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EXHIBIT 10.44
 Execution Version




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TABLE OF CONTENTS
 PageARTICLE I AUTHORIZATION OF NOTES AND FIRST WARRANT
    
    
    1Section 1.01
    
    Amount
    
    
    1Section 1.02
    
    Maturity Date
    
    
    1Section 1.03
    
    Interest
    
    
    2ARTICLE II SALE AND PURCHASE OF NOTE
    
    
    2ARTICLE III CLOSING
    
    
    2ARTICLE IV CONDITIONS TO CLOSING
    
    
    3Section 4.01
    
    Accuracy of Representations and Warranties
    
    
    3Section 4.02
    
    Performance; No Default
    
    
    3Section 4.03
    
    Litigation
    
    
    3Section 4.04
    
    Consents
    
    
    3Section 4.05
    
    Compliance Certificates
    
    
    3Section 4.06
    
    Opinions of Counsel
    
    
    4Section 4.07
    
    Purchase Permitted By Applicable Law, etc
    
    
    4Section 4.08
    
    Proceedings and Documents
    
    
    4Section 4.09
    
    Financing Transactions
    
    
    4ARTICLE V REPRESENTATIONS AND WARRANTIES OF THE COMPANY
    
    
    4Section 5.01
    
    Authorization
    
    
    4Section 5.02
    
    Governmental Authorization
    
    
    5Section 5.03
    
    Ownership of Shares of Subsidiaries and Capitalization
    
    
    5Section 5.04
    
    Financial Statements
    
    
    5Section 5.05
    
    Existing Debt
    
    
    5Section 5.06
    
    Use of Proceeds
    
    
    6Section 5.07
    
    Foreign Assets Control Regulations, etc
    
    
    6Section 5.08
    
    Status under Certain Statutes
    
    
    6Section 5.09
    
    Additional Representations and Warranties
    
    
    6ARTICLE VI REPRESENTATIONS OF CHRP
    
    
    6ARTICLE VII FINANCIAL AND BUSINESS INFORMATION
    
    
    7ARTICLE VIII PREPAYMENT OF THE NOTE
    
    
    8ARTICLE IX AFFIRMATIVE COVENANTS
    
    
    8Section 9.01
    
    Insurance
    
    
    9Section 9.02
    
    Corporate Existence, etc
    
    
    9Section 9.03
    
    Note Security Agreement
    
    
    9Section 9.04
    
    Further Assurance
    
    
    9




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TABLE OF CONTENTS
  PageARTICLE X NEGATIVE COVENANTS
    
    
    10Section 10.01
    
    Liens
    
    
    10Section 10.02
    
    Sale of Assets
    
    
    10Section 10.03
    
    Mergers, Consolidations, etc
    
    
    10Section 10.04
    
    Nature of Business
    
    
    10Section 10.05
    
    Debt
    
    
    11Section 10.06
    
    Transactions with Affiliates
    
    
    11Section 10.07
    
    Investments
    
    
    11Section 10.08
    
    Distributions
    
    
    11Section 10.09
    
    Subordinated Debt
    
    
    11Section 10.10
    
    Inventory and Equipment
    
    
    11ARTICLE XI EVENTS OF DEFAULT
    
    
    12ARTICLE XII ACCELERATION UPON DEFAULT; PREPAYMENT
    
    
    12Section 12.01
    
    Acceleration Upon Default
    
    
    12ARTICLE XIII REGISTRATION; EXCHANGE; SUBSTITUTION AND ALLOCATION OF NOTE AND FIRST WARRANT
    
    
    13Section 13.01
    
    Registration of Note and First Warrant
    
    
    13Section 13.02
    
    Transfer and Exchange of Note and/or Warrant
    
    
    14Section 13.03
    
    Replacement of Note and First Warrant
    
    
    14Section 13.04
    
    Tax Allocation of Note and First Warrant
    
    
    15ARTICLE XIV PAYMENTS ON NOTES
    
    
    15Section 14.01
    
    Place of Payment
    
    
    15Section 14.02
    
    Home Office Payment
    
    
    15ARTICLE XV AMENDMENT AND WAIVER
    
    
    16Section 15.01
    
    Requirements
    
    
    16Section 15.02
    
    Solicitation of the Holder of the Note and First Warrant
    
    
    16ARTICLE XVI NOTICES
    
    
    16ARTICLE XVII MISCELLANEOUS
    
    
    18Section 17.01
    
    Survival
    
    
    18Section 17.02
    
    Successors and Assigns
    
    
    18Section 17.03
    
    Payments Due on Non-Business Days
    
    
    18Section 17.04
    
    Entire Agreement
    
    
    18Section 17.05
    
    Interpretation
    
    
    19Section 17.06
    
    Headings and Captions
    
    
    19
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TABLE OF CONTENTS
  PageSection 17.07
    
    Counterparts; Effectiveness
    
    
    19Section 17.08
    
    Severability
    
    
    19Section 17.09
    
    Governing Law; Jurisdiction
    
    
    19Section 17.10
    
    Waiver of Jury Trial
    
    
    20Section 17.11
    
    Expenses; Attorneys Fees
    
    
    20
 SCHEDULE A
    
    Defined TermsSCHEDULE 5.03
    
    Subsidiaries; Capitalization of CompanySCHEDULE 5.05(A)
    
    Debt to be RepaidSCHEDULE 5.05(B)
    
    Continuing Existing DebtSCHEDULE 10.01
    
    Existing LiensEXHIBIT 1.01(i)
    
    Form of Senior Secured NoteEXHIBIT 1.01(ii)
    
    Form of First WarrantEXHIBIT 4.06
    
    Opinion MattersEXHIBIT 4.09(a)
    
    Form of Note Security AgreementEXHIBIT 4.09(B)
    
    Form of Subsidiary Note Security AgreementEXHIBIT 4.09(C)
    
    Form of Subsidiary GuarantyEXHIBIT 4.09(D)
    
    Form of Mortgage
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Company you CHRP
 ARTICLE I
 AUTHORIZATION OF NOTES AND FIRST WARRANT
 Section 1.01 Amount .
 Note First Warrant
 Section 1.02 Maturity Date .




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Section 1.03 Interest .
 provided
 ARTICLE II
 SALE AND PURCHASE OF NOTE
  ARTICLE III
 CLOSING
 Closing ***
 
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    Portions of this page have been omitted pursuant to a
request for Confidential Treatment filed separately with the Commission. -2-




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ARTICLE IV
 CONDITIONS TO CLOSING
  Section 4.01 Accuracy of Representations and Warranties .
  Section 4.02 Performance; No Default .
  Section 4.03 Litigation .
  Section 4.04 Consents .
  Section 4.05 Compliance Certificates .
 Officers Certificate
 Secretarys Certificate
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Section 4.06 Opinions of Counsel .
  Section 4.07 Purchase Permitted By Applicable Law, etc .
  Section 4.08 Proceedings and Documents .
  Section 4.09 Financing Transactions .
  ARTICLE V
 REPRESENTATIONS AND WARRANTIES OF THE COMPANY
  Section 5.01 Authorization .
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Section 5.02 Governmental Authorization .
  Section 5.03 Ownership of Shares of Subsidiaries and Capitalization .
 Schedule 5.03
 Schedule 5.03
  Section 5.04 Financial Statements .
  Section 5.05 Existing Debt .
 Debt
to be Repaid
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Section 5.06 Use of Proceeds .
  Section 5.07 Foreign Assets Control Regulations, etc .
    Section 5.08 Status under Certain Statutes .
  Section 5.09 Additional Representations and Warranties .
 Sections 3.06 3.19 mutatis mutandi
 ARTICLE VI
 REPRESENTATIONS OF CHRP
 accredited investor
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ARTICLE VII
 FINANCIAL AND BUSINESS INFORMATION
      -7-




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ARTICLE VIII
 PREPAYMENT OF THE NOTE
   ARTICLE IX
 AFFIRMATIVE COVENANTS
  -8-




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Section 9.01 Insurance .
  Section 9.02 Corporate Existence, etc .
  Section 9.03 Note Security Agreement .
 Subordinated Collateral
 Section 9.04 Further Assurance .
    -9-




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ARTICLE X
 NEGATIVE COVENANTS
  Section 10.01 Liens .
   Section 10.02 Sale of Assets .
 Transfer
 Section 10.03 Mergers, Consolidations, etc .
  Section 10.04 Nature of Business .
  -10-




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Section 10.05 Debt .
  Section 10.06 Transactions with Affiliates .
  Section 10.07 Investments .
  Section 10.08 Distributions .
  Section 10.09 Subordinated Debt .
  Section 10.10 Inventory and Equipment .
  -11-




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ARTICLE XI
 EVENTS OF DEFAULT
 Event of Default
 Put Option Event
   ***
  ARTICLE XII
 ACCELERATION UPON DEFAULT; PREPAYMENT
 Section 12.01 Acceleration Upon Default .
  
 ***
    
    Portions of this page have been omitted pursuant to a
request for Confidential Treatment filed separately with the Commission. -12-




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ARTICLE XIII
 REGISTRATION; EXCHANGE; SUBSTITUTION AND ALLOCATION OF NOTE AND FIRST WARRANT
 Section 13.01 Registration of Note and First Warrant .
  -13-




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Section 13.02 Transfer and Exchange of Note and/or Warrant .
 provided
 Section 13.03 Replacement of Note and First Warrant .
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Section 13.04 Tax Allocation of Note and First Warrant .
    ARTICLE XIV
 PAYMENTS ON NOTES
 Section 14.01 Place of Payment .
  Section 14.02 Home Office Payment .
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ARTICLE XV
 AMENDMENT AND WAIVER
 Section 15.01 Requirements .
   Section 15.02 Solicitation of the Holder of the Note and First Warrant .
   ARTICLE XVI
 NOTICES
  -16-




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ARTICLE XVII
 MISCELLANEOUS
 Section 17.01 Survival .
  Section 17.02 Successors and Assigns .
  Section 17.03 Payments Due on Non-Business Days .
 provided
 Section 17.04 Entire Agreement .
 provided however
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Section 17.05 Interpretation .
 include includes including without limitation
 Section 17.06 Headings and Captions .
  Section 17.07 Counterparts; Effectiveness .
  Section 17.08 Severability .
  Section 17.09 Governing Law; Jurisdiction .
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Section 17.10 Waiver of Jury Trial .
  Section 17.11 Expenses; Attorneys Fees .
 provided provided further
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Very truly yours,
Artes Medical, Inc.By:
    /s/ Diane S. GoostreeName:
    Diane S. GoostreeTitle:
    President & CEO The foregoing is agreed
to as of the date thereof.
Cowen Healthcare Royalty Partners, L.P.
By: Cowen Healthcare Royalty GP, LLC
       Its: General PartnerBy:
    /s/ Todd C. DavisName:
    Todd C. DavisTitle: 
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SCHEDULE A
 DEFINED TERMS
  Affiliate control
 Agreement
 Anti-Terrorism Order
 Business Day
 Change in Control
 Closing
 Closing Date
 Company
 Debt
 A-1




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provided
 Debt to be Repaid
 Default
 Default Rate *** base prime
 Event of Default
 FDA
 Financial Statements
 First Warrant
 Fiscal Quarter
 Fiscal Year
 GAAP
 Governmental Authority
 
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    Portions of this page have been omitted pursuant to a
request for Confidential Treatment filed separately with the Commission. A-2




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Guaranty Obligation primary
obligations primary obligor
 holder
 Investment
 Lien
 Mortgage
 Note
 Note Documents
 Note Security Agreement
 Obligations
 A-3




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Permitted Debt
   *** Permitted Liens
     Permitted Investment
      
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    Portions of this page have been omitted pursuant to a
request for Confidential Treatment filed separately with the Commission. A-4




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***
    provided
 Permitted Liens
    
 ***
    
    Portions of this page have been omitted pursuant to a
request for Confidential Treatment filed separately with the Commission. A-5




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***
   Permitted Transfer
      Permitted Working Capital Line of Credit
 Person
 
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    Portions of this page have been omitted pursuant to a
request for Confidential Treatment filed separately with the Commission. A-6




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Prepayment Premium ***
 Put Option Event
 Revenue Agreement
 Second Warrant
 Security Documents
 Securities Act
 Subordinated Collateral
 Subordinated Debt
 Subsidiary Subsidiaries
 Subsidiary Guaranty
 Subsidiary Note Security Agreement
 Third Party
 
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    Portions of this page have been omitted pursuant to a
request for Confidential Treatment filed separately with the Commission. A-7




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Transfer
 USA Patriot Act
 UCC
 A-8