Men's Aesthetics (eBook)

1 The Male Aesthetic Patient: Preferences and Practice

Mildred Lopez Pineiro, Sebastian Cotofana, Terrence C. Keaney, and Jeremy B. Green

Summary

This chapter focuses on describing the key differences in gender preferences regarding minimally invasive cosmetic procedures. With the surge in cosmetic procedures performed for men, it is important for clinicians to understand not only anatomic variations in males versus females but also their aging concerns and any possible barriers to treatment.

Keywords: male aesthetics male cosmetics gender differences cosmetic preferences masculine anatomy

1.1 Background

As minimally invasive cosmetic procedures requested by male patients continue to increase, there still remains a dearth of studies focusing on the specifics of male aesthetic preferences (Table 1.1). According to recent statistics, the total number of minimally invasive procedures sought by men has increased by 72% since year 2000, with 1,092,103 reported cases.1 The most common minimally invasive cosmetic procedures performed for men were botulinum toxin type A (BTX-A) and laser hair removal, followed by microdermabrasion, chemical peels, and soft-tissue fillers. Compared to statistics from the year 2000, the procedure with the most growth overall was neuromodulators (BTX-A), with a 381% increase. Interestingly, the three cosmetic procedures that demonstrated a growth pattern year over year (compared to 2017) were vein treatments (including sclerotherapy and laser treatment), laser skin resurfacing, and soft-tissue fillers.1 It is evident that with this advancing and evolving male interest, clinicians need to be more cognizant of men’s anatomy, aging differences, and beauty preferences as compared to females in order to optimize outcomes and patient satisfaction.

Table 1.1 Minimally invasive cosmetic procedures, 2018 (modified from the ASPS 2018 Annual Survey)

1.2 Anatomy

Gender differences in male facial anatomy include increased skin thickness, higher muscle mass, higher number of terminal hairs as well as sebaceous glands, higher vascularity associated with pilosebaceous units, and different rates of fat and bone resorption with aging given hormonal variations.2 Men have more strongly developed supraorbital ridges and flatter cheeks. They also have a larger glabella and frontal sinus, smaller orbits, and more acute glabellar angles. The mandible is larger and thicker, and the chin wider and square.3 (Fig. 1.1) The subcutaneous architecture in men is significantly different as men have a more developed superficial fascial system and the number of retinacula cutis per defined area is significantly increased compared to females. This implies that the containment forces of the skin to the underlying soft tissues are increased with a decreased probability for skin laxity in comparable female matching pairs.4 In the perioral area, the amount and thickness of terminal hair increases the stability and adhesion forces between dermis and the lamina propria, resulting in the less frequently observed perioral lines (“barcode wrinkles”) compared to females. These notable variations in skin quality and composition, as well as soft tissue and bony anatomy, are essential to understand and consider when planning facial rejuvenation or enhancement procedures. Additionally, one must also consider these differences when estimating the amount of product that will be required to achieve the desired outcome. Longitudinal changes in male anatomy compared to female aging anatomy are complex (Fig. 1.2). With increasing age, males experience an increase in their forehead angle resulting in a steeper forehead, which resembles the female forehead outline.5 The calvarial volume decreases with increasing age, and bone thickness of the skull (temple and forehead) becomes thinner, a trend that interestingly is not observed in females.6

1.3 Patient Preferences

There is one published study in the literature describing the male patient preferences in regard to cosmetic procedures. This cross-sectional online study focused on deciphering which facial areas men are more likely to treat first and the correlation with their areas of most concern, awareness to procedures, and their motivations to undergoing minimally invasive injectable treatment, specifically neuromodulators and soft-tissue fillers.7 They enrolled a total of 600 injectable-naive men between the ages of 30 and 65 years who were “aesthetically oriented,” aware of Botox cosmetic, and considering at least one facial cosmetic treatment within the next 2 years.

In this study, they found that most men were open to talking to their physicians about facial wrinkles (48%) and bags under the eyes (44%). Additionally, it was noted that they were least likely to talk about red/vascular facial appearance (14%) and razor burn (16%). Overall awareness for all aesthetic procedures ranged from 2 to 6%. Specifically, for soft-tissue fillers the awareness was 39%, and for surgical procedures such as liposuction and hair transplant, it was greater than 90%. The two main motivators for undergoing cosmetic procedures were wanting to look good for their age (70%) and wanting to look more youthful (51%).7

On the other hand, the main barriers to treatment were not thinking they needed treatment yet (47%) and concerns about safety or side effects (46%). The five areas of most aesthetic concern were hair loss (27%), double chin (22%), tear troughs (22%), crow’s feet (18%), and forehead lines (15%). Not surprisingly, given what we know about men facial anatomy, perioral lines were the area of least concern (3%). Tear trough and crow’s feet were the two areas that were prioritized in terms of receiving treatment (80%). Finally, they noted a strong correlation (r2 = 0.81) between areas of most concern and areas with treatment priority.7

Of interest, aging concerns of men directly correlate with the expected anatomic changes based on gender (Fig. 1.3). As men age, they are more preoccupied by upper facial lines as opposed to females who switch from being worried about upper facial lines to being more concerned with lower facial lines and perioral wrinkling.8 These concerns likely stem from the expected age-related inversion of the triangle of youth where the cheeks flatten and jowls form, as well as the lack of terminal pilosebaceous units in the perioral skin of females. All these changes seem to be more accentuated in the female face given the drastic hormonal changes endured during menopause.

Moreover, one of the main barriers to treatment identified by this study was lack of knowledge of what minimally invasive cosmetic procedures entail, including risks, benefits, safety, and side effect profiles. This suggests that even “aesthetically oriented” male patients deserve and require a full cosmetic consultation with specific education about procedures that may fit their lifestyle and long-term aging goals. This pretreatment consult visit is a pivotal event in formulating a successful procedural treatment plan that will lead to a positive patient outcome.

Finally, it is important to reiterate that the two main reasons for men to proceed with a cosmetic procedure were to look good for their age and to appear more youthful. These two motivations have social implications in their lives as well, as being youthful gives males a more competitive appeal in the workplace, which can lead to a 5 to 10% higher salary.9 In addition, two studies have demonstrated that cosmetic procedures, such as botulinum toxin neuromodulation, can lead to improved self-esteem and feelings of attractiveness that lead to a better quality of life.10,11 All these represent psychosocial factors to be considered during the cosmetic consult.

1.4 Clinical Practice

The goal of the initial cosmetic visit,...