Dermal Microcoring for Skin Laxity, Rhytides, and Scars

Abstract

BACKGROUND

Dermal microcoring extracts cores of skin that are small enough to allow healing in a scarless fashion. Its use has been reported in the treatment of skin laxity, rhytides, and textural abnormalities.

OBJECTIVE

To report the authors' clinical experience using dermal microcoring in a variety of cases.

MATERIALS AND METHODS

A retrospective chart review was performed looking at dermal microcoring cases for any indication between August 2022 and March 2024.

RESULTS

Thirty-eight patients were treated. Overall, 32 (84.2%) patients were women, with median age of 67 years (R: 20–80 years). Fitzpatrick skin types I to V were represented. Among patients with adequate photographs for review, improvements of grade 3 and 4 (good and excellent) were seen in 85.7% (n = 18/21) treated for skin laxity and rhytides, 50.0% (n = 3/6) treated for acne scars, 66.7% (n = 2/3) treated for traumatic or surgical scars, and 100.0% (n = 3/3) treated for foreign material. Six (15.4%) patients experienced erythema or hyperpigmentation lasting more than 4 weeks, and 2 (5.1%) patients experienced temporary focal scarring, which improved with intralesional therapy and laser treatment. No patients experienced permanent dyspigmentation, prolonged edema, or infection.

CONCLUSION

Dermal microcoring has been demonstrated to safely and effectively treat skin laxity, rhytides, scars, and foreign material.

Skin laxity, rhytides, and textural irregularities can play critical roles in an individual's overall appearance, both as a fundamental manifestation of age-related changes and in the presentation of scars. They can also represent bony, subcutaneous, and cutaneous volume loss. The removal of excess skin has, therefore, played an historical role within the cosmetic and reconstructive surgery fields, including through various surgical procedures, such as facelifts, neck lifts, blepharoplasties, and scar excisions or revisions.

Due to the invasiveness of these traditional surgeries, patients are left with surgical scars of varying degrees of noticeableness. This can be dependent on various factors related to both the surgery and the patient. Because of the creation of new scars, many patients remain hesitant to pursue these more invasive modalities of skin removal. More recently, scarless removal of skin has become a growing area of interest, with the goal of improving skin texture, laxity, and overall appearance without the cost or morbidity of traditional surgical approaches.

A novel dermal microcoring device (ellacor, Cytrellis Biosystems, Inc, Woburn, MA) recently received clearance from the United States FDA in 2021. This device utilizes hollow hypodermic needles to extract small microcores of skin. In a single treatment, hundreds to thousands of these microcores can be removed, which when combined can represent a significant amount of skin removal. Since each individual core is only approximately 400 μm in size¹ (i.e., about the size of a 22-gauge needle), each individual area of core removal is able to heal in a scarless fashion. With subsequent stimulation of neocollagenesis, neoelastinogenesis, and tissue contraction and remodeling,^2,3 this treatment can also leverage the tightening and textural benefits that have historically been seen with other cutaneous treatment modalities.

Here, the authors describe the authors' experience using this novel dermal microcoring device for the treatment of skin laxity, rhytides, scars, and foreign material.

Methods

A review of the electronic medical records was performed at a private practice dermatology clinic (Laser & Skin Surgery Center of New York, New York, NY) over a 20-month period from August 2022 to March 2024. Patients who were over 18 years of age and who were treated with dermal microcoring for any indication were included. Clinical effectiveness was assessed at follow-up by an independent reviewer when adequate photographs were available for grading using Global Aesthetic Improvement Scale (GAIS): poor (grade 1: 0%–25% improvement), fair (grade 2: 26%–50% improvement), good (grade 3: 51%–75% improvement), and excellent (grade 4: 76%–100% improvement). Safety was assessed by visit documentation of any adverse events (e.g., scars, prolonged erythema, prolonged dyspigmentation, infection).

Technique

For the dermal microcoring device, typical treatment parameters included 5% to 7% skin removal, with 3.0 to 4.0 mm depth. Depths closer to 3.0 mm were typically used in the central face and over bony areas, such as the jawline. Anesthesia was achieved with nerve blocks (e.g. bilateral infraorbital nerve block via an intraoral approach) and/or local anesthesia using a multineedle injector containing 1% lidocaine with epinephrine. Local injection was used not only to achieve sufficient analgesia but also to support hemostasis via the vasoconstrictive effects of epinephrine. The additional volume also ensures that the skin is taut for optimal core removal. Manual countertraction was also used as much as possible to further support this.

Care was taken to avoid overlap within the grid pattern; however, when spacing between the grid was seen, gaps were filled using partial pulses (i.e., releasing the foot pedal part way through the pulse) when necessary to ensure that the treatment area was ultimately treated as uniformly as possible. To ensure adequate removal of the microcores at the end of the treatment, the treatment area was firmly wiped using sterile towels and the device's suction tubing was run over the treated area to suction out any partially removed cores. After the treatment, patients were instructed to avoid any topical products for 24 hours and then to frequently apply a topical petrolatum-based ointment with otherwise gentle skincare until healed.

Results

A total of 38 patients were included in the analysis. Overall, 32 (84.2%) were women, and the median age was 67 years (R: 20–80 years). Fitzpatrick skin types ranged from I to V, with the majority (76.3%; n = 29) being type I and II. Indications for treatment included skin laxity and rhytides in 24 (63.2%) patients, acne scars in 8 (21.1%) patients, traumatic or surgical scars in 3 (7.9%) patients, and removal of foreign material in 3 (7.9%) patients. For those treated for skin laxity and rhytides, the most commonly treated areas were perioral (45.8%), lower face (37.5%), cheeks (25.0%), and submentum (12.5%).

For the treatments, the core counts varied widely depending on the treatment area and the indication, with a median of 4,629 cores (R: 120–17,982 cores). Among treatments of skin laxity and rhytides of the lower face, median core count was 8,012 cores (R: 4,446–17,982 cores).

Of the 21 patients treated for skin laxity and rhytides with sufficient follow-up photography, 18 (85.7%) patients experienced GAIS improvement of grade 3 or 4 (good or excellent). The most significant improvements seen were in the outpouching of the commissure-adjacent medial cheeks, fine lines of the upper and lower cutaneous lips, and jowls, in addition to overall improvement in skin laxity and rhytides.

Of the 9 patients treated for scars with sufficient follow-up photography, 3 of 6 (50.0%) patients treated for acne scars and 2 of 3 (66.7%) patients treated for traumatic or surgical scars experienced GAIS improvement of grade 3 or 4 (good or excellent).

Of the 3 patients treated for removal of foreign material, all 3 (100%) patients experienced GAIS improvement of grade 3 or 4 (good or excellent). Two patients were treated for removal of permanent silicone filler, whereas one was treated for removal of polyacrylamide hydrogel (Aquamid, Ferrosan, Denmark) permanent filler that had originally been placed for acne scars. In all 3 cases, extrusion of the associated material was observed during the procedure.

For adverse events, 6 (15.4%) patients experienced erythema or hyperpigmentation lasting more than 4 weeks, with improvement after treatment with the 595-nm pulsed dye laser. One (2.6%) patient experienced an unrelated rash suspected to be allergic contact dermatitis to their post-treatment skincare regimen. Two (5.1%) patients experienced temporary focal scarring, which improved with intralesional therapy (5-fluorouracil [50 mg/cc] mixed 9:1 with triamcinolone [10 mg/cc]) followed by pulsed dye laser. No patients experienced permanent dyspigmentation, prolonged edema, or infection.

Discussion

The removal of excess skin, stimulation of neocollagenesis, and improvement of rhytides and textural abnormalities all represent fundamental aspects of restoring a more youthful facial appearance. By removing hundreds to thousands of microcores sized to heal in a scarless fashion, dermal microcoring technology provides a novel modality to achieve these goals, particularly in patients who want to avoid the cost, downtime, scars, and overall inconvenience associated with more traditional and invasive surgical approaches.⁴

The authors' experience presented here supports the efficacy of dermal microcoring for various indications, including those traditionally reserved for surgery, such as improvement in skin laxity and rhytides. In the authors' experience, the treatment is most effective for patients with mild to moderate skin laxity, and it is particularly beneficial for traditionally hard-to-treat areas, such as the pouching of the medial cheeks near the lateral oral commissure (Figure 1). The treatment was also observed to consistently improve the area of the jowls, which is another historically challenging cosmetic area to treat (Figure 2). Preprocedure consultation for the treatment of skin laxity should, therefore, include critical evaluation of patient appropriateness (e.g., exclusion of patients with severe laxity for which surgical intervention may be more appropriate), discussion of alternatives (e.g., surgery, non- and minimally invasive device treatments), and establishment of appropriate expectations in regard to post-treatment downtime and degree of improvement.

Figure 1.

Improvement in skin laxity and rhytides of the mid to lower face after dermal microcoring.

Figure 2.

Improvement in skin laxity and rhytides of the lower face after dermal microcoring.

For the treatment of scars, a range of treatment options are available to physicians, including ablative and nonablative lasers, radiofrequency microneedling, intralesional injections, pulsed dye laser, and surgical revision, among others. Although these modalities represent mainstays of the authors' approach, each also has their associated adverse events and limitations. The authors have found dermal microcoring to be a valuable addition to add to the authors' overall repertoire, particularly in those who have failed or plateaued with these other modalities or who have contraindications to more aggressive modalities (e.g., ablative resurfacing in darker skin types). Future studies should evaluate the efficacy of dermal microcoring for various types of scars, especially in comparison to other modalities.

For the removal of foreign material, such as permanent dermal filler, the authors have found dermal microcoring to be a transformative therapy. For many of these patients, there historically have been very limited treatment options available, many of which do not offer great or consistent outcomes. Most patients have deferred surgical removal due to concerns of trading the filler for surgical scars and the inability to guarantee complete or significant removal. Dermal microcoring now offers an option for scarless removal by creating channels through which the material can be removed and extruded.⁵ Although the authors' experience has primarily consisted of the removal of permanent fillers to date, the authors anticipate that it may also prove helpful in the removal of other unwanted subcutaneous materials, such as granulomas, osteoma cutis, or small foreign bodies.

Of interesting cases to note, the authors have performed many successful treatments on the neck. The aging neck historically presents fewer treatment options due to its delicate nature and its susceptibility to post-treatment delayed healing and complications with energy-based devices. Moreover, many patients are hesitant to undergo extensive surgical procedures, such as neck lifts, to address skin laxity. In this context, dermal microcoring stands out as a promising treatment option for mild to moderate skin laxity resulting from aging changes on the neck and submentum. The authors have seen successful results with great consistency and reproducibility. In addition, the authors have also combined dermal microcoring with submental liposuction to maximize the benefits of each procedure, which has led to enhanced results and additional neck contouring. This approach allows for the precise removal of full-thickness skin in targeted areas to improve skin texture, while also reducing exaggerated neck fullness typically caused by excess preplatysmal and ptotic jawline fat (Figure 3). These treatments can be conveniently performed in a single session under standard tumescent anesthesia.

Figure 3.

Improvement in submental fullness, skin laxity, and rhytides of the submentum and neck after submental liposuction and dermal microcoring.

Patient consultation should include an extensive discussion of post-treatment expectations. Patients should be aware of the need for approximately 1 week of post-treatment downtime that includes erythema, edema, bruising, and/or crusting. There is also the potential for prolonged erythema that can last several weeks, which is similar to what can be seen from ablative resurfacing. A recent case report described a patient who experienced scarring and a residual visible grid pattern after treatment.⁶ However, this was an early treatment, and the authors are unsure of all of the circumstances related to it, including the temporal nature of what was seen. Although the authors did not experience any such cases, patients should be aware of the potential risk of abnormal healing and scarring. Physicians should take great care to avoid any overlap or convergence of cores, which can increase the core size beyond the threshold of scarless healing and may also cause lacerations, especially from shearing forces after the treatment above which the intact tissue cannot withstand.

Overall, dermal microcoring has proven to be an important addition to the authors' cosmetic and surgical toolkit. It has enabled the authors to offer improvements in skin laxity, rhytides, texture, and scars in such a way that allows patients to avoid or delay more aggressive and invasive surgical interventions.

Conclusion

By enabling the removal of small columns of skin with subsequent neocollagenesis, dermal microcoring is a safe and effective modality that can improve skin laxity, soften rhytides, remodel scars, and remove unwanted subcutaneous material in a scarless fashion. With continued utilization, its applications within cosmetic and regenerative medicine will continue to broaden.