Artefill is the only FDA approved permanent filler that is on the market today that is a non-re-absorbable injectable. The FDA approved this filler in November 2006; however Artefill (Artecoll) has been in use since the late 1980’s, longer than most other cosmetic fillers on the market. While some doctor’s praise the product for its long lasting results (which may still be apparent five years after the treatment), others are wary of injections that are just that – permanent. Artefill is made up of Polymethylmethacrylate (PMMA) microspheres suspended in 3.5% denatured bovine collagen with 0.3% lidocaine. The lidocaine is added to help reduce the discomfort that is associated with this injection. Polymethylmethacrylate (PMMA) is a synthetic polymer that has been used with great success in medical implants, such as bone cement, dentures, and pacemaker covers. In the use of a dermal filler, it is being used under the brand of ArteFill or Artecoll in Europe.

The portion of the injection that has the bovine collagen - is used primarily to provide a smooth suspension and aid in skin matrix integration. After the injection of Artefill, the bovine collagen degrades and dissipates over a period of few weeks. During this time, the PMMA gets encapsulated in the patient’s own collagen which is the body’s natural response to a foreign material and collagen. Artefill has a very high desirable result with a low risk of filler migration. There have been cases of the injection area becoming hard or bumpy, which in fact might be excessive scar tissue formation. If this does happen, an injection of a steroid may help.

The biggest concern is that the face continues to change with time, but permanent injectables like Artefill remain where they were injected, which may not complement the face’s appearance as it ages. Other problems like lumps (like granulomas) which can occur years after injection of any permanent material, and would require surgical excision. Some of these problems are not correctable. However, recent studies show that patients look better five years after treatment than they did six months afterward.

What it is:  Synthetic Microspheres suspended in a collagen gel

Pros:  Longest lasting results – permanent

Cons:  If you are not happy with the outcome, results last upward of five years

How long it lasts:  Up to five years or more

Some of the disadvantages of Artefill include the following:

Lip augmentation using a fat transfer is an outpatient surgical procedure that involves removing fat from one are on the body to the lips. The fat is harvested using the procedure of liposuction on one area of the body (usually the buttocks, abdomen, hips, inner knee or the saddle bags) and then is carefully prepared for injection into the lips. The fat is removed using a small cannula that has limited suction in order not to damage the fat cells. Most surgeons will then spin the fat in a centrifuge to remove the excess fluids and the damaged fat cells. Only the whole undamaged fat cells are injected. Once the fat is prepared it is injected into the lip area using a blunt needle or a syringe. Incisions are made less than 0.2 centimeters in diameter in the corner of the mouth, and normally the fat is delivered in “Micro-droplet Technique”. Another method of fat grafting to the lips involves tiny incisions that are made inside each corner of the mouth, and a tunnel is created under the skin of the lips and then the fat is injected this way.

Although some physicians believe that fat grafting is permanent, it really does depend on the patient and their own absorption rate. Fat grafting is highly technique dependent, and most physicians will have an average re-absorption rate of approximately 50%. To counter what the patient might lose during recovery and the body absorbing some of the fat, most physicians will overfill the area to compensate for this occurring. Physicians who are specialized in fat grafting tend to have a lower absorption rate due to their technique. Fat grafting tends to last longer in the areas of the face that has less movement and also if the area being treated is around muscle and a good blood supply.

Fat grafting is performed on an outpatient basis and normally takes approximately an hour and a half. The results from lip augmentation with fat transfer can last from six months to several years and can range in price from $2,000 - $4,500.

                                                Fat Grafting Instruments

The advantages of fat grafting to the lips or face is that you are using your own tissue, so there is no chance of an allergic reaction occurring. The downside of fat grafting is that it requires another procedure to harvest the fat, which is more invasive than injections alone. The procedure can be time consuming for the patient with the recovery period post procedure. It also can be more costly because of procedure and time it takes to harvest the fat. The less movement the treated area gets, the more fat cells survive. There are forewarnings and uncertainties too with this procedure. The biggest problem is that only a percentage of the injected fat takes hold in the treated area. Additionally, this percentage may vary widely: from about 10% to 50% depending on a variety of factors. Many surgeons have their favorite harvesting and injection techniques and claim higher than average clinical longevity of the grafts.

The Cosmetic Dermatologic Surgery, Darmstadt, Germany reviewed the effectiveness of fat injections in an article published in Dermatologic Surgery Journal. They concluded that:

Swelling is expected after the fat graft and is dependent on the physician’s technique and the patient’s tolerability. Swelling can last from two to several weeks after the procedure. Bruising may be apparent and possible scarring of the fat donor site.

As with any surgical procedure, there are drawbacks to lip augmentation fat transfer surgery. Part of the fat that is injected into the lips is subject to necrosis (tissue death) as a result of the procedure. Also, excess scar tissue can form inside the lips from having this procedure done.

A similar product, Silskin by Richard-James, Inc. (Peabody, Mass.), received an Investigational Device Exemption for a clinical trial on facial wrinkles in 2003. Both products are used off-label as permanent facial fillers.

Silikon 1000 is used commonly for soft tissue defects or facial augmentation including lips, lines, cheeks, under the eye area, and for HIV associated facial wasting. This product provides a very natural looking permanent solution for patients today. The composition of Silikon 1000 comes ready for injection as sterile, clear, colorless silicone oil. The formulation is supplied and packaged by Alcon in 8.5mL each. No skin test is required with this filler and there is no downtime.

Silikon 1000 is best injected with utilizing a “Micro-droplet Technique” and normally the injections are spaced out within six to eight week interval so that the patient’s own collagen will form a capsule around the silicone bead to encapsulate it, by stimulating skin cells (known as fibroblasts) to produce new collagen around each micro-droplet. Once a micro-droplet is surrounded, collagen production stops. Through repeated injections over several months the combination of silicone micro-droplets and new collagen gradually fills depressions by building soft-tissue by encouraging the production of new collagen, the skin’s natural structural protein.

With the silicone bead becoming encapsulated by the patient’s own collagen, it helps secure the product from not migrating. Micro-droplet technique entails the injection of several small drops of sterile Silikon 1000 into numerous points within a desired site. Once injected, the liquid silicone remains chemically unchanged and is consequently enclosed by the collagen capsule produced by the patient’s own skin. Micro-droplet technique minimizes the occurrence of overcorrection and migration of the silicone that has frequently been seen with other injection techniques that involves a large volume. The micro-droplet technique of silicone provides a safe, slowly progressive, and very natural appearing result in all areas of potential treatment.

Several treatments might be needed in order to get the desired results, as with less material injected (from .4 to .6 cc) seems to yield fewer complications than larger amounts injected over time. The results are permanent, so it is better to go slow with Silikon 1000 over time with multiple treatments so that the physician can manage the results better. The results are lasting and also instantaneous.

Silicone is often a less painful treatment than other dermal fillers and patients usually resume their daily activity, without restrictions, immediately. Like other lip enhancement treatments, a topical, local, or a nerve block is offered for comfort and may involve some post-treatment swelling and numbness. These minimal post treatment symptoms subside within an hour.