Some aspects of botulinum therapy in male patients

Society's requirements for the appearance of a modern person motivate men to comply with the canons of gender attractiveness. External signs of aging affect men’s self-esteem and how others perceive them. For the most part, men want to look respectable, which creates a favorable impression on others, especially business partners. Therefore, small wrinkles in the forehead and between the eyebrows are regarded by others as a sign of experience and concentration. Recently, society has adequately perceived men's visits to a cosmetologist, pushing aside the opinion that visiting a cosmetologist is a purely female prerogative. Among the many cosmetic procedures for the male audience, botulinum therapy occupies one of the first places. On the one hand, being in a team and publicity limit the cosmetologist, since most other injection procedures can be accompanied by hematomas, swelling and papules, on the other hand, the male patient wants the result to be expressed in one, maximum two visits to the doctor.

Unlike women who want to completely “erase” the signs of aging from their faces, men need to be rejuvenated “a little bit,” to eliminate precisely those manifestations that are perceived as signs of ill health or fatigue. The task of a cosmetologist is to limit facial expression, reduce the severity of wrinkles that age the face and create the impression of unkemptness. Therefore, the priority for men is injections of botulinum toxin type A (BTA), which effectively solve these problems with quick and fairly long-lasting results.

Based on clinical experience and literature data, we can say that the gender approach to botulinum therapy is based on specifying the dose of neuroprotein, the number of units per injection point and the location of points for BTA.

The trend of modern aesthetic botulinum therapy is the use of a minimal therapeutic dose of BTA. The purpose of the correction is the regression of facial wrinkles while maintaining harmonious and natural facial expressions. If the clinical effect is short-lived, up to 2-3 months, then the dose of neuroprotein, if necessary, is increased gradually from visit to visit, in accordance with the recommendations set out in clinical consensus materials.

Before considering the features of correction of individual zones, I would like to emphasize that in male patients, the problems of wrinkles in the forehead, glabellar and periorbital areas are recommended to be solved in a complex manner.

Features of correction of key areas with abobotulinum toxin (Fig. 1).

The area between the eyebrows is the most active and expressive area of emotional expression in men, so correction of this area is of great importance. A total of 50-80 units of abobotulinum toxin are injected into this zone.

To correct eyebrow wrinkles, injections are performed at five points: one injection into the procerus muscle (m. procerus) and two injections into each corrugator supercilii muscle, 10 units of abobotulinumtoxin per injection.

The location and activity of the muscles can be clarified by performing facial tests (we ask the patient to wrinkle his nose and frown) (Fig. 2).

BTA injections in the forehead area (m. frontalis) are performed to smooth out horizontal wrinkles, preferably while maintaining minimal facial activity. The frontalis muscle in men is stronger and more active than in women. In this case, it is necessary to take into account the characteristic shape of the eyebrows for a man and carry out the procedure while maintaining their original position, without pronounced lifting.

To correct horizontal forehead wrinkles, the injection pattern is built after a facial test (the patient raises his eyebrows up), using a dynamic mesh. As a rule, BTA injections are performed at a greater number of points in men compared to women. On average, 6-9 points are located on one or two horizontal lines or in a checkerboard pattern. Total dose: 20-60 units (Fig. 3).

Also, to balance the depressors of the upper and levators of the middle third, it is necessary to take into account the activity of the muscle that lifts the upper lip and ala nasi (m. levator labii superioris alaequae nasi). Injections are performed at points located above the upper lateral part of the nostrils. Total dose: 4-20 units (Fig. 4).

Correction of the periorbital region in men has a number of features. So, it should be remembered that facial wrinkles in this area are the result of a positive emotional message. Therefore, correction of wrinkles at the lateral angle of the eye in men should be carried out gently, without completely relaxing the orbicularis oculi muscle (m. orbicularis oculi). Injections are performed at three classic points or the mesotoxin technique is used. Total dose: 30-60 units (Fig. 5).

Figure 1. Scheme of correction of key areas with abobotulinum toxin

Figure 2. m. corrugator supercilii, m. procerus Before/After

Figure 3. m. frontalis Before/After

Figure 4. m. levator labii superioris alaequae nasi Before/After

Figure 5. m. orbicularis oculi Before/After

The experience accumulated to date in the successful implementation of botulinum therapy allows us to adequately select and implement an aesthetic correction plan for male patients, taking into account gender and individual characteristics of anatomy and physiology, and obtain the most natural and stable results.