Five-year safety and efficacy of a novel polymethylmethacrylate aesthetic soft tissue filler for the correction of nasolabial folds.

BACKGROUND: A novel soft tissue filler composed of polymethylmethacrylate (PMMA) microspheres suspended in a collagen gel matrix containing 0.3% lidocaine (ArteFill, Artes Medical, Inc.) was recently approved by the Food and Drug Administration for the correction of nasolabial folds. A randomized, multicenter, controlled pivotal trial performed in the United States established the safety and efficacy of this medical device throughout a 12-month study period. OBJECTIVE: The objective was to substantiate the long-term 5-year safety and efficacy of this novel soft tissue PMMA filler. METHODS AND MATERIALS: Attempts were made to contact all subjects treated with the PMMA filler that were enrolled in the original pivotal study. Safety was assessed by standard adverse event reporting methods. Efficacy was determined using a validated six-point facial fold assessment photometric grading scale using blinded observers' assessment of standardized photographs. RESULTS: Subjects (n=119) demonstrated significant improvement in nasolabial folds comparing baseline (before any treatment) to 5 years after their last treatment (p<.001). Notably, subjects also demonstrated continued improvement between 6 months after their last treatment and Year 5 (p=.002). No serious unanticipated device-related adverse events were reported. CONCLUSION: This PMMA filler is the first soft tissue filler to demonstrate continued improvement and persistence of correction over a 5-year period posttreatment.

ArteFill: a long-lasting injectable wrinkle filler material--summary of the U.S. Food and Drug Administration trials and a progress report on 4- to 5-year outcomes.

ArteFill, the successor product to Artecoll, is an injectable wrinkle filler composed of polymethylmethacrylate microspheres and bovine collagen, which offers long-lasting and probably permanent augmentation of wrinkles and skin contour deformities. The pivotal U.S. Food and Drug Administration study consisted of 251 subjects at eight centers in the United States who received injections of ArteFill or bovine collagen dermal filler (control) in 1334 wrinkles of the glabella, nasolabial folds, radial upper lip lines, and corners of the mouth. The efficacy data generated by masked observers using a photographic Facial Fold Assessment Scale demonstrated a significant improvement with ArteFill compared with collagen at 6 months (p < 0.001) in the nasolabial folds. In the ArteFill group, 12-month follow-up was obtained for 111 subjects (86.7 percent) and showed persistence of significant wrinkle correction. A subgroup of 69 patients who received ArteFill were recalled 4 to 5 years later. Five patients reported six late adverse events that occurred from 2 to 5 years after the initial injection; four of the adverse events were mild cases of lumpiness and two were severe. The total number of late adverse events was six of 272 (2.2 percent) wrinkles injected. Among the 272 wrinkles evaluated at 5 years, two events (0.7 percent) in one patient were rated as severe (a nodular, minimally inflammatory to noninflammatory reaction in both nasolabial folds). Investigator Facial Fold Assessment ratings at 4 to 5 years were improved from baseline by 1.67 points (p < 0.001).

Artecoll: the Arizona experience and lessons learned.

BACKGROUND: Artefill is one of several new materials being introduced to the U.S. market as a soft tissue augmenting agent. OBJECTIVE: The objectives were to evaluate the safety and efficacy of injecting Artecoll (Rofil Medical International Breda, the Netherlands) in facial wrinkles compared with injecting Zyderm or Zyplast (INAMED, Santa Barbara, CA, USA) and discuss the practical lessons learned. METHODS: Thirty-eight patients were randomly selected to receive Artecoll or Zyderm/Zyplast into facial defects. Wrinkles were evaluated by the treating physician, the subject, and masked physician evaluators. Similar evaluations were performed on several collagen patients crossing over to Artecoll. Adverse reactions were recorded. RESULTS. All evaluators felt Artecoll to be superior to collagen in all treated areas except for the glabella and upper lip lines. In these areas, differentiation by photographs between the two products became more difficult for the masked evaluators. The adverse side effects of Artecoll were almost equal with those of collagen, but most were of minimal consequence. Three patients developed persistent nodules (all in perioral sites), which were treatable with intralesional steroids. CONCLUSION. Artecoll treatment of wrinkles and folds was found to be effective, long lasting, safe, and associated with a high percentage of patient acceptance. There is a learning curve in injecting this thicker, more permanent product.