Artefill - what are the risks and alternatives?

Artefill is a good product but there are some long term problems such as granulomas which can be very difficult to treat. Of note, the company which makes Artefill filed for Chapter 7 bankruptcy at the end of 2008.

There are other permanent options including silicone, but some fat from the belly or thighs can be used in places that would be otherwise amenable to Artefill or other permanent fillers.

I have seen draining granulomas develop in patients 8 years after their ArteFill was injected who had no problems in between. This is very alarming and difficult to treat. Avoid all permament fillers!

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.