INTRODUCTION
Cosmetic procedures for men have seen a dramatic increase over the last decade. This is thought to be due to an aging “baby boomer†population, greater cultural acceptance of cosmetic procedures, and dramatic improvements in cosmetic products and technologies.1 A survey performed by the American Society for Plastic Surgery Association found that men had over 1 million minimally-invasive cosmetic procedures in 2013, with injectable neurotoxin being the most popular and its use is up over 300% since the year 2000.2 The other most popular procedures in men included microdermabrasion, laser hair removal, and soft tissue fillers.
The reasons for a male patient to see a dermatologist for a cosmetic procedure are broad. The most commonly stated reasons include: “look younger,†“work related,†and “to improve competitivenessâ€.3 Cosmetic interventions can rapidly be performed in the office with minimal downtime and achieve noticeable results, and men have become more aware of these procedures. Regardless of their motivations, an initial consultation is important to assess the patient’s wishes and expectations. Some men will identify particular areas of concern, whereas others may have less specific interests other than overall aging. Although the desired procedures are often the same as in women, the techniques and treatment parameters are different. It is important to recognize that men have different expectations and goals, and their unique facial anatomy and way that they age are important factors to consider when performing cosmetic procedures.
Male Facial Anatomy and Biology
Sexual dimorphism refers to the phenotypic differentiation between men and women. There are significant differences in male skeletal anatomy, skeletal muscle mass, skin thickness, and fat distribution, making the approach to the male cosmetic patient different from their female counterpart. Examining the facial sexual dimorphism that exists is an important starting point for a discussion on tailoring male cosmetic treatments to achieve a more youthful, masculine result.
Differences in Facial Structure
Anatomical differences between the two sexes account for a majority of variation in facial soft tissues. The overall framework of the head is different between males and females, with the female skull being approximately four fifths the size of the male skull.4 In addition to being larger in size, the male face has different cutaneous landmarks and overall shape, and the male facial skeleton is generally more angular. Males possess a greater forehead height and width with greater slope backwards from the brow.5 In line with this, males have a more prominent supraorbital ridge providing a position of the eyebrow that is flatter, straighter, and lower along the supraorbital rim.6, 7 In comparison to the male’s, the orbit in females is smaller and more oval; however, it is proportionally larger relative to the size of the skull.8 Eyebrow shape, position, as well as orbital shape are all important considerations when using neuromodulators and dermal fillers.
The lower face may also represent a prominent area of concern for men. A “chiseled jaw†and a “strong chin†represent certain anatomical features that highlight defining male characteristics. These result from men having a more prominent flexure of the mandible, creating a wider and larger chin with more forward projection and a more defined jawline. Additionally, men have less soft tissue in the cheeks, resulting in
