For the past several years, much has been said about how more men are seeking aesthetic procedures in the U.S. The reasons associated with this trend include increased social acceptance of cosmetic procedures by men and advancements in non-invasive, no-downtime procedures that appeal to them. While a general consensus in the media and among practitioners is that men account for around 10% to 20% of all cosmetic treatments, recent statistics actually show that a downward trend is in progress.
According to 2018 statistics published by the American Society for Aesthetic Plastic Surgery (ASAPS), 7.1% of all cosmetic surgical procedures were performed on men versus 92.9% for females. Among nonsurgical procedures, males accounted for 7.6% of the market, which was down from 2017 (9.2%). The American Society of Plastic Surgeons (ASPS) reported a similar trend: 8% of total minimally invasive cosmetic procedures in 2018 went to males, revealing a 2% drop between 2017 and 2018.
On the other hand, the ASPS reported that since 2000 there has been a 29% increase in men get- ting nonsurgical procedures, mostly in neurotoxin, laser resurfacing and dermal filler treatments.
According to Catherine Maley, MBA, a medical aesthetic marketing consultant in Sausalito, Calif., “The numbers have gone from 10% to maybe 9%, but male patients are now willing to do more procedures than ever before, and the acceptance rate of aesthetic treatments among men has been growing.
“The majority of practices around the country know where their bread is buttered, so 90% to 95% of their clientele is female,” she expressed. “But the numbers vary depending on the region. For instance, if you’re in Los Angeles, Miami or New York City, you’ll see a higher percentage of both straight and gay men going into clinics, while in rural areas there is less activity.”
When a practice spends a larger portion of its marketing dollars to specifically target males, the number of patients will rise. “In addition, I’ve seen very successful practices that cater only to gay men, which works well in places like San Francisco and Miami,” Ms. Maley added.
Interestingly, sexual aesthetics, like penile enhancement procedures, have not caught on beyond small pockets of gay and straight men residing on either coast, where exotic aesthetic procedures like male feminization and transgender surgeries apply to only a small set of patients.
As reported by Gordon H. Sasaki, MD, FACS, a plastic surgeon in Pasadena, Calif., “The main motivation for all men undergoing cosmetic procedures is either the pursuit of a more youthful appearance or to just look better and healthier for their age, while maintaining a masculine look.”
Though ASPS and ASAPS 2018 statistics reveal fewer men are coming into clinics, the ones that do come in are better informed about what’s available, especially nonsurgical, low pain and no-downtime procedures. In addition, certain new treatment types have attracted the male market.
“A few years ago, our numbers were 89% female and 11% male. Then, Kybella was introduced to the market, which has become very attractive to men, as well as women,” noted José Raúl Montes, MD, FACS, FACCS, a cosmetic and oculoplastic surgeon in San Juan, Puerto Rico. “The gender breakdown of Kybella patients in my office is 60% women and 40% men, and our overall male patient population is now closer to 15%, an increase from the 10% or 11% it was before.”
“Increasingly, body shaping has become one of male patients’ main gateway procedures,” said Mark Craig, MD, a plastic surgeon in Tupelo, Miss. “They ask for treatments for both the body and the face, but they really perk up when they learn they can get an energy-based, non-invasive fat reduction or body contouring procedure, such as BodyFX (InMode) or CoolSculpting (Allergan). One of their requirements is no pain. Compared with females, male patients can’t stand much pain.”
Procedures that incorporate muscle toning are gaining popularity, as well, noted Dr. Montes. “A few months ago, we acquired the EMSCULPT device from BTL Aesthetics (Marlborough, Mass.), which has generated a lot of interest from male patients. In fact, we have done approximately 400 treatments so far and around 30% of those treatments have been done on men,” he said.
Along with the electromagnetic, energy- based EMSCULPT system, truSculpt® flex from Cutera, Inc. (Brisbane, Calif.) also offers a muscle sculpting system employing electrical muscle stimulation to target specific muscle groups, as well as reportedly cover the largest treatment area in the body sculpting industry.
Among a wider landscape of body shaping products, InMode’s range of devices – from BodyTiteTM and FaceTiteTM to AccuTiteTM – utilize proprietary radio- frequency (RF)-assisted liposuction (RFAL) technology to achieve mini- mally invasive three-dimensional body remodeling results.
The Z WaveQ system from Zimmer MedizinSystems (Irvine, Calif.), which is equipped with an innovative water-cooled generator that ensures high efficiency and durability, can provide temporary reduction of the appearance of cellulite, and also be used to enhance cryolipolysis and liposuction results.
Beyond body contouring, facial aesthetics remain very popular with male patients, noted Haideh Hirmand, MD, a plastic surgeon in New York City, N.Y.
“Men need more volume with fillers and in the smaller fine lines because their skin is thicker. For the lines on the fore- head I use micro Botox or skin boosting with fillers because men, much more than women, are sensitive to neuro- toxin injections in the forehead. Men start with no brows to speak of and as they age their brows go lower and look more ‘hooded’.”
In addition, men seek ways to address the inevitable baggy eyed look that comes with age, via non-invasive devices as well.
For instance, Venezia Lift from Lasering USA (San Ramon, Calif.) offers a no- downtime mini-eyelift via a CO2 laser operating at a very low power and with a very long dwell time. Fractionally delivered 300 μm laser spots produce significant heat in the dermis without tissue ablation.
For overall skin rejuvenation, the HALOTM hybrid fractional laser from Sciton, Inc. (Palo Alto, Calif.), applies tunable non-ablative (1470 nm) and ablative (2940 nm) wavelengths to the same microscopic treatment zone to maximize results and reduce downtime.
Energy-based devices can also be used to treat other types of male health concerns. For instance, the NightLase® system from Fotona LLC (Dallas, Texas) reduces sleep apnea symptoms via a non-invasive, laser-induced tightening effect that works to contract the collagen in oral mucosa tissue.
Apart from these device-based and even surgical aesthetic approaches, regenerative medicine-type treatments are also catching on with men, stated Dr. Hirmand.
“In particular, men are receptive to regenerative skin treatments, such as platelet-rich plasma (PRP) combined with microneedling and newer nanofat treatments,” Dr. Hirmand advised. “Men are always looking for treatments that have less maintenance and fewer sessions to achieve good results.”
One type of regenerative approach, Renuva from MTF Biologics (Edison, N.J.), is an injectable extracellular matrix made from human allograft tissue that acts as a scaffold, allowing the body to recruit new fat cells to attach to it. “Renuva is the kind of approach that fits well with the male aesthetic population because it is likely the kind of treatment that will not get repeated often,” Dr. Hirmand explained.
Employing the ever widening range of aesthetic therapies to men comes with a learning curve for practitioners, noted Dr. Sasaki. “Physicians need to be cognizant of gender-specific differences in anatomy and behavior in order to assess the male’s goals and expectations,” he said.