Editor’s note: This is the last installment of a four-part series on injectable fillers. To read the first part on Juvederm Ultra and Ultra-Plus, click HERE. To read the second part on Restylane and Perlane, click HERE. To read the third part on Restylane and Perlane, click HERE.

Artefill, by Suneva Medical, is a is a dual-acting wrinkle filler containing bovine (cow) collagen mixed with patented PMMA (polymethylmethacrylate) microspheres.

Artefill is approved by the FDA for correctıng nasolabial folds but it is widely used off-label to fill lines and wrinkles all over the face. The PMMA microspheres are not absorbed by the body and therefore provide permanent support for wrinkle correction after the collagen is resorbed. To insure you are not allergic to the collagen or anesthetic in Artefill, a skin test must be administered by your doctor about four weeks before the initial treatment.

I do not inject Artefill in my office. It has a great reputation and many satisfied customers. However, I have a few patients in my practice who have Artefill in their faces, which was not injected properly or injected into the wrong area. And unfortunately, it’s permanent. So, because of this, I have decided not to inject anything that carries that much risk. If you want to know a good Artefill injector, however, I can refer you to one.

While we’re on the subject of collagen, I should mention that collagen WAS actually the first injectable filler used. You can still get collagen in the form of Zyderm, Zyplast, Cosmoderm and Cosmoplast. It is chemically similar to the collagen found in humans, but because it is derived from cows, there is risk of an allergic reaction.

On average, these products have results that last two to three to months. Treatments typically cost $400 to $700. I do not tend to use them much because the risk of allergic reaction coupled with the fact that the cost is the same for fillers that last much longer.

Collagen is flesh-colored and very light, however, so the one thing it is really good for is threading very fine lines that are too superficial for other fillers. It’s just a bummer that it doesn’t last longer.

Finally there is Silicone Oil, the only FDA-approved for use in the eye – where it is injected into the eyeball to bolster a detached retina.

However, it is being used off-label in a micro-droplet injection technique to permanently replace volume loss in the face. This is done mostly in the HIV facial wasting patient, but can also be used cosmetically for permanent cheek and lip enhancement as well as softening of acne scars on the face. It costs $500 to $1000 per treatment, and much like Sculptra, is done in a series of treatments over time (three to six).

If you wish to find a practitioner who does this, you will have to ask around because this off-label use cannot be advertised. And it is important to note that this is NOT the same silicone you use to seal your bathtub! There are some hideous stories of people who went to their local home improvement store and bought clear silicone and injected it into themselves and others. It was not a pretty outcome and several people died. So please, do NOT try this at home!

Rewards programs

Many of the fillers have “frequent flyer” programs that result in discounts if you use their products again or cash back. Juvederm and Botox are part of Allergan’s program called Brilliant Distinctions. For each procedure you have, Botox or Juvederm, you get a $25 credit. You can then redeem the credits, print them like Monopoly money, and take them back to your doctor’s office to spend on your next Botox or Juvederm procedure.

Restylane and Perlane have the Restylane Rewards program which gives patients $25 to $75 back for each box top of filler they’ve used and paid for. All you have to do is fill out the form and mail in the box top and an original receipt from your doctor’s office.

Things to know about treatment with fillers: Afterward, you might have some swelling, redness, pain, bruising or tenderness in the area of injection. This will normally last less than seven days.

To avoid bruising and bleeding, you should avoid using drugs or supplements that thin your blood or prevent clotting within seven days of your treatment. This includes things such as coumadin, aspirin, Ibuprofen, Naproxen (or any other anti-inflammatory medication), fish oil, vitamin E, Gingko, Ginseng and alcohol.

If you have had facial cold sores before, an injection can trigger another outbreak. For at least 24 hours after treatment, you should avoid manipulating the filled areas, strenuous exercise, consumption of alcoholic beverages and extended exposure to sun or heat. Be sure to report any redness and/or visible swelling that lasts for more than a few days or any other symptoms that cause you concern to your doctor right away.

In rare circumstances, the injector may inject filler into a blood vessel, which can damage the skin. Although extremely rare, this is a significant potential complication. So keep that in mind when deciding which practitioner to use for your filler injections. Unfortunately all beauty treatments are not completely without risk and looking better naked can be dangerous! So be careful!

Darren A. Farnesi, M.D., APC, offers his sound advice and personal knowledge of the industry as a successful doctor with Medical Age Management Inc. He can be reached at (619) 299-0700 or online at his website.