The use of a topical agent, such as tretinoin, or AHA's, for reduction of fine wrinkles is the simplest intervention option. The process is easy and painless, the potential side effects are not severe, and the cost is reasonable. There are limits, however, to their effectiveness. Other more invasive options exist to reverse the signs of aging which include injections (wrinkle-implant therapy and muscle relaxants), resurfacing techniques (lasabrasions and chemical peels), and surgery (face, eyelid, and brow lifts).

IMPLANT THERAPY
Wrinkle implants can best be described as fillers. Substances such as collagen (in its various forms), tissue glue (Hylaform) Artecoll microspheres, Gore-Tex,

SoftForm, fat, or silicone are used to fill furrows, creases, and folds in the skin. These wrinkles are generally deeper than the fine wrinkles caused by sun damage and are often found in areas of muscle pull, for example on either side of the mouth and nose, between the brows, and on the forehead. With the exception of silicone, Artecoll, SoftForm and Gore-Tex, which have unique properties and problems, these agents are organic substances injected into the skin to supplement the facial structures altered with age.

Implants are not new. They were used as early as the nineteenth century. At that time the substances were largely inorganic and included wax, aluminum, gold, cork, ivory, and porcelain. Unfortunately, infections and allergic reactions were common. A classic example was the beautiful Duchess of Marlborough who was once the belle of London society. She became a recluse after a series of liquid paraffin injections caused irreversible allergic reactions, which destroyed her beauty. Today, people are more fortunate than the Duchess because the use of soft tissue implants made from organic substances has proven to be highly successful.

What types of implants are available?
Organic implants are made of the following substances: Zyderm and Zyplast collagen suspensions, Koken atelocollagen solution, Fibrel gelatin matrix implant, Hylaform viscoelastic gel, and fat (microlipid transfer). Inorganic implants are made of silicone fluid, Artecoll microspheres, Gore-Tex or SoftForm. Each differs one from another, and each has both positive and negative attributes.