1 The Male Aesthetic Patient: Preferences and Practice

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

Related posts:

Aesthetic Concerns in Skin of Color Patients Keg to Six Pack: Fat and Cellulite Treatments Taking a Hard Look: Soft Tissue Augmentation Finding the Right Balance: Chemical Peels High Brow Approach to Neuromodulators Tincture of Time: Facial Aging and Anatomical Considerations

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