Aesthetics in men: what dermatologists need to know

ORLANDO – The increasing frequency with which men are seeking cosmetic procedures means that dermatologists need to have a firm grasp on the important, but often overlooked differences between treating their male and female patients.

“Cosmetic procedures performed on men have increased by 273% since 1997 [and] in the last year, about 10% of all cosmetic procedures were performed on men,” Dr. Whitney Bowe said at the Orlando Dermatology Aesthetic and Clinical Conference. “We want to make sure to keep in mind that the male anatomy is very different from the female anatomy, and so you want to make sure not to feminize the male face.”

In an interview at the meeting, Dr. Terrence Keaney of George Washington University, Washington, added that it’s important to take time with your male patients to really understand what they are looking for and how to deliver the most effective treatment in the most timely manner for them.

“Men are a harder nut to crack – they’re not really sure of what procedure they want because they just don’t know about them yet, so their initial concerns are less specific,” Dr. Keaney said. “You have to tease out what men are looking for [because] they’re less likely to be forthcoming about what’s bothering them.”

The two most commonly sought procedures by male patients are neuromodulators and dermal fillers, according to Dr. Bowe, a dermatologist at Mount Sinai Hospital, New York. When it comes to the former, it’s important to remember that men have flatter, more low-set brow lines that rest along the orbital rim. While women typically prefer to have a defined arch to their brow – “like what you’d see with Megan Fox or Kim Kardashian,” Dr. Bowe clarified – this can look highly feminine in male patients, and can lead to dissatisfaction with the overall treatment results.

Furthermore, in order to achieve clinically effective results, men tend to require double the amount of neuromodulator as women. It’s important for dermatologists – and, perhaps more importantly, their staff – to not only use the appropriate amount of neuromodulator, but also discuss what the true financial costs of such procedures will be with male patients ahead of time.

“You want to make sure that you’re dosing [men] appropriately, but it’s also important to consider that when you’re discussing budget,” Dr. Bowe said. “If your staff is used to quoting a certain budget range, for men, that range might actually be doubled as compared to women.”

Men typically seek dermal filler procedures to rejuvenate the area underneath the eyes. The tear trough is a particular area of concern because of its ability to make men look perpetually tired, due to loss of soft tissue in that area – “the greatest reduction in soft tissue as compared to anywhere else on their face,” Dr. Bowe pointed out.

Procedures for the jawline are also becoming increasingly routine among men and are sought after to provide more definition, while also allowing the skin to drape onto the neck. This helps reduce the appearance of girth and mitigate physically uncomfortable situations, such as wearing a button-down shirt that becomes very tight around the neck. For both this and rejuvenation of the tear trough, Dr. Bowe recommends hyaluronic acid fillers that have a high G prime, or poly-L-lactic acid (PLLA).

The other methods for dealing with submental fat in men are deoxycholic acid (Kybella), approved as a treatment for adults with moderate to severe submental fat in 2015; and cryolipolysis. With deoxycholic acid, Dr. Bowe explained, dermatologists can customize the approach because it is administered in a syringe, “something we’re very comfortable doing in our field.” However, the major drawbacks are that it’s difficult to address the lateral deposits of fat when getting close to the marginal mandibular nerve, along with significant swelling that occurs after that procedure for up to 2 weeks.

With cryolipolysis, new applicators on the market have proven effective for treating both submental fat and the lateral fat with minimal postprocedure downtime. However, applicators tend to be “one size fits all,” so if it doesn’t work for a patient, the procedure would have to be done with deoxycholic acid.

A consideration when treating male patients with fillers is that the cheek is more flat in men, who tend to have a flatter ogee curve, so an “upsweeping cheekbone [is] a feminizing look to a male patient” that dermatologists should be keen to avoid, Dr. Bowe said.

In addition, “men tend to have a higher degree of vasculature underneath the skin surface – in fact, Doppler studies show that they tend to have more vessels in their skin – and it’s most likely a result of the fact that they have increased numbers of coarse terminal hairs [which] need to sustain that growth,” cautioned Dr. Bowe. “But that also clinically translates into the fact that they’re much more prone to bruising, so that’s something you need to be very upfront with your male patients prior to engaging in any kind of injectables.”