The Male Patient in Aesthetic Medicine Mauricio de Maio • Berthold Rzany The Male Patient in Aesthetic Medicine Mauricio de Maio, M.D. Berthold Rzany, M.D. Sc.M. Avenida Ibirapuera 2907, cj 2002 Charité–Universitätsmedizin Berlin 04029-200 São Paulo-SP Charité Campus Mitte Brazil Klinik für Dermatologie, division of [email protected] Evidence Based Medicine (dEBM), Charitéplatz 1 D-10117 Berlin Germany [email protected] ISBN: 978-3-540-79045-7 e-ISBN: 978-3-540-79046-4 DOI: 10.1007/978-3-540-79046-4 Springer Dordrecht Heidelberg London New York Library of Congress Control Number: 2009922218 © Springer-Verlag Berlin Heidelberg 2009 This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broad-casting, reproduction on microfilm or in any other way, and storage in data banks. 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Cover design: Frido Steinen-Broo, eStudio Calamar, Spain Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com) Foreword (I) Over the last 100 years, life expectancy in Europe has increased by 25-30 years. What used to be old age has now become middle age. Not only do people live to a greater age but they feel younger for longer. If you feel younger, it is natural to want to look younger. People who feel young do not want to be perceived as old. Given the enormous advances in rejuvenation techniques, it is natural that men should now be following women in wishing to take advantage of the opportunity to look well and less ravaged by time and sun. Male rejuvenation has now come of age. Mauricio de Maio and Berthold Rzany’s “The Male Patient in Aesthetic Medicine” is comprehensive, informative and authoritative. They describe the full range of male derma- tological aesthetics. They do so at a moment when interest in this particular area is grow- ing as men begin to catch up with women. The text is enriched by excellent photographs, helpful do’s and don’ts sections and key pointers. Up to the minute and well researched references ensure that the authors’ statements are, wherever possible, evidence based. Of course, there are many similarities and some differences between men and women. One intriguing difference is highlighted in the section on fillers, where the authors empha- sise the importance of never letting male patients feel pain during aesthetic procedures as any negative experience may lead the male patient to discontinue facial treatments. Women are more hardy than men or at least more prepared to put up with discomfort in the pursuit of their aesthetic goal. This excellent text book will assist immensely physicians and surgeons working in this field. April 2009 Christopher Rowland Payne, M.D. Secretary-General (& Past President) of the European Society of Cosmetic & Aesthetic Dermatolog Consultant Dermatologist, The London Clinic, 5 Devonshire Place, London W1G 6HL, UK v Foreword (II) It is truly an honor for me to write this foreword to The Male Patient in Aesthetic Medicine. The authors Dr. Mauricio de Maio and Dr. Berthold Rzany are truly experts in the field. Having published extensively on aesthetic medicine, they bring perspectives from two con- tinents. The text has been written with the view of dual specialties, dermatology and plastic surgery, with each bringing unique approaches. Male patients are being seen in increasing numbers by aesthetic physicians. Men seek treatment often due to a simple desire to improve their appearance. This may reflect the fact that they have experienced facial changes related to aging or photoaging. It may result from the fact that society in general is becoming more aesthetically oriented. Many other men seek aesthetic improvements to keep a young and vital appearance while being active in the workforce. We all have patients whose cosmetic improvement has helped maximize their retention within a company or increased employment oppor- tunities. This text is a practical approach. It applies the science and art of aesthetics specifi- cally to the male patient. The authors share practical, up-to-date tips which physicians can use in their day-to-day treatment of men. This text is a superb condensation of the approaches many of us are currently using. This text is suitable for practitioners in a busy clinic, the advanced practitioner, or physicians beginning to enter the aesthetic medicine arena. The subjects that the authors have included are comprehensive. They have reviewed the aesthetics of the male face. It is important for the treating physician to understand how the male aesthetic is different from the female. Often, uneducated physicians may in error apply a female aesthetic to a male patient, which results in an undesirable appear- ance. Arched eyebrows seen in a man or a feminine lip on a male face often looks odd. The authors have discussed patient selection as applied to the male patient. Because there are fewer male patients seen than female, one must be careful in selecting the proper male patient. The topics of toxins and fillers have been eloquently discussed. Skin care and resurfacing are well developed. The authors end with a discussion on scalpel surgery in males as well a valuable discussion on the undesirable result. Aesthetic surgery is a field exhibiting remarkably rapid growth. The specialty of aesthetic medicine has had its roots firmly grounded in the care of the patient who wants to look “a little better,” but its branches are now raised high with good, sound, basic research being applied. Because of the cooperative and collaborative relationships which vii viii Foreword are growing among core specialists in the aesthetic field, aesthetic medicine is advancing exponentially. The two authors of this text have worked together to provide a knowledge- able and practical approach to the male patient in aesthetic medicine. April 2009 Timothy Corcoran Flynn, M.D. Clinical Professor, University of North Carolina at Chapel Hill Medical Director, Cary Skin Center, Cary, NC 27608, USA Preface Men are different from women in many ways. Male aesthetics are different from female aesthetics. Most readers would agree with this statement. However, as the majority of our patients are still female, even cosmetic physicians may tend to treat their male patients like female patients. This can lead to dissatisfaction of the patient and consequently of the cosmetic physician. As the demand for aesthetic procedures in male patients is rising, there is a need for good textbooks on this subject. The aim of this book is to explain the specifities of the ageing process and facial aesthetics in men and to present the treatments available. In addition, common skin conditions and diseases that also influence the male aesthetic appearance will be discussed. The book written from the perspectives of a plastic surgeon and a dermatologist should enable us to treat our male patients better, and by that increase the satisfaction of our patients and, last not least, our satisfaction as the treating physicians. Sao Paulo Mauricio de Maio Berlin Berthold Rzany December 2008 ix Acknowledgments Like our first two books, this book would not have been possible without the work of many others. Specifically, our thanks go to our patients who helped us to be where we are now, especially those who contributed their photographs for this book. For the German team: We thank Mr. Frank Bachmann for his help on the content and format of this book; especially, for helping us in building the background chapters on ageing. We thank Mr. Tobias Gottermeier, again, for the excellent photographs and the graphic work. Last not least, we thank Martin Hussain who had the tedious task of formatting the book. For the Brazilian team: Our thanks to Mr. Helvio Piva, Mrs. Liliann Cristina Amoroso, Dr. Celso Pieralini, and Ms. Ivy Ofenbock Magri for helping with the updated references of male patients’ treat- ments, and especially, the clinical assistants Ms. Amanda Rocha Ribeiro Cruz, Ms. Carla Roberta Batista, Ms. Daniele Ferreira de Souza, Ms. Elaine Aguinalda da Silva, and Ms. Patrícia Aquino, who have a wonderful careful way with my patients. For Springer: We also thank Mrs. Marion Philipp and Mrs. Ellen Blasig, who encouraged us with the project and helped us to make the book just like it is. xi Contents 1 Facial Aesthetics in Male Patients ................................................................... 1 1.1 Introduction ............................................................................................... 1 1.2 Facial Landmarks ...................................................................................... 1 1.3 Golden Proportion ..................................................................................... 4 1.4 The Facial Aesthetic Units ......................................................................... 4 1.5 Men and Women ....................................................................................... 6 1.5.1 Eyebrows ....................................................................................... 6 1.5.2 Eyes ............................................................................................... 6 1.5.3 Cheekbones and Mandible ............................................................ 8 1.5.4 Nose ............................................................................................... 9 1.5.5 Lip–Chin Complex ........................................................................ 9 1.6 Ageing ....................................................................................................... 10 1.7 A New Trend? ............................................................................................ 13 1.8 The Goal of Cosmetic Procedures in Male Patients .................................. 17 References .......................................................................................................... 18 2 The Ageing Process in Men .............................................................................. 19 2.1 The Genetic and Environmental Ageing Process in Men .......................... 19 2.2 Intrinsic Ageing ......................................................................................... 19 2.2.1 Genetics in Ageing ........................................................................ 19 2.2.2 The Phenotype of Intrinsic Skin .................................................... 20 2.2.3 Histology of Intrinsically Aged Skin ............................................. 20 2.3 Extrinsic Ageing ........................................................................................ 21 2.3.1 Photoageing ................................................................................... 22 2.3.2 The Pathopysiology of Photoageing .............................................. 23 2.3.3 The Phenotype of Photoaged Skin ................................................ 23 2.3.4 The Histology of Photoaged Skin .................................................. 23 2.3.5 Other Factors Affecting Extrinsic Ageing ..................................... 26 2.4 Classification of Ageing and Wrinkles ..................................................... 28 2.4.1 Classification of Ageing ................................................................ 28 2.4.2 Classification of Wrinkles and Volume Loss ................................ 28 2.5 Prevention of Ageing ................................................................................. 28 2.5.1 Avoidance of Excessive Sun Exposure .......................................... 28 2.5.2 Avoidance of Smoking .................................................................. 32 xiii
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