Hey everyone,
So I've scoured these boards for quite a while, and mainly the conversation has been dorminated by lasers.
I want to hear about people's experiences with the fillers with greater longevity, specifically Silikon 1000, radiesse, and artefill. With the controversy around delayed reactions to silicone, I'm curious as to why there's virtually no mention of Artefill. To my knowledge, it is the only FDA approved permanent filler (Silikon 1000 is used off-label as a medical device).
The mechanism by which it works is in some ways similar to Radiesse and Silicone. It is similar to Silicone because there are microspheres of PMMA (a kind of plastic) that cannot be absorbed by the body. This causes a foreign body response where the body walls off the microspheres with collagen, which creates fullness and lifts the depressions. Imagine a grain of sand that gets caught in a clam that is walled off and becomes a pearl. It's the same idea here. In radiesse, there is also a similar fibrotic response, however, the augmentation is not permanent like silicone or artefill.
Be interested to hear about your experiences with long term fillers.
The controversy surrounding silicone fillers are justified, ESPECIALLY since many of them were done by practitioners who had no idea what they were doing and without awareness of possible long-term side effects. Not to mention, if a silicon filler goes wrong, you're stuck with it for life, unless you go through major surgery that makes your scars even worse.
I've had three rounds of silicone microdroplet as well as one round of artefill. And I still have pretty noticable scars, but maybe softer from the artefill. The first two rounds of silicone I had done over five years ago, and never had a problem, nothing bad to report. After the third with a different doctor I did have an initial reaction at the injection site which I think caused another small scar, but after it resolved, no lumps or granulomas. Really no collagen growth either.
Artefill caused alot of inflammation at first, made the scars feel kind of hard. Didn't like that too much, but eventually it faded and I do think months later there was a little plumpness. But it wasn't enough to make the scars look that much better. I am too scared to get more, as I think it could be donuting a bit around my scars. I have been turned down for subcision multiple times.
If you want a filler that is safe look for LaViv by Fibrocell. I would do it if I had the money.
One doctor just said it would cause more scarring, another doctor said my scars weren't the right type, and he said he did do a lot of subcision in his office. However I think they are bound down a little, but maybe still to superficial for the subcision to do much good. They are soft saucers but I have two larger ones on my left cheek that are right by each other and they really annoy me! I thought fillers would work because when I filled them with saline injection they did look better, but alot of that was just swelling. So, when they swell they look good, but can't get fillers to achieve that look well.
When it comes to silicone and artefill you just want to put in a little at each time, so as to know cause an immune reaction that will cause a granuloma. Decades ago they put it in large volumes, for buts, breasts, even legs I read, and that went horribly wrong. Not much complaints from silicone microdroplet but you need to find a good doctor.
I have not heard good things about radiesse so I won't get that. Artefill is pretty safe now, they came out with a new version just a few years back that is even safer. But, I would never want large volumes of it in my cheeks for things like cheek contouring or fat loss, only for small scars. I wouldn't even want it under my eyes, as that is a problem area for it to stick out and look bad.
You just have to educate yourself on these fillers, they have problems just like laser, but really I didn't want to burn my face off and hope for the best.
Ive had 4 rounds of silicone and i think its the most effective procedure for rolling acne scars period. However you absolutely must go to someone with at least a decade of experience or dont do it at all. My first doctor put too much silicone in a few areas so i switched to Dr. orentriech whose has ~20yrs experience and he did a much better job. Its not a miracle procedure and i still have severe scars on my cheeks, but it did improve the scars on my forehead and glabellar area a lot so im happy i did it.
I've had experience with pretty much every filler on the market except artefill. Yes, I think silicone was used totally inappropriately in the past, meaning in large volumes without the microdroplet technique. I think there also has to be a distinction made between unscrupulous, black market silicone (often industrial grade silicone you find at the auto store) and the purified, medical grade kind that is used "on label" for the eye (off label for scar revision).
I've done two sessions with a DR here in LA, but its been really hard to judge the improvement. Perhaps I need to do more sessions, but I held off after reading some articles that TokyoGirl posted stating that it may be risky if you plan to do laser. There seems to be some differing opinions on this though, because on Realself.com I read that Dr. Jay Barnett (a pioneer in silicone for acne scars) claims that it is safe. I guess the jury is out on this one. To err on the side of caution, I'm going to go through a couple more laser sessions before I do anymore silicone. Personally, I did go through with laser and I haven't seen any side effects from the previous silicone sessions. Maybe i've been lucky or maybe the side effects will pop up later.
Oopli, when you say too much was put in some areas, how did u reduce the lumpiness? With kenalog / cortisone shots? Did the silicone not soften the scars on your cheeks at all? Why did you stop the sessions?
I think with fillers, it's really really technique dependent. Unfortunately I have made the mistake of going to some Med Spa instead of a doctors office in the past, and the result was subpar. Lets just say I walked around with hamster cheeks for a few months.... embarrassing to say the least.
Silicone IS safe. For people that aren't allergic to it, it's 100% inert inside the body. The issue has always been the application of it, which requires a very good doctor, but that's true for any procedure.
In any case, the real issue arises when people begin to age, the effects of which haven't been properly researched yet.
Oopli, when you say too much was put in some areas, how did u reduce the lumpiness? With kenalog / cortisone shots? Did the silicone not soften the scars on your cheeks at all? Why did you stop the sessions?
I have two bumps that Dr. Orentrich injected with kenalog 3 times and it didnt help, he said he could use a higher strength next time. So the bumps are still there, and I think they always will be-silicone is very unforgiving. The scars on my cheeks did improve, but the shallower they become the less amenable they are to silicone because you start risking over correction. Silicone is only meant to do the "heavy lifting" of deep scars so i still have some shallower rolling scars and a bunch of boxscars. As far as lasers go, i think its completey safe to use them with silicone, none of the doctors ive spoken with have said otherwise.
Your forehead looks great oopli, thanks for reporting back on your experience. I think you are right in that silicone can't help certain types of scars, maybe that was my problem all along, my scars are not super deep but some are wider. The lady that did my artefill did not recommend a second round because she thought most of my damage was texture and not depth, so she recommended dermaroller. She performed it on me but it didn't really help. I have since done the dermastamp myself and while it may help some will never give me the improvement I want.
I was also concerned about laser after silicone. What I have read is it may cause more inflammation in individuals with silicone during the healing process, which could cause complications. If the silicone was applied to shallow in the skin the laser could also burn it and it would cause more scars. However, I have read of numerous people that have had laser after silicone with no complications. I just haven't read of that many great stories from laser, maybe with something like recell afterwards it would help, but laser is such a risk in my opinion.
Silicone IS safe. For people that aren't allergic to it, it's 100% inert inside the body. The issue has always been the application of it, which requires a very good doctor, but that's true for any procedure.
In any case, the real issue arises when people begin to age, the effects of which haven't been properly researched yet.
How can you say it is safe when most doctors do not recommend it, not even the microdroplet technique. Yes there are people who have posted good results, and I don't doubt that one bit. Nobody is saying silicone will not plump up the scar and give dramatic results today, of course it will. That is not the issue, the issue is your last statement, "In any case, the real issue arises when people begin to age, the effects of which haven't been properly researched yet."
The issue is not about what you look like today, but what you will look like tomorrow...what you will look like in 10, 15, 20 yrs. Nodules, scar tissue around the silicone, bumps, ever growing tissue and over-correction around the silicon.
When there are a mass of people who get the procedure, and 20 yrs time passes with no severe complications, then I'll believe it is safe.
I don't understand why even go the route of something so permanent with an unproven track record. What is wrong with once a year going to the doctor and getting a temporary filler that lasts a year?
Silicone IS safe. For people that aren't allergic to it, it's 100% inert inside the body. The issue has always been the application of it, which requires a very good doctor, but that's true for any procedure.
In any case, the real issue arises when people begin to age, the effects of which haven't been properly researched yet.
How can you say it is safe when most doctors do not recommend it, not even the microdroplet technique. Yes there are people who have posted good results, and I don't doubt that one bit. Nobody is saying silicone will not plump up the scar and give dramatic results today, of course it will. That is not the issue, the issue is your last statement, "In any case, the real issue arises when people begin to age, the effects of which haven't been properly researched yet."
The issue is not about what you look like today, but what you will look like tomorrow...what you will look like in 10, 15, 20 yrs. Nodules, scar tissue around the silicone, bumps, ever growing tissue and over-correction around the silicon.
When there are a mass of people who get the procedure, and 20 yrs time passes with no severe complications, then I'll believe it is safe.
I don't understand why even go the route of something so permanent with an unproven track record. What is wrong with once a year going to the doctor and getting a temporary filler that lasts a year?
I respect if you think it is too risky for you, but there actually is quite a long track record with the silicone microdroplet, over 30 years. Dr. Alkek is Texas did my first two rounds and he had silicone in his face himself and said he never had a problem and it had been over 30 years it had been in his face. It was allowed long ago, then went off market that later came back on market with the silikon 1000.You just need the medical grade. I think if you compare complications from silikon versus laser, there would be more complications from laser. You have to go conservative with silikon though. I don't think I'll ever get overfill as I never got any fill, he probably went to conservative. Oh well, tried it. I won't go for more. Even Dr. Alkek doesn't really believe in going over three rounds. You have to have a cut off point.
This discussion has been around for awhile, and I believe ylem posted the thirty year study on these boards long ago but too lazy to look it all back up
http://www.prettyskinagain.com/assets/Trmt_AcneScars.pdf
I actually googled it and found it pretty quick
You know the interesting one-liner from that article that i missed before, is in the introduction where it says :
"Artecoll (Rol Medical International, Breda, the Netherlands), consisting of 20 volume percent of microspheres of polymethylmethacrylate and 80 volume percent of bovine collagen, does not maintain its correction, and the statement that the collagen in the Artecoll solution is replaced by an equal amount of your own collagen is not proven."
The other knock against Artefill is that its incredibly expensive.
From the same article, it states that laser can be used on the same areas:
"Having the silicone in the corrected scar does not limit employing other treatments in the area, such as surgery, dermabrasion,
laser, and chemical peeling"
I may go ahead and do more rounds of silicone now. Can't believe I missed these passages before.
About ylem.... initially he was very disappointed, but from following his posts I think he ultimately concluded that it did help him. I had the impression his scarring was also severe.
If my memory is correct, he did 5 rounds with one dr. and then another 7 rounds (my god!) with another doctor.
You are right about the artefill, I have heard it doesn't last forever in some people. It wasn't that expensive for me though when I went to a Kansas City clinic, they are running all kinds of specials on artefill at a lot of different places now. I went to a woman who is not a MD but she was trained extensively by Sunco, I believe they are the makers of artefill now and she trains others as well. Also, Artecoll is different that this new version of Artefill, Artefill is now safer, Artecoll had problems.
Ylem said he was happier with the doctor who did his injections in Florida, but he did require a lot of silicone. He actually said his cheeks were fuller now. I wouldn't want any more fullness in my face, it is full enough, always had a round face! The only filler, which is really not considered a filler, I would want next is LaViv by Fibrocell, as it is natural and can be injected more superficially which is what my face needs. It can send signals up your skin to help renew it while you needle or laser which will help with depth and texture I assume.
I never want to influence people to do silicone or anything else, because anyone could have a bad reaction and I don't want that on my conscious, but I think it is not as risky as some doctors make it out to be. And about the argument of why not just get restylane every year, restylane doesn't work well for some people at all, where silicone can be used more precisely for small scars. The same is true for artefill, it is a bigger substance and you can't be as precise.
I've had Restylane injected several times but I would much rather stick with it then go for a more permanent kind of filler. I've read too many tales of problems arising later on from permanent fillers.. Fillers you have to have re-done every 6 months or so is a perfect idea in my opinion because it's more of an up-keep and continual effort rather than trying to just solve the problem quickly and never have to worry about it again (which can ultimately lead to problems later). I've also read that fillers like Restylane and the other brands that last only a few months have the ability to improve collagen growth, which I think is true when I look at the areas that have had the injections. It's not a huge difference but it still seems much better and I haven't had any fillers for two years now. Will hopefully be getting a filler treatment done soon though and I would recommend Restylane to everyone since my experience with it has been rather awesome.
