Coming & Going: November/December 2022

Coming

Microcoring

The FDA gave its coveted nod to the ellacor system from Cytrellis for the treatment of moderate to severe wrinkles in the mid to lower face in July of 2021.

This is a first-in-category device that safely removes micro-sized portions of excess skin without surgery, thermal energy, or any evidence of scarring.

It may sound too good to be true, but it’s not and that is why it’s taking off. Cytrellis took a rolling launch approach with the ellacor system, introducing it in select markets to gather insights and optimize protocols before initiating a broader-scale rollout this fall, which will continue into 2023.

Dermal micro-coring involves making tiny punches in the skin using a small-gauge needling device. Each micro-core is less than half a millimeter in diameter, and they are placed in a fractional pattern across the mid-and lower face to scarlessly remove up to 8% of the total surface area to shrink and tighten the skin and stimulate collagenesis and elastogenesis. The entire procedure takes about 20-25 minutes. This is the only non-surgical way to remove excess skin, and it’s truly scarless. Expect to hear a lot more about the benefits of ellacor in 2023.

Going

BBL Chop-shops in Florida

It was more than 5 years ago that the Aesthetic Surgery Education and Research Foundation (ASERF), with members of the Gluteal Fat Grafting Task Force, first sounded warning bells about the risk of pulmonary fat embolisms associated with intramuscular fat grafting of the buttocks aka Brazilian Butt Lifts or BBL, for short.

South Florida carries the highest BBL mortality rate in the nation, bar none. There were 25 BBL-related fat emboli deaths from 2010-2022, and 14 of these occurred after the ASERF guidelines and after the Florida Board of Medicine mandated that these procedures only be performed subcutaneously above the deep gluteal fascia in 2019.

It became obvious that more regulation was needed. Now, members of Florida’s medical boards are working to change the state’s office surgery regulations to cap the number of BBLs that a physician can perform in their office to three per day. The proposed legislation also requires surgeons to use ultrasound equipment when performing the procedures to avoid injecting fat into the muscle, which can cause a pulmonary embolism, and bans a surgeon from delegating any part of the procedure to a non-surgeon. These provisions are all part of an emergency 90-day order executed on June 15, 2022.

I am not sure the new law goes far enough, but it is a running start. These surgeons can presumably perform additional procedures such as breast augmentation during that day, so it does little to offset the provider fatigue that has been linked to certain BBL deaths in South Florida. I am hopeful that this will become law, and we can prevent any other deaths from this procedure.