I’ve been a plastic surgeon in New York for 17 years. Plastic surgery attracted me by its artistic, sculptural aspect. I like to say that I’d rather be a chef than a line cook. I like to create and not follow recipes. Most surgeries are a recipe, there isn’t much variance. With plastic surgery, there are many nuances. And, I really like problem solving; every plastic surgery faces a unique set of problems.
I remember when I was in training 20 years ago, there were a lot of plastic surgery lectures about problem patients and red flags to be aware of. Back then, just being a man was considered a red flag. They were seen as potentially difficult patients, there was uncertainty about their motivation or whether we would be able to make them happy.
Men having plastic surgery weren’t as accepted and it was thought that men might be doing it for what we call “external factors” which is always a big concern. If you are seeking plastic surgery because you think it will get you more acting roles, a promotion at work, or to make your wife like you more, these are external factors that are red flags. We can do a big surgery and if that promotion doesn’t happen, the patient is potentially going to blame the surgery. That was the thought at the time.
The increase in the number of men having plastic surgery
I’m primarily a facial surgeon, so I’ve always had male patients because I do a lot of rhinoplasty work. These patients tended to be men coming in for nasal procedures after traumatic injuries. Men still come for this, but there are now more men coming for cosmetic surgery. Where before men made up 5% of my patients, now they are maybe 20-30%. In the non-surgical realm – botox and fillers – men are still in the minority, but I’ve seen this increase as well.
The concept of the “metrosexual” man caught attention in the 90s and I think it was the start of greater social acceptance for men interested in improving their appearance. Now I think plastic surgery for men is fully accepted. I don’t think men feel the stigma more, which is the biggest change. More recently there was a “Zoom boom” which brought in more male patients, because people were seeing themselves on camera a lot.
More and more men are coming for eyelid lift procedures (blepharoplasty), neck lift procedures (platysmaplasty) and for facial liposuction and face tightening. There aren’t many men who ask for lip augmentation, although there are a few exceptions. And more and more men are coming for botox and fillers.
Men generally don’t want brow lifts or heavy brow botox; they accept line retention better. Generally, I’m going to err on the side of conservatism with forehead botox for men, because they’re not going to be upset if there are still lines. Although I make cheek fillers for men, it’s likely to support the under eye area. The men I see are generally not looking for a high cheekbone, although there are always exceptions.
It’s very rare that men show me a picture of another man they want to look like. Luckily, for rhinoplasty and chin augmentation there is imaging software that we can now use, so you can show them what they will look like on a picture of themselves.
The most popular plastic surgeries for men, and who had them
Rhinoplasty is still by far the most popular surgery I perform on men. The second would be chin implants, which is also commonly done with what is called sub-mentoplasty; a surgical jawline tightening that creates more definition. And, the third most popular procedure would be lower eyelid surgery.
But the age demographic of men I see is quite broad. The rhinoplasties I perform are usually on men in their late teens to early thirties. But as we get older, sometimes the nose gets older and the tip droops, which explains the second, much smaller peak I see in men in their 60s and 60s. While I see women in their 30s having eyelid surgeries, it’s usually men over 50 who come for eyelid surgery or neck lifts. Then the men who get botox and fillers tend to be 40+, which again is an older demographic than the women I see.
I don’t think there is any particular reason why men tend to be a bit older than women for certain procedures. It may be related to societal pressures, but I also think that men tend to be less concerned with these issues, for example their upper eyelids, until they become more extreme.
But I don’t think the motivations of men who come to see me for plastic surgery are very different from those of women, it’s mostly an internal motivation; wanting to feel good about themselves, feeling confident, feeling the best they can be for who they are, but not trying to be the person they were 20 years ago. I am no different. I’m looking at a picture of me from 20 years ago and I think it would be awesome if I still looked like this! Usually you can’t look exactly like this, but maybe you can look a little more like this.
But if the motivation for plastic surgery is to worry about how other people treat them or to think that others will react differently by having this procedure, it’s a dangerous road because we can’t control others.
I have seen many men who felt like they were more successful in dating after surgery. find people they love and who love them back. I think it comes from the change in them due to an improvement in self-confidence. I usually see this in men who have had rhinoplasty or chin and jaw surgery. These are the areas that I think the men I see are particularly bothered about.
I’ve probably done several thousand rhinoplasties on men and hundreds of eye and face lifts and chin augmentations, and I don’t think there’s really any difference in treating a man and a man. ‘a woman. Any surgery is about being able to have a dialogue and figure out exactly what the individual wants and getting a result that feels balanced and appropriate.
But for some surgeries, men in general are much worse candidates than women. For facelift procedures, for example, men’s tissues are usually heavier, it’s harder to get the facelift, it tends to feminize the face a bit and cause visible scarring.
I think a man who does a facelift is still not so accepted in society. And, without hair to cover it, a facelift scar is going to have some visibility, which men often don’t like. As a result, for brow lifts and facelifts, my standards for whether a man is a good candidate and will get a good result, and whether it’s worth the inconvenience of those other factors that can cause problems, are much higher.
The future of male plastic surgery
Future trends in plastic surgery likely hinge on whether the “daddy bod” falls out of favor! If there is a societal pushback on the “daddy bod”, then I think there will likely be more men looking for body contouring. As non-invasive machines – electromagnetic muscle building, fat reduction machines – improve, I think there will be more and more men who will seek out these types of treatments because they don’t are not surgical. However, I have seen that the jawline is very important to the men I treat, so I think jawline procedures will continue to increase. And, to a lesser extent, eyelid procedures as well.
I’m really curious to see 20 years from now what the aging population will look like and whether, with an increase in non-surgical procedures, there will be less surgery.
Personally, I don’t think there’s really a difference between going to the salon or getting a perfectly fitted suit and having a non-surgical body contouring. Obviously you can hit the gym or find a personal trainer, but we are all different in our abilities and what we can accomplish and I see no problem doing something to help get you further if it makes you feel good . About you. Once you enter the field of surgery, it becomes a bit difficult to take the same perspective, as the risks increase a bit.
But my role as a plastic surgeon is never to say whether or not someone should have surgery, because that’s not my decision. My role is to say if it’s possible and if the risk associated with it is reasonable for the outcome someone is trying to achieve.
Going on this journey with people is very rewarding. There is a feeling of kinship. My patients have this dream of something they want to accomplish, you make it happen and they are so relieved and happy. You can tell when they walk into the office afterwards that the way they behave is different; the way they interact with people is different. I see so many patients coming out of their shell and feeling good about themselves.
Dr. Richard Westreich is a dual board board certified facial plastic surgeon and founder of private practice New Face NY. Dr. Westreich is an assistant professor at SUNY Downstate Medical Center and on staff at Lenox Hill and Mount Sinai hospitals.
All opinions expressed in this article are those of the author.
As told to Jenny Harvard.