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Aesthetic
Published in Tor Wo Chiu, Stone’s Plastic Surgery Facts, 2018
Polymethylmethacrylate (PMMA) ArteFill® (was ArteColl) is composed of PMMA beads (20%) in bovine collagen; it is regarded as a permanent filler for deeper lines; FDA approval (2006) is limited to nasolabial folds. The initial corrections last up to 6 months until the collagen component is absorbed, followed by tissue growth around the beads that may last >5 years. Skin testing is recommended (1%–3% risk). The most serious side effect seems to be granuloma formation (<0.1% risk).
Fillers for Acne Scarring
Published in Antonella Tosti, Maria Pia De Padova, Gabriella Fabbrocini, Kenneth R. Beer, Acne Scars, 2018
In the initial development stage of PMMA fillers, scientists found that a smaller microsphere size led to a foreign body inflammatory response with giant cell formation. The creation of larger microspheres, 30–50 μm, significantly reduced the rate of granuloma formation to less than 0.01%, and thus came the development of Artefill, which was rebranded as Bellafill (Suneva Medical, San Diego, CA, USA) in 2014 [13]. Artefill is composed of 20% non-resorbable PMMA microspheres suspended in 80% solution of mostly denatured bovine collagen, and was FDA approved for the correction of smile lines. Once the product was rebranded to Bellafill in 2014, it became FDA approved for the treatment of moderate-to-severe, atrophic, distensible facial acne scars on the cheek(s) in patients over 21 years. Bellafill is the only dermal filler in the market that is approved for the treatment of acne scars. Studies have shown a 3% prevalence of hypersensitivity to the bovine collagen, therefore, a skin test is required prior to injection [15,20]. While the bovine collagen leads to volume below the pitted acne scars, the PMMA microspheres create a matrix that stimulates collagen production around the spheres leading to long-term support by autologous connective tissue. Since the microspheres are too large to be phagocytosed by macrophages, they are permanent and, hence, Bellafill is considered an irreversible filler. Additionally, the large size of the microsphere makes the filler unsuitable for thin areas such as the lips and periocular [13].
Choosing an Ideal Filler for Your Patient
Published in Neil S. Sadick, Illustrated Manual of Injectable Fillers, 2020
Third-generation polymethyl methacrylate (PMMA) manufactured by Suneva Medical Inc. (San Diego, CA) is a nonbiodegradable injectable filling agent composed of 30–50 μm smooth and round PMMA microspheres suspended in a water-based gel containing 3.5% bovine collagen and 0.3% lidocaine (18–20). There are approximately 6 million microspheres per 1 mL of product and similar to other soft tissue fillers that contain bovine collagen, patients must be skin-tested for hypersensitivity reactions to bovine collagen prior to injection (21). The collagen provides instantaneous correction while the PMMA spheres are, in theory, chemically inert and stable for many years. The size, smooth surface, and lack of electrical charge enables the microspheres to resist phagocytosis and dislocation as they are encapsulated by the patient’s own collagen (18). Bellafill is the only injectable permanent filling agent approved by the FDA for use for NLFs (Figure 3.4); however, it has been widely used off-label for a variety of other indications, including additional facial wrinkles, contour defects on the face and neck, and acne scars. Previous formulations of PMMA microspheres were marketed under the names Arteplast, Artecoll, and ArteFill. Bellafill is injected into the reticular dermis, just above the dermal-subcutaneous fat interface, by means of a tunneling technique. It should be deposited in a layered fashion to provide a scaffold for tissue infiltration. Injection should be followed by gentle massage to evenly distribute the material. Complications can arise from inaccurate depth of injection. An injection that is too deep can lead to ineffective treatment and may require repeat injection. An injection that is too superficial can lead to erythema and itching or superficial bumps, and may require treatment with topical or intradermal steroids.
Delayed adverse reactions caused by consecutive injections of different fillers in the same region: Murine skin study
Published in Journal of Cosmetic and Laser Therapy, 2019
Euyhyun Chung, Changyoon Sim, Hyun Jo Kim
Permanent fillers have a higher potential to develop granulomatous reactions than resorbable fillers. Some permanent fillers are silicone, microspheres of polymethylmethacrylate suspended in bovine collagen (Artecoll®, Artefill®), polyacrylamide hydrogel (Aquamid®, Interfall®, OutLine®, Royamid®, Formacryl®, Argiform®, Amazingel®, Bio-Formacryl®, and Kosmogel®), Hydroxyethylmethacrylate/ethylmethacrylate fragments and hyaluronic acid (Dermalive®, Dermadeep®), and Polyalkylimide gel (Bio-Alcamid®) (Table 2). As silicone which is well known for granulomatous response with a ‘Swiss cheese appearance’, Artecoll® also displays distinctive histologic features. Artecoll® consists of homogenous microspheres of PMMA uniformly suspended in a solution collagen (3.5%) with 0.3% hydrochloride lidocaine (17). The collagen is selected from healthy animals which contribute to a reduction in adverse reaction. All of the spheres are smooth-surfaced, measuring about 32–40 μm. As shown in this study, it is characterized by multiple small round cystic spaces of approximately the same size and shape which mimics normal adipocytes surrounded by epithelioid cells with foreign body-type multinucleated giant cells in a sclerotic stroma showing class II foreign body reactions.
Replacement of gluteal implants by polymethyl methacrylate filler: case report
Published in Case Reports in Plastic Surgery and Hand Surgery, 2019
Roberto Chacur, Honório Sampaio Menezes, Nívea Maria Bordin da Silva Chacur, Danuza Dias Alves, Rodrigo Cadore Mafaldo, Leandro Dias Gomes, Gina Matzenbacher, Renata Bataiolli
Hilinski [21] has demonstrated improved biocompatibility as a result of increased size and uniformity of PMMA microspheres. This enhanced biocompatibility results in fewer adverse events after the placement of ArteFill thus, providing a permanent volume increase, since the non-absorbable microspheres stimulate the fibroblasts that synthesise and cause collagen deposition around them. A similar study was also conducted by Mcclelland et al [22]. The appropriate technique includes deep subcutaneous implantation, with total correction, which is gradually achieved over several treatments. Complications are limited to the formation of nodules, which are easy to handle, and, in most cases, it can be done with conservative interventions.