28 research outputs found
ArteFillĀ® Permanent Injectable for Soft Tissue Augmentation: I. Mechanism of Action and Injection Techniques
After more than 25Ā years of research and development, in October 2006 ArteFillĀ® became the first and only permanent injectable wrinkle filler to receive FDA approval. ArteFill is a third-generation polymeric microsphere-based filler, following its predecessor ArtecollĀ®, which was marketed outside the United States between 1994 and 2006. ArteFill is approved for the correction of nasolabial folds and has been used in over 15,000 patients since its U.S. market introduction in February 2007. No serious side effects have been reported to date according to the FDAās MAUDE reporting database. ArteFill consists of polymethylmethacrylate (PMMA) microspheres (20% by volume), 30ā50Ā Ī¼m in diameter, suspended in 3.5% bovine collagen solution (80% by volume) and 0.3% lidocaine. The collagen carrier is absorbed within 1Ā month after injection and completely replaced by the patientās own connective tissue within 3Ā months. Each cc of ArteFill contains approximately six million microspheres and histological studies have shown that long-term wrinkle correction consists of 80% of the patientās own connective tissue and 20% microspheres. The standard injection technique is subdermal tunneling that delivers a strand of ArteFill at the dermalāsubdermal junction. This strand beneath a wrinkle or fold acts like a support structure that protects against further wrinkling and allows the diminished thickness of the dermis to recover to its original thickness
ArteFillĀ® Permanent Injectable for Soft Tissue Augmentation: II. Indications and Applications
Patients ask for procedures with long-lasting effects. ArteFill is the first permanent injectable approved in 2006 by the FDA for nasolabial folds. It consists of cleaned microspheres of polymethylmethacrylate (PMMA) suspended in bovine collagen. Over the development period of 20Ā years most of its side effects have been eliminated to achieve the same safety standard as todayās hyaluronic acid products. A 5-year follow-up study in U.S. clinical trial patients has shown the same wrinkle improvement as seen at 6Ā months. Long-term follow-up in European Artecoll patients has shown successful wrinkle correction lasting up to 15Ā years. A wide variety of off-label indications and applications have been developed that help the physician meet the individual needs of his/her patients. Serious complications after ArteFill injections, such as granuloma formation, have not been reported due to the reduction of PMMA microspheres smaller than 20Ā Ī¼m to less than 1% āby the number.ā Minor technique-related side effects, however, may occur during the initial learning curve. Patient and physician satisfaction with ArteFill has been shown to be greater than 90%
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The Direction of Optimal Skin Incisions Derived From Striae Distensae.
Prevention of hyper- and hypotrophic scars through surgical incisions in the direction of the āmain folding linesā of the skin
Langerās lines are still the recommendation and matrix for surgical incisions in most surgical textbooks, even if they were never meant to be by their first describer in 1861. To achieve minimal scarring, surgeons should attempt to make incisions parallel to skin tension lines, i.e., in skin folds or skin creases. On the basis of visible stretch marks (striae distensae) in the skin, which always appear in the same direction against skin tension in men and women, the direction of skin tension lines can be manifested also in the skin of children and young patients. These invisible or virtual tension lines are the same as the main folding lines (MFL) in adults and run perpendicular to the stretch marks. While well-established on the face and abdomen, these folding lines may not be obvious on other parts of the body. On chest, back and extremities, optimal direction of surgical skin incisions should take into account the patterns of striae distensae, which develop perpendicular to skin tension lines. MFL should be used in elective incisions in children, adolescents, and young women as a guide for the prevention of later visible hyper- or hypotrophic scars
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