Derm Topics

Male vs. Female: The Aesthetic Consultation

Aesthetic derm experts Dr. Terrence Keaney and Dr. Deirdre Hooper share pearls on addressing the unique needs of male and female cosmetic patients.

The Male Aesthetic Consultation

    • Male cosmetic patients should be evaluated differently: both anatomy and behavioral differences set male and female patients apart.

      “11” pattern in women
    • The male face is shaped differently by both the skull and soft tissue – features include a high and wide forehead, a wider face, a more prominent supra orbital ridge, a flatter medial midface and more lateral cheek projection with a wider chin and jaw.

      “U” pattern in men
    • Men tend to age more poorly – in blinded assessments men have been found to appear 0.37 years older than their stated aged and women 0.54 years younger.
    • Men’s wrinkle patterns are also unique. For instance, men tend to develop a “U” pattern in the glabella vs the “11” pattern in women.

      Lower fan pattern in men
    • When it comes to the lateral canthi, men tend to have a lower fan pattern while females are more evenly distributed.
    • When it comes to volume loss, men have steady atrophy of soft tissue as opposed to the rapid decline seen in females, and a gradual decrease in circulating testosterone averaging 1% per year beginning at age 30.

The Main Areas of Cosmetic Concern for Men

  • Hairline
  • Eyeline
  • Jawline
Interesting Fact: All of these concerns are considered off-label for fillers


  • The number one cosmetic concern for men is HAIR LOSS.
    • It has a large psychosocial impact:
      • Men who suffer from Androgenetic Alopecia (AGA) are 75% less confident.
      • Loss of self-esteem, introversion, and feeling unattractive.
Interesting Fact: Only 25% of men with AGA seek treatment for hair loss


  • The periocular area is also a prominent concern – many patients will notice that they “look tired” referring to crow’s feet.
  • Beware of eyebrow ptosis:
    • Avoid frontalis in patients with eyebrow ptosis
    • Be wary of treating the corrugators due to possible diffusion to the inferior fibers of frontalis muscle.
  • For male eyebrow lift:
    • Treat eyebrow depressors: procerus and vertical fibers of orbicularis oculi.
    • Avoid peaked eyebrows (feminine feature!).
  • For male jawline, Dr. Keaney recommends combination treatments:
    • Treatment approach to lower face/neck.
      • REDRAPE: Skin tightening with HIFU, RF.
      • RESTORE: Lower face dermal fillers.
      • REMOVE: Non-invasive fat reduction.

Dr. Keaney spends a lot of time with his cosmetic patients discussing technical details and addressing all possible side effects.  Men are less savvy about cosmetic procedures and lack basic understanding of available procedures and therefore may need some extra detail.

  • Keep the treatment plan simple – start with one procedure and then add on more.
  • Men are less tolerant of pain associated with elective cosmetic procedures.

The Female Aesthetic Consultation

For Dr. Hooper, a successful aesthetic consultation with her female patients includes:

  • Listening and understanding her patients’ goals.
  • Being kind and positive.
  • Taking good before and after photographs.
  • Creating a plan:
    • Short-term.
    • Long-term.
    • Within budget *But Present IDEAL Plan FIRST*
    • With clear, realistic expectations.

When working with female patients on a budget, Dr. Hooper recommends:

  • Always address the patient’s primary concern.
  • Balance immediate effect and treating the underlying cause.
  • Be clear if you cannot address the patient’s concerns within their budget.
  • Consider treating one area fully, avoid spreading resources too thin.
  • Consider deferring treatment until budget allows.

When designing treatment plans, keep this in mind:

  • Short Term Plans:
    • Problem focused.
    • A wow.
    • Skin care regimen.
    • Example:
      • 30 u neuromodulator.
      • 1cc Belotero.
      • 3 products.
      • IPL face.
      • 4 products.
  • Long Term Plans:
    • Prevention and Maintenance.
    • References Number Visits/year.
    • Emphasizes Your role as the Guidance Expert.
    • Example:
      • See me 3x/year.
      • Neuromodulator.
      • Skin Care Update 2x/year.
      • Filler 1-2x year.
      • Schedule Skin Treatments.
      • Laser 3x.
      • HydraFacial 3x.

Make Sure She Knows the Plan:

  • Print Materials:
    • Product and Procedure Explanations.
    • Prices.
    • Pre and Post treatment Instructions.
    • Consents.
  • Online Materials:
    • Before and After Photos.
    • Videos.
    • Educational.

Step by step, and to ensure you manage your patient’s goals and expectations, the aesthetic consultation should look like this:

1. Book effectively.
2. Listen, be kind, photograph.
3. Present ideal plan.
4. Establish budget.
5. Present revised short term and long term plan.
6. Put it in writing!

Did you enjoy this post? Find more on Aesthetic Derm topics here.

This information was presented by Drs. Terrence Keaney and Deirdre Hooper at the 16th Annual ODAC Dermatology, Aesthetics and Surgical Conference held January 18th-21st, 2019 in Orlando, FL.  The above highlights from their lecture were written and compiled by Dr Angelo Landriscina.  Dr. Landriscina was one of the 5 residents selected to participate in the Sun Resident Career Mentorship Program (a program supported by an educational grant from Sun Pharmaceutical Industries, Inc.).  Dr. Angelo Landrisicina, is PGY-3 resident at the George Washington School of Medicine and Health Sciences Dermatology Residency Program.