Facial Gender Differences in Nonsurgical Treatments and Treatment of the Tear Trough Deformity

What did Steve Jobs do for Apple? He did something different. He brought to a technology company the concept that design, and how a product is presented, are important. Before him, any computer you bought was just the same boring design; what the technology companies centered on was what was inside that computer, but Steve Jobs proved with Apple that design and presentation make a difference.

So, what connection does he have with facial aesthetics? We must never forget our face is our presentation card, the first impression others have of us. How we look helps us in our interaction with others and in our relationships. This is why aesthetic procedures are more and more popular in today’s world. And this is why the concept that beauty helps us escalate in our life, and in our career, proves true every day.

Looking good does count, as Forbes magazine proved CEOs earn more money when they are better looking. Studies at the University of Texas also showed that an attractive person can earn 3%–4% more than a less attractive peer. In another study, the University of Chicago showed that the more attractive a person is, the more confidence they have in themselves, and the better performance they show in all aspects of their lives.

Also, good design is shown as being glamorous and makes any product look more important and desirable, becoming itself an aspirational buy. This is what we as human beings, in this world, consciously or unconsciously, are seeking. Coming back to us humans, what makes us wanted by others? What make us look like an aspirational catch? Here I am not just referring to how the opposite sex or a future partner sees us, but how corporations see us, how even our own patients see us. The better design we have, the more aspirational we will be for others. Here it is obvious that males and females have clear differences in their structure; we carry preconceptions of male and female appearances, and how we (as men or women) want others to see us. Today, males and females do not necessarily have different goals, but it is clear in the end our sex does not matter, as each individual has his/her specific goal, one he/she owns. This is why I always like to come back to the essence. It is crucial to have the knowledge of the structural differences between a man and a woman, but we must listen to our patients to be able to construct the best treatment for him/her at a specific time and place.

We as surgeons often might want to do a great surgical technique that is just right for this patient, but it is up to the patient to decide if they want to have it or not. Today, it is not like before, where patients came to our office saying, “Doctor, what you think is best for me? You are the specialist.” More and more today, patients are participating actively in their treatment decisions. Because of easy access to information and techniques of today, patients just think they are surgeons already and many come not just asking, but with a demanding attitude: “This is what I want you to do on me,” and if they are not pleased, they will simply go to another doctor. Here, my friends, is where we as doctors need to remember our Hippocratic Oath, which says always give the best to our patients and never harm them.

So, how do you succeed in creating the best possible treatment plan for the patient? Well, if the patient is seeking a nonsurgical option and he/she needs a surgical approach according, to your assessment, then be clear about realistic expectations of the nonsurgical option, but never insist if they state from the beginning they do not want surgery.

Today, we are always running out of time. To have some days off has become a luxury for many, so when you have some free time, you need to weigh up to see how time can be better spent, in leisure time, with family, or in recovery from a surgical procedure.

It is also well known that in aesthetic procedures, we do not make molds and in particular, we can never attempt to use the same approach and treatment plan for males and females. Here are some important observations to bear in mind during a consultation.

Important Anatomical Differences Between Males and Females

There are important anatomical differences between males and females. Dividing them in areas will facilitate the delivery of information to you. We will start giving a general view where we can see how the skull is bulkier in males and rounder in females. Now we will divided into 3 areas: the forehead, the zygomatic and the jawline. The forehead area is normally rounder in males and flatter in females, and where going down towards the supraorbital rim, the supraciliary arch in males is much more prominent than in females. In contrast the zygomatic region is more prominent in females than in males. And the jawline in males is wider, with a more prominent masseter muscle and more definition at the mandibular angle than in females.

Table 10.1

Important Anatomical Differences Between Males and Females

Skull	The male skull is heavier and bulkier; the female skull is rounder and less prominent.
Forehead	Males have a rounder forehead and females a flatter one. Regarding the supraorbital rim, there is a great distinction between males and females, which is that males have a rounder and more prominent supraorbital region and superciliary arch than females.
Zygomatic arch	This is more prominent in males than in females.
Jawline	Males have a more defined and wider jawline and mandibular angle, with more prominent masseter muscles than females.

Differences in Nonsurgical Facial Assessment Between Males and Females

Overall appearance/skin

It is important to have a regular skin tone for a better overall appearance and optimal result with our nonsurgical treatment approach.

Females tend to have more hyperpigmented skin secondary to hormonal changes and dark spots distributed irregularly through their face than men. If this is the case, it is important to include a depigmentation option in the treatment plan.

Males tend to have more open pores and their skin tends to be oilier, so cleaning routines must be included in their treatment plan.

Females’ skin tend to be thinner and more prone to dehydration, so good hydration and skin thickening options must be included in their treatment plan.

Females tend to be more aware of their wrinkles, so options to prevent or minimize them must be included in their treatment plan.

Head overview

Face shape in males tends to be more squarish or trapezoid and in females, more oval or heart shaped; the younger the woman is, the more inverted triangle shape she has.

When a female face that is too square or a male face that is not trapezoid is found during the consultation, treatment options to counteract these facial shapes must be included.

Hair is very important for males and females. In females, hair loss tends to be more generalized all over their scalp but in men, it is more evident, especially as the hairline starts to recede, particularly at the temples, and hair loss is greater in certain areas such as the corona. When hair loss is identified during the assessment, it is a must to include hair-loss treatment options.

Facial thirds

Table 10.2

Facial Thirds, Soft Tissues, and Bony Structure

Upper third	Forehead is wider in males than in females. Eyebrows are lower and straighter in males and higher and more arched in females.
Middle third	More prominent in females than in males.
Lower third	More square in males and rounder in females. Must be prominent in males.

Soft tissues and bony structure

Face shape in males tends to have more angles and in females, it is rounder, smoother, and curvier.

When a female face that lacks smoothness or a male face that is too curvy is found during the consultation, treatment options to counteract these facial shapes must be included.

Lips: We must lose our prejudice that prominent lips are only for women. For a male to be more masculine, it is essential to have a prominent lower third and the lips are crucial here. Many times, male lips share a protagonist role in males along with their squared mandible, especially their lower lip. If you are still not convinced, just have a look at famous good-looking men. They all have prominent lips in their prominent square faces.