ARTEFILL HISTORY AND PATHOPHYSIOLOGY

Polymethymethacrylate (PMMA) was first synthesized by Roehm in 1902 and patented as Plexiglas in 1928. It has been used in dentures, prosthetic devices, and intraocular lenses and as a carrier for antibiotics. In 1985, PMMA was studied by G. Lemperle for soft tissue augmentation.

ArteFill is classified as a permanent soft tissue implant composed of 20% homogenous PMMA microspheres evenly suspended in an 80% mixture of 3.5% purified bovine collagen, 0.3% sodium chloride, and 0.3% lidocaine. The PMMA microspheres stimulate fibroblasts to produce autologous collagen, which then encapsulates each PMMA microsphere. The bovine collagen component of the filler serves as a carrier for deep dermal implantation that prevents clumping on injection and stimulates tissue ingrowth. Following injection, the collagen carrier is degraded by collagenases within one to four months and is replaced by the body's own collagen, ensuring a steady rate of augmentation consisting of 80% autologous connective tissue and 20% PMMA.

PMMA fillers have evolved substantially from Arteplast to Artecoll, now ArteFill. Predecessors of ArteFill had PMMA microspheres of less than 20 μm in size, while those in ArteFill are virtually all 30–42 μm. This optimum size is large enough to avoid phagocytosis, thus facilitating connective tissue encapsulation, but small enough to allow injection into the deep dermis through a 26-gauge needle. Additionally, the PMMA is washed and coated with high-viscosity bovine collagen (versus the Tween 80 or gelatin medium in Arteplast), which reduces the rate of foreign body granuloma formation from 2.5% with Arteplast to 0.01% reported with Artecoll.