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Think "Age Maintenance" -- Not "Extreme Makeover"
Incremental treatments and procedures can help you maintain your best look over time
By Dr. Robert T. Grant, MD, MSc, FACS
Mens esthetic needs differ widely from women. It is no secret that mens muscle mass and hormone levels begin to decrease after age 30 but no where near as dramatically as the rapid decrease in feminine hormone levels that women experience once they go through and after the menopause period. As a result, recommendations for men are not necessarily limited to specific that are able to be correlated to a particular period in time relative to changes in the bodies male hormone levels. As well, certain types of problems impact men from puberty onwards that are independent of whether or not they eat right or exercise. We will talk about those in a few minutes as well.
The reality is that mens circulating testosterone level begins to decrease after age 30, the most important thing a man can do to keep himself looking as youthful as possible is to continue to work at building and maintaining his muscle mass to the best extent possible throughout his adult life. This means that a regular program of both aerobic exercise for cardiovascular fitness as well as weight training in order to mitigate the natural aging consequences of decreased muscle mass is essential. The combination of both aerobic exercise and muscle building exercise is the most important thing a man can do to keep his weight and metabolism under control as he ages. Replacement of muscle with fat means that the mans metabolism decreases over time. The more body fat the man has relative to his amount of muscle means it would be much more difficult for him to lose weight even on those circumstances when he tries to diet. Exercise has tremendous amount of positive benefits no mater which sex, male or female, undertakes this particular type of activity. Increasing caloric burn by exercising is essential to maintaining cardiovascular fitness but since muscle requires more energy at a basal or baseline metabolic rate than fat, it is really a 1-2 punch that is essential to keep a man looking and feeling his best.
For men, skin care and sun avoidance is as important as it is for women. No man can start early enough just like no woman in terms of the sun protective aspects of a skin care regime, whether it is dealing with the changes that have to do with facial acne, or dealing with the deleterious effects of too much sun, smoking, alcoholic beverages or loss of sleep, a skin care regimen is essential for all men throughout their adult life. Skin care does not necessarily need to be as involved as it is for the female patients. For men, skin care consists of using a non-irritating neutral cleanser of the face like Cetaphil, the use of topical treatments like alphahydroxy acids, micro-derm abrasion and light base treatments changes as the man ages through his 30’s, 40’s and 50’s. the use of Botox and fillers also becomes much more common in men in their 40’s and 50’s who are beginning to deal with the reality of loss of some of the skin elasticity in their face relative to environmental and genetic causes. Because mens faces have a more robust blood supply than their female counterparts, treatments must be oriented specifically to the male face in terms of depth of peeling, energy levels for light base treatments and frequency of application of topical medications like Retin-A. Once men hit their 40’s and 50’s, the commonest esthetic procedure involves rejuvenation around the eyes. Eyelid surgery when done well can help rejuvenate a man’s face without stigmatizing him as one who has had facial cosmetic surgery. Brow lift surgery in men can be fraught with complications because the male brow has a flatter arch than the female brow. Men’s hair also thins as they age so the scars that are used for even the endoscopic and certainly the open brow lifting approaches can be problematic. That is why use of neurotoxins like Botox to effect a chemical brow life can be very helpful as adjuncts to keep the man looking as best as he enters middle age and beyond. When a man gets over 50, typically increasing amounts of skin accumulate along the jaw line in the neck. Traditional face lifts and neck lift approaches do not work particularly well in men because the scars cannot be hidden under a hair line particularly if the hair is reseeding or if the man chooses to wear his hairstyle in a short fashion. One advantage that men have over women is that they can have a direct excision of redundant skin of the neck through a geometric pattern which hides the scar in the area between the bottom of the chin and the Adam’s apple. This is a direct excision and a scar will be obvious for months, until it has had a chance to become mature. Many male patients who have this neck skin excised and who end up with an excellent contour with an L-shape appearance to the angle between the chin and neck, often camouflage the scar while it is healing by growing a beard. Obviously women do not have this particular luxury. I find this surgery particularly to be effective in the winter months when it is easy to camouflage the healing neck scar with a turtleneck, a scarf or other type of external clothing. Most men do have a particular type of growth pattern to their facial and neck beard hair. As a result, face lifting approaches which involve the traditional incisions operating in front of the ear and into the scalp hairline can leave the patient with a result that allows for lifting of the skin but alters the hair and beard line. This can be as dramatic a giveaway that the patient had undergone a cosmetic operation as if the scar itself was wide or otherwise noticeable. As a result, traditional face lifting approaches in men must be looked at in a very judicious way. Fortunately for men, society’s double standard impacts facial aging for men in a much softer way than for their female counterparts. In summary, a preventive approach, keeping ones weight under control, exercising both in an aerobic and a muscle building way, minimizing environmental effects like sun, cigarettes, excess alcohol and getting enough sleep, as well as avoiding stress are the most efficient ways for men to remain looking as youthful as long as possible.
Since mens bodies do not have to endure the paradigm shifting changes of pregnancy, body contouring issues in men are dramatically different. Men also tend to deposit their excess weight underneath the muscle layers of the abdomen, inside the actual abdominal cavity. This makes men much likely to develop the excess skin and fat in the abdomen which can be accessed either through liposuction or with skin excision techniques like a tummy tuck. As a result, liposuction in men is really best reserved for those patients with ideal body weight who have congenital amounts of fat in the love handles or submental area. Patient’s who are overweight really need to think about taking the resources that they would use towards having cosmetic surgery and using those instead with a nutritionist or a personal trainer. The improvement in their appearance, as well as the contour of their abdomen, back and flank, is much more long lasting and natural looking than the kind of results that are achieved through the use of plastic surgery techniques.
There are particular circumstances where men have unique needs. One of these is in the example of the condition called gynecomastia. This is the medical term for male enlargement of the breast. Oftentimes through no fault of their own, patient’s develop excess fatty tissue in the breast either around the time of puberty or later in life when they are not able to keep up with the degree of exercise and muscle mass in the chest area transforms into fatty tissue. While there is an association with increased breast size and increased body mass, gynecomastia is typically a condition which occurs independent of the patient’s overall weight. Just counseling the patient to exercise more and lose weight will not correct the problem. Most straightforward cases of gynecomastia can be addressed through a combination of direct excision or liposuction limiting the scars to the area around the pigmented skin of the areolar or hidden in the arm pit or lower fold where the breast meets the chest wall. Patient’s who have developed significant amounts of loose skin are much more of a reconstructive challenge since it can be quite problematic hiding the scars necessary to remove the excess skin which has resulted from weight loss in the breast than in patients who just have areas of excess fat and breast glandular tissue. Most gynecomastia patients are operated on after they have reached puberty in their 20’s. certainly men are candidates for the procedure as long as their cardiovascular and other health remains good throughout their adult life.
It takes a longer period of time for mens skeletal structures to mature. Rhinoplasty in men is another operation which is considered cosmetic to help balance the features of the face. While more female rhinoplasties are done than male rhinoplasties, rhinoplasty in men is one of the more common male cosmetic procedures. Typically male patients because of the blood supply to their face and bony structure have more swelling and bruising than female patients, it can take time for them to recover, more time than many men are willing to give meaning most patients need 6-8 weeks before they are able to get back to a full spectrum of jogging and aerobic activities. This is so in order to allow the bones to heal and the tissues to reduce their swelling by not having increased blood pressure and risk of bleeding complicate an otherwise good result. In summary, there are specific examples like the breast and nose where male cosmetic surgery differs significantly from women. Because men tend to age at a fairly standard rate independent of a sudden dramatic decrease in hormone levels like seen in women, their plan for life stage balance in maintaining their facial and body esthetics is much more straightforward and remains consistent throughout a mans adult life.
If you would like to schedule a consultation appointment with my office, please call 212.832.6182 or e-mail inquires@robertgrantmd.com -- we look forward to hearing from you.