Artefill - what are the risks and alternatives?
I heard a doctor on TV say that Artefill was risky, but my friend had it injected and it looks really good. Is Artefill safe? Does anything last as long, like maybe silicone?
Answers (2)
Artifill has inherent disadvantages
Artifill uses PMMA (plastic) beads, materials which are non-biologic and have no natural defenses against infection. If bacteria form around the beads, the body has no defense against them (i.e. no blood vessels of its own to carry white blood cells or antibiotics) as the bacteria multiply on the foreign object. The body will often try to encapsulate the involved area with scar tissue, calcium deposits and inflammatory tissue as white blood cells degranulate, or discharge their acid sack contents in an attempt to kill the bacteria. This creates an inflammatory lump that is often palpable below the skin surface. Occasionally the lump becomes infected and red. This process can take months to years to occur. The beads and inflammatory reaction can move over time as the dynamic process of the inflammatory response of the body acts on the bead complex.
We have found in our practice the best way to treat the problem is to surgically remove the lumps, usually with small incisions hidden if possible in natural creases or anatomic borders.
Autologous tissue from the patient's own tissues such as LiveFill (fascial fat grafts), all alive when they are placed, are a more permanent, more durable method of augmenting soft tissue in the face. LiveFill grafts have the disadvantage of not being universally available and of being more expensive than injected fillers, and requiring an outpatient surgical procedure to place.
If patients are interested in temporary fillers, current hyaluronic acid (HA) fillers last approximately 6 months (Juvederm, Restylane), and are therefore less durable than Artefill. However HA fillers offer much greater biocompatability, and tend to go away over time. If the results are undesireable, they eventually go away. This is not the case with Artecoll, Artefill or silicone, where bad effects of the injection are often permanent.
There are many patients who have had Artecoll and Artefill injections with no problems and have appreciated the long lasting results. However I have difficulty balancing the risks or a permanent or semipermanent filler with the benefits of longer duration of action. I would agree with the statement that they are risky, for the reasons above.
Artefill permanence is a pro and con
I have not personally injected ArteFill® but am told the advantages include more volume and research documents longer lasting results than other presently FDA-approved dermal fillers. Silicone in not FDA approved as a dermal filler, nor is it recommended.
Longer-lasting fillers like ArteFill, (approved to treat the nasolabial folds or lines from the nose to the outer corners of the mouth) offer some advantage: The duration of results means that you do not have to inject regularly.
However, because of the longer duration, many doctors approach correction conservatively, and it may require re-injection to achieve the desired shape and volume replacement.
A disadvantage is that it is difficult to remove the filler or correct enhancement in the event the patient does not like the effect or has complications including granuloma formation (small bumps that can be felt under the skin). Complication is generally more likely with off-label use, and so the risks associated with off label uses should be thoroughly discussed with a qualified doctor before treatment.



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