January 14, 2011 . Pictured on cover, from left: Dr. Mark Checcone and Dr. Gregory Branham.

Ever since Cleopatra lined her eyes with smoky lead powder, women have had an edge when it comes to enhancing their face. From lipstick to lipo, beauty products and services have traditionally been marketed to the ladies. But gender equality has arrived at the plastic surgeon’s office, although goals and procedures may differ.

    “The vast majority of our patients are female, but we do have quite a few men, as well,” says Dr. Gregory Branham of Washington University Facial Plastic Surgery Center. “For men, the most frequent concern is their eyes—bags, puffiness, the sort of thing that makes them look tired.” Surgery of the lower or upper eyelids (blepharoplasty), Branham explains, gives the face a refreshed appearance, with a lower ‘bleph’ being the more commonly used procedure on male patients.

     “Men and women age differently, particularly around the eyes,” Branham says. “Women generally want a smooth, wrinkle-free appearance. But if you remove that much skin from a man’s face, it would be too smooth and unnatural looking. This is even more true for lifting the brow—in women, you want to lift it significantly and give the brow a nice arch. In a man, the brow is horizontal and you don’t want it arched or rounded.”

    Although men most often address a single area, they sometimes opt for more extensive rejuvenation, Branham notes. “Often it’s a question of downtime. A younger patient who needs to return to work quickly may opt for eyelid surgery, for example, but an older patient with more flexibility may choose to have a complete facelift.” It’s important for patients to understand what will give them the best results, he adds. “Usually we age in three different areas: the face loses volume, things tend to sag as the ligaments are pulled by gravity, and then we have texture changes on the skin itself.”  He says the one problem that is most unrecognized is volume loss, which can be corrected with fat, fillers or cheek/chin implants. “You want to put the sagging tissues back where they belong, but you must deal with the volume loss, as well.”

    While facelifts and eyelid surgery address concerns for men and women, a different surgery is often requested by boys and girls. “The age varies for young people, because you must wait for full maturation—the facial structure must have stopped growing,” explains Dr. Mark Checcone of the Facial Plastic Surgery Center. “In girls, that would be around 16 to 17, and in boys, 17 to 18. You shouldn’t operate any sooner, because there’s a risk of later growth of either the nose or the facial bones.”

    As with other surgical enhancements, there is a gender difference in the ‘design approach’ to rhinoplasty, says Checcone. “There are certain aesthetic norms. Women will usually seek a more feminine appearing nose, narrow with more tip definition. Men, who are perhaps repairing an old sports injury, want to have a straighter nose.”

    In the Battle of the Sexes, it’s now a level playing field for any 21st century Cleopatra and Antony.  LN

On the Cover: Specializing in both cosmetic and reconstructive surgery of the face, head and neck, Dr. Gregory Branham and Dr. Mark Checcone of Washington University Facial Plastic Surgery Center bring more than 25 years of combined experience to their practice. The surgeons see patients at their West County office at 605 Old Ballas Road, Suite 100. For more information, call 432.7760 or visit facialplasticsurgery.wustl.edu. Cover design by Erica Fisher