Stay a While

It’s easy to forget, in this age of Botox parties and lunchtime Restylane, that injecting one’s way to a youthful visage is not exactly a walk in the park. True, a few syringes can iron out forehead creases, fill frown lines and deliver a schoolgirl-plump pout, but servicing a whole face can cost thousands of dollars per visit, is not exactly painless, and often results in the sort of telltale bruising and swelling that makes one want to grab a ski mask. The worst part? Results disappear faster than a bag of M&Ms at a 4 p.m. meeting—or at least it feels that way. Every three to six months, it’s time to head back to the doctor for another fix.

Not surprisingly—given the profit potential—the med-tech industry has been working overtime to create a new class of no-operating-room-required procedures that promise more enduring, even permanent, improvements. But while some doctors are excited about these advances, others worry about the downturn in business that might occur if patients are compelled to visit them less frequently. They also caution that longer-lasting results can mean longer-lasting complications.

Still, that hasn’t stopped the buzz surrounding ArteFill, the first filler shown to last at least five years. “We’ve trained 650 physicians since February, when we first began shipping the product to doctors,” enthuses Diane Goostree, president and CEO of Artes Medical, the makers of ArteFill. Approved by the FDA in October 2006, the injectable is composed of microspheres—made from the same material used to produce dentures and Plexiglas—suspended in bovine collagen and lidocaine, an anesthetic. Once injected into the deep dermis, the bovine collagen is eventually replaced by human collagen that the body produces to protect itself from the microspheres, just as an oyster produces nacre around foreign matter, forming a pearl. While ArteFill is especially effective for nasolabial folds and deep wrinkles (one to two treatments are often needed to achieve full results), doctors are also interested in using it for acne scars and cleft lips. “There are ways you can use it that don’t make sense for temporary fillers,” Goostree says, adding that though the company has clinical data to support only a five-year life span, she believes that Artefill stays in place indefinitely. “Pictures of patients in Europe show that even at 10 years, the microspheres are still present.”

While ArteFill is FDA-approved for use on nasolabial folds, Sculptra, another long-lasting filler, is currently indicated only for restoring volume to the sunken faces of HIV patients. Still, doctors, many of whom use the product off-label, are enthusiastic about its ability to plump those suffering merely from natural aging. Jennifer Linder, a dermatologist in Scottsdale, Arizona, compares Sculptra to a “liquid facelift,” perfect for rounding out temples, cheek hollows and under-eye areas. “The natural course of aging is fairly similar to the [fat loss] that’s induced by the antiretroviral HIV medication,” says Linder, who serves as a paid educator for Dermik Laboratories, the makers of Sculptra, teaching fellow doctors how to properly use the filler. Two to four treatments of Sculptra are typically needed to gradually build volume that lasts up to two years.