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ARTICLE | THE MALE FACE |


Figure 5 40-year-old with melasma, before (A) and following (B) improvement with trichloroacetic acid (TCA) peel


Although some degree of collagen formation


has been proven following treatment with dermal fillers, more advanced skin laxity will benefit from combined procedures.


deposit and layering procedures has recently been suggested for hyaluronic acid fillers30


. As male facial skin


tends to be thicker, some males are more easily treated using a 25 rather than 27 gauge needle or cannula. Other authors prefer supraperiostally deposition of calcium hydroxylapatatite of short (0.3–0.5 cm) strands in a retrograde technique for 3D volumisation31


. Volume loss is a significant feature of HIV-associated


lipoatrophy, stigmatising affected males (and females). Correction of volume loss to the cheeks with a durability of more than 12 months has been achieved with large particle biphasic hyaluronic acid filler (Restylane SubQ; Q-Med, A Galderma Division)32 calcium hydroxylapatatite34


, poly-L-lactic acid33 . Independent from the


reasons for volume substitution in males, a round facial appearance should be avoided as this would reduce facial attractiveness. Although some degree of collagen formation has been


proven following treatment with dermal fillers, more advanced skin laxity will benefit from combined procedures. Laxity can be further improved by serial application of radio frequency and fractionated lasers. A more recent technology is subcutaneous laser application35


.


Lower face and submental area Marionette lines and a dimpled chin are more common indications for botulinum toxin use. The injection technique for both does not differ to that used in females. A combination with dermal filler placement is useful in marionette lines, but the duration of effect is shorter compared with treatment to glabellar lines since the perioral musculature cannot be completely relaxed14 The jaw line is an important measure of facial


.


aesthetics in males, influenced by body weight, platysma anatomy and strength, and sagging. With the authorsÕ technique to correct the down-turn of the lateral corners


24 ❚ June 2012 | prime-journal.com


Figure 6 31-year-old with acne scars. Before (A) and after (B) four sessions of microdermabrasion


of the mouth, a shaping of the jaw line is also possible in younger, non-obese males. Injections are administered using a 30 G needle with the patient in a supine position. Three to four injections are placed on both sites of the medial part of the platysma (each receiving 5 units of Vistabel or Bocouture, or 15 units of Dysport/Azzalure). The depressor anguli oris is treated with superficial injections of the bony insertion point with approximately the same dose36


. The submental fat pad and skin laxity have been


improved by subdermal laser lipolysis alone, or combined liposuction and subdermal laser (Figure 4)37–39


.


, and


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