The Man in the Mirror by Elvira Maricic The face of cosmetic surgery is changing as men enter the arena print article      send to a friend

Statistics show that, although in much lesser numbers than women, men are taking advantage of the surgical advances that can help them hold back time.  They're just not openly discussing what they're having done. 

Out of the Bag

In a recent American Society of Plastic Surgery (ASPS) survey, Americans--both male and female--reported having a more favorable attitude toward cosmetic surgery than they did 10 years ago, with most people approving of aesthetic surgery for themselves or others.  And thanks to a strong economy, surgical advances, and the availability of patient financing programs, elective cosmetic surgery is on the rise. 

ASPS statistics show that there were more than 4.6 million cosmetic surgical and nonsurgical procedures performed in 1999.  Of these, 11% were performed on males.

What Men Want

Liposuction, which accounts for nearly 90% of the procedures men have done, is the heavy favorite. Other procedures popular with men include eyelid surgery, nose reshaping, breast reduction, and facelift. 

"I think the reason men are generally having this kind of surgery is that it's a young, youthful-oriented workforce, and they want to look better so they can be more competitive," says Robert Bernard, MD, a White Plains, New York, plastic surgeon.

"The most common procedure that I do on males is blepharoplasty (eyelid surgery), because I think men's perception is that it's the first thing that's out there when they are sitting across the conference table from somebody else," he says. "They come in less frequently for face lifts.  Liposuction is certainly common, particularly the abdomen and so-called love handles."

Mark Salzman, MD, a Louisville, Kentucky plastic surgeon, concurs. "I think there is pressure on men to compete in the workplace, while women are concerned about whether they're still attractive to the opposite sex.  It's been my experience that men [have surgery] for more independent reasons.  Liposuction is usually skinny guys who work out a lot and [still]  have love handles.  Men will come in and say , 'I've done everything I can, I go to the gym three times a week.  I want to look like the guy in the magazine.' "

Different Strokes for Different Folks

While the surgical techniques designed to make both men and women look better are very similar, there are some major considerations to take into account, especially with facelifts.  "All in all, it's the same operation," says Dr. Salzman.  "It's actually a little easier [with men], because you have to do less surgery.  You don't want it to be as dramatic; you don't want to feminize the face too much and have a 60-year-old executive looking thirty.  You do a little bit less of a procedure; you're less aggressive," he adds.

Dr. Bernard, too, notes that there are differences when performing this procedure on males. "It's definitely more difficult to place the incisions so that they will be cosmetically acceptable, and there are several reasons for that.  First of all, women generally wear their hair longer and are more apt to apply makeup if necessary.  You also have to look at the anatomy. You have a bearded area, and so you become limited in terms of how far back you can pull the male face.  If you pull it back too far, you end up putting hair-bearing skin into the ear or pulling right up into the back of the ear, and then they have to shave back there.  So there are very special considerations in a male that are not necessarily there for a female," he says.

More, or More of the Same?

While men may be hesitant to talk about cosmetic surgery, the ASPS statistics showing they accounted for 11% of it in 1999 speak volumes.  But has there truly been an increase in the number of men having cosmetic surgery?  Dr. Salzman notes that his practice is about 15% male, which is 4% higher that the statistics show.  "It's gone up about three-fold, from 5%, in the past 8 to 10 years," he says.

Dr. Bernard, on the other hand, states that he has not seen an increase in male patients. "Statistics that were generated by the ASPS bear that out," he says.  "I think that over the last few years that trend may have flattened out, and I also think that we're seeing perhaps a change in the kinds of things men have done.  Certainly there's no question that liposuction has gone up.  I think that rhinoplasty (nose jobs) has gone down a bit across the country in both men and women, so the statistics may have flattened out because one is going up and the other is going down a bit."

That doesn't mean that men will stop having surgery anytime time soon however.  "Men have become much more accepting of it," Dr. Bernard adds.  "As our techniques continue to evolve, and we can place the incisions or use techniques in such a way that it even further minimizes the incisions (particularly for a facelift), men will become even more accepting of it.  I don't think any of them have any problem with blepharoplasty, I don't think any of them have any problem with suctioning of the abdomen, because the scars are well hidden.  However, I think that in a frank discussion with respect to the incisions for a male full facelift, they need to know where their incisions are, and they need to know what the limitations are.  If they're willing to accept those, they'll get a perfectly fine result, but they do need to be willing to accept them," he notes.