CUSTOM DERMATOLOGY SEARCH:
Artecoll®. – an injectable micro-implant for longlasting soft tissue augmentation
Our demand for a “filler” that can be injected easily, and which is biologically inert and permanent, has been a major target. Artecoll® is a novel formulation of polymethylmethacrylate (PMMA) microspheres suspended in bovine collagen which would appear to provide such an advance, in terms of permanency.
Mode of action
Artecoll® exploits the body’s natural disposition to encapsulate foreign bodies with connective tissue. The size of the microspheres hinders macrophagal phagocytosis, or dislocation within the connective tissue. In the first weeks following subdermal injection, the microspheres of PMMA are individually enclosed in connective tissue, as is the case with implants such as cardiac pacemakers. The amount of connective tissue generated often corresponds to the quantity of injected collagen previously suspending the PMMA spheres. The collagen vehicle will be degraded by the body within 1–3 months. The microspheres are expected to remain reaction-free and in place for the rest of the patients life.3 During injection, large deposits of Artecoll® should be avoided to minimize any possibility of granuloma formation.
The main indication for Artecoll® implantation is the naturally occurring folds and wrinkles in the face. The ideal patient is between 40 and 50 years old, when the excess of skin does not yet justify a facelift. Artecoll® is not an alternative to a facelift but rather is an adjunct to it. Conversely, it does not interfere with later facelifting.
Dermatologic Indications for Artecoll® Implantation4
INSERT TABLE, IMAGE
Contraindications are a known allergy to collagen or lidocaine, and prospective patients should undergo a test implantation of Artecoll®. Thin and flaccid skin, susceptibility to keloids, and atrophic skin diseases are other contraindications. Do not use Artecoll® for atrophy or defects in subcutaneous fat, or rubberlike nodules might result and be felt for the rest of the patient’s life.4
Directions for use3
A degree of expertise is required for successful use of Artecoll®. It is essential that the operator be given proper instruction, ensuring subdermal placement and the best possible cosmetic result.
Cost of Therapy
The volume required depends on the extent and number of wrinkles, but 1 ml is sufficient for most uses.4 The cost to the patient depends on the overall treatment and services provided by the physician.
Although Zyplast® is cheaper than Artecoll® initially, after one year’s treatment, because Artecoll® lasts longer, the costs become more equivalent.
Dr. Alastair Carruthers.1
In studies to date, the effects of Artecoll® are long-lasting, being still visible after 3, 4 or more years of follow-up. In two studies, ninety per cent of patients surveyed anonymously were pleased or satisfied with the results after as long as three years4, and in one study, 91% of patients would repeat the treatment.5,6
Some local discomfort may occur at the site of injection, along with transient itching which subsides within a matter of weeks. Two reports have been published concerning side effects of PMMA microsphere implants. Dr W.L. Mang of Lindau, Germany has written a critical review7, but the lack of specific details makes this report difficult to assess. The second publication by McClelland and others8, suggests that Artecoll® has the potential to elicit an immune response in humans, and that the microspheres of PMMA are susceptible to phagocytosis and elimination. Prior to 1994, Arteplast® was the PMMA microsphere product trialled. In this product, the microspheres were not uniform in size and not free of irregular particles, and injection was intradermal in some cases. With Artecoll®, the PMMA spheres are uniform in size and free of fragments, injection is sub-dermal rather than intradermal and side effects are much reduced.
When used for the proper indications, and when injected at the proper subdermal level, Artecoll® implantation provides cosmetically acceptable results for as long as four to five years. As a precaution against collagen sensitivity, an intradermal challenge should be performed. Prior instruction is advised in order to acquire a satisfactory technique.
In this issue:
All content ©2004-2017 SkinTherapyLetter® |
Last modified: Friday, 11-Dec-2015 14:45:58 MST