I was recently asked a couple of insightful questions about the long term fillers Bellafill or Artefill. Here are the questions and my answers.
Many doctors have suggested they will not use permanent fillers, such as Bellafill, but, in reviewing scholarly publications, I could find no greater incidence of biofilm development, vascular complications or even the formation of granulomas in Bellafill when compared to the more temporary hyaluronic acid fillers like Juvederm and Restylane. Are there any hyaluronic acids that promote collagen like Bellafill does?
There are no Hyaluronic acids that promote tissue formation other than some minor amounts of scar and that is really a response to the trauma of the injection especially if a needle and not a true response to the HA. You are correct in saying that there is no true scientific evidence of the refined PMMA plus collagen tissue fillers (Bellafill or Artefill) causing any damage or complications. There are many PMMA fillers available outside of the US where the particles are not of uniform size, are not smooth and are not electrically “washed” so that they can attract nanoparticles that can cause problems. These non-standardized Artefill knockoff substances do cause complications such as true granulomas. The 5 year study that has been submitted to the FDA for Artefill reports no long term complications at all and over a 90% satisfaction rating. Conversely the HA 5 year studies (Juvederm and Restylane) did have some minor complications such as Tyndall effect. In summary, Artefill or Bellafill seems to be safer and it will certainly last much longer. The informal studies by Lemperle are now out 15 years with no loss of volume!
What about Silikon 1000 (a liquid silicone)? Can it be safely used as a filler?
Silikon 1000 is not FDA approved for cosmetic use. However, the modernization act of 1997 allows licensed physicians to administer medical agents for off-label purpose and a number of physicians have used it for filler purposes. The literature is full of complications from this product being used in the lips and face. Google scholar can lead you to them if you search liquid silicone injection face and lips. I have seen one patient with significant problems. She was injected in San Diego an area where this is a popular practice. I have another with a problem from this product that is impossible to correct without surgery.
Each injection trial or study shows some risk for every product but these risks are mostly bruising and temporary bumps or lumps. It seems that a permanent material like Bellafill or Artefill in the hands of an expert medical practitioner who thoroughly understands facial anatomy would be the safest route. Is that true?
The HA’s are safe but only last a certain amount of time (up to 2 years). As a consultant for problems with Artefill or Bellafill, what I see or get asked to review are either coincidental problems (issues that are not related to the injection but came up around the time of the injection) or they are injector error issues. I am seeing Bellafill or Artefill patients back 8 years after and their treatments are still working very well. The patients are a little more “mature” however and that is why they are back. They need a little more!
