Idealized masculine facial features tend to include an overhanging, horizontal brow with minimal arch, deeper-set eyes that look closer together, a somewhat larger nose, a wider mouth, a squared lower face, and a beard or coarser texture to the lower facial skin. A major component of aesthetic disharmony in the aging face in both men and women, however, is the loss or redistribution of subcutaneous fat. Detailed studies by Rohrich and Pessa have demonstrated that facial fat (unlike fat elsewhere in the body) is partitioned into discrete compartments that may age independently of one another. Redistribution and loss of these fat pads contribute to formation of the nasojugal fold, malar crease, nasolabial fold, prejowl sulcus and marionette lines, as well as wasting of the temples, superior brow, and buccal fat. These changes can be visualized most strikingly in cases of cachexia and severe HIV-associated lipodystrophy.
When using fillers to restore volume loss and wrinkles in men, care must be taken to not overfeminize the male face. Filler placement in the anteromedial cheek, submalar cheek, temples, tear trough area, nasolabial folds, and marionette areas are often similar to filler placement in women if the patient has an issue with volume loss in those areas. The main difference is placement in the zygomaticomalar region of the cheek (or the point where the maximal light reflection is off of the highest point of the zygoma, or cheek bone) and the lips. Care must be taken not to overvolumize this region in men.
Also, even within ethnic groups, the male lip is typically not as tall and curvy as the female lip; it often appears less full, with more of a shadow cast by the lower lip.
Men tend to prefer treatments with less downtime and more natural results and are less risk tolerant than women are. Keeping these points in mind can increase patient satisfaction when offering fillers to male patients.
Source: Rohrich R., Pessa J. The fat compartments of the face: anatomy and clinical implications for cosmetic surgery. J. Plast. Reconstr. Surg. 2007;119:2219-27.
Dr. Talakoub and Dr. Wesley are co-contributors to a monthly Aesthetic Dermatology column in Skin & Allergy News. Dr. Talakoub is in private practice in McLean, Va. Dr. Wesley practices dermatology in Beverly Hills, Calif. This month’s column is by Dr. Wesley.