Over the last half of the prior century, cosmetic plastic surgery was largely associated with the female gender. From breast augmentation to facelifts, women made up 85% to 90% of the procedures for making one look younger, more fit and to feel better about themselves. Men constituted a minority of the procedures and included eyelid lifts in older men and rhinoplasty in younger men.

But the past ten years has seen the number of men interested in and having cosmetic plastic surgery increase and the old 90:10 women to men ratio change to one closer to 70:30. This has been spurned by a variety of factors including the emergence of the many non-invasive treatments such as Botox, injectable fillers and laser hair removal. But the increase in men has not been driven completely by non-surgical treatments. The number of men having actual surgery has also dramatically increased as society places an increasing value on looking fit and energetic. It is no longer a negative stigmata for men to have surgery as looking good is more valued than how one gets there.

Men now take a greater interest in their appearance than ever before. They not only want to look good dressed but undressed as well. They also want a face that matches their body and helps them look energetic and competitive in the workplace. They work out at home and in gyms, eat more healthy and wear form fitting and fashionable clothing. They work into their later years and retire later. As they get older, their surrounding colleagues become younger. Many are also divorced with younger wives and girlfriends who themselves may have had plastic surgery enhancements.

Men undergo many of the typical face (eyelid lifts, facelifts and rhinoplasty) and body contouring procedures (liposuction and gynecomastia reduction) that have existed for years. But there are also many newer or improved surgeries that have attracted the male patient. Facial contouring procedures such as chin, jaw angle and cheek implants and body contouring surgeries such as pectoral and calf implants and advanced liposuction technologies continue to add to a growing male plastic surgery population.

While the primary goal of all cosmetic plastic surgery is the same, a satisfied patient with a complication-free experience, there are a number of differences between the male and female patient both before and after surgery. When a women comes in for elective plastic surgery, she is usually open to suggestion and recommendations and will often go along with what the plastic surgeon believes is the best course of treatment. This may often be different then what they thought or may be additional procedures to complement their initial request. Many men, however, come in for a very specific treatment and know exactly what they want. They may listen to other recommendations but usually don’t want additional procedures or much of a difference from their preconceived surgical plan.

After surgery, however, is when the greatest differences between man and women exist in plastic surgery. Most people believe that women are more particular in the result and are harder to please. However, that has not been my experience. Contrary to popular opinion, I find men to be much more particular and desirous of further surgical improvement. They are also quick to want to revise an operation even before the final result from swelling and tissue settling has occurred. This has been true whether it is facial or body surgery. But it is not true for all male patients. This is a phenomenon that is most seen in the younger male patient between the ages of 20 to 40 years old. This is likely due to the societal demands that this generation is exposed to and the evolving nature of one’s body and self-image in their younger years.

Dr. Barry Eppley

www.eppleyplasticsurgery.com

Indianapolis, Indiana

Superman has been an American cultural icon since he first appeared in comic books back in 1938. His appearance is absolutely distinctive, most notably that of his red, white and blue colors and the stylized S shield on his chest. The shield is so symbolic of his character than its appearance alone immediately brings image of the comic character.

But beyond the colors and the symbol, many of his other features are particularly iconic of what masculinity and attractiveness is supposed to be. His face is absolutely chiseled and proportioned and exudes strength and power. Such Man of Steel facial features appear to have galvanized one male fan to undergo numerous plastic surgery procedures to try and look like this popular superhero.

Hebert Chavez, a superfan of Superman from the Phillipines, has dramatically altered his face to look more like Superman. New agencies have reported that he has undergone a series of operations since 1995. These have included a chin implant to get a strong chin with a cleft, nose reshaping, injections for fuller lips, cheek and jaw implants and eyelid surgery. As bizarre as this sounds, his surgical results actually look pretty good and not as unnatural as one would think.

Such a plastic surgery story brings to mind another face changer, Michael Jackson, and there is no doubt that they both share the similar malady of Body Dysmorphic Disorder. In this mental illness, a person can’t stop thinking about how their appearance is flawed and that perfection is just a surgery away.

But beneath these extreme cases of facial plastic surgery lies some basic truths about what makes a male face more appealing. It starts with an overall facial shape that has more definition and a square to inverted triangular shape. The three bony highlights of the male face are the chin, cheeks and jaw angles. Some degree of prominence in all of them is important to create a sense of overall angularity. Therein lies the frequent use of chin, cheek and jaw angle implants to create those prominences if they are weak, flat or recessed.

In the more lean male face, creating these prominences with implants alone may be adequate. As the chin, cheek and jaw angles become more visible, the non-bony supported areas (submalar and lateral face and neck) will appear more concave as the amount of subcutaneous facial fat in these areas is thin. In the rounder or fuller face, however, some fat removal will need to be considered. This could include procedures such as buccal lipectomies, lateral face and neck liposuction to try and change a convex shape in these areas to at least one that is flat or ideally a little bit concave.

Not every male face can be made more ‘super’. These facial plastic surgery techniques work best in a face that is not too overly round or thick. Such facial shapes are the kryptonite for obtaining the well defined male face that is deemed in both comic books and in real life as desireable.

Dr. Barry Eppley

www.eppleyplasticsurgery.com

Indianapolis, Indiana

In reading a recent entertainment article which I came across in researching a plastic surgery topic, the writer presented an opinion on the top ten plastic surgery disasters in men. Using before and after photographs, they compared the ‘before’ and ‘after’s of several well known male celebrities- of which there is no doubt that these men have had facial work done. And I am not referring to in-office procedures such as Botox and injectable fillers. All had obvious surgical manipulation of aging facial features.

Those listed are well chronicled and include often cited celebrities such as Kenny Rogers, Gary Shandling, Carrot Top, Sylvester Stallone, Bruce Jenner, Burt Reynolds and David Gest to name a few. While I am certain that they don’t feel unusual looking, most women would disagree. This begs the question of what is it that makes them look unnatural? Is there a common problem that they all share?

In reviewing the ‘after’ images the problem lies for many of them in the work around the eyes and cheeks. On the whole, the appearance of these men has changed to more of a feminine look. This is the result of a variety of changes that include over-elevation of the brows, a ‘pulled too tight’ appearance around the eyes, and unnatural cheek bone augmentation giving an ‘apple-cheeked’ effect. In an effort to rejuvenate the aging and sagging face, they have been overlifted and augmented. Neck and jowl line work, even when done well, can often reinforce a more feminine look.

This may make the skin much smoother and eliminate a lot of skin wrinkles and folds, but the end result is anything but ‘natural’ in appearance, and is a red flag that screams ‘facelift!’ to even the least discerning eye. (even though a true facelift works on the neck and jowl area)  Certainly, men care about their appearance as they age, and want to look as young as they feel.  With regard to celebrities, it’s a usually a foregone conclusion that plastic surgery is a necessity in order to keep pace with the up and coming younger entertainers.  However, great work – and natural looking results are never a guarantee in Hollywood surgical circles, and paying top dollar to a well-known or famous surgeon really has nothing to do with the final outcome.

To get a natural looking result in men, facial rejuvenation really has to be ‘underdone’ in comparison to the female equivalent. Women can aesthetically tolerate more significant tissue movements. The goal of very smooth skin and sleek facial features simply looks better on women. Even when women have gone too far, they rarely look as bad as what can happen in men. Nips and tucks are very helpful to slow the aging process down in men, but dramatic sweeping changes simply trade-off one problem for another. Facial rejuvenation in men illustrates the age-old concept that less is often more.     

Barry L. Eppley, M.D., D.M.D.

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis

While more women than men undergo facelift procedures, men still make up about 15% to 20% of the facelift population. Men are almost exclusively bothered by a ‘neck waddle’ and usually consider a facelift at an older age than women when this waddle is more significant.

One of the keys to facelifting in men is not too overdo it. I have see many men who have had a facelift and they look a little unnatural at best and some even look more effeminate. I am certain this is not what they were seeking from the procedure. A subtle improvement for men is much better than an overdone dramatic one. Men, understandably, are particularly skiddish about being known as having had a facelift.

 
From a planning and technical standpoint, the male facelift patient differs from the female in one significant way….hair. Both the amount and style of scalp hair and the presence of beard skin changes several aspects of the operation. The placement of the incisions and their eventual obscurity is of critical importance. Like all facelifts, the first and most important goal is to have scars that are difficult to find. No matter how great the neck and jowl result is, or how long the result may last, poor and visible scarring will make that all irrelevant. I have yet to find a patient who wants to advertise that they have had a facelift. (although some results that you have seen scream that they have!)

 
Men have beards which provide both an advantage and a disadvantage. The upward-disappearing sideburn that can occur in women with a facelift (the tuft of hair in front of the ear gets higher) is not an issue for most men. When their existing sideburn gets higher after surgery, they simply start shaving lower regaining the lost sideburn. Most men should even start before facelift surgery in growing longer sideburns so they will be at a normal level after surgery. The diadvantages are that the incision in front of the ear must stay…in front of the ear. It can not be placed partially inside the ear as in women (known as retrotragal) because beard skin will drawn up into the ear which is both a nuisance and not natural looking. In addition, because of the direction of pull behind the ear in a facelift, some beard skin will end up behind the ear necessitating shaving this area. As long as men are advised of this possibility and after surgery requirement, I have not seen it to be a problem.
One final thought on male facelift results…..men do not usually get a particularly dramatic result. Their skin often stretches more than a woman’s making it difficult (and unnecessary) to create a super sharp neck angle. They are also prone to more settling or some ‘relapse’ after surgery due to their thicker heavier skin. As already mentioned, however, men are usually not interested in spectacular changes but prefer less obvious ones. This may be the most important key to the male facelift patient.

 
Dr. Barry Eppley
http://www.eppleyplasticsurgery.com/
http://www.ologyspa.com/
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis

Botox® exerts its effects through a muscle weakening or paralyzing effect. Like all drugs, its effectiveness is going to be dose-dependent. How much Botox® is injected will determine how much weakening of the muscle will occur and to what degree of improvement is seen in the undesired facial expression. The higher the dose given, the better the result. (up to a certain point)

To the best of current medical knowledge, it does not appear that humans vary much, if at all, in their responsiveness to Botox®. Contrary to some popular belief, patient susceptibility (how well does it work) is not different. To say that some patients are better responders or get better results with Botox® injections is probably not true. There may be other reasons why some patients have different results (e.g., such as how it is mixed, how old the solution is) but it is not because their muscles are more receptive or more resistant to the uptake of the Botox® molecules. Botox® effectiveness is as simple as the dose….per the amount of muscle into which it is injected.

This is why men usually require much higher doses of Botox® to get the same effect as women. They simply have more muscle mass in their face than women, usually because they are bigger in size and may have more weight. The more muscle thickness and surface area size to it, the more Botox® solution will be needed. However, most men can tolerate less of a profound effect as they usually are not interested in dramatic facial changes. When it comes to men, I usually up my Botox® doses about 20% for the same size area that I would inject in women. I also feel that Botox® doesn’t last quite as long in men than women, but there is not much scientific information to back that up. It just seems logical to me that more active surrounding muscle can overcome the effects of Botox® quicker.

By far and away, the most common area to inject Botox® for men is into the glabellar or eyebrow furrowing area. This can make a dramatic difference in that squinting or frowning appearance. Men seem to tolerate more horizontal forehead creases than women and that is good…as it takes lot of drug ( and cost) to get a profound forehead change in men. Some men may also want the crow’s feet area, to the side of the eye, treated as well but this is less common.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis

Men pose uniquely different challenges than women when it comes to the consideration of facelift surgery. Men age just like women but usually are only concerned with their neck when becomes more of a waddle. As a result, they often are seen in plastic surgery consultation with more advanced facial aging concerns than what one sees in women. Because of their more advanced neck issues and the heaviness of the male skin, minor or more minimally invasive procedures are not going to be effective at making a significant difference in their neck. Only a real facelift procedure will do the trick.

But the typical facelift operation is more difficult in men because of two hair issues….their beard skin and the hairline and quality of hair density (or lack thereof) around their ear area. As the conventional facelift procedure uses incisions in and around the ears, with a subsequent redraping of skin back and over the ear, men will often end up with beard skin behind their ear and potentially even inside their ear after the skin excess is trimmed. For this reason, the male facelift must often use an incision in front of the ear at the junction of the beard and non-hearing skin just in front of the ear to keep hair out of the ear after the operation. Keeping beard skin from ending up behind the ear is difficult and most men should expect that they will have to shave behind their ears after a facelift procedure. ( at least for an inch or behind the ear lobe)

For some men, their sparse hair over the temple areas and around the ear may make a conventional facelift very difficult to do to end up with good camouflaged scars. This is rarely a problem in women. Usually the scar ends up above the ear in the hairline, but with todays’ very short hairstyles particularly in men with thin or little hair,  it may not be very camouflaged and this is a very real consideration and concern. No male wants any area of the facelift scar to be visible so where to end the scar, and how that may affect the outcome of the procedure, must be thoroughly discussed prior to facelift surgery.

Me also will not get as dramatic a change in the neck as women will with a facelift. The heaviness and thickness of male facial skin does not allow it to tightened as much. And the way the facelift must be done in consideration of their hairline will also play a role in the outcome. Men are also prone to more ‘rebound relaxation’ in the jowl and neck area after surgery due to the quality of their skin, another factor that plays into the long-term outcome. Fortunately, men do not usually want a dramatic change anyway from any facial procedure so all of these issues usually add up to a good result that will please most men.

In rare cases of the much older male (usually greater than 65) who has a large neck waddle and does not want or can not undergo a significant operation, the direct neck lift can be an option. Rather than using any incisions around the ears, the loose skin is cut out directly in the neck. This produces a pretty significant change that offers a much more limited recovery. And can be a consideration if the man can accept a scar running vertically down from the chin to the adam’s apple. Surprisingly that scar can heal very nicely due to it being in beard skin which scars less than non-beard skin most of the time. 

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis

While facelifts in men are less common in women, men also have concerns about their sagging jowls and in particular about their neck waddles. My observation about men and facial aging is that they usually only undergo a procedure when their problem is much more advanced and, as a result, they are usually older than the average woman who undergoes a facelift procedure. For the sake of clarification, many patients and plastic surgeons frequently use the terms facelift and necklift interchangeably. And while that concept is reasonable most of the time as most facelifts have their greatest impact on the neck, a necklift can also be different than a facelift particularly in men.

 
A facelift, with its incisions in and around the ears, is a powerful procedure for the jowl and neck area. The greatest benefit with a full facelift is in the neck area. In men, the placement and management of the incisions in and around the ear is critical given where the beard line stops and with most men’s shorter hairstyles. For some men, the severe lack of hair around the ears and the amount of neck waddle present poses a challenge for the traditional facelift operation. Plus, some older men simply do not want to undergo the magnitude of a full facelift and don’t want any significant recovery.

 
For these select few men, a direct neck lift is another option. In this procedure, the skin and fat is cut out directly in the neck, greatly simplifying the operation and recovery. And the result is much better and more long-lasting than a traditional facelift. The trade-off to this benefit is a scar that runs down the middle of the neck, from under the chin down to the lowest horizontal skin crease. While this scar should be given serious consideration, I have always been impressed in my practice here in Indianapolis with how well it does in the bearded neck skin of the male patient. That same scar in a woman does not usually do as well, and for this reason, a direct neck lift is rarely done in necks without beard skin.

 
For an older male with a significant neck waddle, a direct neck lift can be a very simple and uncomplicated procedure that can quickly get the results that you want. A direct neck lift produces immediate and dramatic results that do not change one’s facial appearance (above the neck) at all. If one can accept a thin discrete scar down the middle of the neck, the direct neck lift may be an option to consider that is not familiar to most patients seeking plastic surgery.

Dr. Barry Eppley
http://www.eppleyplasticsurgery.com/
http://www.ologyspa.com/
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis

The use of facial implants for male face enhancement is common and the traditional areas include the chin, cheeks, and jaw angle areas. Every now and then, I get a request or see a patient who really enhancement in a different area of the jaw….the vertical dimension. Making the jawline longer in the vertical dimension to increase lower facial height and put the face in better overall balance. Most of these unusual cases exhibit an underlying jaw deficiency problem, often with a significant overbite relationship at their teeth, indicating a jaw that is both short in the front-back dimension (horizontal development) and in the up and down dimension. (vertical development at the ramus)

In correcting this type of jaw problem, the ideal solution for most of these patients is a course of orthodontics followed by traditional orthognathic surgery. While this may be ideal, most of these patients are beyond their teenage years and do not want to make the multi-year investment of time to make a formal anatomic correction based on the bone. A ’short-cut’ solution is to augment the deficient areas with a synthetic implant. While the actual procedure is not difficult to do, the problem is in finding a commercially-available implant that will match the patient’s problem. When it comes to vertical lengthening of the mandible from one side to the other (wrap-around), there is no such off-the-shelf implant option.

Sometimes a standard chin implant, combined with a jaw angle implant, that is positioned low on the bone below the native bone edge may suffice. But there will be a gap between where the chin implent ends and the jaw angle begins. In some cases, it may work but it is a piecemeal approach that is fraught with problems such shifting of the implants after surgery. (in this case , the jaw angle implant)

A better solution is to have a custom wrap-around implant made off of a computer-generated model. A 3-D CT scan can be done from which an exact replica of the jaw (mandible) can be created. Then a mock-up of the implant (by me) can be done in acrylic to create a one-piece wrap-around jaw implant that sits on the inferior border of the jaw, lengthening it throughout. The acrylic mock-up is then sent to a manufacturer where they make a formal silicone rubber implant. While a lot of work is done on the front end, the implant is easily placed through a small incision under the chin. (it is flexible so it easily folds on itself to be easily inserted through a small incision) It is fixed with a single screw underneath the chin so it does not ever move. It really is nothing more than a long extended chin implant that runs from one jaw angle to the other, but is on the bottom edge of the bone.

I have done this procedure several times over the years and found it to be quite successful. There is some significant cost upfront fron the CT scan, jaw model, and final implant (around $5,000, surgery costs are additional) but it is the best way to go when one is looking for this type of jaw implant)

Dr Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis

While it is true that the overall number of plastic surgery procedures performed in the past few years is up, and the number of men as a percentage of this total is increased, women still far outnumber male patients by about 10:1 for most practices. While male plastic surgery procedures are somewhat different from woman’s, their motivations for undergoing plastic surgery are also different.
While both men and women undergo plastic surgery to look physically better, you have to dig beyond this obvious level to understand what their true motivations are. The desired physical concerns or desired changes are just a reflection of their unspoken concerns. As a general statement, most women’s motivations for plastic surgery are true self-image issues. They want to fell better about themselves. Correcting a physical flaw is one approach to self-improvement. (and perhaps the easiest?) Whether it is to have a breast augmentation to look better in clothes or to have a facelift to not look old, women seem to be much more concerned about doing the surgery truly for themselves. I hear this over and over…’my husband doesn’t think I need it…or…’my friends say I look fine’. But yet, women want to have the surgery anyway…becasue they want to fell better about themselves. Men, conversely, often undergo plastic surgery because they want things. Whether it be to have more women, sex, money or power…it most always deep down is motivated by a desire for external or more tangible things. As a plastic surgerycorollary to ‘Men are Venus, Women are from Mars’…Women do things for themselves, Men usually do things for somebody else.
Men undergoing plastic surgery also are different from women in other ways as well. They usually are not interested in complex procedures that involve any significant recovery, they are usually less compliant than women, their response and tolerance to pain is often more pronounced, and they often are more critical of the results. (or they are at least more vocal) Much of this has to do with the general greater impatience of men who want to get to the final result quickly…and usually more discretely. This is why smaller more subtle procedures for men are often better, even if the result is not as significant. Men get no accolades, and certainly little sympathy, in society for suffering through a plastic surgery recovery. Women, conversely, garner more empathy if they are suffering to look more ‘beautiful’. In fact, our society expects them to do so.
The handling of the male plastic surgery patient, I have found, is quite different from a female patient. And not all plastic surgeons can work well with men. They often require more time and patience than most female patients. And the demands of the younger male patient are higher than that of an older man. The young ‘narcisistic’ male patient can be the most demanding and the most likely to require revisional surgery to achieve a mutually satisfactory result.

Dr Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis

While men still make up a relatively small minority of patients having plastic surgery and office-bsed cosmetic procedures (< 20%), those numbers have been steadily increasing since 2000. The top male cosmetic procedures in my experience include liposuction, rhinoplasty, gynecomastia reduction, and blepharoplasty.
It is no surprise that liposuction remains the top procedure for men given the large potential for fat collections in any one individual and that it can be done in both yong and old alike. Unlike women, however, most male liposuction is relegated to the abdomen, flank, and neck areas. Even in relatively lean individuals, flank fat collections are common as one ages. Today’s liposuction techniques have been refined to include etching procedures for those leaner males who want an easy way to the ’six-pack’ look.
Male rhinoplasty has been a mainstay for many years and remains a popular procedure for the teenage and young adult male. It is far less commonly performed in the older male over 40 who have come to accept their nose, no matter how disproportionate it is to other facial features, and would feel very ‘abnormal’ if it were changed at this point in their life. Rhinoplasty may frequently be performed with chin augmentation if it will improve their facial profile over a rhinoplasty alone.
Gynecomastia reduction is, in my opinion, the one male plastic surgery procedure that is on the rise. Whether it be a small protrusion of the nipple in a teenager, to a more traditional gynecomastia in adolescents, to a droopy and deflated appearance in the middle-aged male, improvement in the mae chest is now quite common.Liposuction, nipple lifting and reduction, and pectoral implants are potential methods for male chest enhancement. Refined liposuction techniques, known as etching, provides better definition to the pectoral outlines which can be combined with any of the other chest contouring procedures.
Eyelid surgery (blepharoplasty) in the male remains a common procedure. Most men wait until their eyelid problems are more severe than many women as some aging around the eyes is more accepted in men. There still remains the senior male who only has his upper eyelids done due to visual field obstruction.
Men increasingly are joining the Botox and Lipodissolve injection therapy ranks as well as having other traditional (e.g., facelift) and more exotic forms (e.g., pectoral or calf implants) of plastic surgery.
Dr Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis