And the men too

Dr Shafer returns to answer more of our readers’ questions

Dr Shafer is a NYC double board-certified plastic surgeon, a Diplomate of the American Board of Plastic Surgery and a Member of the American Society of Plastic Surgeons.

Is there a difference in rejuvenating procedures or in the way these are carried out in men and women? Please describe.

While the basic principles apply to both male and female rejuvenation – relaxation of wrinkles, tightening of skin, defining of contours and reducing fat, the approach, timetable and areas treated often differ.

Most patients, male and female, whether socialites or in the prime of their careers, are looking to achieve smoother and tighter skin. As we age, we lose volume in our face and the skin starts to sag and wrinkle. For that reason, most patients use Botox Cosmetic to smooth the dynamic lines around the eyes, between the eyebrows and on the forehead.

In men especially, because of a strong frontalis muscle of the forehead, it is very important to have the right balance of Botox Cosmetic to maintain brow position and prevent a feminizing look. When done correctly, Botox Cosmetic treatments can make a man look years younger and well rested while maintaining a strong sense of masculinity. Injectable fillers are used to replace missing volume in the cheeks, in the temporal region and along the jaw and chin line. Again, these injections must be performed precisely and accurately to maintain a natural look and to restore the patient’s features.

Men, just like women, often start with non-invasive treatments, prior to the inevitable more permanent facelift and eyelid lift procedures. While women may start injectable treatments at the first sign of a wrinkle, men usually wait until there is already considerable work to be done. However, as plastic surgery is becoming more and more accepted and commonplace, women are bringing in their husbands and boyfriends and men are increasingly seeking preventive treatments to maintain a younger look.

As with injectable treatments, men and women differ in terms of type of invasive treatment they go for. Beyond facelift and blepharoplasty, which both sexes value fairly equally, women tend to focus on breast and buttocks rejuvenation, while men opt for neck, chest and abdominal liposuction. Plastic surgery can be addictive. Once a person has a particular area of the body treated – and sees great results – they start thinking of other areas they want to improve next.

Do men have different requirements and expectations from women?

Both men and women have similar goals – to look younger, to look more refreshed, but also to look “natural”… and like themselves in days past… While women may not mind if their friends know that they’ve had cosmetic procedures, men are adamant that no one should know that they’ve had anything done.

It is a fine balance for a surgeon because, on one hand patients want a dramatic change, yet on the other, they want to look so natural post-surgery that no one would suspect they’ve had a dramatic makeover. Women have greater scope for concealing tell-tale signs of recent surgery – they can cover scarring with make-up, re-style their hair, or use various fashion accessories in a creative way so as to camouflage treated areas that haven’t had a chance to fully heal.

Men, on the other hand, often choose to plan their treatments around weekends and invasive procedures around holidays to give themselves a few extra days to recover.

What are the top refreshing procedures you do for men?

For non-invasive treatments, the top treatment is Botox Cosmetic for wrinkles on the upper face. The second most common treatment is laser resurfacing to smooth the skin and zap away any capillaries around the nose and cheeks. The third most common treatment is injectable fillers in the cheeks and along the jaw lines. Other common treatments are chemical peels, microdermabrasion, Hydrafacial MD, and non-invasive (injectable) rhinoplasty.

For invasive procedures, the top procedure is liposuction of the abdomen, love handles and lower back. The second most common procedure is facelift and the third most common procedure is chest liposuction. Other common procedures are removal of extra eyelid skin, abdominoplasty, chin implant, and rhinoplasty.

What about facelifts in men? Do they work as well as on women?

Facelifts are a common procedure in men and great results can certainly be achieved, but must be approached differently. Again, women can cover the incisions with their hairstyle while they are healing.

Men, in most cases, do not have this luxury. However, the short-scar facelift combined with fat grafting to the midface has transformed the male facelift procedure allowing quicker recovery with shorter incisions which are hidden nicely in the transition zones.

The goals accomplished are the same – removing excess skin from the neck, creating a smooth jaw line without jowls, restoring volume to the midface and smoothing the folds and wrinkles of the face. All this should be accomplished by maintaining anatomically correct proportions to the face and preserving natural animation so as to avoid the “pulled look”.

Are there specifically male rejuvenating procedures?

While there are no rejuvenating procedures specific to men, the techniques used for treating male patients can be modified. For instance, during liposuction, a female patient may prefer a much more curvy shape, while a male patient would desire a more structured shape.

A woman would expect higher cheekbones and a softer chin from a facelift procedure, while a man would want a stronger jaw line. With abdominoplasty, a woman would want her stomach as flat as possible, while a man may benefit from some etched muscle definition. It is important to discuss fully with every patient their goals and expectations and customize the surgical plan to achieve the best outcome.

What does the typical ‘overhaul’, if we can call it that, involve for men who are in power positions in the city and other high end office careers?

For women, the term “Mommy Makeover” has become popular. This is not a specific procedure, but a range of procedures, including breast rejuvenation (breast implants and/or breast lift), tummy tuck, and liposuction. For men, there is no such specifically coined term. However, when most men come in for their first consultation, I recommend a staged approach, customized to their specific needs.

We start with non-invasive procedures such as Botox Cosmetic and dermal fillers to make some fine adjustments to their face. We move on to more invasive facial procedures if needed, such as neck liposuction, blepharoplasty (eyelid lift) or facelift. Then move on to liposuction of the chest, flanks, lower back and thighs. Finally, if needed, abdominoplasty (tummy tuck) to remove excess skin and fat from their abdomen.

In most cases, the surgical procedures should be staggered over a few separate sessions. Ultimately, it all depends on the extent of surgery involved, the health of the patient, the amount of recovery time available, and the number of areas of treated. Throughout, it is important not to lose focus but remember that the goal is to make the patient look as young and energetic on the outside as they feel on the inside. Looking and feeling one’s best is an equal proposition among men and women.