Men and cosmetic surgery

Our society places a high value on looking young and fit. Today, men of all ages and all walks of life are requesting plastic surgery for cosmetic reasons. Men's goals include a more balanced nose, a rejuvenated face, a trimmer waistline. The procedures used to achieve these goals must take into consideration factors such as skin thickness, beard growth, or body type.

This brochure reviews some of the special considerations for men contemplating a cosmetic procedure. It won't answer all of your questions, since a lot depends on your individual circumstances. Be sure to ask your doctor if there is anything you don't understand about the procedure you plan to have.

PLANNING YOUR SURGERY

Good communication between you and your plastic surgeon is essential when planning your surgery. In your initial consultation, you'll be asked to explain in detail why you want the procedure and how you hope to look and feel afterward. It's important to set aside any awkwardness you might feel, and speak candidly about the changes you'd like to see. You should feel completely assured that you and your surgeon understand one another.

Your doctor will also evaluate your health, conduct a physical exam, take pre-operative photographs, and explain which surgical techniques are most appropriate for you. You'll discuss the type of anesthesia to be used, the type of facility where the surgery will be performed, the possible risks, and the costs involved. Medical insurance usually doesn't cover cosmetic procedures. However, some plastic surgeons offer special financing plans for cosmetic surgery or accept credit cards.

Tell your surgeon if any part of the consultation makes you uncomfortable, or if you have any special privacy requests. Above all, it's important to have realistic expectations about your surgery. Remember, your doctor can offer significant improvement, but not perfection. Keep in mind that your age and health may play a role in the quality of the outcome.

THE SURGERY

Extensive information about the particular procedure you plan to have will be provided during your consultation. While going over the steps of the procedure, your doctor will discuss a number of issues that may influence your surgery. Make sure you fully understand these considerations.

Facial surgery: If you are planning facial surgery or neck surgery, your doctor will evaluate your entire head-face-neck region. Is the hairline receding? How full are the sideburns? Does the beard-growing skin extend up the cheeks or down the neck? Are there facial scars? Is the skin sun-damaged? Is the neck skin loose or drooping?

In general, it's known that male facial skin has a richer blood supply than female facial skin. Male faces bleed more during surgery and are at greater risk for forming a temporary collection or pooling of blood under the skin, called a hematoma, after surgery.

Also, any scarring that may result from surgery may be more difficult for men to hide, since they don't wear make-up or style their hair toward their faces, as many women do.

Hair growth and beard growth may play a major role in the outcome of a facelift. If you are balding or have thinning hair, surgical artistry may be required to hide the facelift incision, especially in the temple area. If the hair-bearing skin of your upper neck is pulled behind your ears during surgery, you may find that you must shave behind your ears or the back of your neck. However, sometimes electrolysis can correct this problem. Be sure to discuss these possibilities with your surgeon.

A fatty or "jowly" area beneath the chin is also a concern for many men. In younger patients, liposuction alone may be sufficient to correct the problem. Older patients may require a full facelift and necklift, which may include the removal of excess skin and tightening the platysma muscles, which run down each side of the neck. These muscles are usually thicker in men than they are in women, but do not pose a greater challenge for your plastic surgeon.

"Refinishing" treatments for facial skin: Shaving must be postponed for about 3 weeks after a skin-smoothing treatment such as chemical peel or dermabrasion. Because these procedures strip away the surface layers of skin, you can expect your face to remain sensitive, swollen, and bright pink for several weeks after surgery.

Some men are happy that the beard growth helps conceal the pinkness of their recovering skin -- especially if they feel uncomfortable using camouflage make-up.

Men who feel self-conscious about their condition are also advised to give up alcoholic drinks for about 4 weeks. Alcohol causes the areas of treated facial skin to become noticeably red and flushed.

Changing the facial features: Cosmetic procedures such as eyelid surgery, nose surgery, and facial-implant surgery are performed essentially the same way for men and women. However, it's important to let your surgeon know if you are seeking a more masculine look to your facial features -- a chin with better projection, more prominent cheekbones, a stronger nose.

Hair replacement: The primary consideration for men contemplating hair-replacement surgery is the time involved. Natural-appearing hair replacement usually requires multiple surgical procedures, with long recovery intervals. A full regimen of hair transplants may last anywhere from 18 months to 2 years or more.

You should be aware that incisions or transplant sites may be noticeable to others, especially in the early stages of the hair transplant process. If your work or lifestyle isn't compatible with a long treatment period, ask your surgeon about alternatives to hair-transplant options, such as flap surgery or scalp reduction.

Liposuction/body contouring:The ideal male body shape is considered to be trim and athletic-looking, with broad shoulders and chest, a flat abdomen, and a narrow hip-thigh area. However, as men age, areas of fat tend to accumulate around the abdomen, the flanks ("love handles"), the breast area (a condition called gynecomastia), and along the chin and neck. Men sometimes seek liposuction to remove these fatty areas that are resistant to diet and exercise.

In many cases, liposuction alone can effectively correct these problem areas. Men retain their skin elasticity longer than women do, and the areas of fat beneath the skin tend to be firmer and more vascular than those in women. Because of these and other factors, liposuction in men is usually very effective.

Men who have some loose, hanging skin as well as areas of excess fat may opt for a traditional excision procedure (surgical skin removal) in addition to liposuction. An excision may also be performed on gynecomastia patients whose breast enlargement is made up of mostly glandular tissue, rather than fat.

Abdomen reduction: A full abdominoplasty or "tummy tuck" may be chosen by men who have hanging abdominal skin (usually the result of massive weight loss), loose abdominal muscles, and/or neglected hernias. It is a major surgical procedure that removes excess fat, tightens the muscles of the abdominal wall, and trims the waistline. Men who have a full abdominoplasty are often surprised at the long recovery period. Some patients aren't able to return to work up to 4 weeks after surgery.

Men with good skin elasticity who have only a moderate amount of excess abdominal fat may benefit from liposuction alone.

Muscle-enhancing surgery: In recent years, plastic surgeons have developed ways of improving muscle contour with cosmetic implants and "sculpting" techniques.

Calf implants, which were originally developed to restore leg contour in accident or polio victims, are now sometimes used to create cosmetic fullness in the lower leg. Similarly, pectoral implants, which are used to build the chests of men with Poland's syndrome, can also be used to "bulk out" the existing pectoral muscles of healthy men.

A small number of doctors have begun offering their male patients abdominal etching, a new liposuction technique that creates a muscular, rippled appearance in the abdominal area.

Men who consider cosmetic muscle enhancement should keep in mind that these procedures are still relatively new. It is best to seek out a board-certified plastic surgeon who has received adequate training in these methods.

AFTER YOUR SURGERY

The days and weeks immediately following your surgery are critical to obtaining a good final result. Therefore, it's essential that you follow your doctor's orders to the letter. Following orders may mean taking adequate time off work; wearing bandages or tight compression garments; getting enough rest; staying out of the sun; saying no to alcohol and cigarettes; and avoiding strenuous activity, exercise, sports, and even sex.

However, plastic surgeons understand that it's sometimes difficult for men, who are programmed by society to be stoic, to remain in bed for very long or to accept help from others during recovery. Studies have shown that men often deny their pain and feel foolish about asking for help after surgery. Men who reject help may have an especially difficult recovery if post-operative depression sets in during the weeks following surgery.

To avoid post-operative problems, it's important that you arrange to have a support person available to help you -- both physically and emotionally -- for about a week after surgery. If you get the help and rest you need, you'll improve your chances of a quicker recovery -- and you may see your results a lot sooner.