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Surgical nuances of the male patient

Article-Surgical nuances of the male patient

People are people and discussing cosmetic surgery patients underlines similarities that are gender blind. There are, however, many physical and biopsychosocial differences between men and women. The skin is different, the fat deposition is different, muscles are different, hormonal influences are different, motivation is different and other issues, such as communication and compliance, are different. Although many of the procedures we perform are almost exactly the same for men and women, their preop and post op management has many nuances.

My practice is limited to cosmetic facial surgery and men are about 15% of my patient base. This is a very similar number for many of my colleagues. Other surgeons may have large hair transplantation or rhinoplasty practices and have many more male patients. For the average practitioner, men and women pass through our offices in a very similar manner. Having said that, seasoned doctors can spew forth a list of differences in treating male patients.

In my experience, men are more compulsive and single-procedure oriented than women. Female patients are often frequent fliers in a cosmetic practice. They come in for skin care, spa treatments and surgical procedures along the way. Men, on the other hand, may present for eyelid surgery or a facelift and never be seen again, or not for years. Men do not convert to long-term patients as frequently as females and opt more for the “one and done” concept.

Privacy is a very important factor for cosmetic surgeons regardless of gender, but there is no doubt that having cosmetic facial surgery for a man is, in general, less common and less accepted by male peers than it is for women. While many women will share their cosmetic surgery experience with others, many men won’t. They are also less accepting of allowing their before and after pictures to be used by the office. Many male patients will also admit that they feel uncomfortable arriving at a cosmetic surgery office and being the only man sitting in a reception room full of women. In addition, the average cosmetic surgery office is set up with a feminine theme. The colors, furnishing, magazines, etc. are usually aimed at female clientele. So not only does a male patient feel embarrassed about sitting in a reception room full of women, but there is nothing for him to do there, as he is probably not going to read Vogue.

More In This Article

The Male Psyche

How He Communicates

Nuances of The Male Facelift

Catering to the Male Patient


The Male Psyche

Figure 1. Men are often concerned with excess neck skin. Face and neck lift is the gold standard for improving this concern. This patient is shown before and after cervicolfacial rhytidectomy. Photo credit: Joe Niamtu, III, DMDFrom the beginning of the consultation process, men are frequently hesitant to simply rattle off a list of what bothers them. They are more embarrassed to point out a flaw and ask for help, often present excuses or express guilt to justify why they don’t like their excess neck skin. It is overall a little harder to extract what exactly bothers some male patients and what they want done.

Once a treatment plan is initiated many men become extremely cost conscious. Women find a number of things in life extremely important and even necessary. For many women, having cosmetic facial surgery to look younger and boost self-confidence is a rite of passage that they simply assume is going to happen and the expense is a means of fulfilling their desire. Men, on the other hand, have more “slack” from society in terms of aging. Many men in their sixth decade are considered very handsome if they are in good physical shape and have a thick head of salt and pepper hair. In many older men, facial lines such as nasobabial folds or glabellar creases are construed as macho. Females in their sixth decade with grey hair and wrinkles many times don’t consider themselves attractive. “How come it is OK for men to look older and not women?” is a question that frequently arises in female consultation. Some women may feel insecure when in the company of younger women, whereas older men may feel “alpha.” Few women desire a natural, rugged, angular appearance that is the goal of many men.

NEXT: How He Communicates


How He Communicates

In my experience, women are much more concerned about healing details and products. Many men feel that recovery is for weak people and they don’t adequately plan for a restful recovery period. Recently I was in a preop meeting with a male patient who was going to have facelift and eyelid surgery. He told me he was excited to have surgery. When I asked him why he was so excited, he stated he was going to remodel his garage while off of work! This is clearly a patient who does not “get it” and could be an invitation to severe complications. Men don’t sit at home well and get cabin fever must faster than women who may welcome the recovery period to read, relax or reflect.

Pre- and post-operative communication with men is also frequently more difficult than with females. While women take notes and follow details, some men are much less likely to read the required preoperative instructions and follow postoperative details. “Ahhh, I will be just fine,” is the mantra of many men. Men are less likely to comply with medications after several days and harder to motivate to follow skin care regimens.

NEXT: Nuances of The Male Facelift


Nuances of The Male Facelift

Figure 2. Male facelift incisions can be post-tragal or pre-tragal, but most men have preauricular wrinkles that serve as a natural site for incision and is preferable for the average male patient.
Photo credit: Joe Niamtu, III, DMD

Male facelift patients present a specific list of differences when compared to females. First off, men don’t wear makeup and therefore may take longer to return to normal activities. Women with long hair can easily cover facelift incisions while most men have short hair and often receding hairlines; not only can they not cover the incisions, changes in the hairline are more critical. Bearded skin is another factor. Redistributing hair-bearing skin is a possibility. Bearded skin can be pulled onto the tragus or behind the ear and is problematic. Careful attention must be directed to the hair and beard line, incision lines and earlobe position.

Figure 3. This shows the typical result of a healed pre-tragal facelift incision in a male patient. Photo credit: Joe Niamtu, III, DMDWhereas women desire a soft rounded appearance, many males desire a more sculpted look and request facial implants, including cheek, chin and mandibular angles. Men have larger muscles and thicker skin and can present more anesthetic challenges than petite females. They require more medication for anesthesia and anesthetic maintenance and are often bellicose during anesthetic emergence. It is well documented that the hematoma rate for facelift is greater in men than women.

NEXT: Catering to the Male Patient


Catering to the Male Patient

Sometimes it is difficult to list gender differences, as people are people. If you ask novice surgeons about gender differences, they may have a short list. Seasoned surgeons, however, can voice a more comprehensive list, as it oftentimes takes years of experience to recognize the differences.

If a practice wants to attract or cater to more men, they should appeal to the male personality. Seeing male patients only on certain days will insure that only men are in the reception room and office. On those days, Men’s Health or Car and Driver magazines can replace Vogue and Vanity Fair. Carrying dedicated lines of men’s skin care and health products as well as distributing samples can be very appealing.

In the end, both genders want the same thing: great service and safe surgery with predictable outcomes. Most surgeons who are successful with women are also successful with men, as they have this paradigm in place. But by pointing out the gender differences to men, surgeons offer reassurance. Men feel better when they know their surgeon realizes that there are differences to treating men and women and has the expertise to do so.

Dr. NiamtuJoe Niamtu, III, DMD, is well known in international cosmetic facial surgery circles as surgeon, teacher and author and is regarded as a key opinion leader by academics and clinicians worldwide. He lectures internationally on cosmetic facial surgery and has taught on six continents around the world. Dr. Niamtu has written six textbooks, contributed 31 chapters to other textbooks, and has authored hundreds of publications on various cosmetic facial surgery topics. Dr. Niamtu is a fellow of the American Academy of Cosmetic Surgery and the American Society for Lasers in Medicine and Surgery, and is board certified by the American Board of Oral and Maxillofacial Surgery. 


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