Special Feature: Male Body Contouring

In the 21st century, body image is everything. Whether it’s touched-up photographs of models on the front pages of magazines, or sports idols displaying their toned physiques both on and off the playing field, we’re reminded of that modern ‘body ideal’ everywhere we look.

This preoccupation with emulating media portrayals of beauty – of creating the ‘perfect’ face and body – has generated a boom in aesthetic treatments and procedures. And now, not content with the odd skin treatment to achieve an image closer to their ideal, greater numbers of people are seeking more advanced techniques to get a better-looking body, through reshaping and contouring. Furthermore, practitioners report a paradigm shift in recent years in terms of who they see in their clinics and on their surgical tables: once purely the domain of women, aesthetic cosmetic surgery is increasingly catering to the body-conscious male.

Growing demand

According to consultant cosmetic and reconstructive surgeon Dr Mark Soldin, this trend has been led by the US. “Fifty years ago, very few people in the UK had cosmetic surgery. But the fashion in the US of people opting for cosmetic surgery, as well as it becoming more affordable, means that many people in the UK have decided to follow suit to optimise the appearance of their bodies,” he says.

However, Dr Mike Comins, a specialist in medical aesthetics and medical director of London’s Hans Place clinic, says that in reality, as many as half of the patients he now sees are men. “There’s been a significant increase in the last few years as aesthetic treatments and contouring have become more publicised,” he comments. “The days when the media portrayed these procedures as being for people who wanted to achieve that film star look are long gone. That’s just not true. These are ordinary men with ordinary lives.” Often, Dr Comins says, male patients come to him having spent many years eating a healthy diet and exercising at the gym, but are unhappy with the results. Advancements in technology and developments in the types of procedures available mean that these men can now achieve a highly defined athletic appearance without so much as an overnight stay in the clinic. Anecdotal evidence suggests that one of the most common treatments the modern man wants is for gynaecomastia – enlarged male breast tissue. According to BAAPS, while some degree of breast enlargement is common in teenage boys, less than 10% will have residual signs of the problem as they reach adulthood.² However, it increases again with age, meaning that around one in three older men have gynaecomastia.²

Melting the fat away

In the days when traditional liposuction was the best option – and often the only option – for body contouring, patients could expect considerable bruising and swelling lasting up to six months post-surgery – which would be conducted under general anaesthetic.³ Nowadays, the more discerning patient demands a less invasive procedure with faster recovery and guaranteed results. In recent years, this has been achieved by laser-assisted liposuction, in which a wavelength of light is passed through a cannula inserted into the area of the body being treated. The laser applies energy to ‘melt’ and liquefy the specific area of fat, and because it’s more targeted than traditional liposuction, it can pinpoint the area to be treated without affecting or damaging nearby tissue. This option has the added benefit of causing the small blood vessels to coagulate and collagen to contract, as well as inducing new collagen production, thereby tightening the skin at the same time.^4,5 

Laser- assisted liposuction can effectively treat most areas of the body patients wish to target, which in men is typically the chest, abdomen, flanks, back, and jowls. But, for the last six years or so, a ‘high definition’ variant of laser liposuction has been available in the UK that, according to Dr Comins, was initially aimed specifically at the male market. “It’s particularly suitable for people who want an athletic look with really defined abdominal and pectoral muscles, and it tends to be men who seek that highly defined six-pack look,” he says. The standard ‘mid-definition’ version, Dr Comins adds, is the better option for patients who want a toned yet softer appearance. Men are particularly suitable candidates for more advanced and high- definition versions of laser liposuction, says Dr Ravi Jain, medical director and founder of Riverbanks Clinic, because male patients are typically more demanding than their female peers, requiring the best-possible results. “[Male patients] expect it to work; they take a lot longer making up their minds to have body contouring treatments, and they take far more consulting with than females. Their expectations are extremely high,” he comments. “Whereas women are generally happy with an improvement, men are seeking these procedures to get exactly what they want and expect.”

 Reconstruction suction

The BAAPS study seems broadly consistent with experience in aesthetic practice, but there is another, significant sector of male society that undergoes body contouring not for reasons of vanity. “Body contouring could be aesthetic or cosmetic, but it can also be reconstructive,” explains Mr Soldin, who performs body contouring following extensive weight loss, both in private practice and on the NHS.

“After massive weight loss, many parts of a person’s body hang in folds of tissue, so the abdomen is an apron that hangs down over the thighs and sometimes down to the knees. These people are very happy that they’ve lost weight, but they’re very unhappy in their new bodies.” For these patients, of which men comprise a significant number, an abdominoplasty, or ‘tummy tuck’, might be performed to remove the excess skin and fat to tighten the muscle and fascia of the abdominal wall. In cases of very extreme weight loss, usually as a result of bariatric surgery, a belt lipectomy or ‘lower body lift’ might be performed, in which a large section of tissue is removed from around the lower trunk. This procedure removes the overhanging belly and folds from the back, as well as lifting the buttocks. Some areas can also be treated with liposuction to tighten the appearance above and below the navel, and to give an overall improved look. There are a number of criteria that patients must fulfil to have massive weight loss body contouring on the NHS, in accordance with guidance drawn up earlier this year jointly by the British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS) and the Royal College of Surgeons.⁶ Mr Soldin, who led the group tasked with drafting the guidelines, explains that such invasive surgery to reshape the body requires more downtime, with bruising and swelling taking several months to subside. “It requires a great deal of commitment on the part of the patient, and there is a comprehensive set of instructions regarding what to do and what not to do to optimise results,” he says.

The male of the species

This requisite commitment comes less easily to male patients, Mr Soldin continues: “As a group, men are harder to consult with and have a higher complication rate than women. The reason is that no man likes to be told what to do! The same is true of women, but when it comes to consulting with a doctor, I think women understand the need to listen carefully and ask questions more freely than men do. They’re also more compliant.” Consultant plastic surgeon Mr Chris Dunkin agrees that male patients are different from females in their approach to consultation. “Men are more matter-of-fact.

They’ll tell you ‘I want a rhinoplasty to make my nose smaller’,” he comments. “But women will identify the area they are unhappy with and ask about the options available to help improve it: they listen to advice better!” Listening is a crucial skill for the practitioner, too, he adds, and is often key to eliciting information from a male patient. “The most important thing is to listen to what the client is telling you he wants and then discuss ways to help them achieve this. For example, excess fat on the lower abdomen may be best treated with abdominoplasty, but liposuction might achieve the improvement they want without the long scar, and with a quicker recovery.” As a result, the patient’s expectations can be managed from the outset and compliance maximised. Although different in the way they handle aesthetic treatments in many ways, men have broadly the same psychological issues as women.

 A particular concern for practitioners is to eliminate the possibility of an underlying psychological condition that manifests in the desire to alter the body, such as anorexia nervosa or body dysmorphic disorder (BDD). Despite men accounting for just 10% of all cases of eating disorders in the UK,⁷ a recent study showed that eating disorders among men are growing steadily: the number of males diagnosed between 2000 and 2009 increased by 24%, almost double the rise in females being diagnosed.⁸ Practitioners have a duty of care to make sure that, should one of these men present in an aesthetic clinic, their condition is picked up through expert examination and consultation.

 “A patient who is extremely worried about a perceived physical problem – let’s say gynaecomastia – and reports that it affects every aspect of his life, but an objective physical assessment reveals the problem to be a mild one, would make me concerned,” reports Mr Soldin. In such a case, a referral to a psychologist might be the best path to follow, but this must be handled with care, he adds. “You need to address the issue in a very sensitive manner. It’s often handled with the help of the GP, because the GP knows the patient much better than I do, having often treated them since adolescence or childhood.”

A thorough consultation helps to draw out patients who need some other form of treatment and support, but it’s also critical in determining the subject’s expectations, and managing them appropriately. “I would be very careful with a middle-aged male patient who, say, had just got divorced, and who was projecting all of their anxieties about an aspect of their life onto a part of their body,” says Dr Comins. “Body contouring might improve that body part, but it’s not going to solve all their problems.” 

Whereas women are generally happy with an improvement, men are seeking these procedures to get exactly what they want and expect 

Seek, and he will find

With increasingly larger proportions of clinic lists made up of male patients, it’s not surprising that most practitioners don’t feel the need to market their services specifically to male audiences. “I don’t believe in hard advertising,” comments Mr Soldin. “I think your work speaks for itself, and word of mouth referral is often the best.” Most patients approach a practitioner having been referred by their partner, who may have seen successful results from a similar procedure. The other big source of custom is the internet. “We don’t target men in forums or in male publications online, but a huge number of men come to us having found out about body contouring on the web,” says Dr Jain. “Our conversion rate of male patients is extremely high, because men have typically done so much research that they’ve already made up their minds that they’re going to have the procedure they want – if they’re given the OK – when they first come to us.”

If supplemented with expert advice, careful planning and sound pre- and post-treatment care, and set against an agreed construct of what can realistically be achieved, most male patients can expect to walk out of the clinic having accomplished what they set out to do. Dr Rajpara concludes: “Once I’ve explained about the treatment duration, swelling, bruising and recovery time, men are generally happy because they can plan their working lives around treatment. Most men manage to organise it in a way that affects their life minimally and achieves good results.”