I've been in practice as a plastic surgeon in New York for 17 years. Plastic surgery appealed to me because of the artistic, sculptural element. I like to say that I'd rather be a chef than a line cook. I like creating and not following recipes. Most surgery is a recipe, there's not a lot of variance. With plastic surgery, there's a lot of nuance. And, I really like problem solving; every plastic surgery faces a unique problem set.
I remember when I was in training 20 years ago, there were a lot of lectures in plastic surgery about problem patients and red flags to be aware of. At the time, simply being a male was considered a red flag. They were seen as potentially difficult patients, there was uncertainty about what their motivation was or whether we would be able to make them happy.
Men having plastic surgery was not as accepted and there was a thought that men were maybe doing it for what we call "external factors", which is always a big concern. If you're seeking plastic surgery because you think it's going to get you more acting roles, a promotion at work or to get your wife to love you more, those are external factors that are red flags. We can do great surgery and if that promotion doesn't come to pass the patient is potentially going to blame the surgery. That was the thinking at the time.
The increase of men having plastic surgery
I'm predominantly a facial surgeon, so I've always had male patients because I do a lot of rhinoplasty work. Those patients tended to be men coming in for nasal procedures after traumatic injuries. Men still do come in for that, but there are more men now coming in for cosmetic surgery. While men used to represent 5 percent of my patients, now they're perhaps 20 to 30 percent. In the non-surgical realm—botox and fillers—men are still in a minority, but I have seen that increase as well.
The concept of the "metrosexual" male gained attention in the '90s and I think that was the beginning of more social acceptance for men being interested in improving their appearance. Now, I think plastic surgery for men is fully accepted. I don't think that men feel there is a stigma anymore, which is the biggest change. More recently, there was a "Zoom boom" that brought more male patients in, because people were seeing themselves on camera a lot.
Now more men are coming in for eyelid lifting procedures (blepharoplasty), neck lift procedures (platysmaplasty) and for facial liposuction and facial tightening. There aren't many men asking for lip augmentation, though there are some exceptions. And more men are coming in for botox and fillers.
Men typically do not want brow lifts or heavy forehead botox; they are more accepting of line retention. Generally, I will err on the side of conservatism with forehead botox for men, because they are not going to be upset if there are still some lines. Though I do cheek fillers for men, it's likely to be to support the under eye area. Men I see are not typically looking for a high cheekbone, though there are always exceptions.
It's very rare for men to show me a photo of another man that they want to look like. Fortunately, for rhinoplasty and chin augmentation there is imaging software we can now use, so you can show them how they are going to look on an image of themselves.
The most popular plastic surgeries for men, and who has them
Rhinoplasty is still by far the most popular surgery I perform on men. The second would be chin implants, which is also commonly done with what's called the submentoplasty; a surgical tightening of the jawline that creates more definition. And, the third most popular procedure would be lower eyelid surgery.
But the age demographic of men I see is pretty broad. Rhinoplasties I perform are typically on men in their late teens to early 30s. But as we age, sometimes the nose ages and the tip drops, and that accounts for the second, much smaller spike I see of men in their 60s and 70s. While I see women in their 30s have eyelid surgeries, it's typically men over 50 coming in for eyelid surgery or neck lifts. Then men that are getting botox and fillers tend to be 40s and above, which again is an older demographic than women I see.
I don't think there's any particular reason why men tend to be a little older for certain procedures than women. It may have to do with societal pressures but I also think that men tend to be less concerned with these issues, for example their upper eyelids, until they get more extreme. I would say that with men I see, there are less external motivators now than in women. Maybe that's related to social media. I hate generalizing but I find that social media is generally dominated by female influencers, and there tends to be a lot of photographs posted of the influencer themselves.
But I don't think the motivations of men coming to me for plastic surgery are very different to those of women, mostly it's an internal motivation; wanting to feel good about themselves, to feel confident, to feel like they are the best they can be for what they are, but not trying to be the person that they were 20 years ago. I'm no different. I look at a photo of myself from 20 years ago and think it would be great if I still looked like that! Usually you can't look exactly like that, but, maybe you can look a little more like that.
But if the motivation for plastic surgery is about caring how other people treat them or thinking that other people are going to respond to them differently by having this procedure, that's a dangerous road because we can't control other people.
I've seen a lot of men that felt like they were more successful in dating after surgery; finding people that they like and who like them back. I think that comes from the change in them due to an improvement in self-confidence. I typically see that in men who have had rhinoplasties, or chin and jawline procedures. Those are the areas I think men I see are particularly self conscious about.
I've probably performed several thousand rhinoplasties on men and hundreds of eye and face lifts and chin augmentations, and I don't think there's really any difference in treating a man and a woman. All surgery is about being able to have a dialogue and figure out exactly what it is the individual wants and getting a result that looks balanced and appropriate.
But for some surgical procedures, men in general are much worse candidates than women. For lifting procedures, for example, men's tissues are typically heavier, it's harder to get the lift, it tends to feminize the face a little bit, and result in scars that are visible.
I do think a man getting a face lift is still not as accepted in society. And, without hair to cover it up, a facelift scar is going to have some visibility, which men often do not like. As a result, for brow lifts and facelifts, my standards for whether or not a man is a good candidate and going to get a good result, and whether it's worth the downsides of these other factors that may cause problems, are much higher.
The future of male plastic surgery
Future trends in plastic surgery probably depend on whether the "dad bod" falls out of favor! If there's a push back from society on the "dad bod", then I think there probably will be more men seeking body contouring. As non-invasive machines—electro-magnetic muscle building, fat reducing machines—get better, I think there will be more and more men seeking those types of treatments because they are non-surgical. However, I have seen that the jawline is very important to men I treat, so I think jawline procedures will continue to increase. And, to a lesser extent, eyelid procedures as well.
I'm really curious to see in 20 years from now what the aging population looks like and if, with an increase in non-surgical procedures, there will be less surgery.
Personally, I don't think there is really any difference between going to the salon or getting a suit tailored to fit you perfectly and having non-surgical body contouring. Obviously you can go to the gym or get a personal trainer, but we're all different in our capacities and what we can accomplish and I don't see any problem with doing something to help move that further along if it makes you feel good about yourself. Once you get into the realm of surgery it gets a little difficult to take that same perspective, because the risks go up a little bit.
But my role as a plastic surgeon is never to say whether someone should or shouldn't have a procedure, because it's not my decision. My role is to say if it's possible and if the risk associated with it is reasonable for the result someone is trying to achieve.
Going on this journey with people is very rewarding. There is a sense of kinship. My patients have this dream of something they want to accomplish, you get there and they are so relieved and happy. You can tell when they come into the office afterwards that the way they carry themselves is different; the way they interact with people is different. I see so many patients come out of their shell and feel good about themselves.
Dr. Richard Westreich is a double board certified facial plastic surgeon and founder of private practice New Face NY. Dr. Westreich is assistant professor at SUNY Downstate Medical Center and is on staff at Lenox Hill and Mount Sinai Hospitals.
All views expressed in this article are the author's own.
As told to Jenny Haward.
This article has been updated with additional details from Dr. Westreich.
