Men’s Skin: Female-Based Dosing Standards May Not Be Sufficient for Male Cosmetic Treatments

man, face, botox, skin

It should surprise no one that, as a dermatologist based in image-focused Beverly Hills, I see a significant number of patients concerned with both the health and look of their skin. It is also not surprising—at least to anyone watching industry trends—to say that interest in skincare treatments is on the rise among the male demographic. Dermatology Times recently reported that the previous decade saw administrations of botulinum toxin injections (for smoothing wrinkles) jump by 50 percent, while dermal fillers (for adding volume to specific areas of the face) leapt 230 percent.


What is surprising: Despite the increase in men turning to dermatologists for skincare, there is a noticeable lack of research into how certain treatments and products specifically impact men as a distinct population. This dearth of data translates to what appears to be a dosing disparity: The recommended number of units appropriate for a predominantly and historically female patient base seems to be insufficient to meet men’s needs.


This is based on anecdotal evidence from my own practice and others—but also on findings from a study I authored with four other doctors and presented to the American Society for Dermatologic Surgery in October. Together, we examined data compiled from randomized, double-blind studies exploring the results of Xeomin® treatments. (Xeomin® is an injectable, similar to BOTOX®, that temporarily relaxes wrinkle-forming muscles.) These studies focused on 55 men who were part of clinical trials in the United States and 21 men who participated in a similar study in Europe.


What we found was that men experienced response rates lower than response rates enjoyed by women. Translation? The same dose given to a typical man and typical woman may not yield the same results. A man’s smoother forehead, for example, may not last as long as a woman’s. Or it may not smooth out as quickly. Put quite simply, men require a more potent punch when it comes to cosmetic treatments. That could look like upping the initial dose or otherwise customizing the treatment to the sex of the patient.


There are several reasons why this may be. Basic biology reveals that men’s and women’s faces and skin are different. Men’s skin tends to be thicker and produce more oil. Certain male facial muscle masses are more significant, and the underlying male bone structure is generally longer and wider, creating a more angular face.


Because of these unique factors, treatments and dosages tailored for narrower faces with dryer skin and less muscle mass—based on recommendations made by the U.S. Food and Drug Administration—can yield less-than-desirable results when applied to men with typically male facial characteristics.


Medical researchers have only recently begun researching this issue in earnest, and even now details are only just emerging. In 2013, researchers who examined 17 clinical studies that involved 5,646 patients found that just 11 percent of the participants were men.


While fewer men as study participants may reflect the reality of male/female demographic breakdowns when it comes to actual numbers of patients choosing cosmetic treatments each year (women overwhelmingly dominate across just about every category, save for the male-focused procedures, such as male breast reduction), the fact of the matter is that more research into men specifically is required if dermatologists and other medical professionals want to treat them not just adequately, but well from the first visit.


Yes, a good dermatologist can guide a patient to desirable results. When an FDA-recommended 20-unit dose of a botulinum-based neurotoxin fails to deliver for a first-time male patient, the situation may call for touch-up applications at a follow-up appointment two weeks after the initial treatment. While this strategy may ultimately achieve the desired results, it would be unnecessary if a more appropriately customized dose were given in the first place.


Men have historically not made up a financially significant percentage of cosmetic treatment-seeking patients, but that is changing—and regardless of even that shift, the medical community as a whole would better serve every patient by acknowledging that one size does not fit all when it comes to dosing cosmetic products.


Dr. Derek Jones is a board-certified dermatologist at Skin Care & Laser Physicians of Beverly Hills. BOTOX, dermal fillers, and other treatments are on his menu of services. Contact him online or by calling 310-246-0495.