Male Cosmetic Surgery:
Men appear to age more slowly than women. Some basic differences between the sexes that result in men's aging more slowly have been observed for many years. Think about the movie stars--Robert Redford, Michael Douglas and Sean Connery to name a few--who maintain the admiration and attention of many women despite their advancing years.
The underlying reason for this discrepancy stems from the thickness of the facial skin. Men's facial skin is much thicker due to hair follicles in the beard--added layers which make the tissues less elastic and therefore more resistant to the aging process.
Each year over one million people have cosmetic surgery, with approximately 25%-30% of them men. It is not surprising that men are concerned about their appearance, with the many studies that have documented the importance of one's looks in determining success in the business world. How one appears can have a dramatic effect on self confidence and interpersonal relationships.
This is not a new concept, but one which dates back thousands of years. In one of the tombs of an ancient pharaoh, scientists were delighted to find a well-preserved inscription. Hoping to find a profound message, they were surprised to read a recipe to cure baldness! Through the ages, the Romans wore wreaths of olive branches on their heads to camouflage baldness. As recently as two hundred years ago George Washington and the other colonists would shave their heads completely and wear ornate wigs, for style and vanity.
Styles may change over the years, but the desire to enhance one's appearance is a deep rooted basic instinct for most men. One of the most exciting things in the 21st century is the wide variety of options available for men to enhance their looks.
A handsome man is one whose features are all in balance, working together. If a nose is too large or ears too prominent, they will dominate the face and distract from other more attractive features.
Men seek the advice of a cosmetic surgeon to help achieve this well-proportioned and balanced look so that all their features are working together. Even if one started life with perfect facial proportions, as a result of the aging process the balance begins to change: hairlines recede, noses lengthen, and chins begin to double up with extra tissues.
When considering their options for a treatment program, men factor in the universal concerns of pain, bruising and down time to experience a successful result.
Quick Fix: The Complexion
A healthy complexion is the cornerstone of a youthful appearance. Fine lines and brown sun spots add years to one's looks. Fortunately, great advances have been made over the last ten years with skin care products and skin services.
Sun protection with a minimum of SPF-15 (which allows a person to stay out 15 times longer than if one was wearing no sun screen) should be used daily. For early signs of sun damage, a good exfoliation program combined with skin care services such as lunchtime peels or microdermabrasion can help. These last two treatments involve no down time, but if done regularly can help to achieve and maintain a healthy complexion. Another benefit is that these peels will help reduce one's chance of getting a skin cancer, the fastest-increasing type of cancer.
Men are particularly susceptible to skin cancer because of outside recreation and work, combined with the thinning of the ozone layer. A good healthy diet, lots of water (at least eight glasses daily), and exercise also play a very important role in maintaining a healthy complexion.
Muscles, Muscles, Muscles
Generally, we think of muscles inserting into bones and tendons. The facial muscles are interesting because they insert directly into the skin. Therefore, each time they contract, the skin creases and wrinkles begin to appear. The forehead wrinkles are among the first to appear, usually in the thirties. The frown lines between the eyebrows develop and then the crows' feet or squint lines adjacent to the eye.
One of the easiest treatments for these conditions is quick and generally does not involve any down time: the injection of the muscles with Botulinum A, or Botox . The procedure does not require any anesthesia. Ice or a topical anesthetic may be applied to the skin to dull the brief pricking sensation. However, the Botox is injected with the smallest needle made and is therefore only a momentary inconvenience. The Botox lasts from 3-4 months for most men, and can be repeated when facial activity begins to reappear. Complications are very unusual, making this one of the fastest-increasing procedures for men.
Fillers
Fine lines and thin lips have been treated for years with collagen. The down side was that the collagen came from a cow, therefore skin-testing to detect allergic reactions was necessary.
Dermologen is a human collagen product which lasts about as long as collagen, but doesn't carry the possibility of allergic reaction since it is human tissue. Alloderm is also human collagen. In a study performed at our center, it was found to be present in 89% of the patients a year after being placed.
The Alloderm initially came in sheet form, which requires a local anesthetic for placement. It has been popular in the lip area, the fold between the mouth and the cheek, and for acne scars. An injectable form of Alloderm called Cymetra allows the patient simply to have an injection without the need of an anesthetic.
Tired Eyes
As the aging process continues, excess tissues build up around the eyelid area. Women may come in for a blepharoplasty or eye lift in their late twenties to thirties. Due to the heavy male skin the eyebrows commonly droop early and the men choose blepharoplasty in their late thirties to forties. Blepharoplasty refers to the procedure by which excess eyelid tissues are removed. Because the eyelid skin is the thinnest skin on the body it heals the fastest.
Before an eyebrow lift, as part of the examination the position of the eyebrow should be evaluated. If the brows are drooping or if there are deep frown lines between the brows, a minimal-incision or endoscopic brow lift may be appropriate.
Previously techniques to raise the brow would involve making an incision in the middle of the forehead, resulting in a scar which could take months to fade. The advantage of the minimal-incision facelift for men is that even if there is thinning of the hairline the small incisions, generally about one to two centimeters long, are difficult to find.
The endoscopic forehead lift can be done with a local anesthetic, but more commonly a general or twilight anesthesia. The procedure utilizes the latest in technology: very small telescopes and cameras which project the pictures to a large monitor from which the surgeon can view and perform the procedure. With this procedure the frown muscles can be weakened permanently. (Because Botox is a liquid, it generally gives a more absolute paralysis of the muscles, whereas the surgery weakens the muscles around 75%).
Men may experience bruising for one to two weeks and numbness for up to six months. A very important difference in male brow lifting versus female is that in men the brow should be raised to maintain a relatively flat shape. This is very important to avoid a postoperative feminine look. Generally when women have their brow lifted, the goal is to arch the brow.
The goal of upper eyelid surgery in men and women is very different as well. In women, the goal is to create a crisp, sharply-defined upper eyelid crease. In men the eyelid should be underdone as compared to the women's. Creating a sharp eyelid crease in a man generally creates a telltale sign of surgery. Most of the time, sutures are removed within a week and the patient is back in action. The incision fades and should ideally be hidden by a slight overhand of the skin on the upper eyelid.
Options to treat the lower eyelid include removal of excess fatty tissue which causes puffiness. Laser resurfacing can be added to correct wrinkling or dark circles under the eyes. To remove a larger amount of loose skin a small incision can be made to remove the tissues.
No Turkey Here
With aging, tissues may accumulate along the jawline and neck. Three options are available, and all require a minimum of twilight anesthesia, with bruising possible for up to two weeks.
In the younger patient with fullness along the jaw and neck but good skin tone, facial liposuction can create a very nice improvement. A sling or suture may be placed from the chin to the ear to add definition in the neck area. Chin implants may be placed to help strengthen the profile.
With skin tone loosening in the fifties, men may consider a facelift or rhytidectomy. The modern male facelift should consist of contouring the jawline with liposuction, and tightening both the muscles and the skin.
As excess tissues develop, many men find a wattle of tissue directly under their chins. This 'turkey neck' wears shirts down and is a noticeable obstacle when turning one's head. The turkey neck can be excised in the midline using a relatively simple procedure, with a recovery period of about a week. The midline scar fades within a couple months.
Wrinkles and Acne Scars
Laser resurfacing is the gold standard for wrinkle removal. Surgery removes sags and bags, and the laser removes wrinkles, brown spots and helps to soften acne scars.
The carbon dioxide laser is a focused beam of energy, absorbed by the water in the skin. The laser vaporizes the outer layers of the skin, causing the skin to form new collagen. Exciting research indicates that the new collagen which forms after resurfacing is still present 20 years later. Patients look like they have had a sunburn at two weeks after the procedure, and gradually fade over 4-6 weeks. Laser resurfacing for acne scars may require pretreatment with Alloderm to build up some of the more depressed scars. Spot lasering can be done several times to gain additional improvements.
Thinning Hair
Great advances have been made over the past five years to help stave off baldness. Medications such as Propecia , a once-a-day pill, have been shown to be much more effective than Rogaine for thinning hair on the top of the head. However, Propecia does very little for thinning in the frontal area.
For the treatment of thinning along the frontal hairline a patient can choose between flaps and follicular transfer. Flaps involve taking a strip of hair from the side of the head and flipping it across the front to create a new hairline. The hair density is very thick, and follicular grafting can be done in front of the flap to soften the scar if visible.
Follicular unit grafting is the state-of-the-art for the majority of patients. A strip of hair is removed from the side or back of the head. Under magnification, the hair is separated into single to two-hair units. These hairs are then placed into micro-incisions in the desired area.
Thinning on the top of the head is treated with scalp reductions or grafting. The scalp reduction is performed by excising an oval of bald skin and closing the incision. As the scalp relaxes over 3-6 months, another reduction can be performed. This process is accelerated today with the use of an extender. Before closing the incision, this simple device is inserted under the scalp and helps to pull it together so that by the end of 4-6 weeks the majority of the bald area is removed.
Rhinoplasty
Plastic surgery of the nose is very popular with men. A computer imager allows the patient and doctor to arrive at a common understanding of the patient's goals, with the actual patient on one side of the screen and the desired changes opposite. The goals of male rhinoplasty generally involve maintaining a strong bridge, since a low bridge lends a feminine appearance. The tip of the nose should not be rotated up too much; an angle between the lip and the nose should not be more than 90-95 degrees.
Today the nose surgery is performed without packing, making it a much more comfortable procedure. Due to the male's thicker skin, it may take up to a year and a half for all the swelling to resolve. Men are also more prone to develop scar tissue, which may require a steroid injection during the follow-up period.
Prominent Ears
This is a very common condition from birth. The ears are usually fully-formed, but Mother Nature didn't have time to complete their unfolding. Many times this is corrected when the child is 5-7 years of age; however many adults also have this corrected. The procedure is performed through an incision in the crease behind the ear. The patient may experience temporary numbness; otherwise, patients are back to their activities within a few days.
Conclusion
Cosmetic surgery in men can offer a very exciting and rewarding change. Most patients are pleasantly surprised that there is very little discomfort after the facial procedures, because they commonly will have some temporary numbness.
Male surgery is very different from female surgery, as discussed above. When selecting a facial plastic or cosmetic surgeon, make sure they are aware of these differences and that they have operated on a significant number of men.
Biography
Brian P. Maloney, M.D., F.A.C.S., is a nationally-recognized facial plastic surgeon based in Atlanta whose client roster includes celebrities and sports figures from throughout the world. He lectures internationally on breakthroughs in cosmetic surgery and publishes extensively. Dr. Maloney is often asked to conduct research studies or participate in programs seeking upgrades and improvements in surgical technique. For more information please visit www.maloneycenter.com or call 404-252-5438.
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