Laser and Light-Based Aesthetics in Men
September 2015 | Volume 14 | Issue 9 | Original Article | 1061 | Copyright © 2015
Jeremy B. Green MD,a,b Andrei I. Metelitsa MD FRCPC,c,d Joely Kaufman MD,a,b and Terrence Keaney MDe,f,g,h
aSkin Associates of South Florida, Coral Gables, FL
bUniversity of Miami Department of Dermatology & Cutaneous Surgery, Miami, FL
cInstitute for Skin Advancement, Calgary, Alberta, Canada
dUniversity of Calgary, Calgary, Alberta, Canada
eWashington Institute of Dermatologic Laser Surgery, Washington, DC
fGeorge Washington Hospital Department of Dermatology, Washington, DC
gHoward University Hospital Department of Dermatology, Washington, DC
hLaser and Lipoatrophy Clinic, Veterans Administration (VA) Hospital, Washington, DC
Men represent an important evolving segment of the cosmetic market. With the growing acceptability of cosmetic procedures along with societal and workplace pressure to maintain youthfulness, men increasingly seek the advice of aesthetic practitioners. Despite this so-called "Menaissance," there is a paucity of published literature regarding laser and light treatments of male skin. Herein the differences in male cutaneous physiology are addressed, followed by a review of light-based treatment of conditions largely unique to male skin, pseudofolliculitis barbae, and rhinophyma. Next, the publications related to laser treatment of male skin specifically are examined. We conclude with a discussion of personal observations derived from clinical experience with laser and light-based treatments in men.
J Drugs Dermatol. 2015;14(9):1061-1064.
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The “Menaissance” era is upon us. Drivers of male patients to seek aesthetic interventions include societal pressures to appear rested and refreshed, especially in an increasingly competitive job market. Irrespective of motive, the male aesthetic patient has arrived. Lasers and light sources could potentially serve as a “gateway” procedure, whereby removal of an unsightly cutaneous lesion could open the door to other treatments such as injectables. There is a paucity of literature exploring the effects of lasers and lights on men in particular. After a discussion of male cutaneous physiology we review these existing publications, and conclude with observations from our clinical practices.
Male Cutaneous MilieuSkin Optics
When a laser beam interacts with the skin there are four possible outcomes: it can be reflected, absorbed, scattered, or transmitted.1 Laser scattering is dependent on the laser’s wavelength and affects the depth of penetration of radiation into the skin. In the dermis, scattering depends on the size of structures such as collagen that impede the photons path to the target chromophore. Absorbed photons can produce thermal, mechanical, or chemical changes to the chromophore. Skin structures (eg, terminal versus vellus hairs) that contain increased concentration of chromophore result in increased absorption. The laser-skin interaction, therefore, depends on cutaneous physiology. Since gender is one of the most significant factors that determine cutaneous physiology, it plays a critical role in the laser surgery.Cutaneous Physiology
Skin metabolizes and responds to sex hormones2. The quantitative gender differences of sex steroids lead to gender differences in cutaneous physiology. Male skin is thicker at all ages, 3 but the difference varies with anatomical region.4 Mirroring the gradual decrease in testosterone, male skin thickness decreases linearly with age.5 Gender differences in skin thickness are thought to be due to differences in dermal collagen content and size. The total hydroxyl-proline content in men is greater than women at all ages.6 In mouse models, electron microscopy showed statistically significant differences in the collagen fibril diameter between men and women.7
Male cutaneous appendages show greater activity with men having higher sebum and sweat production. There are significant differences in hair distribution because the growth of sexual hair is dependent on androgens. Androgens convert non-pigmented vellus hairs into pigmented, terminal hairs. Androgen-dependent areas include the chin, upper lip, chest, abdomen, and back. The increase in terminal hairs contributes to the male facial vascular pattern.8 A doppler flow perfusion study documented increased facial vascular perfusion in men.9 A dense plexus of arteries support the hair follicle. Large diameter hair follicles require more capillaries to support their