Many more men are open to cosmetic surgery today. As of 2012, cosmetic procedures for men represent approximately 10% of all cosmetic procedures, and has been on the increase since. This presents an interesting problem in the field of cosmetic dermatology: There are important differences between men and women’s faces anatomically, biologically, and behaviorally. Yet, studies are still primarily focused on the female face – as an assumption. This is a summary of an article, published on Skin Therapy Letter in 2015: Male Aesthetics.
Introduction
Overall, male patients still represent a relatively small minority of cosmetic patients, but the numbers have been on the increase both in absolute terms and proportionately against women. Despite the shifting demographics, the dermatology community may not be keeping up with this trend, focusing mainly on female facial anatomy in studies and innovations. This problem, however, is now being looked at more critically, which will benefit both men and women.
How many men are interested in cosmetic procedures, and why does it matter?
According to the American Society of Plastic Surgeons’ report for 2016,1, men accounted for 13% of cosmetic surgeries and 8% of minimally invasive cosmetic procedures (think Botox and injectable fillers – the wrinkles erasers). This is a significant number and shows how much cosmetic procedures have changed among men. In the early days of cosmetic procedures, the number of men interested in cosmetic procedures was close to zero. As perceptions change, it’s fair to assume that this trend will continue, as men share many of the same motivations and pressures that women face both in their private and public lives to improve their appearance. Physicians need to understand that there are significant and relevant differences in treating men and women in terms of performing cosmetic procedures. We focus on three main differences that are likely to be most relevant: Anatomical, behavioral, and motivational differences between men and women.
Anatomical Differences:
The most significant difference is in the anatomical differences between the male face and the female face. They can differ enough to justify specific adjustments for male patients as an important consideration. Men have various anatomical differences that make up masculine features in the face. The procedures must take these into account and avoid feminizing the face. Additionally, how the male face ages differ markedly from how the female face ages. Below are some of the key differences:
How drastic a change can I expect?
That’s up to the patient. The patient decides what they want from the procedure. Today, most people prefer subtle, soft improvements using small amounts of filler – enough to notice a difference, but one that is not aggressive or drastic. Some patients do prefer a more dramatic change and will opt for a larger dose of filler. Communicate what you want clearly with the performing physician during your consultation.
- Men have thicker skin (literally) and have more prominent facial musculature, making men appear older when facial fat is lost with age.
- Men have larger skulls and different skull shapes from women. Men have a larger forehead, a wider glabella (the forehead area above the nose), and a protruding lower jaw, and a more prominent brow ridge (the bone directly above the eyes)
- Men have more blood vessels in the lower face to support beard hairs, making them more prone to deep bruising during some procedures.
- Men have a more angular cheek and have less soft tissue
- Men have different hair distribution in the chin and upper lip area
- Men have more severe wrinkles – except in the mouth area
- Men tend to develop deeper expression lines
Behavioral
Men behave differently from women in relevant ways. A big divider is how much sun damage they receive, largely due to gender differences in occupation. Men tend to dominate outdoor professions and are also less discerning in their sun protection habits. As a result, photoaging affects men more severely.
- Men are, across ethnicities and income levels, poor consumers of health care and dermatology services compared to women.
- Men smoke more often than women (31% vs. 10%), and smoking is an independent risk factor for elastosis.
- Men are also more likely to be exposed to UV radiation in part due to the occupation but also due to neglect – 41% of men never apply sunscreen.
- The baseline expectation for environmental damage is likely to be much higher in men.
Motivational
Lastly, while both men and women wish to look more youthful and correct flaws that are often associated with aging, their motivations can differ in subtle ways. In particular, men are concerned about looking too feminine as a result of a procedure.
- Botox and dermal fillers are the most common soft procedures performed on men.
- Care must be taken not to over-feminize the face when using Botox or dermal fillers.
- There are techniques to minimize brow arching which can make a face appear feminine.
- Men have a larger surface area on their forehead – more injections may be required to ensure complete and balanced treatment.
- Botox for use in men is understudied – despite that the anatomy has significant differences. Only two studies account for gender differences, which can be a concern regarding dosing efficacy and safety. For male patients, it’s important to look for physicians who have experience with other male patients in their practice.
- Dysport is less effective in men compared to women at similar doses. Botox was found to be more effective in treating male glabella. Men generally seem to require a higher dose.
- Dermal fillers can help male patients with volume loss due to their lack of subcutaneous fat compared to females.
- Upper lip augmentation should be avoided in general to prevent feminizing the face.
Discussion
Men represent a relatively small proportion of cosmetic patients. However, this number is growing rapidly. Physicians need to account for gender differences when performing cosmetic procedures. At this time, very few studies have focused on differences in anatomy when evaluating and treating male patients for minimally invasive procedures. As men’s procedures become more popular, this is an area of growing interest in the practice and academically. It’s good for men who are considering these procedures to ask whether the office and physician have experience performing on men specifically.
Use #AskDermLetter to ask us skincare questions on Twitter. Follow us @SkinExpertsTalks for daily tips and articles on skincare.
1The discrepancy seems to be due to the prevalence of men wanting hair transplantation and male-specific procedures that aren’t represented with the soft procedures.
