If you have questions or concerns about Ellacor, you are not alone. Check out our Ellacor Q&As to find the answers to commonly asked questions by patients. If you are interested in Ellacor Micro-coring, schedule a consultation with us today.
The following questions come from the transcript of the open questions session following our webinar.
Ellacor is a first-in-class device. It is the only skin-tightening device that does not use heat. With all the other skin-tightening devices that we use, what we’re doing is putting a controlled heat injury into the skin. This heat is causing a biological response in the body that gets the body to build new collagen.
With Ellacor, we’re not relying on heat to have its biological effect because heat can be unpredictable in some people.
And in this case, what’s happening is the actual cores of the skin are being removed. This is better thought of as a surgical procedure or a very minor surgical procedure as opposed to a laser. And when removing the skin, we remove small columns, and each column is less than half a millimeter. So the column itself doesn’t scar.
When you take all these columns that are added together, it accounts for about five to seven percent of the skin in that area. And if we’re removing five to seven percent of the skin in that area, as you could imagine, there’s a fair amount of tightening that could happen even after one treatment. If you do this several times over six to twelve months, you can get a pretty decent amount of tightening along the jawline and softening the folds. We’ve been most surprised with the 8improvement in the fine lines, particularly in the cheek areas and the upper lip.
So it’s different than something like Morpheus 8 and more predictable, particularly for fine lines.
The answer is no. Basically, what happens with this device is the needles are going into the skin. And the minute they hit the fat; they stop. So typically, because the needles really slow down once they hit the fat layer, we’re really just removing the epidermis, which is a very tippy top layer of the skin, as well as the dermis where the collagen lives. So we haven’t really seen much in the way of fat removal or any fat loss in our patients.
Basically, right now, it’s technically only approved for use on the lower face and jawline and just above the upper neck. Some practices use it on the body, but I don’t think the technology is quite yet optimized to be used on the body. The really critical part of this procedure is that the cores themselves have to come out. (This is difficult in areas off the face)
For instance, if a needle goes in and the core is not removed, you’re basically doing a fancy microneedling device without any energy. So, very minimal clinical benefits have been seen in parts of the neck, as well as the upper arms, abdomen, or thighs. We just haven’t seen consistent core removal in off-face areas.
While it’s safe for body treatment, we’ve seen really inconsistent clinical results from treating the off-face area. And I think the Ellacor device has to be further optimized to be able to do this effectively.
It does grow back. But you have to think about the fact that when there’s wound healing, we get contraction.
And, if you think about what a plastic surgeon does during the facelift, one thing they do is remove the excess skin in front of the ear, and they’re removing that in one big chunk. And, of course, they’re leaving a scar in front of the ear when they do that. With micro-coring, instead of removing the big single piece of skin, we’re still removing surface area, but we’re doing it in just the small, small little incisions that you cannot see after a few weeks or so.
So, you do get that contraction. The skin does grow back, and that’s part of the reason why we can do this, and it heals so efficiently. But you do get new collagen synthesis and contraction, and you do see tightening.
It’s not quite there yet for body tightening, but it will be there in the future. I’m confident that they’re working on the technology and optimizing it.
Well, with anything that does skin tightening and fine lines, it does take a few months to build collagen. So it will be something that you basically will do and recover from in the course of a week or two, and then pretty much look normal. And then over the course of two months after the treatment, you will see the results. When they did the clinical studies, the patients were treated with anywhere between two to three treatments on average, and the treatments themselves were done about once a month apart.
In our office, we’ve taken a slightly more conservative approach. We found that if you actually wait two months after one treatment, can see the results of the first treatment and kinda optimize and target the particular areas more either efficiently or aggressively on the second treatment. So we’ve been spacing it out that way in our office. We recommend at least two to three months in between treatments in order to optimize the results and get the best possible clinical results for our patients.
I want to put it in two very different categories. Sculptra acts like a filler, but not in the traditional sense.
It’s in a category of fillers that’s called a biostimulatory filler. The way that product works is basically it’s being injected predominantly into the fat and onto the bone. It’s starting a biological process that helps your body build collagen. So, the way that helps the jowls indirectly in people is by helping build volume in the upper part of the face to help support the skin.
Something like Ellacor is actually a really nice compliment to Sculptra. The reason is because this is also building collagen. But where it’s building collagen is in the deeper, different plane of the skin. So while Sculptra is helping kind of reinflate the balloon, it’s providing structural support for our skin.
What something like the Ellacor is doing is tightening the shell of the balloon. So, the two of them together for a particular patient can be a nice one-two punch.
And, in fillers such as Sculptra that actually help build your own collagen, you can do Ellacor while someone has Sculptra in their face, about a month or more after injections and really not affect their filler.
If someone has more of the gel-based fillers like Juvederm or Restylane, you have to be a little bit more careful with those fillers when we do Ellacor because, of course, those fillers, if they’re placed in a superficial part of the skin, the needling device can actually remove it.
So, for individuals who have gel-based filler, we have to be a little bit more careful and discuss the treatment plan ahead of time to make sure we don’t inadvertently remove the filler. But with Sculptra, one month afterwards, something like Ellacor is totally fine, and they’re very likely to actually augment each other and give even better clinical results.
Okay. So, the downtime we found in patients is variable, and it depends quite frankly on your definition of downtime. So I’m just gonna go through again based on what’s involved in the healing process and what most of our patients experience after Ellacor. Because you do have open holes, very small microscopic holes in your face for the first two or three days.
You have to be really careful about what you apply to your skin, and we don’t really want stuff getting stuck in the skin, such as makeup or sunscreen. So, basically, the first two to three days until those holes are closed, most patients are advised to stay at home or minimal contact with the outside world only because you really can’t cover up with anything. You can’t wear makeup, you can’t wear sunscreen. So you basically keep your skin clean with a gentle cleanser, and we provide you in the office with an ointment to use two to three times a day for a very thin layer of moisturizer.
After about seventy-two hours, we do bring most of our patients back. There are some patients who have bruising at that point. And, we go ahead and zap your bruising with a laser such as the V beam to help slow down bruises, or speed up your recovery time and make that bruise go away faster. At that point, most patients’ skin is closed, and you can cover up with things like tinted sunscreen or makeup and not have to worry about it getting stuck in the skin.
So most of our patients feel at about three to five days, they’re coverup-able with makeup and presentable to the world. Now, some patients get red marks that can last past a week or two. And, that’s sometimes difficult to predict. We have found that if we bring those patients in and do something like a VBeam within a week or two of their Ellacor, the redness does resolve faster, but that’s kind of the tricky part of the downtime.
So while your immediate downtime, from the holes closing itself, is usually done within three days, and you’re pretty presentable with makeup by the fifth day, you may not be back to prime time without makeup for a couple of weeks.
So, that’s a great question. This is a new in class device. So we don’t really know the specific answer, at least from an evidence-based standpoint, to that question.
But as we all know, especially those of us who do this procedure, or who have done any of these aesthetic procedures over the years, you know that we don’t stop aging. We don’t age in a vacuum. And, of course, you’re going to need more treatments down the road. Whether it’ll be a series of Ellacor, what you can maintain with one, or if we’ll alternate with another skin type device, time will tell.
We’re going to figure that out together as the technology evolves.
So we’ve done quite a few Ellacors in the office. We’ve had it in our office since about November of 2023.
And, I, you know, those of you who know me know I’m a pretty straight shooter, and, you know, I answer things. You know, I have no poker face. If I’m lying, you’ll know the minute I’m telling you. But I haven’t seen any scarring from Ellacor.
What I have seen in a handful is that they do have redness that can persist. And I did have one patient with redness for a couple of months. But it resolved without any sort of intervention issue, but you can’t tell now that she had any redness or any long term redness from her Elllacor. That’s.. so that’s probably the worst thing I’ve seen from it.
Of course, if you’re putting too many holes in or you’re overlapping your holes or there’s an issue with technique, there is a risk of scarring. But, you know, we obviously are very careful and try to avoid that. And with any of these technologies, it is possible. And if there’s some problem in the past with wound healing, it can be a predictor for potential problems with Ellacor, and we can go through things like that in individual call consults.
But in general for the average patient, I have not seen any problem with scarring. And in fact, they designed the device with these holes small enough because they know that hole size or smaller heals without scarring.
Pain management is pretty straightforward for Ellacor. The only part that hurts with Ellacor is injecting the skin with anesthesia. They didn’t show that in the video, but that’s probably the only uncomfortable part.
We do have a couple of options for patients in the office. We bring you into the office. We, of course, apply cream. And then, in addition to the numbing cream, you do have the option of laughing gas, which is nitrous oxide, during your injections.
The injections themselves are basically the same stuff the dentist uses, but it’s injected locally into the skin. So any of you who had filler and remember that kind of sting right before the filler is injected. It kinda feels like that. Or if any of you have skin biopsies, or it kinda feels like that kind of stinging sensation.
The injections with the anesthesia take about five minutes or less. And we take our time. And, once you’re numb with the anesthesia, it’s literally pain-free. You won’t feel anything after the anesthetic is injected. So it’s about five minutes of discomfort, and the rest of the procedures are really straightforward.
Pain management afterward really is virtually none. You will feel a little tender. Obviously, you know, you have the small procedure done. You also feel a little bit; you’ll have some swelling afterward as well. And, but it’s not something that a patient has required pain meds for afterward and certainly not anything I’ve gotten a phone call for pain post the procedure.
I do think in the center part of the neck where you can stretch the issue over the bone, you can actually get cores there. So I do think it will help with this area. We’ve just started treating a few months ago. And so we’ll have more information, you know, down the road.
The answer is that it’s variable. So, if you decide to come in for a consultation, we’ll provide you with a list of pre and post-care instructions.
One of the biggest thing pre-instruction is about what blood thinners to avoid. So what we’ll do is advise that you avoid the blood thinners that are possible for you and that will really minimize your bruising. In addition, we do offer options after the fact to help clear up your bruising faster. I haven’t had any patients who’ve had any significant bruising that lingered past five to seven days.
So we’ll get you turned around in about that one week of downtime.
So, that is a really good question. And of course, if you think about what this technology does fundamentally, it is taking needles that are being inserted into the skin and removing skin. And if you inadvertently, just by chance, remove hair follicles, you are going to end up losing hair in that area. So in the clinical studies, there were no men done in the studies. So, there’s no real long-term evidence in terms of treating men with hair and seeing what happens in their beard.
In our office, we’ve been very conservative because, of course, we don’t want to affect anyone’s beard line long-term. So if you’re a man and you want to do this procedure, there is this small chance that you could have permanent hair reduction or patchiness in the beard after this treatment. So if you’re someone who really likes wearing a beard, this is probably not the treatment for you. And as you can tell, that’s me. I’ll not be getting one of these done anytime soon. But, if you’re okay with losing some facial hair or you shave closely regularly, then you can do it very safely on a man.
Yes, though in the clinical studies, there were on average two to three treatments done per patient. Since the machine has come out, there’ve been patients who’ve had four treatments without any sort of problem. So in theory, yes, you can absolutely continue Ellacor, but of course there are other technologies.
So, perhaps the best strategy is something like you suggest, doing a series of two or three and then maintaining it down the road.
That’s a great question. EDS, for those of you who don’t know, it’s called Ehlers-Danlos Syndrome. It’s a connective tissue disorder with impaired wound healing.
And this goes back to the question about scarring. You want to be careful on the patient with EDS. Perhaps perform a test spot, depending on the type of EDS they have, and pay attention to what their current scars look like. So this would be someone you would be concerned with scarring about.
So you’d have to have that discussion more, more clearly. But yes, in theory, it can be safe depending on the type of EDS they have, but they would receive it with caution. You should probably do some test areas, do a lower density, and see how you heal.
The answer is definitely easier than Ultherapy.
I have actually not seen an infection with Ellacor.
It turns out in general, just as a general rule in dermatology is that open wounds do not get infected. So, because these holes are left open, I have not seen a single problem with any patients.
Then, regarding things that have been reported in the community, if you come in with stuff on your skin, such as makeup or sunscreen, and the practitioner doesn’t get it all off.
There are some people who’ve had some impaired wound healing from that, but it hasn’t had any long-term problems. In fact, in our office, we basically ask everybody to come in with nothing on their face so that there’s no risk of that.
Other side effects, such as existing infections, you do worry about. Certain patients who have a history of fever blisters or cold sores on their lip can have a reactivation. So, if that’s the case for you, we put you on antiviral medication to prevent this. But other than, you know, the temporary inconvenience of looking funny and having a little bit of swelling and some bruising and some patchy redness, most people have turned around in about a week’s time. And I have had a handful of people who’ve had redness persisting longer than a week, but we’ve been able to manage that, and it’s certainly coverable. So, as long as it’s something you’re prepared for, you can definitely have the treatment without an issue.
Profound, Thermage, and Ultherapy differ in a lot of ways. So what Thermage and Ultherapy are doing is they’re getting the top, the top, and the deeper layer, this muscular skin. And, Profound is just getting that top layer. I will say that Ultherapy and Thermage are probably better for a patient who wants lifting, and something like an Ellacor is better for someone who wants some of the laxity as well as the excess skin and some of the fine lines removed.
The reality is in an ideal world, it’s good to do procedures in both these categories because they’re complementary. Right? So, one is addressing the actual skin – the redundancy of the skin – and the other one is addressing the strength of the collagen layer in the muscle tissue layer.
It really depends on the person and what kind of forty-two-year-old you are. I’ve actually found, surprisingly, that the younger patients take a little bit longer to heal, and they have a little bit more downtime. More mature patients heal much faster. And quite frankly, I think they get better results. So if you’re forty-two and you wanna use a skin tightening device, you might be better served doing something that’s a little bit more straightforward and pasted, and you’ll probably get just as good, if not a better result.
No. It’s not currently approved for the forehead. There are, I have heard of some people who have treated foreheads, and with subpar results. So the technology is really not designed to be used there at this time. But it’s probably something that will be optimized in the future and may potentially be done there for it. But for right now, no.
The answer is no. The needle is designed only for thicker skin right now. We are not treating either upper or lower lids with this technology.
The answer is yes; that’s a great combination. When we Botox the neck, one of the things we’re doing is taking that muscle and relaxing the muscle so it doesn’t pull down on the jawline.
So if you Botox that area to release that muscle and then do something like an Ellacor, you’re really hedging your bet in your favor because then the skin really doesn’t have any downward force. It can really pull up inside.
Great question. So, typically, we start with just underneath the bony prominence of the cheekbone. So just about right here on the sideburn, and we treat right in front of the ear all the way to the fold here on the nose. Same on the other side, obviously upper lip, chin area, and then we do treat down onto here.
And then in select patients who feel crepiness, we do treat down onto the neck. So, it really depends on what your particular needs are. For most people, what we’re doing is here, here, all the way down to just underneath the jawline right here.
So that answered the question of what part of the face and neck is covered.
Million dollar question. Obviously, I would say as long as possible.However, it depends on the blood thinner. Something like aspirin actually has a really long effect on the platelets. So for something like that, two weeks is ideal. For other products, you know, such as green juice, salmon, and fish oils, a week is probably fine. Sooner to two weeks is probably the best answer to that question.
Great question. That is something that is being actively worked on. There’s a limited amount of data.
Of course, there are no studies that have been done. We have seen some good results on some post-surgical scars on the face, as well as surgical scars on the scalp from hair transplants. And, of course, with tattoos, because you’re mechanically removing the skin, you do have the ability to help clear up a tattoo. And so there are some reports of that as well.
So it’s something certainly if you have to get creative, we can use this. It’s not the first line, but it probably is something that will be useful for our stubborn scars and tattoos in the future.
And, I would say mostly the biggest thing to avoid is blood thinners, and don’t just think of medications; think of supplements as well.
Great question.
So, you know, there’s really no reason you have to stop your skin care leading up to it. So you can certainly use your retinol, your vitamin c’s leading up to the procedure.
If you are someone who’s at risk for pigmentation, we will talk about potentially using a bleaching cream ahead of time to minimize the potential risk of pigmentation from the treatment. And that’ll be individualized per person.
If you want to be someone who wants to hedge your bet in the right direction and try to increase your clinical results and decrease your downtime, there is a great product that some of you may be familiar with called Alastin Nectar. It has been shown that if you use it for a week or two prior to your procedure, it actually speeds up your recovery time, but it also helps improve your results because what it’s basically doing is helping break down the damaged collagen to let the new stuff move in. So, that is something you could potentially use to prep your skin for the procedure.
And, yes, it is. So, of course, anyone with a history of hyperpigmentation melasma is at theoretically increased risk for pigmentation, but, it’s because Ellacor is not a heat-based technology, it’s far less likely to do it than, let’s say, a fractional laser would, but it’s something we discuss in your consultations, the potential risk, and potentially think about pre treating you with bleaching cream prior to treatment.
The other thing that I’m pretty strict about, if you are doing a treatment of this nature and you are at risk for hyperpigmentation, or you’re someone with melasma, or you’re someone who likes to get a lot of sun, then this is not the summer treatment for you.
So even though it’s not a laser and there’s no heat, we would recommend you do the procedure in the winter months. And I know, you know, we don’t really have winters here, although we did last year. But, typically, the winters here, while they’re still sunny and warm, there’s just less daylight hours.
So, between daylight savings time, you know, usually October to March would be the ideal time for someone with pigmentary issues to do a procedure like this.
Great question. That’s always, you know, fair, transparent honesty. I would say more than I can count. I would say I’m probably close to a hundred now. (As of March, 2024)
The answer is yes, but just to reiterate, some of the gel fillers will have to talk about how long they’ve been placed there. And, in particular areas, particularly around the mouth, we have to discuss potentially removing those fillers.
And, we have seen clinically that, of course, you know, one of the things that happens to us as we get older is that our upper lip starts to lengthen. There is a surgical procedure called a LipLift where they actually incise this area, remove the excess skin, and pull the lip up. And we found that, you know, with Ellacor, because we’re removing skin in this area we’ve been able to shorten that lip distance in patients and even increase the amount lip show they have, as well as improve some of the fine lines.
This is actually an area where I think Ellacor shines really well, and has a nice result for patients. And the company I know is working on a study to kinda quantify the amount of lip lift you can do. So, yes, this is something that you can do in this area, and it does tend to work pretty well here, and people have been happy about that.
Great question, just to reiterate. We put topical numbing. Topical lidocaine is applied for thirty minutes, then we go ahead and inject you with lidocaine with epinephrine. This is exactly what the dentist uses. And if any of you had skin biopsies done, this is the same product that’s used. And that’s directly injected into the skin.
Like I said before, that’s really the only uncomfortable part. Takes five minutes or less. And if you need extra support like laughing gas, even a medication to relax you, such as Xanax, we’re happy to provide that for you.
This is a very good question. So, the answer to that question is, no, it’s not scar tissue.
And, there is something about the size of the hole that dictates the way it heals. So, when they did the studies with Ellacor, they basically took skin initially when they were trying to figure out what holes to remove. They took skin, and they used different-sized needles on them. They found that at half millimeter or less, the hole itself, once it heals and you look at the samples of skin under the microscope, you can’t find the scar … you can’t find what looks like a scar through the microscope.
So it doesn’t look the same way underneath the microscope, that, let’s say, a surgical scar looks, the collagen is different. So there probably is something about the size that’s really important. Not just because it doesn’t leave a physical scar, but also because it doesn’t heal in the way a scar would underneath the microscope.
I have had a handful of patients who felt like they had a little bit of oozing for about a couple of hours after the procedure, but certainly not, like, bleeding to the point where you’d actually be worried by any significant blood loss or even more than just a minor inconvenience.
The lesions shouldn’t scab because, of course, we’re applying ointment to them. But, there, you will have a pinpoint red marks that you’ll see in about two to three days, and that’s just the hole being closed.
Usually thirty to forty-five minutes. And like I mentioned before, you’re very, very comfortable during the procedure.
If someone wants to start only with the upper lip for smaller areas, and I would recommend you come in for a consultation to discuss that, but we certainly have patients who really just wanna start with, upper lip or feel like that’s the only problem that bothers them. And as I mentioned before, that is an area that works really well on people, and that’s something we can certainly talk about.
And that’s a hard question to answer without seeing someone’s particular double chin. It depends on the cause of the double chin. If it’s skin laxity, you do make improvements in the contour of the area, not just by removing skin here but also tightening the skin up here and having everything pulled up. So we have seen that.
If there is laxity here or the fullness in the double chin is because of a lack of bony prominence or the fact that you have fat there, that’s better treated with something like injectables, like a filler. Or if you have fat, something like Kybella or CoolSculpting. That’ll be something that’ll be individualized and tailored to your particular anatomy.
I frankly haven’t seen uneven results with this treatment.
We take a lot of care in removing the cores, making sure we remove the same number of cores on each side. Of course, if you treat one side at seven percent and the other at three percent, you can, in theory, get a different uneven result. But I have, of course, we take care and make sure we’re putting more or less the same number of holes on one side than the other, and I haven’t seen any sort of unevenness with this treatment.
They have done clinical studies on what they call skin types I to IV individuals. They give people a rating or a scale of one to six in skin type. And the I to IV skin types, I is like a very fair skin that always sunburns, and skin type IV are people who are more olive Mediterranean skin or Asian who almost rarely sunburn. So they did do those studies in those patients and they had very low incidence of side effects such as pigmentation, all of everything resolved without any sort of intervention.
We have treated people; in fact, the patient I think they showed in the video was a slightly darker skin type, and it is theoretically safe for all skin types. Of course, in darker skin types, you do have a greater risk, a theoretical risk of pigmentation, but there are lots of reports in the community of people treating patients with Ellacor who’ve treated all skin types without any significant problems. But we would have to talk about your particular needs as well as, trying to hedge the bets in your favor, such as not doing the treatment during the summer, perhaps treating with the bleaching cream, in order to minimize that.
I haven’t had a problem with rosacea patients who’ve gotten Ellacor.
And I don’t see that as a particular contraindication.
We typically try to avoid treating the mole itself, particularly if it’s a larger mole. Just because we don’t want to do anything that’ll alter the appearance of that mole and prevent us from being able to monitor the mole medically, but we can easily work around moles without any sort of problem.
Million dollar question. It depends on what state you’re in. Every state has different laws. In the state of California, any MD, which is a medical doctor or DO, which is the doctor of osteopathy, nurse practitioner, PA or registered nurse, can perform Ellacor. This particular procedure in our office is done by myself, and I’m a dermatologist, and Dr. Helen Fincher is also a board-certified dermatologist who performs the Ellacor procedure in our office.
And I would say door to door with the numbing cream, and, you know, getting yourself, numb, and then, of course, we clean you sterilely, and then getting you numb with the cream, and then, injecting you with the anesthesia and then treating procedure, expect to be in the office for about an hour and a half or so. You can drive yourself back and forth, especially if you don’t take medications.
If all you do is numbing cream and or laughing gas, you can drive yourself. So there’s no reason why you can’t drive yourself home safely unless we give you something like Xanax to relax you.
And the answer is no. A lot of surgeons actually have this device, and we’re all looking to augment what we do for patients. Not everyone is a surgical candidate, not everyone wants surgery, and not everyone is ready for surgery.
Right? So, this is a great option for patients who didn’t feel like they hadn’t had an option before and didn’t want to do something surgically. So I would say that in general, all of us, dermatologists, plastic surgeons are all really excited about this technology and the more people we can help empower the better.
It’s like comparing apples and oranges.
Remember, one of the things they do during a facelift is they don’t just remove excess skin, but they tighten the muscle layer. So it’s hard to equate facelift surgery to something like an Ellacor because it’s not quite doing the same thing. So, you know, that’s a good discussion to have with somebody during a consultation.
You really wanna weigh all your options and not just the treatments we offer in this office, but even things like surgery that we don’t do in our practice. Cause if it is something you’re ready for or a good candidate for some surgical levels, it might be more cost-effective long term to do something more definitive like that. That’s something I’d be happy to give my honest opinion on, during a consultation. If you’re somebody who’s open to that. But oftentimes, people will come see us in our office who have kind of already ruled out something like a surgical option. So this is a good alternative for somebody who’s not quite there.
For additional Ellacor Q&As, we encourage you to contact our office today.
