Cosmetic Commentary

Journal of Cosmetic Dermatology, 15, 566--574

Specific aspects of a combined approach to male face correction:

botulinum toxin A and volumetric fillers
Max-Adam Scherer, MD*
Clinic of High Aesthetic Medicine, Moscow, Russia

Summary Cosmetologists in the last decade face a permanently increasing number of male
patients. The necessity of a gender-adjusted approach in treatment of this patient
category is obvious. An adequate correction requires consideration of the anatomic
and physiologic features of male faces together with a whole set of interrelated
aspects of psychologic perception of the male face esthetics, socially formed
understanding of masculine features and appropriate emotional expressions, also of
the motivations and expectations of men coming to a cosmetologist. The author
explains in detail the elaborated out of own vast experience methods of complex male
face correction using the above-mentioned gender-specific approach to create a
naturally looking and harmonic facial expression and appearance. The presented
botulinum therapy specifics concern the injection point location and toxin doses for
every point. As a result, a rather distinct smoothening of the skin profile without
detriment to the facial expressiveness and gender-related features is achieved. The
importance and methods of an extremely delicate approach to volumetric plasty with
stabilized hyaluronic acid-based fillers in men for avoiding hypercorrection and
retaining the gender-specific features are discussed.
Keywords: male face correction, gender-specific approach, botulinum toxin A,
hyaluronic acid filler, natural look

attributes, differences in motivations of men and

Introduction
Cosmetologists in the last decade face a permanently
increasing number of male patients. This places the topic
of a gender-specific esthetic correction on the agenda.
The concept of a gender-specific approach encompasses
consideration of the differences in anatomic, physiologic,
and esthetic features of male and female faces, socially
formed perception of masculinity and femininity
*Plastic surgeon, cosmetic dermatologist, rejuvenation injection methods
specialist in private practice.
Correspondence: Max-Adam Scherer, Clinic of High Aesthetic Medicine,
Bolshoy Karetnyy lane 24/2, Moscow 127051, Russia.
E-mail: dr.max.adam.scherer@gmail.com
Accepted for publication May 11, 2016
women, their behavior and emotional expression.
From a psychological point of view, the appearance
of a male person directly represents his gender role,
identity and corresponds to social status, although con-
genital anthropometric and anatomic–physiological
parameters such as facial skeletal proportions, skin tex-
ture, intensity of sebum production, and other remain
in the background. Often even age-related changes are
being ignored as such. For males, “to look younger”
implies an intention to accentuate their successfulness
and importance in the presence of younger men,
unconsciously percepted as competitors, and to demon-
strate wealthiness and sex appeal when communicat-
ing with women.
The majority of men strive for a trustworthy look to
impress surrounding people, especially business

566 © 2016 Wiley Periodicals, Inc.


partners, in a positive way. That is why slightly notice-
able wrinkles on the forehead and between eyebrows
give the male appearance an air of proficiency and are
percepted as signs of concentration and attentiveness.
If women want to completely “erase” the signs of aging
from their faces, men, on the contrary, need a “very
slight” rejuvenation, that is, to eliminate precisely
those features, which can be percepted as signs of sick-
ness, weariness, and indifference. The goal of a cosme-
tologist is to limit facial expressiveness, to reduce
wrinkles which make the face look older and unkempt,
to restore the important for gender imaging volumetric
parameters, nevertheless avoiding an ideal “childish”
smoothness. Psychologists point out that childish fea-
tures enhance the attractiveness of a female face, but
by no means of a male appearance.1
General considerations
Most often, men come to a cosmetologist to eliminate
expressive static or/and dynamic wrinkles. Injections of
botulinum toxin type A (BTA) allow to solve the prob-
lem effectively with a fast and relatively long-lasting
effect; therefore, the treatment has become perhaps the
most popular with this patient category.
My experience shows that a gender-specific approach
comprises an adjustment of the toxin dosage and an
alteration of dose distribution among the injection
points, also different placement of the points to guide
the propagation/diffusion of BTA. These alterations are
determined namely by the anatomic–topographical and
physiological distinctions of a male face, for example,
men often have very conspicuous superciliary arches,
and this gives the face a stern, rough look. If such a
gender-specific feature is present, BTA should not be
injected into the frontalis muscle in big (“masculine”)
doses to avoid transformation of roughness into
surliness.
The use of minimally sufficient BTA doses for male
face correction complies with the trends of modern
esthetic botulinum therapy. Nowadays, absence of
facial expressiveness is regarded as not desirable, and
the goal of correction is to achieve regression of
expressive wrinkles along with retaining a sufficient,
harmonic, and natural facial expressiveness.2 More-
over, quite young men aged 30–40 with the clinical
picture of a “grumpy” or “tired” face seek our help
with increasing frequency. They express a wish to get
rid of wrinkles – not only static, but also dynamic – on
the forehead and in the interbrow area. In this case, a
cosmetologist faces particularly the necessity to limit
the activity of facial expressive muscles. One more
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Specific aspects of combined male face correction . M-A Scherer
aspect – a visit to the cosmetologist must “remain
inconspicuous”, otherwise a noticeable correction of
esthetic problems/signs of aging may be perceived by
others as a failure and cause disapproval.
Before considering technical aspects, I would like to
emphasize the importance of a comprehensive
approach to the problems with wrinkles on the fore-
head, in the periorbital area and between eyebrows in
men, including a correction/fixation of the brow
position and shape to avoid both eyebrow ptosis and a
“female-type” rise.
I reduce BTA with a slightly less solvent volume:
2 mL of saline (instead of 2.5 mL) for a standard BTA
amount of 500 U. Such a dilution grade allows to pre-
cisely forecast and limit the solution propagation and
toxin diffusion areas. This helps to achieve good injec-
tion results especially in men because of a slightly
higher BTA concentration.
Volumetric face plasty with fillers mostly based on
stabilized hyaluronic acid is another equally popular
procedure (Fig. 1). I widely use in my practice prepara-
tions of cross-linked stabilized hyaluronic acid (HA)
which allow for a natural, harmonic, and predictable
outcome of the volumetric correction that lasts for the
period of 12–18 months.
Volumetric filler injections are indicated not only for
mature-aged men. Quite young patients presenting the
clinical picture of a “tired look” with hypotrophy in
the temporal, malar, and suborbital areas, deep nasola-
bial folds are also treated with this method. Gender-
specific aspects of the face can also be accentuated
through volumetric filler injections in the mandibular
angle and mental areas.
It must be pointed out that in volumetric plasty, the
filler must be introduced exactly into a definite adipose
Figure 1 The main zones of volumetric filler injections in men.
567
Specific aspects of combined male face correction . M-A Scherer
compartment showing constitutional or age-related
atrophy. Successful correction is based on knowledge
of topographic anatomy of the fat regions that provide
structural support for the overlying soft tissues,3 and a
clear comprehension of the appropriate HA gel dosing,
taking into account specific volumetric features of the
preparation selected for the procedure. A modeling is
performed within the target adipose compartment or in
the subcutaneous adipose tissue to ensure an even dis-
tribution of the preparation and a natural look. I point
out that the volumetric preparations of cross-linked
stabilized HA should not be introduced interdermally;
it must be injected only in the subcutaneous or deep
adipose tissue.
Let us discuss with more detail the correction of key
areas.
The forehead and the interbrow area
correction
Botulinum therapy
The morphologic features of a male forehead are the
following: It is more receding, wider, and often higher
than a female forehead. Frontal protuberances are
usually smoothed, and the superciliary arches are
conspicuous. Facial expressive motility in a male fore-
head is rather high, and horizontal wrinkles appear
early: begin to show or are already formed at the age
of 20–25. Often such wrinkles are related to habitual
glowering. The frontalis muscle in men is not only
more pronouncedly active, but also stronger than in
women. An increase in the standard BTA dose seems
therefore to make sense. But this would impair the
achievement of a natural result: A smooth “childish”
forehead creates an air of serenity – not typical for
men and undesired by them. Moreover, the approach
with bigger doses increases the risk of iatrogenic brow
ptosis.
Another important point is that horizontal wrinkles
on the forehead are seldom corrected alone, because
their formation and, further, elimination are associated
with the activity of muscles in the interbrow area –
the most motile and emotionally expressive zone in
men. In course of botulinum therapy, it is necessary to
maintain a harmonic activity correlation of the levator
– frontalis muscle – and the depressors – muscles of
the interbrow area (the brow crimpling muscle – cor-
rugator; the brow-lowering muscle and the procerus
muscle) and to avoid unplanned compensatory muscle
activation.4 This is achieved through rational place-
ment of the injection points and reasonable choice of
568
Figure 2 The zone of the upper face third: drawing of the
dynamic topographic net. The layout shows botulinum toxin type
A doses for each rectangle, and also the distribution of doses for
injection points in the interbrow area.
BTA dosages. The activity and strength of expressive
muscles, their anatomic–topographical features should
be evaluated prior to introduction of the preparation. It
is facilitated by use of a dynamic topographic net sys-
tem that I have elaborated (Fig. 2).
Step one in correction of forehead wrinkles is to
locate the borders of the epicranial tendinous aponeu-
rosis. To visualize the muscle volume, strength, and
activity and to locate the aponeurosis borders, a series
of tests is accomplished. In particular, the patient is
requested to rise the brows high (to show surprise) sev-
eral times. This shows the position of a point important
for the correction of this area – let us call it “the
aponeurosis point” (AP). This point indicates the low-
est location of the aponeurosis: Demonstration of sur-
prise forms no wrinkles in the central part of the
forehead above this point.
When building the dynamic net, the patient is first
of all requested to show surprise and the universal AP
is marked (the “x” mark in Fig. 2). When the patient
frowns and squints, the points of maximum brow head
motility, of maximal brow curvature, and points of the
brow tail are well visualized. Three lines are drawn
vertically upwards out of the points marked on the
brows – on the right and on the left side correspond-
ingly. Two horizontal lines are drawn: one through the
AP and the other on the halfway between the AP and
the line connecting the brow heads. (Important: any
flat image somewhat distorts the proportions of a 3-D
object, so be sure to place the lower horizontal line in
the middle between the AP and the brow heads in
Fig. 2) The sections of the resulting net correspond to
zones of different expressive activity.
© 2016 Wiley Periodicals, Inc.

BTA is introduced in the center of each section (rect-
angle) of the dynamic topographic net. It is a handy
reference benchmark for the therapist, while it allows
to make injections at the same level, to distribute the
toxin dose systematically and to exactly document the
injection layout of each procedure.
When injecting BTA in the forehead, the needle is
introduced at an angle of 90° to the skin down to the
periosteum and subsequently slightly drawn back into
the frontalis muscle. There is another technique, per-
haps more simple: the needle is introduced directly into
the muscle at an angle of 45°. It is possible to make
subcutaneous BTA injections to achieve a “soft” relax-
ative effect. The BTA doses per injection point are 2.5–
5 U (Fig. 2) depending on the degree of facial expres-
sive activity.
So, three ribbon zones of toxin introduction can be
distinguished according to the presented dynamic net:
level A – from the brow line to the lower horizontal
line; level B – between the lower and upper horizontal
lines; level C – above the aponeurosis central fixation
point (this is the level where the frontalis muscle fibers
transit to the aponeurosis).
Level B is the main region for correcting horizontal
forehead wrinkles in men, and in women as well. This
zone is the highest activity area of the frontalis muscle,
and the introduction of BTA does not lead to a change
in brow position.
On level C, BTA is also injected in all sections except
the central one (we consider this level in case of a high
forehead and/or low position of the aponeurosis central
attachment point). BTA dose per injection point is
2.5 U. Important: in case of a low forehead or deep
wrinkles with apparent tissue excess, the injections are
made only on level C.
The choice of injection points on level A should be
more considerate. No injections are made in the zone
between two medial vertical lines for prevention of
brow head ptosis. In men, BTA may be injected in the
paracentral rectangles, 2–2.5 U per injection point.
The injections are made more superficially. Working
on this level allows to retain the horizontal outline and
low positioning of the brows in men.
Formation of the interbrow area wrinkles and
creases is secondary to hypertonus/hyperactivity of the
corrugator, procerus, and the brow-lowering muscle.
A partial relaxation of the corrugator and the brow-
lowering muscle should be achieved to make vertical
wrinkles less distinct. Here, a standard BTA dose for
the glabella zone correction of 20–40 U is used. The
first injection point corresponds to the corrugator head
(bone fixation zone), the projection of which is the
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Specific aspects of combined male face correction . M-A Scherer
point of maximum brow head motility while frowning.
The injection is deep, intramuscular, the BTA dose is
7.5–15 U into each point on the right and on the left
side, and in case of injections in young patients, the
dosage may be reduced to 5 U. The use of mentioned
toxin dosages allows to maintain full facial expressive-
ness in the interbrow area. For men, this is essential.
When correcting horizontal wrinkles in the inter-
brow area, BTA is introduced into the procerus muscle,
in the point situated in the middle of the vertical (cen-
trofacial) segment between two horizontal lines drawn
from one brow head to the other and – with eyes look-
ing straightforward – from one pupil center to the
other. The muscle location and activity can be defined
more exactly through facial expressiveness tests (the
patient is asked to wrinkle the nose and frown). The
injections are intramuscular, 3–4 mm deep; the BTA
dose is 10–15 U.
Correction of the brow position
The goals set in correction of brow position and outline
in men and women differ drastically. When working
with a female face, the attention is focused on forma-
tion of a brow curvature or on lifting of the brow lat-
eral part – if not the entire brow. In male face
correction, it is more often necessary to preserve the
brow position and less often to lift the brows evenly
provided that their linear horizontal outline (a gender-
specific feature) is maintained. Nevertheless, I hear a
request “to open the eyes” by slightly lifting the brow
rather frequently; it comes more often from young and
middle-aged patients who usually work in places with
a mixed personnel. In older patients, such a correction
is performed in case of a somewhat overhanging upper
eyelid.
Botulinum therapy
The injection layout is elaborated with the use of the
dynamic net and the points located in the brow area
(Fig. 2). As a rule, in women, BTA is introduced on
brow level into projection points of the upper orbital
part of the orbicular muscle of the eye. A brow curva-
ture is formed and the brow tail levation takes place
due to relaxation of this muscle and prevalence of the
levator activity of the lateral part of the frontalis
muscle.
In men, BTA is introduced directly into the brow,
into the upper orbital part of the orbicular muscle of
the eye as well (Fig. 3). An additional point is used for
injections, and it is located in the middle of a segment
569
Specific aspects of combined male face correction . M-A Scherer
Figure 3 The botulinum toxin type A injection layout for correc-
tion of an excessively low brow position (brow lift).
between the point of maximal brow head motility and
the point of brow curvature corresponding to the
brow-lowering muscle projection. BTA introduction
into 4 points in the brow area allows to relax the cor-
rugator, the brow-lowering muscle, and the upper
orbital part of the orbicular muscle of the eye. Due to
even traction of the frontalis muscle, the brow is
slightly lifted without change of the linear shape, that
is, preserving the gender-specific feature. A BTA dose
of 2.5–5 U is introduced into the brow tail point, 2.5–
5 U – into the relative brow curvature point, 2.5–5 U
into the intermediate point, and a dose of 5 U into the
point of the brow head (this point is also used in cor-
rection of interbrow area wrinkles in Fig. 2). For
enhancement of the levator function of the lower part
of the frontalis muscle, BTA is introduced into points
located symmetrically in the upper depressor part of it
on level C on the left and on the right (two points on
each side), 2.5 U per point (Fig. 3). In this case, the
compensatory muscle activity mechanism comes into
action.2,4
Volumetric plasty for brow lifting
Correction of the brow position can be performed with
fillers in patients with a low-active frontalis muscle
and faintly accentuated superciliary arches. Therefore,
BTA injections are made into the discussed above 4
points on the brow and into the procerus muscle, and
after 2 weeks, the filler is injected. A slight levation of
the brows is achieved, and motility in the forehead is
maintained.
This method is simple enough. The cross-linked sta-
bilized HA preparation is introduced through a 25G
cannula 50 mm long. The cannula entry point is
570
Figure 4 Brow lifting with volumetric filler injections.
situated a bit laterally from the extreme point of the
brow tail. The cannula is introduced down to the
periosteum and is moved medially upward toward the
frontal protuberances, and 0.3–0.5 mL of filler is intro-
duced in each of their projection points (Fig. 4). Conse-
quently, an active upward modeling of the preparation
is being performed. Creation of a certain convexity of
the frontalis muscle leads to a brow line rise by several
millimeters.
Correction of the temporal area
Volumetric plasty
Depression of the temporal area soft tissues is an
esthetic defect as such and can cause lowering of the
brow tail. Adipose tissue atrophy of the temporal area
often comes along with an involution of the adipose
tissue in the brow area (retroorbicularis oculi fat,
ROOF). That is the reason why temporal area volumet-
ric plasty encompasses, as a rule, correction of the lat-
eral brow end area as well (Fig. 5).
In correction of the temporal area, it is necessary to
avoid injury to the superficially located vessels and
nerves.5 The interfascial layers are considered in this
context to be the most safe filler injection level.6 The
technical procedure that I suggest allows to inject the
filler exactly into this level: the soft tissues of the tem-
poral area are grasped between two fingers and are
lifted over the muscle, and the needle or cannula is
introduced into the base of the formed crease. The total
filler amount should not be more than 0.3–0.5 mL for
one side. This preparation volume provides for a suffi-
cient and harmonic outcome. Immediately after the
injections, an active modeling is made to distribute the
introduced material evenly. When performing fan-type
© 2016 Wiley Periodicals, Inc.

(a)
(b)
Figure 5 Volumetric correction of the temporal area: (a) the
bolus technique; (b) linear injections with a cannula.
Figure 6 Location of botulinum toxin type A injection points in
correction of the lateral eye corner zone and elimination of
compensatory medial eye corner wrinkles.
injections with a cannula, the entry point is situated
on the zygomatic arch, upward from the line drawn
from the pupil of the eye to the ear lobe. The cannula
is advanced through the temporal fossa to the border
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Specific aspects of combined male face correction . M-A Scherer
of the temporal area, and ≥0.05 mL of the preparation
is injected retrogressively along every vector. Some-
times a venous pattern may appear, but this undesired
effect resolves completely in 10–14 days after full inte-
gration of the preparation.
Wrinkle correction in the lateral eye corner
area
Botulinum therapy
In men, esthetic problems of the periorbital area form
early and are significantly expressed due to the preva-
lence of hypertensive or hyperkinetic muscle activity
type. Age-related changes of the area around eyes are
undoubtedly related to a change in brow position:
brows and eyes form an integrated esthetic entity. In
correction of the periorbital area, it is necessary to con-
sider skin tonus of the lower and upper eyelid, pres-
ence of expressed skin excess and edema as well. These
are relative contraindications for esthetic correction.
Correction of the lateral eye corner area in men is
not meant to relax the muscles of this area completely.
A deep relaxation of the lateral part of the orbicular
muscle of the eye creates the impression of an open
and trustful gaze, which befits women very well, but is
out of question for men – the gender-specific “aggres-
siveness” is lost.
The goal of esthetic correction is to smoothen the
wrinkles in the central and lower parts of the lateral
eye corner; nevertheless, preservation of small wrinkles
in the upper part of this area is possible. Therefore, it
is necessary to relax only the lower lateral part of the
orbicular muscle of the eye, leaving the upper lateral
part active. To do so, the injection points are located
lower than the intercanthal line, and the injections are
made intra- or subcutaneously. In such a correction,
the skin rugosity is eliminated but single rhytids
remain. So, the ability to convey positive emotions
through natural, hearty facial expressions (for exam-
ple, a sincere Duchenne smile7) is preserved.
The injection points are selected as follows (Fig. 6):
Several lines are drawn from the pupil midpoint with
the patient looking straightforward – the first line to
the brow tail; the second is a horizontal line drawn
through pupil centers of both eyes; the third line is
drawn to the ear lobe; and the fourth is drawn verti-
cally through the pupil midpoint (the midpupil line).
These lines form projection sections of the orbicular
muscle of the eye with the orbicular bone edge as the
inner border. A total of 5 U of BTA is introduced into
the central part of each section, except the upper
571
Specific aspects of combined male face correction . M-A Scherer

lateral one (hatched in Fig. 6). This technique is rec- (a)

ommended for fan-type location of wrinkles. An adjust-
ment is possible in every particular case.
Injections in the lower eyelid area should be per-
formed with caution: BTA introduction in high doses
may lead to a prolapse of the infraorbital fat and her-
nia aggravation – that happens more often exactly in
men and may also lead to ectropion formation. The
importance of wrinkle correction in the eye inner cor-
ner area should be noted. These rhytids may be of a
compensatory origin. For prevention of their develop-
ment, 1–2.5 U of BTA is introduced intracutaneously
into the point where the midpupil line crosses the
lower orbital edge (marked with “*” in Fig. 6). The (b)
preparation is injected intradermally with papula for-
mation to avoid eyelid eversion. The dose is reduced to
1–1.25 U if the patient earlier underwent a lower eye-
lid blepharoplasty.

Correction of the zygomatic area

Volumetric plasty

The buccomalar area is the center of face harmony and

balance. Volume of the deep (suborbicularis oculi fat,
SOOF) and superficial adipose tissue layers (the intraor-
bital fat/malar mound/and the middle cheek fat) in the
zygomatic arch area is of big importance for the esthet-
ics of the face middle third, ensuring the malar and, par-
tially, cheek form, curvature, and rotundity. The
inferior suborbital adipose tissue (SOOF) – statically
attached, nongliding, and nonmovable through motility
of facial expressive muscles – does not sag with age, but
is susceptible to involution; therefore, the volume recov-
ery of this compartment is an important step of esthetic
correction.8 When working with male patients, it is
important, as mentioned above, to rule out hypercorrec-
tion which may cause face feminization.9 Therefore, it is
regarded essentially important to use small volumes of a
cross-linked stabilized HA filler. The filler is introduced
with a needle in a microbolus technique: A total of 5
consecutive injections of 0.1–0.2 mL each (total volume
not more than 0.5–1 mL on each side) are made on the
zygomatic arch line (Fig. 7). Preparation location depth
is above the periosteum. It is possible to carry out zygo-
matic area correction with a cannula 25G 25 mm long:
Retrogressive injections are carried out in a fan tech-
nique, and the cannula access is provided in a point
located on the so-called McGregor’s patch (a fibrous tis-
sue clump in the center of the zygomatic arch). The
midpupil line limits the vectors medially, and it allows
to avoid injuring the neurovascular bundle emerging
Figure 7 Volumetric filler injections into the malar zone: (a) the
microbolus technique; (b) fan technique using a cannula.
from the infraorbital foramen.6 Total volume for one
side is 0.5–1 mL, and for one vector 0.1–0.2 mL. A
thorough modeling is carried out after injection.
Conclusion
The increasing number of male patients in practice of
esthetic medicine specialists has become an incentive
for comprehensive analysis of this trend. In the opinion
of psychologists, motivation of male patients to
undergo an esthetic correction comes not only from
awareness of face aging, but also from a number of
social aspects. For men, the necessity of rejuvenation is
inseparable from accentuating gender-specific features,
male sexuality, personal wealthiness, social status, role
in the community. The final expectance regarding
esthetic correction is to look rejuvenated, irradiating
health and energy, successful, keeping up with time
(Fig. 8). But it is important not only to maintain but
even accentuate to some extent the masculine features
of the appearance. Along with common issues, wishes
of patients may differ according to age, social status,
occupation, and professional environment. Some men

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 Specific aspects of combined male face correction . M-A Scherer

(a) (b) (c) (d)

(e) (f) (g)

(h) (i) (j)

Figure 8 Metamorphosis of male patients at various stages of esthetic correction. Patient L., age 36: (a) presented with complaints
about wrinkles in the forehead and a tired, haggard look. A combined correction was carried out. In the first step, 75 U botulinum toxin
type A was introduced in the upper face third and the lateral orbit area. In 2 weeks, volumetric correction of the malar area and the
nasolabial folds (cross-linked stabilized hyaluronic acid, 2 mL) was performed. (b) The outcome. (c) and (d) correction layout. Patient D.,
age 30: (e) presented with complaints about a tired look, also looking older than his age. Botulinum therapy (in the interbrow area) and
volumetric correction with 3 mL of cross-linked stabilized hyaluronic acid preparation were carried out. (f) The correction outcome. (g)
correction layout. Patient A., age 32: (h) presented with complaints about a “tired face”. Botulinum therapy (in the interbrow area) and
multizone volumetric correction with 3 mL of cross-linked stabilized hyaluronic acid preparation were carried out. (i) The correction lay-
out. (j) The outcome.

are proud of their “scowl”, and some, to the contrary,
come with a request to lift the brows a little and
“open” the eyes. Whatever procedure is carried out,
the key point for success will be moderateness of the
outcome. An outside observer must notice no particu-
lar changes, only improvement of the appearance as a
whole, a harmonization of the face.
In botulinum therapy, universal injection algorithms
should not always be the only reference. The specific
features of male skin, muscles, and facial bones require
a special approach to esthetic drawbacks correction.
The continuous changes of face esthetics perception in
the society transform the correction goals as well. My
accumulated clinic experience shows that in botulinum
therapy of the upper and middle third of male faces, it
is appropriate to use the same BTA dosages as recom-
mended for women – without increasing them by 50
or even 100%. The therapy specifics concern the injec-
tion points location and toxin doses for every point. As
a result, a rather distinct smoothening of the skin pro-
file without detriment to the facial expressiveness and
gender-specific features is achieved.
To my opinion, optimal results of volumetric filler
injection procedures are achieved with the use of –
however paradoxical it may seem – fairly “delicate” fil-
lers, which create a discreet volume, nevertheless with
a possibility of modeling in the tissues. Although a
slight volumetric hypercorrection of the middle face

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Specific aspects of combined male face correction . M-A Scherer
third is acceptable in females (an extra rotundity and
tenderness of the face), in males it may deprive the
appearance of a masculine air. Men perceive such
things as extremely negative (a “doll-like” face). Use of
a cross-linked stabilized HA preparation allows to carry
out volumetric correction in men with a maximally
natural-looking and stable outcome.
Acknowledgements
The author is thankful to Dr. Razumovskaya E.A. for
consulting and kind help with preparation of this article.
Conflict of interest
The author reports no conflicts of interest regarding
this article.
References
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