| FACIAL AESTHETICS | PEER-REVIEW (33 kg versus 21 kg) 3 . The same can be said for the facial


mimic muscles, the bone structure is larger as is vascularisation of the male face. There are some aesthetic gender differences


between male and female faces. The ideal female face is heart shaped with ovoid cheekbones, smooth forehead, brows far apart and arched, a small nose, and full lips. In women the proportions of the upper to lower face are greater in comparison with men. The ideal male face is different. Men have an angular


shape caused by prominent bones and muscles, square jowl/jaw and chin, horizontal heavier brows that are closer together, wide mouth, beard, and a strong, wide neck. The proportions between the lower and upper face are equal, which is in contrast with women.


Gender ageing processes Ageing is a multi-faceted process, determined genetically and by the modus vivendi of the individual and proceeding under the influence of both exo- and endogenous factors. Ageing has both a varied and atypical character; that is to say, the tempo of the ageing process is uneven and different parts of the face age at different speeds. All facial tissues are subject to ageing: the bone and muscle tissues, the subcutaneous fat compartments, dermis, and epidermis. The process of ageing with regard to the male and female face is variable and individual by nature. However, for either gender this process will affect all levels of tissue. From a biological point of view, the changes in the


hormonal profile of men leads to the development of partial androgen deficiency in the ageing male (PADAM) syndrome, which, apart from the creation of the somatic signs of ageing, carries with it a psychological imbalance and development of aesthetic problems. These include androgen alopecia, a lessening of the thickness of the skin, a redistribution of the deep fat pad, the formation of folds and wrinkles, and excess weight 5


. Other signs of ageing in the male face include:


■ The skin becomes thinner, dryer, and less elastic, with spots of pigmentation. It also becomes more vascularised, and there is a loss and displacement of volume in the mid and lower parts of the face


■ Volume loss in the mid-cheek produces pronounced cheek hollowing with sagging jowls


■ Volume loss in the lower part of the face leads to changes in the perioral area, resulting in the appearance of nasolabial folds and grooves, marionette lines, and atrophy of the lips 6


. In contrast to women, in whom the speed of


resorption of the bone structure is dependent on the level of oestrogen present and accelerates with the onset of the menopause, this process proceeds relatively gradually in men. The aesthetic markers of ageing for the female


face are:


■ A sagging process that leads to a displacement and loss of volume in the mid-cheek area. Additionally, there is a flattening of the cheekbone area owing to bone structure atrophy


■ A change in the mid-face area from the appearance of excessive skin in the upper lid; lowering of the brows; rupturing and deformation of the lower lid; a change in the contours of the mid-face, such as the appearance of a tear trough, mid-cheek and palpebromalar grooves, and nasolabial folds


■ Changes in the lower face area, such as those to the lower contours and perioral area owing to bone structure atrophy. The lips become thinner and wider 7


. The main goal of cosmetic procedures for both


genders is treating and preventing the visible ageing processes, achieving a more harmonious face, equal harmony of the face for both the patient and the doctor, as well as a natural look and feeling after treatment, without pain or complications. Male patients will most often approach the specialist


in aesthetic medicine with a definitive defect, which they wish to correct, and having approached a specialist, they tend to place their complete trust in them. Male patients are not concerned about the cost of a procedure, as long as they make the payment themselves they have no need to explain why they have spent the money. They are motivated by procedures, the effects of which will be felt for a long period and be more long-lasting and workable 2


. Men


Figure 1 The aesthetic gender difference between male and female face


prefer to be in control, and any situation in which they lose such control may be problematic for them. They are wary of treatment and the subsequent result of such treatment, preferring to undergo procedures without pain or complications. They also like to see an immediate result. The preference of the male patient is to look healthy


and muscular, and not just younger or more attractive, which is in contrast to women. Treatment for men is quicker and more radical. Treatment for women is different — not so radical,


more preventive, and the result may not be so noticeable — but the treatment can be more aggressive, and with a longer duration because women are more tolerant to pain and prepared for a longer period of rehabilitation. The priority areas for correction for the female


face are the cheekbone area, the upper face, and the lips. For the male face the priority areas will be the cheeks, the lower face, chin, and mandibular line.


Volume restoration for the female face


There are two main goals of treatment; the first of which is to remove the markers of ageing, such as


volume loss, grooves, and folds; the second being the ‘beauti-phi-cation’ of the face to make it more attractive7


prime-journal.com | May/June 2013 ❚ .


The ‘beauti-phi-cation of the face is to bring the proportions of the face closer to those of the ‘Beauty Mask’, based on ‘phi’ and


37


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