The face of middle age increasingly is smooth and wrinkle-free as more and more Americans are using an arsenal of cosmetic procedures — eyelid lifts, lasers and skin fillers — to turn back the clock.

This is more than just a vanity play.

The $12 billion-a-year industry is big business for companies such as Medicis Pharmaceutical Corp., which has hitched its growth to selling skin products that make people look and feel younger.

Medicis sells the nation's most widely used "dermal filler," Restylane, and has two more anti-wrinkle products on the way.

While the Scottsdale, Ariz.-based maker of skin and acne products sees a lot more room for growth, so does its chief rival, Irvine, Calif.-based Allergan Inc., which makes Botox and recently launched Juvederm, a skin filler that competes with Restylane.

Both companies see dollars in demographics. Fewer than 1 million people now pay for these dermal filler injections that plump up wrinkles to help skin retain its youthful appearance, but more than 25 million American women age 30 and older earn enough money to afford such treatments.

Both companies are embarking on aggressive marketing campaigns that highlight their fountain-of-youth formulas.

"There are plenty of people out there who ought to be customers but don't know about these products," said Jonah Shacknai, chief executive officer at Medicis. "We think we know who they are and where they are. It's just a matter of telling a good story."

So far, Medicis has launched the more unconventional approach in this wrinkle war.

In addition to courting dermatologists and plastic surgeons at conferences in elite settings such as Vail, Colo., and Maui, the company is reaching out directly to consumers through advertising and "viral marketing."

Medicis hired a Hollywood producer to film its search for the "Hottest Mom in America," a casting call for mothers in six cities including New York, Miami and Los Angeles.

The company will pitch footage to network television stations with the goal of airing the search as a reality show. The idea: Expose prime-time viewers to Restylane, which sponsored the search. Medicis has not yet announced any deal.

Medicis wants creative advertising, in part, because it's squaring off against a much larger company.

Allergan, a pioneer in saline and silicone breast implants, skin products and obesity treatments, collected more than $3 billion in revenue last year compared with Medicis' annual revenue of about $350 million. And Allergan has the proven marketing chops: It is the company that made Botox a popular culture mainstay.

While Allergan has not revealed details of its marketing plan, company representatives say it likely will include a mix of print and television advertising.

"Our approach would never be one that would be driven around salacious media," said Robert Grant, president of Allergan Medical. "Partnering with the physician community is really the approach we want to go after."

The American Society for Aesthetic Plastic Surgery reported nearly 1.6 million procedures for dermal fillers last year. Patients typically need two to three procedures each year, depending on the extent and depth of facial creases and wrinkles.

Botox, a neurotoxin that relaxes muscles under wrinkles, remained the most popular anti-wrinkle procedure with nearly 3.2 million procedures last year. Botox generally is injected to the forehead and upper face while dermal fillers Restylane and Juvederm, both hyaluronic acids, are used to smooth smile lines and lower facial wrinkles and even to fill lips.

Medicis expects to gain federal approval any day now to sell a more robust filler, Perlane, and the company next year plans to roll out Reloxin, a neurotoxin that is expected to compete with Botox.

Doctors still don't have a good handle on which product will win over consumers.

"It is still very early in testing," said Carl Mudd, chief executive officer of Dermacare, a Phoenix-based company that owns or franchises nearly 50 skin care clinics nationwide. "Juvederm is purported to provide a smoother look, although, frankly, we have had issues with the lumpiness of Restylane."

He believes the company will find enough customers who want to look young to ensure both products will sell well.