Many attempts have been made during past decades to fill wrinkles or scars with biological or artificial implants. Most biological materials are however, reabsorbed within 1 year, where synthetic materials until now, showed side effects like migration, granuloma formation, late allergic reaction and other unwanted material behavior. This is mostly caused by a wrong selection and use of materials. Size and shape also play a role. Based on the history of all known implant materials, of biological or (non) biodegradable synthetic origin, Professor Gottfried Lemperle, Department of Plastic Surgery, St. Markus Hospital, Frankfurt, Germany, developed the theory of subdermal augmentation by using microspheres of polymethylmethacrylate in an injectable form. All microspheres have a defined size of 32-40 microns in diameter and have a smooth round surface, thus showing optimal, lasting, results with limited side effects. The use of PMMA in the medial field has been common practice since 1945. PMMA is applied in dental prostheses, hip implants, bone cement, inter-ocular lenses, repair material for cranio-facial surgery as well as many other medical devices. The chemical inertness and biocompatibility of PMMA has been positively discussed in many scientific articles. Animal experiments with PMMA microspheres were undertaken in 1985 at the University of Frankfurt, to prove the biocompatibility of the material. The first use as tissue augmentation material in patients started in 1989 and between 1989 and 1999 and used in over 100 000 patients. To date, all case studies of Artecoll have shown a high degree of safety and an extremely low complication rate.