Bro-tox & Six Packs: The Truth About Cosmetic Procedures for Men

Announcer (00:02):
You are listening to Alabama the Beautiful with cosmetic surgeon, Dr. James Koehler and Kirstin Jarvis.

Kirstin (00:09):
Hey, Dr. Koehler.

Dr. Koehler (00:10):
Hey, Kirstin.

Kirstin (00:11):
What are we talking about today?

Dr. Koehler (00:13):
Always your choice. What do you want to talk about?

Kirstin (00:15):
Oh, I get to pick.

Dr. Koehler (00:16):
Yeah, you get to pick.

Kirstin (00:17):
Okay. Do you think that the statement is true that men don't really get cosmetic treatments as often as women do?

Dr. Koehler (00:24):
Oh yeah, that's for sure. Yeah, a hundred percent they don't.

Kirstin (00:27):
Okay. When you do have a man come to you, what do they complain about?

Dr. Koehler (00:31):
Women.

Kirstin (00:36):
This isn't that kind of podcast. Okay.

Dr. Koehler (00:38):
Well, I'm just saying if you want to know the truth. No, I mean, so first of all, I would just say I do think that men are definitely concerned with their appearance. That wasn't what I, but your question was, they definitely don't come into the frequency that women do for aesthetic treatments.

Kirstin (00:55):
What do you do for men?

Dr. Koehler (00:57):
I mean, sort of the most popular things that I would say men come in for are liposuction, gynecomastia, so fullness in the chest, occasionally tummy tucks after weight loss, not having kids. But nowadays, we're seeing a lot of people that have been on weight loss drugs and they've lost a lot of weight, and so now they want to get rid of the excess skin. So tummy tucks, but nose surgery for guys, rhinoplasty and chin implants, I would say are, and then not as much, like we're seeing more and more men actually choose facelift surgery. And actually that's something that I've noticed over the years. Men are, especially in professional careers, sales positions or CEOs of companies, I've heard people say, well, I really just for my job, I need to look young. And I think they feel a little bit, not threatened, but there's these up and coming young guys and they don't want to quit and they want to keep working. So yeah, so we're seeing guys that choose facelifts and eyelids I'd say it is also, especially upper and lower eyelids, really, we do see that. I share a picture often in consultation of a patient of mine who was a farmer who he came in to get his lower eyelids done, and he's like, I really don't even care that much about how I look. He says, but I'm just sick of people telling me I look tired all the time. I'm not tired. So there are different reasons why people will come in and get things done.

Kirstin (02:21):
How do you feel like the ratio of men to women compares in the office?

Dr. Koehler (02:27):
Oh, it's probably, I mean, we will see 20 women to one guy, and we do see men for injectables, some Brotox.

Kirstin (02:43):
You know what surprised me is a lot of men come in for laser hair removal.

Dr. Koehler (02:47):
Yeah, we do for nonsurgical stuff. Yeah, laser hair removal and Miradry for underarm sweat, which is, that's the one that actually, I feel like it's the one thing I offer in the office that I feel like if more people actually knew about it, they'd actually get it done. I mean, I've had it done. I did it for my sons, my daughter's had it done. I mean, it's a great treatment where you just basically, I mean, you don't sweat under your arms anymore. It's great. So a lot of professional men I've seen come in to get that kind of thing done. If you're an attorney and you're having to be in a shirt and tie in a court and whatnot, you don't want to have underarm sweat. Don't let 'em see you sweat.

Kirstin (03:28):
How do the goals for men differ than women, do you feel?

Dr. Koehler (03:33):
The key to all of this, whether it's a man or woman, is number one, first trying to establish exactly what it is that bothers a person. If we don't really have a full understanding of what their issue is, then we're not going to achieve their goal. So once we understand what the problem is, then the second thing is, is there a procedure that will address that to the extent that they will be happy? And if it is, then it's educating that person on what we can achieve, what's realistic, what's not, and then explaining the procedure and the recovery. And those goals are no different for men than for women. I would say maybe in the past that female patients come more educated about the procedures. I would say that would be more true in the past, but I don't really see that. I mean, maybe because of social media and everything, like

Kirstin (04:23):
Yeah, they've got a phone in their hand, now so.

Dr. Koehler (04:26):
Yeah, I mean, I feel like people that come in are generally, like they've done at least some research and they have more or less an understanding, whereas years gone by, maybe they're just like, is there something I can do for this? And they hadn't really done the research.

Kirstin (04:42):
Yeah. So we talked about men getting Brotox. Does your approach change when you're treating a man versus woman with toxin?

Dr. Koehler (04:52):
Yeah, I mean, whether we're using Botox or Dysport or any of the neurotoxins for treating dynamic facial lines. So the dosing is probably the biggest thing. And the dose that we're giving is based on the size and strength of the muscles. So yeah, there's standard doses that we typically give, and those doses just tend to be higher in men. I mean, just like in the muscles on other parts of the bodies. I mean, generally men are more muscular than women. That's not a hundred percent across the board, obviously. But in general, that would be probably a fair statement. And we tend to see the same types of things in the facial expressions. And some men have very, very strong corrugator muscles, and that's my favorite area to treat for anybody. But in particular men is if you can get rid of those deep furrows in the midline.

(05:46):
I mean, it's the only lines that really give a negative emotional connotation that you're either angry, or you're frustrated, or you're concentrating, but it's negative. But the dose tends to be higher. Men tend to require a higher dose, and so that is sometimes a little bit of a put off. Not entirely, but if, let's say I've got a husband and wife and the wife's coming to get her Botox, and it costs her this to get her areas treated. And then the guy comes in and he's like, why is it more for me? Well, it's not a one dose fits all. And I have some female patients with very dynamic facial expressions that require higher doses. So that's probably the main difference for men and women. I'd say the other big difference for doing Botox for men is men tend to have lower set brows, and if they've got a lot of forehead lines and they want to make those gone, it can be a challenge because when you treat that muscle to get rid of these forehead lines, that's also the muscle that is raising your brow.

(06:53):
And if you already have a naturally lower brow position, like a lot of men do, it can make their brow feel heavy. And so then there's a trade off. Are you willing to accept a heavier brow to get rid of those lines? Or what's it going to be? So there's some definitely differences between men and women in terms of Botox, but I'd say my male patients definitely number one area would be glabella, just not looking so angry. And women are much more bothered by crow's feet. A lot of my male patients, crow's feet, doesn't bother them. That doesn't bother them.

Kirstin (07:25):
That's interesting. Okay. Well, we talked about the surgical procedures that men are getting. Do you feel like your male patients recover a little bit harder? Do they struggle with taking it easy?

Dr. Koehler (07:40):
You are totally trying to do.

Kirstin (07:42):
No.

Dr. Koehler (07:42):
That's, you are. I mean, the guys are tough. They are tough. They're tougher than the women most of the time.

Kirstin (07:48):
Well, that's what I'm saying. Do they go out and mow their grass when they're supposed to be recovering on the couch?

Dr. Koehler (07:54):
I know where this is going. You're going to be like, oh, when my husband gets a cold, it's like the man cold, right? Is that what we're going to talk about, man cold?

Kirstin (08:00):
No, no, no. I just mean, is it harder to keep 'em down because they're wanting to go mow the grass or clean the pool or whatever.

Dr. Koehler (08:07):
Actually, I would say, you know what? It's hard to generalize. I have some wimpy male patients, and I have some wimpy female patients. I couldn't generalize in that regard, but so the procedures that men, it depends a lot on the procedure. Liposuction, if you're just getting love handles done, that's not a big deal, and people are up and moving pretty quickly. But if you do abdomen, chest, and love handles, now all of a sudden that's a lot more sore. So the recovery is very different, even though it's liposuction, it can be different depending on how many areas and how difficult it is to remove the fat.

Kirstin (08:45):
Do you feel like with men with liposuction, is it a little bit more difficult because you're sculpting them and their bodies are shaped, their goal is different than a woman. You want to make her an hourglass and a man, he wants to still have abs and.

Dr. Koehler (09:03):
Yeah. Well, there are other differences, like with men the fat in general tends to be a lot more fibrous than in women, although we do have female patients that have fibrous fat too. So one of the things when we're doing liposuction for men, I would say a tool that I use more frequently is ultrasonic or vaser assisted liposuction where we first break up the fat using ultrasonic energy, and then we'll come back and do the actual liposuction. And that has to do with, because their fat is more fibrous and dense and it's harder to just suction it off. We have to do things to kind of make it easier to do that. And yes, obviously the anatomy and the goals for the liposuction can be different. Something that maybe men will tend to choose more or have a desire for more is things like something called high definition liposuction, which is a whole subject in and of itself, but basically it's where you're not just liposuction, for instance, an abdomen. It's not like you just suction all the fat out, because you can do that, but that's not going to give you definition. High definition liposuction is a little bit of creating shadows in the right locations. And so it's selectively removing fat, where you remove, let's say, more fat in certain areas to help enhance, let's say the midline groove of the abdomen or the lateral edge of the rectus muscles. And then for the six pack, you're kind of helping better define those grooves in the six pack.

Kirstin (10:38):
We like the V.

Dr. Koehler (10:39):
Yeah, then you get the V. But those are great things to do. But the thing about high definition liposuction, and I would say definitely men would gravitate more to that, but you've got to meet, in my opinion, you've got to meet certain criteria. You've got to have stable weight that you're exercising fairly regularly, because if you aren't taking care of yourself, and that might look good right now, but in five years time now, it's going to look like somebody just carved some grooves in your fat and it's not going to look good. So my only worry about that high def liposuction is having a committed patient to, that's a long-term commitment there.

Kirstin (11:16):
Well, what about gynecomastia and breast reduction? Is it crazy different from a woman getting a breast reduction?

Dr. Koehler (11:24):
Oh, yeah. I wouldn't say crazy different. It's definitely different because there's sort of different extremes. So there's just your traditional run of the mill gynecomastia where let's say through puberty or maybe somebody did some steroids and working out, and anyhow, the breast tissue grows. And so sometimes men will have it because men have breast tissue, just like women do. And men can get breast cancer like women do. It's not nearly as common, but it can happen. The male chest is composed of fat and breast tissue just like a woman's is, but there's much less breast tissue. And in men, if that breast tissue gets enlarged, it can be tender, so they can have nipple tenderness, and they can have even firmness up underneath the nipple. And it can be uncomfortable, but it can also be just aesthetically not appealing. So I remember many years ago, I had a guy that was getting ready to go overseas in the desert, and he had gynecomastia, and he's like, I'm in the military.

(12:24):
I'm in the best shape of my life, but I feel like I've got breasts. And so it can be, that's something that, yeah, guys don't like to have that appearance. So there's an easy way to fix that involves just a little tiny incision at the base of the nipple, and sometimes involves liposuction as well, and that can take care of some of the milder cases of gynecomastia. But then there's sometimes people who've maybe had gynecomastia, but then maybe also had issues with weight gain and weight loss. And so now not only do they have maybe too much fullness in their chest, but they also have droop where their breast tissue is sagging over the crease of their breast. And so that tends to be more like what we would see in women, right? Because women typically, they have some of their own breast tissue they get sagging. If they're getting a reduction, they typically have a lot of their own breast tissue, and it sags, so we're not only just removing breast tissue, we're trying to reposition it. And so we do that for men, but it's a little different. We're trying to hide the scars a little differently. So sometimes with men, it's just an incision around the nipple and a horizontal incision underneath, but there's a lot of variations, and it's just depends on the case. But yeah, the gynecomastia is definitely, I mean, it's a more common surgery than people think.

Kirstin (13:45):
And male tummy tucks?

Dr. Koehler (13:48):
Yeah, I definitely have seen an uptick in male tummy tucks, although, and I think that's mainly just because of all of the Ozempic and GLP-1 agonists where people have lost significant amount, significant amounts of weight, and now they're dealing with the loose skin. And so yeah, probably the biggest difference between a male tummy tuck and a female tummy tuck, the operation is essentially the same, except for probably the most significant differences is probably with 90 plus percent of female tummy tucks, we're going to do some muscle repair, and that's because most of the women coming and getting tummy tucks are getting them because of damage from pregnancy. In other words, the muscles get stretched out and they don't kind of go back where they're supposed to. And so they have the separation of the muscles, and so part of a tummy tuck is repositioning those. But with the male patients, sometimes we see that with significant weight gain and weight loss, so we do muscle repair on men, but there's a lot of male tummy tuck where we don't need to do that muscle repair, and so that it's a faster recovery when you don't have to do the muscle repair.

Kirstin (14:52):
All right. What else do men come get?

Dr. Koehler (14:56):
Well, I mentioned eyelids. I mean, and a lot of men get, upper eyelids is something that will often get covered by your health insurance. When you start getting so much sagging skin that it affects your peripheral vision, that a lot of times is it's the one cosmetic surgery that for men that would likely be covered by insurance. Now they won't cover lower eyelids. Lower eyelids is almost always cosmetic. So you want to get rid of the puffy bags under your eyes, then yeah, also, it doesn't really change your appearance per se. The one thing about eyelids surgery, and the reason that I think guys feel better about, I think guys sometimes worry about they don't want to look like different people. And that's the great thing about eyelid surgery. Most of the time, a very successful eyelid surgery, the best thing you're going to hear is just, oh, you look really rested, or you look good, and they can't really pinpoint what's going on.

(15:47):
Well, that's a successful eyelid surgery, but it's not going to be so noticeable that people are like, oh, you had something done. And that's the fear I think sometimes for guys when it comes to facial stuff. But, rhinoplasties, we see that for men and women really, and the goals are different for everybody. Some people, they just like, I don't want to have a hump on my nose. So it's maybe a family thing. And then again, chin implants is another thing that oftentimes we're doing that in conjunction with nose surgery just to give balance to the face. So sometimes if you have got a really strong nose that we're trying to maybe not make it as powerful, like taking down a hump or whatever, but if you also have a weaker jawline, like we're trying to give some balance there. So we'll do a chin implant to try to give the face more balance. So the chins and noses are kind of procedures that sort of often go hand in hand.

Kirstin (16:40):
Dr. Koehler, everybody wants to know what you've had done.

Dr. Koehler (16:44):
Well, you know, nothing.

Kirstin (16:47):
You came that way.

Dr. Koehler (16:49):
Yeah, no, I had my love handles liposuctioned.

Kirstin (16:54):
Okay.

Dr. Koehler (16:55):
It's been a long time. I did it probably, it's been, well, probably about 12 or more years ago. That's the one area, I think for guys, the whole thing about liposuction is it's ideally suited for treating an area of stubborn fat. So even when you get down to your, let's say, your ideal weight and you have this area, it's like you can't get rid of that last little bit. Well, that's where liposuction really shines. It's not a weight loss procedure, and it's not a substitute for working out and eating healthy and all that stuff. But anyhow, for me, I did not like my little love handle area, and so suck it out, get it gone.

Kirstin (17:42):
Our reps treat us very well and make sure we're very well stocked with Botox and Dysport.

Dr. Koehler (17:48):
Yeah, I do that.

Kirstin (17:49):
We all.

Dr. Koehler (17:49):
I do Botox for sure, and Dysport. I mean, those are good. I wish I had the time to do it during the day, but getting things like the HydraFacials and microneedling and stuff, I enjoy getting those treatments, but it's just trying to get people to stay after hours to do that for you.

Kirstin (18:07):
Why do you have some men that come get microneedling?

Dr. Koehler (18:10):
Yeah, no, it's good. I mean, I think definitely there's things that women get done that guys just wouldn't, I don't know whether they just embarrassed to come in and get it done or whatever. I'm in this industry, so I want to try some of this stuff, and I don't mind doing it. But keeping your skin looking healthy, I mean, sure, radiofrequency microneedling is great. I like it.

Kirstin (18:35):
But also, if we're talking about manly things, like you mentioned Miradry, also tattoo removal.

Dr. Koehler (18:41):
Yeah, I did Miradry, I had that done too, too. Yeah. I haven't had tattoo removal. I haven't got a tattoo either.

Kirstin (18:48):
Oh, well, we treat a lot of men with different lasers and whatever, but we have tattoo removal here too that they utilize.

Dr. Koehler (18:54):
Yeah. Yeah. Tattoos can be a challenge. But yeah, the Miradry. I will say that's one thing that I love that I got that done that was like, it was awesome. I still, I'll put on deodorant, but I don't need to wear antiperspirant at all. I can go work out and it's great.

Kirstin (19:12):
That's what you think?

Dr. Koehler (19:14):
Yeah.

Kirstin (19:15):
I'm just kidding. I'm just kidding. It works well.

Dr. Koehler (19:19):
No, it does.

Kirstin (19:20):
I think just about everybody here has had Miradry and is happy with their results.

Dr. Koehler (19:24):
Yeah. Well, I mean, it's not going to, again, with one treatment, you're not going to a hundred percent eliminate all sweating, but it's a significant reduction way more than you would ever achieve with antiperspirant.

Kirstin (19:35):
Yep. All right. Anything else?

Dr. Koehler (19:39):
Well, I will say maybe what is it? Women tend to be a little better about instructions than guys, I think, I will say. I think they read through the booklet actually before surgery. It's kind of like, I'm not going to lie, I'm going to be in this category if I buy a new television or something, like owner's manual? What's that? I only need that after I've failed at putting together whatever it is that I thought I could do. So I think that probably carries over into surgery a little bit too. The guys are maybe not as good as reading through the instruction booklet, which I will say, and I will just make this comment to anybody who's listening here, reading through the do's and don'ts beforehand, you need to do that. There's things sometimes people realize, like herbal supplements and things that they're taking, they have no idea how that can impact their surgery in terms of bleeding and bruising and just general complications. So that stuff's important. But I would say that if I had to look at people who didn't follow certain instructions, I'd say the men are probably a little more guilty of not doing it.

Kirstin (20:52):
No.

Dr. Koehler (20:53):
Yeah. That's the only thing.

Kirstin (20:55):
The only thing, okay. All right. Well, do you have a burning question for Dr. Koehler or me? You can leave us a voicemail on our podcast website at AlabamatheBeautifulPodcast.com. We'd love to hear from you. All right. Thanks, Dr. Koehler.

Dr. Koehler (21:13):
Thanks, Kirstin. Talk to you soon.

Kirstin (21:15):
Go back to making Alabama beautiful.

Announcer (21:17):
Got a question for Dr. Koehler. Leave us a voicemail at AlabamatheBeautifulPodcast.com. Dr. James Koehler is a cosmetic surgeon practicing in Fairhope, Alabama. To learn more about Dr. Koehler and Eastern Shore Cosmetic Surgery, go to easternshorecosmeticsurgery.com. The commentary in this podcast represents opinion and does not present medical advice, but general information that does not necessarily relate to the specific conditions of any individual patient. If you enjoyed this episode, please share it and subscribe to Alabama the Beautiful on YouTube, Apple Podcast, Spotify, or wherever you like to listen to podcasts. Follow us on Instagram @EasternShoreCosmeticSurgery. Alabama the Beautiful is a production of The Axis, theaxis.io.