Artefill Permanent Facial Volume Replacement Treatment Overview
Robert James TroellBackground:
Permanent volume replacement options include polymethylmethacrylate-collagen (ART), silastic implants (SI), and fat grafting (FG). When choosing ART for volume replacement, there are a number of considerations to achieve both optimal aesthetic outcomes and minimize complications.
Objective:
The following considerations were queried: (1) Is skin testing necessary? (2) What is the most effective anesthesia technique? (3) microcannula versus needle injection regarding side effects and placement accuracy, (4) best microcannula manufacturer, (5) vascular compromise avoidance techniques, (6) Does LED minimize bruising? (7) effective anatomic areas for ART treatment, and (8) assessment of a midface permanent volume replacement algorithm.
Methods & Materials:
ART subgroups from 2009 to 2025 implemented chart review, clinical study data, and injector survey scores.
Results:
A total of 1645 patients were injected with over 4000 ART syringes (mean 3.4 per patient) with no observed allergic reactions. In the first 6 months using ART, skin testing prior to aesthetic treatment were done with no allergic skin reactions. Tear trough was the most common area treated (80.5% of patients). ART browlift was effective in 85%, with 91.6% requiring 1 syringe. The combination of ART with FG was used in 25%, and SI in 15.4%. Overall patient Global Aesthetic Improvement Scale (GAIS) satisfaction was 95%.
Conclusions:
Skin testing is unnecessary without lidocaine or red meat allergic history. The best anesthetic was synthetic ice followed by topical anesthesia. TSK followed by DermaSculpt manufacturer using 25 G 1½-inch microcannula was the most accurate with least injection force, less bruising, and pain. LED light resolved bruising faster than control. All facial areas, excluding lips, are effectively treated with low adverse events. Combining ART, FG, and/or SIs offers comprehensive full-face permanent volume enhancement.