Does Non-Surgical Micro-Coring Rival A Surgical Facelift?

There are plenty of non-surgical procedures that get billed as facelift alternatives. And, while some have the ability to firm and smooth the skin sans scalpel, none have been able remove skin without surgery – until now. Since it received clearance from the United States Food and Drug Administration (FDA) last year, there has been a lot of buzz around Cytrellis’s Ellacor™ and its micro-coring technology.

Since we all know that trendy treatments have a tendency to come and go, you may be wondering if this one lives up to the hype. The short answer is that, in many ways, it does – though it’s not exactly a substitute for a facelift. To break down everything you need to know about Ellacor™ and micro-coring, we tapped top dermatologists and plastic surgeons for their honest assessment. Here’s the scoop.

What Is Micro-Coring?

Although some may be calling micro-coring the next best thing to a facelift, it's significantly different. For starters, it isn't surgery at all. Instead, micro-coring or fractional micro-coring is a new category of cosmetic treatment that involves the excisional removal of tiny columns of skin over a larger surface without cutting, thermal energy, or scarring.

Micro-injuries are made in the skin using a tiny, hollow needle while simultaneously removing small tissue areas to address mild laxity. “During a facelift, surgeons trim the skin from the sides,” says Paul Jarrod Frank, MD, a board certified celebrity cosmetic dermatologist in New York City. “With micro-coring, we inject local anesthesia and remove eight to 10 percent of the total skin surface.” As he explains, the idea of micro-coring originally came from the concept of skin tightening and wrinkle removal in studies showing follicular unit extraction (FUE), which involves removing individual hair follicles from the scalp before transplant. “When the tissue heals, the skin is much tighter,” he notes.

To date, there’s only one micro-coring device on the market, Ellacor™, which has positioned itself as a minimally invasive facelift alternative thanks to its ability to remove skin without surgery. The first-of-its-kind treatment is cleared by the FDA to treat moderate to severe wrinkles in the mid- to lower-face in patients with Fitzpatrick skin types I to IV.

Ellacor™ removes micro-portions of excess skin improve the appearance of wrinkles, says Jill Waibel, MD, a board certified dermatologist in Miami. “Whereas other skin revitalization devices use heat generated by a laser, radiofrequency, or ultrasound energy to induce intentional thermal injury to the skin, Ellacor™ uses patented micro-coring technology to reduce wrinkles,” she says.

Who Is an Ideal Candidate for Micro-Coring?

Not everyone is an ideal candidate for micro-coring. “It's for someone who wants to take a more minimally invasive and natural-looking route to obtain tighter, younger-looking skin,” says Dendy Engelman, MD, a board certified dermatologist in New York City. This can appeal to people at different stages of life (and aging). “I sometimes recommend micro-coring to younger patients who are starting to notice changes in their skin and want to nip it in the bud,” she shares. And she also suggests it to “patients with more mature skin who do not want to undergo a full facelift and the associated recovery.”

To see success with Ellacor™, the degree of skin laxity – which should be on the mild to moderate side – is imperative. “Someone with excessive hanging skin is going to do better with a more invasive surgery,” Dr. Frank notes. In addition, the treatment works best on the cheeks, around the mouth, and under the chin, since these areas are where loose skin tends to accumulate.

As we mentioned, the procedure is currently only FDA cleared for Fitzpatrick skin types I to IV. “A separate clinical study is needed to evaluate the proper protocols for using Ellacor™ on darker skin types,” Dr. Waibel notes.

How Micro-Coring Works

It may seem unfathomable, but, in 2022, we are at the point where doctors can remove minimal amounts of loose skin without the need to cut with a scalpel.

Before an Ellacor™ treatment starts, local anesthesia is injected into the area (topical anesthetic may also be used) to make the procedure more comfortable. Next, a small handpiece is placed over the desired location, creating cores in a grid formation (similar to energy-based treatments). The hollow needles within the handpiece quickly go to work and pierce out microscopic amounts of skin (less than half a millimeter). “With each excision, the tissue is removed from the needles through an integrated suction system, treating a 10 millimeter square area in less than three seconds,” Dr. Waibel says.

Your doctor can adjust the depth of the treatment depending on your needs. There is pinpoint bleeding at each core site, which quickly resolves. Not all skin that falls within the coring square is removed. “After removing the excess skin, the body's natural healing response goes into effect as the dermal tissue quickly realigns to close the cores, resulting in improved skin architecture,” Dr. Waibel shares. As Dr. Engelman explains, removing the skin in this controlled fashion stimulates the wound-healing response that increases collagen production, ultimately promoting younger, healthier-looking skin.

Micro-Coring Recovery & Results

A series of three 30-minute treatments are usually recommended to achieve optimal results, though many patients report seeing benefits after the first appointment. “Micro-coring results are more subtle than facelift surgery since each session of Ellacor™ only removes up to eight percent of the treated skin area,” says Siamak Agha, MD, a board certified plastic and reconstructive surgeon in Newport Beach, CA. “Less skin is removed than what a facelift can offer, but, with Ellacor™, that skin removal can be increased substantially without any scars.”

According to the clinical trials, each column of skin is selectively targeted and heals within an average of three days. But, of course, expect some scabbing, redness, slight bruising, and mild swelling. “The redness of the treated areas may last 30 days or more, signifying deeper tissue healing and tightening,” Dr. Agha says. Because the skin is sensitive and somewhat compromised after treatment, a simple, bland skincare routine (similar to what is used post-laser or surgery) is often best. Once the skin is fully healed and the resulting holes from the cores are closed up, you should be safe to resume wearing makeup and following your regular skincare regimen.

One of the significant advantages of a micro-coring treatment over something like a facelift is the low risk of scarring. “Due to the tiny needle used in micro-coring (22 gauge), the scars are microscopic and therefore not visible to the naked eye,” Dr. Engelman says. For reference, needles used to administer neurotoxins (read: Botox®) are usually 30 or 32 gauge. A filler syringe is 27 or 30 gauge. Higher numbers indicate smaller needles.

FAQs: Micro-Coring Edition

Now that you have a better understanding of how micro-coring technology and Ellacor™ treatments work, it’s time to get to some of the questions you no doubt have about what it’s truly capable of. We answer a few of the most common below:

1. Is Micro-Coring Anything Like Microneedling?

We’d understand if, at this point, you are wondering what (if any) relation micro-coring has to microneedling. As it turns out, the only similarity between the two is that both modalities have the prefix ‘micro’ in their names, and both employ needles to some degree. As Dr. Waibel explains, microneedling uses tiny needles to injure the skin, and there's no tissue removal — the tissue is only temporarily displaced — during the procedure.

The needle depth of a professional microneedling treatment is anywhere from 0.25 millimeters to 2.5 millimeters. The hollow needles used for micro-coring can penetrate up to 4 millimeters to remove the microscopic columns of skin. While microneedling safely creates micro-injuries in the skin to incite collagen production and decrease the appearance of acne scars, fine lines and wrinkles, and sun damage, it does not excise any tissue.

2. Is Micro-Coring a Replacement for a Facelift?

A traditional facelift does more than just remove loose skin. It also addresses the underlying muscles and repositions fat and tissue for more significant support and a fully rejuvenated yet (hopefully) natural look. Every doctor we spoke to for this story agreed that micro-coring is not a substitute for a facelift, though it may be a suitable alternative for those who are not ready for surgery but desire some skin tightening and wrinkle reduction on the lower face.

Micro-coring acts on the skin alone. So, while the results of the minimally invasive procedure can be significant, it does not address the fundamental structure of the face and cannot provide a facelift-like result. But that’s not to say it doesn’t have value. “I think micro-coring is going to offer a lot more than other minimally to non-invasive treatments like Ultherapy®, Thermage®, and other forms of energy-based microneedling,” Dr. Frank says. “With micro-coring, we are going to fill that niche between non-invasive and invasive plastic surgery.”

THE SIMILARITIES

• Skin Removal: Both a facelift and micro-coring can remove loose skin, however, the amount of skin laxity addressed through a non-surgical treatment is less than surgery.
• Smoothing: Micro-coring and facelifts improve wrinkling on the lower part of the face. Of course, what can be achieved with surgery is always greater than less invasive options.
• Patience: The results can take time to settle and fully reveal themselves after both a facelift and micro-coring, though there's more of a noticeable improvement right away post-facelift.

THE DIFFERENCES

• Comprehensiveness: Micro-coring does not correct or address anything below the skin like fat, tissue, and muscle. Only a facelift can target those underlying structures of the face.
• Lift: Whereas a facelift physically lifts the skin and requires tension, micro-coring induces collagen remodeling and firming through micro-injuries. The chances of having an unnatural result are lessened.
• Scarring: The tradeoff for a facelift is the scarring, though board certified plastic surgeons are trained to conceal the incision. There are no cuts, incisions, stitches, or scars with micro-coring.
• Timing: Two to three sessions of micro-coring are necessary to achieve full results. Dr. Engelman says patients typically start to see results of 60 to 90 days after the procedure, and there is usually significant improvement after just one treatment. A facelift is one and done, with results lasting a decade or more.

Micro-coring is far less invasive than a sugical facial rejuvenation procedure such as a facelift. But, just because it's less invasive, doesn't mean it is fool-proof. As with all aesthetic procedures, a full consultation before the treatment is necessary and there is always the risk of adverse effects.

3. Micro-Coring vs. Facelift: Which One Is Better?

There's no right or wrong treatment here. What checks of all your skin-tightening and rejuvenating boxes may not do the same for someone else. For patients who don't have the time – or, should we say, downtime – for surgery or don’t want it (for whatever reasons), micro-coring is perhaps one of the most promising alternatives available.

With that said, Dr. Engelman reminds us that no procedure (surgical or non-surgical) is without strings. There is still anesthesia involved, your skin will require a few days to recuperate, and there is no instant gratification. “Downtime is minimal, but it will take some time for the results to be visible,” she shares. And be sure to keep your expectations in check. The results “will be more subtle,” she adds.

4. Can Micro-Coring Delay the Need for Surgery?

Given the array of non-surgical modalities available today, it may be possible to delay the need for facial surgery with the right combination of treatments. But will Ellacor™ alone allow you to sidestep a facelift in the future? Probably not. “Micro-coring does not offer the same results as more invasive techniques, like facelifts,” Dr. Engleman says. “So, in that regard, it cannot replace these more dramatic techniques.” That’s not to say it doesn’t have it’s place though. “It is a great alternative for people seeking more natural-looking results with less invasive methods,” she shares.

The Takeaway

Micro-coring is a new skin-eliminating treatment that is the first of its kind, which means there is still a lot to learn. Will it replace the standard facelift? Probably not – at least not right now – but it gives both patients and providers a lot to be excited about. “There is absolutely no doubt that it is going to offer a new category of treatment in between totally non-invasive and totally invasive procedures,” Dr. Frank says. “It will help fulfill that growing niche of patients that want to do something significant in terms of wrinkling and skin tightening but are not yet ready or willing to go through more invasive techniques.”