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testosterone — before they become mature and as

carried out with the thyroid — and supplementing when needed could be beneficial. The link between testosterone substitution treatments and the risk of prostate cancer are not currently known, however18


DHEA DHEA (dehydroepiandrosterone) is a prohormone that also has an androgenic action. It metabolises into hormones such a testosterone, estradiol and cortisol and, depending on the individual’s enzymatic heritage, one of them will be prevailing. At present, we are unable to determine what transformation will take place; therefore a biological inventory of the different hormones at T0 and 6 weeks after DHEA supplementation should be carried out. This supplementation will be continued only if a rise in the testosterone levels has been noted (as detected by blood test DHEA-S). It should not be forgotten that testosterone is more

likely to be converted into estradiol when the male individual is overweight as this aromatisation takes place in body fat. It is also important to note the DHEA : cortisol ratio that influences our capacity of resistance to psychological stresses. This capacity is reduced with age and as a result, the stresses of life have a greater impact. DHEA itself also diminishes with age, while our cortisol levels increase; this ratio is therefore reduced by a factor of 10 between the ages of 20 and 50 years. Supplementation through DHEA allows a prevention of this weaker stress resistance induced by the years.

The most common cosmetic treatments for men In the US, figures with regard to treatments on men for 2011 can be found in Table 2. With regard to common cosmetic procedures for men in France, the author offers her own opinions as solid statistics are unavailable in the literature: ■ Laser hair removal. Among young men (i.e. under 45 years of age), demand seems to focus on the shape of the beard, or ‘tidying’ of the shoulders and back. Mature men are more concerned about tidying the inside of the ears and nose

■ Periorbital circles. A significant demand concerns the reduction of signs of fatigue. Fillers containing hyaluronic acid to the tear trough or carboxytherapy on purple or dark circles of the eyes are very popular

24 ❚

Figure 2 The dose of botulinum toxin is increased owing to the stronger muscles in male patients compared with female patients

■ Lifting bone structure. Dermal filler volumisers are more suited to men than simple fillers (for the tear trough and cheek bones). Men usually desire a restructuring treatments than simply filling wrinkles

Key points

■ Male demand for cosmetic treatments has been rapidly increasing over the past few years. Not only do men want to look younger and more attractive, but they are also aiming to smooth over the signs of fatigue

■ Male patients will usually opt for laser hair removal, treatments for periorbital circles, lifting the bone structure, botulinum toxin, and treatments for rosacea

■ Men now desire increasingly clean and healthy-looking skin, with a fresh complexion

■ The younger generation are more likely to request cleaner-shaven skin than the more mature generation, targeting areas such as the shoulders, back, and nape of the neck, as well as the hands and the abdomen

■ While the beauty care applied to and by women cannot be transferred to men, it is the role of the physician to adapt this, to match male specifications and supply men with treatments that meet their expectations

November/December 2012 |

■ Botulinum toxin. This treatment methodology corresponds well with the desires of male patients when seeking aesthetic treatments — one-shot and without frequent maintenance — and corrects unpleasant facial expressions, such as signs of anxiety or dissatisfaction. Wrinkles are not usually the first concern of male patients

■ Rosacea. This condition has a negative impact on public image as it is often associated with alcoholism. Men cannot stand to leave even a few vascular signs on the face, but want perfectly clear skin.

The characteristics of treatment methodologies for men Botulinum toxin The eyebrow shape in men is usually more rectilinear and lower on the arch of the brow line. Therefore, relaxation of the forehead muscle should not result in an excessive lowering of the eyebrow or a change in its shape. Physicians should also remain vigilant of a feminisation of the facial shape19

. In fact, Carruthers and Carruthers even suggested

that ‘real men’ have brow ptosis, with the corrugator supercilii inserted more laterally11, 21

. Flynn20 recommends

treating male patients over two sessions, with the first session treating the upper part of frontalis and the lower part treated in the second session, 14 days later. A double dose to the forehead is required as men’s

muscular power is much greater compared with women. Carruthers and Carruthers recommend treating the glabella with 80 UI Vistabel (Allergan) compared with 40 UI21

. Blitzer22 recommends that men need between

25% and 100% of supplementary doses for all muscles in cosmetic procedures. The author of the current article, however, believes that this is correct for the upper face but not for the lower face. Early alopecia may also compel the physician to treat the upper part of the frontalis. In the lower face, the depressor anguli oris is not as

necessary to treat as the mouth has less tendency to fall (doses will be a maximum of 5 UI). The platysma is usually treated from the age of 65 years in men, while treatment to this area begins at approximately 55 years for women (a dose of 5–8 UI administered to each side of platysma).

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