Cosmetic surgery in men: Fad or new trend?

Americans spent approximately $16 billion on cosmetic surgery in 2016, according to an American Society of Plastic Surgeons report. Traditionally, cosmetic surgeries have been popular among women, with approximately 90% of all cosmetic surgery cases performed in female patients. However, growth in the male aesthetics market has translated into increased interest in cosmetic surgical procedures (Dermatol Clin 2018; 36:5-10). The male market has increased for several reasons: Shifting social attitudes, improved professional competitiveness, new trends in fashion, and the attainment of an idealized self are a few reasons most often cited in the literature (J Drugs Dermatol 2015; 14:1043-51).

Of concern is whether the increased demand for male cosmetic procedures is a passable trend or a lasting norm. Clinicians interested in servicing this new community will have to consider the benefits of shifting their practice in order to meet the demand for male-focused cosmetic procedures.

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In this article, we provide an overview of the key concepts a clinician must take into consideration when consulting with men interested in undergoing a cosmetic surgical procedure.

Male pattern of aging

In order to understand what treatments men want and are eligible to receive, clinicians must first gain familiarity with the male pattern of aging. Males and females have distinct variations in anatomy, specifically in regards to bone structure, muscle mass, thickness of skin, and distribution of fat. In general, men have greater periocular changes as they age. They develop more severe rhytides (wrinkles) on the face, except around the mouth, and are more likely to experience hair loss.

As males have thicker skin and more muscle mass around their face, the loss of fat with age shows deeper and more prominent facial lines, making them appear much older than their actual age and their female counterparts (Semin Cutan Med Surg 2014; 33:188-97). As men and women differ both in their anatomy and their goals for pursuing cosmetic surgery, it is important for clinicians to specialize their treatment, dosages, and technique accordingly (Semin Cutan Med Surg 2014; 33:188-97).

Next: Behavioral differences in menBehavioral differences in men

It is also important to note significant behavioral differences between males and females. There are many external risk factors for aging including sunlight exposure, pollution, cigarette smoking, repetitive muscle movements, and poor diet, with the most common being ultraviolet light exposure and smoking (JAMA 2014; 311:183-92). Men who smoke tend to smoke more than their female counterparts, which increases their risk for skin aging (J Invest Dermatol 2003; 120:548-54). Furthermore, men are more likely to be exposed to UV radiation and less likely than women to apply sunscreen and utilize sun-protective behaviors.

Physicians need to be more cognizant of these gender differences in behavior and how these behaviors affect overall patient management.

Goals/expectations of treatment

In a patient considering cosmetic surgery, it is crucial that physicians assess the patient’s goals and expectations. This includes a determination of the patient’s aesthetic goals. Typically, males want to look younger while also enhancing features to appear more masculine. However, there is a point at which an aesthetic can become too masculine and may be undesirable by the patient. Therefore, it is important for clinicians to determine what features are considered aesthetically appealing in advance. More often, this is crudely defined as a mixture of masculine and feminine facial features.

In general, males focus their facial cosmetic concerns around the hairline, periocular region, and jawline, according to statistics from the American Society for Aesthetic Plastic Surgery. Men want to maintain their scalp hair, tighten their jawline, reduce dark circles and bags under the eyes, and reduce the prominence of wrinkles. Men also want to maintain their figure by having a slim waistline and smaller breast size if they have gynecomastia (Dermatol Clin 2018; 36:5-10).

Cosmetic surgery has also increased in males as a result of genitourinary concerns. Studies show that if a man feels negatively about his “genital self-image”-the way a man regards his genitals-it may affect his sexual performance. If men are anxious and worried about their genitals’ size, appearance, and function, the result could be increased anxiety and subsequent sexual dysfunction.

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Research shows that approximately 20% of males are embarrassed or unsatisfied with the appearance of their genitals (J Sex Med 2013; 10:1516-25). As such, it is noted that the number of scrotal lift procedures, penile and testicular enhancements, and adult cosmetic circumcision procedures is also increasing.

A second consideration is the patient’s willingness to undergo intrusive therapies. Consideration for the degree of invasiveness tolerable by the patient will limit the degree to which the clinician is able to achieve the patient’s desired aesthetic. However, technological and technical advances are reshaping the extent of aesthetic change possible with noninvasive and minimally invasive techniques.

For example, over the last two decades, the way facial aesthetic procedures are typically performed has changed. Facial procedures were regularly completed in the operating room, but with the emergence of noninvasive techniques, many of these procedures can now be completed in an office setting. There has been a noticeable increase in nonsurgical procedures, such as botulinum toxin A (Botox, Dysport, Xeomin) injections, soft tissue fillers, and chemical peels (Aesthet SurgJ 2017; 37:1039-43).

Next: Trends in cosmetic proceduresTrends in cosmetic procedures

The top five cosmetic surgical procedures for men in 2017 were liposuction, eyelid surgery, breast reduction, tummy tuck and facelift (table 1). In 2017, men accounted for 10% of all liposuction procedures, 15% of all eyelid surgeries, 22% of breast reduction cases, 6% of tummy tucks, and 10% of all facelift surgeries (Statistics: The American Society for Aesthetic Plastic Surgery. 2017. www.surgery.org/media/statistics).

Minimally invasive procedures have increased in popularity among men as well. Over the last 5 years, there has been a 44% increase in injectables, with a 5% increase from 2016 to 2017. Of all the injectable procedures performed in 2017, men accounted for 9%, with botulinum toxin injections being the top nonsurgical procedure (table 2) (Statistics: The American Society for Aesthetic Plastic Surgery. 2017. www.surgery.org/media/statistics). There has been a notable increase in nonsurgical cosmetic procedures, especially among men.

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In general, men prefer noninvasive cosmetic procedures, as they can be done in the office setting, are relatively quick, and deliver noticeable results. Minimally invasive procedures are suitable options for patients who want an alternative to surgery and often have the added benefit of producing a long-lasting patient-clinician relationship.

Conclusion

It is evident that although men are not the major consumer in the cosmetic industry, they are on track to become significant consumers of cosmetic procedures. Examination of data over the last two decades shows men are becoming an increasingly important sector of this industry, with greater attention paid in developing techniques and technologies to address the demands of this population.

As longevity increases, there will be greater societal focus on maintaining a healthy, youthful physical appearance. This interest will create novel opportunities for clinicians to develop and deliver novel cosmetic surgical solutions to address this demand. In the future, men may eventually surpass women as recipients of key cosmetic procedures.

Ashraf Allahwala, MD

Dean S. Elterman, MD, MSc

Dr. Allahwala

is a clinical research associate and 

Dr. Elterman

is assistant professor, division of urology, University Health Network, University of Toronto.  

Section Editor Steven A. Kaplan, MD,

is professor of urology at the Icahn School of Medicine at Mount Sinai and director benign urologic diseases, Mount Sinai Health System, New York. Follow him on Twitter at

@MaleHealthDoc.