ArteFill

by Peter T. Pacik, MD, FACS

Arteplast (Artes Medical, San Diego, Ca) is a permanent facial filler that uses polymethylmethacrylate spheres. There is considerable experience with this, especially in the European literature.

Polymethylmethacrylate was first synthesized in 1902, patented as Plexiglas in 1928 and is used medically as bone cement. Arteplast was first introduced in Europe in 1991. The carrier gel is replaced by collagen which encapsulates each of the spheres, and gives a long lasting result. Arteplast was replaced by Artecoll in 1995, using spheres of a more uniform diameter. The most recent change resulted in an even more uniform product, now labeled as ArteFill, which has been given FDA approval.

Arteplast has a complication rate of 2.5% especially that of foreign body granulomas. Artecoll has a lower complication rate of .01%. Other products exist using these spheres.

A review of complications using polymethylmethacrylate permanent facial fillers manufactured by various companies, appeared in Plastic and Reconstructive Surgery 121: 1811-1819 May 2008. 32 complications were treated by a Brazilian clinic, ranging from tissue death (necrosis) to foreign body reactions. Chronic inflammatory reactions may occur years after the injections.

We have given serious thought to the use of permanent facial fillers and have decided against this approach. We have concerns about delayed reactions, and granulomas, which can be difficult to treat. We also have concerns that as facial aging progresses, there may be continued volume loss elsewhere nearby in the face with the possibility of a permanent unnatural mound from previous injections. In addition, we have spoken to one of the investigators of permanent facial fillers. He noted that after 5 years he began to see a number of complications and has decided to discontinue the use of permanent facial fillers.

We have had excellent success with the temporary facial fillers such as Juvederm Ultra, Juvederm Ultra-Plus, Restylane, Perlane, and Radiesse. Fat grafting is another option. We continue to advocate the use of long-lasting temporary facial fillers and feel that this is in the best interest for our patients.

In December 2008, we were notified that Artefill has filed for bankruptcy.

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The Plastic Surgery Center of Manchester, New Hampshire specializes in cosmetic plastic surgery, including body lifts, breast enlargements, breast lifts, breast reductions, eyelid surgery, ear surgery, facelifts, fat grafting, liposuction, neck and chin surgery, rhinoplasty (nose surgery), surgery after massive weight loss, and tummy tucks. We also offer facial rejuvenation (chemical peels, dermabrasion, Obagi Blue Peels, Glycolic Peels, Microdermabrasion), injectables and facial fillers (BOTOX® Cosmetic, Radiesse®, JUVEDERM™ Injectable Gel, Perlane® and Restylane®) and advanced skin care to patients from all over New England (Maine, Vermont, New Hampshire, Massachusetts). While no responsible practitioner gives guarantees for the work they do on the human body, we can at least reassure you that you will receive the expertise and dedication of over 30 years in practice. Our patients become an important part of our family and we try to get to know each patient individually and customize their treatment to meet their desires.