Maximize cosmetic procedures for men

MIAMI BEACH – More men are seeking cosmetic dermatologic procedures and products, and successfully engaging and treating this segment of the population require recognition of a number of gender-specific differences with respect to skin biology, skin aging, behaviors, and rejuvenation goals, according to Dr. Ivan Camacho.

"We need to be able to understand all of these the differences in order to be able to provide tailored treatments for our patients, so they can get the best results possible," Dr. Camacho said during a focus session on men’s aesthetics at the annual meeting of the American Academy of Dermatology.

Skin biology

When it comes to skin biology, men and women share a number of characteristics, but there are important differences driven by genetic or hormonal specificity that can affect treatment outcomes, Dr. Camacho said. For example, although the number of cell layers and thickness of the stratum corneum is similar in men and women, the dermis is about 20% thicker in men than in women, across the age spectrum and in all anatomic locations, he noted.

Men also have higher collagen density early in life, but they experience skin thinning at a younger age than women. For women, skin thickness generally remains constant until menopause, and then the skin begins to thin rapidly. This difference is most likely because of the role of testosterone in maintaining collagen content, said Dr. Camacho of the University of Miami.

Men also have less subcutaneous fat, greater distribution of body fat in the abdomen and trunk, and higher facial bone density mass than women, Dr. Camacho explained. In addition, men tend to have higher transepidermal water loss because of the lack of estrogen, which has positive effects in the stratum corneum, he said.

Dr. Camacho described other functional differences in men’s skin compared with women’s skin, including:

• A fourfold increase in sebum generation.

• A 30% overall increase in sweating.

• Different hair distribution as determined by androgens, but also by genetics.

• Stronger skin tone.

• Greater sensitivity to ultraviolet radiation, and thus a lower minimal erythema dose threshold and increased rate of skin cancers.

• Greater susceptibility to bacterial and viral infections and slower healing rates as a result of the inhibitory effects of testosterone and hydrotestosterone with respect to wound healing.

• Greater susceptibility to stress-induced immunosuppression, which may explain the higher skin cancer rates and delayed wound healing.

Skin aging

As for the aging process, men age differently from women in that their higher collagen density leads to better maintenance of elasticity, and their higher facial bone density provides better overall support, said Dr. Camacho.

However, thicker skin and stronger muscles make men more prone to develop deeper expression lines, as opposed to the "superficial wrinkles that women complain about," Dr. Camacho noted.

Also, the reduced level of subcutaneous fat in men can lead to more dramatic volume loss.

"Men are ‘sinkers.’ We sink more than wrinklers or saggers, because we have good elasticity, but we actually tend to lose quite a bit of subcutaneous fat," Dr. Camacho explained.

As a result of other differences related to skin aging, he said, men’s skin may be:

• More prone to acne and enlarged pores due to the higher sebaceous gland count.

• More prone to darker and/or redder complexions because of the increased tone and vascularity.

• More likely to have dull areas due to the epidermal water loss.

• Less prone to perioral lines and wrinkles due to facial hair distribution, which acts as a structural support.

• More likely to have unwanted fat in the abdominal and trunk region.

• More likely to develop both melanoma and nonmelanoma skin cancers and to experience photoaging because of greater sensitivity to ultraviolet radiation.

Behavior

In Dr. Camacho’s experience, men tend to be very goal oriented, and that carries over to cosmetic procedures.

"Men are very results-oriented, so we want to have a very clear purpose of what we want to achieve with a given treatment or product," he added, noting that male patients often prefer a lot of detail about procedures and processes.

Providing the extra details requires a greater educational effort on the part of the physician, he said, but "that’s a great thing, because they are going to be well informed about the pros and cons of a given treatment."

Male patients also want fast results. For these reasons, injectables and laser therapies are probably a good fit, he noted.

Men also tend to prefer simplicity, minimal discomfort, and minimal downtime, making noninvasive procedures and multifunctional skin care products ideal, he added.

Rejuvenation goals

Men often have rejuvenation goals that are different from those of women, Dr. Camacho said.

The most common reason that men seek cosmetic treatment is for a "tired, sinking face"; they want to look refreshed and confident, but they want subtle, natural-looking results, he said.

And, of course, there’s hair.

"Hair, hair, hair. Hair is a huge concern for men," Dr. Camacho said.

Sometimes men think they have too much hair, sometimes they have too little. Men drive the market for hair loss treatments, and also are increasingly seeking hair removal treatments, Dr. Camacho noted. Since traditional methods for hair removal, such as waxing, shaving, and epilation, are temporary and can cause irritation, laser hair removal is increasing in popularity among men. In fact, according to the American Society of Aesthetic Plastic Surgery, it was the second most common nonsurgical cosmetic intervention for men in 2011, Dr. Camacho said.

Other useful cosmetic procedures

One of the most popular noninvasive cosmetic interventions for both men and women is neuromodulation injections, for softening of expression lines and treating areas including the glabella, forehead, and periocular area, that can contribute to an angry-, tired-, or sad-looking face, Dr. Camacho said.

In 2011, men accounted for 9.1% of botulinum toxin treatment patients, and this represented a 258% increase from the year 2000, he noted.

Skin resurfacing treatments are increasing in popularity among men as well. In 2011, men accounted for 7.3% of skin resurfacing treatments, making skin resurfacing the fourth most common nonsurgical cosmetic intervention in men, Dr. Camacho said.

Other treatments for skin issues of concern to men include laser and light therapies to improve the complexion, and skin-tightening procedures, such as radiofrequency and ultrasound, to help improve skin laxity

In addition, data from 2011 showed that men accounted for about 20% of patients undergoing CoolSculpting, which is both effective and appealing to men seeking treatment for abdominal and trunk fat deposits, Dr. Camacho said.

Treatment pearls

When providing facial treatments for men, preservation of a masculine appearance is essential, Dr. Camacho said.

"The last thing we want to do is have a man’s face looking like a woman’s face; we need to be able to preserve the masculine appearance," Dr. Camacho said, noting that in his experience, a combination of neurotoxins and dermal fillers is excellent for achieving desired results.

For neurotoxins, remember that men require doses at about 1.5 to 2 times as much as women, he said

"But also remember that men want to preserve some animation, so it’s always important to keep a balance between being effective with our treatment, but also keeping the patient happy with what they want," he said.

In Dr. Camacho’s experience, most men are less concerned with periocular lines, but some are, so be sure to ask them exactly what they want at a treatment session.

"You can’t assume they want three areas treated at a time as we usually do with women," he said.

Be sure to preserve the masculine position of the brow, which in men is very subtle, located right at the supraorbital rim, and has no major arching, said Dr. Camacho.

By avoiding injecting at the superior portion of the orbicularis ocular muscle, the subtle arch at the supraorbital rim can be maintained, and feminization of the brow avoided, he said.

"Also, when treating the frontalis major make sure to go all the way lateral, because you don’t want a little bit of frontalis pulling and giving some arching to the eyebrows," he added.

As for fillers, keep in mind that men probably will require higher volumes, which is an important consideration when discussing finances during the initial consultation.

Fillers are particularly useful in the tear trough area for men seeking treatment of tired-looking sunken eyes.

"Very easily, we can create a smooth transition between the lower eyelid and cheek. We can also use (fillers) for prominent nasolabial folds," Dr. Camacho explained.

Before filling the lines, however, consider restoring the cheek to correct for the midfacial fat loss common in men, he noted.

Also, if treatment involves the lip area, avoid overfilling the vermilion border – this will feminize the lips, he said.

Breaking into the men’s market

Consider developing a marketing strategy that shows your practice’s appeal to both genders – by launching a website and developing marketing materials that feature both male and female models and patients, and by offering cosmeceutical product lines developed for men, Dr. Camacho suggested.

"The modern man is here, and the modern man is actively looking for advice on cosmetic procedures and recommendations for skin care. Dermatologists will have a very important role in male aesthetics," he said, noting that a dermatologist’s role can include enhancing awareness and cultural acceptance of cosmetic interventions for men.

"We have every day in our practices, an opportunity to educate our male patients on the multiple treatment options available for them. We also have a responsibility for being knowledgeable about the specificities of male skin ... to be able to formulate tailored treatments, and to be able to, therefore, obtain the best results for our male patients," he said.

Dr. Camacho reported having no disclosures.

MIAMI BEACH – More men are seeking cosmetic dermatologic procedures and products, and successfully engaging and treating this segment of the population require recognition of a number of gender-specific differences with respect to skin biology, skin aging, behaviors, and rejuvenation goals, according to Dr. Ivan Camacho.

"We need to be able to understand all of these the differences in order to be able to provide tailored treatments for our patients, so they can get the best results possible," Dr. Camacho said during a focus session on men’s aesthetics at the annual meeting of the American Academy of Dermatology.

Skin biology

When it comes to skin biology, men and women share a number of characteristics, but there are important differences driven by genetic or hormonal specificity that can affect treatment outcomes, Dr. Camacho said. For example, although the number of cell layers and thickness of the stratum corneum is similar in men and women, the dermis is about 20% thicker in men than in women, across the age spectrum and in all anatomic locations, he noted.

Men also have higher collagen density early in life, but they experience skin thinning at a younger age than women. For women, skin thickness generally remains constant until menopause, and then the skin begins to thin rapidly. This difference is most likely because of the role of testosterone in maintaining collagen content, said Dr. Camacho of the University of Miami.

Men also have less subcutaneous fat, greater distribution of body fat in the abdomen and trunk, and higher facial bone density mass than women, Dr. Camacho explained. In addition, men tend to have higher transepidermal water loss because of the lack of estrogen, which has positive effects in the stratum corneum, he said.

Dr. Camacho described other functional differences in men’s skin compared with women’s skin, including:

• A fourfold increase in sebum generation.

• A 30% overall increase in sweating.

• Different hair distribution as determined by androgens, but also by genetics.

• Stronger skin tone.

• Greater sensitivity to ultraviolet radiation, and thus a lower minimal erythema dose threshold and increased rate of skin cancers.

• Greater susceptibility to bacterial and viral infections and slower healing rates as a result of the inhibitory effects of testosterone and hydrotestosterone with respect to wound healing.

• Greater susceptibility to stress-induced immunosuppression, which may explain the higher skin cancer rates and delayed wound healing.

Skin aging

As for the aging process, men age differently from women in that their higher collagen density leads to better maintenance of elasticity, and their higher facial bone density provides better overall support, said Dr. Camacho.

However, thicker skin and stronger muscles make men more prone to develop deeper expression lines, as opposed to the "superficial wrinkles that women complain about," Dr. Camacho noted.

Also, the reduced level of subcutaneous fat in men can lead to more dramatic volume loss.

"Men are ‘sinkers.’ We sink more than wrinklers or saggers, because we have good elasticity, but we actually tend to lose quite a bit of subcutaneous fat," Dr. Camacho explained.

As a result of other differences related to skin aging, he said, men’s skin may be:

• More prone to acne and enlarged pores due to the higher sebaceous gland count.

• More prone to darker and/or redder complexions because of the increased tone and vascularity.

• More likely to have dull areas due to the epidermal water loss.

• Less prone to perioral lines and wrinkles due to facial hair distribution, which acts as a structural support.

• More likely to have unwanted fat in the abdominal and trunk region.

• More likely to develop both melanoma and nonmelanoma skin cancers and to experience photoaging because of greater sensitivity to ultraviolet radiation.

Behavior

In Dr. Camacho’s experience, men tend to be very goal oriented, and that carries over to cosmetic procedures.

"Men are very results-oriented, so we want to have a very clear purpose of what we want to achieve with a given treatment or product," he added, noting that male patients often prefer a lot of detail about procedures and processes.

Providing the extra details requires a greater educational effort on the part of the physician, he said, but "that’s a great thing, because they are going to be well informed about the pros and cons of a given treatment."

Male patients also want fast results. For these reasons, injectables and laser therapies are probably a good fit, he noted.

Men also tend to prefer simplicity, minimal discomfort, and minimal downtime, making noninvasive procedures and multifunctional skin care products ideal, he added.

Rejuvenation goals

Men often have rejuvenation goals that are different from those of women, Dr. Camacho said.

The most common reason that men seek cosmetic treatment is for a "tired, sinking face"; they want to look refreshed and confident, but they want subtle, natural-looking results, he said.

And, of course, there’s hair.

"Hair, hair, hair. Hair is a huge concern for men," Dr. Camacho said.

Sometimes men think they have too much hair, sometimes they have too little. Men drive the market for hair loss treatments, and also are increasingly seeking hair removal treatments, Dr. Camacho noted. Since traditional methods for hair removal, such as waxing, shaving, and epilation, are temporary and can cause irritation, laser hair removal is increasing in popularity among men. In fact, according to the American Society of Aesthetic Plastic Surgery, it was the second most common nonsurgical cosmetic intervention for men in 2011, Dr. Camacho said.

Other useful cosmetic procedures

One of the most popular noninvasive cosmetic interventions for both men and women is neuromodulation injections, for softening of expression lines and treating areas including the glabella, forehead, and periocular area, that can contribute to an angry-, tired-, or sad-looking face, Dr. Camacho said.

In 2011, men accounted for 9.1% of botulinum toxin treatment patients, and this represented a 258% increase from the year 2000, he noted.

Skin resurfacing treatments are increasing in popularity among men as well. In 2011, men accounted for 7.3% of skin resurfacing treatments, making skin resurfacing the fourth most common nonsurgical cosmetic intervention in men, Dr. Camacho said.

Other treatments for skin issues of concern to men include laser and light therapies to improve the complexion, and skin-tightening procedures, such as radiofrequency and ultrasound, to help improve skin laxity

In addition, data from 2011 showed that men accounted for about 20% of patients undergoing CoolSculpting, which is both effective and appealing to men seeking treatment for abdominal and trunk fat deposits, Dr. Camacho said.

Treatment pearls

When providing facial treatments for men, preservation of a masculine appearance is essential, Dr. Camacho said.

"The last thing we want to do is have a man’s face looking like a woman’s face; we need to be able to preserve the masculine appearance," Dr. Camacho said, noting that in his experience, a combination of neurotoxins and dermal fillers is excellent for achieving desired results.

For neurotoxins, remember that men require doses at about 1.5 to 2 times as much as women, he said

"But also remember that men want to preserve some animation, so it’s always important to keep a balance between being effective with our treatment, but also keeping the patient happy with what they want," he said.

In Dr. Camacho’s experience, most men are less concerned with periocular lines, but some are, so be sure to ask them exactly what they want at a treatment session.

"You can’t assume they want three areas treated at a time as we usually do with women," he said.

Be sure to preserve the masculine position of the brow, which in men is very subtle, located right at the supraorbital rim, and has no major arching, said Dr. Camacho.

By avoiding injecting at the superior portion of the orbicularis ocular muscle, the subtle arch at the supraorbital rim can be maintained, and feminization of the brow avoided, he said.

"Also, when treating the frontalis major make sure to go all the way lateral, because you don’t want a little bit of frontalis pulling and giving some arching to the eyebrows," he added.

As for fillers, keep in mind that men probably will require higher volumes, which is an important consideration when discussing finances during the initial consultation.

Fillers are particularly useful in the tear trough area for men seeking treatment of tired-looking sunken eyes.

"Very easily, we can create a smooth transition between the lower eyelid and cheek. We can also use (fillers) for prominent nasolabial folds," Dr. Camacho explained.

Before filling the lines, however, consider restoring the cheek to correct for the midfacial fat loss common in men, he noted.

Also, if treatment involves the lip area, avoid overfilling the vermilion border – this will feminize the lips, he said.

Breaking into the men’s market

Consider developing a marketing strategy that shows your practice’s appeal to both genders – by launching a website and developing marketing materials that feature both male and female models and patients, and by offering cosmeceutical product lines developed for men, Dr. Camacho suggested.

"The modern man is here, and the modern man is actively looking for advice on cosmetic procedures and recommendations for skin care. Dermatologists will have a very important role in male aesthetics," he said, noting that a dermatologist’s role can include enhancing awareness and cultural acceptance of cosmetic interventions for men.

"We have every day in our practices, an opportunity to educate our male patients on the multiple treatment options available for them. We also have a responsibility for being knowledgeable about the specificities of male skin ... to be able to formulate tailored treatments, and to be able to, therefore, obtain the best results for our male patients," he said.

Dr. Camacho reported having no disclosures.

MIAMI BEACH – More men are seeking cosmetic dermatologic procedures and products, and successfully engaging and treating this segment of the population require recognition of a number of gender-specific differences with respect to skin biology, skin aging, behaviors, and rejuvenation goals, according to Dr. Ivan Camacho.

"We need to be able to understand all of these the differences in order to be able to provide tailored treatments for our patients, so they can get the best results possible," Dr. Camacho said during a focus session on men’s aesthetics at the annual meeting of the American Academy of Dermatology.

Skin biology

When it comes to skin biology, men and women share a number of characteristics, but there are important differences driven by genetic or hormonal specificity that can affect treatment outcomes, Dr. Camacho said. For example, although the number of cell layers and thickness of the stratum corneum is similar in men and women, the dermis is about 20% thicker in men than in women, across the age spectrum and in all anatomic locations, he noted.

Men also have higher collagen density early in life, but they experience skin thinning at a younger age than women. For women, skin thickness generally remains constant until menopause, and then the skin begins to thin rapidly. This difference is most likely because of the role of testosterone in maintaining collagen content, said Dr. Camacho of the University of Miami.

Men also have less subcutaneous fat, greater distribution of body fat in the abdomen and trunk, and higher facial bone density mass than women, Dr. Camacho explained. In addition, men tend to have higher transepidermal water loss because of the lack of estrogen, which has positive effects in the stratum corneum, he said.

Dr. Camacho described other functional differences in men’s skin compared with women’s skin, including:

• A fourfold increase in sebum generation.

• A 30% overall increase in sweating.

• Different hair distribution as determined by androgens, but also by genetics.

• Stronger skin tone.

• Greater sensitivity to ultraviolet radiation, and thus a lower minimal erythema dose threshold and increased rate of skin cancers.

• Greater susceptibility to bacterial and viral infections and slower healing rates as a result of the inhibitory effects of testosterone and hydrotestosterone with respect to wound healing.

• Greater susceptibility to stress-induced immunosuppression, which may explain the higher skin cancer rates and delayed wound healing.

Skin aging

As for the aging process, men age differently from women in that their higher collagen density leads to better maintenance of elasticity, and their higher facial bone density provides better overall support, said Dr. Camacho.

However, thicker skin and stronger muscles make men more prone to develop deeper expression lines, as opposed to the "superficial wrinkles that women complain about," Dr. Camacho noted.

Also, the reduced level of subcutaneous fat in men can lead to more dramatic volume loss.

"Men are ‘sinkers.’ We sink more than wrinklers or saggers, because we have good elasticity, but we actually tend to lose quite a bit of subcutaneous fat," Dr. Camacho explained.

As a result of other differences related to skin aging, he said, men’s skin may be:

• More prone to acne and enlarged pores due to the higher sebaceous gland count.

• More prone to darker and/or redder complexions because of the increased tone and vascularity.

• More likely to have dull areas due to the epidermal water loss.

• Less prone to perioral lines and wrinkles due to facial hair distribution, which acts as a structural support.

• More likely to have unwanted fat in the abdominal and trunk region.

• More likely to develop both melanoma and nonmelanoma skin cancers and to experience photoaging because of greater sensitivity to ultraviolet radiation.

Behavior

In Dr. Camacho’s experience, men tend to be very goal oriented, and that carries over to cosmetic procedures.

"Men are very results-oriented, so we want to have a very clear purpose of what we want to achieve with a given treatment or product," he added, noting that male patients often prefer a lot of detail about procedures and processes.

Providing the extra details requires a greater educational effort on the part of the physician, he said, but "that’s a great thing, because they are going to be well informed about the pros and cons of a given treatment."

Male patients also want fast results. For these reasons, injectables and laser therapies are probably a good fit, he noted.

Men also tend to prefer simplicity, minimal discomfort, and minimal downtime, making noninvasive procedures and multifunctional skin care products ideal, he added.

Rejuvenation goals

Men often have rejuvenation goals that are different from those of women, Dr. Camacho said.

The most common reason that men seek cosmetic treatment is for a "tired, sinking face"; they want to look refreshed and confident, but they want subtle, natural-looking results, he said.

And, of course, there’s hair.

"Hair, hair, hair. Hair is a huge concern for men," Dr. Camacho said.

Sometimes men think they have too much hair, sometimes they have too little. Men drive the market for hair loss treatments, and also are increasingly seeking hair removal treatments, Dr. Camacho noted. Since traditional methods for hair removal, such as waxing, shaving, and epilation, are temporary and can cause irritation, laser hair removal is increasing in popularity among men. In fact, according to the American Society of Aesthetic Plastic Surgery, it was the second most common nonsurgical cosmetic intervention for men in 2011, Dr. Camacho said.

Other useful cosmetic procedures

One of the most popular noninvasive cosmetic interventions for both men and women is neuromodulation injections, for softening of expression lines and treating areas including the glabella, forehead, and periocular area, that can contribute to an angry-, tired-, or sad-looking face, Dr. Camacho said.

In 2011, men accounted for 9.1% of botulinum toxin treatment patients, and this represented a 258% increase from the year 2000, he noted.

Skin resurfacing treatments are increasing in popularity among men as well. In 2011, men accounted for 7.3% of skin resurfacing treatments, making skin resurfacing the fourth most common nonsurgical cosmetic intervention in men, Dr. Camacho said.

Other treatments for skin issues of concern to men include laser and light therapies to improve the complexion, and skin-tightening procedures, such as radiofrequency and ultrasound, to help improve skin laxity

In addition, data from 2011 showed that men accounted for about 20% of patients undergoing CoolSculpting, which is both effective and appealing to men seeking treatment for abdominal and trunk fat deposits, Dr. Camacho said.

Treatment pearls

When providing facial treatments for men, preservation of a masculine appearance is essential, Dr. Camacho said.

"The last thing we want to do is have a man’s face looking like a woman’s face; we need to be able to preserve the masculine appearance," Dr. Camacho said, noting that in his experience, a combination of neurotoxins and dermal fillers is excellent for achieving desired results.

For neurotoxins, remember that men require doses at about 1.5 to 2 times as much as women, he said

"But also remember that men want to preserve some animation, so it’s always important to keep a balance between being effective with our treatment, but also keeping the patient happy with what they want," he said.

In Dr. Camacho’s experience, most men are less concerned with periocular lines, but some are, so be sure to ask them exactly what they want at a treatment session.

"You can’t assume they want three areas treated at a time as we usually do with women," he said.

Be sure to preserve the masculine position of the brow, which in men is very subtle, located right at the supraorbital rim, and has no major arching, said Dr. Camacho.

By avoiding injecting at the superior portion of the orbicularis ocular muscle, the subtle arch at the supraorbital rim can be maintained, and feminization of the brow avoided, he said.

"Also, when treating the frontalis major make sure to go all the way lateral, because you don’t want a little bit of frontalis pulling and giving some arching to the eyebrows," he added.

As for fillers, keep in mind that men probably will require higher volumes, which is an important consideration when discussing finances during the initial consultation.

Fillers are particularly useful in the tear trough area for men seeking treatment of tired-looking sunken eyes.

"Very easily, we can create a smooth transition between the lower eyelid and cheek. We can also use (fillers) for prominent nasolabial folds," Dr. Camacho explained.

Before filling the lines, however, consider restoring the cheek to correct for the midfacial fat loss common in men, he noted.

Also, if treatment involves the lip area, avoid overfilling the vermilion border – this will feminize the lips, he said.

Breaking into the men’s market

Consider developing a marketing strategy that shows your practice’s appeal to both genders – by launching a website and developing marketing materials that feature both male and female models and patients, and by offering cosmeceutical product lines developed for men, Dr. Camacho suggested.

"The modern man is here, and the modern man is actively looking for advice on cosmetic procedures and recommendations for skin care. Dermatologists will have a very important role in male aesthetics," he said, noting that a dermatologist’s role can include enhancing awareness and cultural acceptance of cosmetic interventions for men.

"We have every day in our practices, an opportunity to educate our male patients on the multiple treatment options available for them. We also have a responsibility for being knowledgeable about the specificities of male skin ... to be able to formulate tailored treatments, and to be able to, therefore, obtain the best results for our male patients," he said.

Dr. Camacho reported having no disclosures.