Episode 28 - Dr. Chi: ArteFill Is The Latest Injectable and It Is Permanent
Lines around your mouth getting you down? There is a new filler in town. Move over Restalyne, Radiesse, Perlane. There is a permanent filler to give your face a lift. Tired of looking like you are haggard and worn. Listen to Beauty Now interview Dr. Chi, one of the first experts in plastic surgery to use ArteFill. Dr. Chi also informs us what the other fillers do. Botox for your neck? It all sounds good to me. Look and feel young with this episode of Beauty Now. Share with your friends so they can look their best too.
Teri Hausman: I'm Teri Struck, host of Beauty Now. Tune in weekly to hear the latest on lifts, lasers, lipo, breast augmentation and more. Today we’re very lucky to talk with Dr. Chi who is going to tell us all about ArteFill.
[excerpts of Peter Chi’s interview responses]
“Anything that is semi-permanent or permanent, there is always a risk of what we call, forming a granuloma. A granuloma is like a healing tissue that your body produces when you have something that is foreign. The new substance that we have, which is ArteFill, is much refined. The particles are more even, so the risks are fewer.”
“Do you want something permanent or something temporary? Number two: Once you decide on that, the area that is injected. Number three: You have to see longevity and the comfort level of the surgeon or the doctor who is injecting it.”
“Botox works by stopping or weakening your muscle action that forms these frown lines while these fillers fill these lines when you don’t have any muscle action.”
I'm Teri Struck, host of Beauty Now. Today we’re very lucky to talk with Dr. Chi who is going to tell us all about ArteFill. Welcome Dr. Chi.
Peter Chi: Thank you.
Teri Hausman: So ArteFill is a permanent filler.
Peter Chi: That’s right.
Teri Hausman: It’s a permanent filler so why don’t you tell us about ArteFill.
Peter Chi: Sure. Well actually ArteFill, the basic substance of ArteFill has been around for a long, long time. Europeans have been using something similar to ArteFill for years and before the United States finally got this substance FDA approved. So they relabeled it and renamed it ArteFill.
In Canada, the same thing is actually called Artecoll. And that has been in Canada, I believe, ever since 1999. When it first came out, I was actually one of the first doctors that used Artecoll. So I’m really happy, finally, that ArteFill has arrived in the United States. I think doctors around the nation have been waiting for something like this. We lack. We actually have very few semi-permanent or permanent fillers available here in the United States and very few options.
So ArteFill is actually a permanent injectable and it has been FDA approved for the injection of improving the laugh lines. It is typically injected underneath the skin to fill the depressed area such as your laugh line. It can be a scar and sometimes it can be applied off label to inject the frown lines that we have, in addition to Botox. Also sometimes we could use it to fill certain scars on the face to alleviate the depression.
Teri Hausman: So to be clear, you’re saying that ArteFill is only used for specific areas of your face.
Peter Chi: Yes. It has been FDA approved for the laugh lines but cosmetic surgeons, dermatologists and doctors have been using it for elsewhere. As long as there is a depression and there is an irregular contour of the skin, ArteFill would be a great option to improve it, to alleviate it.
Teri Hausman: So what would be the danger of injecting a permanent filler? It sounds a little scary.
Peter Chi: Number one, with anything that is semi-permanent or permanent, there is always a risk of what we call, forming a granuloma. A granuloma is like a healing tissue that your body produces when you have something that is foreign. The studies have been done and the risk of that happening is extremely rare. I think it happens more frequently, perhaps, when you inject too much or when you inject it such that it clumps up in one little area.
Like I said, I’ve used this when I first started in Canada. I’ve never seen one. I believe Europe may have a few records of patients that developed granuloma. But the manufacturer claims that that is because it is not as refined. The new substance that we have, which is ArteFill, is much refined. The particles are more even, so the risks are even fewer, less than the Artecoll.
Teri Hausman: So what would be the difference? There are other fillers on the market now. There is Restylane, Perlane, Radiance.
Peter Chi: Yes and those are all very good fillers except they don’t last forever. We were recently involved in a study with Restylane and Juvederm and Perlane and all that. They could last from six months or eight months. Some I’ve seen as long as one year but after that, it dissipates and that’s it.
Teri Hausman: And are they used for other areas because you can’t use ArteFill on your lips? Is that true?
Peter Chi: No. In fact, ArteFill can be used for the lip as long as you inject it very deeply into the lip tissue. You don’t want to inject anything that is semi-permanent too close to the surface of the skin because then you get these irregular lumps.
Teri Hausman: The white little lumpies, right?
Peter Chi: Yes. It would appear lumpy. But Restylane, of course being a softer material, you can inject it much closer to the skin without having that side effect. But no, ArteFill is quite useful for injection of the lip.
Teri Hausman: That’s good to know because it has been hard to find a permanent filler for the lip.
Peter Chi: Exactly and that’s the limitation. We, as cosmetic surgeons, have very few options for the lip. Lip is one area that we have very few options for. We used to use all these Gortex, these foreign materials allografts, and otografts but none of them have very satisfactory results. A lot of them have infection, rejections, extrusions. Even if you put something such as fat, it goes away. The results are unpredictable. But now, we have these permanent fillers and I think that answers a lot of the limitations.
Teri Hausman: So are you going to stop using the other ones: Juvederm, Perlane and all that or are you going to use those for other things? What can those be used for?
Peter Chi: No. I think those still have a role. Now remember, ArteFill has to be injected below the skin surface because it is semi-permanent. For that reason, if you have a scar that is very close or very superficial to skin, I don’t believe ArteFill will work very well because it is too close to the skin’s surface.
So in those cases, Restylane, Juvederm, are still very good options because those, you can, in fact, are supposed to inject into the skin and close to the skin surface to get the right clinical effect. And also, some patients are still reserved about having something permanent on their face before trying something temporary.
So I think there is still a significant role for Juvederm and Restylane. Our demands for Juvederm or Restylane have not decreased ever since ArteFill came on the market.
Teri Hausman: Now can people get just one treatment and then that does it or do they have to come in for two treatments?
Peter Chi: Yeah, it’s like climbing up the stairway. I don’t like to hit a homerun every time. We like to go half way up and then perhaps a few weeks later, we finish the rest of the steps and finally get to the target. Because remember, this is permanent. Once you put it in, you can’t take it out. You don’t want to over-inject this thing. So it’s better to go conservative, one step at a time, before you hit the target. You don’t want to hit a homerun right off the bat.
Teri Hausman: What’s the substance in ArteFill? What is it made of?
Peter Chi: It’s called polymethylmethracrylate. Fancy name but what it is, it’s a polymer. Actually, the orthopedic surgeons have been using the same material for hip repairs and so forth. So it has been used for a long time. It has only been recently that finally, a manufacturer has been able to put that together and get it FDA approved so we can inject it on the face.
Teri Hausman: Does it hurt?
Peter Chi: Without local anesthetic. We’re using a larger gauge needle so it does hurt more than Restylane but I always do a nerve block or a dental block, what have you, and numb it up.
Teri Hausman: That’s good! I’m all for that!
Peter Chi: Yeah, so the patient doesn’t feel it.
Teri Hausman: I like all the products. I’m a baby with that stuff. So that’s good! So numbing cream doesn’t actually work then? You have to do a block?
Peter Chi: No, you have to do a block. The numbing cream doesn’t work.
Teri Hausman: The numbing cream doesn’t work unless you have somebody to drive you and you can drink. [laughter]
So you’re saying then, after your couple treatments, you really do think this is permanent? Some of the doctors are touting some of these other injectables as permanent, but they’re really not.
Peter Chi: Yeah, you know, I think the FDA study for ArteFill has gone on for five years. As far as I’m concerned, if you can see clinical effects for five years, I think that’s pretty permanent for all practical purposes. Five years is good.
Teri Hausman: Five years is good. What about Radiance? How long does Radiance work?
Peter Chi: I think they’ve got FDA approved for something like a year or two. I’m not certain whether it’s a year or not. But I think Radiance is also considered, they call it semi-permanent, but I’ve seen some patients with results from Radiance that last longer than two years. I have not followed them beyond two years but in two years they’re still pretty good so I think that’s a long, long time.
Teri Hausman: For our listeners, will you define Radiance and Restylane and Juvederm? I think this is what is so confusing because I know all about the injectables but I even get confused.
Peter Chi: Yes. And I think the decision as to which one to use is you have to decide number one: Do you want something permanent or do you want something temporary?
Number two: Once you decide on that, the area that is injected.
Obviously, you’re not going to inject an area that is extremely soft, sensitive with Radiance because Radiance is very firm; it’s much firmer material. So such as the lip, that’s hard to do. You have to inject it very deep because if you inject it too superficially, you are going to feel it and see it.
And then number three: Of course you have to see longevity and the comfort level of the surgeon or the doctor who is injecting it.
I personally am very comfortable with ArteFill, Artecoll because it’s soft; it feels very natural. Not to say that Radiance is inferior, but it all depends on the physician as well. But you do need a collagen test though too for ArteFill.
Teri Hausman: That was my next question: Do you need a test? What does it entail?
Peter Chi: It’s a very simple little test. You come in and we inject a tiny little blab of collagen on your forearm to make sure you’re not allergic to it. Fourteen days later or twenty-eight days later, as long as you don’t develop a skin reaction, it means that you’re not allergic to collagen so then you can schedule for ArteFill anytime.
Teri Hausman: But if you’ve had the test for collagen, that wouldn’t be the same as ArteFill, so you would still have to go to test.
Peter Chi: If you’ve already had collagen before and never had a reaction, then you are totally safe for ArteFill. It’s the same collagen, bovine collagen.
Teri Hausman: Fantastic! We’re going to need to take a break to thank our sponsors and we’ll be right back with Dr. Chi and talking about ArteFill.
Hi we’re back with Dr. Chi and he’s answering all our questions about ArteFill and all the injectable fillers so we can continue on our quest for anti-aging. Welcome back Dr. Chi.
Peter Chi: Thank you.
Teri Hausman: So last we were talking about the skin fill called ArteFill.
Peter Chi: Right.
Teri Hausman: How many people are allergic? What would be the percentage of people that would actually come up allergic?
Peter Chi: This would be extremely rare. I only recall, ironically, one of the persons that was allergic was one of the sales reps for collagen.
Teri Hausman: That would be so sad!
Peter Chi: Yes, many years ago. And since that one, I perhaps maybe recall only two other patients perhaps. So it’s extremely, extremely rare.
Teri Hausman: That would be really sad if you worked for the company and you weren’t able to get it.
Peter Chi: Exactly but it’s extremely rare but it’s something that you must do.
Teri Hausman: OK let’s talk price. I would think that this would be more expensive just because it would be permanent so it wouldn’t be as affordable as the other ones.
Peter Chi: Yes.
Teri Hausman: So we should do that too because I think Restylane and Juvederm, you can do little by little so it’s more affordable for the main public. But this would be a little bit more pricey, I would think. Is that true?
Peter Chi: It is a little bit pricey but you probably can think of it in the long run. You actually save more money because you certainly don’t have to come back repeatedly for getting Juvederm or Restylane. This is a one-time investment that stays with you much, much longer so in the long run, you probably save money.
But let me give you a ballpark of the price. It could be probably from anywhere from 1100 to 1500 dollars for one syringe which is 0.8 cc’s. What does that mean? It usually means--for example, if you wanted to correct the laugh line. In our experience, to adequately correct the laugh line, of course it depends how deep you have it, usually the range is anywhere from one half syringe to a full syringe for each side.
So in other words, to correct both sides, at a minimum you need at least one syringe, up to a max of probably about two syringes.
So you could spend anywhere from 2200 dollars all the way to 3,000 for correction of your laugh line.
Teri Hausman: Right. But a lot of surgeons will allow you--is this not correct--to come in and pay for half of your syringe and then you come in to get the next bout of it and then you pay for the other part. Is that true that many surgeons do that?
Peter Chi: Yes that is true. Like I said earlier, sometimes we don’t like to inject the entire syringe that you need right off the back. We like to do it sort of step wise.
Teri Hausman: Like the hem of your dress, just a little bit at a time.
Peter Chi: A little bit at a time, exactly. So it is possible. Usually if you were to do that, we would like you to come back about four weeks out.
Teri Hausman: Four weeks out.
Peter Chi: Yes and what is interesting is this. With any injectable, whether Restylane or ArteFill, we’ve actually, like I said, we did a study. We have taken pictures of patients, of the laugh lines before and after, three months out, six months out, nine months and twelve months out. To our surprise, you will find, some of the results that are at nine months are actually better than three months out.
Why? Because after we inject this material, your body will form some collagen or some scar tissue or tissue around the substance that you injected. And that in itself has an additional filling effect.
Teri Hausman: So basically, you’re telling me that the collagen is being stimulated so it looks even better after months.
Peter Chi: That’s exactly right. So if you feel that you don’t get an adequate correction, I really would not be in a hurry to right away to “you must get the syringe right today.” In fact, we have a few patients that are like that and we have them wait for about a month or two and come back. We take another picture and we can show them, “Wow you’ve actually improved over time.” So sometimes, that is certainly a possibility that you probably require less than you think.
Teri Hausman: And so that’s why you tend to under-inject when you first go in.
Peter Chi: Exactly. I don’t think it’s a good idea to be too aggressive with these semi-permanent injectables.
Teri Hausman: I concur with that. That is something that I’ve always thought. If you over-inject, it’s pretty sad because you have to wait for it to go down.
Peter Chi: Correct.
Teri Hausman: The other thing I wanted to ask you about is, this is not a replacement for Botox.
Peter Chi: No, this is a totally different, mode, modality in terms of rejuvenation, and both work in different ways. Botox works by stopping or weakening your muscle action that forms these frown lines while these fillers basically fill these lines when you don’t have any muscle action.
For example, a lot of people have these number elevens or frown lines on the forehead.
Teri Hausman: Number elevens; I like that!
Peter Chi: You’ll see them even when they don’t frown. That’s when the filler is very, very helpful because even when they don’t frown, you’ve got these lines so you need something to fill it so that these lines will be less apparent. But what Botox will do is will stop these lines from getting deeper and it will soften these lines further by relaxing the muscles that form these lines.
So these two substances, one is a filler, the other one is Botox, work in totally different ways but they are synergistic when it comes to the frown lines.
Teri Hausman: Now don’t doctors have to be really careful with the frown lines because there is a major vein there that you can hit that can cause necrosis?
Peter Chi: Rarely that happens. As long as you inject it medial to the supraorbital nerve or the supraorbital notch, which is close to the medial one third of your brow, as long as you are medial or inside of that line, you are totally fine. I really don’t think that’s too much of a concern.
Also, with Botox, it’s amazing how shallow or how superficial these muscles are located. Anybody who is a surgeon who does forehead lifts will appreciate that these corrugator muscles, the muscles that actually respond for frowning are pretty close to your skin. And understandably so, because that’s how they form the lines and the wrinkle lines.
Teri Hausman: But with ArteFill, you would have to go deeper so you’d go deeper than the Botox.
Peter Chi: Well with ArteFill, you’re actually going underneath the skin. You are actually underneath that dermis. So you are actually above the muscle and just below the skin. Botox, you probably have to go a little deeper. You have to get it directly into the muscle.
Teri Hausman: Oh I see. And you can use a thinner needle.
Peter Chi: Oh absolutely. Botox uses really small needles like 30-gauges and that’s a very fine needle. You cannot use that for ArteFill. The ArteFill would not be able to go through that needle.
Teri Hausman: I also want to ask you, do you “botox” necks for women?
Peter Chi: Yes I do. I probably don’t do it very often because most of the time I do surgery for those patients to improve those chords that run down the middle of your neck. Those are probably best simply improved with surgery. But yes, I have injected some Botox in there. They do get some modest improvement but certainly not to the same extent as surgery.
Teri Hausman: But what about doing the surgery and the Botox? Is that not necessary to botox the neck?
Peter Chi: No, I really don’t think so. I don’t think that is necessary at all. Because the surgery, what you’re doing is you’re actually either cutting the muscle--there are many different ways of doing it. You either cut the muscle or you plicate--you bring the muscles together. Both techniques basically alleviate that chord appearance of the neck and once it’s gone, it’s gone. I really don’t think Botox is going to do very much after that.
Teri Hausman: I have seen a few of my friends that have had that surgery and then those chords come back in a way so that they’ve needed to do Botox and that’s a temporary fix though, like you’re saying. So if there were a way to cut those chords out, it would be good.
Peter Chi: Yes and there is a surgical method of cutting those chords and you’re right. Some patients have--what will happen is the stitch gave way and as the patient continues to age, those chords will eventually return. Oftentimes, one of the ways of alleviating it permanently is sometimes just to cut that chord out which is the front edge of a muscle in the neck. And that could be easily done with a tiny little incision that is made below the chin.
Teri Hausman: Well, we’re going to have to do another show on that one because I actually would like to talk about necks the whole time. A lot of women don’t like their necks. Their face looks so great because of fillers like ArteFill and Radiance, Restylane, all those and then their necks don’t look so good. That’s how you can really tell a woman’s age.
Peter Chi: You are absolutely right. I have to tell you. I always tell patients to put a lot of sun block on the neck, well of course their face too. But we have very few surgeries that can improve the neck. For that reason, you should probably pay more particular attention to the neck than the face. We have a lot of procedures available for the face but unfortunately, not very many for the neck and not very effective either.
Teri Hausman: OK so ladies we need to take good care of our necks. We’re listening to Dr. Chi tell us about out necks. I think that’s great advice because I do think that’s one thing that I hear a lot of women say about other women. It’s like, “Oh her face looks good but her neck doesn’t.”
Peter Chi: Right, right. We’ll leave it for another segment but there are other modalities that can tighten skin without downtime and that may have a role in the neck. But right now, certainly, we don’t have very good surgical or good aggressive way of improving the neck like we do on the face.
Teri Hausman: Well we’re here to find out all that we can from anti-aging. Is there anything else you want to say about ArteFill before we get off the air?
Peter Chi: I try to answer some of the things that my patients generally ask me. One of the things that patients always ask me is if ArteFill feels very natural. No foreign body that we inject in the body feels natural on its own. It feels natural because of where we inject it. The deeper we inject, the more natural it’s going to feel.
Teri Hausman: And look, right?
Peter Chi: I’m sorry?
Teri Hausman: And look natural. I think that’s a big factor.
Peter Chi: Exactly, exactly. And the deeper you inject it, the more natural it will look. It’s when you inject it too close to the skin that these injectables will show and you will feel it. That’s probably one of the things that you need to remember.
Teri Hausman: What can you do if that does happen to you from somebody else?
Peter Chi: I always tell the patient to massage it and massage it. Eventually, it will go out. This may even take a few weeks; it might even take a few months.
Teri Hausman: And to find a qualified doctor. What you can do is you can go to personallifemedia.com and we have all the board certified surgeons and also Dr. Chi who, if you want a transcript of today’s show, you can go to personallifemedia.com. We’re going to link Dr. Chi’s website to our website. And you’re going to be able to find him and other qualified surgeons who inject ArteFill.
Thank you so much Dr. Chi. We are running out of time. I’ve really enjoyed talking to you today. We’re going to have you back to tell us more of what we can do about our necks.
Peter Chi: Sure. Very well.
Teri Hausman: And I really appreciate talking to you. So that’s ArteFill ladies. I shouldn’t leave out the men. The men might want to get their “elevens” injected. You can go to our website and find out and if you want to email me, you can email me at [email protected]. Thanks and have a great day.
[music to end of audio] “You Had A Little Work Done” by Mark Winter (http://www.mark-winter.com/)