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Cosmetic Surgery: Is There Still a Stigma for Men?

It probably won’t surprise you to learn that plastic surgery and cosmetic procedures across America are on the rise. A look through the American Association of Plastic Surgery’s annual report shows doctors in America performed more than 17.1 million cosmetic procedures in 2016, the most recent year for which data is available. These procedures ranged from breast implants and Botox to calf augmentation, and they represent a four percent increase over the 2015 totals. But buried in the report is something you might not expect. Despite the public perception that these procedures are predominantly focused on women, a growing number of cosmetic plastic surgery patients are men.

Overall, men still only represent a fraction of the total number of patients – 13 percent to be exact. The number of male cosmetic patients increased by three percent last year, fueled mostly by surgeries like nose reshaping, eyelid surgery, breast reduction, liposuction, and facelifts. The numbers also show increases in non-invasive procedures like Botox, laser hair removal, chemical peels, and soft-tissue fillers. The findings clue us into two things: First, they tell us which areas of the body most men tend to focus on when it comes to cosmetic procedures, and second, they tell us that more and more men are comfortable getting this work done.

“There’s been a shift in a certain population of the United States where men are spending more time to look good,” said Joshua Fosnot, MD, an assistant professor of Plastic Surgery at Penn. “That includes being fit and working out, but also paying attention to an overall image.”

The numbers tell us part of that story. Three of the top five surgical procedures for men focus on the face. The other two focus on looking fitter, which is where the statistics for men are truly skyrocketing. The procedures that saw the biggest growth from 2015 to 2016 are lower body lifts (29 percent increase), pectoral implants (25 percent), and buttock implants (23 percent). The overall totals may be small, but the increase is significant.

“Most of these procedures show a focus on social situations, like men being able to wear a bathing suit without a shirt and feeling comfortable on a beach,” Fosnot said. “These are procedures that leave minimal scarring that can be hidden.”

There are also certain procedures that are predominantly performed on men as opposed to women, which is more evidence the stigma of cosmetic surgery is fading away. Some of these, like pectoral implants, are obviously gender specific, but others are not. Men made up 72 percent of all hair transplantation patients in America in 2016. They also accounted for 55 percent of mentoplasties, a surgery to enhance or reshape the chin. Fosnot says the growth of these procedures has been fueled by word-of-mouth.

“There are now more people out there who have had surgeries, and as a result, they’re able to tell their stories of success,” Fosnot said. “That means there are more people out there who recognize what can and can’t be done.”

It’s also possible the ease of these treatments is drawing in more male patients. Minimally-invasive procedures rose 74 percent from 2000 to 2016. While that includes Botox and fillers, it also includes treatments like microdermabrasion, a procedure that exfoliates the skin. There are countless products focused on this and other skin care therapies that are sold over-the-counter. As men learn what might make them feel better about their appearance, it may be making them more interested in other procedures down the road.

Patient education is a huge component of any cosmetic procedure, and surgeons say that burden rests on both the doctor and the patient. Fosnot also pointed out that it’s crucial for these procedures to be patient-driven, rather than being influenced by someone else like a partner or parent.

“We want to make sure our patients are looking to make an improvement for themselves and not for someone else,” Fosnot said. “That’s why we spend a lot of time setting expectations and being realistic about what we can offer.”

Fosnot says it’s important for patients to understand their bodies as a whole, and for doctors to emphasize that these procedures are best-suited for people who are already working hard on their health and wellness but still have areas giving them problems. He says surgery is not a fix for not going to the gym and not dieting.

“I spend a considerable amount of time talking to men about that, trying to understand what their daily routine is and whether they’re a motivated person who knows what they want,” Fosnot said.

While techniques are generally the same across genders, there are variations caused by the differences in the bodies of men and women, especially when it comes to fat and muscle. They also vary based on the part of the body involved. That’s why it’s crucial for patients to make sure they’re going to an expert.

“People think of plastic surgery as being something easy or less serious, but it’s quite the contrary,” said Aron D. Wahrman, MD, MBA, MHCDS, FACS, an assistant professor of Plastic Surgery at Penn and chief of Plastic Surgery at the Corporal Michael J. Crescenz Philadelphia Veterans Administration Medical Center. “Some of the best cosmetic surgeons started out as great reconstructive surgeons, and you really can’t divorce one from the other. You need to be a master of anatomy and a master of technique, and have a passion for restoring the normal.”

While cosmetic procedures may have a reputation as being about vanity, Fosnot says it’s important to keep the mental health aspect of these surgeries in mind, and that the true goal is to help people get past problem areas that may be negatively impacting their lives. That’s something that cuts across gender lines.

“We’re not going to make you look like so and so,” Fosnot said. “The main goal of cosmetic surgery is to make you feel better about yourself.”

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