Julie Ann Woodward, M.D. Durham, N.C.
"Generally, most male patients come into the office primarily motivated by medical concerns. They are usually referred by another physician to evaluate the potential medical benefits of the increased visual field provided by upper eyelid blepharoplasty."Many men are more likely to be uncomfortable than women at the idea of visiting a cosmetic surgeon. Whether this discomfort is cultural or biological, it is certainly abetted by the numbers: 92 percent of all cosmetic surgeries in 2010 were performed on women. Most men feel more comfortable making an appointment under the gentle suggestion from their referring physician that their upper blepharoplasty may be covered by insurance. However, once a male patient moves past that initial step, he may be very open to the suggestion of adding a cosmetic lower blepharoplasty to be done at the same time.
"I suspect that increasing numbers of men will schedule cosmetic surgery motivated by the desire to enhance their career due to the emphasis that American culture places on physical appearance. The financial benefit for men is important for surgeons to realize. Once the discomfort factor has been eliminated, men are willing to discuss the cosmetic benefits of surgery. While upper blepharoplasty has a significant therapeutic benefit, a lower-lid blepharoplasty is purely cosmetic in nature. Further, blepharoplasty can be enhanced with laser skin resurfacing, fat transfer or filler injections. In recent years, I have seen more men interested in scheduling a variety of procedures to enhance their blepharoplasty.
"In addition, an increasing number of male patients have presented at my office for cosmetic evaluation at the encouragement of their significant others (SO). It is not uncommon at all to have male patients come in with their wives or partners not only for surgical evaluations, but also for injections of neuromodulators and fillers with their SOs. When it comes to injections, many couples have begun to view this as a 'date night' activity — something fun that they can do and enjoy together."
Walter W. Tom, M.D., F.A.C.S. Santa Rosa and Napa, Calif.
"Men tend to make quicker decisions about what treatment they desire, yet are more intolerant of any delayed downtime. Men and women want to be attractive to the opposite sex, yet women are also motivated to look good for other women. Men are less pressured to look good for other men, yet men are definitely motivated to look good (strong, healthy, vibrant) in the workplace.
"There are also special technique considerations in treating the male patient for facial concerns. One cannot singularly apply the techniques we use for women in men. Specifically, we do not want to feminize the male patient. For facial procedures, one must understand the gender differences. Although the eyes are the focal point for both groups, they are framed differently. Other differences include the following: men's brows are heavier; men's eyebrows tend to be horizontal or slope downward from middle to outside of the eye, whereas women's eyebrows tend to be curved; both sexes have malar prominence in youth, but they tend to be not as full in men; women's faces are heart-shaped, the-so called "Triangle of Beauty," but in men, the face should be square with a strong jawline; and an attractive male face has a strong chin and jawline.
"With these caveats, my botulinum (Botox, onabotulinumtoxinA, Allergan) technique is modified for treating the glabellar frown lines. In men, the desired Botox arching of the female eyebrows should be prevented by injecting a small dose of Botox on the superior-lateral aspect of the frontalis muscle (forehead). This maneuver drops the lateral aspect of the eyebrow.
"I am more aggressive in recommending fillers to revolumize the glabellar and supraorbital ridge that opens the eyes but maintains a masculine appearance. I also use fillers (Restylane, hyaluronic acid, Medicis) in the infraorbital region to minimize the bags under the eyes, but moderately fill the malar area and avoid an overly aggressive filling of the lateral zygomatic region to prevent creating a feminizing triangle of beauty. I also follow the above guidelines for facial fat grafting in men. For a weak chin and jawline, I use fillers or fat to enhance the chin. As a standalone treatment or in conjunction with facial fat grafting, I prefer using laser liposuction (Smartlipo, Cynosure) for the chin, neck and jawline area."