Male Cosmetic Surgery

Male Cosmetic Surgery At A Glance

By Peter T. Pacik, MD, FACS

Our society places a high value on looking young and fit. Today, men of all ages and all walks of life are requesting plastic surgery for cosmetic reasons. Men's goals include a more balanced nose, a rejuvenated face and a trimmer waistline. The procedures used to achieve these goals must take into consideration factors such as skin thickness, beard growth, or body type.

Though cosmetic surgery follows well-established principles to achieve safe, effective results, there are a number of differences between male and female cosmetic plastic surgery. These differences have been noted in the plastic surgery literature and are also noted in our practice.

During the past 30 years of practice, I have noted changes in how men view cosmetic plastic surgery. Nowadays, men take a greater interest in their appearance. Men want to look good in clothing and they also want to look good out of clothing with a face that matches their younger spirit. They work out in gyms, eat healthier and wear stylish clothing. They work into their later years and remain in the public eye longer. They often work with younger people and want to retain their youthfulness. They may be in a second relationship with younger women, or in an ongoing relationship with women who have had cosmetic plastic surgery themselves.

Generally, when a woman comes in for cosmetic facial plastic surgery, she will outline the areas she doesn"t like, and eventually says something like "and anything else you can do to improve my appearance would be appreciated.” A woman is open to suggestion. A man on the other hand, will indicate the area that needs to be improved and often mentions that he doesn't want anything else done. An example of this is the man who is seen for a "turkey gobbler” deformity (laxity of the neck) and does not want an associated face lift even if this would help the overall results. Apart from these general observations, there are also differences that are specific to the type of surgery planned.  

Face and Neck Lift:

Facial aging is similar in men and women. There is a descent of the facial and neck tissues, following excess folds of skin. Weight loss will often contribute to the degree of laxity.

The benefits of a face and/or neck lift are a rejuvenated appearance that does a great deal for how one feels about oneself. The improved self-image makes a world of difference of how we relate to others, and how we celebrate the day. Suddenly, the face once again matches the vitality that is within, and we actually feel younger in the process. Our unique spirit is capable of lasting well into our 80’s and 90’s and now we no longer have to look old. Eyes can be rejuvenated, the face and neck tightened, the nose balanced, the quality of the skin improved, and the hair colored, all so that we are back in harmony with our innermost spirit.

Male face and neck lifts tend to have a higher rate of postoperative bleeding than women. The reasons for this are not always clear. It is more likely that a 50-60 year old male will be on prophylactic aspirin that can cause both intra-operative and post-operative bleeding. I find that it is helpful to be off aspirin for at least a month before surgery because of the lingering effects of this anticoagulant.

A man in this age range tends to have more heart disease than a woman of similar age, and should have medical clearance including cardiac evaluation prior to surgery. The local anesthesia injected before the surgery contains adrenalin and this could tip the balance towards an arrhythmia in a male with undiagnosed borderline heart disease.

Finally, the location of the scars is more of a problem in males. In women, I prefer to create a scar in front of the ear that goes inside the tragus (cartilaginous structure in front of the ear). This conceals the scar quite nicely, allowing for an inconspicuous scar between the sideburn and the ear, disappearing behind the tragus, and then following the natural crease in front of and behind the earlobe. In a male, the hairless area in front of the ear needs to be preserved because of the beard and shaving problems if the scar in within the tragus and too close to the earlobe. The scar preserving the hairless area usually heals quite nicely, but may be more conspicuous than in the female.

Healing time, bruising and swelling are similar in both sexes. Drains are usually removed after 24 hours and both men and woman can expect a recovery time of 5-7 days, with final resolution of swelling at about 2 weeks.

Both men and women appear to be equally satisfied after a face lift. Women will generally continue with advanced skin care products to further improve the quality of their skin, whereas men often don’t want to be bothered with this. An advanced skin care program is quite effective in both men and women.

The image above shows a loop of small intestine from a mouse. The glistening membrane inside the loop of bowel is mesentery; mesenteric blood vessels running through bundles of fat are clearly visible. This area is filled with considerable fat in overweight people.

Liposuction

Fatty depositions in males tend to involve the abdomen and love handles as the most common areas of concern. Often these areas tend to be “problem areas” despite working out and weight loss. They are often due to hereditary factors. The benefits of liposuction and liposculpture are a more pleasing appearance both in and out of clothing, and a feeling of vitality as we recapture our youth. Clothing fits better and self-image is improved. Liposculpture gives added definition to certain abdominal areas, giving the abdomen a more muscular and well-defined appearance.

From a technical point of view, the operation for liposuction and liposculpture is similar between men and woman. There are a few differences that are noteworthy.

Abdominal Liposuction: Men who have a “beer belly” often have considerable intraperitoneal fat. This is the fat that is located within the abdominal cavity that cannot be suctioned in contrast to the fat under the skin that is the area amenable to liposuction. The mesentery is a filmy structure located within the abdominal cavity that attaches to the small and large intestines and keeps these structures from getting “tangled up”. The mesentery is a fat storage area. In the male, there may be as much fat in this area as subcutaneous fat under the skin. The fat in the mesentery is an important component of the abdominal protrusion and cannot be suctioned. This may give rise to inadequare correction of the problem and needs to be carefully evaluated during the consultation.

 

The image above shows a loop of small intestine from a mouse. The glistening membrane inside the loop of bowel is mesentery; mesenteric blood vessels running through bundles of fat are clearly visible. This area is filled with considerable fat in overweight people.

Liposuction of the “Love Handles”: Males are more prone to fatty deposition in the love handle area which may extend around the sides to the back, almost to the spine. Often considerable fat is located within the love handles. It is often more difficult to rotate a large man to get to these areas, and the surgical approach to the love handles will be discussed during your consultation.

Results are gratifying for both men and women, healing time, brusing and swelling appear to be similar for both sexes.

Liposuction of the Breasts: For men with male breast enlargement (gynecomastia), this becomes a source of embarrassment to the point that many men always wear a T-shirt on the beach or to bed. They are self-conscious and generally very aware of any situation that might cause them to take their shirt off. A patient of mine confided that his wife never saw his chest in their 20-year marriage. If the gynecomastia dates back to childhood, there is the added embarrassment of locker room jokes and sometimes physical torment when other men kid around and touch their breasts. This may set the stage for life-long self-consciousness.

Getting rid of this stumbling block has allowed patients to once again celebrate their bodies, and suddenly gives them the freedom to feel normal and secure.

Liposuction is usually the procedure of choice for male breast enlargement. In the female breast, glandular tissue is replaced with fat in the aging process and is fairly easy to liposuction. The male breast, however, tends to maintain a fibrous quality to the breast tissue, and this may be more difficult to liposuction. An incision in the lower portion of the areola may be needed to further excise tissue that cannot be liposuctioned (subcutaneous mastectomy).

Psychologically, men appear to be more difficult to please after liposuction of the breasts. This is because a male hopes to be completely flat after the surgery, and this is usually not possible.

As for most procedures, healing time is similar between men and women.

Botox

Males tend to have heavier more pronounced facial musculature than females, especially involving the frown lines and forehead wrinkles. These deep creases add to the aging appearance and may give the false illusion of a person who is scowling.

The benefits of Botox are a more relaxed appearing face. A side benefit is the reduced tension in the forehead, and often the elimination of headaches involving the forehead.

Though the sites of injection are similar, more Botox is generally needed in the male to effectively reduce the degree of dynamic wrinkling.

Please Note: For those having difficulty affording cosmetic plastic surgery, we offer financing through CareCredit. Please refer to our Financing Section on this website.

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