In the field of aesthetic medicine, many aesthetic practitioners are familiar with augmenting and enhancing the female face since women make up a large portion of patients that actively seek cosmetic treatments. This reality can be sup-optimal for male patients who undergo aesthetic procedures, as it can increase the chances of feminine-looking results, such as female-like cheeks and high-arched eyebrows. While some men may desire and explicitly request such features, these results would be less than ideal for many men. In most cases, a successful male augmentation session involves restoring, maintaining, or enhancing attractive masculine features. Inexperienced physicians must take the time to carefully study the dissimilarities in facial features between males and females and understand the way to produce the desirable features on their patients.
Following puberty, growth and sex hormones, including testosterone, act on the facial cutaneous ligaments. Men then tend to develop angular-shaped jawlines, which are results of a strong platysma, and they also gain distinctively masculine lines in the mid and lower region of the face from taut lines of masseteric and zygomatic cutaneous ligament. Other universally recognizable and attractive masculine features include flat planes of cheeks, more horizontally-placed eyebrows, and larger width and angle of the jaw and chin. Compared to women, who tend to have narrower lower faces and wider cheeks, men have square-shaped faces due to less space between their cheeks and their (usually smaller) jaws. This space, sometimes known as the hot hollow, is formed by the zygomatic cutaneous ligament superiorly and masseteric cutaneous ligament anteriorly. While correcting this space may result in a younger- and smoother-looking face, the masculine features can be inadvertently erased, and male patients may end appearing feminine. Hence, physicians must maintain or enhance the masculine aesthetics when treating their male patients.
Additional considerations for augmenting the male face
Most of the time, female patients displaying aging signs will have lost volume replaced via anterior and lateral projection along the convex curve. Additionally, their upper face is also usually augmented to be wider in order to give an illusion of a more pointed chin. Augmenting the male face using these kinds of techniques will only result in feminization of the face.
Physicians must avoid bringing about these feminizing results if the patients have clearly stated that they want their masculine features enhanced. Instead, male patients with facial volume loss should have the hollow areas in the mid-face volumized without creating any convex curve. Besides that, their profile must be maintained or enhanced to be angular, while the treated planes remain flat. The straight flat edge of the jawline must also be maintained during the procedure. The injection of fillers must be done without compromising the defined lines of the temporal crest, zygomatic arch, orbital margin, and masseteric cutaneous ligament.
Choosing the appropriate filler and tools
For best results, the chosen dermal filler must be highly cohesive and have the ability to deliver excellent projection once injected into the periosteum layer through the soft tissues. That being said, the injectable gel must be able to integrate seamlessly with the surrounding soft tissues once implanted sub-dermally. The filler can be administered using a cannula if the areas along the zygomatic arch to the deep medial fat compartment are treated. The usage of cannula is also ideal for younger patients, as it will accentuate the cheekbones if the filler is administered at an angle and in a flat manner instead of along the convex curve. A needle can also be used to reinforce the skin structure at areas where the most volume loss has occurred. Physicians are recommended to use a needle and to administer the product in the mid-face region. This technique, which is suitable for older patients, will then help to strengthen the junction between the cutaneous ligament of the orbicularis oculi and the malar groove.
Treatment of the aging male’s mid-face
Male patients who are presented with mid-face aging signs must first be assessed during the pre-procedural session. Their medical history (e.g. underlying medical conditions, previous history of aesthetic treatment, medications and/or supplements taken, etc.) must be reviewed to rule out any patients who are deemed unsuitable. Patients’ aesthetic imperfections must be inspected extensively, and the areas of concern should be photographed, as it can serve as an excellent assessment tool after the completion of the procedure. Male patients may develop under-eye bags if they experience loss of fat tissues and volume in the mid-face region. In order to rectify this issue, physicians should restore the volume and support in this area using a suitable hyaluronic acid-based filler. Estheticians are strongly advised to use a cannula when injecting the filler due to the close position of the angular artery. They should inject the chosen soft tissue implant in a straight line along the zygomatic arch and close the gap caused by the loss of fat tissues in the deep medial fat compartment. It is imperative that the aestheticians do not augment the area along a convex curve or even overcorrect the area under the cheeks, as it might result in the feminization of the face. A male patient’s face tends to look more attractive with a flat plane or if the concavity is below the zygomatic arch and lateral to the masseteric cutaneous ligament. After augmenting and reinforcing the mid-face region, physicians can then augment the jawline and zygoma in order to accentuate the masculine features. The procedure is completed once the filler is injected into the area that is located on the underside of the zygoma and on top of the masseteric cutaneous ligament. This will help to define the demarcation of the hot hollow from the frontal view and support the nasolabial fold, if necessary. Patients with dynamic facial wrinkles, such as glabellar lines and horizontal brow lines, can be treated using botulinum toxin injections for a more polished and masculine appearance.
Aesthetic correction of the face is not just about filling in wrinkles and creases. The procedure must be done by taking into account and maintaining the physical differences between the male and female faces. Physicians are also greatly encouraged to attend courses, so as to acquire the knowledge needed to effectively augment the appearance of their male patients.
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