This article reviews the most common male cosmetic procedures that are performed in combination with more than one procedure. Evidence-based medicine for many of these combination therapies is not rampant in the medical literature, but the author uses his current experience to share how combining therapies can be useful for our male population seeking cosmetic improvements in our offices.
Key points
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Combination therapy for cosmetic procedures for men is an important consideration to give optimal outcomes to men with cosmetic concerns.
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More evidence-based medicine is needed to document that the combination works, that it is safe, and that the end result is what we are looking to achieve.
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When done correctly, men will be more likely to request advice on how to enhance their cosmetic appearance.
Introduction
Men have as many cosmetic concerns as their female counterparts, yet we see more women in our clinics. This circumstance is due to a variety of reasons; but regardless, we seem to be reaching more and more men in the cosmetic arena than ever before as we end 2017 and begin 2018. Increasing numbers of nonsurgical cosmetic procedures are being performed on men, which is beneficial to both the patients and the cosmetic surgeons.
Since the economic downturn and eventual recovery of the past decade, more and more men, either active or entering the market place, realize that their physical appearance is important when presenting themselves to potential employers or clients. For these reasons, most of us have seen an increase in the number of men that seek cosmetic procedures; many of these procedures entail using combination therapy for optimal results. The most common of the cosmetic nonsurgical cosmetic procedures performed on men, according to the American Society for Aesthetic Plastic Surgeons (ASAPS) are intense pulsed light (IPL) treatments (13.9% men), laser hair removal (12.9% men,) and neurotoxin injections (11.5% men).
This article reviews the most common male cosmetic procedures that are performed in combination with more than one procedure. Evidence-based medicine for many of these combination therapies is not rampant in the medical literature, but the author uses his current experience to share how combining therapies can be useful for the male population seeking cosmetic improvements in our offices.
Nonsurgical cosmetic procedures have been described in detail elsewhere in this supplement; thus, the author’s focus is on using a combination approach to therapy. Combination treatments provide perhaps the best aesthetic outcomes, which are described in this article. How do we use neurotoxins with dermal fillers? How do we use skin care with everything we do? How do we combine fat reduction with skin tightening? How do we use absorbable sutures with skin tightening? Finally, how do we use platelet-rich plasma (PRP) with hair transplants to enhance the results we now see with our hair transplant procedures?
Introduction
Men have as many cosmetic concerns as their female counterparts, yet we see more women in our clinics. This circumstance is due to a variety of reasons; but regardless, we seem to be reaching more and more men in the cosmetic arena than ever before as we end 2017 and begin 2018. Increasing numbers of nonsurgical cosmetic procedures are being performed on men, which is beneficial to both the patients and the cosmetic surgeons.
Since the economic downturn and eventual recovery of the past decade, more and more men, either active or entering the market place, realize that their physical appearance is important when presenting themselves to potential employers or clients. For these reasons, most of us have seen an increase in the number of men that seek cosmetic procedures; many of these procedures entail using combination therapy for optimal results. The most common of the cosmetic nonsurgical cosmetic procedures performed on men, according to the American Society for Aesthetic Plastic Surgeons (ASAPS) are intense pulsed light (IPL) treatments (13.9% men), laser hair removal (12.9% men,) and neurotoxin injections (11.5% men).
This article reviews the most common male cosmetic procedures that are performed in combination with more than one procedure. Evidence-based medicine for many of these combination therapies is not rampant in the medical literature, but the author uses his current experience to share how combining therapies can be useful for the male population seeking cosmetic improvements in our offices.
Nonsurgical cosmetic procedures have been described in detail elsewhere in this supplement; thus, the author’s focus is on using a combination approach to therapy. Combination treatments provide perhaps the best aesthetic outcomes, which are described in this article. How do we use neurotoxins with dermal fillers? How do we use skin care with everything we do? How do we combine fat reduction with skin tightening? How do we use absorbable sutures with skin tightening? Finally, how do we use platelet-rich plasma (PRP) with hair transplants to enhance the results we now see with our hair transplant procedures?
Combination therapies for men
The advent and use of botulinum A neurotoxin has been the real game changer for most of us in the cosmetic and aesthetic industry over the past several decades. The author has seen the number of procedures from the statistics of both the ASAPS and the American Society for Dermatologic Surgery (ASDS). Both of these groups have shown that the number of these procedures has been steadily increasing, and they are the most common nonsurgical cosmetic procedures that are performed in our offices over this period in total. There has been an increase in the growth rate of these neurotoxin injections in men; according to the statistics given, the use of neurotoxin injections has increased from 9.2% of all nonsurgical cosmetic procedures performed on men in 2005 to 11.5% of nonsurgical cosmetic procedures performed on men in 2014, according to data from the ASAPS. According to the ASDS, the number of neurotoxin injections performed on men was 10% of all procedures in 2011 and increased to 13% in 2014. The use of Botox Cosmetic (Allergan, Irvine, CA), Dysport (Galderma, For Worth, TX), and Xeomin (Merz Aesthetics, Raleigh, NC) have all transformed our approach to the aesthetic market and to our patients with lines and wrinkles that concern them. This point is true for both women and men. We need to make sure that we consider the potential differences in anatomy and muscle size in men; men may require more neurotoxin than women when giving these injections for the same indications. But with skill and an understanding of the anatomy of the face in both women and men, success with injections for both can be successfully achieved.
Although on most occasions these injections are given without other procedures being performed at the same time, the author always recommends that men, who are less likely to use skin care, incorporate a skin care routine with these injections to enhance the results given and to provide adequate skin protection following the investment that one is taking with these and any cosmetic procedure. And when one talks of skin care, we must always recommend sunscreens to our patients, the most important skin care group we have and something the author tries to make sure male patients are using on a daily basis. Also, as has been shown, the use of neurotoxins and IPL has been shown to improve and enhance the results of using a neurotoxin alone. So, in many instances, where an IPL is indicated, the author often recommends having the IPL treatments given along with the neurotoxin injection. And if there are other concerns, such as wrinkles, telangiectasias, and flushing, the use of neurotoxins given in a mesotherapy approach has been shown to be a very useful combination treatment, something that would benefit men as well as women.
Soft tissue dermal fillers are also a popular cosmetic procedure being performed on more and more men. What has been noted is that the growth rate for these fillers has not changed too significantly as we see with the neurotoxin injections. According to the ASPAS’s surveys, the use of dermal fillers was 8.2% of all nonsurgical cosmetic procedures in 2005 and only grew to 8.3% in 2014. The ASDS’s data correlates with the ASAPS’s data as well, showing an increase from 8% to 9% from 2011 to 2014. This finding may, to some, seem rather surprising; but one can assume from the results presented that neurotoxin procedures are more popular today than ever before and that perhaps clinicians are not recommending dermal fillers as much to our patients when we are evaluating them for wrinkles and lines and, with fillers, for volumization. Many of us had our initial burst of male patients when we had the approval of Sculptra (Galderma, Fort Worth, TX) in our patients with human immunodeficiency virus with lipoatrophy. The author has also, over the years, had great success with all of the hyaluronic acid dermal fillers and volumizers, with the Polly L Lactic Acid product for aesthetic volumization and with calcium hydroxyapatite for wrinkles and contour defects in male patients. But statistically, according to the ASAPS and the ASDS, we are not overall injecting more patients today than we were several years ago.
But when one thinks of combination therapy for our patients, the use of neurotoxins, where appropriate, along with dermal fillers and skin care is, perhaps, the best combination for our male patients to reduce lines and wrinkles, to volumize the skin where appropriate, and, with skin care, to protect and treat any other skin concerns. When appropriate, the use of these products with IPL, or other laser technologies, can improve and enhance the skin as well. Many of the lasers we use every day in our practices can be used in combination without fillers, and many use them regularly.
Fat removal is one of the more popular procedures that are being performed, and there are several current and popular technologies that are being used regularly in our clinics. These technologies include CoolSculpting (Zeltiq, A Division of Allergan, Irvine, CA) and ultrasound devices, such as UltraShape, now known as UltraShape Power (Syneron-Candela, Yokneam, Israel). Alone, they work very well in reducing stubborn areas of fat and have been demonstrated to be safe and efficacious in how they work for patients in this regard. CoolSculpting has become the number one fat reduction treatment in the world and is used on more and more men each and every day. The results of this treatment are well documented and are not reviewed here. What is interesting is that when one combines CoolSculpting with either acoustic wave technology or with radiofrequency (RF) skin tightening, we know that we can achieve even better results than just using CoolSculpting alone. Clinical work with the Z Wave acoustic wave device (Zimmer Aesthetics, Germany) has shown that we can improve the results of our CoolSculpting treatments; this is recommended immediately after most of the CoolSculpting procedures that the author performs. An example of this is shown in Fig. 1 . In addition, the use of RF skin tightening devices after CoolSculpting treatments has also shown enhancements with the overall cosmetic results. In one study, Few and colleagues described the use of the Venus Legacy (Venus Concepts, Toronto, Canada) and showed it increased efficacy and better cosmetic outcomes following the use of CoolSculpting in a series of patients. Ten patients were evaluated in this clinical protocol and were treated with CoolSculpting and then randomized to receive posttreatment RF treatments versus no further treatment. The results showed a statistically significant improvement on the sides that received the RF therapy as compared with those that did not receive them. An example is shown in Fig. 2 . From these findings, it seems that if one is performing CoolSculpting in your offices, you ought to be offering either acoustic wave technology or one of the myriad RF skin-tightening devices that exist on the market.
