Case Study: Treating a Drag Queen

By Kerry Hanaphy / 10 May 2020

Aesthetic nurse Kerry Hanaphy shares her approach and recommendations for lip and skin enhancement in a male patient

Consultation and considerations

A 30-year-old male patient presented to my clinic requesting treatment for the first time. As the patient was in the public eye, working as a drag queen, he was particularly interested in improving his skin quality and enhancing his lips. The patient had mild signs of ageing such as fine lines and wrinkles, which were easily rectifiable with a good treatment plan.

During the consultation, I discussed the pros and cons of undergoing lip filler and botulinum toxin injections, outlining the side effects and risks that can occur while detailing their longevity and expected results. We also talked about how mesotherapy injections could be beneficial, as well as a chemical peel, to really enhance the results.

The patient explained that he was particularly conscious of a deep line on his forehead which tended to collect makeup, but was nervous that toxin treatment would make him look ‘too stiff’ – a common concern for many patients and something that was particularly relevant to this patient, with his job requiring him to have an expressive face. 

With this in mind, I suggested that we start on a good skincare regime to begin improving skin quality before progressing to botulinum toxin injections. In regards to the lips, the patient said he was keen for the dermal filler result to be more dramatic, as he wanted to enhance the look created in his drag act and achieve the ‘wow factor’. 

After thoughtful discussion, the decision was made to start the patient on a skincare regime, before going ahead with a chemical peel and mesotherapy in one session, followed by lip filler and botulinum toxin injections at an appointment two weeks later. 

I believe it’s important to emphasise here that while this male patient dresses up and applies makeup to appear as a woman for his drag act, he is not transgender and requires a very different treatment approach from that of someone in the trans community. Drag queens identify as male and will generally want to preserve their masculine features, while transgender patients will most often be looking to create more feminine features, such as softening of the jawline and mid-face structure, through aesthetic treatment. 

As with any patient, each should be consulted with and treated on an individual basis. Of course, it’s imperative that practitioners carefully manage patients’ expectations and consider any risk of body dysmorphic disorder (BDD); anecdotally, most men don’t want their results to be noticeable and will specifically request subtle enhancement, whereas, in this case, the patient really wanted to see an obvious difference with his lips. He did not display any warning signals of BDD, so I was confident to go ahead with treatment. According to Dr Raj Arora in his article published by Aesthetics last year, warning signals generally consist of obsessive concerns about appearance and compulsive behaviours.1

Appropriate consent was obtained and the patient returned for treatment a couple of weeks later.

Treatment

Prior to the patient’s chemical peel, he was given a resurfacing cream to use for the 10 days leading up to the treatment. This product is called resurfacing peel booster from mesoestetic and was chosen for its glycolic and salicylic properties, which aim to resurface the skin.2 On the day of the peel, I cleansed the skin using products from the same range, including the hydra milk cleanser and hydratonic facial toner, before applying the mesopeel with salicylic acid at a strength of 20%. This has a strong keratolytic and sebum-regulating effect, which was particularly beneficial for this patient.3 Finally I applied a factor 50 sunscreen and advised the patient to use this daily.

Following the peel, I performed the mesotherapy treatment. For this I used a mesotherapy gun, injecting 2ml superficially all over the patient’s face. I use the Viscoderm Skinko product, which contains more than 50 elements including non-crosslinked hyaluronic acid, minerals, amino acids and vitamins.4 I find mesotherapy keeps the skin looking fresh and maintains a glow, while also improving wrinkles.

Two weeks later the patient returned to clinic for his injectable treatments. He explained that he is quite sensitive to pain, so I applied LMX4 anaesthetic cream prior to injection to numb the area. I also ensured I spoke very calmly and played music of the patient’s choice in the background to help him relax.

The patient had thin lips and of course wanted to see a noticeable difference in volume, so we decided to inject 0.8ml of Restylane Kysse to the area. I injected the product along the vermillion border, using a needle with a linear technique, which resulted in a nice volumised lip with significant structure. As this product is designed for the lips, I find that it doesn’t induce much swelling and tends to last longer – up to nine months.

Dental surgeon Dr Barry O’Driscoll then performed the botulinum toxin treatment using Azzalure. For the procedure, he injected a total of 125 units to the patient’s frontalis (30 units), glabellar (50 units) and orbicularis oris (45 units) muscles. Doing so improved the patient’s frown lines and crow’s feet, which he was particularly happy with.

Following the treatments, I recommended that the patient visit the clinic on a monthly basis for mesotherapy injections to further enhance results.

Post procedure

Following treatment I advised the patient not to apply makeup until the next day. I also had to really emphasise the importance of avoiding exercise for the next 24 hours – it was important to stress the risk of swelling as the patient is a big gym goer and could have been tempted. He did not experience any notable side effects or adverse events. I recommended the patient use the mesoestetic skincare range moving forward, specifically the cleanser and resurfacing peel booster, which has 10% glycolic acid and 2% salicylic acid, which is great for cell renewal and removal of dead skin. I also encouraged used of hydra-vital factor k moisturiser and a good factor 50. Finally, the patient was given the crystal fibre at-home facemask, which is full of hyaluronic acid and I find can really enhance results.

The patient continues to visit the clinic for monthly mesotherapy appointments and has been delighted with the results. His confidence has increased, he has taken on more television work and has reported that he feels happier overall in his life.

As aesthetic practitioners, it is imperative that we recognise that patients can’t all be treated in the same way just because they are of the same sex. We should take the time to listen and understand their individual requirements, while taking care to ensure we manage their expectations and provide the best results possible.

Patient perspective

Hanaphy’s patient, Paul Ryder, said…

“Following years of mistreatment, I was never happy with my skin. I’ve spent a long time wearing too much makeup for drag, without the proper care, meaning it had sagged and looked tired. There was also a massive line across my forehead which used to swallow makeup, making me look older than I am.

Upon consultation in Kerry’s clinic, I expressed concern with looking too stiff and having overinflated ‘duck lips’. Kerry reassured me that we could start on good skin treatments, before moving to injectable treatments that would work for me.

The peel was fantastic – I really noticed a difference in my skin. As my skin was a bit drier afterwards, having to moisturise really taught me to get into a good routine of taking care of my skin. For me, the mesotherapy has been the ‘holy grail’ of all my treatments – I still have them regularly and they’ve completely changed my skin over the past two years. I was also really happy with the injectables – I don’t think I noticed how small my lips were before as I was so used to accentuating them with my drag makeup. I fell in love with the result and it’s amazing how much they’ve shaped my whole face. Kerry really masters the art of creating what you want in a way that suits you as an individual.

Having aesthetic treatment has really changed my outlook – I was so used to looking at my face in drag and didn’t really take care of my own face. Following the procedures, I am way more confident about my skin for the first time in years. The treatment plan Kerry advised was definitely the right course of action for me! 

For practitioners new to treating men, I would remind them that not everyone is the same and we should be treated as individuals. It’s also good to remember to respect patients’ privacy – I am open about working as a Drag Queen and why I wanted treatment but others may not want to go into much detail, so it’s important to consider that.”

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