| lavinia k chong m D
Medically reviewed by Lavinia K. Chong, MD, FACS

Not long ago, male grooming was restricted to shaving and haircuts.  Fashion, globalization and paradigm shifts converge on the Internet to make today’s man as well plumed as any male in the animal kingdom. Gender bias holds that females are predominant aesthetic medicine consumers; however this is beginning to change.  A reconstructive plastic surgery practice which takes hand, trauma, cancer and congenital anomalies may have an even mix of men and women.  When my practice took a decidedly elective focus, women were my steady clientele; however they eventually recruited their husbands and male friends.

Botox is so firmly entrenched in today’s cosmetic portfolio because of its minimally invasive nature, affordability and reversibility.  Our practice demographics range from the 30 something young professional who enjoys being “carted,” to the CEOs in their 60’s who use Botox to accentuate their authority.  Imagine the cognitive dissonance when the boss harangues the staff with a placid forehead.  Anatomically, the male brow’s lie is generally heavier and has a more horizontal lie than females (think George Clooney, Russell Crowe).

Nevertheless scowl lines and brow wrinkles aren’t always equated with power.  Some gents observe that Botox gives them an advantage by softening the scowl lines (in between the brows), thereby conveying a less stressed appearance.  Patterns of Botox injection differ between men and women, because of gender specific differences in Bro-tox preferences, which include:

  • Overly pitched lateral brows (the Vulcan or Mephisto) Think of Nicole Kidman in the Channel 5 campaign;
  • May require higher units because of intrinsically thicker male forehead muscles;
  • Request incomplete blockade of all forehead lines because a “frozen” brow is not generally desirable;
  • Will experience a longer latency between treatment and onset of effect, because of the muscle bulk;
  • May require dermal fillers, hyaluronic acid to “eradicate” vertical lines between the brows, because of prior “etching” effect.

Botox has been euphemistically dubbed the “gateway drug” to other cosmetic procedures.  I prefer to think of it as an “ice breaker”.  As patients gain in confidence, they become emboldened to explore other “solutions”, which could include skin resurfacing, dermal fillers, Ultherapy (nonsurgical skin lifting), eyelid lifts, rhinoplasty, body contouring and rarely facial rejuvenation.  The governing principle for male facial aesthetics is subtlety.

Why? Consider the deluge of images of “celebrity surgery gone bad”, (Kenny Rogers, Mickey Rourke) and you will appreciate the value of restraint in planning and execution.  Final thoughts on the differences between the male and female facial surgical candidate:

  • Males may experience more bleeding episodes because of the superior facial blood supply conferred by the beard;
  • Facelift scars are not as easily camouflaged, because of their short hair. Laser hair removal may be needed for beard bearing skin, which is re-draped behind the ear;
  • For the select patient, direct excisional lifts (brow and neck) may be suitable;
  • Ultherapy is a safe, effective option for redefinition of the jaw;
  • Male aesthetic ideals are less influenced by fashion and history.

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