“Man-some”: A Review of Male Facial Aging and Beauty

Facial aging results from progressive changes to the skin, soft tissue, and skeletal structure. The changes associated with aging are produced by both intrinsic and extrinsic factors.¹ Intrinsic aging refers to the role of one’s genes and hormones in the aging process. Extrinsic factors are environmental insults, such as smoking and sun exposure, which accelerate facial aging. Although the factors influencing aging are well understood, the rate and pattern of aging is unique to each individual due to the combination of behavioral, genetic, and anatomical differences. Gender is a key determinant in the aging process because of the genetic and behavioral differences between men and women. The importance of recognizing male facial aging is critical when planning an aesthetic treatment on men. What is less understood is the aesthetic goal when treating the aging male face. What is the male aesthetic ideal? What makes men beautiful or “man-some”? Since beauty is in the eye of the beholder, it is important to understand the male aes- thetic ideal when planning aesthetic treatments. Ultimately, an aesthetic treatment is successful if the results align with the patient goals. Men exhibit a different set of motivations, goals, and concerns about aging than women. With increasing aesthetic interest among male patients, an understanding of anatomy and aging is not enough. This article will review facial aging and beauty ideals in men in order to pro- vide a framework for physicians to plan successful aesthetic treatments in men.

Men tend to age more poorly due to their susceptibility to intrinsic and extrinsic factors.² Men have reduced innate antioxidant capacity and are more prone to greater UV-induced immunosuppression.³ Men are also more likely to participate in high risk health behaviors that accelerate aging. Men are more likely to smoke and are less likely to adopt sun protective behaviors.⁴ Men use sunscreen less frequently, are more likely to develop a sunburn, and have demonstrated less knowledge regarding sun safety and skin cancer formation than women. Rhytides tend to be more severe and develop earlier in men starting on the forehead.⁵ The male wrinkle pattern is unique due to differences in facial muscle movement and cutaneous appendages. Men lack substantial perioral rhytides. The downward fan lateral canthal wrinkle pattern and “U” glabellar wrinkle pattern are more common in men. A steady atrophy of facial soft tissue occurs in men as opposed to the rapid decline found in perimenopausal women.⁶ Male volume loss is more pronounced in the periocular area with men developing more severe lower eyelid sagging.⁷ Men are also more susceptible to hair loss, with 50 % of Caucasian men showing at least some signs of hair loss by age 50. Hair loss is associated with the loss of youth and can make men appear older than their stated age.⁸ While the pattern and rate of facial aging differs between genders, the underlying facial anatomy differs as well. Testosterone plays a critical role in secondary sexual characteristics including skeletal shape, subcutaneous fat distribution, and cutaneous physiology. A “masculine” youthful face is not only larger but exhibits a different shape. The male face is wider at all levels including the forehead, cheeks, and jawline. Men exhibit less subcutaneous soft tissue that is distributed more evenly with less anterior medial projection and more lateral projection in the midface. Men have more prominent supraorbital ridges and a wider and larger chin with forward prominence. These features contribute to the “square” and “angular” contour of the masculine, male face.