Men Ask. Male Aesthetics - Facial Aging and Hair Loss

"Do you know any proven ways to slow down and reverse hair loss?"
"I am working out and eating healthy. Yet I am seeing signs of aging on my face. Why? And what can I do about it?"
I have been receiving many private messages from men with questions similar to those ones and decided to write a separate post on the matter.
​In this post: male facial aging concerns - anti-aging in general and facial aging; male facial aging - three lines; rejuvenation options; information resources; male medical aesthetics is a growing trend; basic anti-aging advice. 
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Facial aging and anti-aging

I will begin by saying that unfortunately this is not entirely an anti-aging question. 

Yes, nutrition, physical exercise, sleep, alcohol consumption, smoking, anti-aging supplements, fasting, etc influence how young a face looks; however, a person can be perfectly healthy and fit and have an amazing body, and the face will still show signs of aging due to genetics, environmental factors, prior weight gain - weight loss cycles, or, what I call, tear-and-wear. 
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There are several anatomical  layers on the face: several layers of skin (epidermis and dermis), superficial fat pockets, muscles, deep fat pockets, connective tissue and, possibly, interstitium, and the bones. While the lifestyle and anti-aging regimens have a large impact, the anatomical layers still age, and they age at a different pace, under the influence of different factors. 

​Facial and body rejuvenation above and beyond what is/can be achieved with the lifestyle changes and anti-aging supplements is addressed by the medical branch called medical aesthetics. 
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Male facial aging concerns - the three lines

​MDs who specialize in the male facial aesthetic treatments and know what their clients want, use an almost coined phrase, "Men are concerned with three lines: jawline, eyeline, and hairline." (unlike women who are concerned with so much more :))
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Jawline - lost definition of the lower face, facial sagging and/or fat accumulation under the chin/jaw. 
Eyeline - dark circles, hollowness or puffiness, "I look tired".
Hairline - the hair loss that frequently starts in 20s and affects at least 50% of men.
I will also add the fourth one - a deep line(s) between the eyebrows. ​
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Rejuvenation options

It is always better to prevent an issue than to correct it, and at the end of the blog post I included some basic anti-aging advice.
​For those who are already facing the issues, modern aesthetic medicine and cosmetic industry offer numerous options, including inexpensive and non-invasive ones, for the facial rejuvenation and hairline restoration. 

The full high-level lists of options to treat the three lines are -
Hairline:

• topical Minoxidil; 
• topical peppermint oil and/or lavender oil; 
• topical caffeine solution; 
• a range of vitamins and minerals; 
• specifically formulated oral hair growth supplements;
• oral Finasteride; 
• Low Level Laser Therapy (sometimes combined with LED);
• PRP/PRFM (Platelet Rich Plasma/Platelet Rich Fibrin Matrix) injections;
• SVF (stromal vascular fraction) injections;
• autologous micronized or unprocessed fat injections, alone or combined with SVF or PRP (our fat is the richest source of stem cells in our bodies);
• micro needling with an electric device or at-home micro needling with a derma roller, alone or combined with topically applied immediately before and after the procedure PRP or growth factors/stem cells;
• surgical hair transplantation. 

Eyeline: 

• high quality eye creams and serums to hydrate and plump the skin and trigger collagen and elastin production and hyaluronic acid saturation;
• LED to gently stimulate skin rejuvenation;
• injection of specifically formulated for the eye area hyaluronic acid fillers;
• fat transfer;
• a more refined procedure of micronized fat transfer or fat with SVF transfer;
• lower eyelid surgery, alone or combined with fat transfer.

Jawline:

• under the chin injections of Kybella to dissolve fat;
• device enabled fat melting procedures;
• device enabled skin tightening under the chin;
• micro current treatments to tone and lift facial muscles to improve the overall definition of the face including the jawline; 
• fat transfer or volumetric filler injections to replace lost volume and lift the skin (that will improve the jawline too);
• RF and Ultrasound Device skin (dermis) tightening procedures;
• surgical facelift;
• facial implants.

​Unfortunately, even in a long blog post, it is not possible to give an answer suitable for everyone as to what the best option is, not only because of the number of the options, but also because reasons for an aged look and the stage of aging vary from person to person, and the most suitable option also depends on the age of a patient and the budget. 

​Take the hair loss, for example.
​It may be tempting to give an advice like in many blogs, "use minoxidil 5%, it's inexpensive, and has a high likelihood of effectiveness".
The reality is that - 

1. 10% Minoxidil may be more effective (yes, there are no clinical studies, it's not approved by FDA, however, Minoxidil has been shown to be dose-dependent),
2. Some people have an allergic reaction to Minoxidil (itching),
3. Some men do not see results from Minoxidil, for example, because the reason for their hair loss is not androgenetic (androgenic) alopecia or it is just not effective for them;
4. Some men have so much on their plate that it is not realistic to apply the product twice-a-day for months;
5. Non-surgical treatments, if they work, only work on the areas where the dormant dying hair follicles still exist deep inside. If an area has had no hair for several years, meaning that the hair follicles are probably completely gone, non-surgical options are unlikely to produce results.

(Source: ​Topical Products for the Hair Growth. Minoxidil)
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Every situation is different, and in the section below I included information sources for research on possible treatments.  In the end I also included a generic preventative facial anti-aging advice.
If you don’t have time for research and want information and advice geared precisely to your situation/question, I give private paid consultations on the phone (I have all the information starting with the facial anatomy, anatomy of the facial aging, and the treatment options, but I do not perform any treatments). ​
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The line between the eyebrows 

An easy answer can be given only to the question on treating the line (deep wrinkle) between the eye brows.
The only truly effective way to deal with it is an injection of Botulinum Toxin (Botox, Xeomin, or Dysport).
The Botulinum Toxin injections are statistically number one non-invasive cosmetic procedure, with 7.2 million procedures performed in 2017 in USA alone (2018 data is not yet available). Roughly 11% of those 7.2 mln procedures were performed for male patients. 

​The major difference between Botox injections between genders is that on the face too, men have bigger and stronger muscles and men typically require an injection of more units of Botox than women do to achieve the same result. The effect from the injections lasts 4 to 6 months, after that the muscle returns to the same state it was before the injection. ​
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Information Sources for Research 

There is a lot of information on the facial aging and rejuvenation treatments at:

• Medical Aesthetics Information Platform and Solutions. MAIPS.com - Science based information centered around issue/area of concern with a large spectrum of options covered, the focus is on non-invasive options (not surgery);
• realself.com - Doctors answer questions on treatment options and surgery. I like the sheer volume and variety of questions and answers. The drawback is that doctors' opinions vary a lot depending on which technique/procedure they are proficient with. In my opinion, this is a great source to find a doctor once you are somewhat clear on the desired procedure;
• High level description of procedures by American Society of Aesthetic Plastic Surgery;
• High level description of procedures by American Society of Plastic Surgeons. 

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Medical aesthetics for men is a growing trend

In case you were curious... 
​There already are medical aesthetics clinics, and more are opening,  specializing in male procedures. In South America this was the case already 15-20 years ago; USA and Canada are starting to catch up. This is in addition to the medical aesthetics clinics, centers, spas, plastic surgery centers that service clients of both genders.
To clarify, aesthetic and cosmetic procedures include a wide range of non-surgical, non-invasive or minimally invasive options such as injectables and various device enabled treatments. 
​
​To elaborate on why there are separate clinics for men - 

• ​First, there are some differences between male versus female anatomy. There are no major differences in how treatments are performed on men versus women, however, the aesthetic goals vary. The idea is to make a man's face look younger while preserving its masculine features; and the treating doctor should have the aesthetic sense and vision for the male beauty and treat accordingly; 
• Second, some men don't want to be seen by women during the procedures;
• Men are often interested in body-contouring procedures as much as in the facial rejuvenation (and hence the clinic's offerings differ);
• There is also a growing demand for the sexual rejuvenation/enhancement treatments that are obviously different for men and women (not covered in this post).

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​The point is that the mere fact that the number of those clinics grows is an indicator of the flourishing demand for the male aesthetic procedures, including facial ones. The statistics by American societies of plastic surgeons confirm the trend.

Reasons why men get interested in aesthetic treatments vary - 

• Some men go for procedures because their wives have been taking care of their faces, and at some point a husband starts looking like a father to his wife, and some couples want to address that. As a matter of fact, most referrals to medical aesthetics clinics that provide services to both genders are made by wives and girl-friends;
• ​An increasing number of people in their late 30s, and in 40s and 50s are back on the dating stage;
• Some other men, and women too, feel young at heart and are physically fit and they don't like a dissonance between that and the facial aging they see in a mirror;
• American culture that places an emphasis on youth and looks, and men are sometimes motivated by career considerations, wanting to be perceived as strong and vibrant at the workplace. 

Whatever the reason, worldwide, male rejuvenation/aesthetic/cosmetic procedures is a fast growing area of the medical aesthetics. A recent survey showed that 40% of men were interested or possibly interested in cosmetic procedures, 43% were not satisfied with facial appearance. And sales in men's grooming industry reached $50 billion in 2017. 

It is worth noting that men are more reluctant than women to reveal even to their peers that they had any cosmetic procedure done and they are less tolerant to the downtime after procedures. 
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Basic preventative anti-aging advice for the face

Just like with any anti-aging, the best strategy is to prevent rather than to correct. What measures above and beyond healthy lifestyle and broad-spectrum anti-aging approaches can be taken to delay the signs of facial aging? 

1. If you have light-colored skin, apply a sunblock or a broad-spectrum sunscreen of at least SPF30 whenever you go outside and the UV Index is over 4-6 (you can see it in any weather app) and wear sun-glasses. Exposure to strong UVA and UVB from sun ages skin, resulting in the destruction of collagen and elastin and in the accumulation of dark pigmentation. Those changes lead to wrinkles, lines, brown spots, overall aged looking skin. Strangely, the majority of SPF advertisements are still found in the magazines with female audience.
   
2. When in the sun, wear sun glasses. Squinting from bright sunlight speeds up development of the crow's feet wrinkles around the eyes.
3. ​Avoid (minimize) ups and downs with the weight, starting at the young age (18 - 20 years of age). Weight loss always results in a loss of fat in the deep fat pockets of the face. These deep fat pockets are not excessive fat, but a part of the facial structure that creates the youthful look. If you gain weight, these deep fat pockets do not get inflated as much as the rest of the fat deposits on the body. When you lose weight, these pockets get deflated at least at the same rate as elsewhere on the body. Thus, the cycling of weight gain - weight loss is a downward spiral for the look of the face. The same size outside tissue (skin) will be hanging on a smaller size frame (due to less fat volume inside).
4. Use a good moisturizer, facial cream, and eye cream starting in your 20s. Creams and serums will not help with the hair loss and the jawline, but they will help preserving the overall quality of the skin and the delicate skin around the eyes. The most basic and inexpensive are A) any basic Hyaluronic Acid Serum (search on amazon) - it hydrates and plumps the skin, also conceals superficial wrinkles; B) Vitamin C serum or a Retinoid (Vitamin A cream). Apart from these basic options, cosmetic industry offers hundreds of product lines, and some of them are designed specifically for men.  South Korea leads the planet in the quality and effectiveness of their cosmetic products, and you can use any cream typically advertised for women (skin is skin), or choose from the product lines designed for men. Missha is an expensive line, sold in the USA, has products for men.
5. ​For the hair loss prevention, if you are genetically predisposed to it, some hair doctors recommend using 2% Minoxidil.​
6. Take vitamins and minerals. Particularly, calcium, magnesium and vitamin D combined work to preserve the bones (the bones start deteriorating and the skull starts decreasing in size starting around the age of 60). 

Any comments, questions or suggestions are welcome.