The Rise of Male Aesthetics: An Abundance of Potential or Unfounded Hype

Much ado has been made about the male patient in aesthetic medicine in recent years, and indeed, more men than ever are seeking cosmetic improvement of their face and form. While maybe not yet focused on designing therapies with men in mind, companies are beginning to frame their marketing that direction whenever feasible. And experts believe that the male market will continue to grow.

Words like ‘explosive’ and ‘exponential’ have been employed to depict the rise of male aesthetic medicine, but does this reflect reality? The fact is that while the male aesthetics market is experiencing noteworthy expansion, the industry as a whole is growing and women still represent a tenfold larger market share. This has been stable over the last several years, according to Terrence Keaney, MD, founder of SkinDC in the Washington, D.C. area. “Men still represent a minority, but growth within that demographic is keeping pace with growth in the female market.” Looking at the yearly reports from the American Society of Plastic Surgeons (ASPS)^1-3 from 2017 to 2019, out of approximately 16 million procedures each year, 8% were undergone by men.

Awareness may be the biggest impediment holding the male aesthetics market back. In the manner that women as a whole are only recently becoming more aware of feminine wellness therapies, men don’t have the grasp of aesthetic medicine as being ‘for them’ the way women do, according to Dr. Keaney. “When lecturing I like to say that men are about ten years behind women when it comes to awareness, and as they become more aware of the variety and quality of treatments available to them, they are more likely to consider them and be moved to action. Once they get into the office, we can educate them, but if they don’t consider those options in the first place they remain on the sidelines. The aesthetic medical market is still geared largely toward women.”

Also, there is a vast difference between what’s going on in a sprawling metropolis like New York or Los Angeles, and the nation as a whole. “You have to remember that many of us seeing a lot of male patients are practicing in areas where the average awareness, financial means and interest may not match up with the majority of the country,” said plastic surgeon Robert Singer, MD, director of PRIME Plastic Surgery (La Jolla, Calif.). “Trends toward a more active lifestyle, plus a higher concentration of business and professional types, play a major role. But this is being overcome to some extent due to the pervasive influence through social and mainstream media exposure to aesthetic medicine, and the growth of male aesthetics since 2010 has been profound.”

While not exactly a Big Bang explosion, the market for male aesthetic treatments remains a viable, growing – and relatively untapped – segment of the patient population. RealSelf.com reported⁴ increases of online research interest in surgical and nonsurgical cosmetic treatments for men of 4% and 6%, respectively. Among aesthetic therapies, research into injectables has grown the most, which might suggest a gathering storm.

“Injectables were the gateway to the realm of aesthetic medicine decades ago, it may be the same for men,” said Dr. Keaney. “Again, it is about awareness, and accessibility plays a part of that. The story may be more about the huge market potential rather than current growth, especially as we take note of how emerging technologies gain traction within the male population. This market is still in its infancy.”

Much of the impetus for growth in male aesthetics is the same as that which has driven overall market expansion, according to Dr. Singer. “Over the last decade the stigma associated with cosmetic procedures is dramatically reduced. Treatments are more accessible and affordable. There are more options, especially among less invasive procedures, with more natural-looking outcomes than we saw ten years ago.”

But what about men’s needs in particular? “Compared to women, men are more interested in health, wellness and strength than the details of their appearance, and for different reasons,” said urologist Judson Brandeis, MD, founder of Brandeis MD Male Rejuvenation Center (San Ramon, Calif.). Dr. Brandeis authored a forthcoming book on male health and wellness, due in mid-2021. “The concept of beauty in aesthetic medicine is about improving something to meet a subjective ideal that changes over the decades and across cultures. When you look at what we do for women, it is a more youthful look and secondary sexual characteristics such as softer facial appearance, feminine curves and larger breasts, indicative of fertility. The ‘why’ doesn’t change, and it represents what matters globally to individuals of that gender. Men want to look younger, strong, capable, confident and vital because that’s what attracts more ideal mates.”

Confidence is boosted by improved overall self-image, according to Dr. Brandeis. “Look at some of the better actors out there who, taken at face value, aren’t very attractive but have so much confidence and charisma that women are attracted to them. Think about the average man in sweat pants, then that same man in a tailored suit. A man who projects strength, security and prosperity is more attractive to potential mates.”

“Increased awareness about health and wellness has led to a more aged work- force. Men want to ensure that they look like they feel as they contribute to the workforce. The media constantly displays this youthfulness and vitality as well, and there is so much information about rejuvenating procedures right at our fingertips,” said plastic surgeon Sanjay Grover, MD, of Grover Aesthetics in Newport Beach, Calif.

As such, social media pressure will continue to push growth in male aesthetics and aesthetic medicine in general. “The rise of the ‘selfie’ is an example of this,” Dr. Singer explained. “Ten years ago social media was emerging; it has since driven average self- consciousness about appearance upward considerably. Moreover, since COVID-19 and the huge increase in online meetings, people have become even more critical of their facial appearance.”

And in an increasingly competitive job market, men want every edge they can get. “It is tough out there, and men as well as women feel the need to stay at the top of their game,” Dr. Singer continued. “They must compete with younger individuals, and in a leadership role they want to appear vital, confident, formidable and worthy of respect.”

“The evolution of less invasive procedures, both in quality and quantity, has definitely played a role in attracting men as well,” Dr. Grover added. “We are doing a lot of injectable neurotoxin and fillers because they can be done quickly, provide a subtle and natural-looking result, and have very little downtime. Standard facial treatments such as ultrasound- or radiofrequency-based skin tightening and intense pulsed light are also popular for the same reasons. Men are generally less tolerant of downtime; businessmen are not eager to take extra time from work to recover, so these therapies are appealing to them.”

According to Dr. Grover, men may seek treatment independently but are often referred by their significant other, who may be a patient already. “The partner may be the gateway to our practice, whether they are encouraging the men to seek treatment or simply sharing their positive experience. If accompanying their partner to our office, their curiosity may inspire them.”

Men are also more likely to ruminate about the prospect, whereas women will confide in friends. “A woman’s friends encourage her to act,” Dr. Keaney said. “But can you envision men, fishing or taking a rest from a pick-up basketball game, disclosing their interest in a laser treatment or facial injectables? They are more likely to discuss it with a significant other, which is a different dynamic.”

Also, men and women have differing aesthetic concerns. “With men we see three main areas of concern. Hair loss, the periocular area and the jawline,” Dr. Keaney explained. “Hair loss is, by far, the number one cosmetic concern in men. It isn’t lumped in with aesthetic medicine or offered in the average aesthetic practice as often because it is a niche male therapy, and many techniques require the acquisition of an entirely new skillset to perform. Surgical hair restoration techniques such as follicular unit extraction (FUE), for example, are effective but not as easily adopted in the traditional aesthetic practice.”

Nonsurgical techniques have emerged that help stave off hair loss. “Less invasive modalities are always of interest if effective, and easily combinable with other procedures with minimal inconvenience,” he added. “The emergence of platelet-rich plasma (PRP) is a good example because it is more within the skillset of aesthetic practitioners, and gives great results when combined with traditional medical therapies. Also, we still have room to refine and improve PRP protocols.”

“With injectables, we’ve been focused on the mid-face, but men generally want to avoid femininization so we focus around the eyes and the lower face,” Dr. Keaney noted.

“Periocular injections with neurotoxins and fillers can reduce the tired, aged appearance and are highly desired,” he continued. “For the lower face, reduction of the submentum with Kybella from Allergan Aesthetics (Irvine, Calif.) can expose the jawline, while injectable fillers can strengthen the jawline. And, with a new FDA-cleared indication for Voluma (Allergan) to augment the chin, these products and treatments have even more appeal to men. There’s no concern about femininization when building up the jawline, which is a very masculine feature,” Dr. Keaney added.

“FDA clearance means more direct-to-consumer marketing, which raises awareness. Off-label uses that may be beneficial to men don’t get the same exposure, and most physicians aren’t attending conferences to learn, then offer, these therapies,” Dr. Keaney said, “but regardless, the lack of marketing reduces public awareness. As more of these off-label indications are brought to the forefront with FDA clearance, this unshackles a company’s ability to raise public aware- ness. More physicians will have access to these techniques, and focused marketing will expose men to them.”

According to the 2019 ASPS report,³ the most common surgical procedures for men are liposuction, gynecomastia, blepharoplasty, tummy tucks and rhinoplasty. While among the more costly alternatives, high definition body sculpting using energy-assisted liposuction in combination with fat grafting and/or other body sculpting technologies is highly sought. “This isn’t as far out of reach cost-wise as one might think, depending on where you go or what region you live in,” Dr. Grover said. “The results are impressive, and with so many options available, men are being enticed to at least learn more.”

The advent of more powerful nonsurgical body contouring therapies may have a significant impact on the male aesthetic market in the years to come. “Regardless of gender, everyone wants to be slimmer or reduce stubborn pockets of fat,” stated Dr. Grover. “HIFEM treatment actually builds muscle, which certainly piques the interest of men. And, the leaders of this technology, BTL Aesthetics, (Marlborough, Mass.) just launched a new device – Emsculpt Neo – which has demonstrated significant results for reducing fat and building muscle. This will be huge for men. Other popular non-invasive technologies such as cryolipolysis are still viable and are ideal for localized adiposity.”

Dr. Brandeis agreed. “When you consider what drives men at the deepest level, HIFEM has obvious appeal. Most of my patients are over 50, so I’m more concerned about strength, long-term functionality and reducing injury. This is my favorite technology because the wellness benefits of HIFEM treating the core musculature are physical as well as psychological. Beyond building muscle, it can improve posture, basal metabolic rate, balance and incontinence, among other things that will boost self-image, and subsequently, help project confidence as well as improve health and quality of life.”

“Non-invasive body contouring is one arena where there is more marketing toward men,” added Dr. Keaney. Effectively targeting the male market means focusing on the millennials and thinking long-term. “They are young, more image conscious, increasingly willing to engage in preventative care, and savvy with information technology. The older patient may have the most to gain from many procedures, but that generation is reluctant to take the step. Many of the social conventions holding the older generation back are blurred or erased in the younger, prospective patient.”

As with the overall patient base, realistic consultation and expectations management are essential. “There may be physical health benefits in some cases, but there are clear emotional wellness benefits to aesthetic medicine,” Dr. Singer said. “Nevertheless, this requires a healthy attitude from the patient because aesthetic medicine isn’t going to fix all of their problems. It is our responsibility to be sure their motives, and ours, are the right ones. Men like to hear the straight facts, and not everybody is a candidate for every type of procedure.”

References:
1. From the American Society of Plastic Surgeons 2017 Plastic Surgery Statistics Report. https://www.plasticsurgery.org/documents/News/ Statistics/2017/cosmetic-procedures-men-2017.pdf. Accessed October 18, 2020.
2. From the American Society of Plastic Surgeons 2018 Plastic Surgery Statistics Report. https://www.plasticsurgery.org/documents/News/ Statistics/2018/cosmetic-procedures-men-2018.pdf. Accessed October 18, 2020.
3. From the American Society of Plastic Surgeons 2019 Plastic Surgery Statistics Report. https:// www.plasticsurgery.org/documents/News/ Statistics/2019/cosmetic-procedures-men-2019.pdf. Accessed October 18, 2020.
4. https://www.realself.com/news/male-interest-in- nonsurgical-procedures-increases. Accessed October 18, 2020.