Relaxed social stigmas draw more men to Botox, fillers

San Francisco - A significant part of the recent explosion in cosmetic procedures such as injection of botulinum toxin and fillers is due to increased interest among the male population, and treatment considerations for these patients often differ from those for women, according to Christopher Zachary, M.D.

"I think men have always been interested in their appearance, but I think it's become more acceptable for them to seek professional advice for cosmetic improvement," notes Dr. Zachary, clinical professor of dermatology, University of California, San Francisco.

Also, many men find it very helpful professionally to enhance their looks in an economy increasingly focused on appearance and even age, he says.

"Men are often more precise than women. They will often mention the one thing that bothers them, whereas women often have a greater understanding of the subtleties of their expressions and may have a longer shopping list," says Dr. Zachary, who is also co-director of dermatologic surgery and the Laser Center at UCSF Health Care.

"Guys will often point to the vertical creases between their eyes and say they've been told that they tend to look angry much of the time," he says.

In male candidates for botulinum toxin type A (Botox Cosmetic^® , Allergan) treatment, Dr. Zachary is careful not to overtreat.

"Some people like the paralytic look, but I think, particularly for men, it's not natural or appropriate to have a total lack of expression," he says.

Anatomy dictates Male patients, however, require stronger dosages of Botox than do women because of their bulkier, stronger musculature, Dr. Zachary notes. He often doubles the female dose.

"Where you might inject 16 units of Botox between the eyes and theglabellar complex, you might give 32 units to a man," he says.

After a series of at least three injections at three-month intervals, he continues treatments every five to six months.

While the strong frontalis muscles call for more aggressive treatment, more is not better in all locations, he cautions.

Men generally have thicker, flatter eyebrows that tend to be ptotic. Too much Botox too far down may cause difficulties for a man's vision, he says. Thus, in men he injects across the forehead, at least 2.5 cm to 3 cm above the eyebrow, to avoid exaggerated brow ptosis, and also laterally to avoid the "Dr. Spock look," he says.

"In women we tend to give Botox in the lateral brow to cause a nice arching," Dr. Zachary says. "In a man, however, that could give a rather confusing and ambiguous appearance, because it would look rather feminine."

For crow's feet, he uses similar techniques in men and women laterally by injecting about 1 cm lateral to the lateral canthus. He avoids, however, injecting the inferior orbicularis oculi muscle under the lash line in men so as not to produce the "open-eye" look that is popular in women. He also avoids relaxing the superolateral orbicularis in the lateral brow, so as to avoid the high-arched look.

Perioral technique The musculature around the mouth atrophies more slowly in men, Dr. Zachary notes. To correct the downward angling of the mouth, which gives the appearance of a sad expression, he injects approximately five units of Botox into the depressor anguli oris (as opposed to three units in women) to achieve a 2 mm to 5 mm elevation of the modiolus.

"You want to be careful not to inject too medially, because otherwise you might suppress the depressor activity of the lower lip muscles, which causes problems with smiling, whistling, chewing and so forth," he warns.

As in women, he injects into the depressor anguli oris just superior to the mandible in line with the nasolabial fold.