Men are becoming more open to the idea of facial aesthetic treatment but are still in the minority in numbers treated. Both can benefit greatly, so what are the differences in treating male and female patients? The American Association of Plastic Surgeons statistics for 2013 show females as having 91% of cosmetic procedures overall, broken down to 94% of all botox treatments, 96% of all dermal filler treatments and 92% of all chemical peels. Within this, the most requested female treatment was botox (55%), then fillers (20%), peels (11%), laser hair removal and microdermabrasion (each 7%). For men botox was again the most requested treatment (41%), followed by laser hair removal (20%), microdermabrasion (19%), peels then fillers (each 10%).
Physical – male and female faces have some general differences, even with masculine female faces and feminine male faces. Men’s skin is 25% thicker with more collagen (one of the most important building blocks of skin) and oilier with larger pores and more hair follicles. This makes it more prone to acne and smoothing out irregularities often requires more treatment. Sun damage is more common in men due to work and lifestyle with a greater resistance to using sunscreen. Women have an advantage as beauty and skin products often containing sunscreen as an ingredient. Wrinkles in women tend to be more numerous but finer, men’s wrinkles tending to be fewer (due to thicker skin and support from hair follicles) but deeper. Horizontal forehead lines in men often appear earlier as the forehead muscle (frontalis) is continually working to hold up the brows which are heavier than for women.
The development of the face is an important factor to consider as when infants boys and girls are often difficult to tell apart. Essentially all faces start as feminine and develop gender characteristics over time. Numerous studies have shown that feminine faces are intrinsically more attractive to males, females, children and infants so this feature provides a protection and survival mechanism in infancy. Faces become distinctly male or female in childhood and continue to differentiate in maturity.
- The overall shape of the face is characteristically different. In women the upper half of the face is more prominent with a taper to the lower half whereas men’s facial shape is more angular and square with larger jaws which evenly balances the upper and lower parts.
- Forehead: male foreheads are muscular with flatter eyebrows and larger brows, whilst the female brow is more rounded. The heavier brow, notably towards the center, can often look assertive and dominant (the current Dr Who, Peter Capaldi, has what were described as “attack eyebrows”). Male foreheads show earlier wrinkles which may deepen if the forehead muscle needs to act (generally subconsciously) to stop the eyebrows dropping further over the eyes. Female eyebrows are often shaped or even tattooed to alter the appearance of the eyes and the face.
- Eyes: male eyes are deeper set, narrower and slightly less open. As a fresh, youthful appearance is highly prized in women, a wide-eyed look is desired and make-up is used to accentuate this. There are a number of eye shapes that were detailed in the Focus on eyes blog.
- Cheekbones and mandible: the mid-to-lower face shows an important difference between men and women. The female face tapers in to the chin which accentuates the cheekbones and eyes. This smooth and slightly rounded appearance of the cheeks in youth is a very important sign of a young face, but leads to jowling earlier in women. This is because there is less support for the cheek from the jaw as the fat pads of the cheek drop and the thinner skin becomes less elastic and sags. For men the cheekbones are less prominent and the lower jaw is larger and squarer with the muscles being larger as well as the bone. Very flat cheekbones are a sign of aging and this can affect even young men. Women normally have more jowling.
- Nose: in general the nose is slightly larger in men, this can be longer, wider or both. The nose-to-upper lip (nasolabial) angle is more open in females which displays the upper lip better.
- Lips and chin: although there can be a wide range of different lip and chin shapes, in general the female chin lies slightly behind the lower lip which again accentuates the lips. Female lips are smaller in width but more voluminous with more of an upturn at the corners of the mouth (the commissures). The male chin is stronger, males have larger mouths and thinner (especially upper) lips.
- Facial skeleton: the facial skeleton is different for men and women as well, surprisingly. The major differences are larger brows, jaws and nose opening (pyriform aperture) in male skulls and the shape of the eye sockets is slightly different between aged male and female skulls.
These differences lead to a general trends in what men and women are interested in correcting or improving when they attend an assessment. Women will request treatment earlier so the aging process is not as advanced. Often male patients are more concerned with cheek and neck lax tissue and deep nasolabial folds which have formed in the 30s and into the 40s, whilst women focus not only on the lower face but also on the forehead and eyes with finer lines from the 20s and 30s.
Sociopsychological– men and women have different wishes for what treatment they desire and why it is necessary. Women normally request therapies for rejuvenation and beautifying with important social and emotional aspects. Treatments for men are normally with the aim of restoration and enhancement, often wanting to look fresher for professional reasons rather than 5 or 10 years younger. There are social pressures which are felt throughout populations with trends that may be influential (for example the ‘metrosexual’ look), and occasional social events such as weddings or interviews can be the impetus for seeking treatment. Discussing appearance is very different for men and women with men feeling anxious and considering their concerns as vain and unimportant, although when they decide to have a treatment men are generally less price-sensitive and more focused on their cosmetic target. Often the pressure to seek treatment comes from a partner or spouse, and even being married itself slightly decreases the perceived age although this is more evident in women (1.9 years) than men (1 year).
Treatment– a combination of aesthetic anatomical differences, reasons for wanting treatment, number of areas to be treated and recovery time from treatment must be considered when considering male and female aesthetic therapies. Minor asymmetry in male faces is less crucial than in female faces and needs to be planned in to the treatment. With men’s wrinkles being deeper by the time treatment is requested, some degree of wrinkling is natural so complete correction is not normally desired. As women have finer wrinkling, especially if presenting for treatment in the 20s to 30s, complete correction is a preferred aim. The most common male concerns are forehead wrinkles, crow’s feet, telangiectasia (spidery red lines on the skin), lentigines (flat brown individual freckles), acne scars, jowls and laxity of neck and brow skin. The common female concerns are forehead and glabellar lines, crows feet, dull skin, jowling and lax neck skin. In general male patients are less tolerant of pain with higher anxiety levels about treatment. Men are also more concerned about healing and time issues, with treatment evidence afterwards a concern as they do not have the benefits of using make-up for concealment. Thus overall men prefer single treatments for a single area of concern with long-lasting benefits whilst women prefer more frequent treatments over a more widespread area with an appearance that can be modified periodically.
Botox – for all patients undergoing their first treatments there is a need to explain carefully the differences that will be achieved but men often find the change to a less mobile look more disconcerting. The treatment areas most frequently requested by men and women are the forehead, glabella (the ‘angry 11s’ between the eyes) and crow’s feet. Treatments almost exclusively requested by women are brow lifts and nose ‘bunny lines’.
Jaw reshaping is possible with botox placed at the corner of the jawbone which narrows the face and this again produces a more feminine look. Tiny amounts of botox can be placed in the lower eyelid to provide a wider-eyed look which appears more awake and refreshed, and a large eyed look is much more appropriate for women in general. As males have larger muscles (including the face) more botox is required. Additionally the male forehead is larger with the potential for a receding hairline so a larger area needs to be treated.
Fillers – fillers are generally associated with enlarging cheekbones and lips so are often thought of as a purely feminising treatment. However masculinising treatments are possible with fillers such as augmenting the chin and corners of the jawbones, and some male faces have flat cheekbones or unusually thin lips which can benefit from a small, but important amount of carefully placed filler.
Men often need more filler in areas such as the nose-to-mouth nasolabial folds due to the thicker, heavier nature of the skin. For the glabella men often require botox and filler in combination to reduce deep creases with hyperactive muscles which have been present for a long time.
Peels – chemical peels will work for men as well as women. The treatment is essentially the same with the same results and the differences come with following the recommended creams for optimal results during and afterwards. The most important of these is sun cream and men are less likely to continue using the cream for the time after the active treatment has finished.