Male facelift

Share of patients

• Male facelifts are about 10% of US facelifts per year (PMID 36696315).
• ABPS tracer data 2006-2021: 91% of 3,400 facelift patients were women (PMID 38302713).
• CosmetAssure: 8.8% of 11,300 facelift patients were men (PMID 26578747).

Hematoma in men

• Baker 1977: large hematomas occurred in men more than twice as often as in women (PMID 909960).
• Baker 2005, 985 men over 30 years: evacuated hematoma fell from 8.7% to 3.97% with strict blood pressure control; women 1%-3% (PMID 16327611).
• CosmetAssure: male sex relative risk 3.9 for hematoma (PMID 26578747).
• Clonidine protocol, 1,089 facelifts: 10 hematomas, 5 in women and 5 in men; 5.2% of men (PMID 25811571).
• Rohrich 2017, 83 men vs 83 matched women: hematoma 6.0% vs 0% (P = .0587) (PMID 28125532).
• Grover 1,078 facelifts: male sex an independent hematoma risk factor (PMID 11513508).
• Abboushi 630 facelifts: hematoma risk higher in men (PMID 22446820).
• Maricevich 229 facelifts: male sex independent risk factor on multivariate analysis (PMID 24912427).

Technique differences

• Incision design follows hair growth patterns; dissection avoids follicle damage; hypotensive anesthesia avoided (PMID 28125532).
• Men seek a masculine outcome not closely tied to youth; techniques adapted to avoid signs of surgery (PMID 35367032).
• Male deep-plane specifics: denser subcutaneous tissue, more vascularity, prominent subplatysmal structures, hypertrophic digastric and visible glands (PMID 40889761).
• Male deep-plane and neck lifting with limited skin delamination and gonial and cervicomental angle reconstruction (PMID 38936991).
• Vector analysis: SMAS lift vector less vertical in men (65.4 degrees) than women (71.3) (PMID 38657095).
• Bald men, 68 deep-plane lifts over 10 years: skin-excess handling method for near-invisible scars; high FACE-Q scar satisfaction (PMID 31881604).
• Trichophytic incision and incision placement as male-specific details (PMID 32866978).
• Male face-lift preoperative markings and analysis (PMID 36696315).

Male neck

• Dual-plane reduction neck lift: deep volume reduction under the platysma, superficial redraping under minimal tension (PMID 35367033).
• Direct neck lift (submental skin excision) avoids periauricular scars; candidates have laxity above the thyroid cartilage and accept an anterior neck scar (PMID 40992434).
• Direct neck lift techniques and incision patterns (PMID 38936992).
• Short-scar male neck lift for localized cervical aging without midface descent (PMID 40962266).

Volume

• Fat grafting the male face: each area needs technique that avoids feminization (PMID 38936996).

Outcomes

• Rohrich 25-year series: male and female patients had similar results and revision rates (PMID 27348643).
• AI age estimation, 15 men: 2.0-year reduction at 3 months (P = .06) (PMID 36706713).

Glossary

• Trichophytic incision: incision beveled so hair grows through the scar (PMID 32866978).
• Direct neck lift / direct cervicoplasty: excision of submental skin through an anterior neck incision (PMID 40992434).
• Gonial angle: angle of the mandible (PMID 38936991).
• Hypotensive anesthesia: deliberately low blood pressure during surgery; avoided in the male protocol to prevent hematoma (PMID 28125532).

Papers

Open questions / controversies

• Hematoma is higher in men in every series listed here; the prevention evidence in men is retrospective (PMID 25811571, PMID 28125532, PMID 16327611).
• Deep plane vs SMAS in men: technique articles are expert opinion (PMID 38936991, PMID 40889761).
• Direct neck lift scar acceptance vs facelift scars in men (PMID 40992434).