Equal Opportunity
The major stereotypes of the male cosmetic medical patient have been the aging, narcissistic homosexual actor and the young, narcissistic homosexual bodybuilder. Now there is a new stereotype and label for a man who cares about his appearance but does not want to be labeled gay—the metrosexual. In fact, there are plenty of males who seek cosmetic interventions who do not fit into any of these categories.
Men have the same basic concerns about appearance that women do, and there are cultures past and present where male adornment is as important if not more so than female adornment. Still, the aging process has always been more socially acceptable in men than in women. Aging tends to emphasize a man’s masculine features and tends to garner him more respect. Older men, especially successful men, have less trouble finding romantic partners than do older women. Having said that, men (and women) value fi rm, muscular, well-proportioned physiques for men. Features such as waistline fat, saggy eyelids, and too little or too much hair on certain body parts are not favored.
As we have seen, standards of personal appearance are culturally determined and perpetuated by media and marketing. In our culture, at least until recently, men have not been much targeted by the fashion, beauty, and cosmetic medical industries. In modern times, with increasingly sedentary jobs and rising obesity rates, fewer and fewer men are candidates for statuary modeling. This shifting of the typical American male body away from the Apollonian ideal has led to a series of fitness crazes and the birth of a subculture, the Bodybuilder. Beginning with Eugene Sandow, billed as “The World’s Most Perfectly Developed Man,” and followed by Tarzan, Charles Atlas, the Mr. Universe contestants, and other familiar contemporary icons turned politicians, bulked-up men have achieved a certain level of status in our society. The antithesis—the fl abby couch potato—is a person almost certain to be discriminated against socially and in the workplace. Thus liposuction has earned its place beside dusty treadmills and unused health club memberships on the to-do list of many American men. The cosmetic medical care industry has added to its mantras a new oxymoron: “Pampering Tarzan.” According to the ASPS, about 1.2 million cosmetic procedures were performed on men in 2005, less than 15 percent of the total cosmetic procedure volume. As a group, men are more inclined toward procedures with little or no downtime, no swelling or other evidence of treatment, and stripped-down skin-care instructions. Therefore, men lean toward the minimally invasive procedures and are also said to be the fastest growing segment of consumers of cosmeceuticals. Nose surgery is the cosmetic operation most frequently chosen by men. Following rhinoplasty and vying for a distant second place, the invasive cosmetic procedures men most commonly seek are hair transplantation, liposuction, and eyelid surgery. The fifth most common operation is gynecomastia surgery (male breast reduction). The volume of fringe procedures like penis lengthening, despite a certain amount of lurid press, is probably overinflated. No one knows for sure.
In the men’s noninvasive category, Botox rules, followed by microdermabrasion, laser hair removal, chemical peels, and filler injections.
MALE RHINOPLASTY
Of the nearly 300,000 cosmetic operations on men reported for 2005, about 35 percent were nose reshapings; still, far fewer men than women undergo rhinoplasty. Many cosmetic surgeons feel that rhinoplasty, despite its popularity, has signifi cant psychological risks associated with it for adult men, whereas teenage boys usually adjust well. In fact, some experienced cosmetic surgeons feel that the adult male rhinoplasty patient is the most difficult category of cosmetic patient. A reduction rhinoplasty, in which the nose is made smaller, seems particularly prone to creating dissatisfaction. As an interesting corollary, there is some evidence that homosexual men seeking rhinoplasty to feminize their features are more likely to be satisfi ed with the results.
MALE FACELIFT, EYELID LIFT, AND BROW LIFT
Men do have facelifts, but the numbers are relatively small. Often they cite professional reasons or the desire to impress a younger lover. Facelifts on a man can be more challenging surgically than is the same operation on a woman. Physiologically, male facial skin differs from female facial skin; it is thicker and has increased blood supply. The hair is of different quality, and hair distribution must be considered not only for the sake of appearance but for the mechanics of shaving. After a facelift some men can be left with an inconvenient change in their facial hair growth pattern, especially in the ear region, and some patients may even need to consider laser hair removal or electrolysis as treatment for undesirably relocated hair. The robust blood supply of a man’s facial skin leads to a higher risk of blood collection (hematoma) after surgery, which can lead to skin loss or long- term skin pigment changes. It is difficult to hide the evidence of a facelift on a man; unless he wears makeup or long hair, his barber and other close observers will likely notice the scars. Men also have eyelid and brow lifts, often to improve their fi eld of vision. Eyelid lifts are similar to those performed on women. Brow lifts on men usually present the dilemma of where to put the incisions, and the resulting scars may be visible. A man with a receding hairline may be horrified to wake up one day and discover that his scalp scar is suddenly on his forehead. Facelifts, eyelid lifts, and brow lifts are discussed in other posts.
HAIR TRANSPLANTATION
All surgical forms of hair replacement involve transplanting a patient’s own hair from one portion of the scalp to another. For men with large bald areas, operations called flap procedures may be necessary. Tissue expansion is another option, in which balloons are positioned under thick hair-bearing areas of scalp and infl ated slowly to stretch the scalp. Later, portions of the bald scalp are removed and the stretched hair-bearing sections pulled over the excised bald areas. These kinds of operations require general anesthesia. Tissue expansion creates a significant, although temporary, deformity of the head shape and as a result may not be feasible for many men. For a man whose baldness is confined to a limited spot on the crown of the head, it may be possible simply to excise the bald area during a series of operations, often under local anesthesia. This surgical technique is called scalp reduction.
Less extensive baldness is commonly treated with hair transplants and has evolved from the visible plug transplants to what is called microtransplantation, in which tiny grafts of one to three hair follicles are moved from thick growth areas on the sides or back of the head to thinned areas in front or on top of the head. Microtransplants are performed with local anesthesia, with or without sedation, in an office setting. Because the procedure is tedious, multiple sessions over many months or years may be required. Some physicians specialize in hair transplantation and have developed an extremely streamlined, labor-intensive pro cess in which up to several thousand grafts can be transplanted per “megasession.” Successful hair transplants tend to be stable and long lasting; even though microtransplanted hairs fall out shortly after surgery, most will regrow. The best candidates for hair transplantation are patients with thick, healthy hair growth along the sides and back of the scalp, the prime donor areas. Patients with extreme baldness and very little donor hair are much less likely to have a natural looking result, no matter what procedure is performed, and most prospective patients in this category should be discouraged from undergoing surgical hair transplantation.
Complications of hair transplantation procedures are low. Major flap operations have higher risks, scarring may be visible, and additional procedures are often necessary. After microtransplantation some hairs will not survive, requiring additional sessions to achieve the desired effect. The characteristics of a transplanted hair may not be the same as the original hair, and original hairs in a balding area may continue to thin out over time.
The bottom line: Hair transplant techniques have improved dramatically, but in order to get a good result, most patients still need to submit to multiple tedious procedures over a long time period at signifi cant expense.
BODY CONTOURING FOR MEN: LIPOSUCTION AND IMPLANTS
Men seek body-contouring cosmetic surgery for several reasons. Some want to reduce “middle-age spread,” some desire to rid themselves of excess skin after major weight loss, and others are involved in self-sculpture. For the first group liposuction and skin excisions are often prescribed (see Chapter Eight). For the last group, liposuction has been used to sculpt belly fat to simulate the bulging muscles of a “six-pack” abdomen, and synthetic implants may be used to enhance the contours of pectoral muscles, arms, legs, and buttocks. Synthetic implants inserted to augment muscle contours are prone to several complications, also discussed in other posts.
MALE BREAST REDUCTION
Some men have distressingly prominent tissue in the breast area. Breast enlargement in men is called gynecomastia and can be due to breast gland enlargement or obesity. Men can also develop gynecomastia as a result of using drugs such as marijuana and anabolic steroids. A man with gynecomastia that is severe or fails to resolve after adolescence should have an evaluation by an endocrinologist (a physician who expertise includes conditions caused by hormone abnormalities). In rare cases, male breast enlargement can be caused by breast cancer.
Gynecomastia can be treated surgically with excision, liposuction, or a combination of techniques. The surgery requires general anesthesia and possibly an overnight stay in the facility. Drains may be left in place for several days, and the patient must wear a tight, vestlike compression garment for weeks. Pain can be significant for the first forty-eight hours. Risks include permanent contour irregularities and noticeable scars, especially if significant amounts of skin have to be removed. Gynecomastia in teenagers is discussed in other posts.
OUTCOMES FOR MEN
Many cosmetic surgeons note that male patients do not listen or communicate as well as female patients, and as patients men can be more challenging than women. Their compliance with instructions tends to be less than ideal. As a group, men also recover from surgery differently than do women. Men have lower pain thresholds and more difficulty curbing their activity level during the recommended recovery period. Nonetheless, with the possible exception of adult male rhinoplasty patients, men overall tend to have outcomes as good as those of women. However, in order to facilitate their convalescence, prospective male cosmetic patients should make a conscious effort to be informed about what to expect postoperatively.
Tags: BODY CONTOURING FOR MEN, BROW LIFT, chemical peels, EYELID LIFT, filler injections, Hair Transplantation, Laser Hair Removal, LIPOSUCTION AND IMPLANTS, MALE BREAST REDUCTION, MALE FACELIFT, MALE RHINOPLASTY, microdermabrasion