A novel microcoring technology: A completely new concept of enlarged pore treatment

Enlarged facial pores are a common dermatological and cosmetic concern, which are difficult to treat because their pathogenesis is multifactorial. Many technological treatments have been developed to treat enlarged pores. Despite these efforts, enlarged pores remain problematic for many patients.

pores, including antiandrogen medications, that control sebum production, chemical peels, fractional lasers, and other energy-based devices. 2,3 However, these commonly used treatment methods are not efficacious in maintaining the dramatic results of the enlarged pore treatment. 4 Fractional ablative laser treatment with CO 2 or Er:YAG lasers has emerged as an efficacious treatment option for enlarged pores.
These methods use a wound-healing process that artificially damages skin tissue to convert enlarged pores into normal tissues. Using high-energy lasers inevitably results in a prolonged recovery time and side effects, such as burns and hyperpigmentation, which can lead to rapid reepithelization, dermal hole filling, and stimulated dermal remodeling. Furthermore, laser equipment uses microsized tips, which limits the treatment of large pores. 5 In addition, laser devices have the potential to damage surrounding tissues due to the heat effect. 3 Microcoring needles have been proposed as part of an alternative strategy for grafting scars by removing the fibrous bands and skin tightening caused by the removal of the dermal-epidermal column ( Figure 1). 6 Coring needles, similar to fractional ablative lasers, can remove many small, full-thickness skin columns, without the photothermal damage caused by the laser. Through the highspeed rotation of a microneedle, these are known to minimize collateral damage while providing selective ablation of the target tissue.
Because there is no excessive thermal damage to the surrounding tissues, the downtime and postinflammatory hyperpigmentation can be controlled.
This study used microcoring methods to examine the results of three clinical patients with enlarged cheek pores.

| MATERIAL S AND ME THODS
The study was conducted in accordance with the Declaration of Helsinki. Written informed consents were obtained from all participants. We used microcoring system with the N-Derm (N-finders, Korea, Inc) platform, which resects the skin pore in the cheek with 0.5 mm in diameter rotating scalpels. The study adhered to the tenets of the Declaration of Helsinki and its later amendments. The current study was conducted in compliance with the relevant ethics guidelines. All the consents were collected before the procedures.

| CLINIC AL E XPERIMENT
Three patients, two women and one man with a mean age of 30 (male), 31 (male), 32 (female) years, participated in the treatment.
Lidocaine cream was applied as topical anesthesia for 30 min before the procedures. Lidocaine was injected locally for infraorbital nerve block. A coring needle was used to remove approximately 40-50 holes. Coring needles with a 0.5 mm inner diameter were manually inserted to create full-thickness skin holes ( Figure 2).
With each needle insertion, the core of the skin was extracted, extending from the epidermis to the superficial subcutaneous fat.
Forceps were used to remove the remaining specimens from the treatment site.
F I G U R E 1 Shows schematic image of microcoring system in which rotation of a micro needle causes selective ablation of the target tissue by removing the dermal-epidermal column.
F I G U R E 2 Shows the right cheek during the microcoring technique performed on the right side of the cheek. Microcoring system with the N-Derm (N-finders, Korea, Inc) platform, which uses 0.5 mm rotating scalpels to resect skin pores in the cheek region for clinical experiment.
After the procedure, the patients received oral cefalexin 500 mg three times daily for 5 days as prophylactic treatment. The procedure was performed using a single handheld needle with a single punch. The needle's depth was manually adjusted. The resected sites were closed using a stretched elastic adhesive dressing to enhance wound healing. After 7 days, the compressive dressings were removed. The patients came for follow-up visits on the day of the procedure, 7 days, and 1 month postoperatively.
Scanning was performed bilaterally at 45° views 60 cm from the face with the same brightness at the time of the visit. The exclusion criteria for this study included a history of mechanical allergy, other serious medical conditions, or surgical or nonsurgical facial area treatment within the previous 6 months. All patients received a sufficient explanation of the study's purpose and protocols.
After 4 weeks of follow-up, patient satisfaction was assessed according to "very satisfied," "satisfied," "disappointed," and "very disappointed" scales with a self-report questionnaire. The selfadministered questionnaire asked about the side effects of the treatment, such as persistent pain, folliculitis, erythema, edema, hyperpigmentation, or hypopigmentation.
In addition to the self-questionnaire, two dermatologists checked for bleeding (none, trace, mild, moderate, or severe) and examined the healing profile (presence of ecchymosis, purpura, fluid accumulation, hyperpigmentation, hypopigmentation, roughness, dryness, inflammation, erythema, crusting, scarring) and adverse events.

| RE SULTS
No adverse events, including serious side effects, were reported in any of the clinical trials.
The pain in the facial skin during the procedure was measured using a visual analog scale (VAS) score. The VAS scores were 3, 2, and 3 during the procedure. The VAS scores after the procedure were 2, 2, and 2 on Day 1 and 0, 0, and 0 on Days 7 and 4, respectively. During treatment, two patients experienced minor bleeding, and one experienced moderate bleeding. The visible pores in the photographs were examined after 30 days of treatment. The pore was graded by two of the patients' dermatologists as "severe" to "mild" and one as "mild" to "almost clear". According to the selfquestionnaire responses, of the three patients, two were very satisfied, and one was satisfied (Figures 3-5). Furthermore, no patient reported persistent pain, folliculitis, erythema, edema, hyperpigmentation, or hypopigmentation.

| DISCUSS ION
Although enlarged pores are not medical problems, they are cosmetic concerns for many people. The three major clinical causes of enlarged facial pores are high sebum excretion, decreased elasticity around the pores, and increased hair follicle volume. In addition,  An increased sebum secretion level rather than sex or age is the most significant factor causing enlarged pores. 12 Excessive sebum excretion has been identified as one of the most important etiological factors of acne vulgaris, and patients with acne tend to have enlarged facial pores. 13 Previous studies have reported that fractional lasers have good clinical efficacy in treating acne scars and large facial pores; however, these lasers can indirectly cause epidermal damage, such as burns, and adjustments to the depth of radiofrequency thermal zones are imprecise. 14,15 These limitations are expected to be overcome by the newly introduced microcoring device. 6,16 Microcoring was used in the first study on pigs. The aim was to tighten the skin and mechanical skin removal using a coring needle effectively accomplished this goal. 5,17 The treated area was reduced by 9% after 10% of the skin was removed via microcoring. 5 At microcoring sites, histological examination revealed increased fibroblast activity and collagen. 17 An enzyme-linked immunosorbent assay revealed an 89% increase in collagen levels 3 months after treatment. 17 Pozner et al. performed the same skin tightening examination in humans, concluding that it is safe and well tolerated with its effect on skin rejuvenation. Early findings were observed, such as skin tightening and increased skin thickness. 16 In a previous study, Dayan used a microcoring system to correct skin laxity on the submental fat pad and neck rejuvenation in 31 patients. Most patients had ≥1-grade improvement in investigatorevaluated skin laxity and lipodystrophy; 84% were satisfied with their neck and jawline appearance, and 97% were likely to recommend the procedure. 6 The study of Pozner et al. described three clinical trials that analyzed the safety of using microcoring treatment on abdominal and facial skin, both short-and long-term. The results showed that the treatment resulted in scarless skin removal and was well-tolerated by patients. Healing was quick, with minimal side effects. Long-term effects included skin tightening and an increase in skin thickness. The authors concluded that MCT treatment is safe and well-tolerated, and while further studies on efficacy are needed, the initial findings are promising for skin rejuvenation. 16 In their study, Gfrerer et al. investigated the safety and efficacy of using a dermal microcoring device for treating facial wrinkles in 51 subjects. The researchers measured the treatment outcomes using the Lemperle Wrinkle Severity Scale and the Global Aesthetic Improvement Scale (GAIS). The study showed a mean change of 1.3 grades in the Lemperle Wrinkle Severity Scale, and 89.7% of treated sites demonstrated improvement in the GAIS. Based on these findings, the authors concluded that microcoring treatment is a safe and effective method for treating moderate to severe facial wrinkles, resulting in high patient satisfaction and a quick recovery time. 18 Our study marks the first application of microcoring technology as a primary treatment option to address pores. Three patients were subjected to a single treatment of rotational fractional resection using rotating scalpels to resect skin pores in the cheek region. All three patients experienced improvement in enlarged pores and did not experience severe skin-related adverse effects. After a 30-day follow-up, all three patients expressed satisfaction with the treatment outcomes. The main limitation of this study is its small sample size, which limits the generalizability of the findings to a larger population. The study also lacks a control group, making it difficult to determine the effectiveness of the treatment compared to other existing treatments. The follow-up period was short (30 days), which F I G U R E 5 Shows a 32-year-old woman with an enlarged cheek pore before (A) and after 4 weeks of treatment (B) The patient reported no side effects with satisfying results.
is not enough to determine the long-term effects of the treatment.
The study only evaluated the treatment's efficacy in treating pores in the cheek region, which limits the generalizability of the findings to other areas of the face or body. Future studies should aim to expand the treatment areas and increase the sample size to improve the generalizability of the findings.
In the field of skin tightening, microcoring is a relatively new concept. The system removes the skin with hollow needles avoiding scar tissue formation. This is the first article to deal with enlarged pores

ACK N OWLED G M ENTS
This study was conducted in compliance with the principles set forth in the Declaration of Helsinki. Consent was received from the families of the deceased patients before beginning the dissections. The authors sincerely thank those who donated their bodies to science so that anatomical research could be performed. Results from such research can potentially increase mankind's overall knowledge that can then improve patient care. Therefore, these donors and their families deserve our highest gratitude.

CO N FLI C T O F I NTE R E S T S TATE M E NT
I acknowledge that I have considered the conflict of interest statement included in the "Author Guidelines." I hereby certify that, to the best of my knowledge, that no aspect of my current personal or professional situation might reasonably be expected to significantly affect my views on the subject I am presenting.

E TH I C S S TATEM ENT
The study was conducted in accordance with the Declaration of Helsinki. Written informed consents were obtained from all participants.

DATA AVA I L A B I L I T Y S TAT E M E N T
The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.