CosmeticSurgery.com Staff Report
CONSUMER BRIEF: Injectable facial fillers have become a huge hit with busy consumers who want quick results. Injectable fillers allow the patients to leave the surgeons' offices immediately after treatment and resume their normal activities. If European reports are to be believed, the newest facial filler, ArteFill, promises to be another quick procedure -- but the first one that may be permanent.
Injectable facial fillers, often referred to as "a facelift in a needle," -- are tremendously popular because the various fillers provide temporary relief of facial aging by plumping up the face, filling in folds in the skin and smoothing wrinkles.
In the constant struggle against Father Time, consumers in vast numbers are choosing injectable fillers like Restylane and now, ArteFill, which:
- Are relatively inexpensive (compared to surgery)
- Provide immediate results
- Involve none of the dreaded "down time" for recovery and healing
According to the American Society for Aesthetic Plastic Surgery (ASAPS,) injectable wrinkle fillers were among the top 10 in surgical and non-surgical cosmetic procedures delivered in 2005, which is a 35 percent increase over the previous year. That means about 1.5 million Americans had some type of dermal filler last year. The injectables are so much in demand because as we age, the body's ability to produce collagen -- a natural component of skin that keeps a face smooth and wrinkle free -- gradually declines.
The latest injectable filler, ArteFill, received FDA approval in November 2006. The big news is that ArteFill may remain in patients' faces as long as 10 years, without a touch-up.
According to the manufacturer, Artes Medical Inc. in San Diego, skin tests and packages of the product were being distributed to physicians during January and February of 2007 and should be widely available by March 2007.
Cosmetic Plastic Surgery
To provide a first look at ArteFill, CosmeticSurgery.com interviewed several physicians who have used ArteFill and its cosmetic sibling Artecoll for many years.
French physician Nelly Gauthier, M.D., has specialized in cosmetic rejuvenation of the face and areas around the mouth for 13 years. Douglas Hamilton, M.D., a Los Angeles dermatologist, is one of 12 American physicians authorized to study both Artecoll and ArteFill and their effects on human patients for the FDA. Dr. Hamilton started an ArteFill study in 1998 which concluded in 2000; he then performed a follow-up study on his subjects in 2005. He says he has probably performed more ArteFill and Artecoll injections than any other physician in the United States, and is currently on Artes Medical medical advisory board.
"There is very little difference between Artecoll and ArteFill," says Dr. Hamilton. "Basically, the bovine component of the filler and one other substance in ArteFill are now supplied from the United States, and not Europe."
Facial Cosmetic Surgery
Dr. Gauthier has used Artecoll in her Paris practice for facial rejuvenations since 1993. The best news: Some of her patients report their injections have lasted 10 years or longer.
However, the other currently available fillers -- Restylane, Captique, collagen and most others -- only last for a few months, after which the patient must have another injection.
But, of course, like everything else in life, there are a few downsides to ArteFill that careful patients may want to consider.
"ArteFill is a permanent soft tissue filler," says Dr. Gauthier. "It has mostly been used in Europe to fill the nasolabial fold, that thick crease of skin running from the outer edges of the nose to the corners of the mouth. I have also used it to treat the 'lipstick' line wrinkles around the mouth, on the chin, and the glabella, the area between the eyebrows that shows frowning."
Current injectable fillers like Restylane can be frustrating because some areas -- like that nasolabial fold -- are always in motion, thanks to:
- Eating and swallowing
All that activity means the substance is being worn away and must be replaced to maintain a more youthful appearance. Even the most popular current long-lasting fillers are absorbed by the body after about six months.
In the United States, ArteFill is officially approved for use in the nasolabial folds. However, according to Dr. Hamilton, plastic and cosmetic surgeons may also use their best clinical judgment for off-label uses, including:
- Treatment of other deep wrinkles
- Depressions under the eyes
- Depressed acne scars
"ArteFill and Artecoll can permanently eliminate unsightly lines and wrinkles, leaving the skin looking younger, radiant and revitalized," says Dr. Hamilton. "Plus, the effects look extremely natural."
A topical anesthetic is first spread on the treatment area. The site shows immediate improvement when treating depressed scars which are raised to the normal level of skin. After treatment, some patients may feel a little mild stinging for a day or two afterwards.
Once you know the filler is permanent -- and would require surgical removal if you decided you didn't like it -- the next most important thing to know is the skill level of the doctor doing the injections, according to Dr. Gauthier.
"ArteFill and Artecoll are both verboten in thin skin," says Dr. Gauthier. "That leaves the skin around the eyes and on the neck off limits.
"Under thin skin, ArteFill would be seen as a whitish conspicuous thread," she says. "So it is not used to fill an area of too much sagging skin because the amount of filler required to plump up the area would instead create a permanent heaviness."
European research shows about two-thirds of patients required only one treatment session. Another 25 percent needed two appointments while 10 percent of patients required three injections. Only one percent needed four injections. Because ArteFill and Artecoll work under your skin to produce more collagen long after the injection, appointments with the doctor are usually scheduled three months apart.
Experts say 20 percent of ArteFill is PMMA, a material also used to make Plexiglas but also safely used in medicine for the last half century. The PMMA in ArteFill consists of highly polished -- but very tiny -- microspheres mixed with 80 percent purified bovine collagen. A small amount of lidocaine, a painkiller, is also included.
Artes Medical says the substance is the only dual-acting, injectable wrinkle filler. After being injected, it first corrects wrinkles. Then, as collagen grows, the microspheres provide long-term support so the skin can stay wrinkle-free, longer. So ArteFill's long life is due to the microspheres that remain suspended in the skin.
In FDA studies, some side effects have been noted, like a few patients who developed lumps and bumps where the filler is injected. Those conditions are treated with steroids or by removing the lumps. ArteFill is not intended for patients who have a hypersensitivity to lidocaine, people with bovine allergies or susceptibility to keloid scarring.
Acne Treatment for Scars
According to an expert panel commissioned by the American Society for Dermatologic Surgery (ASDS,) ArteFill may also be used to treat defects left in the skin after corrective nose shaping surgery and to fill in acne and chicken pox scars.
Artes Medical says the cowhides used to make the collagen in ArteFill come from specially controlled, isolated and monitored herds so there should be no risk of passing on the so-called "mad cow" disease.
"A few treatments of ArteFill at four week intervals may be necessary to gradually and safely get the desired correction," says ASDS President Gary D. Monheit, M.D., a dermasurgeon in Birmingham, Alabama.
But surgeons constantly remind their patients that the idea is not to move the clock back twenty years -- plastic surgeons only want to help create the best possible version of you.
Because a nice-looking face, they say, is always a handy letter of recommendation.