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skin products available from The Hamilton Plastic Surgery Centre.

Artecoll® is a new type of injectable implant used for skin augmentation, the long lasting correction of wrinkles and other skin depressions. Artecoll is composed of tiny microspheres called polymethyl methacrylate (PMMA) which are suspended in a collagen solution with lidocaine for the relief of mild post treatment tenderness.

The PMMA microspheres are 32-40 µm in size. PMMA has been used since the early 1930's in such common procedures as dental prostheses, eye lenses, bone repair, orthopedics and in pacemakers. These microspheres are well tolerated by human tissue (no rejection), and are 4-5 times the size of a red blood cell.

Details: Artecoll utilizes the body’s natural ability to encapsulate foreign bodies by the formation of connective tissue surrounding the PMMA microspheres. The process of encapsulation of the microspheres by the body’s own connective tissue (collagen) is complete in about 3 months. Absorption (phagocytosis) and/or dislocation of the microspheres is prevented by the encapsulation of each individual microsphere with connective tissue.

It is possible that after the swelling has gone down, your wrinkles may temporarily return after a few weeks. This is a normal occurrence, and they will start to disappear again over the next few months as the body forms its own connective tissue.

The implanted PMMA microspheres stimulate the growth of connective tissue (fibroplasia) and collagen synthesis to increase the volume of soft tissue beneath the depression for cosmetic enhancement.

Procedure: Normally a topical anesthetic such as Emla® (lidocaine - prilocaine) is put on the area to be treated one hour prior to the procedure. Also, Artecoll contains lidocaine to minimize post-treatment tenderness. The needle used for Artecoll is very fine and the injection is virtually painless.

• A series of tiny injections under the skin's surface.
• Artecoll fills the gaps, raising the skin to its normal height.
• Some minor smoothing may be done immediately after the injection.
• The procedure is done in the doctor's office.
• Over time (2-3 months), your body will permanently anchor Artecoll for a long-lasting effect.

Length: It takes about 3 months for the full effect to be seen.
Recovery:

• Artecoll contains an anaesthetic that works at the injection site to minimize any discomfort.
• There may be some minor swelling, redness, bruising, tenderness or itching lasting 1 to 2 days.
• Artecoll has an excellent safety record with less than 0.1% incidence of side effects (mainly allergy and inflammation).
• It takes about 3 months for the full effect to be seen.

Results: Results are considered permanent; there's no need to continually retreat as with some other procedures. The improved results should be visible at least five years or longer depending on the patient. The implant will remain for the rest of the patient’s life. The cosmetic effect of the implant will diminish over time as new wrinkles are formed.

Depending on the patient and the correction to be made, a second or third injection may be needed if the degree of correction from the first injection is not optimal. Artecoll is a long-lasting implant. Unlike collagen which lasts 3-6 months, Artecoll’s effect lasts for at least 5 years or more, depending on the patient. The implant remains for the life of the patient. An over correction is not recommended with Artecoll.

Risks/Side Effects:Possible side effects include swelling, redness, slight bruising and moderate pain after injection. Slight itching at the implantation site is a rather common symptom. These symptoms normally subside in a few days

.Frequently Asked Questions:

Q. Is Artecoll safe?

A. Yes. Artecoll is extremely safe. There have been no reports of rejection of the PMMA microspheres. PMMA has been used since the early 1930's in dental prostheses, and since 1947, when the first hip prosthesis was introduced. Many scientific articles on bone repair have mentioned the chemical inertness and biocompatibility of PMMA.

Q. What is the source of the collagen used in Artecoll?

A. The atelocollagen used in Artecoll is sourced from a closed herd of cattle located in the United States, which has been declared as a BSE free country by the Canadian Food Inspection Agency (CFIA)..

Q. Can a face-lift be performed after an Artecoll implantation?

A. Yes. A face-lift can be performed after an Artecoll implantation. The skin on the face is thick enough to prevent the implants from becoming visible after a face lift. However, Artecoll should not be used in thin, flaccid skin. It is possible that an implant in thin skin will be visible after a face-lift.

Q. Is an Artecoll injection painful?

A. No. Normally a topical anesthetic such as Emla® (lidocaine - prilocaine) is put on the area to be treated one hour prior to the procedure. Also, Artecoll contains lidocaine to minimize post-treatment tenderness. The needle used for Artecoll is very fine and the injection is virtually painless.

Q. How long does the Artecoll implant last?

A. The improved results should be visible at least five years or longer depending on the patient. The implant will remain for the rest of the patient’s life. The cosmetic effect of the implant will diminish over time as new wrinkles are formed.

Q. Who invented Artecoll?

A. Professor Gottfried Lemperle in Germany. Dr. Lemperle is a plastic surgeon who is currently working in the Division of Plastic Surgery, University of California, San Diego.

Q. What are the Indications?

A. Artecoll is an injectable implant for skin augmentation, the lasting correction of wrinkles and other skin depressions.

Common Uses: folds and wrinkles of the face lip augmentation acne scars nasolabial folds horizontal frowns glabellar frown lines depressed corners of the mouth

Other Uses: subcutaneous skin defects filling of orbita of the eyes augmentation of cheek bones, chin or bridge of the nose irregularities of the nose small facial bone or hand bone defects augmentation of the nipple

Q. What are the contraindications with the use of Artecoll?

A.

• Positive reaction to skin test
• Known allergy to lidocaine
• Known allergy to collagen or bovine products
• Known immune diseases
• Susceptibility to enlarged scars (keloids)
• Thin, flaccid skin
  

Q. Can Artecoll be used during pregnancy?

A. Consult your physician to evaluate the potential benefits versus the possible side effects.

Skin Testing

Q. What is the purpose of the skin test?

A. The skin test is used to determine if the patient is sensitive or allergic to the collagen or lidocaine in the product.

Q. What is contained in the Artecoll test syringe?

A. The test syringe contains a collagen solution and lidocaine (no PMMA microspheres).

Q.Where should a doctor inject the test syringe?

A. The inside of the arm near the elbow.

Q. How long should the doctor wait after the skin test?

A. 3 - 4 weeks. A second test may be performed if the results from the first test are not clear.

Q. Is it necessary to do skin testing?

A.Due to the low incidence of sensitivity reaction (< 0.1%), skin testing is not mandatory. Skin testing is now optional, at the discretion of the physician.

Q. I have been previously injected with collagen. Do I need to receive an Artecoll skin test?

A.The absence of an allergic reaction
to previous collagen injections is highly indicative that Artecoll will be
well tolerated and that an additional skin test is not
required.

Techniques And Tips

Q:	Can Artecoll be used in thin skinned areas?
A:	Thin, flaccid skin is a inadvisable (contraindication) for Artecoll. The risk of the skin becoming lighter (blanching) is much increased as well as the potential for the implant to be detectable (palpable) or visible as rubber-like nodules.

Q:	Has Artecoll been injected into elderly skin?
A:	Yes. Artecoll has been injected in women over 70 years old. Care must be taken in patients with thin or flaccid skin.

Q:	Is there data in patients who have been injected more than 5 years ago?
A:	The use of Artecoll was first investigated in 1989 and there are patients who have had implants for more than 5 years (personal communication from Dr. Lemperle). However, Artecoll does not stop time and new wrinkles can be expected to appear close to the site of implant. There are no reports of problems with these first treatments.

Q:

Is there a chance of migration as with silicone injection?

A:

Artecoll has been created to eliminate this possibility. The collagen is designed to be absorbed by the body in the first few weeks after injection. The PMMA microspheres are perfectly smooth so as to inhibit absorption (phagocytosis) and giant cell formation. The size of the microspheres is 32 - 40 microns and is too large to be engulfed by a macrophage. The microspheres are also too large to migrate on their own and migration is further inhibited because each microsphere is encapsulated by connective tissue.

Granulomas

Q:	What is the incidence of granuloma (inflammation under the skin) formation with Artecoll?
A:	The development of granulomas after the administration of Artecoll has been reported very rarely. There are 10 reported cases from more than 8,000 patients (< 0.125%). In the event of a granuloma, it can be effectively treated with corticosteroids. Since Artecoll was introduced on the Canadian market in August 1998, no incidences have been reported.