The rise and rise of male cosmetic surgery

If 2014 was the year of the Selfie then 2015 is shaping up to be the year of the “Brotox”. Cosmetic enhancement for men isn’t just on the rise; it’s positively booming.

According to current statistics from the American Society for Aesthetic Plastic Surgery (ASAPS), the number of cosmetic procedures for men has increased by more than 273 percent since 1997.

By far the biggest contributor to this statistic is non-surgical procedures. According to ASAPS figures, the top surgical procedure for men is liposuction, with nearly 52,000 men in America having the surgery in 2013. Compare this, however, with the top non-surgical procedure, anti-wrinkle injections – a whopping 385,000 men had botulinum toxin injections in the same period.

In total, men had more than one million cosmetic procedures performed in the US alone in 2013 and this number is set to rise in the pending 2014 ASAPS statistics.

Men are wanting more

‘Cosmetic surgery for men is a booming field, and non-surgical treatments are growing exponentially faster than surgical,’ says US plastic surgeon Dr Grant Stevens. ‘Men wear resumes on their face – we are seeing more men come in for fillers and anti-wrinkle injections. It’s no longer just the domain of women.’

Such has been the steady growth each year of male clientele that Dr Stevens has recently opened Man Land, a separate male-only cosmetic clinic that looks more like a cross between a sports bar and a smoking lounge.

There’s been a shift in attitudes towards male cosmetic enhancement, particularly over the past few years. Better information, better access, more predictable results and the widespread use of non-surgical treatment are factors contributing to the increase in men visiting their cosmetic practitioner. Competition in the job market and being attractive to women are also key motivators to ‘going under the knife’.

More and more men are opting to refresh an ageing face, remove unwanted body hair, get rid of love handles, etch a six-pack, and possess a more chiselled chin – and that’s just scratching the surface. Today’s attitude is about making guys feel good about looking great.

The fact that a number of male celebrities have spoken out about their own surgery has perhaps also gone some way to remove any stigma attached to the male makeover.

Tough-talking celebrity chef Gordon Ramsay first revealed he had undergone cosmetic surgery in 2009 to improve the appearance of deep lines in his chin. ‘Simon Cowell suggested that now I’m a success in America, I should do something, so I had a filler put under the deep crevices,’ he told the Radio Times in an interview at the time. ‘My mother said they were smile lines. I could deal with that at 21, but not at 42.’

Hollywood heartthrob George Clooney did his part to promote male surgery when he underwent surgery to remove eye bags — something he admitted
to Julia Roberts during an interview for Oprah Winfrey’s Oscars special
back in 2007. Once voted the ‘Sexiest Man Alive’, Clooney had a blepharoplasty to improve the appearance of sagging, aged skin and small pockets of fat around the eye area. Asked what had been the last biggest change in his life, Clooney told Roberts: ‘I had my eyes done. Can you tell? I think it’s important to look awake.’

Key to male cosmetic surgery success

The key to male cosmetic enhancement is to keep the results as natural-looking as possible, with no obvious “operated on” look.

For this reason, most experienced surgeons prefer to leave expression lines and some of the “rugged” features of the male face alone and instead focus on the features out of balance, such as a crooked nose, receding chin, sagging neck, jowls or eyelids, or deep nasolabial grooves (lines running from the side of the nose to the mouth).

In the hands of a skilled practitioner, cosmetic enhancement can create both a more youthful and more masculine and attractive appearance.

A different technique for men

While many of the same procedures that women undergo are available to men – abdominoplasty, nose reshaping and eyelid surgery, for example – there are some technical anomalies given the anatomical and structural differences between the genders.

Men tend to have thicker skin than women, and have a greater blood supply, meaning the risk of bleeding during surgery is increased, and healing may take longer. The tendency to wear their hair shorter than women also means that special attention needs to be given to the length and position of the scar during facelift surgery.

It is well established that women generally have a higher percentage of body fat than men. The scientific explanations for the dramatic difference in body fat distribution between men and women are largely unknown, although differences in hormones, hormone receptors, and enzyme concentrations play a part.

Given their anatomical differences, there are a number of cosmetic procedures designed specifically for men. Gynaecomastia (male breast enlargement), penile surgery and hair transplants, for example, are some of the most common cosmetic surgeries requested by men.

Whatever the motivation, it seems cosmetic surgery is no longer a woman’s world. Male surgery has become a popular talking point and is helping thousands of men overcome issues with their appearance.

SURGICAL

Liposuction

Liposuction can remove fat from the body or to remove a double chin or jowls, in areas usually unaffected by diets and exercise. Fatty deposits are suctioned out through small incisions. Liposuction can be performed as day surgery and patients can usually return to work after about one week, although bruising may last for several weeks and swelling for up to around two months. An increasingly popular approach is “Hi-Def” liposculpture. Whereas traditional liposuction aims to remove large amounts of fat, Hi-Def liposuction is able to work in the superficial layers of fat underneath the skin to sculpt or ‘etch’ the appearance of the underlying muscle structure. This procedure is commonly performed on the abdomen but can also be performed on the arms, chest and outer abdominal areas.

Eyelid surgery (blepharoplasty)

Blepharoplasty improves the appearance of the upper and/or lower eyelids to give a more refreshed appearance to the surrounding area of the eyes. With upper eyelid surgery, excess skin, muscle and fat are removed to reduce hooding in the upper eyelid. Lower eyelid surgery corrects under-eye bags, sagging and puffiness. Results of eyelid surgery become apparent gradually, with swelling and bruising subsiding in around two weeks to reveal a smoother, better defined eye region and a more alert and rejuvenated appearance.

Nose surgery (rhinoplasty)

Rhinoplasty is used to change the size of the nose, remove a hump, narrow the nostrils, change the angle or refine the tip. The procedure is performed by either the open-structure technique, when the incision is at the base of the nose, or closed, when the incisions are inside the nose. Swelling and bruising usually subsides within seven to 10 days but final results may not be evident until after a year. The results are permanent.

Male breast reduction (gynaecomastia)

Gynaecomastia (male breasts) is a common condition that is usually a result of an imbalance of hormones in the body. The condition may occur in one or both breasts. The technique used to treat gynaecomastia depends on the size and composition of the male breast. Excess fatty tissue is usually removed with liposuction. If the problem is breast glandular tissue, it is treated by excision. Scarring is relatively minimal, however, scars tend to be more prominent if a large amount of tissue is removed.

Ear correction (otoplasty)

Otoplasty is used to correct prominent ears. A thin strip of skin is removed behind the ear and the middle cartilage layer is folded back and secured in position for permanent results. The ears are wrapped for a week and are swollen for a few weeks. Normal activities can be resumed in around one to two weeks.

Facelift (rhytidectomy)

This technique is used to tighten the skin and the muscles of the face, chin and neck, with results lasting around seven to 10 years. Incisions are made behind the hairline and around the ear, then excess facial fat is removed and muscles are tightened. Swelling and bruising may last a few weeks and full recovery may take up to three months.

Abdominoplasty (tummy tuck)

This type of surgery offers a flatter stomach with repaired abdominal muscles and can also be used to sculpt a ‘six pack’. An incision is made across the lower abdomen, then excess skin and fat is removed and the stomach muscles are tightened. The navel is repositioned when the skin is re-stretched over the stomach and a large scar is created across the lower abdomen. A firm strap and drain are normally worn for a day afterwards, then replaced with a compression garment for several weeks. Most patients need around three weeks off work.

Implants

Body implants are used to enhance the appearance of the buttocks, biceps, calves, face, pectorals, penis and triceps. They are also used on patients who have had previous surgery, injury or disease. The implant is inserted either above or below the muscle through an incision.

They can be used to correct facial imperfections such as sunken cheeks or a receding chin and can improve facial balance when combined with a facelift or eyelid surgery. Implant surgery can create numbness but this usually subsides. Facial implant surgery can result in swelling and bruising for several days, making talking and eating difficult. Normal activities can usually be resumed after around four to seven days, and the results are permanent, unless the implant is removed.

Hair transplants

Mini-grafts, micro-grafts and follicular grafts are used to produce natural-looking thicker hair. Tiny segments of hair-bearing skin are transferred from the permanent fringe area at the back of the head to the bald area for permanent results. The procedure is performed under local anaesthesia in a series of sessions, which take up to three hours, depending on the number of grafts inserted. Some men can return to work the day after treatment.

Penis enlargement

Surgery can lengthen the penis by up to 5cm and widen it by up to 2cm. With lengthening surgery, a low abdominal incision is made and ligaments are cut at the base of the penis. Fat grafts are taken from the waist or buttocks and are inserted under the skin of the penis to widen it. Patients can take around six months to fully recover, and sexual intercourse should be avoided for at least six weeks. The results are permanent.

NON-SURGICAL
Wrinkle and filler treatments

Wrinkle relaxant (botulinum toxin) injections are used to treat dynamic wrinkles – those formed by repeated muscle contraction from facial expressions such as frown lines, crow’s feet and marionette lines. These injections are also effective for chin creases and horizontal wrinkles in the lower part of the front of the neck. Patients can return to work straight after treatment and results are seen after around four to 10 days. Repeat treatment is necessary after about three to five months in most cases.

Fillers and fat transfer are used to treat static wrinkles, which are caused by ageing and repetitive muscle movement, and loss of facial volume. The range of dermal fillers available are designed for use near the surface of the skin to treat wrinkles as well as at deeper levels to restore volume. Their duration depends on the mobility of the treated area and the formulation. Fat transfer is a longer lasting option where the patient’s own fat is harvested, often during a concurrent surgical procedure.

Hair removal

Hair reduction laser and intense pulsed light (IPL) treatments treat hair growth on areas such as the chest and back. A laser or light beam targets the follicle of the hair to destroy it at the base. Around six treatments are needed to remove or thin hair, depending on the area to be treated and the individual patient. The treatment involves mild discomfort and results are long term.

Photorejuvenation (IPL)

In addition to hair reduction, IPL can be used to smooth fine lines, even skin tone, treat broken capillaries and improve sun damage. It uses multiple wavelengths of light to target specific chromophores (light-receptive cells) in the skin. Several treatments are required for optimal results. There is typically minimal downtime.

Non-surgical skin tightening

Non-surgical skin tightening modalities target the skin’s deeper dermis and subcutaneous layers, tightening the underlying tissue structure without damaging the outer layers of skin. It typically involves minimal discomfort and downtime so patients can continue their daily routine as quickly as possible. These modalities use either radiofrequency, ultrasound or infra red energy to target deeper levels of the dermis to induce new collagen formation and remodelling gradually over the ensuing months. This improves skin texture and reduces sagging skin, as well as offering subtle contouring of the jaw line and softening wrinkles around the mouth, eyes and forehead.

Laser skin resurfacing

Lasers are used to treat lines and wrinkles, sun damage and pigmentation by removing damaged skin and encouraging the production of new collagen. Modern laser treatments have been finessed and generally involve only temporary tenderness and redness lasting a few days in some cases. They can often be used on the entire face and body as well as the delicate area under the eyes. Carbon dioxide (CO2) lasers can treat severe scarring but involve more serious side effects and longer recovery time.

Non-surgical fat reduction

There are a number of non-invasive body contouring systems designed to smooth contours and eliminate fat deposits with minimal downtime. These devices harness some form of energy – be it radiofrequency, ultrasound, laser or cryolipolysis – to penetrate the skin and break down underlying fat. The fat cells are then metabolised through the body’s usual processes over several weeks. Most devices offer a combination of fat reduction and skin tightening. There is normally no downtime, minimal patient discomfort, and complications are rare.

In conjunction with a healthy diet and exercise regime, results should be long lasting because, just as with liposuction, when fat cells are permanently destroyed they will not return. Generally, a series of treatments per area achieves noticeable, measurable results, although some patients note a circumferential reduction in the area after the first treatment. It is best suited to people within a healthy weight range with localised fatty deposits impervious to exercise and diet.