L&M's investigations

"When men take care of their appearance

Catherine De Goursac, MD

Dr. Catherine De Goursac, MD

Aesthetic doctor and #AntiAge for over 25 years.
Medical aesthetic office in Paris XVII


Report and interview: "Aesthetic treatments for men".



"We have moved from a culture of text to a visual culture, a phenomenal change that we have not yet taken seriously. The image always speaks louder than words"., written Heather Wuiddoq, a British philosopher, professor at the University of Birmingham in the United Kingdom and author of Perfect Me ", a book on the contemporary cult of beauty. 

Due to the development of reality TV, social networks like Facebook or TikTok We are no longer on TV because we did something remarkable, but we become remarkable when we appear on our flat screens or even with the multiplication of apps and influencers on our smartphones. Hence the ever-increasing importance of the image that we give to others, without forgetting the image that we can have of ourselves.  This is the reason why women, who for a long time were the only ones to worry about their "look", to watch their figure, to use and abuse medicine and cosmetic surgery, no longer have a monopoly on coquetry. Today, little by little, men, forced by the new social conditions, are more and more numerous to be concerned about their look and to join them on this ground.

The men are right, because in the last quarter of the last century, researchers have discovered "the halo effect of beauty": it confers benefits in all areas of life, "right down to the space you are given when you walk down the street," says Nancy Etcoff, professor of psychology at Harvard Medical School.

We can therefore legitimately assume that in this hyper-competitive world it is easier to find a job and/or a partner when one presents a neat and dynamic appearance.

How looking beautiful has become a moral imperative in today's world. https://press.princeton.edu/books/hardcover/9780691160078/perfect-me 2022 Princeton University Press. All Rights Reserved Privacy


Anchor Books ISBN: 9780385479424; €14.64; 11/07/2000; 336 pp. Psychologist, Harvard Medical School and Massachusetts General Hospital. Suffolk County, Massachusetts, USA.


And it is normal that the magazine "Look and Medicine" invites in this issue of LM3, Catherine de Goursac, who has been thinking about this evolution for more than 10 years.

1. A recent male mutation: men have evolved a lot in the importance they give to their appearance

He is more interested in his physical appearance and more willing to pamper his skin with better adapted care products. No matter, if the masculinity of the XXIst century is still searching for itself, it has already laid the foundations of what it will be. The phenomenon will accelerate with the younger generations, teenagers and young adults who spend more and more time in the bathroom. And the "woke" trend has young men looking to feminize themselves and young women looking to masculinize themselves to erase sexual appearances. À Unlike their elders, young people have understood that the health and beauty of the skin can be preserved on a daily basis.

Whatever the case, from the youngest to the oldest, the man of the XXIst century strives to please himself and all those around him, even if it means using all the effective techniques to beautify, slim down without too much effort and erase the imperfections that tarnish the radiance of his face or erase the wrinkles that accuse him of his age and make him stand out from the demanding social scene. Because the pressure is strong on the image they project.

A man who seems to feel good about himself, with a dynamic and well-groomed appearance is more valued in all facets of his life, whether they are professional, social or private.

2. What is the state of male aesthetic demand today?

Twenty-five years ago, men represented only about 5% of cosmetic medicine patients compared to 20 % today. 

In the 80's, the majority of them were often homosexuals or even transsexuals. They mainly consulted for the removal of pigmentation spots or for the treatment of rosacea. 

This clientele is still there, joined today by more and more heterosexuals.

And today the demand for men's beauty care is growing with :

  • Treatment of acne scars with fractional laser,
  • The treatment of wrinkles by botox or hyaluronic acid injections,
  • Maintenance of skin quality with LEDs or radio frequencies,
  • But also that of the management of their possible overweight
  • And medical solutions to delay hair loss.

 3. What are the pitfalls that the aesthetic doctor must avoid?

He must know how to detect people suffering from dysmorphophobia: a psychiatric disorder linked to the non-acceptance of one's own image.

Daisnes of Salt Lake City in 2008 states that it is essential to interview patients seeking aesthetic treatments in order to detect people suffering from dysmorphophobia, a psychiatric disorder related to the non-acceptance of one's image.

We all know that, as beauty professionals: Dysmorphophobic patients should not be treated because, far from being relieved by our interventions, they are likely to see their disorders worsen and they will ask for more and more invasive procedures, which will not satisfy them.

In the 1950s, according to Daines, most of the men who came to the offices of doctors or cosmetic surgeons suffered from this psychiatric problem.

At present, the ratio of dysmorphophobic men to others who come to our consultations is the same as in the normal population. It is in the order of less than 5%, so it is relatively low.


4. What is the specificity of the treatment of men in aesthetic medicine?

It is not because men are concerned about their appearance that aesthetic doctors can transpose the gestures performed on women. Their skin, their demands and their expectations are different.

With a few colleagues, we have taken a close interest in this particular type of care, by multiplying the number of working groups and communications in congresses, and we are now able to offer our male patients the care they are looking for.

  • It is important to know that men often have to start by exercising and adopting a healthy diet. In many cases, this is the first step that will lead them to aesthetic treatments.
  • If generation Z is fond of cosmetics adapted to their skin and hair, this is not the case for mature men.
  • Instead of daily care, they prefer a one-time aesthetic medical procedure, preferably painless and not requiring social eviction.
  • It is important that nothing shows and the practitioner must be sure of his gesture.
  • When these conditions are met, more and more people consult cosmetic medicine practices.
  • Their main motivation is their appearance. They want to project a positive image, to look fit, energetic and healthy, rather than seeking rejuvenation at all costs. Indeed, men are not looking for more beauty but for less fatigue and bitterness, more dynamism and performance.

It must be said that the way society looks at men differs from the way it looks at women.

  • While wrinkles are considered a sign of aging in women, they appear in men as a sign of maturity.
  • On the other hand, the aging of the man causes his face to become heavier.
  • The features are marked, hardened and show the fatigue.
  • In addition, they want to do away with rhinophyma that suggests alcoholism or a frugal lifestyle.

Aesthetic treatment of men and their aging must absolutely take into account, in addition to their requests, the specificities of their skin and their morphology. Medical and cosmetic surgery similar to those performed on women could lead to a feminization of their face, which is not what they want.


I/ Extracts from a brief review of the literature

1/ Paes EC, Teepen HJ, Koop WA, Kon M. Perioral wrinkles: histologic differences between men and women. Department of Plastic, Reconstructive and Hand Surgery, University Medical Center, Utrecht, The Netherlands. Aesthet Surg J. 2009 Nov-Dec;29(6):467-72.


Background: Women tend to develop more and deeper wrinkles in the perioral region than men. Although much is known about the complex mechanisms involved in skin aging, previous studies have described histologic differences between men and women with respect to skin aging only incidentally and have not investigated the perioral region. 

Objective: The purpose of this study was to investigate gender-specific differences in the perioral skin. 


To determine wrinkle severity, skin surface replicas of the upper lip region in 10 male and 10 female fresh cadavers were analyzed by using the dermaTOP blue three-dimensional digitizing system (Breuckmann, Meersburg, Germany). In 30 fresh male and female cadavers, three full-thickness lip resections were investigated in a blinded fashion for specific histologic features. All results were statistically analyzed in a linear regression model with SPSS software (version 15.0; SPSS, Chicago, IL).


The female replicas showed more and deeper wrinkles than the male replicas (P < .01). Histologic analysis revealed that the perioral skin of men displayed a significantly higher number of sebaceous glands (P = .000; 95% confidence interval [CI] 23.6-53.2), sweat glands (P = .002; 95% CI 2.1-8.1), and a higher ratio between vessel area and connective tissue area in the dermis (P = .009; 95% CI 0.003-0.021). The amount of hair follicles did not significantly differ between men and women, although the average number of sebaceous glands per hair follicle was greater in men (P = .002; 95% CI 0.33-1.28).


Women exhibit more and deeper wrinkles in the perioral region and their skin contains a significantly smaller number of appendages than men, which could be a feasible explanation for why women are more susceptible to development of perioral wrinkles.

2/ Hegyi J, Hegyi V, Messer G, Arenberger P, Ruzicka T, Berking C. Confocal laser-scanning capillaroscopy: a novel approach to the analysis of skin capillaries in vivo. Department of Dermatology, Ludwig-Maximilian University, Munich, Germany. Skin Res Technol. 2009 Nov;15(4):476-81.


Background: New techniques for diagnostics and therapy in dermatology are becoming increasingly non-invasive, among which confocal laser-scanning microscopy (CLSM) is the most prevalent. It allows visualization of cellular structures of the skin up to a depth of 300 micron in vivo. Until now, most studies have been conducted on pathologically altered skin, mostly oncologic lesions. We now present a detailed analysis of capillaries located in the upper dermal papillae.

Methods: Multiple measurements were performed on the dorsal and ventral surface of the right forearm of 30 healthy volunteers (22-88 years) under standard conditions (room temperature, body position, time of day). Images were obtained with the Vivascope 1500 (Lucid) under standard settings and analyzed using the freeware ImageJ with a custom written macro plugin. The following parameters of the capillaries in vivo were measured: area, perimeter, circularity and maximum diameter.

Results: Statistical analysis showed that all four parameters were constant within a narrow range, regardless of the body site, sex and age. In this physiological study, we can clearly demonstrate that by confocal laser-scanning capillaroscopy (CLSC), it is possible to visualize and measure skin capillaries at the extremities in a reproducible manner.

Conclusion: This new approach offers a considerable advantage compared with nailfold capillaroscopy, which can only be performed at the proximal nail segment, and over histological analysis, which can be hampered by fixation artifacts resulting in altered size and shape of the vessels to be analyzed. CLSC could allow for precise analysis of in vivo skin vasculature in systemic and proliferative diseases of the skin. PMID: 19832961 [PubMed - indexed for MEDLINE]

3/ Tzellos TG, Klagas I, Vahtsevanos K, Triaridis S, Printza A, Kyrgidis A, Karakiulakis G, Zouboulis CC, Papakonstantinou E. Extrinsic aging in the human skin is associated with alterations in the expression of hyaluronic acid and its metabolizing enzymes. 2nd Department of Pharmacology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece. Exp Dermatol. 2009 Dec;18(12):1028-35.


Extrinsic skin ageing or 'photoageing', as opposed to intrinsic skin ageing, is the result of exposure to external factors, mainly ultraviolet irradiation.  Glycosaminoglycans (GAG) and particularly hyaluronic acid (HA) are major components of the cutaneous extracellular matrix involved in tissue repair.  However, their involvement in extrinsic skin aging remains elusive. In this study, we investigated the expression of HA and its metabolizing enzymes in photoexposed and photoprotected human skin tissue specimens, obtained from the same patient.  Total GAG were isolated, characterized using specific GAG-degrading enzymes and separated by electrophoresis on cellulose acetate membranes and polyacrylamide gels. Quantitation of HA in total GAG was performed using ELISA. Gene expression of hyaluronan synthases (HAS), hyaluronidases (HYAL) and HA receptors CD44 and receptor for HA-mediated motility (RHAMM) was assessed by RT-PCR.  We detected a significant increase in the expression of HA, of lower molecular mass, in photoexposed skin as compared with photoprotected skin.  This increase was associated with a significant decrease in the expression of HAS1 and an increase in the expression of HYAL1-3.  Furthermore, the expression of HA receptors CD44 and RHAMM was significantly downregulated in photoexposed as compared with photoprotected skin. These findings indicate that extrinsic skin aging is characterized by distinct homoeostasis of HA.  The elucidation of the role of HA homoeostasis in extrinsic skin aging may offer an additional approach in handling cutaneous aging.

PMID: 19601984 [PubMed - indexed for MEDLINE]

4/ Giacomoni PU, Mammone T, Teri M. Gender-linked differences in human skin. Clinique Laboratories, Melville, NY 11747, United States. pgiacomo@estee.com. J Dermatol Sci. 2009 Sep;55(3):144-9. Epub 2009 Jul 1.


Background: The physiology of body organs can be affected by gender. Skin and skin appendages are influenced by sex hormones.

Objective: This review work has been undertaken to point out the most conspicuous physiological differences observed between men's and women's skin.

Methods: The literature has been searched and relevant results have been gathered.

Results: Men's and women's skins differ in hormone metabolism, hair growth, sweat rate, sebum production, surface pH, fat accumulation, serum leptins, etc. Examples of differences in the proneness to cutaneous diseases and skin cancer are quoted.

Conclusion: The knowledge of gender-linked cutaneous differences might help in preparing male-specific products for more appropriate dermatological treatments or cosmetic interventions.

PMID: 19574028 [PubMed - indexed for MEDLINE]

5/ Darvin M, Patzelt A, Gehse S, Schanzer S, Benderoth C, Sterry W, Lademann J. Cutaneous concentration of lycopene correlates significantly with the roughness of the skin. Charité-Universitätsmedizin Berlin, Department of Dermatology, Berlin, Germany. Eur J Pharm Biopharm. 2008 Aug;69(3):943-7. Epub 2008 Feb 13.


Antioxidant substances in the skin are expected to slow down photo ageing. We therefore developed the hypothesis that high levels of antioxidant substances may be correlated to lower levels of skin roughness. By utilizing modern optical non-invasive in vivo methods, the structures of the furrows and wrinkles as well as the concentration of lycopene were analyzed quantitatively on the forehead skin of 20 volunteers aged between 40 and 50 years. In a first step, the age of the volunteers was correlated to their skin roughness. Here, no significant correlation was found. In a second step, a significant correlation was obtained between the skin roughness and the lycopene concentration (R=0.843). These findings indicate that higher levels of antioxidants in the skin effectively lead to lower levels of skin roughness, and therefore support our hypothesis.

PMID: 18411044 [PubMed - indexed for MEDLINE]

6/ Dao H Jr, Kazin RA. Gender differences in skin: a review of the literature. Johns Hopkins Medical Institutions, Baltimore, Maryland, USA. Gend Med. 2007 Dec;4(4):308-28.


Background: There has been increasing interest in studying gender differences in skin to learn more about disease pathogenesis and to discover more effective treatments. Recent advances have been made in our understanding of these differences in skin histology, physiology, and immunology, and they have implications for diseases such as acne, eczema, alopecia, skin cancer, wound healing, and rheumatologic diseases with skin manifestations.

Objective: This article reviews advances in our understanding of gender differences in skin.

Methods: Using the PubMed database, broad searches for topics, with search terms such as gender differences in skin and sex differences in skin, as well as targeted searches for gender differences in specific dermatologic diseases, such as gender differences in melanoma, were performed. Additional articles were identified from cited references. Articles reporting gender differences in the following areas were reviewed: acne, skin cancer, wound healing, immunology, hair/alopecia, histology and skin physiology, disease-specific gender differences, and psychological responses to disease burden.


A recurring theme encountered in many of the articles reviewed referred to a delicate balance between normal and pathogenic conditions.  This theme is highlighted by the complex interplay between estrogens and androgens in men and women, and how changes and adaptations with aging affect the disease process.  Sex steroids modulate epidermal and dermal thickness as well as immune system function, and changes in these hormonal levels with aging and/or disease processes alter skin surface pH, quality of wound healing, and propensity to develop autoimmune disease, thereby significantly influencing potential for infection and other disease states.  Gender differences in alopecia, acne, and skin cancers also distinguish hormonal interactions as a major target for which more research is needed to translate current findings to clinically significant diagnostic and therapeutic applications.


The published findings on gender differences in skin yielded many advances in our understanding of cancer, immunology, psychology, skin histology, and specific dermatologic diseases. These advances will enable us to learn more about disease pathogenesis, with the goal of offering better treatments.  Although gender differences can help us to individually tailor clinical management of disease processes, it is important to remember that a patient's sex should not radically alter diagnostic or therapeutic efforts until clinically significant differences between males and females arise from these findings. Because many of the results reviewed did not originate from randomized controlled clinical trials, it is difficult to generalize the data to the general population. However, the pressing need for additional research in these areas becomes exceedingly clear, and there is already a strong foundation on which to base future investigations.

PMID: 18215723 [PubMed - indexed for MEDLINE]

7/ Roh M, Han M, Kim D, Chung K. Sebum output as a factor contributing to the size of facial pores. Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, 134 Shinchon-dong, Seodaemun-gu, 120-752, Seoul, Korea. Br J Dermatol. 2006 Nov;155(5):890-4.


Background: Many endogenous and exogenous factors are known to cause enlarged pilosebaceous pores. Such factors include sex, genetic predisposition, ageing, chronic ultraviolet light exposure, comedogenic xenobiotics, acne and seborrhoea. This study was an attempt to determine the factors related to enlarged pores.

Objectives: To assess the relationship of sebum output, age, sex, hormonal factors and severity of acne with pore size.

Methods: A prospective, randomized, controlled study was designed. A total of 60 volunteers, 30 males and 30 females, were recruited for this study. Magnified images of pores were taken using a dermoscopic video camera and measured using an image analysis program. The sebum output level was measured with a Sebumeter.

Results: Using multiple linear regression analysis, increased pore size was significantly associated with increased sebum output level, sex and age. Among the variables, sebum output level correlated most with the pore size followed by male sex. In comparing male and female participants, males had higher correlation between the sebum output level and the pore size (male: r = 0.47, female: r = 0.38). Thus, additional factors seem to influence pore size in females. Pore size was significantly increased during the ovulation phase (P = 0.008), but severity of acne was not significantly associated with the pore size.

Conclusions: Enlarged pore sizes are associated with increased sebum output level, age and male sex. In female patients, additional hormonal factors, such as those of the menstrual cycle, affect the pore size.

PMID: 17034515 [PubMed - indexed for MEDLINE]

8/ Reeder AI, Hammond VA, Gray AR. Questionnaire items to assess skin color and erythemal sensitivity: reliability, validity, and "the dark shift. Cancer Society of New Zealand Social & Behavioural Research Unit, Department of Preventive & Social Medicine, Dunedin School of Medicine, University of Otago, P.O. Box 913, Dunedin 9054, New Zealand. tony.reeder@otago.ac.nz. Cancer Epidemiol Biomarkers Prev. 2010 May;19(5):1167-73.


Background: Skin pigmentation is a key factor for UV radiation exposure related cancers. To appropriately target cancer control activities related to this exposure and for better representation in epidemiologic studies, a valid and reliable assessment of skin color is required.

MethodsThe validity and reliability of two self-report measures were assessed: skin color and erythemal sensitivity. A sample of 289 university students categorized their unexposed skin color and photosensitivity via a questionnaire. Skin color was also measured by spectrophotometer. After 7 days, participants repeated the self-report assessment.

Results: Significant correlations were found for both self-report items with objective measures, indicating that these items may be valid assessment tools (color: Spearman's rho=-0.75, P<0.001; photosensitivity: Spearman's rho=-0.64, P<0.001). No sex differences in validity were evident. Stronger correlations were found among those of European than those of non-European ethnicity (color: Spearman's rho=-0.78 versus -0.59, bootstrap P=0.007; photosensitivity: Spearman's rho=-0.63 versus -0.28, bootstrap P=0.001). Strong biases toward overestimation of skin pigmentation were evident, ranging from 36% in the self-identified fair skin group to 77% in the medium skin color group. Intrarater reliability of the questionnaire items was high (color: k=0.78, P<0.001; photosensitivity: k=0.77, P<0.001).

Conclusions: Study findings suggest that self-report may be a valid measurement strategy when assessing skin type, but there is a bias toward overestimation of skin color and, potentially, UV radiation resilience.

IMPACT: This bias has the potential to undermine the effectiveness of skin cancer prevention efforts and needs to be addressed in health promotion programs.

9/ Malley RC, Muller HK, Norval M, Woods GM. Vitamin D3 deficiency enhances contact hypersensitivity in male but not in female mice. Menzies Research Institute, Clinical School, University of Tasmania, Private Bag 29, Hobart, Tasmania 7000, Australia. r_malley@utas.edu.au. Cell Immunol. 2009;255(1-2):33-40. Epub 2008 Nov 13.


To ascertain the influence of vitamin D3 and its metabolites on the function of the skin immune system and the induction of the contact hypersensitivity (CHS) response, a population of vitamin D3-deficient BALB/c mice was established, through dietary vitamin D3 restriction and limitation of exposure to UVB irradiation.  Vitamin D3 normal female mice had higher CHS responses than their male counterparts, and dietary vitamin D3 deficiency significantly increased the CHS responses in male, but not in female, mice.  This change in the vitamin D3-deficient male mice was not due to an alteration in skin dendritic cell function including antigen carriage, migration or costimulatory molecule expression.  In addition, 18 h after sensitization, the lymph node populations in the vitamin D3-deficient and normal male mice showed similar proliferation and IFN-gamma production.  However, during the sensitisation phase of CHS, there was lower lymphocyte recruitment to the skin draining lymph nodes of the vitamin D3-deficient and normal male mice compared with their female counterparts which could account for the difference between the sexes in the extent of the CHS response.  These results indicate the vitamin D system can influence cutaneous immune responses in male mice, but this did not occur through the modulation of the dendritic cell functions analyzed.

PMID: 19012883 [PubMed - indexed for MEDLINE]

10/ Leong GW, Lauschke J, Rutowski SB, Waite PM. Age, gender, and side differences of cutaneous electrical perceptual threshold testing in an able-bodied population. Spinal Injuries Unit, Royal North Shore Hospital, Sydney, New South Wales, Australia. grleong@nsccahs.health.nsw.gov.au. J Spinal Cord Med. 2010;33(3):249-55.


Objective: To investigate age, gender, and left-right differences in cutaneous electrical perceptual threshold (EPT) testing in an able-bodied, Australian sample.

Study design: Prospective experimental.

Setting: Hospital-based spinal cord injuries unit.

Methods: Cutaneous electrical stimulation of the 28 dermatomes at ASIA sensory key points (C2-S4/S5) was performed on 29 female and 16 male healthy volunteers aged 21 to 76 years. Mean EPTs for each dermatome were compared (repeated measures ANOVA) for left-right, gender-related, and age-related (50 years of age) differences.

Results: There was no group difference between sides (repeated measures ANOVA, P = 0.934). Women across all ages had lower group mean EPTs than men (P < 0.0001). Women younger than age 50 years had lower mean EPTs than those older than age 50 years (P = 0.008). There was no group difference between younger and older men (P = 0.371). Analysis of individual dermatomes revealed no significant differences in thoracic dermatomes between genders or age groups, contrary to the limb dermatomes.

Conclusion: There were gender differences in EPT values across all ages. Women had higher EPTs as they advanced in age, but this was less clear in men. There was considerable somatotopic variability in EPTs, especially in the lower limbs. If EPT testing is to be applied to detect subclinical changes within a dermatome, establishment of age- and gender-specific somatotopic normograms is a prerequisite.

PMID: 20737798 [PubMed - indexed for MEDLINE] PMCID: PMC2920118 [Available on 2010/11/1]

II/ Summary of the literature review

1. Whether it is female or male, the skin fulfills many functions:

This organ of touch is primarily a mechanical barrier that isolates the body and protects it from bacteria, viruses, dust and other allergens. It is also involved in the thermoregulation of the body, thanks to the sweat glands in particular. But men's skin is much more impregnated with testosterone than women's. This leads to variations in thickness, sweat and sebaceous glands and hair follicles.

2. A thicker skin, a different aging process.

Many studies (see attached bibliographic list) measured the skin of a group of men and women on areas as different as the forehead, the back of the hand, the cheeks, the back of the neck, the arms and the legs, using a sound ultrasound device. The results show that men's skin is on average 16% thicker than women's, which would make it significantly more resistant.

3. A more detailed examination shows a large number of differences:

  • The horny layer, of similar thickness to that of women is, however, less effective as a mechanical barrier because steroids have an adverse effect on permeability.
  • The epidermis it is 10 % thicker.
  • The dermis has a thickness of about 2.3mm while it is 1.8mm in women (Pr MC Martini. Men's Cosmetology). This difference is due to a higher density of collagen, linked to the impregnation of testosterone.
  • Conversely, the subcutaneous adipose tissue is thicker in women. In men, this thickness decreases progressively over the years, while in women, it suddenly thins when menopause sets in.

4. This gives us a better understanding of the skin aging process in both sexes.

  • Men's skin is firmer than their female counterparts' until the age of 30, at which point it suddenly decreases before stabilizing around the age of 40/50. The firmness of women's skin gradually decreases from the age of 30.
  • Similarly, men's skin is more elastic than women's, but its elasticity decreases more rapidly.
  • But let's be concrete: it's very obvious on the faces.
  • In men, the first wrinkles arrive a little later, but once they do, they set in more quickly and deeply.
  • Aging phenomena are progressive in women, whereas they are more radical in men.
  • The evidence is there: clinical studies showing that, at the same age, skin folds and grooves are often more marked and deeper on a male face than on a female face.

Men's cosmetology. Marie-Claude Martini. Professor at the Laboratory of Dermopharmacy and Cosmetology, ISPB, Lyon. https://www.decitre.fr/livres/cosmetologie-masculine-9782743010201.html

5. Testosterone and its actions on the skin

 Testosterone is a steroid hormone secreted almost exclusively (95%) by Leydig cells in the testes, with the remaining 5% secreted by the adrenal glands.

  • Hence the presence of this male hormone in small quantities in women, which explains most of the skin characteristics of men.
  • Testosterone acts as a chemical messenger and regulates many functions including the differentiation and maturation of your reproductive organs.
  • It also stimulates the secondary sexual characteristics involved in your behavioral habits necessary for reproduction.
  • In addition, it plays an important role in almost every cell of the male body.
  • Thus, free testosterone acts either directly in certain tissues such as muscle, which do not have 5 α-reductase (the enzyme that transforms free testosterone, which is often ineffective, into effective dihydrotestosterone).
  • It also acts indirectly through active metabolites that increase and diversify its biological effects.
  • The most potent of its active metabolites is dihydrotestosterone (DHT), which has significant effects on the skin.
  • Like the prostate, the skin and scalp have testosterone receptors. The more numerous they are, the greater the risk of acne and hair loss. But their distribution is genetic.
  • DHT, in synergy with free testosterone and its other metabolites, is involved in all the differences between the skin of men and women and including:
    • Skin thickness is between 15 and 25% greater in men.
    • A lower pH negatively influences the barrier function of the stratum corneum and promotes colonization by aerobic bacteria and consequently acne and folliculitis of the beard.
    • The sweat glands are more active in men and therefore produce more sweat, more acid and more odorous.

During physical exercise, men sweat more profusely and rapidly than women.

  • The sebaceous glands are more numerous and larger, which is a source of skin shine, enlarged pores and acne, but offers better protection against the elements due to the increased presence of seborrhea.
  • The vascularity of the face is more developed in men and this phenomenon can be attributed to the importance of hair. Numerous studies have shown by Doppler that the greater vascular flow in men is due to the greater number of micro-vessels, which explains the risk of rhinophyma (Mayrovitz, Regan).
  • Thicker collagen, with oblique rather than vertical fibers.
  • The hair follicles are more numerous on the face as on the body.


The differences between men and women can be seen in the facial structure. The male forehead is slightly flatter, concave, less double S, the temples are more easily hollowed, the eyebrows under the orbital rebound are horizontal and do not form an arch, the cheekbones are flat and not convex, the nose is more powerful, the jugal hollows are often more pronounced, the chin is powerful and square, the mandibular angle is powerful.

6. Warning on DHT supplementation because of the links with benign prostate hypertrophy and prostate cancer (Pr. Jean-Paul Meningaud).

The positive effect of DHT supplementation seems to be most useful during the embryonic period and in adolescence. 

In addition to the muscle on which testosterone acts directly (without prior 5alpha reduction), DHT acts on :

  • The central nervous system
  • The libido
  • Protein anabolism.

Of course DHT acts, but when you block DHT with 5 alpha reductase inhibitors, you mechanically increase the level of testosterone. So it's a zero sum game.  DHT and testosterone act on the same receptors but in different ways.  

So a DHT deficiency in adulthood does not have much impact. In addition, DHT would be responsible for prostate cancer in adulthood.  Similarly, one must be careful about testosterone deficiency, because most often the increase in receptors compensates for the decrease in hormone levels. Real LAODs exist, but they are rare, and they are in any case overestimated by anti-aging doctors. This is because the small doses prescribed (possibly) will block the hypothalamo-hypophyseal axis and therefore reduce testicular stimulation. This results in a form of male contraception.

Mayerovitz, Regan

7. Oiler skin

  • sebaceous secretion. There are countless articles in the scientific literature showing that sebaceous secretion, It is low during childhood, increases from the beginning of puberty, remains at a fairly high level during adulthood and gradually decreases in the elderly. There is no significant difference between the two sexes during childhood.
  • But everything changes at puberty, when sebum secretion becomes more important in men. It reaches a maximum peak between the ages of 25 and 50 for all sexes, and then decreases more markedly in women, especially after menopause, when the skin becomes visibly dry and uncomfortable.
  • Lebaceous glands, Another important difference in men is that the hair follicles are larger and more numerous on the face, scalp and genitals (400 to 900/cm2). Under the influence of dihydrotestosterone, they are also more active, hence the greater frequency of oily hair in men.
  • The pores (pilosebaceous follicle openings) are more dilated, probably due to their more abundant secretion of sebum.
  • For all these reasons, men generally have oilier skin than women, their pores are more visible and in principle, they are more easily prone, especially in their youth, to skin imperfections which are also more important than in women.


8. Increased sweating.

  • The differences between men's and women's skin do not end there. t Lhe 2 million sweat glands are distributed on the chest, armpits, forehead, hands and feet and their secretions. Curiously, these glands are more numerous in women, but men sweat more in quantity and their perspiration starts at a lower temperature. So, as you can see, they sweat more easily and also more quickly in case of thermal stress.
  • Another surprising specificity is that sweating is higher in men in the armpits between the ages of 15 and 50, while at puberty, young girls sweat more from their hands and feet.
  • Be aware that the average pH of male sweat is lower of about 0.5 units than that of female sweat, i.e. more acidic, i.e. pH 4.5 for men and 5.3 for women, according to Professor Martini. This is due to the lactic acid content resulting from the breakdown of glycogen in the sweat glands. It is significantly higher in men, thus influencing the pH of their sweat.

9. More hairy skin.

  • Men have more hair than women. This is normal since male hormones stimulate hair growth while female hormones limit it.
  • However, contrary to what one might think, the difference is not at the level of the density of the hairs which is identical in the man and in the woman, but the latter has more down than real hair. It is at puberty, under the influence of androgens that the male hair system is beginning to change.
  • The so-called terminal hairs develop in great density on the thorax, arms, legs and on the face.
  • The beard It first appears on the upper lip, then on the chin and finally extends to the cheeks and neck. When mature, the beard is more or less important according to the individuals and can comprise between 6000 and 25000 hairs.
  • On the body, there are between 200,000 and 1 million hairs.
  • The rate of growth varies according to gender, individual and body location. It goes from 0.21mm (on the thigh in women) to 0.50mm (on the scalp) per 24 hours.


10. Let us add that the nails of the hand of men are a little thicker. As for those of the toesThey thicken significantly more over the years than those of women.


9. Differences that influence lifestyle and stressors

Men have much less regard for their skin than women. Rather than using mild cleaners, most prefer to use a soap. They are wrong, especially if they are used to shaving.


10. shaving problems

Indeed, shaving, whether electrical or mechanical, removes the natural lipidic protection layer and the most superficial layers of the epidermis. The combination of shaving and aggressive cleansers alone explains the irritation that many men complain about.

Moreover, since men take less care of their skin and protect it less from external aggressions than women, they are more prone to small skin disorders such as actinic keratoses, small basal cell cysts, etc. Far from being a pleasure for the skin, shaving is a source of daily stress or almost. In fact, the outer cell layer of the stratum corneum is eliminated by the blade instead of desquamating naturally.  This action leads to an acceleration of cell turnover and exposes to the external environment cells that were not "programmed" to resist its effects. 

But this is not the only problem. The hydrolipidic film that protects the skin from external aggressions is altered by the blade and if a man uses an ordinary soap, it is partly eliminated.

It is also known that the IWL (Insensible Water Loss) on the cheeks is more important in men than in women. As a result, the skin's barrier function is much less effective in this very specific area.

The combination of these different factors will cause dryness, dehydration of the skin, as well as sensations of heating, tightness and irritation commonly called "razor burn". 

We also see men with folliculitis of the beard in consultation. It is an inflammation of the beard hair usually resulting from shaving, which I will discuss later7


11. Greater sensitivity to climatic factors

Wind, cold and heat cause the corneal layer to deteriorate and the skin to become dehydrated, especially on the face, which is the most exposed area. Weakened by shaving and rarely protected by specific skin care products, men's skin is particularly sensitive to these aggressions. Moreover, a study conducted in 2009 in Germany by Professor Kutmann showed that pollution microparticles accelerated skin aging by increasing wrinkles and pigment spots.

12. A chronic lack of skin care

The aberrant rhythms of today's society, lack of sleep, fatigue, prolonged screen work, pollution, smoking, alcohol and dietary imbalances can have repercussions on the skin. The eye contour area is the most affected. Its skin is very thin and marks easily. Dark circles deepen and bags appear. Insofar as men do not mask them with concealer, do not have the idea of massaging themselves or applying a suitable skin care product, they are often more visible and more accentuated than in women.

13. The effect of androgen decline on the skin

Around the age of 50, most men, but not all, are affected by andropause.

Androgen receptors sare strongly linked to eccrine and apocrine secretions. This decrease in testosterone results in less seborrhea, a poorer hydrolipidic film, and therefore a skin that becomes thinner, drier and more fragile in the face of bad weather because sebum production slows down. In addition, there is a loss of hair, but strangely enough, the hair on the nose proliferates, as do the eyebrows and the ears. Moreover, the sensitivity of keratinocytes to androgens increases, the activity of 5 alpha reductase decreases, as does its action on melanocytes: This results in a decrease in the pigmentation of the penis and scrotum. In addition, men tend to start to arch their backs and get fatter at this time. As the years go by, the belly becomes more and more prominent. The excess weight generates more estrogen through the aromatization of testosterone. This results in a feminization of the skin, which becomes thinner and drier.

Fummel S., Kurfurst R., Bonté F., Zouboulis CC. Responsiveness to androgens and effectiveness of antisense oligaonucleotides against the androgen receptor on human epidermal keratonocytes is dependent on the age of donor and location off cell origin. Horm. Metab. Res. 2007:39: 157-165. https://pubmed.ncbi.nlm.nih.gov/17326012/

14. The effect of androgen decline on the skeleton of the face :

  • The front is a bit irregular
  • The orbits are getting bigger
  • The zygomatic arch loses volume
  • The reduction of the angles of the eyebrows, nose and chin was visualized by scanner
  • The eyebrow will go down with too much hair and too long
  • The temples are hollowed out
  • The periorbital veins become prominent
  • The nose appears to be elongated by resorption of the bone mass
  • The valley of tears deepens
  • The lower part of the face becomes heavier, which leads to a sort of feminization of the face
The influence of androgens

IV/ Men and their specific approach to aesthetics

A particular use of cosmetic products

To seduce the male clientele, it is necessary to adapt to its ergonomics. For the face, men need fluid products that are easy to apply. He likes functional packaging that is big enough to fit in his hands. He also looks for heavy, aesthetic, easy-to-use products. Out of horror of waste, he hates tubes and often cuts them with scissors in order to finish them. To the terms: "cream", "moisturizer", "unctuous", he prefers "fluid" or "balm ".

A different approach to cosmetic medicine and surgery

According to a Dallas surgeon, "these men are much more pained than women and have more difficulty expressing their expectations, so they are more easily disappointed. They also don't want to have multiple visits and are looking for single-preference treatments that are not very repetitive, not very painful, but radical.

For Richard Fried, men also come to aesthetics to simplify their daily care.

  • They can resort to laser hair removal and lower face wrinkle filling to simplify shaving,
  • Many people prefer liposuction to dieting or intensive sports to reshape their figure
  • And that they often prefer to go straight to hair transplantation rather than trying to hide an incipient baldness with complicated hairstyles.
  • This is why, for many authors in the scientific literature of dermatology and aesthetic medicine, humans are very fond of hyaluronic acid injections, botulinum toxin, but also techniques capable of improving skin texture such as radiofrequency and LED. In a way, we can consider that when we find the solution that really corresponds to his request, the man is easier to take care of than the woman provided that we know how to decipher his expectations.

A demand highly motivated by social and practical aspects

When he consults, the man mostly talks about how tired he looks. He is not really concerned about his wrinkles or the thinning of his lips. On the other hand, the sad and drooping aspect of his face bothers him as well as the dark circles or bags under his eyes. Because it ages him and weakens his social position. The vast majority of requests concern a masculinization of the face.

Men want to affirm the mandibular angle, the powerful chin, reinforce the attenuated jugal hollows, fill in the emaciated face. It is then necessary to take care not to feminize the face.

  • The botulinum toxin must be injected with care so as not to raise the tail of the eyebrow or make it form an arc as in women.
  • Also be careful not to bulge the cheekbones which should just be enhanced and not to plump up the lips too much.
  • The nose must remain powerful and the naso-labial angle at 90 % less open
  • However, the temples should not remain hollow because they age and signal a loss of power.
  • It is also important to correct dark circles and the valley of tears to erase the traces of fatigue.

The reason why men resort to cosmetic medicine is because they want to look dynamic and successful, while maintaining maturity and authority.

  • It would be well to place himself in the race to the social that man has recourse to medicine and cosmetic surgery.

The results show that all the people who have had cosmetic medicine and surgery treatments feel a real sense of well-being.

  • They feel more confident, their quality of life improves and the benefits are reflected in their social and professional life.


RG Fried

V/ The figures for male aesthetics since the end of the last century

In 1997, it was estimated that 56% of women and 43% of men in the United States were dissatisfied with their appearance. Male demand for cosmetics and aesthetic medicine and surgery treatments has been growing steadily.  

In 2010, the men's cosmetics market was already worth $11 billion with a growth rate of 15% in Latin America and 7% in Asia.

In Europe, one man out of three uses male cosmetics, but it is often his girlfriend who buys them (50% of cases).

Since 1997 in the United States the beauty market in aesthetic medicine has grown by 88%.

A constant growth that amounts to 2% in one year between 2009 and 2010, according to the "Wall Street Journal".

Overall, the global medical aesthetics market is estimated to have grown by 10% in 2010 after a decline of 15%.

The average number of cosmetic surgery procedures performed on men increased by 12% between 2009 and 2010 (source: American Association of Plastic Surgeons)

  • Eyelid surgery: +15%
  • Facelift : +14%
  • Gynecomastia: +8%
  • Liposuction: +7%

A/ The International Society of Aesthetic and Plastic Surgery (ISAPS) survey


The International Society for Aesthetic and Plastic Surgery (ISAPS) today released the results of its annual International Survey of Aesthetic Surgery, which shows an overall increase of 5.4 % in procedures performed in 2018.

  • Botulinum toxin treatment had the largest increase since 2017, jumping 17.4 %,
  • followed by hyaluronic acid fillers, at 11.6 %.


  • https://www.indexsante.ca/nouvelles/752/la-plus-recente-etude-internationale-demontre-que-la-popularite-de-la-chirurgie-esthetique-continue-d-augmenter-partout-dans-le-monde.php#:~:text=Les%20femmes%20demeurent%20celles%20qui,soit%202%20935%20909%20interventions.
  • https://www.indexsante.ca/chroniques/253/phenomene-de-la-chirurgie-esthetique.php

B/ Details of the ISAPS 2020 Global Survey.
West Lebanon, New Hampshire, December 28, 2021

The International Society of Aesthetic Plastic Surgery (ISAPS) today released the results of its annual Aesthetic and Cosmetic Procedures Survey, which highlighted the impact of the pandemic on cosmetic plastic surgery procedures worldwide throughout 2020.

Strong points

Plastic surgery procedures for aesthetic purposes decreased overall by 10.9 % in 2020, and 77.8 % of surgeons worldwide experienced temporary practice closures during the COVID-19 pandemic. Non-surgical procedures (primarily fillers and hair removal treatments) continued to increase, but by less than in previous years (5.7 % in 2020, compared with 7.6 % in 2019). This resulted in an overall decrease of 1.8 % for all procedures. Dr. Arturo Ramirez-Montañana, Chair, ISAPS Global Survey Committeesaid, "This downward trend is consistent with our survey results of decreased patient demand due to safety and financial concerns during the COVID-19 pandemic. At the same time, many of us also saw an increase in demand due to increased patient flexibility, the possibility of a more private recovery and, particularly for facial procedures, the "zoom" effect. This has limited the impact of COVID-19 on overall procedures."

Aesthetic procedures

Surgical procedures most common in the world remained the same in 2020 :

  • Breast augmentation accounted for 16 % of all procedures,
  • Liposuction 15.1 %,
  • Eyelid surgery 12.1 %,
  • Rhinoplasty 8.4 %
  • Abdominoplasty 7.6 %.

The top five non-surgical procedures also remained constant :

  • botulinum toxin (43.2 % of all non-surgical procedures),
  • hyaluronic acid (28.1 %),
  • hair removal (12.8 %),
  • non-surgical fat reduction (3.9 %)
  • and photo rejuvenation (3.6 %).
  • Approximately 85 % of nonsurgical procedures were performed on women.

Despite the overall reduction in surgeries, rhinoplasty and brow lift surgeries continued to increase, and nonsurgical facial rejuvenation showed an increase of 13.9 %, compared with a decrease in 2019 and 2018. Overall, nonsurgical procedures increased, with the exception of botulinum toxin, hyaluronic acid, and microablative resurfacing (which decreased by 0.9 %, 6.1 %, and 11.3 %, respectively).

The most common surgical procedures for men continue to be:

  • Eyelid surgery,
  • Liposuction,
  • Gynecomastia,
  • Rhinoplasty
  • And ear surgery.

If we look at the age distribution of the different procedures,

  • Those aged 19-34 years represent the largest proportion of rhinoplasty recipients (67.9 %),
  • While 35-50 year olds represent the majority of botulinum toxin procedures (50.2 %).

At the time of this survey, only 45 % of surgeons had seen a return to pre-pandemic patient volume. Dr. Ramirez-Montañana stated: "Despite the terrible pandemic we are experiencing, it appears that most cosmetic plastic surgeons are returning to a near-normal practice and I am optimistic about 2021, both for the plastic surgery field and for surgical and non-surgical procedures."

Statistics by country

  • The United States experienced an increase in both surgical and non-surgical procedures, solidifying their position as the leading country for surgical procedures performed worldwide (14.7 % of total surgical procedures)
  • and taking the lead in the non-surgical procedures made in the world on Brazil (22.1 % of total non-surgical procedures).
  • The top 10 countries for procedures in 2020 were the United States, Brazil, Germany, Japan, Turkey, Mexico, Argentina, Italy, Russia and India, followed by Spain, Greece, Colombia and Thailand.
  • Mexico, Turkey, and Colombia had the highest proportion of foreign patients: 28.2 %, 25.8 %, and 21.8 % in 2020, respectively.
  • Thailand, which ranked first last year, was fourth with 20.9 %.
  • Hospitals remain the primary facility where surgical procedures are performed (43.8 % worldwide), with the exception of the United States, where offices (45 % of procedures) and freestanding surgical centers (34.3 %) are more commonly used.


Survey Methodology

Survey participants completed a questionnaire that focused on the number of specific surgical and nonsurgical procedures performed in 2020, as well as some ancillary questions related to the impact of COVID-19, surgeon demographics, and the prevalence of medical tourism. This questionnaire was sent to approximately 25,000 plastic surgeons in the ISAPS database.  Data from a total of 1,081 plastic surgeons were compiled for this surveyThe results were gathered, listed and analyzed by Industry Insights, an independent research firm based in Columbus, Ohio. ISAPS is the only organization that collects this type of data on a global scale each year. For a copy of the full results, visit https://www.isaps.org/medical-professionals/isaps-global-statistics/

C/ About ISAPS

The International Society of Aesthetic and Plastic Surgery (ISAPS) is the world's leading professional organization of qualified cosmetic plastic surgeons. Founded in 1970, ISAPS provides an open forum for the exchange of plastic surgery knowledge worldwide. ISAPS sponsors and supports scientific meetings around the world, and provides its members with up-to-date and continuing education. Today, ISAPS has more than 5,100 members among the world's most respected plastic and reconstructive surgeons in 110 countries.  Patients seeking a cosmetic surgeon can use our "Find a Surgeon" option to find a qualified and experienced surgeon with a demonstrated commitment to ethical practice and patient safety.

D/ The financial stakes of male aesthetics are enormous.

In 2010, the aesthetic medicine market literally took over the growth of the sector with double-digit growth rates:

  • 10% for laser and ultrasound equipment, for 790 million euros.
  • And active cosmetics, for 675 million euros.

Botulinum toxin and hyaluronic acid are not to be outdone:

  • Botulinum toxin progressing from 11% to 9% in humans, at 570 million euros,
  • Hyaluronic acid from 13% to 10% in humans, at 520 million.

This growth for men is still lower than that of the women's market, but it is increasing. The male public shows the same specificities, when it comes to cosmetics and aesthetic medicine procedures:

  • He needs effective, fast and one-step techniques that avoid social eviction as much as possible.
  • He doesn't like the idea of having to come back to the doctor's office regularly for minor maintenance.
  • This is why he particularly appreciates botulinum toxin (including 225,000 injections performed in 2010, according to the American Society for Aesthetic Plastic Surgery) and thehyaluronic acid.

 The USA 2018 figures for 2017 it should be noted an increase of 325% in total demand in humans.

  • Botulinum toxin: 452,812 cases: - 3%
  • Laser hair removal: 184,668 cases: 0%
  • Micro dermabrasion: 366,885 cases: - 4%
  • Wrinkle Filling: 100,702 cases: +5%
  • Rhinoplasties: 52,860 cases: +1%
  • Blepharoplasty: 31,500 cases: -1%

Between 2014 and 2023, the market global of the aesthetic should even almost triple, from 5.7 to 14.8 billion euros, the report even anticipates.

  • These figures include sales of equipment and products used to modify the body's appearance, such as
    • lasers,
    • medical cosmetics,
    • robots,
    • injectable products,
    • breast implants, etc.
  • In detail, injectable products such as botulinum toxin and hyaluronic acid remain the leading market in terms of value (over 50% of the market) 5.6 billion in 2019.
    • The segment is dynamic, growing at an anticipated 9.2% per year through 2023.
    • Energy-based equipment (lasers, radio frequencies, ultrasounds, body reshaping devices) represent, them, 2.4 billion euroswith an expected annual increase to 7.5% by 2023.
    • Then come cosmeceuticals (medical cosmetics) à 1.5 billion eurosalso showing good momentum,
    • While the breast implants (about 1.3 billion euros in 2019) remain stable.
  • In terms of markets, the United States accounts for nearly 50% of the global market, followed by the Asia Pacific region and Europe.
  • In terms of trends, noninvasive treatments increased by 10.4% between 2017 and 2018, the report recalls, while cosmetic surgeries conversely saw a slight decrease of 0.6% over the same period.

 "Cosmetic surgery has a bright future ahead of it. " 

the aesthetic medicine market




Aesthetic health based on scientific evidence

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