The New Non-Surgical Facelift: Can Dermal Micro-Coring Come Close to Surgery?

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Despite the immeasurable rise of machines and injectables over the last 20 years, one could argue that a weak spot still exists in the non-surgical armamentarium: a truly powerful way to lift and tighten the skin.

Plastic surgeons often bemoan the lack of noticeable improvement derived from energy-based devices, describing them as “unpredictable” and “underwhelming.” Some doctors even call false advertising on hyaluronic acid fillers touting lifting prowess. (I'll co-sign here, actually—then quickly duck and cover—because as much as I love and lean on injectables, my 41-year-old DNA, absent any superhuman J. Lo-like telomeres, is woefully prone to lower-face sagging, and no reasonable amount of cheek-plumping filler can deliver the boost needed to appreciably smooth my smile lines and sharpen my jaw.) But a new technology currently in clinical trials could soon make our “knife-free facelift” fantasies a reality. 

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From the Boston-based biotech company Cytrellis comes the world’s first dermal micro-coring device, an energy-free needling tool that mechanically drills out minuscule columns of skin—each less than half a millimeter in diameter—in a fractional pattern across the mid and lower face, scarlessly removing 5 to 7.5 percent of the total surface area to shrink the skin overall, explains New York City dermatologist Robert Anolik, MD, a researcher on the trials. “We're using 22 gauge needles to core out the skin, so these excises are tiny," he says. (For reference, a Botox needle is typically 30 or 32 gauge, and a filler needle 27 or 30 gauge, with higher numbers indicating smaller needles.) "The gaps left behind then come together and heal up, triggering the remodeling phase of collagen for a firming effect,” Dr. Anolik adds.

Images courtesy of Roy Geronemus, MD

In the most recent company-funded study, 93 percent of subjects and investigators rated the treatment area “improved” to “very much improved,” and participants, on average, saw less than four days of downtime (primarily pinkness and swelling). Skin biopsies taken from select subjects in the months following treatment showed improved collagen quality and zero evidence of scar tissue. “The development of micro-coring could potentially enable us to lift and tighten the skin in a more meaningful way, hopefully approaching the effects we see when someone undergoes surgery,” says Dr. Anolik. 

Unlike a facelift, however, micro-coring does not affect the muscles or fascia of the face, acting on skin alone. Surgery's main goal, beyond trimming away redundant skin, is to hoist and reposition fallen musculature to recapture a more buoyant, youthful version of your face. As for how micro-coring's skin resection compares to traditional surgery, “it’s difficult to quantify a percentage of skin removed during a facelift, but it could be anywhere from five to 15 percent of the lateral cheek skin on an average 40-something,” says New York City plastic surgeon Lara Devgan, MD. Cytrellis's technology should be available by the end of 2019. Point me to the waitlist, please.