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Should Americans Cross The Border To Get Artecoll For Acne?

By Megan Griffith

Reviewed for medical accuracy by Dr. Jaggi Rao,
MD, FRCPC Double board-certified dermatologist

Artecoll is a filler for acne scars that has been available in Europe for about a decade and available in Canada and Mexico almost as long. It has become relatively inexpensive, just about US $300 per treatment at clinics conveniently located at the US border in Canada, and as little as US $100 per treatment in Mexico and Costa Rica. That’s a lot less than people who have acne scars will pay for their treatments in the United States. But is treatment with Artecoll a good idea?

artecoll acne scar treatment
Artecoll can be used to treat acne scars, but some side effects occasionally occur.

What Is Artecoll?

Artecoll is an injected filler for acne scars. It consists of about 75% beef collagen and about 25% PMMA (polymethyl methacrylate), the same substance that is used in many other cosmetic procedures for certain dental procedures and bone repair. Outside the USA, Artecoll is used for filling in wrinkles, folds, and scars1.

How Does Artecoll Work?

Artecoll works in a way that is completely different from Botox. Injections with Botox temporarily paralyze the muscles underlying the skin2 so that they cannot force the skin to wrinkle. The plastic microspheres of Artecoll hold beef collagen in place in the skin long enough to provoke an allergic reaction. The swelling of the tissue just beneath the skin triggered by the collagen, which later breaks down and is absorbed by the body, creates just enough swelling to erase a scar or a wrinkle. Or at least it does in most cases. Results are not visible for up to 3 or 4 months.

How Long Does Artecoll Treatment Last?

Botox treatments have to be repeated every 3 or 4 months. Injections with another popular filler, hyalouronic acid, have to be repeated every 6 to 12 months. Artecoll lasts up to 5 years, although it does not stop new wrinkles from forming if the sun is exposed to too much sun.

Can Anything Go Wrong With Artecoll?

The advertisements for Canadian Artecoll clinics will tell you that over 100,000 men and women of all ages have been treated with Artecoll in Canada, and only about 100 have suffered a serious side effect called granuloma. In these relatively rare cases the product generates too much inflammation, and the skin generates a lump, a knot, or a small area of skin discoloration that has to be treated with an anti-inflammatory drug or surgically removed.

It’s possible to have a serious, systemic reaction to Artecoll, but responsible practitioners will give you a small test injection first to confirm that you do not have a strong allergic reaction3 to the treatment. Don’t have Artecoll injections if you have not been given the test treatment.

So, Why Isn’t Artecoll Available In The United States?

So far, it seems like the only reason Artecoll isn’t available in the United States is that the FDA’s regulations haven’t caught up with the research. Several studies on Artecoll have been conducted in the United States and found that Artecoll is both effective and safe. For instance, one article conducted on 38 participants in Arizona found that Artecoll was a more effective treatment than collagen4 in all areas except around the lips or mouth, with no more adverse reactions than those associated with collagen. That study is a little small, so you might be wary to trust the results, which is why we also want to direct your attention to another study which involved 251 participants in the United States. This study also found Artecoll to be more effective than collagen, with no significant difference between the two when it came to adverse effects5.

OK, I’m Not Going To Canada To Get Artecoll, What’s Available Instead?

There are a number of treatments for acne scars other than Artecoll. Here are just a few of them:

  • Artefill/Bellafill. Artefill is a microsphere-based filler remarkably similar to Artecoll, but it’s approved by the FDA for the treatment of “smile lines,” AKA, the wrinkles around your mouth and nose6. Like Artecoll, it contains 20% microspheres and 80% bovine collagen, but it also contains 0.3% lidocaine. Technically Artefill has not been approved for use with acne scars, but many dermatologists will still use it for that purpose because it works. However, if you want to use a filler that is officially approved by the FDA for treating acne scars, there is another option: Bellafill. Bellafill is the newest version of Artefill, and it is officially approved for the treatment of “moderate-to-severe atrophic, distensible facial acne scars on the cheek in patients over 21 years of age”7.
  • Laser resurfacing. The downside of getting laser resurfacing for acne scars is that some kinds of scars, such as ice-pick scars, just can’t be treated with laser resurfacing. The results take several months, and the procedure may have to be repeated a number of times8. Each laser treatment is about twice as expensive than Artecoll, which is only done once.
  • Injections of bovine collagen without the PMMA microspheres that hold it in place. Bovine collagen is “Jell-O” made from cow tendons. This procedure works in the same way as Artecoll, without the PMMA microspheres to hold the collagen in place so the skin fills in precisely as desired. It is found to work well for people with soft, distensible scars9.
  • Injections of human collagen, products such as Cymetra or Fascian. These products are made from collagen taken from human cadavers, with and sometimes without the consent of the family. Aside from the creepiness factor, human collagen has its benefits and its problems. The product works without inducing an allergic reaction. You get the “fill” as soon as it is injected. But the way this kind of collagen is injected, the dermatologist can’t necessarily see the injection site. It’s relatively easy to hit a blood vessel and cause a bruise. Plus, if you are allergic to lidocaine, or if you take an anticoagulant like Plavix, you can’t have this kind of collagen injection.
  • Injections of your own fat. The plastic surgeon withdraws fat from your hips or belly and injects them into the scars. Your body won’t reject its own fat. But it will, eventually, burn it. Fat injections only last a few months and aren’t appropriate for all kinds of scars.
  • Microinjections of your own blood. In this treatment, the dermatologist draws your own blood10, spins out the red blood cells, mixes the remaining plasma with calcium, and uses a micro-tattoo device to needle it into your face. The downside? The procedure makes a bloody mess, and very few doctors perform it. Each treatment is about $600.

It’s also possible, of course, to manage your scars with makeup, though deep atrophic scars can sometimes be difficult to hide completely even with makeup. If you aren’t sure where to start with your acne scar treatment, it may be helpful to make an appointment with a dermatologist and get their professional opinion.

 

References:

  1. Lemperle G., Sadick N.S., Knapp T.R., Lemperle S.M. ArteFill® Permanent Injectable for Soft Tissue Augmentation: II. Indications and Applications. Aesthetic Plastic Surgery. 2010;34(3):273-86.
  2. Kang S.M., Feneran A., Kim J.K., Park O., Kim J.E., Won C.H., Chang S., Lee M.W., Choi J.H., Moon K.C., Youn C.S., Cho S., Lee S.H. Exaggeration of Wrinkles after Botulinum Toxin Injection for Forehead Horizontal Lines. Annals of Dermatology. 2011;23(2):217-21.
  3. Haneke E. Managing Complications of Fillers: Rare and Not-So-Rare. Journal of Cutaneous and Aesthetic Surgery. 2015;8(4):198-210.
  4. Thaler M., Ubogy Z. Artecoll: the Arizona experience and lessons learned. Dermatologic Surgery. 2005;31(11 Pt. 2):1566-1574.
  5. Cohen S., Holmes R. Artecoll: a long-lasting injectable wrinkle filler material: Report of a controlled, randomized, multicenter clinical trial of 251 subjects. Plastic and Reconstructive Surgery. 2004;114(4):964-976.
  6. Lemperle G., et al. ArteFill® permanent injectable for soft tissue augmentation: I. mechanism of action and injection techniques. Aesthetic Plastic Surgery. 2010;34(3):264-272.
  7. Wollina U., Goldman A. Fillers for the improvement in acne scars. Clinical, Cosmetic, and Investigational Dermatology. 2015;8:493-499.
  8. Connolly D., Vu H.L., Mariwalla K., Saedi N. Acne Scarring—Pathogenesis, Evaluation, and Treatment Options. The Journal of Clinical and Aesthetic Dermatology. 2017;10(9):12-23.
  9. Varnavides C.K., Forster R.A., Cunliffe W.J. The role of bovine collagen in the treatment of acne scars. The British Journal of Dermatology. 1987;116(2):199-206.
  10. Alser O.H., Goutos I. The evidence behind the use of platelet-rich plasma (PRP) in scar management: a literature review. Scars, Burns, and Healing. 2011;115(2):230-4.
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