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The Journal of Clinical and Aesthetic Dermatology logoLink to The Journal of Clinical and Aesthetic Dermatology
. 2016 Dec 1;9(12):33–43.

Nonsurgical Cosmetic Procedures For Men: Trends And Technique Considerations

Corey S Frucht a,✉, Arisa E Ortiz b
PMCID: PMC5300725  PMID: 28210397

Abstract

Once sought nearly exclusively by women, nonsurgical cosmetic procedures are increasingly being sought after by men. Reviewed here are survey data that characterize the spectrum of nonsurgical cosmetic procedures men are preferentially utilizing, the percentage of nonsurgical cosmetic procedures consumers who are men, and how some of these figures are changing with time. while men still comprise a small minority (approximately 10–20%) of those pursuing nonsurgical cosmetic procedures, this sector is growing, in particular for injection of neurotoxins. Practitioners performing nonsurgical cosmetic procedures on male patients need to be aware of anatomical, physiological, behavioral, and psychological factors unique to this demographic.

NONSURGICAL COSMETIC procedures (NSCPs), such as injection of neuromodulators and dermal fillers, laser treatments, and sclerotherapy, are becoming increasingly accepted and sought by mainstream society. For example, a recent survey from the American Society for Dermatologic Surgery (ASDS) indicated that dermatologists alone performed nearly three million neuromodulators and soft tissue filler procedures in 2013.1 Men are becoming increasingly concerned about their appearance. This is reflected not only by their increasing use of NSCPs, but also by their behaviors to maintain physique through use of anabolic steroids.2 While the NSCP market has historically been overwhelmingly dominated by female consumers, numerous studies and anecdotal experience suggest that there is increasing interest in these procedures among male patients. Further, physician attitudes toward these patients are changing as well.

While it had previously been posited that the prevalence of psychiatric disease among male cosmetic patients is higher than that among the general population, more recent studies suggest that this is not the case.3 In recognition of these trends, there are now specific centers dedicated to cater to the male cosmetic patient. The present review aims to compare available survey data across specialties and nations to qualitatively assess trends in utilization of NSCPs by men. Further, gender-specific differences in anatomy, physiology, and accordingly in technique are briefly reviewed for injectables (i.e., neurotoxins and soft tissue fillers) as well as sought-after laser treatments.

SURVEY DATA CHARACTERIZING TRENDS IN UTILIZATION OF NONSURGICAL COSMETIC PROCEDURES BY MEN

Since 2005, The American Society for Aesthetic Plastic Surgery (ASAPS) has been issuing an annual survey on cosmetic procedure utilization to more than 21,000 practicing dermatologists, plastic surgeons, and otolaryngologists.4–13 According to the 2014 ASAPS survey, the NSCPs with the highest percentage of male patients was intense pulsed light (13.9% males), laser hair removal (12.9% males), and neurotoxin injection (11.5% males) (Table 1). In each year the survey was administered, neurotoxin injections were by far the most popular NSCP for men. The ASAPS surveys suggest that the percentage of all NSCPs being performed in men is on the rise (Figure 1). In 2005, only 8.3 percent of NSCPs were performed on men, whereas this number increased to 10.1 percent in 2014 (Table 1). While the number of neurotoxin injections performed on men has increased from 9.2 to 11.5 percent from 2005 to 2014,the change in the percentage of soft tissue filler procedures being performed on men has been insignificant, from 8.2 to 8.3 percent, respectively. These results further suggest the overall number of NSCPs performed regardless of gender appears to be remaining relatively stagnant (Table 1). These data suggest that the rate at which males are seeking neurotoxin injections is growing more rapidly than that for females. The rate of growth for filler injections, however, is about the same for patients regardless of gender.

Table 1.

Gender-specific demographic data for nonsurgical cosmetic procedures from The American Society for Aesthetic Plastic Surgery procedure surveys from 2005 to 20144–13

YEAR TOTAL FEMALE TOTAL FEMALE % MALE TOTAL MALE %
TOTAL PROCEDURES 2005 9,297,730 8,525,713 91.7 772,017 8.3
2006 9,533,982 8,786,240 92.2 747,742 7.8
2007 9,621,999 8,725,422 90.7 896,577 9.3
2008 8,491,862 7,794,073 91.8 697,789 8.2
2009 8,522,139 7,747,782 90.9 774,357 9.1
2010 9,336,814 8,586,740 92.0 750,074 8.0
2011 7,555,986 6,904,810 91.4 651,176 8.6
2012 8,416,470 7,608,459 90.4 808,011 9.6
2013 9,536,562 8,654,899 90.8 881,663 9.2
2014 8,898,652 7,998,136 89.9 900,516 10.1
NEUROTOXIN 2005 3,294,782 2,990,658 90.8 304,124 9.2
2006 3,181,591 2,881,119 90.6 300,472 9.4
2007 2,775,175 2,445,656 88.1 329,519 11.9
2008 2,464,123 2,239,024 90.9 225,099 9.1
2009 2,557,068 2,299,282 89.9 257,786 10.1
2010 2,437,165 2,211,930 90.8 225,235 9.2
2011 2,619,739 2,355,455 89.9 264,284 10.1
2012 3,257,913 2,915,865 89.5 342,048 10.5
2013 3,766,148 3,381,476 89.8 384,672 10.2
2014 3,588,219 3,174,856 88.5 413,363 11.5
FILLER 2005 1,645,441 1,511,305 91.8 134,136 8.2
2006 1,972,131 1,868,934 94.8 103,197 5.2
2007 1,723,478 1,610,616 93.5 112,862 6.5
2008 1,528,829 1,444,505 94.5 84,324 5.5
2009 1,579,897 1,461,550 92.5 118,347 7.5
2010 1,547,679 1,457,647 94.2 90,032 5.8
2011 1,441,703 1,336,346 92.7 105,357 7.3
2012 1,623,346 1,497,811 92.3 125,535 7.7
2013 2,125,506 1,964,853 92.4 160,653 7.6
2014 1,908,993 1,751,049 91.7 157,944 8.3
LASER HAIR REMOVAL 2005 1,566,909 1,334,669 85.2 232,240 14.8
2006 1,475,296 1,308,739 88.7 166,557 11.3
2007 1,412,658 1,226,974 86.9 185,684 13.1
2008 1,280,963 1,101,255 86.0 179,708 14.0
2009 1,280,031 1,113,996 87.0 166,035 13.0
2010 936,271 817,383 87.3 118,888 12.7
2011 919,802 812,352 88.3 107,450 11.7
2012 883,893 757,489 85.7 126,404 14.3
2013 901,570 773,278 85.8 128,292 14.2
2014 828,480 721,874 87.1 106,606 12.9
ABLATIVE LASER 2005 475,689 432,606 90.9 43,083 9.1
2006 576,512 528,061 91.6 48,451 8.4
2007 509,901 479,799 94.1 30,102 5.9
2008 570,880 532,008 93.2 38,872 6.8
2009 522,319 463,339 88.7 58,980 11.3
2010 562,605 518,275 92.1 44,330 7.9
2011 345,587 319,810 92.5 25,777 7.5
2012 432,496 401,915 92.9 30,581 7.1
2013 359,404 334,026 92.9 25,378 7.1
2014 408,433 381,890 93.5 26,543 6.5
INTESE PULSED LIGHT 2005 N/A N/A N/A N/A N/A
2006 N/A N/A N/A N/A N/A
2007 647,707 584,530 90.2 63,177 9.8
2008 526,828 479,941 91.1 46,887 8.9
2009 452,210 404,534 89.5 47,676 10.5
2010 381,480 345,545 90.6 35,935 9.4
2011 439,161 396,866 90.4 42,295 9.6
2012 337,482 308,764 91.5 28,718 8.5
2013 456,613 413,186 90.5 43,427 9.5
2014 370,496 318,846 86.1 51,650 13.9
FRAXEL 2005 N/A N/A N/A N/A N/A
2006 N/A N/A N/A N/A N/A
2007 167,351 153,954 92.0 13,397 8.0
2008 110,392 103,468 93.7 6,924 6.3
2009 119,676 109,091 91.2 10,585 8.8
2010 102,016 94,003 92.1 8,013 7.9
2011 100,433 92,719 92.3 7,714 7.7
2012 86,313 75,349 87.3 10,964 12.7
2013 90,801 83,490 91.9 7,311 8.1
2014 84,833 75,589 89.1 9,244 10.9
NONINVASIVE TIGHTENING 2005 N/A N/A N/A N/A N/A
2006 N/A N/A N/A N/A N/A
2007 258,236 239,168 92.6 19,068 7.4
2008 257,995 232,594 90.2 25,401 9.8
2009 275,118 264,366 96.1 10,752 3.9
2010 247,500 236,588 95.6 10,912 4.4
2011 297,795 279,549 93.9 18,246 6.1
2012 350,353 318,196 90.8 32,157 9.2
2013 388,311 342,277 88.1 46,034 11.9
2014 433,671 395,581 91.2 38,090 8.8
SCLEROTHERAPY 2005 554,252 548,045 98.9 6,207 1.1
2006 559,284 541,291 96.8 17,993 3.2
2007 471,639 467,844 99.2 3,795 0.8
2008 423,842 417,465 98.5 6,377 1.5
2009 452,924 442,015 97.6 10,909 2.4
2010 444,888 434,994 97.8 9,894 2.2
2011 354,731 348,501 98.2 6,230 1.8
2012 296,501 282,229 95.2 14,272 4.8
2013 375,446 367,384 97.9 8,062 2.1
2014 315,707 305,377 96.7 10,330 3.3
MICRODERMABRASION 2005 1,023,931 939,508 91.8 84,423 8.2
2006 993,072 921,970 92.8 71,102 7.2
2007 829,658 743,748 89.6 85,910 10.4
2008 557,131 517,307 92.9 39,824 7.1
2009 621,943 565,031 90.8 56,912 9.2
2010 450,744 416,315 92.4 34,429 7.6
2011 499,427 468,466 93.8 30,961 6.2
2012 498,820 454,069 91.0 44,751 9.0
2013 479,865 452,351 94.3 27,514 5.7
2014 417,034 372,218 89.3 44,816 10.7
CHEMICAL PEELS 2005 556,171 533,009 95.8 23,162 4.2
2006 558,430 530,147 94.9 28,283 5.1
2007 575,081 536,044 93.2 39,037 6.8
2008 591,808 554,492 93.7 37,316 6.3
2009 528,285 492,335 93.2 35,950 6.8
2010 493,806 469,570 95.1 24,236 4.9
2011 384,222 360,313 93.8 23,909 6.2
2012 443,824 418,774 94.4 25,050 5.6
2013 444,268 412,870 92.9 31,398 7.1
2014 484,053 452,872 93.6 31,181 6.4
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Figure 1.

Figure 1.

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Percentage of total nonsurgical cosmetic procedures versus time for neurotoxin injections and soft tissue filler injections performed on men from 2005 through 2014. Data from The American Society for Aesthetic Plastic Surgery procedure surveys.4–13

The National Ambulatory Medical Care Survey (NAMCS) is a survey of office-based physicians across specialties. In 2007, Housman et al14 analyzed NAMCS data from 1995 to 2003 and found that dermatologists were performing more NSCPs than other specialists.14 Using ICD-9-CM procedure codes, these authors interrogated the data for cosmetic procedures including NSCPs. The authors’ analysis suggested that 21.3 percent of all NSCPs during this time were being performed on men (Table 2). Interestingly, these data suggest the most popular procedures for men in order were chemical peels, then soft tissue fillers, then dermabrasion. These observations stand in contrast to ASAPS data and common experience, both of which suggest neurotoxins followed by dermal fillers are the most popular NSCPs for men.13 These particular data are subject to the limitation of including only data for which ICD-9-CM codes were entered. A large number of cosmetic procedures are billed directly to the patient, rendering procedure codes unnecessary. Therefore, particular procedures that are more likely to be covered by insurance in part or in whole (e.g., scar rehabilitation) are more likely to be included in this survey than procedures paid for exclusively by the patient.

Table 2.

Gender-specific data on nonsurgical cosmetic procedures from the National Ambulatory Medical Care Survey pooled from 1995 to 2003. Data from Housman et al 2008.14

PROCEDURE TOTAL NUMBER TOTAL % NUMBER WOMEN % WOMEN NUMBER MEN % MEN
CHEMICAL PEELS 2,706,802 28.8 1,796,168 66.4 910,635 33.6
DERMAL FILLER 2,570,137 27.3 1,814,297 70.6 755,841 29.4
SCLEROTHERAPY 1,803,140 19.2 1,715,284 95.1 87,856 4.9
NEUROTOXIN 746,079 7.9 720,977 96.6 25,102 3.4
EPILATION 383,499 4.1 377,920 98.5 5,578 1.5
DERMABRASION 1,172,808 12.5 953,865 81.3 218,943 18.7
COLLAGEN 19,524 0.2 19,524 100.0 0 0.0
TOTAL 9,401,989 100 7,398,035 78.7 2,003,954 21.3
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The ASDS surveys dermatologists annually on the number of procedures they are performing. Gender-specific data are available only for neurotoxins and dermal fillers from 2011 through 2014, and these data are summarized in Table 3.1,15–17 In summary, the data show that the percentage of neurotoxin injections performed on men increased from 10 percent in 2011 to 13 percent in 2014, whereas the percentage of soft tissue filler procedures performed on men increased from eight to only nine percent over the same time interval. In accordance with the ASAPS data, these results suggest that the percentage of men seeking neuromodulator injections is increasing more rapidly than that for other NSCPs.

Table 3.

Table 3. Gender-specific data on nonsurgical cosmetic procedures from The American Society for Dermatologic Surgery procedure survey from 2011 through 20141,15–17

YEAR TOTAL FEMALE NUMBER FEMALE % MALE NUMBER MALE %
NEUROTOXIN 2011 1,200,000 1,080,000 90 120,000 10
2012 1,493,147 1,328,901 89 164,246 11
2013 1,800,000 1,602,000 89 198,000 11
2014 1,740,000 1,513,800 87 226,200 13
FILLERS 2011 830,800 764,336 92 66,464 8
2012 916,455 843,139 92 73,316 8
2013 995,000 895,500 90 99,500 10
2014 1,010,000 919,100 91 90,900 9
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The 2013 International Society of Aesthetic Plastic Surgery (ISAPS) procedure survey, including data from 10 nations, indicated that men comprise 11.3 percent of those undergoing NSCPs (Table 4).18 Men made up the largest percentage of those seeking laser hair removal (15.1%), followed by neurotoxin injection (12.5%). Men made up the smallest percentage (6.4%) of those obtaining noninvasive facial rejuvenation procedures such as intense pulsed light. Data from previous years is not available for review.

Table 4.

Gender-specific data on nonsurgical cosmetic procedures from the International Society of Aesthetic Plastic Surgery 2013 procedure survey18

PROCEDURE TOTAL TOTAL % TOTAL FEMALE FEMALE % TOTAL MALE MALE %
NEUROTOXIN 5,145,189 43.3 4,501,514 87.5 643,675 12.5
CHEMICAL PEEL, CO2 RESURFACING, DERMABRASION 773,442 6.5 682,647 88.3 90,795 11.7
NONABLATIVE REJUVENATION 1,307,300 11.0 1,223,520 93.6 83,780 6.4
FILLERS 3,089,686 26.0 2,787,799 90.2 301,887 9.8
LASER HAIR REMOVAL 1,440,253 12.1 1,222,720 84.9 217,533 15.1
SCLEROTHERAPY 119,040 1.0 109,771 92.2 9,269 7.8
TOTAL 11,874,910 100 10,527,971 88.7 1,346,939 11.3
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GENERAL CONSIDERATIONS FOR MALE PATIENTS UNDERGOING NSCPs

There are significant anatomical, physiological, and behavioral differences in the aging male face that warrant specific treatment considerations. For example, men have more skeletal musculature than their female counterpart19 and this likely extends to mimetic musculature given that men have more facial muscular movement than women.20 These observations may explain why men tend to generally have more exuberant dynamic facial rhytids than women21 in areas other than the perioral area.22 Non-facial skin is thicker in males and has a higher collagen content than in females.23 These findings likely extend to facial skin. Men also tend to have more sebaceous skin and may therefore be more inclined to seek treatment for sebaceous hyperplasia. Men have greater vascularity and perfusion of facial skin, which may carry implications for complications of NSCPs,24 such as bleeding and bruising.

There are gender-specific differences in facial bone structure. In particular, men have a more prominent supraorbital rim, a larger forehead, and flatter cheeks that are more angular.25 Men also have a greater forehead slope from brow to hairline, a flatter brow, and a more defined hairline with a wider and more forwardly projected chin.26 These anatomic differences are of paramount consideration in the context of cosmetic interventions, as exaggeration rather than restoration of typical male features can result in an aggressive or threatening appearance, whereas accentuation of feminine features will have a feminizing effect.26

In addition to considerations of gender-specific anatomical and physiological considerations, behavioral and psychological factors must also be considered when addressing cosmetic concerns of male patients. Men, like women, find facial symmetry desirable.27 However, men often do not desire complete eradication of dynamic rhytids, preferring instead to have them softened.26 Men may also be less inclined to request procedures associated with downtime such as fully ablative resurfacing,28 perhaps due to a combination of social stigmatization and career issues. Men also tend to be more conservative and tend to elect for only one procedure at a time, particularly with their first treatment sessions.28 Although it has not yet been studied, a higher percentage of male cosmetic patients may be naïve and may therefore have a less clear understanding of procedures from which they may benefit. Regardless of current trends, men still make up a small minority of those seeking NSCPs, so they are less likely to have heard about specific procedures from same-gender peers. It is therefore possible that new male cosmetic patients may require more counseling than their female counterparts.

Clinics with a specific understanding of male NSCP patients can foster an environment with which these patients will be comfortable and in which they will achieve desirable outcomes. Such clinics may serve to destigmatize NSCPs among some men who may still believe that these procedures are “only for women.” However, caution must be used to avoid creating spaces that feel hypermasculine for this would have the potential to alienate some patients.

GENDER-SPECIFIC APPROACH FOR NONSURGICAL COSMETIC PROCEDURES FOR MALE PATIENTS

Data suggests that men seek treatment with nonablative fractional resurfacing devices for different indications than do women. According to one study, the most common indications for men in decreasing order were acne scars, facial photoaging, and traumatic/surgical scars.29 In contrast, the most common indications for women were facial photoaging, non-facial photoaging, and acne scars in descending order. Anecdotal evidence also suggests that men are less likely than their female counterparts to seek more than one cosmetic treatment per visit, in particular for their initial treatment.28 Men also tend to be less patient and expect immediate results, yet do not tolerate post-procedure edema and erythema and are relatively unwilling to use masking agents such as make-up, but also tend to have fewer post-procedure acne flares than women.28 One author has reported the use of devices, such as the 590nm LED, to reduce post-procedure erythema and edema to minimize downtime after photorejuvenation with nonablative lasers in men.28 The same author advocates using higher fluences with men than with women, perhaps owing to some of the aforementioned gender-specific differences in anatomy and physiology of skin. Another technique the authors’ group commonly employs is use of a single application of a high potency topical corticosteroid immediately after the procedure to reduce post procedure erythema and edema.

Careful consideration of male facial anatomy is essential for patients seeking injection of dermal fillers. For example, outcomes may be more favorable when men are injected with volumizing filler in the lateral face (i.e., zygomatic cheek), as filler injected in the central face tends to be more feminizing. Also, the increased vascularity in the beard area of the male face suggests that men may be more prone to bruising following injections of filler for neurotoxin into the lower face.24,25,30

There are numerous gender-specific differences in facial anatomy that render special attention to technique absolutely essential for men requesting neurotoxin injections. Many of these differences have been reviewed elsewhere,26,30,31 so the present discussion will highlight solely a few salient points. Men tend to have larger foreheads, often resulting in the need for more injection sites. Men also tend to have brows that are low by nature, so injections that are too low or potent can easily result in ptosis.30 The male brow also tends to be flatter than that in women, so when choosing injection sites, care must be taken to avoid central or lateral brow lift.30 While there is at present no data to suggest that men require significantly more units of neurotoxin to successfully treat forehead rhytids, a randomized, double-blind study showed that men may require as much as 40 to 80 units of onabotulinumA to successfully treat glabellar rhytids, and that these high doses are not associated with an increased risk of complications.32 With treatment of the glabellar complex and resulting chemodenervation of the medial frontalis, there can be recruitment of lateral frontalis resulting in lateral brow lift.31 This is generally an undesirable outcome in males as it results in an eyebrow arch that is more typical of the female brow. Fortunately, this can be corrected or anticipated by treating the lateral frontalis at the same time as the glabellar complex.31 Moreover, the orbicularis oculi extends more laterally in men, so additional lateral depots may be required when treating lateral canthal folds.31

DISCUSSION

Men are showing increasing interest in NSCPs, perhaps more so than in surgical cosmetic interventions for which interest among males may not be rising as rapidly.33 The ASAPs survey data reviewed here suggest that the percentage of all NSCPs performed on men is slowly trending upward, implying that the male cosmetic sector is growing more rapidly than the female sector. Much of this trend is likely attributable to the high rate of growth of neurotoxin injections, which were the most popular NSCP requested by men in a survey series (Table 1). The ASDS survey results also suggested that rates of neurotoxin injections are on the rise among men, whereas filler injection rates are increasing modestly, if at all. All three surveys reviewed suggest that men comprise approximately10 to 20 percent of individuals seeking NSCPs, which is consistent with rates at our practice. It therefore bears emphasizing that while the male sector of this industry is increasing, males still make up a small minority of those pursuing these procedures.

There are likely numerous reasons why men are increasingly seeking out NSCPs. The overall trend regardless of gender is toward more NSCPs, and this is likely associated with societal destigmatization. Further, while in recent years there have been “reality” television programs that have shown cast members undergoing procedures, there are currently on-air several programs that focus specifically on cosmetic procedures. In addition to the societal destigmatization, it is possible that an additional contributing factor is the movement of so-called “metrosexuals”— progressive young urban heterosexual men who are meticulous about their appearance, a trait that had historically been attributed to women and homosexual men.34 It is plausible that men self-identifying as “metrosexual” may be over-represented among those seeking NSCPs, but this has not yet been studied.

Future studies should aim to further characterize this segment of the NSCP market with behavioral surveys. Further, the data reviewed here are merely semiquantitative, meaning there is still a need for systematic studies that will allow a more accurate characterization of these trends over time. One significant limitation of survey data is that changes in survey protocols may be altered from year to year, rendering comparisons across survey years problematic. Despite these limitations, the data reviewed here consistently suggest that men are increasingly interested in NSCPs. Clinics treating a large number of male cosmetics patients need to be aware of not only the gender-specific anatomical and physiological considerations reviewed here, but also the behavioral and psychological attributes specific to the population comprising this burgeoning niche.

Footnotes

Disclosure:Dr. Frucht reports no relevant conflicts of interest. Dr. Ortiz is an Allergan stockholder; has received equipment loans from Zeltiq, Sciton, Solta, Inmode, and BTL; and is an advisory board member for Inmode and Sciton.

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Articles from The Journal of Clinical and Aesthetic Dermatology are provided here courtesy of Matrix Medical Communications

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