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| THEAGEING MALE | ARTICLE skin infection6


a result, men have a significantly greater potential for .


Dermis The average thickness of the dermis in a man is 2.3 mm, compared with 1.8 mm in women. A strong collagen density as a result of the impregnation of testosterone induces


this


difference. With age, the dermo–epidermic junction flattens3


. The arch of the eyebrow, the


Dermal annexes The sebaceous glands are bigger and more numerous in men. The sudoriparous glands secrete more sweat, which is also more acidic as well as more odorous. When exercising, men sweat earlier and more abundantly compared with women7, 8


zygomatic arch and the chin area of the jaw are more


prominent in men than in women.


.


Vascularity The vascularity of the face is sufficiently more developed among men, and can be linked to the significant levels of hairiness among this gender. Many studies have shown that the higher vascular flow in men is caused by the greater number of microvessels, resulting in a greater risk of rhinophyma9


.


Bone structures The arch of the eyebrow, the zygomatic arch and the chin area of the jaw are more prominent in men than in women.


Muscles The frontalis, occipitofrontalis muscle and the masseters weigh more and have a higher tensing power compared with that in women. The consequences can be seen in treatments such as botulinum toxin, for which the doses used must be double that for women.


Procedure


Table 2 Cosmetic procedures in men (2011) Number of


Percentage of procedures in men


Botulinum toxin A Laser hair removal Hyaluronic acid fillers IPL laser treatment Liploplasty


Microdermabrasion Rhinoplasty Chemical peel Blepharoplasty Gynaecomastia Facelift


Statistics from ASAPS 201124 prime-journal.com | November/December 2012 ❚


264 284 107 450 78 962 42 295 41 663 30961 24 533 23 909 22 905 17 645 10 400


total procedures performed (2011)


10.1% 11.7% 6.5% 9.6%


12.8% 6.2% 19.5% 6.2% 15.5% 100% 9%


Table 1 The ADAM test


■ Have you noticed a decrease in sexual desire?


■ Do you feel you are lacking energy?


■ Have you noticed a decreased muscle strength and/or a decreased endurance?


■ Has your height decreased?


■ Do you feel less happy?


■ Do you feel sad or moody?


■ Are your erections less firm?


■ Have you noticed a decreased exercise capacity?


■ Do you feel sleepy after your meals?


■ Have you noticed a recent decrease in your working capacity?


If you answer ‘yes’ to more than three of these questions, then you could be lacking androgen.


Correct facial proportions According to Mommaerts10


. , the ideal proportions for the


face should see the height of the lower third of the face at approximately 48% of the overall height, and the cheeks to be rather long. The upper lip and the philtrum are generally larger in men11


Physiological differences Testosterone The cutaneous receptors to androgens are closely linked to eccrine and apocrine secretions. A decrease in testosterone levels with age will induce less seborrhoea, a poorer hydrolipidic film and therefore, poorer protection against stresses affecting the skin. However, it should not be forgotten that excessive weight causes a significant quantity of oestrogen and a feminisation of the skin through the aromatisation of testosterone12 On average, the testosterone level drops by 1–2% every year after the age of 40 years13


. , but the usual values are in


such a wide range that some authors even claim that 80% of men still have a normal testosterone level at the age of 60years14


. This has led many to believe that in a few years,


an early testosterone test (e.g. at 35 years of age) could be developed in order to determine each individual’s physiological levels and supplement when necessary. The instructions on the substitutive treatment of male


menopause (i.e. andropause) will be evaluated not only against a biological check-up, but also with regard to symptoms based on the ADAM (Androgen Deficiency in Ageing Males) test and a clinical examination (Table 1). The positive effects of androgen supplementation :


are15–17


■ An increase in muscle mass by 1–3 kg ■ A decrease in fat by up to 2% ■ Enhanced bone mineralisation ■ A decrease in total cholesterol ■ Improved cognitive function and mood. It is now well known that low levels of testosterone are


linked to a higher risk of prostate cancer and that, conversely, high levels of testosterone reduce this risk. This is the reason why knowledge of men’s levels of


23


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