The perception of beauty and aesthetics are not only shaped by external factors such as trends, press and social media, but also by personal experiences and expectations. Over the years, one of the areas most commonly performed in aesthetics is the face; of which, the lower third has become increasingly popular, both in men and women.
When planning treatment, it is important for a practitioner to understand that gender differences with regards to the anatomy, histology of hard and soft tissues and surface contours must be considered. In addition, a performing physician should also have a sound understanding that these factors would also evolve through the distinctive male and female ageing patterns.
Face Ideals: Males vs Females
Although it is important that a practitioner never make assumptions as to what a patient’s treatment goals are based on gender or any other demographic measures, features that contribute to an overall aesthetically pleasing appearance are variable based on many factors including, but not limited to, age, gender and ethnicity.
Generally, facial attractiveness for women is mostly attributed to the cheekbones and prominent upper facial features, and traditionally the ‘golden ratio’ of upper to lower lip is 1:1.6; however, a shift in recent trends tends to favour the 1:1 ratio.
Conversely, male attractiveness is mostly attributed to the masculine appearance that can be created with a strong jawline and chin, with the ideal facial shape having the chin width that corresponds to that of the mouth.
Anatomical Differences in Males and Females
Understanding that face ideality differs between genders is essential for the treatment of facial contouring, and having good anatomical knowledge of both genders plays an important role.
Due to these anatomical differences, the perception and fundamental of beauty and attractiveness may also vary. In general, the ideal facial height to width ratio is thought to be 1.35:1 for males and 1.31:1 for females; with the vertical facial thirds being typically equal in women, while in men, the anterior lower facial height often slightly greater than that of the middle third.
1. Bone Structures
Image credit: Chris Gralapp via https://deschamps-braly.com/what-is-facial-gender-confirmation-surgery/
Males and females are structurally different - at the bony level, a Caucasian female facial skeleton is more rounded and v-shaped while a Caucasian male skeleton is typically more angular and square in formation. The male mandible is also more prominent in terms of flexure, thus resulting in a stronger, wider and more anteriorly projected chin with a more defined jawline and greater definition at the ramus and angle of mandible. On the other hand, females have demonstrated a significantly larger gonial angle (angle of the mandible).
2. Histological Differences
Knowledge in the physiological and chemical differences between male and female skin can also help practitioners devise a more tailored treatment plan to deliver optimum results. Some studies have shown that male skin comprises of larger pores and produces more sebum, making it more prone to congestion, the formation of pustules (spots) as well as the development of acne at a pre-adolescent age. In addition, skin pigmentation and cross-sectional thickness are also significantly higher in men. Male skin is also naturally higher in collagen content and demonstrates higher levels of lactic acid production, while at the subcutaneous level, female skin is shown to contain higher relative quantities of adipose tissue.
3. Differences in Muscles
The anatomical size and dynamic function (movement) of facial muscles also differs in the two genders. Generally, the female muscle bulk, including that of the facial musculature, is significantly lower than that in men, and kinetic energy generated by these muscles is comparably greater in men than in women. This results in larger movements of surface features and dimensionally greater facial expressions in men. Ultimately, these differences can have an impact on the formation of rhytides (wrinkles) and in turn define the differences in gender-specific ageing patterns.
4. Soft Tissue Features
When considering the soft tissues of the lower face, anatomical studies have shown that the female chin and jaws are narrower and less prominent compared to that of the male - with the chin sitting slightly posterior to the lower lip, whilst in men, they are in line. Deeper labiomental grooves are also observed in men, with most men having larger mouths (intercommissural distance), but smaller lips (particularly the upper lip) with wider and thicker philtral columns as compared to women. These differences in the soft tissue features can also have an effect on the different gender-specific ageing patterns, which can affect the overall attractiveness as well as the type of treatment required.
Gender Specific Facial Ageing
Anatomical structures differences and other factors can cause the facial ageing patterns in both genders to be significantly different. For example, facial ageing in the lower third of the face in men may be due to the gradual and progressive reductions in testosterone production as they age, while in women, it may be attributed to the abrupt decline in oestrogen production. This causes men to lose the masculine features of the lower third with reduction in the overall bony dimensions of the mandible (jawbone) through skeletal resorption, loss of the angular shape and definition of the jawline and sagging of the overlying skin to create pre-jowls; while on the other hand, women may experience masculinised ageing, adopting the typical male ‘square’ shaped lower face.
Furthermore, due to a higher level of adipose tissue at the subcutaneous level, women may more likely develop fine surface lines, as opposed to the deeper rhytides seen in men. In terms of the dynamism of the lower face, both men and women can be prone to masseteric hypertrophy through bruxism and other parafunctional habits, but the resulting cosmetic impact can be distinctively different with females developing a more masculine facial shape while irregular contours and aggressive appearances form in the male face.
Treating the Lower Facial Third
When treating both male and female patients, the fundamental principles of thorough patient assessment, knowledge and understanding of anatomy, correct product selection and safe practice apply. Additionally, there are a variety of treatment modalities including laser technology, threads and skin resurfacing techniques that can be used to treat and contour a patient’s lower facial third.
The differences in anatomical structure in men and women, means that men may require more lifting to get comparable results to women. For example, in non-surgical procedures, techniques involving the deeper tissue layers of the face and neck may be required so that the male skin looks lifted and the face looks more natural, while for surgical procedures, longer use of compression dressings and drains may sometimes be required.
In the same vein, a practitioner has to consider one of the most common physiological factor when treating men, which is the greater number of microvessels present in the face, coupled with a dense vascular plexus to support hair follicles that produces thicker facial hair; as this could lead to a higher risk of hematoma, or a collection of blood beneath the skin post procedure when treating male patients.
Differences between the two genders are numerous and extremely variable; therefore, it is important for both the practitioner and patient to be fully aware that there is no ‘one-size fits all’ treatment - even if treating patients who are of the same gender. In all, it is imperative for a practitioner to understand the various differences between the two genders as well as how such differences can affect the outcomes on patients.
Aesthetic medicine is ever evolving, and in order to truly achieve excellence, a practitioner must not only stay ahead of the changing market trends, but has to be equipped with the right skills, knowledge and techniques. What constitutes a beautiful face for one may not apply to another, especially more so if they are of different genders. This importance also applies to the use of techniques and application of skills. Thus, in order to deliver better results and leverage patient satisfaction, it is crucial for a practitioner to possess a good understanding of the different anatomical characteristics and manage patient expectations.
Hope you have enjoyed the article! Stay tuned for our future posts about more techniques and information related to our advanced aesthetic and cosmetic training courses!
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