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Figure 3: (Ai) ArteFill® composed of 20% PMMA microsphere (30-50 μm) and 80% denatured bovine collagen; (Aii) tissue growth stimulated due to
collagen maintaining the viscosity of microspheres; (Aiii) the presence of blood vessels is observed and bovine collagen has been replaced with autologous
connective tissue; (Bi) histological image of ArteFill® at month 3: capillaries are present in the implant and have been integrated into the patient’s
body (×40); (Bii) histological image taken 10 years after implantation of Artecoll®: connective tissues are mature, characterized by active fibroblasts,
microsphere encapsulation, ingrown capillaries, and an absence of immune reaction (×40). Image modified with permission. [35]
The formulation was later improved with the restriction of superior improvement in nasolabial folds when compared to
microsphere size to 30-50 μm to avoid phagocytosis, which collagen and also had fewer adverse effects, although these
in turn decreased the rate of granuloma formation. [36-38] differences were not statistically significant. In another study
Either bovine collagen (Artecoll® or Artefill®; Artes Medical, in which 950 patients were surveyed about their experience
San Diego, CA, USA) or HA (Dermalive®; Dermatech, Paris, with Artecoll® for the long lasting correction of wrinkles,
France) can be used to suspend PMMA microspheres in order 515 surveys were returned. 29% of the respondents felt that
to facilitate the deposition of collagen in the surrounding the treatment was very good, 38% felt that it was good, 23%
region. It is important to note that unlike other injectable found it satisfactory, and 8% reported no difference. 91% of
fillers, Artefill® stimulates the patient’s own collagen while the respondents indicated their willingness to repeat the
keeping the microspheres well-dispersed secondary to their treatment. Carvalho Costa et al. carried out a study in
[41]
[40]
viscosity [Figure 3A]. When the collagen is resorbed, which PMMA injections were administered to 266 patients
[35]
the microspheres persist and become encapsulated by (154 women, age: 17-72 years), with each patient receiving
[35]
connective tissue, resulting in a bulking effect. As from 1-4 injections over an interval of 40 to 60 days. The
demonstrated in Figure 3B, fibroblasts and collagen fibers average number of sessions required was four, with 8 mL of
have completely enveloped the PMMA microspheres three PMMA used per session. While 90% of the patients reported
months following injection with Artefill® [Figure 3B]. satisfactory results while the remaining 10% reported mild
[35]
Allergy testing is required prior to use since the collagen improvements, 20% of the patients experienced temporary
contained in the product is of bovine origin. adverse effects including swelling, bruising and erythema
with no late complications.
[41]
[39]
Cohen and Holmes compared 123 patients treated with
bovine collagen with 128 patients treated with Artecoll® Overall, PMMA-based fillers are inexpensive, readily accessible
for the treatment of 1,334 wrinkles (nasolabial folds, radial and simple to use. Although immediate adverse reactions have
upper lip lines, glabella lines, and corner of mouth lines). One been reported in many of the studies, these primarily consist
month after injection, only glabellar lines showed noticeable of lumps or nodules which may appear immediately following
improvement, and collagen achieved better results. By month injection and in some cases several years later.
3, the nasolabial folds and corner of the mouth lines treated
with Artecoll® also showed significant improvements. Six Poly-L-lactic acid
months following injection, Artecoll® demonstrated a As a biodegradable thermoplastic polymer, PLA is extracted
78 Plast Aesthet Res || Vol 3 || Mar 23, 2016