Micro-Coring: A New Breakthrough in Non-Surgical Facial Rejuvenation?

Dr. Grant Stevens

Hello and welcome back to the technology of beauty. Where I have the opportunity to interview the movers and shakers of the beauty business, and today is no exception. Today in our studio we have Karen Cronholm. Hi Karen. She's come all the way out from Boston to talk to us about a very exciting and new technology. So first of all, welcome to LA.

Karen Cronholm

Thank you. Yeah, I'm enjoying the warm weather. It's great.

Dr. Grant Stevens

I bet you are. It's great weather, isn't it? Yes. Before we get into your technology, could you tell us a little bit about yourself? Where'd you grow up? Where'd you go to school? That sort of thing to start.

Karen Cronholm

Yeah, sure. So I grew up in Massachusetts. I actually went to UNH. I'm actually a scientist by training, so I have a degree in microbiology. And then went on to get my MBA from Northeastern. So exciting to have.

Dr. Grant Stevens

Did you live in the back bay there or when you were in .

Karen Cronholm

No, but I've always lived in the Boston area. Just in Boston area. Really love it out there, despite the cold weather.

Dr. Grant Stevens

My daughter lived in the back bay. She she went to school there at the Berkeley College of Music. Oh, nice. So I had the chance, hang out there around Northeastern. So that's where you got your mba? And what'd you do? What was your first job after that?

Karen Cronholm

Actually, I started off behind the bench. So as a scientist in the life sciences industry. And then eventually find my, found my way to Cynosure. So that's really where I got my aesthetic experience and just really loved that, that job and had a great time. And when I heard about what Cytrellis was doing, I really just had to be involved. It was such a great idea and a great opportunity.

Dr. Grant Stevens

So what year did you go to Cynosure.

Karen Cronholm

So I was in Cynosure from like 2008 to 2012.

Dr. Grant Stevens

Okay. And what did you do while you were there? What was your main?

Karen Cronholm

So I managed the body contouring products. So I had Smart Lipo cellulase and a couple other cellulite products as well.

Dr. Grant Stevens

Okay, cool. And then you were recruited to go to Cytrellis? So is Cytrellis the name of the company or the technology?

Karen Cronholm

It's the company. The technology is Micro-Coring, and our product name is ellacor.

Dr. Grant Stevens

That's a lot. So ellacor, ellacor, how do you spell that?

Karen Cronholm

E L L A C O R.

Dr. Grant Stevens

Ellacor. That's the product? [Yep.] The company name is Cytrellis. And when did you move to Cytrellis?

Karen Cronholm

So that was actually in 2015. And I just, when I heard about the opportunity, I, like I mentioned, I just had to be involved. It's actually Rox Anderson and Jay Austen are two of the founders. So we have an exclusive license out of MGH and it was just just made sense.

It's such a simple technology and just a great idea that they had at the time we actually hadn't done too much. It was real early days. It was more of an idea than anything. Huh And but when I heard about, hey, we're just removing these micro cores of tissues, so we remove the epidermis and the dermis, that's a full thickness core of skin that gets removed.

And it just seemed so straightforward and I thought, gosh, that's just gotta work. That's gotta make sense for treating wrinkles and reducing lax skin. And, my, from my days at Cynosure, we spent a lot of time on, developing products for those applications. I had a good idea of hey, what's working really well or what ideas might work even better.

So that's, Really how I wanted to be involved with the company and take things further and see if we could, really make it work. And we have made it work. We now have an FDA clearance.

Dr. Grant Stevens

Congratulations. That's recent. And have you been the CEO the entire time?

Karen Cronholm

No. The founding ceo Doug Levinson, he pulled the company together and did an amazing job putting together a group of great investors, KOLs as well. Opinion leaders, physicians that we worked with and handed over to me in 2017.

Dr. Grant Stevens

Okay. So you've been at the helm for four years then, right? And now you have FDA approval? [Yep.]

Let's go back a little bit before I ask you how you're going to roll this out, but let's talk a little bit more about the science and what actually happens. You've mentioned that there's coring. You've mentioned skin laxity. You've mentioned epidermis and DMIs, but for the listeners and watchers, let's take a step back and redefine just what this technology is

Karen Cronholm

Yeah, sure. Yeah, so again, at the heart of it, we're just removing that epidermis and the dermis and if you talk to Rox Anderson and Jay Austen, our two founders, really, their idea behind that was, how could we find a better way? When you're treating, let's say a fractionally, a blade of laser, which, Rox Anderson had a lot of involvement with developing that product.

He always thought, why aren't I seeing maybe a better tightening effect? And he theorized maybe it's because you have all this coagulated tissue from when you use a laser and the skin doesn't actually close, so you don't, you're not really removing any tissue. And he thought what if I could just remove the tissue using, not using any, So no heat, no rf, no radio frequency ultrasound, anything like that.

Just a mechanical removal of the tissue that the skin would collapse on itself and you just have less skin. So it's just as simple as that, he his theory. And Jay's work on the product as well, really panned out. And we see that in our clinical studies, we're able to remove about five percent of the skin in a given treatment. And so really it's a math equation. How much skin can we remove in one treatment versus multiple treatments? And we see better and better results with more treatments and obviously being able to do that without causing any scarring. It's not a surgical procedure.

Dr. Grant Stevens

That's the question I have. How big are the cores that you're taking out? You're taking a core.

Karen Cronholm

It's about 500, or sorry, less than 500 microns in diameter, so we're around 400 microns and that there's an important science behind that as well. We definitely wanted to make sure we really understood the science and the technology really well, so we've done a lot of clinical studies to really hone into that right size and also right percentage of skin to remove, to make sure we're getting great efficacy, but also a great downtime healing profile for the patient as well.

Dr. Grant Stevens

What is the downtime or healing for a patient, say they treat their neck?

Karen Cronholm

So the patients reported to us in our clinical studies. It's actually about three days on average of downtime.

Dr. Grant Stevens

Okay. And these cores, are they are they a grid or are they individual and how far apart are they?

Karen Cronholm

They're a grid. So basically we remove skin with a stamping technique. So the consumable that we have with the device actually has these tiny little super sharp microcoring needles that lay down a pattern within that one square centimeter.

And we can either increase the number of cores that we remove or decrease them to change that percent of skin that we remove within that sort of stamp.

Dr. Grant Stevens

So you can change the number of coring devices in a given stamp?

Karen Cronholm

Yes. It's adjustable. [Interesting.] Almost think of it as a really simple robot in a way that we have incorporated with the way the device works. We have these very precise and accurate motors that control the needles, and we can position them anywhere in space.

Dr. Grant Stevens

Yeah. And there's no energy involved. RF ultrasound you mentioned, no cautery. There's no, there's no bleeding per se.

Karen Cronholm

No. There is a little bit of bleeding during the procedure. [but it just naturally stops] Yeah, sure. We advise that physicians use a little bit of local anesthesia and because.

Dr. Grant Stevens

Is that topical or injected?

Karen Cronholm

Injected. And so there's epinephrine in there that, obviously helps with the bleeding. And to control the pain. Obviously lidocaine patients report to us about a pain level of two during the procedure and then no pain afterwards. So I think that's a real big advantage of the lack of energy. Is, there's no sustained pain and the procedure itself is not very painful either with, the right anesthesia.

Dr. Grant Stevens

And that's on a pain scale of one through 10 or one through

Karen Cronholm

five? One, one to 10.

Dr. Grant Stevens

Yep. So a pain of on a one through 10 is only two? [Correct.] The procedure and post procedure, it's nothing. Zero. Nothing. Any special dressings?

Karen Cronholm

Nope. Nope. Just we recommend that, patients put Aquaphor on post procedure.

Dr. Grant Stevens

Any contraindications?

Karen Cronholm

We have a few that, we just want a couple things. We just like to be, cautious about, obviously if somebody's had like filler in that area, we would wanna be really careful about treating right over that.

So certainly there's a few things that we like to make sure we include when we're talking to physicians, really it's a very simple procedure and we're not going that deep into the tissue. For instance, you could treat over structures that, maybe you wouldn't with other heat based technologies.

Dr. Grant Stevens

How deep do the actual core biopsy or the core needles?

Karen Cronholm

Yeah, we just need to be at the bottom of the dermal layer to remove the tissue. Most patient, most people, on average, they have, two millimeter skin thickness, so we make sure we go to about, say three, sometimes four, depending on the patient, just to make sure we're going deep enough, but really doesn't impact the tissues underneath at all.

Dr. Grant Stevens

If you're removing that five to 8%, whatever it is, and the heal. Two questions

how soon could could I have a second procedure? And how many procedures could I have?

Karen Cronholm

So you could have as many procedures as you want. In our clinical studies, we've done, we did up to three. So two to three to, achieve the efficacy that we were looking for but. And then we did a regimen of 30 days in between treatments. But certainly you could, you know what we hear a lot from physicians is we could treat as soon as patients are healed.

Dr. Grant Stevens

And each time you lose, say 5%, five to 8%, correct? So let's take 5%. I could lose 15 plus. With three treatments, separated by a month.

Karen Cronholm

And one of the really interesting things we discovered is that we were able to improve these more severe wrinkles. So moderate to severe wrinkles is actually what we're indicated for. So not fine lines and wrinkles, which is what a lot of other products have. And we really targeted the, mid to lower face area, and able to address an area that not a lot of other technologies can really treat.

Dr. Grant Stevens

Now have you treated the entire face like the forehead, the eyelids, the cheek, and so forth?

Karen Cronholm

We've just really focused on the mid to lower face.

Dr. Grant Stevens

And have you gone commercial yet? Is this a commercialized product?

Karen Cronholm

We're just starting to roll out the launch and the products. We have shipped our first system, which we're really excited about.

Multiple Speakers

You have. Oh, yes, we have. Yeah. Oh, congratulations. Thank you. Yeah, that's wonderful. But really planning on doing a big launch in 2022.

Dr. Grant Stevens

I certainly hope that you're launching at the aesthetic Society. We'll be there. We'll back in Society for Aesthetic Plastic Surgery, my Beloved Society in April in San Diego.

Multiple Speakers

Yeah, that's a great meeting. So we will be there. Thank you. Good. You will be there for sure. Great.

Dr. Grant Stevens

Can you compare and contrast your technology with the Recros technology?

Karen Cronholm

Yeah, sure. I think we're doing different things. I think that we're really focused on the skin. I know from what I've heard they're it's going a little bit deeper into, trying to remove some fat as well.

So a bit of a different application and also, think again, we're trying to stick to the entire mid to lower face and really treating those broader areas. I would say the other thing that we've done differently as well is just the style of, or the manner in which we're removing the tissues different.

Dr. Grant Stevens

Can you explain that? I'm unclear on that.

Karen Cronholm

So we have developed a method with these super sharp coring needles where we're just puncturing into the tissue and then removing the tissue. They don't rotate, versus the Recros technology with which rotates. So a little bit of a different style there as well, I believe.

Our core sizes are much smaller as well. Which we, again, as I mentioned, we studied that quite extensively, so we really feel that's like the best way to remove the tissue and again, to get the best safety and efficacy that we can.

Dr. Grant Stevens

Thank you. Cuz they both sound similar when I, when I hear them. They sound very similar, but yours is straight in and out. Theirs is rotary. And theirs is deeper, you said, and that includes fat.

Karen Cronholm

That's my understanding.

Dr. Grant Stevens

So tell me something. When you look in your crystal ball, where do you see the future of this industry and in particular, the future of Cytrellis? I'm sure you have other things if working with Rox. I'm sure you have other ideas.

Karen Cronholm

Yeah, we have a ton of ideas. We have so many ideas. I really see the device as a technology platform. So while this is our first indication for use for wrinkles I think there's a lot more that we can do with the device.

A lot of applications that we're working on right now to explore and, hopefully come out with additional indications for use, additional clearances. We believe really strongly in innovation. We're a very innovative company and I have a team of brilliant engineers that are already working on the next great thing. So stay tuned for some more exciting products to come from us as well.

Dr. Grant Stevens

Any plans on going off the face and onto the body? [We'll see.] Ah, yeah, I think you're holding out on me. I think that'd be great because laxity is a big problem. Anything you can do to help.

Karen Cronholm

The other thing I think I'm excited about with our technology is we have such natural looking results.

Like we make patients, look like a better version of themselves. And I hope, really hope that brings more patients into the practices. That may have been a little bit hesitant to try a procedure. They afraid they might, look pulled or frozen or what have you. And so I think if you look at our results, patients would be really excited about that, that kind of outcome I think that's a big obstacle for a lot of folks. So how do we bring, new patients into aesthetics that maybe wouldn't have had these types of treatments in the past?

Dr. Grant Stevens

I think you're onto something that way. I remember when you first presented it at the Aesthetic Innovation Summit or AIS, and I thought the same thing.

I thought there are some people that just do not want a facelift. They don't want the cut. They don't want the scar, they don't want all the stigma and so forth. And this seemed like a way in which you could minimize some of the skin, right? And thereby decrease the lax, the redundancy.

And it seemed like a minimally invasive, not non-invasive right, but minimally invasive approach. Too tightening and lifting yeah, exactly. I applaud your efforts. I hope you continue. Thank you. And I hope you go off the body also because there's so many areas that patients ask us about all the time.

And I love your concept of expanding the market because there are so many people that are looking for alternatives. And I want to thank you for coming here and spending your time here in the studio at the technology of, We sure appreciate it. I look forward to having you back on the show as you develop these new applications of this coring technology.

Karen Cronholm

Great. Thank you so much. It was a pleasure to be here.

Dr. Grant Stevens

Oh, you're very welcome. And I want to thank all of you for joining us once again at the Technology of Beauty, where I have the opportunity to interview the movers and shakers of the beauty business you've just heard about Cytrellis. And a very novel way to lift and tighten the skin with a multiple core biopsy type of technique.

So join us every Tuesday and you can hear our podcast or watch us on YouTube and go to the technologyofbeauty.com. Take care. Thank you very much.