Fillers and toxins are safe, quick, and require no downtime; the immediately visible results can boost a man’s self-esteem, confidence, youthfulness, and sense of competitiveness in the personal and professional realms of the world. The approach to using these agents has changed from ironing out the skin to remove wrinkles and lines to a restructuring of the 3-dimensional face. This new strategy, volumetric structural rejuvenation (VSR), relies on intimate knowledge of facial anatomy and the pathophysiology of aging. It is of essence to know the key anatomic differences between the 2 sexes to avoid potential feminization.
Key points
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Among the most popular noninvasive cosmetic treatments men seek today are fillers and toxins.
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Volumetric structural rejuvenation can be applied to both genders, but particularly when customizing this approach to men, it is of essence to know the key anatomic differences between the 2 sexes to avoid potential feminization.
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Volumetric structural rejuvenation is a term used to describe the technique of naturally restoring the face structure.
Introduction
Among the most popular non-invasive cosmetic treatments men seek today are fillers and toxins. Aside from safe and effective, these treatments are quick, require no downtime; the immediately visible results can boost a man’s self-esteem, confidence, youthfulness, and sense of competitiveness in the personal and professional realms of the world. Clinically, the approach to using these agents increasingly and fundamentally has changed from ironing out the skin to remove wrinkles and lines to a highly-sophisticated restructuring of the 3-dimensional face. This new strategy, applied to and individualized according to each patient’s goals and needs, relies on intimate knowledge of facial anatomy and the pathophysiology of aging. Volumetric structural rejuvenation (VSR) is a term coined by the author to describe the technique of naturally restoring the face structure, and also hints at the philosophy behind it: rejuvenating the face for natural aesthetic outcomes. VSR can be applied to both genders, but particularly when customizing this approach to men, it is of essence to know the key anatomic differences between the 2 sexes to avoid potential feminization.
Introduction
Among the most popular non-invasive cosmetic treatments men seek today are fillers and toxins. Aside from safe and effective, these treatments are quick, require no downtime; the immediately visible results can boost a man’s self-esteem, confidence, youthfulness, and sense of competitiveness in the personal and professional realms of the world. Clinically, the approach to using these agents increasingly and fundamentally has changed from ironing out the skin to remove wrinkles and lines to a highly-sophisticated restructuring of the 3-dimensional face. This new strategy, applied to and individualized according to each patient’s goals and needs, relies on intimate knowledge of facial anatomy and the pathophysiology of aging. Volumetric structural rejuvenation (VSR) is a term coined by the author to describe the technique of naturally restoring the face structure, and also hints at the philosophy behind it: rejuvenating the face for natural aesthetic outcomes. VSR can be applied to both genders, but particularly when customizing this approach to men, it is of essence to know the key anatomic differences between the 2 sexes to avoid potential feminization.
Pathophysiology of aging in men
Facial aging is characterized by a myriad of changes that affect the skin, musculature, adipose and skeletal compartments. These include photoaging, wrinkles, ptosis, and volume changes, that together via a complex interplay manifest to an aged face appearance ( Fig. 1 ).
Skin
Men have thicker dermis, but matrix degradation during skin aging due to intrinsic (genetics) and extrinsic factors (UV radiation, smoking) generates reactive oxygen species (ROS), leading to the appearance of increased skin laxity or prominent folds around the nasolabial region, periorbital region, and jowl. Moreover, studies have shown that men are more likely engage in lifestyle habits (smoking, less than rigorous use of sunscreen) that aggravate skin aging.
Fat
As the face ages, redistribution and descent of facial fat pads contribute to the signature look of being older (see Fig. 1 ). Facial fat has been shown to be partitioned between superficial and deep fat, organized in discrete anatomic compartments. The deep fat acts as the structural foundation over which subcutaneous fat lies. Age-related depletion of these fat pads results and loss of their even distribution, leading to predictable change in the appearance of the aged face, where sagging and hollowness persist. Specific areas that contribute to this look include diminishing of the cheek projection, atrophy in the periorbital, forehead, temporal, and perioral areas, leading to sagging due to the relative excess of remaining skin. Although both genders sustain similar age-related changes of the adipose tissues, because men have less subcutaneous adipose tissue, they develop more prominent deep wrinkles rather than the fine lines observed in women.
Bone
Craniofacial remodeling caused by aging also substantially impacts facial features and overall male aesthetics. Consistent age-related skeletal changes in both genders include an increase in mandibular angle that may cause blunting or loss of definition of the lower border of the face and an increase in the pyriform aperture that can lead to an appearance of nose elongation. Midfacial bone loss may exacerbate the nasolabial fold appearance. In men, as the forehead is oblique, the glabella and frontonasal suture are more pronounced, the supraorbital rim is prominent and the mandibular is angular, bone resorption leads to a general look of droopiness in the upper midface areas, and loss of the signature feature of male attractiveness, the strong square chin.
Overview of the volumetric structural rejuvenation technique
The VSR methodology is designed with the aim to structurally reconstruct the face and replete tissues (fat, skeleton, skin) that have been resorbed because of the aging process. VSR is based on the bimodal trivector approach, where filler injections are placed at 3 sites (see Fig. 1 ) and at 2 levels: a deep dermal/supraosteal level and a subcutaneous level.
The first step when performing the bimodal trivector approach involves supraperiosteal injections in the upper, middle, and lower face, thus reintroducing to the face a structural platform by mimicking the volume lost in the supportive temporal, preaurical, lateral cheek, midcheek, and mandibular fat pads and by addressing musculoskeletal atrophy. Three injection points are strategically selected and injected ( Fig. 2 ), to not only address specific age-related indications, but to also minimize patient discomfort.
