Artefill - how can I avoid having my injection "migrate?"

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!!!