ArteFill® Permanent Injectable for Soft Tissue Augmentation: II. Indications and Applications

Abstract

Patients ask for procedures with long-lasting effects. ArteFill is the first permanent injectable approved in 2006 by the FDA for nasolabial folds. It consists of cleaned microspheres of polymethylmethacrylate (PMMA) suspended in bovine collagen. Over the development period of 20 years most of its side effects have been eliminated to achieve the same safety standard as today’s hyaluronic acid products. A 5-year follow-up study in U.S. clinical trial patients has shown the same wrinkle improvement as seen at 6 months. Long-term follow-up in European Artecoll patients has shown successful wrinkle correction lasting up to 15 years. A wide variety of off-label indications and applications have been developed that help the physician meet the individual needs of his/her patients. Serious complications after ArteFill injections, such as granuloma formation, have not been reported due to the reduction of PMMA microspheres smaller than 20 μm to less than 1% “by the number.” Minor technique-related side effects, however, may occur during the initial learning curve. Patient and physician satisfaction with ArteFill has been shown to be greater than 90%.

Purtscher-Like Retinopathy and Diffuse Alveolar Hemorrhage Caused by Soft Tissue Injection for Gluteal Augmentation

“…At the time of administration, the patient was told she was receiving a variation of polymethylmethacrylate (PMMA) and bovine collagen mixed with an unspecified additional ingredient and labeled as "Venezuelan Artefill" because she could not afford the pure product. Artefill ® (Suneva Medical, San Diego, CA) is a third-generation PMMA product that is FDA approved for the treatment of nasolabial folds, but is often used off-label for other indications [5]. It is important to note that it is unknown if Artefill was used as a component of the treatment, and that neither of these complications have been previously reported with the use of Artefill.…”

Nonanimal Stabilized Hyaluronic Acid for Tissue Augmentation of the Dorsal Hands: A Prospective Study on 38 Patients

“…Resurgence in the treatment of aging hands, in both the aesthetics of the hand and volumetric options for intrinsic aging, is occurring due to (1) patient demand; (2) the current literature on face rejuvenation [1][2][3][4][5], and (3) the creation of dedicated societies like the Multidisciplinary European Group for Aesthetics of the Hand (MEGAHAND). However, most of the therapies have concentrated on keratosis, solar lentigo, solar purpura, and rhytids.…”

“…Its typical effects can last up to 9 months depending on the treated area. Despite the numerous studies evaluating this therapy on the face [1][2][3][4][5], there is still a paucity of studies [14,15] describing its potential on hand rejuvenation. This prospective study was initiated to evaluate the effect of subcutaneous HA injections in aging hands, with special attention paid to complications, patient satisfaction, and outcomes, i.e., clearance of rhytids, veins, bony prominences, and dermal and subcutaneous atrophy.…”

Biocompatibility of Injectable Microspheres

“…Implantation of washed PMMA microspheres of 32-40µm in diameter with reasonable smooth surface [56,57] caused rarely foreign body reactions [57,58] but immediate phagocytosis, encapsulation with fibroblasts and collagen fibers in humans. Three months after implantation of PMMA-microspheres, one can detect in-growing capillaries, which convert the injectable into a "living implant", which bleeds when cut ( Figure 10).…”