Male Aesthetics: A Review of Facial Anatomy and Pertinent Clinical Implications

Men also have larger facial pores and produce more sebum than women. Caucasian men have an average of 3 μg of sebum per square centimeter of skin surface, while Caucasian women have 0.7 μg/cm².^42,43 Sebum helps waterproof and lubricate the skin, and maintains flexibility of the stratum corneum. Men usually find excess sebum undesirable, as it is associated with pore enlargement, greasy-appearing skin and acne.⁴³

In 2014, the two most common cosmetic procedures performed in men were injections of botulinum toxin type A (BTX-A) and dermal fillers.¹ Successful use of these injectable agents requires a balancing act between masculinizing and feminizing the face, as overuse or misplaced agents may result in poor cosmetic outcomes.

The presence of larger facial muscles in men requires higher doses of BTX-A to achieve the same cosmetic effects observed in women. A prospective, double-blind, randomized study by Carruthers and Carruthers showed that the glabellar region in men should be treated with at least 40 units of BTX-A, which is twice the standard dose given to women.⁴⁴ When treating forehead rhytides in men, the medial and lateral frontalis should be equally treated to avoid creating an eyebrow arch (“Mephisto sign”), which is feminizing when present in a male patient. Crow’s feet in men usually have an inferior fanning pattern due to the relative increased size of the zygomaticus