Dr. Eshbaugh’s Interview with Florida Weekly – Cosmetic Surgery Options for Men


Cosmetic surgery

the Body
Florida Weekly Correspondent

 Azul before and after mens injectable fillers.  Azul before and after mens injectable fillers.

Punta Gorda plastic surgeon Michael Stampar can’t help but notice that even the world’s most beautiful men could benefit from a brow lift.

Tom Cruise and Brad Pitt are handsome men but as they’ve gotten older you can see their brows are almost touching their eyelashes,” he observes. “I tell my wife both of them are future candidates.”

At Spago, Dr. Stampar’s day and medispa, he performs a somewhat simple procedure that won’t produce the Hollywood surgery-gone-bad look — you know the one: deer-in-the-headlights eyes and wind-tunnel-stretched skin. Gore alert ahead: Instead of “pulling at the top of the head to high heaven,” he makes an incision in the eyelid and peels up about a centimeter until the brow is once again resting on the bone.

After a few days of minimal discomfort and minor bruising, patients look younger and less tired — two of the top reasons that bring men into local plastic surgeons’ offices. Treatment for belly fat, love handles and gynecomastia, or male breasts, also are popular procedures for male patients.

 After  After

More men are turning to the plastic surgeon to address issues associated with aging — heavy eyelids, turkey necks, sagging jowls. But they’re not exactly running. Plastic surgery, says Fort Myers surgeon Ralph Garramone, is still a female-dominated world.

“There’s women behind the counter and women in the waiting room. That often prevents men from considering surgery,” he says. At his practice, laser hair removal, liposuction above the belt and gynecomastia are the top treatments performed on men.

Concerns about recovery time and visible bruising that screams I HAD SURGERY also deter men from consulting with an expert. So, too, does the fear of needles and pain, say several local surgeons.

“You know that saying about the bigger they are, the harder they fall,” says Dr. Stampar.

Male patients typically start with non-invasive procedures like Botox and other fillers, fat-blasting CoolSculpting and SculpSure, and skin-tightening and wrinkle-reducing Pelleve and Thermage.

Simple procedures with little to no downtime can make men instantly look younger and less angry — important in business and if they’re re-entering the dating scene. Some male patients seek a surgeon’s skill from pressure at home, acquiescing to a spouse tired of waking up to a man who looks, well, tired or has a “gobbler neck,” according to Manuel Peña, who’s been practicing in Naples since 1990. “Their wife is the one sitting next to him and looking at him all the time.”

 Above and right: Pelleve before and after.  Pelleve Before

Men tend to furrow their brows and make other facial expressions that eventually leave lasting marks — the deep vertical 11s between the eyes and the rippling transverse waves along the forehead.

“Botox brings men in because it’s a common and simple procedure to erase frown lines,” says Patrick Flaharty, who focuses solely on facial plastic surgery at his Azul Cosmetic Surgery and Medical Spa. “It takes away those vertical lines that make us look angry and frowny — although some men like the intimidation factor. After treatment men look approachable, younger and less stressed. The world treats them differently.”

Men account for 3 to 10 percent of all local cosmetic surgery practice patients. Nowhere near those of large metropolitan areas and less so in Charlotte County, Dr. Stampar says. Promising new procedures are likely to reel in more men — NeoGraft hair transplants, permanent double chin-zapping Kybella and minimally invasive InstaLift that tightens and lifts the face and uses special sutures that stimulate collagen as they dissolve.

 Pelleve After

“A lot of men in their 40s feel they’re fighting to maintain their job or they’re going up the ladder and want to look like they’re still in the game,” says Dr. Peña. “Some are still working and keep getting asked when they’re going to retire.”

Those who do decide to fight the aging process — from fillers and fat reduction to whole facelifts and hair transplants — are glad they did. It boosts self-confidence.

“It was the best thing I did,” says Steve A., who underwent a hair transplant shortly after Riverchase Dermatology and Cosmetic Surgery introduced Neo- Graft a year ago. “My grandfather was bald and my father was bald. I’d done the traditional transplant a while ago and it didn’t work and left a noticeable scar.”

Riverchase’s Bill Eshbaugh performed Steve’s NeoGraft, a transplant that individually harvests every third hair follicle from the lower and back of the head — areas not genetically programmed to fall out. The follicles are specialized cells and the smallest unit that can be transplanted; each follicle can produce four to seven hair shafts.

“We’ve had a lot of success with Neo- Graft and get natural-looking results,” Dr. Eshbaugh says. “A lot of men who have had the traditional transplant are self-conscious about the scar. This is the most appealing technology available for men frustrated with the scar or the side effects of medications. Good transplants don’t get noticed because they look so good. People tend to notice the bad ones.”

“It’s amazing. I’m more confident,” says Steve, who’s in his early 50s and considering a second round for the front of his head. “Dr. Eshbaugh and his team hit a home run. Everybody looks at me and says, ‘Oh, my gosh.’ It wasn’t painful and there was no recovery time. I was working right away.”

At Azul, Dr. Flaharty treats a variety of patients in various stages of their career or the aging process.

“Younger men are more open to fillers usually, men in their 50s and 60s may have loose skin on the neck which a shirt and tie accentuates, and aging CEOs in their 60s and 70s want to look younger and more competitive because the 30- to 40-year-olds are eyeing their job and their desk. Men are living longer and working longer but they don’t want to look their age.”

Nonsurgical CoolSculpting, which freezes and kills fat cells, can create washboard abs, reduce love handles and add contouring without any downtime, says Dr. Eshbaugh.

“People take care of themselves, exercise and eat right but still have problem areas,” he says. “Physical trainers say you can’t spot reduce, but we can.”

Although basic treatments are the same for men and women there are differences a surgeon needs to be tuned into, says Dr. Peña. Big beautiful eyelids look great on a woman but don’t translate to the male face.

“Men want to look like men and you have to find a plastic surgeon dialed into that,” he says. “I purposely keep eyelids to a masculine shape and size. Businessmen want to look good; they don’t want to look old or feminine. A masculine jaw line is also important. A man’s face should look filled but without high cheekbones.”

Besides injectables for sculpting, filling and eliminating lines, other nonsurgical treatments offer great results. Thermage and Pelleve work below the skin surface to tighten and lift and stimulate production of collagen, the missing youth factor.

But Dr. Stampar cautions that Pelleve works best before “lines are imprinted. It has to be done early enough before men develop jowls or a hanging neck, or it’s too late. Then they need a facelift and that depends on hair patterns to hide the scars. The longer men wait, the longer the incision and it gets harder to make it inconspicuous.”

Minimally invasive laser techniques have also proven successful with less downtime than full surgery.

Dr. Peña reports success with Thermi- Tight, a new treatment that tightens the lower face with radiofrequency energy and a needle that in essence “shrinkwraps the skin. It’s been most successful on men with loose necks,” he says. “It works well in three to six months and you get full results in a year. Downtime is literally a weekend.”

Surgical procedures have also been perfected, allowing surgeons to place hidden incisions behind the hairline and in the ear to freshen up aging faces. Reducing male breasts is surprisingly one of the top procedures performed locally, according to local surgeons who cite steroid use as one of the top contributing factors. Obesity and genetics also contribute.

Ironically, male athletes and men who shed a lot of weight often end up with gaunt, flattened faces, which can be corrected nonsurgically with a liquid facelift. Dr. Stampar says injectables like Scultpra fill in the face while aiding the production of collagen. “It plants the seeds to grow the face back,” he says, noting 80 percent of his patients maintain the look two years after a series of injections.

“So many people have the misconception that once they start Botox or fillers they have to keep it up,” he says. “All that’s going to happen if they stop is they’re going to go back to where they were before they started. Every time they smile, they’re crushing the filler and not their own skin. They’re going to look better a year later because there’s no damage to their tissue.”

Facial expressions lead to lines. During consultations, Dr. Stampar observes patients’ facial movements, noting if they tend to smirk when they smile or purse out of a nervous habit or stress.

“They don’t smoke but they chew on their lip or smirk on one side of the face. It’s hard to change habits but I make them conscious of it and teach them to take a deep cleansing breath with their lips parted. If their lips are parted they’re not going to get lines.”

There are also tricks of the trade that nourish the body while it’s healing from even the most noninvasive surgeries. Taking vitamin C or a collagen supplement post-surgery supplies nutrients to aid recovery and probiotics cleanse and ease bloating after body sculpting procedures.

Proper skin care is also important; however plastic surgeons say it’s difficult to get men to commit.

“A man is not going to use six products,” says Dr. Flaharty. “I’m happy if they cleanse every night and use a product with active ingredients with the new generation of collagen and growth factors that rejuvenate the skin.”

“People invest a lot of time, money and risk and want to maintain the results,” says Dr. Eshbaugh. “They drop the ball when it comes to skin care during healing. You have to protect your investment even with something as minimal as Botox. Proper skin care, staying out of the sun and away from smoke are important.”

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