All you needle is love

When doctors at Massachusetts General Hospital noticed that some procedures involving needles — such as blood draws — could heal without scarring, they began to wonder about the potential for skin treatment.

After years of testing and research, a device was developed that uses needles to remove cores of skin with no scarring, and microcoring was born. Ellacor device and tip. Photo courtesy of Cytrellis.

Morgan Murphrey, MD, MS, FAAD, a clinical dermatologist in Boston and researcher at the Wellman Center for Photomedicine at Massachusetts General, said the device has a handpiece with an attached needle array and suction to remove skin cores. 

“The needles penetrate the epidermis, dermis, and into the subcutaneous tissue so that cores can be extracted,” she said. “Needle depth and percentage of skin removal can be adjusted based on the treatment area.”An Ellacor treatment. Photo courtesy of Morgan Murphrey, MD, MS, FAAD.

The outcome is removal of a percentage of skin, which reduces wrinkles in the treatment area — currently limited to the mid and lower face in adults aged 22 years or older with Fitzpatrick skin types I-IV.

“We have also used the device clinically for mild skin laxity in the lower face,” Dr. Murphrey added. “It has also shown promise in other skin body sites, such as the abdomen, where it can help skin laxity.”

Face time

Although there is some interest in microcoring as a treatment for acne scarring, Dr. Murphrey said more research in that area needs to be conducted before it can gain widespread use.

Morgan Murphrey, MD, MS, FAAD“Acne scarring is heterogeneous, and treatment depends specifically on the type of acne scarring,” she explained. “At this time, use for acne scarring specifically has not been studied.”

That doesn’t mean there isn’t potential there for the future treatment of certain types of acne scarring.

“In patients with small, well-demarcated scars — such as boxcar or ice pick scars — where punch biopsy excision may be useful, microcoring could potentially be a treatment option in the future,” Dr. Murphrey said. “Other potential indications go beyond cosmetics and could include skin grafting for non-healing wounds or ulcers.”

Pros and cons

The benefits of microcoring are primarily treating lower face wrinkles, including parenthesis lines around the mouth. But the uses don’t stop there.Before and 30 days after an Ellacor treatment. Photo courtesy of Mathew Avram, MD, JD, FAAD.

“We have also seen success with perioral rhytides, which are notoriously difficult to treat,” Dr. Murphrey said. “Microcoring can also result in improvements in mild lower facial laxity."

Dr. Murphrey said it is important to let patients know the procedure does not duplicate a facelift and is not intended for moderate to severe laxity. For mild cases, however, it can be “a great alternative to surgical interventions, especially in those patients who are not candidates for other surgical procedures,” she said.

But while microcoring is considered a relatively safe procedure that can be done in the office without sedation, there are some common side effects, including bruising and post-procedure redness, that can last for weeks after the procedure.

“In those scenarios, we will typically use the pulsed-dye or KTP laser to address any persistent redness,” Dr. Murphrey said. “There is also a remote chance of pigmentary changes or scarring, but these outcomes are rare.”

For patients contemplating the procedure, she said it is important to see a dermatologist who has experience with the device and understands the appropriate technique, as the overlap of pulses can result in scarring.Immediately following an Ellacor treatment of the perioral area. Photo courtesy of Morgan Murphrey, MD, MS, FAAD.

“These nuances are important, and an expert in providing the treatment is necessary for optimal outcomes,” Dr. Murphrey said.

Looking ahead

While microcoring is still a relatively new treatment whose results currently do not mimic those from surgical procedures like facelifts, Dr. Murphrey said future device innovations will likely lead to improved outcomes and expanded uses for the technology.

“While currently only indicated for face wrinkles, it is likely the device will be used off the face in areas such as the abdomen for abdominal skin laxity, such as in a post-pregnancy setting,” she said. “The technique of microcoring also has potential indications for uses such as wound healing, where full-thickness skin microcores can be grafted scarlessly from healthy skin tissue into wounds to improve or expedite wound healing. There are also potential indications for research, where scarless skin cores can be removed and studied for other skin pathologies.”