Male Body Contouring
September 2015 | Volume 14 | Issue 9 | Original Article | 1052 | Copyright © September 2015
Babu Singh MD,a Terrence Keaney MD,b and Anthony M. Rossi MDc,d
aDepartment of Dermatology, Boston University Medical Center, Boston, MA
b VA Hospital,Washington, DC
cDermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY
dWeill Cornell Medical College, New York, NY; New York Presbyterian Hospital, New York, NY
Men are increasingly turning to dermatologists and plastic surgeons to request procedures that correct or enhance physical features. With the advent of this emerging new patient population, alterations in preexisting aesthetic techniques, gender-specific uses of existing devices and overall approaches need to be revisited and adapted to obtain results that are suitable for the male patient. Recently, body contouring has become one of the most sought out procedures by men. Although the majority of clinical studies involving body contouring esthetics are performed with female patients, gains from such studies can be extrapolated to men. Body contouring can be broadly classified as non-invasive or invasive, depending on the modality used. Non-invasive contouring is most frequently performed with devices that target subcutaneous adipose with focused electrical or thermal energy, including low-level laser, cryolipolysis, ultrasonography, and radiofrequency. Invasive body contouring modalities useful for male body contouring include liposuction, pectoral and abdominal wall etching, jawline fillers, synthetic deoxycholic acid injections, and solid silicone implants. The purpose of this review is to bring attention to the unique aspects, strategies, and modalities used in aesthetic body contouring for the male patient. J Drugs Dermatol.
According to the 2014 American Society for Aesthetic Plastic Surgery (ASAPS) consensus data, men account for 10% of all cosmetic procedures performed, totaling more than 1 million procedures.1 Since the ASAPS began collecting
data in 1997, they have observed an increase of over 273% of procedures in men, and 7.1% in the past year.1 Two of the most common procedures are male breast reduction for gynecomastia and liposuction, indicating that men are seeking procedures to contour slimmer builds.1 Furthermore, as depicted
in Figure 1, men underwent approximately six times more nonsurgical skin tightening and fat reduction procedures than invasive lift procedures, indicating the importance of noninvasive
body contouring for men. Male patients may prefer non-invasive body contouring because of decreased down time, minimal postoperative complications, and a perceived more discreet and natural appearance after the procedure. Recently published survey data of male patients undergoing consultation
at an esthetic surgical group found that the abdominal zone was the most desired body part to contour.2 The survey also showed that the percentage of men who underwent body contouring procedures increased from 6.4% in 2005 to 32.9% in 2013.2
Differences between fat distribution between men and women have historically been described as “android” in men where fat is distributed over the anterior chest and central abdomen, and “gynoid” in women where fat is distributed over buttocks and lateral upper thighs. Differences in fat distribution for aesthetic
treatment purposes, although observed, have not been systematically
quantified. However, epidemiological studies have correlated a central fat distribution in men with an increased risk of glucose intolerance, hyperlipidemia, and hypertension.3 A study by Shimokata et al., found that both men and women develop upper and central body fat deposits with age, but men develop fat deposits at a much earlier age.4 Furthermore, in a prospective study published by the Baltimore Longitudinal Study of Aging found that waist circumference was larger in men and weight gain in men had larger effects on the waist to hip circumference ratio than women.5 Another study utilizing whole-body computerized tomographic (CT) scans determined that the abdominal subcutaneous fat volume decreases with age, although visceral fat volume increases 2.6 times larger in males than in females.6 This visceral fat cannot be targeted by invasive or non-invasive procedures and therefore the male patient
should be counseled accordingly preoperatively.
The Golden Ratio (GR) is a measure of proportionality used frequently in art, architecture, and esthetic medicine. Also represented
as the Greek letter “phi,” some consider the ratio to fall between 1 and 1.1618. The GR has been applied to the male physique, referred to as the “Adonis Ratio.” This ratio has been commercialized in numerous fitness and weight loss products. It has been defined as the ratio of shoulder and waist lengths. Ratios approximating 1.1618 are considered more esthetically and visually pleasing.