CHAPTER 41 The Male Model Makeover: Dramatic Changes with Injectables
Summary
The number of nonsurgical cosmetic procedures and male patients seeking them are steadily increasing. The wealth of experience in using injectable fillers for female facial volumization can be readily translated to the male patient population after understanding the key concepts to providing gender-appropriate treatment. The Male Model Makeover technique is a combination of volume restoration and facial feature augmentation using injectable fillers. The goals of the technique are to create a youthful and masculine contour. The cornerstones are correction of any stigmata of facial aging (nasolabial folds, marionette lines, deep rhytids, and tear troughs), a conservative volumization of the midface, and augmentation of the bony skeleton of the mandible. Filler is injected to create prominence of the gonial angles, a wider chin, and a sharp or angular mandibular contour that all masculinize the face. Overfilling the midface may create an overly artificial or feminized appearance, so the malar prominence should be approached with care. The same low complication profile is expected as with any injectable treatment, but the anatomy of the facial and angular arteries as well as the communicating branches in the periorbital region should be kept in mind, along with the usual meticulous technique. As presented below, this technique yields predictable results and is easily modified for the individual patient’s anatomy and desires.
Introduction
The latest data (circa 2016) show that 85% of all cosmetic procedures performed on male patients were minimally invasive, reflecting the continued popularity of nonsurgical treatments. 1 The male aesthetic is now in focus more than ever, with a growing body of evidence on the importance of masculine appearance. In a number of studies, masculinized faces were rated as more attractive, more dominant, and a growing cohort of men are becoming aware of their surgical and nonsurgical options to create a more youthful and masculine appearance. 2 , 3 However, aesthetic procedures for men have not yet gained the same mainstream acceptance as the established palette of interventions offered to the female patients. 4 This is reflected by the male patients’ preference of nonsurgical methods to achieve a tasteful result with minimal downtime and without the stigmata of surgery.
The Male Model Makeover technique is designed to cater specifically to this need by using the natural advantages of injectable fillers. The technique is based on two primary concepts: rejuvenation and augmentation. Features associated with aging (nasolabial folds, tear troughs, and volume loss) must be corrected to impart a youthful appearance. Next, strategic filler placement along the bony skeleton of the zygoma and mandible creates a distinctly masculine facial contour, creating an overall harmonious and attractive result. The reader is assumed to be familiar with the use of injectable fillers, so the focus here will be on using them in a gender-appropriate fashion to rejuvenate and masculinize.
Physical Evaluation
Patient History
Aside from the usual points, the following must be addressed in detail:
Allergies (systemic or localhypersensitivities), current medications (especially anticoagulants or antivirals).
History of keloid or hypertrophic scarring.
History of cold sores (herpes simplex virus).
If positive, most practitioners will prescribe a prophylactic course of antivirals (valacyclovir 500 mg immediately before and again 12 hours after the procedure). In case of an outbreak, the same regimen is prescribed again. 5
Previous filler or injectable use (most im-portant), and history of facial surgery.
If the patient has had injectables placed recently (within a year), extra caution must be taken to accommodate the plan for future loss of volume with filler resorption.
Understanding the patient’s satisfaction with previous filler types and volumes injected (especially with the help of any pre-or post-photographs) is of great help toward understanding the patient’s goals and the magnitude of change he is seeking.
Physical Examination
Note any scars or incisions; correlate these with previous injuries or surgery.
Evaluate facial symmetry. This is of the utmost importance. Close attention is paid to the nasal spine, tip and dorsum, and the chin. Assess the midlines of the mandibular and maxillary dentitions. Make note if any are off midline. Note any crossbite, and carefully compensate for it when treating the jawline.
Take high-quality plain and three-di-mensional photos. These are helpful in re-cording preexisting asymmetry and can be used to point out differences by superimposing the facial halves.
Note the presence or absence of soft-tissue fullness over the bony landmarks to be treated (mandible, maxilla, and zygoma).
Assess the overall facial proportions, as well as the occlusal relationship. 6 This is crucial as patients with deficient or excessive lower face height would benefit from a genioplasty for optimal correction. Malocclusion should be treated with orthognathic surgery; fillers may help mask the improper relationships, but only surgery will correct the root cause of the problem.
Anatomy
Two categories of concepts must be kept in mind to perform this in a safe and efficacious fashion: (1) anatomical landmarks of the neurovascular bundles, and (2) the skeletal differences between the male and female.
Safety
Aside from the complications inherent to the filler itself (infection, granulomas, and the Tyndall effect), the highest risk is presented by inadvertent intravascular injection, which can lead to ischemia and necrosis of the affected area. The danger zone to be aware of specifically during this procedure is the crossing of the facial artery over the body of the mandible; great care must be taken to avoid an intravascular injection here ( Fig. 41.1 ).
Volumizing the lower eyelid–cheek junction and the nasolabial folds must also be done with care, keeping in mind the communications of the periorbital vessels with the retinal artery and the location of the angular artery, respectively. See the Pearls and Pitfalls and the Management of Complications sections for more detail.
Masculine Anatomy
It is crucial to understand the differences in the male versus female facial skeleton; these concepts are the underpinning to the procedure, as the filler is injected to provide the appearance of more masculine bony features. These principles have been well described in the literature detailing the facial component of gender reassignment surgery and are illustrated in Fig. 41.2 . We will focus here on facial characteristics that are modifiable with injectable fillers and are thus part of the Male Model Makeover technique. The reader is encouraged to refer to a comprehensive examination of gender-specific facial traits for a review of the other areas. 7
Cheeks
In men, the zygoma is less projecting and flatter, with less triangulation with the chin, thus avoiding the feminine heart-shaped face in favor of the more masculine trapezoid or squared-off appearance. Female cheeks are fuller, higher, and have more projection. This must be kept in mind when treating any malar or zygomatic deflation. Augmenting the malar eminence and increasing the zygomatic width can be beneficial as the feminine contour is also a more youthful one but must be done carefully to avoid an unnatural or feminized cheek silhouette.
Lips
In men, lips are thinner overall and show less vermilion, particularly with age. This volumizing of the lips may benefit a man to give him a fuller, younger and healthier look. However, it should be done extremely conservatively to avoid a feminizing appearance.
Chin
The classic masculine chin is broader, taller in vertical height (as measured from the lower lip), and is more projecting. The contour is squared off, following the straight lines of the mandibular body and ramus—a rounded chin or a V-shaped jawline is distinctly feminizing, and is an often-requested feature by female patients in Asian cosmetic surgery clinics.
Jawline
The male mandible is wider at the gonion (increased mandibular flare), and the angle of the mandible is sharp. The inferior border of the mandibular body and the posterior edge of the ramus project as linear features, lending an overall strong, crisp appearance to the jawline, working with the chin to create an angular appearance that is distinctly opposite from the curving feminine contour.
Related posts:
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
