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There are several problems unique to men as well as anatomic and lifestyle preferences that require modification of surgical procedures. The most common procedure in men remains rhinoplasty, but other common operations include eyelid surgery, liposuction, hair transplantation, facelift, and gynecomastia correction. Men are less conditioned to the use of routine products but can benefit just as much from preventive skin care including sunscreen, moisturizers, exfoliants, and other skin care products.
Skin resurfacing can be completed in men like women, but the postoperative care is more complicated since men are not willing to use makeup to mask the redness that occurs. For this reason, more superficial peels or lasers may be more appropriate. Despite a massive female predominance, Botox®, fillers, and fat grafting are useful in the treatment of male wrinkles and contour depressions. Similarly, spider veins, although more common in women, do occur in men and are also amenable to electrodesiccation, sclerosis, and laser treatments.
Rhinophyma is the end-stage of severe acne rosacea with overgrowth of the sebaceous glands of the nasal skin, characterized by a red, thickened and bulbous nose. The abnormal skin can be removed by dermabrasion, C02 or Erbium resurfacing laser, or excision. The abnormal tissues are removed and skin appendages re-epithelize the skin. After surgery, the nose is dressed with antibiotic ointment or a moist, nonstick dressing that requires changing at least daily with soap and water cleansing to limit crusting as the wounds will ooze. Most of the wound will heal within 7-10 days, although additional scattered areas may take another 4-5 days. Redness should subside within a month, but low-grade redness may persist due to persistent acne rosacea.
Male facial rejuvenation is rapidly increasing and the techniques for male facial rejuvenation are modified to account for beard and sideburn position as well as hair loss. The full facelift incision is usually placed in front of the ear and along the existing sideburn, temple hairline, and posterior hairline. Most scars heal imperceptibly but if a poor scar occurs, it may be visible due to this location. But short scar facelift techniques, such as a MACS (Minimal Access Cranial Suspension), can reduce these risks. Also, the bearded facial skin is thicker and more vascular, increasing the risk of bleeding complications such as hematoma. Aged male necks can be he be removed with direct excision beneath the chin. Larger amounts of skin are most commonly removed with a traditional facelift, but can be removed with a horizontal and vertical excision of the skin, typically with z-plasty (interdigitation of tissue flaps to disrupt the scar lines and adjust angles of tension).
The Male Eyebrow/Forehead descends with age as it does in women, but the male eyebrow starts lower than the female brow, at or slightly above the supraorbital bony rim. As the eyebrows descend, vision and cosmesis can suffer. In males, the brow lift must be planned according to current and future hair loss. For this reason, Dr. Park uses endoscopic brow lift even more often in men, but in patients with minimal hair, direct excision in a wrinkle or above the eyebrows may be the best choice although a scar will remain.
Male eyelids have wrinkles, as do women, but men more often seek blepharoplasty consultation for bags in the lower lids and excess sagging skin with protruding fat pads of the upper lids that may obstruct peripheral vision. If a visual study can document obstruction of peripheral vision, upper lid blepharoplasty and/or browlift may be considered a reconstructive procedure covered by insurance.
Male rhinoplasty is often performed to correct an undesired size or shape of the nose or a crooked nose resulting from previous trauma. A septum deviated by trauma may obstruct airflow, which is a functional problem and may be covered by insurance. Due to larger and stronger bone structure and facial features, rhinoplasty should be more conservative to avoid feminization. Male nasal skin is thicker, limiting the ability to refine the nasal tip.
An excessively prominent male chin can be corrected with a reduction genioplasty and a receding chin can be corrected with a chin implant or chin advancement. The general technique is similar between the sexes, but techniques or implants can be modified to enhance or maintain a stronger, square chin.
More males are seeking body contouring, typically for fat in the lower abdomen around the waist, thighs, back, and arms. These areas can be addressed with liposuction or excisional techniques. Many men have a prominent abdomen due to internal fat on and around the bowel, which is obviously not correctable. In most cases, liposuction is directed at focal fatty deposits, especially flanks (“Love Handles”). Although less common except after massive weight loss, excess skin requires excisional techniques such as a mini-abdominoplasty, abdominoplasty, panniculectomy, or circumferential body lift, but technical modifications maintain the masculine ideal of the v-shaped thorax, rather than hourglass. Moderate pain may require prescribed narcotic medication for several days. A binder is helpful for 10 days to 3 weeks as light duty is resumed and escalated to strenuous activities at 4 - 6 weeks. Males cosmetic breast surgery is usually limited to polythelia (accessory nipples), gynecomastia (male breast enlargement), and chest implants as discussed previously.
All of the descriptions for the various procedures are condensed from the text of the upcoming textbook written by Dr. Christopher Park and Dr. Malcolm Marks and are copyrighted, "The Artistry of Plastic Surgery: Exploring the Experience” . |
