\s=b\ Collagen implants (Zyderm) have found extensive applications in the adjunctive management of the aging face and in the primary treatment of cutaneous defects resulting from acne, trauma, or prior surgery. Our initial clinical experience from 1979 to 1982 involving more than 300 patients is analyzed for treatment efficacy, duration, and untoward responses. A majority of our patients are clearly pleased. Likewise, our confidence has increased as our experience evolved.Positive skin tests number 3.5% and delayed hypersensitivity reactions 1.3%. We have found injectable collagen relatively easy to use as well as safe and effective.Further research may enable prolonged results. (Arch Otolaryngol 1984;110:93-98) Facial cutaneous imperfections due to aging, acne, trauma, surgery, infection, or other causes have always existed and have stubbornly resisted a uniform approach to treatment. Spe¬ cifically included are nasolabial creases, glabellar lines and furrows, circumoral and periorbital wrinkles, and the cutaneous sequelae of acne.Often, one or another group of facial rhytides constitutes the focal point of a patient's concern in seeking cosmet¬ ic surgery.Traditional modes of therapy have included surface treatment with dermabrasion or chemical peel; and di¬ rect augmentation by surgical exci¬ sion, and an interesting assortment of injectable substances such as silicone, fibrin foam, homogenized fat, suture threading, and collagen. A familiar body of literature has evolved regard¬ ing dermabrasion1 and chemical peel2; however, neither modality is appro¬ priate for creases, folds, or furrows as are often found in the nasolabial or glabellar regions and at the lateral oral commissures. In addition, there are substantial risks, discomfort, and sun-related restrictions. The more naturally pigmented the skin and the more long-term the sun exposure, the greater is the risk of persistent, dis¬ agreeable pigmentary changes. Thus, not all patients are candidates for dermabrasion or chemical peel. Direct surgical excision of a partic¬ ularly deep nasolabial fold or glabel¬ lar furrow can be effective, but the resultant scar represents a compro¬ mise, and thus generally restricts the indications for this approach. Superfi¬ cial undermining during facial rhyti¬ dectomy may be extended across the nasolabial creases to improve their appearance temporarily; however, surgical morbidity increases. A coro¬ nal flap with myectomy or myotomy is best reserved for the occasional woman with a low forehead and ptotic eyebrows.Despite the surface and surgical modalities available, the need has per¬ sisted for a material that could be used to fill soft-tissue deficiencies directly. To this end, a number of plant materials, plastics, ceramics, man-made polymers, and animal and human tissues have been tried.3 Dur¬ ing the first third of this century, impure paraffins were used for subcu¬ taneous injection. The predictable results were inflammatory responses, occasional systemic toxic reactions, delayed foreign body reactions, and some ...
