The aesthetic differences between the male and female face are based on anatomical, physiological, and psychological gender differences. Therefore, there are different priority areas for volume restoration in male and female faces. The strategies of treatment, zones of correction, and correction techniques for volumisation are discussed in this article. As there are particular requests for aesthetic treatments for men, volumisation of the male face is a rewarding procedure for both doctor and patient.

According to the American Society of Aesthetic Plastic Surgeons (ASAPS), male patients accounted for 9% of all cosmetic treatments performed in 20111. This figure represents nearly 800 000 procedures out of a total of 9 million performed that year on men and women combined. The number of cosmetic procedures for men has increased by over 121% from 1997, and by more than 1% from 2010 1. An increasing number of male patients are requesting aesthetic treatment, and this increase is directly linked to a greater motivation among male patients to achieve a youthful look. The demand for aesthetic treatments from male and female patients is the result of gender-related motives.

The basis for treatment requests from women lies in their wish to achieve a heightened sexual attractiveness. On the contrary, the main reason for aesthetic treatment among men is the desire to find new ways to improve their self-confidence, in order to be seen as the ‘winner’ against all competitors of their gender. Men tend to seek treatment when they reach a point of dissatisfaction in their social life. Therefore, dissatisfaction with their appearance is secondary and manifests when serious problems arise in their lives that lead to a lowering of their psycho-emotional state. The necessity to maintain a continued social importance forces them to seek aesthetic treatments more frequently. The modern successful man — ‘metro-sexual’ — has a high status in society and pays greater attention to his appearance. The main indicators of youth in modern society are the external signs of youth, high capacity for work, and competitiveness. For its part, this competitiveness, as a rule, is based on the lack of visible signs of ageing 2.

The aesthetic gender differences

There are many differences between the male and the female patient. Firstly, there are the anatomical and physiological differences. The skin of the male is thicker and rougher, with a less developed sub-dermal fat compartment; its age-related atrophy leads to the skeletonisation of the face. Also, muscles are bigger and stronger, with the mass of skeletal muscles significantly greater in comparison with women (33 kg versus 21 kg) 3. The same can be said for the facial mimic muscles, the bone structure is larger as is vascularisation of the male face.

Figure 1. The aesthetic gender difference between the male and female face

Figure 1. The aesthetic gender difference between the male and female face

There are some aesthetic gender differences between male and female faces. The ideal female face is heart shaped with ovoid cheekbones, smooth forehead, brows far apart and arched, a small nose, and full lips. In women the proportions of the upper to lower face are greater in comparison with men.

The ideal male face is different. Men have an angular shape caused by prominent bones and muscles, square jowl/jaw and chin, horizontal heavier brows that are closer together, wide mouth, beard, and a strong, wide neck. The proportions between the lower and upper face are equal, which is in contrast with women.

Gender ageing processes

Ageing is a multi-faceted process, determined genetically and by the modus vivendi of the individual and proceeding under the influence of both exo- and endogenous factors. Ageing has both a varied and atypical character; that is to say, the tempo of the ageing process is uneven and different parts of the face age at different speeds. All facial tissues are subject to ageing: the bone and muscle tissues, the subcutaneous fat compartments, dermis, and epidermis. The process of ageing with regard to the male and female face is variable and individual by nature. However, for either gender this process will affect all levels of tissue.

From a biological point of view, the changes in the hormonal profile of men leads to the development of partial androgen deficiency in the ageing male (PADAM) syndrome, which, apart from the creation of the somatic signs of ageing, carries with it a psychological imbalance and development of aesthetic problems. These include androgen alopecia, a lessening of the thickness of the skin, a redistribution of the deep fat pad, the formation of folds and wrinkles, and excess weight 5.

Other signs of ageing in the male face include:

  • The skin becomes thinner, dryer, and less elastic, with spots of pigmentation. It also becomes more vascularised, and there is a loss and displacement of volume in the mid and lower parts of the face
  • Volume loss in the mid-cheek produces pronounced cheek hollowing with sagging jowls
  • Volume loss in the lower part of the face leads to changes in the perioral area, resulting in the appearance of nasolabial folds and grooves, marionette lines, and atrophy of the lips 6.

In contrast to women, in whom the speed of resorption of the bone structure is dependent on the level of oestrogen present and accelerates with the onset of the menopause, this process proceeds relatively gradually in men.

The aesthetic markers of ageing for the female face are:

  • A sagging process that leads to a displacement and loss of volume in the mid-cheek area. Additionally, there is a flattening of the cheekbone area owing to bone structure atrophy
  • A change in the mid-face area from the appearance of excessive skin in the upper lid; lowering of the brows; rupturing and deformation of the lower lid; a change in the contours of the mid-face, such as the appearance of a tear trough, mid-cheek and palpebromalar grooves, and nasolabial folds
  • Changes in the lower face area, such as those to the lower contours and perioral area owing to bone structure atrophy. The lips become thinner and wider 7.

The main goal of cosmetic procedures for both genders is treating and preventing the visible ageing processes, achieving a more harmonious face, equal harmony of the face for both the patient and the doctor, as well as anatural look and feeling after treatment, without pain or complications.