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Contrasting needs of male and female patients

Article-Contrasting needs of male and female patients

While there is no real variance in how procedures are performed on women versus men, differences exist in the anti-aging goals, and the ways in which practitioners address areas that satisfy both gender and individual patient needs.

Both genders tend to pursue comparable aesthetic results; however they may be focused on different body areas, said Terrence Keaney, M.D., F.A.A.D., a dermatologist in Arlington, Va. “The use of injectables to restore youthful facial features is important to both men and women. Women care more about specific facial areas, such as the cheeks and lips, while for men it’s more about the eyes and jawline. Also, men often seek body contouring, especially in the submentum and abdomen, as well as non-surgical hair restoration with platelet-rich plasma (PRP). Hair loss is important to women, as well, but it is not a top cosmetic concern as it is for men,” he said.

“Definitely more men are seeking aesthetic solutions,” expressed Gregory P. Mueller, M.D., F.A.C.S., a plastic surgeon in Beverly Hills, Calif., who noted that over 40% of his patients are male. “They are coming in for facial procedures like neurotoxin injections, which have been popular with men for the last ten years.”

Nevertheless, he continued, “When men come in they’re not asking for higher cheekbones or a change in the way their face looks. Generally, they want to retain their facial shape, but maybe improve skin quality, tone and texture. Men want to make their skin look younger, they don’t want to look ‘done.’”

For Shino Bay Aguilera, D.O., a cosmetic dermatologist and dermatologic surgeon in Fort Lauderdale, Fla., there are important distinctions between men and women in aesthetics. “Females tend to be more body conscious, worrying about cellulite, wrinkles and laxity, their arms and excess fat. Because of the way they dress, a lot more flesh is exposed. Men can hide pretty much any of these issues from others.”

“In my experience, lots of men worry about crow’s feet more than anything else,” Dr. Aguilera commented. “Their second area of concern is the double chin. Off the face and neck, the waist and love handles are of great concern to men.”

In the body treatment category, men now realize that they can have cosmetic medical procedures without having to deal with the invasive nature of surgery. “There has been an uptick in body treatments for men, as well as skin tightening procedures,” Dr. Mueller reported.

According to experts, both men and women are drawn to non-invasive solutions, such as cryolipolysis, ultrasound, laser or radiofrequency (RF). truSculpt® 3D from Cutera, Inc. (Brisbane, Calif.), is one such modality, based on monopolar RF. This system takes a multidimensional approach to decrease circumference and diminish fat by delivering clinically therapeutic temperatures to the subcutaneous adipose tissue to achieve high clinical efficacy quickly, with enhanced safety and comfort.

Notably, many men are copying women in seeking certain aesthetic procedures. “After seeing their wives or significant others transform into a younger version of themselves, men generally start to feel concerned about their weight, the inability to eliminate stubborn body fat, wrinkles and aging skin,” said Shelena C. Lalji, M.D., an OB/GYN and medical director of Dr. Shel Wellness & Medical Spa (Houston, Texas).

“Neurotoxin injections and/or non-invasive fat reduction treatments are the gateway procedures for men in my practice,” she shared. “Both types of procedures are very quick and painless, and patients are able to see the results fairly quickly.”

While most referrals of husbands and boyfriends are made by significant others, there is actually a combination of referrals at work, Dr. Keaney noted. “Male-to-male peer referral is the most effective, but the most challenging to build. Men are often reluctant to reveal that they had a cosmetic procedure to their male friends or colleagues.”

Compared with women, “Men are a little more clandestine than women,” noted Dr. Aguilera. “While they are willing to do anything they can to make themselves look better, they also want no downtime or indications that they got cosmetic work done. They are most comfortable with not letting anybody find out that they did it. However, I see the wives come in and get a body shaping treatment and next thing you know the husband or boyfriend is in our office, asking about it.”

The growth of male aesthetics has also been affected by the up-and-coming Millennial generation, which is perhaps more dedicated to aesthetics than any other demographic.

“The Millennial patient is a lot more cosmetically adventurous and educated about procedures,” Dr. Aguilera pointed out. “We see many young patients come in for enhancement. The older patients need this kind of therapy, but the younger ones want it.”

“Millennials see a friend of theirs on social media who has had some work done, for instance,” said Dr. Mueller. “They are growing more aware of what is available, and they are going for it.”

Similarly, gay men are more adventurous, almost the way a woman would be, according to Dr. Mueller. “There’s a whole world of gay men talking to other gay men about what kinds of aesthetic procedures they have had. Gay men will talk about it more than straight men. They are not afraid to come in and ask, what do you think I need? I’m not happy about the way my body looks. Should I have liposuction? They are a bit more open to what we suggest and they are very dedicated. They will refer their friends to me if they are happy with the results. It’s quite an incredible patient-to-patient referral.”

In recent years, rejuvenation of the genital area has become considerably more popular with both men and women. Penile enhancement is a growing niche in the aesthetic industry; however, most of the advances in techniques and technologies, including clinical studies and FDA approvals, have been made in non-surgical vaginal rejuvenation procedures.

Experts pointed out that currently most of the penile enhancement procedures being used are experimental, however, procedures that extend the penis’ length and girth, should become mainstream soon.

“Regarding girth enhancement, everything out there is considered, at best, experimental,” confirmed Paul Perito, M.D., a urologist in Coral Gables, Fla., who performs over 500 penile implant surgeries per year.

“When it comes to the glans, work has been done in Korea in the use of filler-type materials, such as PMMA or different forms of hyaluronic acid (HA). One evidence-based approach I’ve heard of is the use of a synthetic nanoparticle that shows promising results in increasing girth.”

Eventually, this developing penile cosmetic niche will be brought into mainstream medicine, Dr. Mueller insisted. “It is going to be a huge area. It doesn’t matter if a guy is gay or straight. Yes, there are some unresolved issues, but think women and breast implants. Breast implants remain very popular even though there are lots of problems with them,” he stated. “With penile enhancement, there are numerous surgical procedures out there that are not good and produce major deformities. I’ve seen some results using silicone that have been disasters. If somebody can come up with an answer to that then yes, the interest will be very high.”

By comparison, “Females are asking for procedures that are far less experimental, such as vaginal rejuvenation – from surgical to energy-based techniques,” Dr. Perito said.

For instance, the top trends in feminine rejuvenation include any non-invasive treatment option that improves both the function and appearance of the vagina.

“Women are highly interested in any treatment that allows them to remain as comfortable as possible, with little to no pain, downtime, prescription medications and/or invasive surgeries,” Dr. Lalji acknowledged.

Women’s pelvic muscles go through a great amount of trauma throughout pregnancy, childbirth and even aging, causing the pelvic floor muscles to weaken and not function properly, Dr. Lalji continued. “When this happens, women experience laxity and incontinence, as well as a large change in the appearance. This typically leads to sexual dysfunction and/or a decline in sexual desire. Oftentimes, this results in a loss of self-confidence, feelings of embarrassment and a tailoring of their lives according to this,” she said.

In Dr. Lalji’s experience, when it comes to successful approaches to managing patient expectations in non-invasive feminine rejuvenation procedures, “The results vary from patient to patient, but one aspect that remains constant is that nearly all my female patients have experienced life-changing results,” she indicated. “In order to successfully maintain the results and expectations for this type of treatment, it is important that women go through a series of maintenance sessions on an ongoing annual basis.”

Easy-to-use energy-based technologies (RF, laser, ultrasound) have put vaginal rejuvenation on the radar for a lot of practitioners.

“We offer an RF-based procedure and while it has been a slow uptake it is an incredible technological approach,” Dr. Mueller stated. “The treatments not only help with sexual function, but also with bladder control, as well as other conditions that are now fairly easy to treat compared with surgery.”

Characteristic of this type of device, ThermiVa® from Thermi, an Almirall company (Dallas, Texas) is a temperature- controlled system that uses RF-based energy to gently heat tissue so that women can reclaim their intimate wellness without discomfort or downtime. The ThermiVa electrode is designed to treat the internal and external anatomical features of the vagina.

Similarly, Votiva from InMode (Richmond Hill, Ontario, Canada) uses FormaV or FractoraV RF technologies to address the internal and external areas of concern. FormaV’s subdermal heating technology applies uniform RF heat to internal vaginal tissue and external vulvar laxity or labial hypertrophy. Treatment addresses a variety of intimate wellness concerns such as aging, hormonal changes and/or physical damage. FractoraV utilizes customized fractional RF energy to improve superficial skin tone problems and for skin tightening. Full-depth heating improves elastin and collagen remodeling to positively impact a woman’s feminine health and quality of life.

Among CO2-based devices, V-Lase from Lasering (San Ramon, Calif.) is a non-ablative, non-fractional CO2 modality for feminine rejuvenation. V-Lase creates mild thermal damage in the mucosal lining and underlying tissues of the vaginal canal and vulva. This remodels existing collagen and induces fibroblasts to create new collagen, elastin, reticular fibers and glycosaminoglycans. Treatment is safe, pain-free, non-invasive and results in thickening, tightening and more elastic and pliable vaginal walls, as well as a restoration of vaginal moisture and pH balance.

At the practice level, the problem is not a lack of technology, but rather how do you bring up vaginal rejuvenation during the consultation? “For us, performing these types of treatments and getting the great results is easy,” Dr. Mueller expressed. “The biggest challenge is in the conversation. You don’t want to make the person feel uncomfortable during the consult.”

In reality, anyone seeking aesthetic treatments, regardless of the desired procedure, gender or generation, wants to build a solid trust with the physician performing the work. “The leap into cosmetic procedures can be a reluctant one,” said Dr. Keaney. “Trust in the physician is critical for a patient to make that leap. Do not overpromise results and carefully explain the side effects. With men, we see lower tolerance of side effects, such as bruising, because of their work schedule
and concern of being identified as having had a procedure, etc.”

As described by Dr. Perito, male aesthetic patients are ‘one and done.’ “When you set the expectations, they are on board,” he said. “They want to come in and get it done that day. They don’t want to wait. If you string them along then they lose interest. Give them a plan and they will stick with it.”