In reading a recent entertainment article which I came across in researching a plastic surgery topic, the writer presented an opinion on the top ten plastic surgery disasters in men. Using before and after photographs, they compared the ‘before’ and ‘after’s of several well known male celebrities- of which there is no doubt that these men have had facial work done. And I am not referring to in-office procedures such as Botox and injectable fillers. All had obvious surgical manipulation of aging facial features.

Those listed are well chronicled and include often cited celebrities such as Kenny Rogers, Gary Shandling, Carrot Top, Sylvester Stallone, Bruce Jenner, Burt Reynolds and David Gest to name a few. While I am certain that they don’t feel unusual looking, most women would disagree. This begs the question of what is it that makes them look unnatural? Is there a common problem that they all share?

In reviewing the ‘after’ images the problem lies for many of them in the work around the eyes and cheeks. On the whole, the appearance of these men has changed to more of a feminine look. This is the result of a variety of changes that include over-elevation of the brows, a ‘pulled too tight’ appearance around the eyes, and unnatural cheek bone augmentation giving an ‘apple-cheeked’ effect. In an effort to rejuvenate the aging and sagging face, they have been overlifted and augmented. Neck and jowl line work, even when done well, can often reinforce a more feminine look.

This may make the skin much smoother and eliminate a lot of skin wrinkles and folds, but the end result is anything but ‘natural’ in appearance, and is a red flag that screams ‘facelift!’ to even the least discerning eye. (even though a true facelift works on the neck and jowl area)  Certainly, men care about their appearance as they age, and want to look as young as they feel.  With regard to celebrities, it’s a usually a foregone conclusion that plastic surgery is a necessity in order to keep pace with the up and coming younger entertainers.  However, great work – and natural looking results are never a guarantee in Hollywood surgical circles, and paying top dollar to a well-known or famous surgeon really has nothing to do with the final outcome.

To get a natural looking result in men, facial rejuvenation really has to be ‘underdone’ in comparison to the female equivalent. Women can aesthetically tolerate more significant tissue movements. The goal of very smooth skin and sleek facial features simply looks better on women. Even when women have gone too far, they rarely look as bad as what can happen in men. Nips and tucks are very helpful to slow the aging process down in men, but dramatic sweeping changes simply trade-off one problem for another. Facial rejuvenation in men illustrates the age-old concept that less is often more.

Barry L. Eppley, M.D., D.M.D.

Indianapolis, Indiana

Recent stories have surfaced that the actor, Michael Douglas, has had a facelift. Based on what are perceived to be scars at or around the ears, reporters are questioning as whether he had had this plastic surgery procedure. Given that many celebrities and ordinary men have facelifts, I am not sure what makes this story news worthy. But the story does raise important issues about the male facelift and the objectives of any facelift surgery.

Facelift surgery for men is becoming more commonplace today. Men are becoming increasingly desirous of a more youthful and attractive appearance in both the business and social world. As the popularity and commonality of plastic surgery in general has risen, so has it also become more acceptable for men to be concerned with their appearance as well. In my Indianapolis plastic surgery practice, I am seeing more men than ever who do not like the appearance of their sagging necks and jowls.

The goals of a male facelift are certainly similar to that of a conventional facelift for women. In both, a refreshed and rejuvenated facial appearance is desired. Equally so, however, is a natural and unoperated look afterwards. The overall strategy for achieving such results is gender identical, including the lifting and tightening of loose jowl, neck, and lateral face skin as well as the removal of neck fat and the tightening of the platsymal neck muscle. However, a facelift in men requires the consideration of some different techniques to get the most non-conspicuous result.

The key difference between facelifts in men vs. women is in regards to the incisions made during surgery. Because men not only wear their hair shorter but usually have less hair than women, hiding the incisions used in a male facelift is more challenging. The male hair and beard locations allow for less flexibility in where incisions can be made. The basic incision pattern is along the natural crease where the ear meets the side of the face, around the earlobe, and into the lower scalp area extending out from the back part of the ear.

The key decisions to make about this incision placement is whether to use a preauricular (along the natural skin crease in front of the ear) or a retrotragal (bringing it inside the ear) location. The retrotragal approach hides the incision better but requires beard management, either removing hair follicles during or after surgery. There are plastic surgery advocates for both approaches. Also, how and where the backcut of the incision on the back of the ear is made is also of cosmetic significance. Not having a visible scar extending from behind the ear into the scalp which is not seen from the side or back is important. Limiting this incision so that it can be better hidden (keeping it in the crease) also influences how much neck improvement can be obtained.

Men also have more blood vessels in their face than women as well as a higher incidence of high blood pressure. This combination means that the risk for bleeding after surgery and getting a hematoma is higher. Pain control, blood pressure management and a good dressing are very important immediate after surgery precautions that need to be done.

Lastly, successful male facelift surgery to me is one in which it is not obvious that the procedure was done. Mild to moderate neck and jowl improvement that is not unusual looking is more important than a more significant improvement that looks unnatural. A common problem in men that have multiple facial plastic surgery procedures is that the male face can become feminized, looking too angular or defined.  

 Dr. Barry Eppley

Indianapolis, Indiana