The word “metrosexual” reportedly was coined in 1994,1 but did not go mainstream until 2002, when soccer star and sex symbol David Beckham was described in a Salon.com article2 as the prime example of this term that refers to a heterosexual male who is heavily invested in his physical appearance and wardrobe. In the decade or so since then, men have become increasing interested in aesthetics. For example, male skincare products have transformed from an aftershave gift-package afterthought to a $3.4 billion market.3
This paradigm shift represents a significant opportunity for dermatologists who are performing elective cosmetic procedures, as well as their colleagues who are considering widening the scope of their practice to include more aesthetics. Men are one of the fastest growing patient segments in aesthetics and represent a significant opportunity for practice development. Both personal and professional forces are driving this trend, according to experts.
“On a personal level, men want to feel attractive at every age of life, and they are often influenced and motivated to look better by their significant other,” says Ivan D. Camacho, MD, FAAD, a board certified dermatologist in private practice in Coral Gables, FL, and a voluntary assistant professor of dermatology and cutaneous surgery at the University of Miami Miller School of Medicine in Miami. “Perhaps even more integral to growth of the male aesthetics market, says Dr. Camacho, is that we live in a society that puts great emphasis on appearance, and men are feeling the pressure to look their best to improve their chances of advancing their careers.”
Dr. Camacho says he is seeing a new type of male patient in his practice: The “modern man,” who is concerned about improving his appearance, aware of the importance of skincare and motivated to confront the natural process of aging. “In 2013, men accounted for 9.4% of the more than 9 million non-surgical cosmetic procedures performed in the United States alone, representing a 13% increase from 2012. Also in 2013, over $5 billion was spent on non-surgical procedures and men represented 10% of those expenditures,”4,5 says Dr. Camacho.
Addressing this burgeoning market makes sense from a business and clinical perspective. “There is great demand and a growing acceptance for aesthetic interventions among men. Our male patients are encouraged by the availability, efficacy and safety of these procedures, when performed by experienced hands,” he says. “They appreciate our expertise in being able to provide the natural appearing results that they expect.”
If You Build It…
The Washington Institute of Dermatologic Laser Surgery in Washington, DC, was on the forefront of the male aesthetics movement. In 2013, The Institute expanded by introducing W for Men, the nation’s first cosmetic and dermatologic laser surgery center devoted solely to caring for men’s needs. Under the direction of Terrence Keaney, MD, W for Men serves the growing demand for men’s aesthetic procedures. Dr. Keaney says that once it became apparent that interest in male aesthetics was more than an aberration, it only made sense to cater to the demand. The saying, “if you build it, they will come,” turned out to be more than a catchy line from a baseball movie classic, it was the formula for a thriving practice, he says.
“To attract male aesthetic patients, you have to make men a priority whether through the creation of a separate clinic, waiting room, marketing materials and/or patient education programs,” advises Dr. Keaney. “Men need to feel comfortable and need to know that they are not going to get treated just like all of your female aesthetic patients.”
Since the inception of W for Men, the percentage of his time with male aesthetic patients has grown to approximately 70%. “Body contouring, laser resurfacing and surgical robotic hair restoration are growing and popular procedures among my male patients,” explains Dr. Keaney. “Hair can be an indicator of health, age and vitality. For many, a receding hairline or male pattern baldness can be an emotional and professional set back.” W for Men uses the Artas Robotic System (Restoration Robotics Inc., San Jose, CA) for hair restoration, which uses high definition imaging to identify and select optimal hairs for harvesting and this helps to improve efficiency and results, according to Dr. Keaney.
Competitive Edge
With the emergence of new technologies, there is an increased interest in skin tightening and non-invasive body contouring including radiofrequency, ultrasound and cryolipolysis for men, according to Dr. Camacho. However, botulinum toxin type A injection is by far the most popular cosmetic treatment among men. In 2013, men accounted for 11% of botulinum toxin patients representing a 258% increase from 2000.4,5 Men’s stronger facial musculature often requires higher doses of botulinum toxin to achieve an optimal response, he points out. “In order to appropriately treat — and avoid feminizing the patient’s facial features, we need to understand the patient’s specific musculature — taking into account the increased forehead height and width often seen in men or the presence of a receding hairline; as well as the male facial anatomy, including preserving the masculine position of the brow — horizontal — at the level of the supraorbital rim and without curvature,” he says.
The use of Botox (Allergan, Inc.) in male patients has become so commonplace, that it has spawned its own nickname; but the term “Brotox” is more than just an entry in the Urban Dictionary — it is a harbinger of things to come. Paul Jarrod Frank, MD, a New York City cosmetic dermatologist, points out that the pair of companies synonymous with cosmetic neuromodulators are developing marketing campaigns geared toward men. Dr. Frank, who authored, Turn Back the Clock Without Losing Time: A Complete Guide to Quick and Easy Cosmetic Rejuvenation, in 2002, right around the time when the male cosmetic market was emerging as a bona fide entity, devotes 100% of his practice to cosmetics.
In 2000, when he founded The Fifth Avenue Dermatology Surgery and Laser Center, men represented 5% of his practice; today close to half of his patients are male. “I’m a professional, heterosexual man who cares about the way he looks. I first had Botox when I was 28, and I’m 45 now. I exercise and mediate every day and I don’t do anything to my patients that I wouldn’t have done myself. They come to me because there’s a sense of affinity — they recognize themselves in me and feel comfortable with me,” he explains.
“All men at some point feel like they are being aged out by younger people, and I think that’s an impetus for wanting to take better care of themselves. That may be by going to the gym, it may be by getting their hair colored, it may be by getting a little Botox or laser resurfacing,” says Dr. Frank. “There’s been a shift in the way men think about cosmetic procedures. They consider them as maintenance; they’re a means to an end of being the best version of themselves. It’s like an extension of going to the gym — most men don’t go to the gym for their heart disease they go because it makes them look and feel good and that’s what these procedures do, too.”
As Dr. Frank noticed growth in demand for male cosmetic procedures, he began producing and posting videos on his practice website addressing those demands. Men surreptitiously surfing online for information about aesthetic interventions would invariably end up viewing his videos. He observed a consistent spike in viewership between midnight and 2 am, and made an association that, while not particularly flattering, rings quite true. “I know it is men who are watching these videos and they do it in the dark of night when no one else is around because there’s still a bit of a social stigma associated with men pursuing cosmetic treatments — but not enough to deter them from following up and following through,” he says. “Men have the same cosmetic concerns as women — they are human after all — and the Internet is such a great anonymous resource,” he adds.
What’s the Difference?
Dr. Camacho points out that the correct approach in male aesthetics is to recognize that there are important differences between genders, primarily driven by genetic and hormonal factors, such as the effect of testosterone and the lack of estrogens that translate into specificities in skin biology, facial anatomy, the aging process and “therefore our rejuvenation goals and aesthetic ideals.”
He says, “Men’s dermis is 20% thicker, with higher collagen density, allowing us to age with less superficial wrinkling and better elasticity and men have greater facial skeletal muscle and movement, generating deeper expression lines. As a result of this increased mass and, perhaps in part due to different physiological responses, men require higher doses of botulinum toxin to achieve optimal results.”
Dr. Keaney cautions that, “It’s important to avoid feminization by creating a feminine peaked eyebrow with botulinum toxin or leaving them with feminine full medial cheeks with dermal fillers.”
Dr. Camacho adds, “Men have higher facial bone density mass and stronger facial bone structure with unique bone structural features such as greater glabellar projection, greater forehead height and width, prominent suparorbital ridges, larger orbital size, larger chin and sharper mandibular angles. They also have a lower amount of facial subcutaneous fat and faster fat oxidation rates.” As a result, he explains, volume loss is a key component of the aging face in men, often requiring higher volumes of dermal filler to correct volume changes.
He Says, She Says
Dr. Frank points out that men rarely present saying they want to look more attractive or younger. It is more common to hear male patients describe their goal as looking well rested or less stressed. “I never remove wrinkles in men; I improve them or reduce them. I don’t want a man’s face perfectly rounded and smooth. I want a little ruggedness in it. I want a little hollowness in it. I under treat because I know that for a man, it’s so much more important to look natural,” he explains.
The distinction between the sexes often extends beyond biology to behavior. For instance, Dr. Frank says while his female aesthetic patients tend to make calculated decisions that they discuss with their husband or friends, his male patients are apt to be more decisive. “Once my male patients decide they want Botox or a laser treatment, they’re inclined to say ‘let’s do it now,’ or if they come in for a liposuction consultation, odds are they’ll book it before leaving the office. If they don’t book within 48 hours, they probably never will.”
He says his male cosmetic patients also tend to be quite loyal, which, of course, is a boon for practice growth. “In my experience, female patients tend to be swayed by suggestions from friends and media influences, whereas once a man is happy with his barber, his tailor and his cosmetic dermatologist it’s unlikely that he’s ever going to consider going anywhere else,” says Dr. Frank.
Joshua Zeichner, MD, another Manhattan dermatologist with a significant male patient base, treats men for rosacea, acne and acne scars. “In many ways, I am a one-stop-shop because we provide clinical treatment for acne lesions, but in many cases patients are left with permanent scarring that we can treat effectively — electively — with lasers,” says Dr. Zeichner, director of cosmetic and clinical research, department of dermatology, Mount Sinai Hospital. “In the professional world, marks on the skin are looked down upon, and I have a lot of male patients who are in high-profile finance jobs or with large corporations and there is an expectation of how they need to look to be able to compete in these fields,” he explains.
When he discusses cosmetic procedures with his patients, Dr. Zeichner maintains a neutral stance. “I bring the subject up so that patients are aware of what’s available and what’s possible, and more and more men are following up with a frequency that has risen even just in the last year,” he notes.
He says while it is important to appreciate the obvious distinctions inherent in discussing cosmetic procedures with male and female patients, the key points remain the same, “It’s about bringing up the topic without seeming pushy and without making the patient feel uncomfortable — know your audience, know your key points and keep it short and simple. Once you bring it up, if someone is interested they are going to follow up.”
References
1. Dictionary.com. https://dictionary.reference.com/browse/metrosexual. Accessed July 24, 2015.
2. Simpson M. Meet the metrosexual. Salon. July 22, 2002. https://www.salon.com/2002/07/22/metrosexual/. Accessed July 24, 2015.
3. Euromonitor International. Men’s grooming in the US. https://www.euromonitor.com/mens-grooming-in-the-us/report. Accessed July 24, 2015.
4. 2013 American Society for Dermatologic Surgery Survey on Dermatologic Procedures.
5. 2013 American Society for Aesthetic Plastic Surgery - National Data Bank.
The word “metrosexual” reportedly was coined in 1994,1 but did not go mainstream until 2002, when soccer star and sex symbol David Beckham was described in a Salon.com article2 as the prime example of this term that refers to a heterosexual male who is heavily invested in his physical appearance and wardrobe. In the decade or so since then, men have become increasing interested in aesthetics. For example, male skincare products have transformed from an aftershave gift-package afterthought to a $3.4 billion market.3
This paradigm shift represents a significant opportunity for dermatologists who are performing elective cosmetic procedures, as well as their colleagues who are considering widening the scope of their practice to include more aesthetics. Men are one of the fastest growing patient segments in aesthetics and represent a significant opportunity for practice development. Both personal and professional forces are driving this trend, according to experts.
“On a personal level, men want to feel attractive at every age of life, and they are often influenced and motivated to look better by their significant other,” says Ivan D. Camacho, MD, FAAD, a board certified dermatologist in private practice in Coral Gables, FL, and a voluntary assistant professor of dermatology and cutaneous surgery at the University of Miami Miller School of Medicine in Miami. “Perhaps even more integral to growth of the male aesthetics market, says Dr. Camacho, is that we live in a society that puts great emphasis on appearance, and men are feeling the pressure to look their best to improve their chances of advancing their careers.”
Dr. Camacho says he is seeing a new type of male patient in his practice: The “modern man,” who is concerned about improving his appearance, aware of the importance of skincare and motivated to confront the natural process of aging. “In 2013, men accounted for 9.4% of the more than 9 million non-surgical cosmetic procedures performed in the United States alone, representing a 13% increase from 2012. Also in 2013, over $5 billion was spent on non-surgical procedures and men represented 10% of those expenditures,”4,5 says Dr. Camacho.
Addressing this burgeoning market makes sense from a business and clinical perspective. “There is great demand and a growing acceptance for aesthetic interventions among men. Our male patients are encouraged by the availability, efficacy and safety of these procedures, when performed by experienced hands,” he says. “They appreciate our expertise in being able to provide the natural appearing results that they expect.”
If You Build It…
The Washington Institute of Dermatologic Laser Surgery in Washington, DC, was on the forefront of the male aesthetics movement. In 2013, The Institute expanded by introducing W for Men, the nation’s first cosmetic and dermatologic laser surgery center devoted solely to caring for men’s needs. Under the direction of Terrence Keaney, MD, W for Men serves the growing demand for men’s aesthetic procedures. Dr. Keaney says that once it became apparent that interest in male aesthetics was more than an aberration, it only made sense to cater to the demand. The saying, “if you build it, they will come,” turned out to be more than a catchy line from a baseball movie classic, it was the formula for a thriving practice, he says.
“To attract male aesthetic patients, you have to make men a priority whether through the creation of a separate clinic, waiting room, marketing materials and/or patient education programs,” advises Dr. Keaney. “Men need to feel comfortable and need to know that they are not going to get treated just like all of your female aesthetic patients.”
Since the inception of W for Men, the percentage of his time with male aesthetic patients has grown to approximately 70%. “Body contouring, laser resurfacing and surgical robotic hair restoration are growing and popular procedures among my male patients,” explains Dr. Keaney. “Hair can be an indicator of health, age and vitality. For many, a receding hairline or male pattern baldness can be an emotional and professional set back.” W for Men uses the Artas Robotic System (Restoration Robotics Inc., San Jose, CA) for hair restoration, which uses high definition imaging to identify and select optimal hairs for harvesting and this helps to improve efficiency and results, according to Dr. Keaney.
Competitive Edge
With the emergence of new technologies, there is an increased interest in skin tightening and non-invasive body contouring including radiofrequency, ultrasound and cryolipolysis for men, according to Dr. Camacho. However, botulinum toxin type A injection is by far the most popular cosmetic treatment among men. In 2013, men accounted for 11% of botulinum toxin patients representing a 258% increase from 2000.4,5 Men’s stronger facial musculature often requires higher doses of botulinum toxin to achieve an optimal response, he points out. “In order to appropriately treat — and avoid feminizing the patient’s facial features, we need to understand the patient’s specific musculature — taking into account the increased forehead height and width often seen in men or the presence of a receding hairline; as well as the male facial anatomy, including preserving the masculine position of the brow — horizontal — at the level of the supraorbital rim and without curvature,” he says.
The use of Botox (Allergan, Inc.) in male patients has become so commonplace, that it has spawned its own nickname; but the term “Brotox” is more than just an entry in the Urban Dictionary — it is a harbinger of things to come. Paul Jarrod Frank, MD, a New York City cosmetic dermatologist, points out that the pair of companies synonymous with cosmetic neuromodulators are developing marketing campaigns geared toward men. Dr. Frank, who authored, Turn Back the Clock Without Losing Time: A Complete Guide to Quick and Easy Cosmetic Rejuvenation, in 2002, right around the time when the male cosmetic market was emerging as a bona fide entity, devotes 100% of his practice to cosmetics.
In 2000, when he founded The Fifth Avenue Dermatology Surgery and Laser Center, men represented 5% of his practice; today close to half of his patients are male. “I’m a professional, heterosexual man who cares about the way he looks. I first had Botox when I was 28, and I’m 45 now. I exercise and mediate every day and I don’t do anything to my patients that I wouldn’t have done myself. They come to me because there’s a sense of affinity — they recognize themselves in me and feel comfortable with me,” he explains.
“All men at some point feel like they are being aged out by younger people, and I think that’s an impetus for wanting to take better care of themselves. That may be by going to the gym, it may be by getting their hair colored, it may be by getting a little Botox or laser resurfacing,” says Dr. Frank. “There’s been a shift in the way men think about cosmetic procedures. They consider them as maintenance; they’re a means to an end of being the best version of themselves. It’s like an extension of going to the gym — most men don’t go to the gym for their heart disease they go because it makes them look and feel good and that’s what these procedures do, too.”
As Dr. Frank noticed growth in demand for male cosmetic procedures, he began producing and posting videos on his practice website addressing those demands. Men surreptitiously surfing online for information about aesthetic interventions would invariably end up viewing his videos. He observed a consistent spike in viewership between midnight and 2 am, and made an association that, while not particularly flattering, rings quite true. “I know it is men who are watching these videos and they do it in the dark of night when no one else is around because there’s still a bit of a social stigma associated with men pursuing cosmetic treatments — but not enough to deter them from following up and following through,” he says. “Men have the same cosmetic concerns as women — they are human after all — and the Internet is such a great anonymous resource,” he adds.
What’s the Difference?
Dr. Camacho points out that the correct approach in male aesthetics is to recognize that there are important differences between genders, primarily driven by genetic and hormonal factors, such as the effect of testosterone and the lack of estrogens that translate into specificities in skin biology, facial anatomy, the aging process and “therefore our rejuvenation goals and aesthetic ideals.”
He says, “Men’s dermis is 20% thicker, with higher collagen density, allowing us to age with less superficial wrinkling and better elasticity and men have greater facial skeletal muscle and movement, generating deeper expression lines. As a result of this increased mass and, perhaps in part due to different physiological responses, men require higher doses of botulinum toxin to achieve optimal results.”
Dr. Keaney cautions that, “It’s important to avoid feminization by creating a feminine peaked eyebrow with botulinum toxin or leaving them with feminine full medial cheeks with dermal fillers.”
Dr. Camacho adds, “Men have higher facial bone density mass and stronger facial bone structure with unique bone structural features such as greater glabellar projection, greater forehead height and width, prominent suparorbital ridges, larger orbital size, larger chin and sharper mandibular angles. They also have a lower amount of facial subcutaneous fat and faster fat oxidation rates.” As a result, he explains, volume loss is a key component of the aging face in men, often requiring higher volumes of dermal filler to correct volume changes.
He Says, She Says
Dr. Frank points out that men rarely present saying they want to look more attractive or younger. It is more common to hear male patients describe their goal as looking well rested or less stressed. “I never remove wrinkles in men; I improve them or reduce them. I don’t want a man’s face perfectly rounded and smooth. I want a little ruggedness in it. I want a little hollowness in it. I under treat because I know that for a man, it’s so much more important to look natural,” he explains.
The distinction between the sexes often extends beyond biology to behavior. For instance, Dr. Frank says while his female aesthetic patients tend to make calculated decisions that they discuss with their husband or friends, his male patients are apt to be more decisive. “Once my male patients decide they want Botox or a laser treatment, they’re inclined to say ‘let’s do it now,’ or if they come in for a liposuction consultation, odds are they’ll book it before leaving the office. If they don’t book within 48 hours, they probably never will.”
He says his male cosmetic patients also tend to be quite loyal, which, of course, is a boon for practice growth. “In my experience, female patients tend to be swayed by suggestions from friends and media influences, whereas once a man is happy with his barber, his tailor and his cosmetic dermatologist it’s unlikely that he’s ever going to consider going anywhere else,” says Dr. Frank.
Joshua Zeichner, MD, another Manhattan dermatologist with a significant male patient base, treats men for rosacea, acne and acne scars. “In many ways, I am a one-stop-shop because we provide clinical treatment for acne lesions, but in many cases patients are left with permanent scarring that we can treat effectively — electively — with lasers,” says Dr. Zeichner, director of cosmetic and clinical research, department of dermatology, Mount Sinai Hospital. “In the professional world, marks on the skin are looked down upon, and I have a lot of male patients who are in high-profile finance jobs or with large corporations and there is an expectation of how they need to look to be able to compete in these fields,” he explains.
When he discusses cosmetic procedures with his patients, Dr. Zeichner maintains a neutral stance. “I bring the subject up so that patients are aware of what’s available and what’s possible, and more and more men are following up with a frequency that has risen even just in the last year,” he notes.
He says while it is important to appreciate the obvious distinctions inherent in discussing cosmetic procedures with male and female patients, the key points remain the same, “It’s about bringing up the topic without seeming pushy and without making the patient feel uncomfortable — know your audience, know your key points and keep it short and simple. Once you bring it up, if someone is interested they are going to follow up.”
References
1. Dictionary.com. https://dictionary.reference.com/browse/metrosexual. Accessed July 24, 2015.
2. Simpson M. Meet the metrosexual. Salon. July 22, 2002. https://www.salon.com/2002/07/22/metrosexual/. Accessed July 24, 2015.
3. Euromonitor International. Men’s grooming in the US. https://www.euromonitor.com/mens-grooming-in-the-us/report. Accessed July 24, 2015.
4. 2013 American Society for Dermatologic Surgery Survey on Dermatologic Procedures.
5. 2013 American Society for Aesthetic Plastic Surgery - National Data Bank.
The word “metrosexual” reportedly was coined in 1994,1 but did not go mainstream until 2002, when soccer star and sex symbol David Beckham was described in a Salon.com article2 as the prime example of this term that refers to a heterosexual male who is heavily invested in his physical appearance and wardrobe. In the decade or so since then, men have become increasing interested in aesthetics. For example, male skincare products have transformed from an aftershave gift-package afterthought to a $3.4 billion market.3
This paradigm shift represents a significant opportunity for dermatologists who are performing elective cosmetic procedures, as well as their colleagues who are considering widening the scope of their practice to include more aesthetics. Men are one of the fastest growing patient segments in aesthetics and represent a significant opportunity for practice development. Both personal and professional forces are driving this trend, according to experts.
“On a personal level, men want to feel attractive at every age of life, and they are often influenced and motivated to look better by their significant other,” says Ivan D. Camacho, MD, FAAD, a board certified dermatologist in private practice in Coral Gables, FL, and a voluntary assistant professor of dermatology and cutaneous surgery at the University of Miami Miller School of Medicine in Miami. “Perhaps even more integral to growth of the male aesthetics market, says Dr. Camacho, is that we live in a society that puts great emphasis on appearance, and men are feeling the pressure to look their best to improve their chances of advancing their careers.”
Dr. Camacho says he is seeing a new type of male patient in his practice: The “modern man,” who is concerned about improving his appearance, aware of the importance of skincare and motivated to confront the natural process of aging. “In 2013, men accounted for 9.4% of the more than 9 million non-surgical cosmetic procedures performed in the United States alone, representing a 13% increase from 2012. Also in 2013, over $5 billion was spent on non-surgical procedures and men represented 10% of those expenditures,”4,5 says Dr. Camacho.
Addressing this burgeoning market makes sense from a business and clinical perspective. “There is great demand and a growing acceptance for aesthetic interventions among men. Our male patients are encouraged by the availability, efficacy and safety of these procedures, when performed by experienced hands,” he says. “They appreciate our expertise in being able to provide the natural appearing results that they expect.”
If You Build It…
The Washington Institute of Dermatologic Laser Surgery in Washington, DC, was on the forefront of the male aesthetics movement. In 2013, The Institute expanded by introducing W for Men, the nation’s first cosmetic and dermatologic laser surgery center devoted solely to caring for men’s needs. Under the direction of Terrence Keaney, MD, W for Men serves the growing demand for men’s aesthetic procedures. Dr. Keaney says that once it became apparent that interest in male aesthetics was more than an aberration, it only made sense to cater to the demand. The saying, “if you build it, they will come,” turned out to be more than a catchy line from a baseball movie classic, it was the formula for a thriving practice, he says.
“To attract male aesthetic patients, you have to make men a priority whether through the creation of a separate clinic, waiting room, marketing materials and/or patient education programs,” advises Dr. Keaney. “Men need to feel comfortable and need to know that they are not going to get treated just like all of your female aesthetic patients.”
Since the inception of W for Men, the percentage of his time with male aesthetic patients has grown to approximately 70%. “Body contouring, laser resurfacing and surgical robotic hair restoration are growing and popular procedures among my male patients,” explains Dr. Keaney. “Hair can be an indicator of health, age and vitality. For many, a receding hairline or male pattern baldness can be an emotional and professional set back.” W for Men uses the Artas Robotic System (Restoration Robotics Inc., San Jose, CA) for hair restoration, which uses high definition imaging to identify and select optimal hairs for harvesting and this helps to improve efficiency and results, according to Dr. Keaney.
Competitive Edge
With the emergence of new technologies, there is an increased interest in skin tightening and non-invasive body contouring including radiofrequency, ultrasound and cryolipolysis for men, according to Dr. Camacho. However, botulinum toxin type A injection is by far the most popular cosmetic treatment among men. In 2013, men accounted for 11% of botulinum toxin patients representing a 258% increase from 2000.4,5 Men’s stronger facial musculature often requires higher doses of botulinum toxin to achieve an optimal response, he points out. “In order to appropriately treat — and avoid feminizing the patient’s facial features, we need to understand the patient’s specific musculature — taking into account the increased forehead height and width often seen in men or the presence of a receding hairline; as well as the male facial anatomy, including preserving the masculine position of the brow — horizontal — at the level of the supraorbital rim and without curvature,” he says.
The use of Botox (Allergan, Inc.) in male patients has become so commonplace, that it has spawned its own nickname; but the term “Brotox” is more than just an entry in the Urban Dictionary — it is a harbinger of things to come. Paul Jarrod Frank, MD, a New York City cosmetic dermatologist, points out that the pair of companies synonymous with cosmetic neuromodulators are developing marketing campaigns geared toward men. Dr. Frank, who authored, Turn Back the Clock Without Losing Time: A Complete Guide to Quick and Easy Cosmetic Rejuvenation, in 2002, right around the time when the male cosmetic market was emerging as a bona fide entity, devotes 100% of his practice to cosmetics.
In 2000, when he founded The Fifth Avenue Dermatology Surgery and Laser Center, men represented 5% of his practice; today close to half of his patients are male. “I’m a professional, heterosexual man who cares about the way he looks. I first had Botox when I was 28, and I’m 45 now. I exercise and mediate every day and I don’t do anything to my patients that I wouldn’t have done myself. They come to me because there’s a sense of affinity — they recognize themselves in me and feel comfortable with me,” he explains.
“All men at some point feel like they are being aged out by younger people, and I think that’s an impetus for wanting to take better care of themselves. That may be by going to the gym, it may be by getting their hair colored, it may be by getting a little Botox or laser resurfacing,” says Dr. Frank. “There’s been a shift in the way men think about cosmetic procedures. They consider them as maintenance; they’re a means to an end of being the best version of themselves. It’s like an extension of going to the gym — most men don’t go to the gym for their heart disease they go because it makes them look and feel good and that’s what these procedures do, too.”
As Dr. Frank noticed growth in demand for male cosmetic procedures, he began producing and posting videos on his practice website addressing those demands. Men surreptitiously surfing online for information about aesthetic interventions would invariably end up viewing his videos. He observed a consistent spike in viewership between midnight and 2 am, and made an association that, while not particularly flattering, rings quite true. “I know it is men who are watching these videos and they do it in the dark of night when no one else is around because there’s still a bit of a social stigma associated with men pursuing cosmetic treatments — but not enough to deter them from following up and following through,” he says. “Men have the same cosmetic concerns as women — they are human after all — and the Internet is such a great anonymous resource,” he adds.
What’s the Difference?
Dr. Camacho points out that the correct approach in male aesthetics is to recognize that there are important differences between genders, primarily driven by genetic and hormonal factors, such as the effect of testosterone and the lack of estrogens that translate into specificities in skin biology, facial anatomy, the aging process and “therefore our rejuvenation goals and aesthetic ideals.”
He says, “Men’s dermis is 20% thicker, with higher collagen density, allowing us to age with less superficial wrinkling and better elasticity and men have greater facial skeletal muscle and movement, generating deeper expression lines. As a result of this increased mass and, perhaps in part due to different physiological responses, men require higher doses of botulinum toxin to achieve optimal results.”
Dr. Keaney cautions that, “It’s important to avoid feminization by creating a feminine peaked eyebrow with botulinum toxin or leaving them with feminine full medial cheeks with dermal fillers.”
Dr. Camacho adds, “Men have higher facial bone density mass and stronger facial bone structure with unique bone structural features such as greater glabellar projection, greater forehead height and width, prominent suparorbital ridges, larger orbital size, larger chin and sharper mandibular angles. They also have a lower amount of facial subcutaneous fat and faster fat oxidation rates.” As a result, he explains, volume loss is a key component of the aging face in men, often requiring higher volumes of dermal filler to correct volume changes.
He Says, She Says
Dr. Frank points out that men rarely present saying they want to look more attractive or younger. It is more common to hear male patients describe their goal as looking well rested or less stressed. “I never remove wrinkles in men; I improve them or reduce them. I don’t want a man’s face perfectly rounded and smooth. I want a little ruggedness in it. I want a little hollowness in it. I under treat because I know that for a man, it’s so much more important to look natural,” he explains.
The distinction between the sexes often extends beyond biology to behavior. For instance, Dr. Frank says while his female aesthetic patients tend to make calculated decisions that they discuss with their husband or friends, his male patients are apt to be more decisive. “Once my male patients decide they want Botox or a laser treatment, they’re inclined to say ‘let’s do it now,’ or if they come in for a liposuction consultation, odds are they’ll book it before leaving the office. If they don’t book within 48 hours, they probably never will.”
He says his male cosmetic patients also tend to be quite loyal, which, of course, is a boon for practice growth. “In my experience, female patients tend to be swayed by suggestions from friends and media influences, whereas once a man is happy with his barber, his tailor and his cosmetic dermatologist it’s unlikely that he’s ever going to consider going anywhere else,” says Dr. Frank.
Joshua Zeichner, MD, another Manhattan dermatologist with a significant male patient base, treats men for rosacea, acne and acne scars. “In many ways, I am a one-stop-shop because we provide clinical treatment for acne lesions, but in many cases patients are left with permanent scarring that we can treat effectively — electively — with lasers,” says Dr. Zeichner, director of cosmetic and clinical research, department of dermatology, Mount Sinai Hospital. “In the professional world, marks on the skin are looked down upon, and I have a lot of male patients who are in high-profile finance jobs or with large corporations and there is an expectation of how they need to look to be able to compete in these fields,” he explains.
When he discusses cosmetic procedures with his patients, Dr. Zeichner maintains a neutral stance. “I bring the subject up so that patients are aware of what’s available and what’s possible, and more and more men are following up with a frequency that has risen even just in the last year,” he notes.
He says while it is important to appreciate the obvious distinctions inherent in discussing cosmetic procedures with male and female patients, the key points remain the same, “It’s about bringing up the topic without seeming pushy and without making the patient feel uncomfortable — know your audience, know your key points and keep it short and simple. Once you bring it up, if someone is interested they are going to follow up.”
References
1. Dictionary.com. https://dictionary.reference.com/browse/metrosexual. Accessed July 24, 2015.
2. Simpson M. Meet the metrosexual. Salon. July 22, 2002. https://www.salon.com/2002/07/22/metrosexual/. Accessed July 24, 2015.
3. Euromonitor International. Men’s grooming in the US. https://www.euromonitor.com/mens-grooming-in-the-us/report. Accessed July 24, 2015.
4. 2013 American Society for Dermatologic Surgery Survey on Dermatologic Procedures.
5. 2013 American Society for Aesthetic Plastic Surgery - National Data Bank.
