Men and liposuction

Key Points

Chicago - Men represent nearly one-fifth of all liposuction cases, according to 2005 statistics by the American Academy of Cosmetic Surgery.

But, to assume that men and women are similar liposuction patients would be a mistake.

Studies have shown that while women aspire to have smoother, svelte figures, men want at least the illusion of more muscle - an etching effect, rather than sculpting, according to Ella L. Toombs, M.D., dermatologist, Washington, and assistant professor of dermatology at Rush University Medical Center, Chicago.

Physical differences

Compared with women, men tend to have more abdominal truncal fat, as opposed to fat in the extremities, particularly the thigh and hip areas.

"If you look at the process of maturity, we are all born with about the same amount of body fat. However, as young boys enter puberty, their fat mass changes. They seem to develop more truncal abdominal fat and relatively less subcutaneous fat in the hips and thighs. This continues throughout life until they reach about age 65," Dr. Toombs says.

Assessment, plan of action

From the dermatologist's point of view, the differences between male and female liposuction patients start in the consultation, when dermatologists must understand the male patient's desired outcome.

The assessment differs, as well. In the male patient with enlarged breasts, for example, the dermatologist would first determine if there are correctable causes for the enlarged breasts and check for cancerous masses.

"You want to look at diseases that can be associated with enlarged breasts, including Klinefelter's or renal failure. You want to check to make sure that they are not on any drugs, including dietary supplements, which might enlarge the breasts. Obviously, they need to discontinue those before they make the decision to undergo liposuction in that area," Dr. Toombs says.

Special considerations

Researchers debate whether men are more likely to suffer than women from the ill effects of lidocaine.

To be on the safe side, Dr. Toombs carefully monitors the amount of lidocaine, especially with male patients. Dermatologists should also be aware that men may have an increased tendency toward bleeding from liposuction, she says.

Dr. Toombs uses different instrumentation and a different approach to the male liposuction patient.

She says that male submandibular skin is more dense and fibrous than female skin in that area, so it tends not to contract as well. Dermatologists can combat this by treating the double chin more aggressively than they would in a female patient.

"In males, the cannulas are much more aggressive. It is as if you are rasping the skin to get that tight look that you want at the end of the day," she explains.

The same is true of the males' flank skin.

"Up until the development of power liposuction, I would be perspiring by the time that I was half-way through suctioning the male flank area. Women's fat in the area is much softer and easier to remove," Dr. Toombs says.

Dermatologists might want to warn male patients who elect abdominal area liposuction that, particularly in the lower abdomen, excess fluid may flow down into the testicular sac and cause swelling and bruising 24 to 48 hours after surgery. This resolves spontaneously, she says.

Lipo etching

Dr. Toombs says she tries to etch the fat out, so that she can create as much of a muscular look at possible.

"There are special, very tiny cannulas. If you palpate along the rectus abdominus muscle in a pattern (like a tic-tac-toe without the center group of boxes), you create the illusion of the rectus abdominus that otherwise would not have been visible," she says.

Being aware of the nuances of male liposuction is important - especially given the procedure's growing popularity among men.

"You want to give the patient what the patient wants in terms of the ultimate outcome. Women just want to be smaller, smoother. Men really do want to be etched. To achieve that, you have to be more aggressive with your instrumentation and with your procedure," Dr. Toombs says.