Alexander Rivkin, MD
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Alexander Rivkin, MD
Plastic surgeon | Views: 244041

Friendname: AlexanderRivkinM.D.
Business Name: Westside Aesthetics
Website: www.westsideaesthetics.com
Location: 1033 Gayley Ave #104
los angeles, CA 90024
United States
Telephone: 310 443 5273
Languages Spoken: English

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Ask An Expert > Alexander Rivkin Message Board > switching to a permanent filler after using juvederm?
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switching to a permanent filler after using juvederm?
I'm 31 and have been using juvederm for a couple years to add volume to, and better define, my cheek.
About six years ago I lost a significant amount of weight from what was an already healthy weight. I was extremely underweight and as a result lost fat from my face which has not come back (even after gaining weight back) and left my face looking flat and gaunt.
I am very happy with the results I get from juvederm, I use one syringe to fill both sides of my face, but am looking for a more permanent solution.

I have read mixed results about artecoll, am enticed by it's long lasting appeal, but am worried about disfigurement, lumping and scaring.

Would I be a good candidate for a permanent filler? Or should I stick with juvederm?

Thank you!

Plastic surgeon
los angeles, CA
United States
View My Professional Profile
Maybe, but not my first choice  April 12, 2013 1:33 PM

I use Artefill all the time to augment noses and chins, but i would hesitate to use it in the cheeks. First of all, you will need alot of Artefill - most likely 2 syringes at a time and one session is almost never enough. It will get pricey. I would try Radiesse first. It should get you more duration - 10 to 12 months, and you will not need more than 1 syringe. We are anticipating the approval of Voluma - that will be a hyaluronic acid filler that lasts even longer.

beverly Hills, CA
United States
View My Professional Profile
  April 16, 2013 7:35 PM

The popularity of facial restoration by injectablea has seen the approval of various injectable fillers and toxins by the FDA which should have never seen the light of day. The effects of best injectable filling agents are temporary and very rarely associated with permanent problems. In the past, the permanent injectable silicone had been used but had been so problematic that the Justice Department filed injunctions against certain physicians on behalf of the FDA. After 2000 a dangerous pattern grew in the corridors of Washington, D.C., where politics and money changed the face of America and the field of aesthetics to the detriment of the faces of the consumers. Industry has accomplished the approval of synthetic agents which should have never reached the market. Once injected under skin the body cannot digest these agents and the immune system walls them off with resultant formation of nodules, which at times require surgical removal. One such product that was approved was Artefill® or Artecoll®. This product is polymethylmethacrylate or which is injectable Plexiglas beads. This product has long been associated in the worldwide dermatologic literature with scarring, and disfigurement only amenable to correction by surgery. At present, Artecoll®, the predecessor of Artefill®, is no longer available in Europe or Canada. In 2003, the American Society of Dermatologic Surgery newsletter 'Currents" promoted the use of Artefill® to fellow dermatologists. Physicians in this Newsletter encouraged and promoted the use of this agent. It was later revealed that at least one of these physicians had been given a large amount of stock (35,000 shares) by the manufacturer, which was not publicly revealed.
We knew from the experience of Artecoll® in Canada that pharmaceutical companies cannot be relied upon to report adverse events to authorities, yet the FDA claims that it can evaluate adverse reactions by relying on doctors and "Big Pharma" to report these directly to the FDA. Furthermore, merely changing the name of the product (e.g. Artecoll® to Artefill®) doesn't change the history or adverse experiences of the past. In the literature, consultants have used the names interchangeably. Furthermore, if Artefill® is new and improved, how can one gain FDA approval of Artefill® by studying Artecoll®
In 2003 The "Currents" newsletter of the American Society of Dermatologic Surgery established an expert panel on fillers from which I was excluded. This was odd as I was the filler editor of the Journal of Dermatologic Surgery as well as the recognized world authority on fillers. Could the reason be that I had lectured prior to this newsletter on the problems with Plexiglas fillers? It was well known to me that Artefill®/Artecoll® (Artes-Medical, San Diego, CA) caused severe adverse reactions which frequently required surgical removal of the product. It was later revealed that Artes founder Dr. Gottfried Lemperle, a
plastic surgeon, improperly injected 10 people in the United States with some form of the company's wrinkle-filler before it was approved for market by the FDA. Subsequently, Gottfried Lemperle resigned as the company's chief scientific officer and a director but was retained by the company briefly as a consultant.
Both Gottfried and his son were cited in a lawsuit filed by Hairdresser Elizabeth Sandor, 40, who alleged in May 2006 that Dr. Lemperle used Artefill® as an injection to fill her facial wrinkles in 2002. She alleges that Lemperle falsely convinced her that Artefill® had received FDA approval, and that he never disclosed his lack of license in California. Her claims detail suffering of pain and disfigurement she attributed to a reaction to Artefill. Sandor's face was inflamed, she had scarring near the injection sites and had a fever and aches and pains. Prior to approval by the FDA there were European reports of a significant incidence of large lumps 3-4 years post implantation. Furthermore both Germany and Switzerland had already advised physicians not to use this product.
The purpose of the FDA is to protect the public interest in safety and efficacy of all medical products. Prior to the release of Artefill® in the USA, I contacted a senior member of the FDA with articles regarding the foreign experience with Artecoll but this did not prevent release of this product. Subsequently an article which quoted me in the Wall Street Journal revealing the seriousness of adverse reactions to Artefill® helped cause the parent company to go into bankruptcy.

Recently Suneva Medicial Inc. San Diego,Ca has brought this product back to market. Why ? Because. These products have gained approval because these paid physicians ensure that the products are marketed to doctors reading the trade journals and through communications from their medical societies. These products fill the communication highways of the medical community despite a total lack of information and scientific data concerning their behavior once injected under the skin. Some of these agents have had a disastrous history abroad, but the FDA aesthetic device panel showed disinterest in these studies. Since when does the FDA not pay attention to controlled studies? The answer is simple, when their results are not agreement what the industry is supporting. The lead physicians appearing before the FDA supporting many of these agents were foreign and not licensed in the U.S. Furthermore, on at least one occasion the physician's significant financial interest in one of these companies was not disclosed. Often times the studies they performed were done outside this country and of questionable validity yet the FDA was most accepting of this data. I feel it is critical these studies be done in the USA.Throughout the time I was attempting to awaken the FDA to the problems with Artefill® I attempted to reach Stephen P. Rhodes, a pivotal individual who works closely with the Cosmetic Device Panel of the FDA. He had been working closely with Artes but only contacted me after my article was published in the Wall street Journal about the severe problems with Artefill®. In response to my article; a public hearing was held in November 2008 at the FDA regarding problems with injectables. The meeting was led by an oncologic surgeon and invited spokesmen were plastic surgeons with a poor understanding of the art and science of injectables. I spoke to the oncologic surgeon and he promised me I would be given sufficient time to speak.
I traveled 3000 miles yet at the meeting was not allowed to speak to panel members and was given 4 minutes to review my 30 years experience with fillers. At the hearing they evaluated all fillers as a single group which prevented a thorough evaluation of each injectable. As a result only the most frequently used injectables received warnings. What I took away from that meeting was the realization that freedom of speech had all but been extinguished at the FDA. They was far more interested in protecting the manufacturers than the patients. In this the patients would better described as victims!
]In 2013 medical meetings have become nothing more than trade shows where drug companies discuss and demonstrate their latest wares. The meetings are often held in grand resorts at distant foreign locales. Additionally, much of the medical literature itself has evolved into nothing more than promotional material of questionable accuracy also underwritten by Big Pharma. Presently even continuing medical education (CME) in the USA is no longer a science but a business where the manufacturers of these products promote the use of filler products and even teach off label use (using the product outside of what the FDA has approved it for) without regard for informing doctors of adverse reactions. The manufacturers underwrite the costs of these large conventions and CME courses to the tune of a billion dollars annually. In the world of facial Aesthetics especially this behavior is rampant? So please be cautious of what you put in your face and read before you have anything injected.
Arnold W. Klein, MD
Professor of Medicine and Dermatology UCLA
Klein Chair in Dermatology UCLA
Consultant to the General and Plastic Surgery Devices Panel of the FDA "Doctor Klein is a brilliant physician and a amazing artist"
-Larry Ellison

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Plastic surgeon
Miami, FL
United States
View My Professional Profile
  April 17, 2013 5:19 AM

Dr Klein is the expert and I totally agree with his responses.



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