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    Gender-tailored approach best when using fillers, toxins in male patients

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    Market data show that men are a fast-growing segment of the cosmetic surgery population and they have a particular interest in procedures with minimal to no downtime, such as dermal fillers and botulinum toxin injections.

    Surgeons who hope to grow their practices by capitalizing on the market trends, however, need to understand that achieving success among male cosmetic surgery patients will require adopting gender-specific approaches to counseling, treatment and follow-up, says Terrence Keaney, M.D.

    "Clearly, there are anatomical differences between men and women that dictate differences in cosmetic goals and treatment. However, it is often overlooked that there are gender-related behavioral differences that also need to be addressed when trying to satisfy male cosmetic surgery patients," explains Dr. Keaney, a graduating dermatology resident at the University of Miami Miller School of Medicine. This year, he will begin working with Tina S. Alster, M.D., to open the first men's dermatology and laser institute at the Washington Institute for Dermatologic Laser Surgery in Washington, D.C.

    Growing interest in cosmetic surgery among men may be attributed in part to their perception that looking younger is an asset in today's competitive workplace. In contrast to women who are more aesthetically driven, men are less likely to be looking for perfection. However, surgeons should not presume this will make men easier to manage, Dr. Keaney says.

    Since men favor treatments with minimal downtime and are generally less educated about cosmetic procedures, they tend to have a lower risk tolerance than women. The fact that men often have less knowledge of cosmetic options than women also means they may need more in-depth consultations to determine their needs and preferred treatment, he explains.

    "Men tend to be less specific about their goals than women, so the physician should plan to spend more time determining what the male patient desires. In addition, because men are less informed about the range of available procedures, they need to be more thoroughly educated about the various options with a full discussion of their individual risks and benefits," Dr. Keaney says.

    TREATMENT TARGETS Success in using dermal fillers and botulinum toxin in men requires a balancing act between masculinizing and feminizing the face, as excessive use of either may result in an undesired cosmetic outcome. A thorough understanding of the unique male facial anatomy that determines "masculinity," as well as clear understanding of the male patient preferences, will allow the cosmetic surgeon to provide the best results, Dr. Keaney says.

    Enhancement of the lower face is a major focus of filler injections in men in which the filler is injected along the mandible and below the mentalis muscle to strengthen the mandibular line and give prominence to the chin. Fillers in men are also often used in the upper face to enhance the male forehead prominence by injecting the material into the bony sulcus over the eyebrows.

    Filler augmentation of the cheeks is also done in men to provide structure and lift and to reduce nasolabial folds. However, the site of the injections is medial to avoid creating wide lateral cheeks, which is a feminine characteristic. In contrast to women for whom lip augmentation is a leading use of fillers, the upper lip is generally avoided in men due to the risk of feminizing, Dr. Keaney says.

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    Cheryl Guttman Krader
    Cheryl Guttman is a medical writer based in Deerfield, Ill.

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