Artecoll, a new, permanent, option for propping up wrinkles and indentations, and creating fuller lips, is poised to be approved by the Food and Drug Administration in 2003. While this injectable implant hasn't yet gotten final approval from the FDA, it has been approved in other countries and marketed worldwide since 1994. Since then, more than 200,000 people have used it in Europe, Canada, Mexico, and South America.

Artecoll is a whitish, toothpaste-like injectable gel composed of tiny, perfectly smooth spheres of polymethylmethacrylate or PMMA -- about the thickness of a human hair, wrapped in bovine (cow derived) collagen, and laced with the anesthetic lidocaine.

PMMA has been employed for various medical devices including hip implants and inter-ocular lenses for more than five decades. Unlike other collagen injections, which the body eventually absorbs over the course of a few months to once more reveal your wrinkles and furrows, the Artecoll microspheres remain in place allowing your own collagen tissue to form around them as the products collagen is absorbed by your body. Within two to four months your body will have enmeshed itself with the spheres to create a permanent structure to prop up the depression. Your body might eventually ferry it's own new tissue away, but you'll still have the microspheres in place. Whether new collagen is formed or not, as much as 75 percent of the injection volume may remain.

Manufactured by the San Diego, California-based Artes Medical, Artecoll is indicated for use in horizontal forehead furrows; glabellar frowns (aka scowl lines); single crows feet if the skin is thick enough (thin skin might reveal the implant beneath); collapsed nostrils or other irregularities of the nose; nasolabial folds (the furrows between nose and the corners of your mouth); lip augmentation (promotional information in Canada, where the injections are already available, takes credit for Elizabeth Hurley's pouty mouth); perioral lines (also known as smokers lips, those lines that radiate out from your lips); marionette lines (wrinkles drawn down from the corners of your mouth to your jaw line); horizontal chin and neck folds; nipple augmentation for flat or inverted nipples; acne scars; ice pick scars; and chicken pox scars, among other uses.

According to Artes Medical, Artecoll is a good alternative for patients between 40 and 50 years of age who aren't yet candidates for a facelift and don't have a lot of excess skin.

HOW IT'S DONE: Two to three weeks before the procedure, you should be tested for allergic sensitivity to bovine collagen with a test implant into the soft area of the forearm. If in the past you've found you are sensitive to collagen injections, implants, or sutures, you won't pass the test as Artecoll employs bovine collagen.

If you aren't hypersensitive to collagen, a local or topical anesthetic is used at the treatment site, and then the Artecoll is precisely injected subdermally into the wrinkle or depression using a "tunnel and fill" technique. After injection, the doctor will use her fingertips to evenly distribute the gel beneath the skin. Depending on the treatment site, skin tape may be applied to prevent overuse of the area while the product takes hold over two to three days.

In most cases, more than one session under the needle will be required one to three months after the initial treatment to fill particularly deep furrows, or fill in where the products' collagen has been absorbed.

POTENTIAL SIDE EFFECTS: Like all forms of cosmetic surgery, there are potential side effects. Some of the potential side effects, like an acute allergic reaction or anaphylactic shock, may be ferreted out with an allergy test administered by your doctor prior to scheduling the procedure. Others, like hypertrophic scarring, redness, swelling, migration or the spheres or dislocation of the implant, over-correction of the area, skin atrophy, and the presence of small superficial nodules from the beads, are risks that arise later. Some of these may resolve by themselves with time, but others can mar the result.

FDA documents show that 16.3 percent of patients in U.S. clinical trials had some sort of adverse reaction, from mild redness to lumpiness, also known as granuloma formation (13 percent of collagen users, in contrast, reported adverse side effects). For some in the Artecoll group, the lumpiness refused to go away after six months. The manufacturer, Artes Medical, says the lumpiness can be successfully treated with cortisone injections. However, since the plastic beads eventually get tangled up in your body's own collagen, in a worst case scenario, the only way to remove a bad result is to cut the area out.

Dermatologist Nancy Silverberg of Newport Beach, California notes that the permanent aspect should give those considering the procedure pause and encourages them to find a doctor who is experienced with Artecoll before committing to it. The skill level of the doctor, says Silverberg, will influence the results.

Despite the concerns over side effects, studies have show that the majority of people who have chosen this treatment are satisfied with the result two years later. In one German study published in 1995 nearly 90 percent of subjects were pleased or satisfied with the results. Just over 10 percent reported no difference or an adverse side effect.

A follow-up study published in 1998 found nearly identical results. Ninety one percent of the study participants said they would have the treatment again and just three percent reported a complication with the treatment.

WHAT IT'LL COST YOU: While final prices haven't been set in the United States, expect to pay about twice what you'd pay for traditional collagen injections, around $1,500 per treatment (of course, those are guaranteed to need regular touch-ups while Artecoll is a more permanent fix). It may take as many as three treatments for the best possible results so the cost could run into the thousands.

Karmen B. Saran
DERMAdoctor Staff Writer

(Any topic discussed in this article is not intended as medical advice. If you have a medical concern, please check with your doctor.)

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