Q&A: Micro-coring ellacor device could improve facial wrinkles, laxity

Last year the FDA cleared ellacor, a minimally invasive micro-coring device, for the treatment of moderate to severe wrinkles in the mid to lower face.

The technology, which removes thousands of tiny pieces of skin without lasers or surgery, was developed at Massachusetts General Hospital and is marketed by Cytrellis.

Healio spoke with Mathew M. Avram, MD, JD, director of the Massachusetts General Dermatology Laser & Cosmetic Center, director of dermatologic surgery at Massachusetts General Hospital and associate professor of dermatology at Harvard Medical School, about the device’s uses and future.

Healio: What is ellacor?

Avram: Ellacor is tissue micro-coring. It’s not a laser or an energy-based device. It’s not microneedling. It’s its own distinct technology and it works by removing microscopic cores of skin during a treatment that takes about 10 to 15 minutes. Over that period, it removes about 10,000 to 12,000 microcores of skin, which ranges from about 4% to 8% of the skin. Those microcores heal over several days. Over 2 to 3 months, you see smoothening of lines and improvement in laxity. Basically, it’s a device to help with lines of the chin, cheeks and jowls and facial laxity. Essentially, it’s taking little, tiny punch biopsies.

To make the procedure relatively comfortable for treatment, you need to do nerve blocks with injected anesthesia.

Healio: What makes this different from other treatments for facial lines or skin laxity?

Avram: The idea behind this is distinct because first of all, there’s no energy being used at all. If you use radio frequency microneedling or if you use an ablative fractional device, you are using an energy-based source to create thermal injury in the skin. This isn’t using any energy at all. It’s using stainless steel microneedles that are removing cores of skin. There’s no heat, no energy, no laser, no radio frequency, no ultrasound. It’s extracting the skin.

We use punch biopsies to assess for skin cancers and for inflammatory conditions. This is doing the same thing, except at a much smaller scale. There is no scar left behind, and that doesn’t just mean a scar that’s visible to the eye, but even under a microscope there is no scar.

When you have skin laxity, where the skin is draping over and there’s excess skin, this procedure is similar to a facelift. While the efficacy is not the same and they are very different procedures, the idea is the same. It is removing a certain amount of skin to achieve an improvement in lines and tightening.

With this you’re not taking a huge chunk of skin surgically, you’re taking thousands of tiny micro cores, less than 500 µm in size, and it is tightening the skin and smoothing the lines.

Healio: What kind of pain and recovery are associated with this treatment?

Avram: It’s very important to get good anesthesia when you do the treatment. The best way to do that is to inject lidocaine with epinephrine to get nerve blocks. Then outside the areas where nerve blocks are effective, you infiltrate the skin with injectable anesthesia in the same way you would with a punch biopsy or shave biopsy.

In terms of recovery, there’s swelling immediately after the treatment. There will be bleeding and oozing, which you would expect if you’re taking out a percentage of the skin, as well as redness. After a few days, these things start to clear out. You can also get bruising with the treatment lasting 7 to 10 days.

Healio: Who are the best candidates for ellacor?

Avram: We are still early in our experience with the device but looking at the studies and my own limited experience with patients in our clinic, the best candidates are patients who have early to moderate changes in skin laxity and mild to moderate lines of the cheeks. If someone has severe laxity, this isn’t going to achieve a clinically significant result. However, patients that have moderate laxity will see some improvement. I don’t think there’s a fixed age or a fixed best candidate. It is individualized based on the clinical exam of the patient.

Healio: Is this technology being examined for any additional uses?

Avram: We are at the very beginning of this story. There may be potential new avenues with treatments to help with scars, tattoos or even skin grafting. We have to take our time and see how this develops. It will be interesting to see how it plays out.

Healio: What types of patient reactions have you received so far?

Avram: It’s still early, but patients have been happy.

It’s crucially important at the consultation to give patients a fair assessment of the improvement that can be seen with this treatment. If a patient expects facelift-like results, they will be disappointed. And there are variations in the amount of improvement that you’re going to get. But I have seen significant improvement in lines even with one treatment. It is at least comparable to or exceeds the ablative fractional lasers.

We will probably figure out even better ways of achieving results for our patients as we treat more people, and we will see how this develops.

Healio: What should clinicians know about ellacor?

Avram: Clinicians should know that there’s a new way to go after skin laxity. I see this as being most valuable to those with jowls and lower medial cheek laxity and lines — areas often not improved by fillers and lasers. This offers a new opportunity to get a more significant benefit.

It’s important to know there is some downtime with the procedure and patients need to see someone experienced with energy-based devices to get this treatment.

For more information:

Mathew M. Avram, MD, JD, can be reached at mavram@mgh.harvard.edu.

Reference:

• Cytrellis announces FDA clearance for breakthrough ellacor micro-coring technology. https://www.prnewswire.com/news-releases/cytrellis-announces-fda-clearance-for-breakthrough-ellacor-micro-coring-technology-301341572.html. Published July 27, 2021. Accessed Feb. 9, 2022.