INTRODUCTION
The number of aesthetic procedures performed in the United States has skyrocketed in recent years, as trained practitioners are satisfying the wishes of an increasingly interested public. Between 1997 and 2014, there was a 274% increase in the number of cosmetic procedures performed annually.1 During these same years, the pursuit of non-invasive procedures surpassed that of invasive procedures. In 2014, Americans spent approximately 5 billion dollars on an estimated 9 million non-operative cosmetic procedures. Recent data suggests that this growth is not slowing.1 According to a 2014 American Society of Dermatologic Surgery study, 5 in 10 adults are considering a cosmetic procedure.2
While the focus in aesthetic medicine has classically been on females, the market for male aesthetics is growing. Between 1997 and 2014, there was a 273% increase in the number of cosmetic procedures performed on men, with neurotoxin and dermal filler being the most common.1 The number of adult males seeking cosmetic injections has increased by 81% since 2010 and 254% since 2000--totaling 571,307 injections in 2014.1 Several theories for this increase have been proposed, including a desire to be more competitive and youthful in the workforce, an increase in the social acceptability of cosmetic procedures, and a greater awareness of the safety and efficacy of botulinum toxin and dermal filler. Additionally, cosmetic injections offer immediate results with minimal post-treatment recovery, enabling men to return to work immediately.3
The approach to male aesthetics differs from that of females. Anatomical, psychological, and social factors determine treatment goals. Here we review male facial anatomy to help guide physicians performing noninvasive cosmetic procedures in male patients.
Facial Proportions
The standards of facial beauty vary according to culture and are known to change with time, thus eluding an objective definition. Facial beauty may be characterized by a combination of factors that involve symmetry and aesthetically pleasing proportions. Measurement of the ideal face has been well described and documented since the days of ancient Egypt and classical Greece. A recovered limestone bust of Queen Nefertiti, dating to 1350 BC was designed symmetrically and geometrically using grids of equal sized squares.4 In the 5th century BC, Phidias, a Greek sculptor, based his creations on golden sections or rectangles; he used divisions of a line to form ratios of proportion in which the smaller was to the larger segment as the larger was to the whole (1:1.618).5,6 This principle has been incorporated into aesthetic models that divide the ideal face into distinct facial units or shapes based on Phidias’ principle.7
500 years later, in the early Christian era, the Roman architect Vitruvius (circa 70-25 BC) divided the face into horizontal thirds that are equal in size and volume, a concept that was incorporated into Leonardo da Vinci’s Vitruvian Man, and a practice that is still performed by many cosmetic physicians (See Figure 1).8,9
