The man getting Botox, fillers and any number of skin-resurfacing or tightening lasers (or all of the above) is not who you might think.More often than not, it's a middle-aged, heterosexual man."I see a lot of executive men," said Dr. Ellen Marmur, a cosmetic dermatologist and surgeon whose namesake Marmur Medical practice consists of 40 percent male patients, about triple that of five years ago. And the vast majority of them are straight."The pendulum has swung from antiaging fascination to 'preservation' aging," Marmur explained during an interview at her office on New York City's Upper East Side. "There are so many reasons: It's not considered [strictly] a feminine thing to get Botox or fillers, the stigma has gone away...[and] men don’t ask questions. They don't come in and ask, 'What do you think I should do?' They sit down and they do it. They have enough money and they are in the professional game so they need to age well. It's a matter of why not? Why wouldn't they?"Most men who get an injection here or there are reluctant to advertise it, but the rate at which they're visiting their doctors for Botulinum Toxin (the formal name for the family of neurotoxin injectables Botox, Dysport and Xeomin) and more is certainly on the rise — and the spike is hardly unique to Dr. Marmur's practice. It mirrors a trend doctors are experiencing nationwide, and there are numbers to prove it.According to data from the American Society of Aesthetic Plastic Surgery, there has been a 27.3 percent lift in surgical cosmetic procedures for men in the past five years. Also: men love Botox just as much as women. The market saw a 101 percent increase in the amount of male botulinum toxin procedures performed between 2010 and 2016.Men have always been part of the aesthetic market — that's nothing new — but the percentage of overall procedures they make up is rising rapidly."All the attention has really gone to the women, while in the background it's been steadily growing year-over-year. The [American] Society [of Aesthetic Plastic Surgery] tracks a lot of these procedures, they've been tracking this stuff for 20 years, and over that time they've seen the number of men getting these treatments increase by 325 percent. The growth has been kind of happening in a quiet but steady way," said Colleen McKenna, vice president of marketing, facial aesthetics at Allergan.The reasons for this spike?There are several, including an influx of filler options manufactured by medical giants like Allergan and Galderma designed to target specific parts of the face. While products were once limited, fillers today are not only more natural looking but possess unique properties from consistency (Voluma is considered a heavy filler while Boletero is among the lightest) to the length results could last (some fillers wear off after six months and others last up to two years). In tandem, an uptick in products gave way to enhanced techniques that allowed for doctors to use any number of fillers to sculpt different portions of the face.McKenna believes much of the growth in the men's market has to do with the emergence and widespread adoption of social media."That whole medium has really given people more voice, more platforms to talk and share what they're doing, what they're thinking. There's just a greater openness," she said.There are societal reasons, too.San Francisco-based dermatologist Dr. Vic Narurkar said the increase stems from a culture where men aren't afraid to take care of themselves appearance-wise anymore. Previously, men were "dragged in by their significant others," he noted, where it was nearly unheard of for a male patient to come in of his own free will for a cosmetic procedure. Surely, men have a lot of catching up to do to women in terms of mainstreaming, but there is definitely an uptick in awareness and acceptance of men who want to preserve their appearance and keep aging at bay."I think also there's more awareness that you can do things that don't require a lot of recovery, and that also don't change your masculine features. The biggest fear that men have is feminization of the face," he said.Narurkar also acknowledged Facebook founder Mark Zuckerberg's infamous quote that companies should not hire people over the age of 30, crediting this sentiment to a surge in male patients — especially those in a competitive work environment. For men in their 40s and 50s, vying for positions being handed to guys decades younger creates a need to maintain the appearance of youth more than ever.Similar to Marmur, a significant portion of Narurkar's male patients hail from San Francisco and Silicon Valley — the "epicenter of youth" — and are "predominantly straight men." He contended that the percentage of men he sees has "grown dramatically in the last five years," jumping from 10 to 25 percent of his practice. The most requested procedure is neurotoxin injections, largely due to increased awareness."Deion Sanders is the face of men's Botox and that's brought in a whole other group of patients who I’d never in my wildest dreams have expected to see. It's the 'man's man,' the sports guy who really 'doesn't care'.…But men really do care. As a man I care — and it took 10 years of doing Botox on everyone else to do it on myself," Narurkar admitted.He added: "There is an intrinsic [idea] among men, which I think stems from our fathers, that you need to be tough, and that this [caring about appearance] is not for the man.…That culture is changing, first with the metro sexual and now with an ordinary man who wants to take care of himself."Marmur, who joked that she is the "iron surgeon for male cosmetic surgery," told a story about a competition that takes place during the American Society for Dermatologic Surgery Annual Meeting each year. A select group of doctors have to present a case in front of 6,000 attendees, she said, comparing the event to the show "Iron Chef,” and after being presented with a series of dermatological-related cases, doctors vote on the most favorable outcome. Her "case" just happened to be a cosmetic surgery makeover performed on a man in his mid-50s.He "got the works," she said, holding up before and after photos as she detailed the various treatments the patient received. Brown spots were removed with lasers, and fillers such as Restylane, Voluma and Radius were injected in the under-eye region, in the cheek bones to "square off the face" and in the jawline and temples, respectively.Marmur won the competition. And truth be told, this man really did look younger (yet still age-appropriate). Presented with these photos in a different context, one might attribute a lot of sleep, a healthier lifestyle and/or an extended vacation for this "fresher" look. To the untrained eye, it would be nearly impossible to discern that his new youthful appearance was the result of a series of noninvasive facial procedures."They like to keep some wrinkles. We put filler in the forehead lines instead of Botox — like Boletero, Juvederm Ultra or Restylane Silk — and use Botox in the '11's' and a little in the upper crows feet because it actually lifts their brow," said Marmur. (For those who don't know, the '11's' is the area between the eyebrows that, over time, can give the appearance of a "furrowed brow" with the appearance of wrinkles.)She cautioned — as did all doctors interviewed for this story — that retaining a patient's masculine features, or "making sure you don't feminize" a man's face, remains the single most important aspect when it comes to men. Earlier work from decades past often produced male faces that appeared "softened" or feminized, a result of a lack of product options and less-evolved techniques.Which is why cosmetic procedures for men — both noninvasive and invasive — have gotten such a bad rap. In addition to a fear of walking out of a doctor's office looking "different" or feminine, the notion of a man doing work to his face remained a cultural taboo because it goes against the "alpha male" ideals that define modern society today. (For straight men, at least.)When asked what the most popular procedure for this group is, Marmur swiftly replied: injecting filler under the eyes. But funnily enough, these patients never rarely come in asking for under-eye fillers because most still don't even know this is a viable option to eradicate under-eye concerns, from hollowness to bags to dark circles."They come in and say, 'I look tired,'" Marmur said, adding that the runner-up to filler is neurotoxins, or "Brotox." "Men come in for the overhaul. They are just like, 'OK, tell me the executive plan. How much of it can I do at once?' and then you plan out the year for them and maybe they come in two to three times and optimize their time.”Then there are doctors who maintain that men have always comprised a healthy portion of their patient bases.Dr. Jason Diamond, a plastic surgeon based in Los Angeles who appeared in E!’s reality series "Doctor 90210" that documented patients before and after plastic surgeries, said seeing a lot of men is "nothing new to his practice." Currently, 25 to 30 percent of surgical patients and 25 percent of non-invasive patients are men.For him, a focus and expertise in men's facial procedures spans more than two decades. Early on in his career he spent two years at a New York-based dermatology practice where about 90 percent of the patients he saw were men (there was also a "very high percentage of gay patients")."In my first year in practice I probably did more male cosmetic surgery than most surgeons do in their entire year. I'm not joking. I basically did all men for two years; I did about 400 male surgeries in two years," Diamond said. "I started off really early taking care of a lot of guys, and because of that, even after I left that practice, I carried a lot of the guys with me. I've always seen a lot of men."Once he left the first practice in New York, the tide started to shift. He began to see a smaller percentage of gay men and an increase in straight men.Today, the most popular procedure performed on this group, as a gender, is Diamond's signature "The Diamond Tripartite,” a surgical technique he’s tweaked and honed for 15 years that addresses every layer of the neck and jawline. The combination of three techniques includes augmentation to the bone, tightening of the muscle to secure and contour the muscle near the bone and tightening of the skin to treat all areas. But before one runs to Diamond’s Beverly Hills office to contour his jawline, know that these surgeries don’t come cheap. The triple threat starts at about $25,000.Diamond also has developed a nonsurgical version of his Tripartite (he calls it “facial sculpting”) that’s achieved using a combination of fillers. It was born from the surgical implants he’s been customizing for years, obtained by radiology and using putty implants to craft over bones of the face to create the exact augmentation he wants.“Based on that knowledge and experience, I figured out how to nonsurgically do this without surgically placing an implant. I can inject it [filler] into the bony region the way I want it to be shaped,” Diamond explained of the procedure, which starts at $3,900. “It’s a way to get really sharp angulation to the lateral prominences and elegant contours and it doesn't create puffiness, roundness or fullness. It creates angularity; that’s what I do most for men in-office.”Even with the documented rise in the number of men getting cosmetic procedures, some doctors claim they still hardly see any men at all.Dr. Paul Nassif, the Beverly Hills plastic surgeon who starred in “Botched,” another E! reality series about plastic surgery, said he’s not seeing the same rapid increase in male patients that his peers have. He called the hoopla a “bunch of BS,” and cited “maybe 10 percent growth” in men undergoing cosmetic procedures like rhinoplasties.“Men still come and have a few things done — they might have a little Botox once in a while [too]. That’s pretty much all I’ve seen,” Nassif stated, adding that body-fat reduction with Coolsculpting and facial micro-needling and skin-tightening via radio frequency treatments like Profound are picking up speed. “There’s no stigma, I just think that men are too busy. I'm just not seeing them do that, I don't see the huge [spike].…They’re not coming in for invasive or minimally invasive [procedures].”The only thing that has grown with respect to men, however, is the Nassif MD skin-care line he launched on HSN about a year-and-a-half ago. He noticed a lift in Millennial and male customers that was reflected on the direct e-commerce site nassifmdskincare.com.“Men are taking care of themselves a little better. Not surgically, but at home they do,” Nassif said.
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