Monday, March 17, 2008

Artefill and FUD?

One of my favorite products for minimally-invasive, in-office cosmetic procedures is an injectable filler called Artefill. It's a product used for the correction of deep facial folds, such as smile lines, and for contouring other areas of the nose and face as well. It's chief advantage is that it is permanent. So I was surprised to find that a few of my colleagues across the country have been suggesting that Artefill is a not such a good product.

I couldn't disagree more. Now, reasonable physicians will disagree about treatments and techniques from time to time. Our regional and national meetings are filled with such debates and discussions. The problem here, however, is the way in which Artefill is often being attacked—through "FUD."

"FUD" is a marketing term that stands for "Fear, Uncertainty, and Doubt." It's a technique used to attack a competing product or service, often when there is no real basis for the attack. So lets address the most common claims head on:


Claim 1: "This product is too new to know what it's long-term safety is."

Answer: Although Artefill is new to the United States, its sister product, Artecoll, has been used in Canada since 1998 (nearly ten years ago) in thousands of patients. I, myself, first treated patients with Artecoll in 1999 during my fellowship training in my home town of Toronto and have been very pleased with its performance. And Artecoll's predecessor, Arteplast, was used in Eupore earlier still. And PMMA (poly-methyl-methacrylate), the chief component of Artefill, has been used in other applications in humans for decades. This is not to say that it has no risks. Local complications of nodule formation and other skin reactions are known risks and are somewhat technique dependent.

But the broader point is that new products, techniques, and technology are constantly being introduced and refined. That doesn't mean that I jump willy-nilly on every new thing that comes down the pike (far from it), but do we really want to practice medicine the way it was done decades ago? Plus, long-term data from the Canadian experience with Artecoll has been published in peer-reviewed medical journals reviewing just such risks of complications.1 Similar data exists for the U.S. experience during Artefill's FDA-approval process.

Claim 2: "It's permanent. I'd have to always worry about the long-term changes to my patients' faces."

Answer: Of course! But as a facial plastic surgeon I routinely have to take that into consideration. Whenever my colleagues or I perform surgery (e.g., a rhinoplasty, an eyelid lift, or an otoplasty) we are creating permanent changes that have to take into account long-term changes. This is why it's serious stuff and why I harp on having the right training to do these cosmetic procedures.

Now, the cynical side of me has another theory about why some practitioners are opposed to using something permanent on their patients. Permanent products don't require continual re-application (or continual payments to the doctor). I sometimes wonder if those patients are simply seen as an annuity that will keep paying dividends year after year!

Dr. Arnold Klein, for example, a dermatologist in Beverly Hills, has asserted that Artefill will "destroy" the soft-tissue augmentation field. But consider that Dr. Klein has been paid for years to consult for Allergan and Medicis, makers of the competing and non-permanent products of Juvederm and Restylane, respectively. [FYI, Juvederm and Restylane are also excellent products, and I use them in areas of the face that are not as well suited for Artefill, such as lip augmentation and fine wrinkle correction]. And in case you're wondering, no, I do not have any relationship with any of these companies.

Claim 3: "There's too much guesswork in the volume of Artefill needed."

Answer: This claim, I think, simply comes from ignorance of the proper technique for this product. Artefill is not placed the same way as other fillers. Full correction with Artefill is achieved gradually over two or three (maybe more) sessions separated at least two months apart. I counsel patients that perfection lives at the edge of a cliff. We want to ease toward that goal, not rush toward it where we might overshoot it. I purposely under-correct facial folds with Artefill since it's easy enough to add more, but difficult to take it away.


In summary, Artefill is just another tool in our armamentarium for the correction of facial folds and other contour problems of the face. It is not for everyone. And like all procedures in facial plastic surgery, there is risk involved. To put it in perspective, I would put Artefill below surgery in terms of risk, yet above other temporary fillers like Radiesse, Restylane, and Juvederm.

Hopefully this information will be helpful to you as you consider your choices with injectable fillers and other cosmetic procedures.

1Bagal A, Dahiya R, Tsai V, Adamson PA. Clinical experience with polymethylmethacrylate microspheres (Artecoll) for soft-tissue augmentation: a retrospective review. Arch Facial Plast Surg. 2007 Jul-Aug;9(4):275-80.

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