Guide to Filling Wrinkles

Learn about all the different kinds of wrinkle fillers.

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Artecoll and ArteFill
ArteFill consists of tiny balls of plastic (polymethyl-methacrylate) mixed with the anesthetic lidocaine in a collagen base. (Hard contact lenses are made out of this material.) Once injected, ArteFill becomes surrounded by scar. A plastic, it never breaks down. Like liquid silicone, it violates that basic principle of plastic surgery: any foreign substance that doesn’t dissolve must be removable. ArteFill can’t ever be removed. A 2004 study extolled the virtues of Artecoll, another filler, showing clinical improvement in facial wrinkles for up to a year. But plastic surgeons who fail to study the history of silicone are doomed to repeat its problems.

Artecoll and ArteFill sound good, since they permanently fill in scars and wrinkles and plump lips. However, like silicone, they cause lumps and areas of inflammatory scarring called granulomas. These problems prompted the Swiss Society for Dermatology, the Swiss Society for Plastic Reconstructive and Aesthetic Surgery, and the Swiss Society for Aesthetic Medicine to advise against the use of Artecoll and silicone in the face. In addition, it can migrate to unwanted areas. Artecoll has been used on four hundred thousand patients in Europe and around the world since 1994 and was just approved in the United States. A skin test is required before injection because the filler contains highly allergenic collagen.

Gore-Tex
While not technically injectable, tiny pieces of Gore-Tex (expanded polytetra- fluoroethylene, e-PTFE) are threaded into fine wrinkles. Poor results are frequent. Scar is made around the Gore-Tex and is often visible through the skin. A foreign material, it can become infected and extrude through the skin. I have removed Gore-Tex from many patients. A fine material for dental floss and shoes, it is a poor wrinkle filler. The material is supposed to be inert and not biodegradable, but in 2006 the Environmental Protection Agency found that Teflon (the closely related chemical polytetrafluoroethylene) is ‘‘a likely carcinogen.’’ In November 2006, the company voluntarily withdrew all Gore-Tex products from the plastic surgery market.

Surgisis Soft-Tissue Graft
An interesting material, not technically an ‘‘injectable,’’ Surgisis is a sheet of collagen taken from pig intestines. All the cells are removed and the material is sterilized. Tissue grows into it when implanted into humans. The material is many times stronger than human tissue and therefore can strengthen the abdominal wall in tummy tucks. In the nose, it can smooth bumps. Surgeons are using it to help pull up tissues in face-lifts and to make lips larger. Time will tell how satisfactory this material is in the long run.