in some patients this treatment may cause changes in the skin and cause pitting or rough texture which may be difficult to fix.
Ask your treatment provider for more information.
Ellacor side effects
The most common side effects associated with the micro-coring procedure are redness, swelling, bruising, bleeding, pain, or discomfort. These side effects are to be expected as the treatment is removing up to 8% of your skin in the treatment area and are mild and should resolve with time without need for medical intervention.
Other non-common but possible side effects are infections, hypo-/hyper-pigmentation, skin necrosis, allergic reaction to the anesthesia.
Your treatment provider will inform you about all possible risks prior to performing the treatment.
How much does Ellacor micro-coring treatment cost?
Being launched on the market only very recently in 2022, Ellacor is currently available in just over 20 clinics in the United States. We can expect its availability to increase all over the USA and hopefully soon in other parts of the world as well.
Ellacor seems to be currently priced at around 1,500 USD to 3,000 USD per treatment.
Sources
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JR Fernandes – Plastic and Reconstructive Surgery, Feb 2013
DOI: https://doi.org/10.1097/prs.0b013e3182789afa - Micro-fractional, directional skin tightening: A porcine model
E Russe – Lasers in Surgery and Medicine, Mar 2016
DOI: https://doi.org/10.1002/lsm.22444
- Significant skin-tightening by closure of fractional ablative laser holes.
E Russe – Lasers in Surgery and Medicine, Jan 2018
DOI: https://doi.org/10.1002/lsm.22748 - Cytrellis: A Novel Microcoring Technology for Scarless Skin Removal: Summary of Three Prospective Clinical Trials.
JN Pozner – Plastic and Reconstructive Surgery Global Open, Oct 2021
DOI: https://doi.org/10.1097/gox.0000000000003905 - Dermal Micro-coring for the Treatment of Moderate to Severe Facial Wrinkles.
L Gfrerer – Plastic and Reconstructive Surgery Global Open, Oct 2022
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