Artefill vs Juvederm. Which dermal filler is better for long term results?

I have to admit that a permanent wrinkle filler sounds pretty good to me. You get it done once and it lasts for years. The only problem is that I've read some bad reviews about it. I wouldn't want to mess up my face at 29 years old. On the other hand, there is Juvederm, except it has short lasting results, meaning I'd have to redo the treatment pretty much twice a year. Not very practical, nor cheap. Which approach should I choose?

Unlike traditional hyaluronic acid-based injectable wrinkle fillers, Artefill is composed of synthetic microspheres. Because these microspheres cannot be absorbed by the body naturally, like hyaluronic acid, the effects of Artefill are permanent. Also, because the treatment cannot be undone with an injection of hyaluronidase as with HA fillers, there's no quick and easy way to remove Artefill if you're not happy with your results.

This makes Artefill a very powerful but slightly more risky option than traditional dermal fillers. Artefill received its FDA approval in 2006 but, to date, it isn't nearly as popular as its non-permanent competitors for this very reason.

I can't give you any specific medical advice without a personal consultation but, generally speaking, if a patient has never explored dermal fillers, I’d recommend that, for their initial treatment, they go for a traditional filler in the treatment area. If they are happy with the results, then they may be more comfortable moving forward with a permanent option.

Because Artefill is a permanent filler, the skill and expertise of the injector is extremely important to consider. Be sure to consult with an experienced plastic surgeon or dermatologist who has a history of beautiful results.

Artefill has attracted a lot of attention ever since its manufacturer released data from a five-year efficacy/safety study it conducted. According to the manufacturer, this was the most comprehensive and in-depth study conducted to date.

It is understandable that people who, in order to achieve the results they desire, are accustomed to requiring repeat visits, would be over the moon at the idea of a one-time permanent treatment. But it isn’t for everyone. In fact, I’m very skeptical of permanent fillers like Artefill. Over the course of time, they can lead to serious issues.

While fillers made of hyaluronic acid, such as Juvederm, are naturally reabsorbed by the body, Artefill contains synthetic microspheres which are not reabsorbed; this is what makes it “permanent.” This can be viewed as a very positive aspect of the treatment. However, for the very same reason it can be positive (its permanency due the contents’ incapacity to be reabsorbed by  the body), it can be very negative if you’re gravely unhappy with the results and stuck with them. And unlike hyaluronic acid fillers, Artefill (aka, Bellafill) cannot be broken down with hyaluronidase. You have to accept the results as they are or undergo a surgical procedure to remove the product from your system. Moreover, even if you are happy with the results, as you age, things may look different.

Another option to consider is natural fat grafting, which in some cases may be preferable to all types of facial fillers. However, most reputable dermatologists and plastic surgeons prefer hyaluronic acid fillers. I recommend Juvederm, which has been around the longest and has a great safety record. Any other HA fillers from the same ‘family’ as Juvederm would also be recommended as they’re easier to manage and their results are reversible and temporary. As you age, you can also adjust your treatment strategy to achieve a more natural appearance.

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Determining which treatment is best for you depends on what you are looking to accomplish.

But before getting to this I’d like to issue a warning: I am vehemently against permanent fillers such as Artefill. Initially, they may produce good results but, from a few months to a decade later, can result in terrible complications—and these complications may be irreversible. By ‘terrible’ I mean that they may leave a patient permanently disfigured. In other words, if the doctor makes even a small error, you could be left with permanent, life-altering side effects, even if the doctor is an experienced injector.

Now let’s discuss the filler treatments that can have a positive result: Juvederm is a sterile gel filler comprised of hyaluronic acid (HA). HA is a naturally-occurring sugar in the skin. Temporary  fillers made with HA, including Juvederm and Restylane, do not have any animal or human DNA and boast the safest track record of all the filler treatments on the market. These fillers are approved by the FDA for the treatment of nasolabial folds but are considered off-label when used to treat other areas. With Juvederm, there will be less swelling during the first few days following treatment. I personally believe it is superior to Restylane.

There are also other dermal fillers that you didn’t mention.

Radiesse is essentially a bone/cartilage injectable cream. The manufacturers of this product claim that the effects of Radiesse last longer than those of HA-based injectables, but I am not a believer. In my experience, I’ve found that it causes more complications.

Sculptra is a poly-L-lactic acid based volumizer. It is best used for facial hollowing and for restoring facial volume in patients who have undergone significant weight loss (or who are naturally very thin). This is a great treatment for patients over the age of 60, for whom plastic surgery is a bit riskier. Sculptra sometimes causes bumps and is more difficult to inject. If you are interested in this treatment, it is important that you seek out a board-certified dermatologist or board-certified plastic surgeon to perform the procedure.

Fat injections are also popular among some doctors and patients because they’re closest to a natural dermal filler. Results can be unpredictable, however, and, in some cases, patients are left with lumps. Fat injections also cause some swelling and bruising. Even experienced dermatologists and plastic surgeons find this injection technique difficult.

Schedule a consultation with a dermatologist or plastic surgeon to discuss which of these treatments would best meet your needs.

Many patients query whether it is better to use temporary fillers or a permanent filler to achieve their facial aesthetic goals. The short answer is that each option has benefits and disadvantages that need to be carefully considered in light of your skin’s characteristics and the cosmetic outcome you desire.

Artefill (nowadays commonly referred to as Bellafill), is the only permanent filler approved for use in the U.S. It’s a gel filler consisting of millions of tiny synthetic microspheres that are suspended in purified bovine collagen. These microspheres are non-resorbable, which means the body cannot metabolize them. The results therefore last significantly longer than other dermal fillers. The microspheres also stimulate the body to generate its own collagen to encapsulate each microsphere, gradually replacing the bovine collagen over several months. Bellafill also contains Lidocaine, a local anesthetic, to reduce any discomfort during injection.

Bellafill is FDA-approved for the treatment of nasolabial folds (smile lines) but can also be used off-label for lip augmentation, acne scarring, or other wrinkles. It is not appropriate for wrinkles in areas where the skin is thinner, such as crows' feet. It is injected directly beneath the wrinkle, and adds a permanent support structure which helps to smooth the skin out. Sometimes two treatments may be necessary to achieve an optimal result.

Bellafill is most suitable for men or women who have already tried other dermal fillers like Juvederm. These patients are already comfortable with the effects of dermal fillers, are seeking an alternative to regular injections and the financial obligation of regular maintenance, and feel ready for permanent results. For this last reason, it’s not advisable to commit to a permanent solution like Bellafill without having first experimented with temporary facial fillers.

Some rare complications that can still arise after using Bellafill include redness, swelling, granulomas, and pain or sensitivity at the injection site. Many of these side effects usually resolve over time. However, if you are dissatisfied with the cosmetic results of Bellafill, there is no way to reverse the effects.

Therefore it is critical to minimize this risk by being certain you are ready for a permanent filler, and finding a board-certified plastic surgeon who is qualified and experienced in Bellafill injection technique. Your surgeon will also perform a simple allergy test on you thirty days prior to your procedure to test your skin for sensitivity to bovine collagen.

Hyaluronic acid fillers, or HA fillers such as Juvederm, can both soften facial lines and restore volume loss. They can be used on multiple facial sites, including more fragile areas such as the tear troughs and crows' feet. The results are long lasting, but not permanent.

Furthermore, as hyaluronic acid occurs naturally in the body, it is almost impossible to have an allergic reaction. And in case you don’t like the results, there is an enzyme available that will reverse the treatment. Risks associated with HA fillers include swelling, bruising, mild inflammation, lumpiness or redness.

To help you make the right decisions and achieve your aesthetic goals, I suggest you schedule a consultation with a local board-certified plastic surgeon or dermatologist who specializes in filler treatments. He or she will be able to examine your unique skin characteristics, and direct you to the treatment that is most beneficial and appropriate for your specific situation.

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The only long term filler that is available in the US is Bellafill.  You can always find negative reviews on a medical device but if you look at the satisfaction ratings for Bellafill on RealSelf, it is 93% which is pretty high and Juvederm id 91%.  Both are great fillers but Bellafill will last at least 5 years.

I hope that helps.

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Yes the downside to the Artefill are ALL the potential untreatable complications. Stick with the HA fillers once or twice a year as the safer alternatives. Regards Dr  B 

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