- HEALTH TRACKER
|by George John Bitar, MD
It is no secret that the popularity of aesthetic surgery for men is on the rise. American society tends to accept plastic surgery for women more than for men, but that trend is changing. Procedures for men increased nearly 20-fold from 1992 to 2004. Men’s reasons for having aesthetic surgery are as varied as women’s: improving self-esteem, becoming more attractive to the opposite sex, looking less “tired,” or sometimes— quite plainly—reacting to jealousy of a partner who has had successful plastic surgery. Whatever your reasons, if you are a man in search of a more perfect face and form, you are not alone.
The advent of lasers, injectables and less-invasive procedures in the 1990s has given men the opportunity to have aesthetic enhancement without having to explain those facelift scars in front of their ears. Another type of male plastic surgery that is becoming very popular is aesthetic surgery after massive weight loss, typically from a gastric bypass procedure. This article will outline for you just four of the most popular surgical options for men: rhinoplasty, neck lift, blepharoplasty, and abdominal liposuction. The information here can help you begin to explore the ways you can look your best.
Unfortunately, there are few perfect noses in this world, and most could use improvement. Since the heyday of the Greeks, many criteria have been proposed to guide us toward the ideal dimensions of the aesthetically pleasing nose, given that it is the centerpiece of the face. As our society becomes more ethnically diverse, so do the noses that facial plastic surgeons address. You may seek a rhinoplasty for a variety of reasons. Sometimes the reason is self-consciousness about your nose and the belief that it makes you less attractive. Other times it is for more functional reasons—for example, difficulty breathing due to a deviated septum—but perhaps you will opt for “a little touch-up of the tip” while you are under anesthesia. Whatever your reasons may be, rhinoplasty (Figure 1) on a normal patient who is realistic about his reasons and expectations, will yield tremendous satisfaction. This is one operation for which the margin for error is narrow. Your results should be fairly predictable.
Techniques to address noses are probably as diverse as their shapes. I first ask my patients what bother them about their nose, dividing it into top, middle, and lower thirds. I try to get as much information as possible about the specific nose each patient would ideally like to have. I then discuss each aspect of a rhinoplasty in a systematic fashion, covering each portion of the nose: the dorsum, the tip, the nostrils, the columella, the bony pyramid, and the septum. I also advise him as to whether an open or closed approach would be preferable, as well as to whether he would need an implant. If you are looking at a secondary rhinoplasty, you need to be advised that the level of difficulty is higher and that the results may be less predictable. Aftercare for a rhinoplasty patient is very important. Make sure you follow up with your surgeon as required after your procedure.
The Giampapa suture suspension neck lift was designed for men who did not want the visible scarring of a facelift but were unhappy with their neck laxity. Men who want a more youthful neck find this alternative to a full facelift very appealing, because it gives significant facial rejuvenation with less downtime and fewer, better-hidden scars, without the stigma of a full facelift. In the preoperative evaluation, the main issue is whether the patient is an appropriate candidate—medically and psychologically—for neck-rejuvenation surgery.
Once you have been determined to be an appropriate candidate, it is time to consider which technique will provide the best results. Should you receive a neck lift, neck liposuction or a full facelift? Furthermore, do you need chin augmentation with the neck lift to give you a more prominent jaw line? The glands below the jaw need to be evaluated to determine whether they should be corrected at the same time. Otherwise, they will become more prominent after the loose neck skin is corrected.
Male patients tend to bleed more due to the rich blood supply in the neck, so it is imperative to have excellent control of bleeding and blood pressure postoperatively. You should not shave your neck for two weeks after surgery to avoid injuring the numbed neck flaps. You will most likely return to work much sooner after a neck lift than with a facelift and, if you are like many other men who choose a neck lift procedure, you may find you get rid of the beard that was hiding your weak chin, “turkey waddle,” or both after a neck lift (Figure 2).
One of the less invasive procedures that gives men great satisfaction is blepharoplasty, or eyelid reshaping. Because most men do not apply makeup around their eyes as women do, they do not have to deal with excess upper eyelid skin daily. Therefore, awareness of the problem does not surface until the upper eyelids are in a more advanced stage of laxity—usually when men are in their 50s and 60s—as opposed to women, who tend to notice this when they are younger. Many men seek upper blepharoplasties because they are frequently told that they look tired when they are not.
Because blepharoplasty must be done very precisely and cannot produce perfection in every case, it is important that your surgeon discuss other facial procedures that can be done simultaneously with a blepharoplasty—or instead of it—when you come in for treatment.
Techniques for upper eyelid blepharoplasty vary. In the traditional technique, the excess skin of the upper eyelid is removed after the patient is preoperatively marked in the supine position—that is, on his back with his face toward the ceiling.
Most men who seek lower eyelid lifts complain about the bags under their eyes, and the surgeon should help create realistic expectations. Sometimes patients complain about the lower eyelid, but what really bothers them are the festoons, or severe excess lower eyelid skin, which are difficult to address. Your surgeon can explain to you what a lower blepharoplasty can and cannot accomplish in your case.
The lower eyelid is very delicate, and complications can result that are difficult to correct if the lift procedure is not done properly the first time. Your surgeon should become familiar with the details of your case:
• Do you wear glasses or contact lenses?
• Do you have dry eyes?
• Do you have excess skin, excess fat, or both?
• Should additional facial procedures be performed at the same time?
Most men are quite satisfied after having a blepharoplasty, whether it is performed alone or in combination with other facial procedures. (Figure 3). In addition, men with significant lateral hooding, excess skin at the side of the eye, benefit from improvements in peripheral vision.
“Six-Pack” Abdominal Liposuction
Ever since liposuction was introduced to the United States in the early 1980s, it has been very popular. Men seek liposuction for the same reasons women do: to get rid of those extra pounds of fat that they cannot lose at the gym, or because they are “too busy” to exercise. In general, men who seek liposuction are health-conscious, eat a proper diet, and exercise, but they cannot seem to get rid of the extra unwanted fat.
Liposuction can be performed in many ways. In low-volume liposuction (less than 2 liters), the various techniques do not offer significant differences, but in high volume liposuction, they can. Most surgeons have their own preferred technique because liposuction is such a common procedure.
Most men—and women, for that matter—who work out and take care of their bodies find the abdominals one of the most difficult areas to “tame.” “Muscle men,” with defined biceps and thigh muscles but bulging abdomens, can be found in any gym. Even if the abdomen has well-defined muscles, they can be covered with fat. The solution is a specialized form of liposuction: “six-pack” abdominal liposuction, or abdominal etching.
Abdominal etching can be performed separately or in conjunction with a traditional abdominal liposuction. If a man is muscular, but has some fat overlying his well-defined abdominal muscles, abdominal etching is all he needs. It is a one-hour procedure that may be done under general anesthesia or heavy sedation.
For men with more fat, a traditional abdominal liposuction is performed, followed by a six-pack etching. However, results are not usually as good as they would be in someone with less fat and better defined muscles.
After the procedure, 1¼ two by seven-inch strips of cotton are laid down in carefully outlined areas of the abdominal. The taped cotton dressing is changed after one week and kept for another week, after which the patient can gradually resume activity.
A six-pack abdominal liposuction is the “push” that most men want to improve their abdominal appearance (Figure 4). It also serves as a springboard to working out the abdominal muscles more, improving the diet, and receiving positive feedback, especially when they get compliments at the gym!
Aesthetic surgery in general is on the rise, and men are requesting more procedures. The procedures discussed here are some of the more common ones, but this was by no means a comprehensive discussion. Ultimately, aesthetic surgery is about your happiness. Careful research, good communication, adequate planning and excellent surgical care go a long way toward accomplishing this goal.
George John Bitar, MD, is a board-certified plastic surgeon in private practice in northern Virginia. He is on staff at INOVA Fairfax Hospital in Falls Church, VA, and Prince William Hospital in Manassas, VA. He can be reached at (703) 206-0506 or via his Website, www.DrBitar.com.