How to Avoid Having Artefill Migrate?

It appears that Artes Medical, makers of Artefill is going bankrupt. As of today, the stock is trading at 7 cents. Bioform, makers of Radiesse, is now trading for about $1.11 on the stock exchange and going down quickly, not a good sign for the longevity of either of the products.
While this may render questions of Artefill and soon Radiesse moot, there are many existing "permanent" fillers out there, and more emerging.
It is my strong belief, and the belief of other very reputable clinicians with solid University affiliations, that permanent fillers should not ever be used in the face. I stand by that contention, and continue to offer my patients hyaluronic acid products, which are long lasting but temporary.
I will continue to treat the granulomas and deformities from patients who had the substance injected, just as I treat patients with deformities from silicone injections. I stand by my belief that permanent fillers are never indicated for injection into the face.

Complications with Artefill are difficult, but sometimes possible to correct. Migration of fillers occurs in some cases. Raffy Karamanoukian Los Angeles

I'm amazed at the misinformation included in some of the other comments. I am not aware of a single peer-reviewed study showing that Artefill migrates, despite my colleague's contention that it does. There is a study in the literature specifically looking at migration of microsphere fillers, but it did not find migration to occur in the range of particle sized used in Radiesse and Artefill.
For reference, the study is: "Migration studies and histology of injectable microspheres of different sizes in mice." Plast Reconstr Surg. 2004 Apr 15;113(5):1380-90. I would challenge my colleagues to show some good science (not speculation) that indicates migration with Artefill.
Likewise, although biofilm formation is an interesting area of concern with any long-lasting filler, there are again no studies demonstrating biofilm formation around the microparticle fillers such as Radiesse and Artefill. Is this possible? Maybe. And if it is, what's the incidence? Also, it appears that Dr. Klein does not understand what a biofilm is. It is not where "the body creates a protective wall around the implant, known as a biofilm." Rather, biofilms are created by the colony of microorganisms to protect the microorganisms. I'll agree, though, that they can be a serious issue for both biologic and non-biologic implants.
No filler is without risk, including serious risk, but science, not fear-mongering should guide our discussion and decision-making with patients.
--DCP

A syringe of Artefill consists of a very small amount of
plastic like beads called PMMA. This
material has been used for decades in orthopedics and other specialties as a
bone cement and a large volume filler.
The PMMA in a syringe of Artefill makes up about 0.01 cc and the rest of
the syringe is filled with collagen.
Collagen was the first filler for wrinkle correction on the market and
it lasts about 3 months before it is gets absorbed, usually by about 6
months). As the collagen is absorbed you
make your tissue around the fine PMMA beads and replace the collagen. Therefore,
Artefill is like a fat transfer in that it makes you generate your own tissue.



Neither collagen nor the small amount of PMMA dust has ever
been seen to migrate. Artefill is a
wonderful filler that makes a natural fill of your own tissue. Many people do not understand that it takes
about 6 months for the final result to be seen with Artefill. In the mean time you may feel bumps from the
collagen or scar from the trauma of the injection. You may even see some discoloration in the
area of the injection from bruising or blood staining again from the injection
but this too will resolve.



Artefill may be the perfect filler as it is natural and
will last at least 5 years. The new 5
year study should be out soon. I believe
that you will see and hear a lot more really good things about this product. I hope that helps.Best regards

I'm glad you asked this very important question. Stay with me here, I am going to give you a long but very important answer.
First, I'm sorry to tell you that you cannot prevent Artefill from migrating or moving to areas outside the targeted or desired treatment area. There are several important reasons for this.

One of the reasons this happens is due to the permancence of the product.

As we age, we lose volume and elasticity in our skin, and as anyone who has experienced the slightest signs of aging knows, gravity is not our friend as we get older. We will all experience this natural sign of aging. Thankfully, there are things we can do to minimize these and improve them, but it is logical that when you place something into the face at age 30, this implant will not be in the same exact location at age 50. As the face ages and the tissues lose volume and elasticity, the implant does not.

Another reason for the shifting or migration is that the face has many muscles, which move thousands of times each day.

This is what causes what are referred to as dynamic wrinkles, or wrinkles caused by repeated motion. As these muscles move, they can displace or move the filler product that has been injected, in your case Artefill. When you take into account that permanent fillers such as Artefill are non-biologic, meaning that they are artificially made and do not occur naturally in the body, so our bodies see them as foreign invaders and create an immume response which tries to eliminate them.
The manufacturer of Artefill has indicated that they changed the PMMA (Plexiglas) bead size in Artefill, hoping this would help to reduce migration, but recent studies have shown that the bead size and shape once injected changes, so this would appear to make migration occur more easily!

Furthermore, bacteria can form around the implant whereby the body creates a protective wall around the implant, known as a biofilm.

This can occur as a very low-grade reaction, which is not necessarily visable (although it can be), but over time, this can become much more dramatic, creating lumps, or granulomas, which can become painful, red, swollen and fluid filled. With Artefill/Artecoll, these reactions have been reported in the medical literature as long as 12 years after the product was implanted!
Some physicians have reported limited success using steroids injected into these lumps, but ultimately it has been my experience that more often than not surgical excision is the only way to get rid of the implant, and even with surgery it is almost impossible to remove all of the Artefill.

This is one of the reasons that I do not advocate the use of permanent fillers in the skin. Permanent fillers cause permanent problems.

I feel very strongly that you should only use biologic substances in the skin and that they should be temporary. We have many good biologic substances such as the hyalruonic acids Restylane or Juvederm or bovine collagen such as cosmoderm or cosmoplast or Zyderm or Zyplast, all of which, when used by properly trained and experiened doctors, give a very good and natural result.
Is it worth the risk with permanent fillers, just to get something that lasts longer? I hope you will agree after reading this that it is not!!!