ellacor™ for sagging: Microneedling on steroids? More like a facelift? I had it done, w/BEFORE/AFTER
Updated: Mar 6
NOTE: this post is not sponsored - I just wanted to share my experience 🙂
There is no affiliate relationship with Cytrellis or the Dr offices where I had the procedures. If you mention my name (please do) to them I will receive no kick back of any kind. That said, they were gracious and I would love for them to know I referred you IF you choose to book with them! I put their info on the second blog (healing progression).
Just over a year ago I read about a fascinating new in-clinic device that was soon to be released. The device, called ellacor, had just received FDA approval for the treatment of moderate and severe wrinkles in the mid to lower face. Press coverage concluded that Ellacor was the first 'minimally invasive alternative to a facelift'.
Since then, I've done a 'deep dive', learning about Ellacor from a variety of sources including directly from the company that makes it (Cytrellis), talking to doctors and other practitioners, reading peer reviewed studies, and even having the procedure done (along with my friend Nancy). In this blog and accompanying video I'll share all that I've learned. This blog is lengthy, so I've broken it down into several sections:
Background: how did it come about?
What is it?
What isn't it?
Results: what can you expect?
What are my impressions of Ellacor?
In addition to the information above, I've created a separate blog that includes day-to-day Ellacor™ healing progress photos, plus tips on what we learned about the healing process from having ellacor™ two times.
Typically I focus my attention on home-based treatments and products that can improve the health and appearance of the skin. So why have I chosen to do a 'deep dive' on Ellacor? For a few reasons. Firstly, Ellacor™ is the first medical device in its class, pioneering an entirely new technology in dermatology called microcoring. The vast majority of the aesthetic devices and injectables launched every year are 'predicated' on a technology that was pioneered years ago (that's not because there's little innovation but rather because landmark inventions such as laser and hyaluronic acid-based fillers were extremely innovative and have extremely robust research validating their safety and efficacy).
Secondly, Ellacor™ is the brainchild of perhaps the most acclaimed inventor/physician in dermatology; R. Rox Anderson. Rox Anderson is the pioneer of laser-based treatments and procedures now commonly used in medical care to remove birthmarks, scars and other skin lesions. Anderson’s groundbreaking laser technology advanced laser-based solutions for other areas, including permanent hair removal, acne treatment, tattoo removal and the treatment of burn victims. Anderson has been awarded more than 80 national and international patents and has co-authored over 250 scientific books and papers. So when Rox Anderson develops a pioneering technology, the world listens!!
WHAT IS Ellacor™?
Ellacor™ uses Micro-Coring™ to address moderate to severe wrinkles and laxity in a minimally invasive way. It uses no heat, but rather creates a core (think apple core or skin biopsy). The needles have built in vacuums to stabilize the surrounding tissue while removing the tiny columns of excess skin. Not just a few either, during a single procedure on the mid-face to neck the patient might have in excess of 20k microscopic cores of skin removed.
"Ellacor™ is indicated for use by medical professionals for the treatment of moderate and severe wrinkles in the mid and lower face in adults aged 22 years or older with Fitzpatrick skin types I-IV."
Depending on the skin thickness, wrinkle severity, patient goals and other factors, the practitioner might choose to remove from 1% to 8% of the skin's surface and create cores from depths varying from 2.5mm to 4mm. Both times I had the procedure I had 8% removed.
ellacor™ Skin Removal Pattern and Depth
WHAT ellacor™ IS NOT
With any new modality, many of us are trying to put into context what Ellacor™ is by understanding what it isn't. Since letting people know that I was having the procedure done, perhaps the biggest question I've had has been 'How is it different from ______'. I've summarized my findings below (I am working on a table, I'll add it as soon as it's complete!).
How is Ellacor™ different from a facelift?
Thirty years ago, having a 'facelift' typically meant having skin removed and the remaining skin pulled up to tighten the face, perhaps with some removal of fat. This type of surgery didn't involve deeper connective and muscle tissues. Results were often short lived, as the underlying tissue wasn't addressed. Since then, a number of more advanced procedures (most evolutionary) have been introduced which allow surgeons to lift deeper tissues while, at the same time, removing lax skin.
Ellacor™ removes lax skin, but microcoring differs from the latest facelift technology in several significant ways. The key thing to remember is that a facelift can reposition tissues beneath the skin whereas Ellacor cannot. Additionally, a surgeon can remove a larger quantity of tissue with surgery than is possible with a series of ellacor™ treatments. A facelift leaves one or more scars, and while surgeons will take care to position these discreetly, there's no way to avoid scars with traditional surgery. An Ellacor™ treatment is far less invasive than plastic surgery of the lower face, so the resultant inflammation and swelling is far less and healing time is much quicker.
FACELIFT: During a facelift, excess facial fat is typically removed, facial muscles are tightened, lax skin is removed and remaining skin is stretched to give a smoother appearance. The SMAS (superficial musculoaponeurotic system), is a tissue sheet of collagen and elastin fibers, and fat cells extending from the neck up to the forehead connects mimetic expression muscles to the dermis. The latest facelifts make adjustments in this SMAS layer in addition to impacting the skin. Scars are created where the skin is stitched back, but these are generally done discreetly and heal over a period of months/years. Facelifts are performed by plastic surgeons.
Ellacor™ : Skin is removed but not surgically stretched. Rather, the tiny holes quickly close up and heal together. Deeper facial tissues are not impacted. Ellacor can be performed by doctors (including plastic surgeons and dermatologists) and physician's assistants.
How is Ellacor™ different from fractional laser treatments such as C02?
Fractional lasers are resurfacing lasers that target wrinkles and textural issues by creating columns of heat damage in the skin. By sending columns of heat into the skin (contrasted with allover damage) skin is able to heal and regenerate more quickly leading to the appearance of a revitalized complexion.
FRACTIONAL LASER. Fractional lasers send tiny beams of heat into the surface of the skin with the objective of collagen remodeling
Ellacor™ . Ellacor™ uses no heat but instead removes cores of the epidermis and dermis.
How is Ellacor™ different from microneedling?
Unlike microneedling, which induces new collagen and a chain of events that help to make the skin healther, by using needles to pierce small holes in the skin, Ellacor™ removes cores of skin using extremely fine hollow needles. With microneedling at home, shallow depths are recommended (<.3mm for cosmetic needling and 0.3 to 0.5mm for medical needling) whereas Ellacor™ has 2.5-4mm needle coring depth, reaching into the depths of the dermal layer. Microneedling can be done at home with appropriate equipment and sanitary conditions while microcoring is done only in a clinical setting with pain reliever.
MICRONEEDLING: Needles pierce small holes to elicit collagen induction and skin remodelling.
Ellacor™: Hollow needles remove cores of tissue
How is Ellacor™ different from plasma fibroblast?
Plasma fibroblast (also called plasma pen) projects a focused high-frequency electric current to tiny areas of the skin. The tip of the device doesn’t directly touch the skin, but rather, releases a targeted current just above. The hot current creates micro-injuries in the epidermis which breaks down proteins in the epidermis. Proponents claim that the procedure encourages tissue regeneration by stimulating fibroblast activity and causes the skin to tighten.
PLASMA FIBROBLAST: Plasma fibroblast essentially burns small holes in the very top level of skin - the epidermis. While some tightening may appear to occur initially, the procedure has drawbacks which include risk of eye injury and risk of hyperpigmentation. Some countries, including Canada, have banned the procedure.
Ellacor™: Ellacor™removes tiny cores from the skin without the use of heat. Ellacor presents no risk or burning nor risk to the eye. Ellacor goes into the deepest level of the dermis.
How is Ellacor™ different from Morpeus8™ and other radiofrequency/microneedling treatments?
Morpheus8™ and other RF/MN tools are used in a clinical setting to promote collagen production and elastin to firm skin and minimize wrinkles. RF/MN devices use tiny needles to deliver RF energy to different depths of the skin. The needles and heat from the radio frequency energy create micro-injuries, which trigger the body’s natural healing response
Morpeus8™ (MN/RF): MN/RF uses microneedles to deliver radio frequency generated heat into deep layers of the skin
Ellacor™: Ellacor uses no heat, but rather removes tiny cores of skin.
RESULTS: WHAT CAN YOU EXPECT?
Okay, we know what Ellacor is, and what it isn't - now for the good stuff: BEFORE/AFTERS!!
A consistent way to measure results
Let's quickly address how the dermatology profession gauges the efficacy of a device like Ellacor™. In their studies, Cytrellis, the maker of Ellacor™, focused on wrinkles of the mid to lower face. The study followed 51 women with an average age of 63 (ranging from age 57 to 69) who had two to three treatments. As a tool to gauge the effectiveness of the procedure, the Lemperle Wrinkle Severity Scale (LWSS) was used. The LWSS scale was developed over 20 years ago to assess the effectiveness of various fillers at reducing wrinkles, so its a tried-and-true way to determine the effectiveness of Ellacor. The study also used the Global Aesthetic Improvement Scale (GAIS) which measures participant and clinician's perceptions.
To be included in the study, the subjects needed to be between 40 and 70 years of age at baseline with mid to lower face wrinkles with a grade of 3 (moderately deep wrinkles) and/or 4 (deep wrinkles, well- defined edges) on at least one side using the Lemperle Wrinkle Severity Scale (LWSS) and Fitzpatrick Skin Type I to IV. I think this is a key thing to note - the study was aimed squarely at women who had moderate to deep wrinkles, not subtle laxity.
Lemperle Wrinkle Severity Scale
0: no wrinkles
1: just perceptible wrinkle
2: shallow wrinkle
3: moderately deep wrinkle (Ellacor™ sweetspot)
4: deep wrinkle with well-defined edges (Ellacor™sweetspot)
5: very deep wrinkle with redundant fold
The 51 participants in the Ellacor™ trial experienced a mean improvement of 1.3-grades on the Lemperle Rating Scale after two to three Ellacor™ treatments. Effectively that means that a study participant who had 'deep wrinkles with well defined edges' at the beginning of the study moved down a rung to having 'moderately deep wrinkles' in the areas treated. Pretty impressive, as you'll see in the below photos.
Global Aesthetic Improvement Scale (GAIS)
In addition to improvements that were physically measurable, the pivotal study measured how participants perceived the treatment, Improvement in the GAIS was reported for 89.7% of treated sites in the Ellacor study, and average improvement of GAIS was 1.5 (halfway between 'much improved' and 'very much improved'.) I think this is an important measurement. After all, it's how we feel about the changes in our skin that matters the most!!
Below we have a series of photos depicting the results of two to three Ellacor treatments on women in various age brackets. The first two are me and my friend, the remaining six are courtesy of Cytrellis, the brand that makes Ellacor™. The third photo was taken by a practicing clinic and the remaining photos were taken as part of Cytrellis' study on the efficacy of Ellacor™.
As you can see from the photos above, the study demonstrated that indeed, women with moderately deep and deep wrinkles showed significant improvement after one to three Ellacor treatments. You can see from the first two photos of me and my friend that mild laxity, while improved (Nancy's, not mine), doesn't give the 'wow' factor as does the treatment results on deeper wrinkles and laxity.
Ellacor™: THE PROCEDURE - MY EXPERIENCE
The Ellacor procedure itself was very straight-forward. These are the steps I went through:
'Before' photos were taken
Numbing cream applied
Consultation with the practitioner and goals re-discussed, areas on face outlined for treatment.
Nerve blocks (lidocaine with epinephrine injected). This was the trickiest part. Honestly, it's a bit intimidating seeing all of those needles lined up on a tray. Most injections aren't too painful but the ones around the mouth/chin are a bit spicy and unnerving.
The procedure. Once the pain medication was in full force I found the procedure virtually painless. Certainly there's a bit of a vibration and a feeling that the doctor was sort of 'jack hammering' my face, but it was a bit funny/odd rather than concerning. There was a fair amount of blood (yes, I'm a 'bleeder' 🩸) but it was quickly dabbed away by the PA's damp cloth. I had both face and neck done (including sub-mental area) and the procedure itself took about 25 minutes.
When I was finished I was quite a bit puffy for a while, but I was given prednisone to help bring down the puffiness.
Ellacor™ : THE HEALING - BEFORE-CARE AND AFTERCARE and healing photos
ELLACOR: WHAT ARE MY RECOMMENDATIONS AND IMPRESSIONS?
This is a procedure, not a 'treatment'. Be prepared, make sure it's for YOU and that it's the optimal way to invest in addressing the specific issues that you want to address (don't just jump on the bandwagon because it's new!!)
Make sure you book a pre-procedure consultation. Ask questions (I have a list for you here!). Make sure you find a practitioner who has experience specifically with Ellacor. Yes, the modality is new, but many practitioners who've only had the device for 6-12 months have focused on Ellacor in their practice and performed in excess of a hundred treatments.
Make sure you're aware of what Ellacor is best at. From what I've observed, the best results are in the areas of jawline definition and smile lines (accordion lines), and the most impressive outcomes come from patients with more significant wrinkling and laxity than Nancy and I had.
Make sure you're prepared with aftercare - BEFORE you go into the treatment. I took longer to heal the first time - I paid more attention to prep and post care for my second treatment.
Perhaps the second most common question I get when I mention to people that I had Ellacor™ was 'were you glad you did it?' For me it was a fantastic learning experience. I had gone into the treatment to gather info and experience to share and possibly get a little lip lift. Nancy was looking for a 'lift' that might come about after removing 15% of skin (two treatments). Did we see this lift? Not so much. But if I look back at what Ellacor™ promises, it really doesn't claim to offer a lift for people with mild laxity. Instead, its focus is the removal of excess skin that's contributing to wrinkles. Also, I'm prone to hyperpigmentaion and experienced PIE/PIH and some textural (above my lip has texture that I didn't have before...I am hoping it'll resolve itself) changes to my skin that are taking time and investment to resolve. My friend Nancy didn't experience these things. This is why it is so important for us to learn all we can about procedures, reflect on what we know about our own skin and how it responds, find an experienced practitioner and ASK QUESTIONS.
I think Ellacor is a very compelling procedure for women (there have not yet been studies on men) who have moderate to deep wrinkles and are not prone to hyperpigmentaion.
To learn more about ellacor™ do over to their website ellacor.com/microcoring-procedure/
Q. What is the ‘ideal patient profile’ for ellacor?
ellacor is indicated for the treatment of moderate and severe wrinkles in the mid and lower face in adults aged 22 years or older with Fitzpatrick skin types I-IV. It appears that the most successful treatments are those that address accordion lines and laxity that creates folds/wrinkles in the mid and lower face (have a look at the before/after photos, above)
Q. How is Ellacor different from other treatments that address laxity such as Morpheus8, lasers and a facelift?
See blog above.
Q. How long does the treatment take?
While the treatment itself typically takes under an hour, my experience is that you’ll want to reserve at least 90 mins before and also after. Beforehand your practitioner will take photos, numb you up and possibly inject additional pain medicine. Depending on what pain medication you received, you’ll want time afterwards for any bleeding to stop, to reacclimate, and to prep yourself for travel home. While I experienced very little pain during the treatment, it is quite an unusual experience to have cores removed from your face (picture a mini jackhammer - there’s a sensation/vibration). I think it’s good to take time to ‘reset’ yourself before leaving a clinic.
Q. Is Ellacor preventative? In other words, if I have minor laxity at age 45-50 and have a series of 2-3 Ellacor procedures, will it help me avoid future laxity?
We won't be able to comment on this as we don't currently have studies to support it; information would need to come from a doctor.
Q. Is Ellacor painful?
You certainly wouldn’t want to have Ellacor without good anesthetic. Typically, both topical and injectable anesthetics are used before the procedure. Different clinicians may have different pain management protocols so this is definitely something you should discuss with your doctor. I find the injection of nerve block quite a ‘bracing’ experience, so for me, that was the worst part of it, but everyone is different! The brand communicates that the average pain reported by pivotal study patients was less than a 2 on a 0-10 scale.
Q. What will I look like immediately after? Will I be able to drive home? How much downtime can I expect?
I looked very pink/red after the sessions and had minor pinpoint bleeding that stopped within a few hours of the procedure. The pinpoints go on to create tiny scabs that don’t slough off for several days. As for recovery time, I think this is variable on a number of things but I was able to go out in public with makeup and have little appearance of a procedure done (I could still see the stamps but others may not have been able to.... the skin definitely wasn't looking its best) within about 10-12 days. Do follow your practitioner's instructions about aftercare and have a look at my own ‘recovery recommendations’ to set yourself up for the best results. Also, look at my and Nancy’s healing photos to get a sense of how the two of us healed differently. The brand communicates that in their pivotal clinical trial, 70% of patients were comfortable going out in public or returning to work 3 days post-procedure. This was not my experience. However, everyone is different. Some people may prefer a few extra days of recovery time until they're comfortable going out in public, or until the skin has fully healed post-procedure.
Q. What is the diameter of the Ellacor coring needles when compared with microneedles on the Dr. Pen cartridge?
A. Ellacor's needles are 0.5mm. Dr. Pen's needle varies depending on the cartridge but I have seen from 0.18mm on Dr. Pen M8 and A6S to 0.25 on the Dr. Pen A6. Keep in mind that the ellacor needle is hollow to enable to create the skin core whereas the microneedling needles are solid.
Q. What is the range of depth of extraction of skin that can be set? What is the most common depth?
The most common depth is 4mm but the range is 3-5mm
Q. I read about a company called Recros Medica who was bringing a tool to market called the Nuvellus which is supposed to be similar to Ellacor. Is there any news here?
Recros Medix decided not to launch Nuvellus to the market. Ellacor is the first-and-only non-surgical procedure that removes sagging skin with patented Micro-Coring® Technology.
Q. What price range can I expect?
Ellacor is charged per procedure and the typical patient will require 2-3 procedures for optimal results. The range I’ve seen is $3,400 to $6,000 for two treatments.
Q. Is Ellacor available outside the US?
Currently, Ellacor is only available in the US. However, as the procedure is minimally invasive and has quick prep and healing time, US Ellacor practitioners are reporting patients flying in from Europe and further afield for treatments. Bear in mind that the average person would need two to three treatments to see the best results, so the travel could get expensive.
Q. Would Ellacor be a viable option to help shorten the philtrum (the space between mouth and nose?
While the Ellacor process removes up to 8% of skin during each session, there’s no evidence that the removal of this skin between the mouth and nose shortens the philtrum. Neither Nancy nor I observed philtrum shortening after two treatments (we were both hopeful!)
Q. Are there applications/risks of removing fat with Ellacor?
Ellacor is not currently indicated for removing fat.
Q. When will I see changes? Immediate vs 3 months vs 6 months?
Changes will be gradual and depend on the skin of the patient. In the clinical trial, most patients underwent a series of two to three procedures spaced approximately 30 days apart and many began to see changes in their skin between 30-90 days post procedure.
Q. Can Ellacor be used to treat scars? Remove tattoos?
Ellacor is not currently indicated for treating scars or removing tattoos.
Q. Does Ellacor create scar tissue?
Ellacor is minimally invasive and does not use thermal energy or create scarring.
Q. Does Ellacor remove hair follicles/beard hair?
Men may notice a slight decrease in facial hair which may be permanent. If this is a concern I’d recommend you discuss this with your clinician.
Q. I've seen that Ellacor is only advised for Fitzpatrick I-IV. Is there a risk of hyperpigmentation?
A . This is an important question. I experienced hyperpigmentation and for reference I am a fitzpatrick 2-3
because darker skin types (V and VI) may react differently to aesthetic treatments than lighter skin types (I-IV), a separate clinical study is needed to evaluate the proper protocols for using Ellacor on darker skin types.
Q. Can Ellacor address nasolabial folds?
Nasolabial folds are caused by a complex set of variables. Loss of fat in the deeper tissues and loss of muscle in the midface can contribute, as can the loss of collagen and elastin in the face. Ellacor doesn’t deal with the deeper layers of the facial tissues (fat and muscle) but can reduce the laxity of the skin which can cause sagging.
Q. Can Ellacor address marionette lines?
Marionette lines are caused when the depressor anguli oris muscle (DAO) pulls down the corners of the mouth, causing the corners of the mouth to droop. The issue can be exacerbated when we lose elasticity and volume in the skin. So yes, while lax skin isn’t the only contributor to marionette lines, dealing with skin laxity can be part of the solution.
Q. Does Ellacor give a 'lifting' effect?
In my personal experience (and observations when looking at my before/after photos), Ellacor did not provide a ‘lifting effect’. We know that producing a ‘lifted’ appearance has much more to do than lifting the outer tissue (skin), as the underlying fat, fascia and muscle all play a role in how taut our skin appears. Having said that, depending on a person’s unique physiology and where the laxity stems from, it’s certainly possible that some patients observe a lifting effect.
Q. Can Ellacor be used for sagging skin near knees, elbows, thighs and the back of the arms?
Some doctors are using Ellacor ‘off-label’ on other areas of the face and body beyond the lower face. It’s important to note that all published papers and testing to date have been done on the lower face. It isn’t necessarily problematic that the device is used in other areas (with an Ellacor-trained clinician) but no clinical data yet exists to support this use.
Q. In addition to skin removal, does Ellacor offer the same 'collagen induction therapy' benefits of microneedling, laser and RF/MN?
While no studies have been performed to measure ‘collagen induction’, it’s reasonable to expect that the process of excision stimulates collagen production in much the same way as microneedling. According to the paper Dermal Micro-Coring™ for the Treatment of Moderate to Severe Facial Wrinkles published in October 2002 ‘Preliminary findings included a significant increase in skin thickness in MCT (microcore)-treated areas when compared with control in both abdominal and facial skin.’
Q. I’m prone to post-inflammatory hyperpigmentation (PIH) and post-inflammatory erythema (PIE.) Is Ellacor right for me?
I’ll be honest here, I had both PIE and PIH after my two Ellacor treatments. I’ve also experienced some undesirable textural changes to my skin that I wasn’t expecting. I would say that if you have any concerns about PIE/PIH it’s important that you discuss this with your doctor well in advance of the treatment (keep in mind that my friend Nancy is not prone to PIH/PIE and experienced neither of these issues with Ellacor.)
I am working on gathering answers to MANY more questions. If you leave them below my YouTube video I will do my best to get them answered and add them here!
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