Advertorial: Dermal Filler for Male Patients

By Dr Kishan Raichura / 06 Sep 2022

Dr Kishan Raichura discusses the rise in popularity in non-surgical treatments for male patients

FOR HEALTHCARE PROFESSIONALS ONLY

Dermal filler implants can be used for beautification/enhancement, transformation, correction and eventually, with the progression of time, to effect positive ageing. 

In younger male patients who generally do not face the issues of skin laxity, fat pad deflation or ptosis, the objectives for treatment might solely be the enhancement of existing masculine features. The mature male face however, requires a different brief, requiring subtle re-support of the classic areas of ageing mentioned above. 

The mandible as a focus for treatment in a full-face approach 

Enhancement of the existing jaw anatomy is an often-requested target for this type of treatment. A generous mandibular dimension in the frontal plane conveys the look of masculinity and is an attractive secondary sexual characteristic. During puberty the male facial skeleton widens at the mandibular body, ramus, and the chin under the virilising influence of the potent androgenic hormone dihydrotestosterone. These bony changes herald the transition of a boyish face to a more mature masculine profile. Perhaps at an unconscious level it is this observation of developmental changes in puberty that highlight the relationship between androgenic hormones and male anatomy that makes this a desired facial feature.

Product selection 

As practitioners there are many considerations for choice of product in these patients. As well as the product performance and rheology, safety is a principal concern. For both of my cases here I used fillers from the Merz Aesthetics range. I have personally never had any complications using them, and furthermore the safety data with regards to the BELOTERO and RADIESSE range of fillers is robust. The UK incidence of complication such as delayed onset nodules is significantly low.1,2 When using a higher G-prime hyaluronate filler to sculpt and add definition in the male face, it is also reassuring to use products that have proven ease of extrusion, consistent volumising effect3 and durability4 in the case of BELOTERO Volume for up to 18 months. 

Patients treated at our clinic have been extremely happy with results from BELOTERO fillers, which is reflected in the research with high patient satisfaction rates and in global aesthetic improvement scales,5 thanks not only to the rheology but also to the excellent tissue integration which is a result of Merz Aesthetics CPM technology.6

With my cases, in addition to using the BELOTERO HA portfolio, I also used RADIESSE, a calcium hydroxyapatite biostimulator injectable from Merz Aesthetics, which is my ideal product, over and above hyaluronate fillers to define contours in the lower face. 

While research studies have supported this observation and preference, in my practice, I generally reserve this for patients who have already experienced, and most importantly, happy with, enhancements of the lower face previously with a reversible hyaluronate treatment.7 In these patients, the bio-stimulating effect following placement of RADIESSE results in formation of denser collagen and elastin fibre networks within nine months.8

Case Study 1

After a thorough consultation with my youthful-looking 30-year-old patient, we planned a course of treatment using BELOTERO hyaluronate fillers and RADIESSE biostimulator injections.

Patient goals for treatment 

To achieve a more handsome, masculine, alert and attractive appearance through widening the jaw and the lateral aspects of his cheekbones. He requested for a more ‘angular’ look rather than the softer contours he presented with. We also noted that his temporal region was somewhat concaved, and while in a male face a mild depression here or a flat surface can be attractive, we decided to target this area too.

Identified areas for enhancement 

Temples – to lift concavity to a flatter, more youthful appearance.

Mandibular contour – to widen and define further the posterior body, angle and the ramus of the mandible. 

Zygomatic arches – to create more definition and a slightly sharper, more defined look.

Apex of the nasolabial fold – while the depth of the parenthesis was mild, we took the opportunity to treat this at the same time.

Treatment 

Temples: 1ml total. 0.5ml BELOTERO Volume per temple using a supraperiosteal injection with careful aspiration for 10 seconds prior to delivery of the product. In this area, the superficial artery should be located and injections directed away to avoid complications. 

Zygomatic arches: 1.4ml total. 0.7ml BELOTERO Volume injected using a cannula in a horizontal vector, similar to the Frankfort plane, injecting product in line with lower aspect of the arch. This effects a more masculine look than using product in an upward vector or in the upper aspect of the arches which may be more appropriate when treating the female face. 

Jawline: 4.5ml total of RADIESSE. I used a cannula from the mid-point of the mandibular ramus, working my way backwards towards the angle, in the superficial subdermal plane delivering threads of 0.05ml of product with each pass with a total of 1.5ml for each side. I used a second entry point at the posterior mandible to work in an upwards direction to augment the ramus portion of the jaw, delivering 0.75ml of product each side. 

Apex of the nasolabial fold: 0.6ml total of BELOTERO Volume. I used a 27 gauge needle to place 0.3ml of product at the base of each of the nasolabial folds, injecting after waiting 10 seconds of aspiration, to lower the risk of intravascular injection.

Outcomes 

The patient was counselled and consented for the common and rarer side effects and complications of having treatment. Within one week, the immediate post treatment swelling after receiving a total of 7.5ml of product, had completely resolved and there had been no bruising or other issues. At the one month review appointment, the patient reported being very happy with the results.

Case Study 2

The next patient is an already very good-looking 42-year-old-male who had never had dermal filler treatment before and decided to try some facial volumising for slightly different reasons.

Patient goals for treatment 

His chief areas for improvement were for his eyes to look less tired, to regain some firmness of the lower face and to improve his cheek contour, which was looking a little sunken. He also wished to look more masculine and handsome, however in his case we had to address some classical signs of facial ageing too.

Identified areas for enhancement 

Temples – to lift the temporal concavity for a more youthful, less gaunt look.

Anterior cheek – to address volume loss in the anterior cheek and soften the emerging malar split and medial tear trough. 

Mandibular contour (jawline) – to widen and define the posterior body, angle and the ramus of the mandible.

Nasolabial fold – parenthesis was visibly deeper in this patient’s face which is often associated with facial ageing.

Treatment 

Temples: 1ml total. 0.5ml BELOTERO Volume per temple using a supra-periosteal injection with aspiration for 10 seconds prior to delivery of the product. 

Anterior cheek: 1.8ml total. 0.9ml of BELOTERO Volume injected with 27 gauge needle in the deep fat pads using aspiration prior to each bolus, along the tripod of the zygomatic body and a lesser amount along the arch of the complex to give indirect support to the tear trough, anterior cheek and the lateral portion of the cheek. 

Jawline: 2ml total. 1ml of BELOTERO Volume each mandible border and angle. I used a 25 gauge cannula from the mid-point of the mandibular ramus, working my way backwards towards the angle, in the subdermal plane delivering threads of product in a retrograde injection, from the angle moving anteriorly. I also used the same entry point to deliver product over the ascending ramus. 

Nasolabial fold: 1.2 ml total of BELOTERO Volume. I used a 27 gauge needle to place 0.1ml of product at the base of each of the nasolabial folds, injecting after waiting 10 seconds of aspiration, to help lower the risk of intravascular injection. Subsequently, I placed 0.5ml of product along the nasolabial fold with a 25 gauge cannula to lift the fold further utilising the high G-prime rheology of BELOTERO Volume to reduce the depth of this anatomical fold further.

Outcomes 

Our patient experienced little, if anything, in the way of post-treatment swelling6 or bruising after a total of 6ml of volumising filler, and, at the one month review appointment, the patient reported being very happy with the results. His post-treatment photography indicates an effective broadening of the jawline contour with durable restoration of volume in the key areas of facial ageing including the temples, cheeks and the nasolabial fold.

Conclusion 

Both of my patients were seen at The Lovely Clinic in Chelsea, London where we have seen an increase in the proportion of male patients over the last five years. This observation has been reflected in wider surveys in the US and in London, particularly with respect to the increase of neuromodulator treatments in men. This report indicates how judicious use of high performance dermal fillers can be used to enhance, masculinise and restore the male face and is a potential area for treating discerning patients of different age groups.9

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