A recent study was conducted about the use of Botox, one of the most common treatments for wrinkles. That study found that in 2019, men underwent nearly half a million Botox injections in the US alone. That was nearly a 400% increase as compared to the year 2000. So while men may not be openly talking about their wrinkles, they certainly appear to be thinking about them. To help us better understand the causes and management of wrinkles, we spoke with Dr. Jasmine Yun.
Dr. Jasmine Yun
Dr. Yun is a board-certified and licensed dermatologist who earned her undergraduate degree from UCLA. She then received a joint MD/MBA from the UCLA School of Medicine and the Anderson School of Management at UCLA. She proceeded to complete her dermatology residency at MLK-Harbor and Harbor-UCLA and then completed a dermatopathology fellowship at the Ackerman Academy of Dermatopathology in New York. Dr. Yun serves as a Clinical Associate Professor of Dermatology at USC Keck School of Medicine where she has devoted much time educating resident physicians and also has spent time participating in medical missions in developing countries. She also has a private dermatology practice in Los Angeles.
08/11/2021
Better Man Clinics
Today we’re going to be talking about wrinkles, an issue that most guys won’t openly talk about, but many of them are really thinking about. And how do we know that? Well, to give you one example, a year or two ago, a study was done which showed that about half a million men in the United States alone underwent one of the most common treatment for wrinkles, Botox. That was a 400% increase since the year 2000. Today, we’re really fortunate to be joined by an expert on wrinkles, a board certified and licensed dermatologist who treats men and women for wrinkles every day: Dr. Jasmine Yun. The first question I have for you is really just in terms of your own experience. As a dermatologist, I’m sure you see a lot of patients seeking help for the management of the wrinkles. What fraction of those patients are men?
Dr Yun
I’ve been practicing for 21 years now. And every year the percentage grows. Wives are bringing their husbands into the office, and they’re both getting Botox together. I would say that over the last five years, the percentage has grown from 10% to 20% of my patients who are men seeking treatments for cosmetic reasons such as wrinkles.
Better Man Clinics
What is the age of your typical male patient that comes in for wrinkles?
Dr Yun
Well, the range would probably be from age 20 to our baby boomers in their 70s. But the average is probably men in the Gen X generation: men in their 30s to 50s. And now we have social media, so we have a lot of patients who are young and are interested in “pre-juvenation”, which means the prevention of wrinkles. Our Gen Xers are just starting to show the visible signs of aging. My practice is in Studio City, California, named after all the studios in proximity to our practice. We have a lot of celebrities and actors as well as people behind the cameras: the crew, the directors, the cameraman. They want to come in and just get a little “zhuzh”; you know, nothing like a facelift, not anything that would make anyone suspect that you had something done. They just look a little bit more relaxed and rested.
Better Man Clinics
Everyone knows what a wrinkle looks like but, from a medical standpoint, what is a wrinkle and what causes them?
Dr Yun
Rhytid is the medical term for a wrinkle. Over time, natural aging and other factors may be part of the process that creates wrinkles. Because I’m a pathologist, I read slides and I see the skin under the microscope. In people with wrinkles, there’s less collagen, and less elastin in the dermis. The building blocks creating the foundation of our skin are collagen and elastin. That is what make the skin “bounce back” when pulled. As we get older, the collagen and elastin weakens and that begins to cause the skin to sag and to get thin. That is when you start to have fine wrinkles. When you repeatedly make expressions over time, like frowning or smiling or smoking or puckering – those actions cause dynamic wrinkles, which means that your muscles are moving a lot and you start to have those deep wrinkles. Through the same mechanism, you also get the frown lines, smokers lines and crow’s feet. And those are different types of wrinkles that we can have over time. And the deeper that they get, the harder it is to erase them. If you’re 80 years old and you realize that you have all these deep lines, it’s harder for me to reverse them at that point as opposed to if you start at a younger age (like 20-30) and try to prevent those wrinkles.
Better Man Clinics
That’s interesting. You hear a lot of criticism of younger people treating wrinkles. But, if I am understanding you correctly, the sooner you start some kind of intervention or prevention, the better success you’ll have in the longer term? If you’re waiting truly until you’re in late middle age, and those wrinkles are quite obvious, they’re harder to reverse and you will probably have less success?
Dr Yun
Exactly. Also, the younger that you start with prevention, the fewer treatments you’ll need per year. You will still be able to emote and have facial expressions, but you won’t have those deep furrows and lines that are hard to reverse.
Better Man Clinics
Let’s talk about some of the causes of wrinkles. One thing you mentioned was smoking. You specifically mentioned smoking in terms of how people pucker their lips on the cigarette. Does the cigarette smoke itself (or the chemicals in it) also cause wrinkles, or is it just the process of puckering around a cigarette that causes wrinkles?
Dr Yun
When you smoke you get the pucker lines, but you also have less oxygen going to your skin. Your skin is always repairing itself by trying to fix the DNA damage of natural aging. If you deliver less oxygen, it can increase the free radicals and the toxins that build up in our skin which can limit that repair. That increases premature aging as well as signs of aging like wrinkles. So its definitely important to stop smoking both to limit the puckering and to decrease the DNA mutations in our skin. You want a lot of oxygen going to your major organs- its good for your heart, good for your lungs and good for your skin.
Better Man Clinics
How much does sun exposure impact wrinkles? Or does it?
Dr Yun
Oh, definitely. The literature shows that UV rays increase DNA mutation. That’s what causes skin cancer and it also increases wrinkles and other signs of aging. I always tell my patients in Los Angeles, “you want to enjoy your life, you want to have an active lifestyle; but cover up, wear big hats, try to avoid sunbathing at all costs, avoid tanning salons, and avoid being outside between 10am and 2pm. Because, yes, sun exposure definitely increases your risk of skin cancer and premature signs of aging like wrinkles.
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Do people with different skin tones have different propensity for wrinkling based on UV exposure?
Dr Yun
Genetics and race definitely have an effect on the risk of skin cancer. Fairer individuals have an increased risk because the melanin in the skin of brown and black people is protective. Under the microscope, we can see that the solar damage is increased in patients with fair skin who have had a lot of sun exposure. Patients with brown or black skin have decreased sun damage under the microscope. The same appears to apply with regards to wrinkles.
Better Man Clinics
A term I love that you just used earlier was “pre-juvenation” – a kind of prevention, even before you start seeing wrinkles. What does that entail. If you’re a young person, what can you do to “pre-juvenate”
Dr Yun
Our 20 year old and 30 year old patients are coming in for, what is referred to on social media as, pre-juvenation, which basically means prevention. What can you do to pre-juvenate? You can get over the counter items like topical creams. Those options are obviously non-invasive and easy to acquire. You can just go to your regular corporate pharmacies like CVS or Target and get these great creams. I would say in the morning, you can start off with a vitamin C serum – that seems to be shown to decrease the free radicals from all the pollution in our cities (and sun exposure), and can decrease that the oxidative damage from just being alive in the world today. The vitamin C serum should be put that on clean skin. And then I would use sunscreen, at least SPF 30, in the morning- it’s just a great habit to get into for both men and for women. I know a lot of men who have an aversion to putting anything greasy, or really anything on their skin. They just want to brush their teeth, shave and go. But it is always good to get in the habit of putting the vitamin C serum then the sunscreen on as well – then you don’t have to worry about the sun. If you’re outside swimming or sweating, reapply after an hour. If you have been outside all morning, then reapply midday. Also, if you’re outside, wear a big hat. For nighttime, you can get an over the counter retinol or Retin-A. Some common versions include tretinoin, Retin-A, Tazorac, Adapalene and others-some of them are over the counter while others require a prescription from a physician. These creams work in a couple different ways. First, they’ll take off that dead flaky skin on the outside so you’ll have a little mini peel. Then, after maybe a couple weeks, the dead flaky skin is off and it’s promoting differentiation of your skin- the skin is turning over a little bit more quickly so you have more of a glow. And then over months and years if you’ve been using Retin-A, it promotes collagen building. We talked before about how the building blocks of our skin is the collagen. By promoting collagen building, the Retin-A promotes a good foundation for your skin and it helps tighten and prevents saggy skin. So I always recommend those three things for patients in their 20s and up : vitamin C serum in the morning, sunscreen after that, and a retinol or Retin-A at night.
Better Man Clinics
Are there any side effects of these various over the counter creams that men should look out for?
Dr Yun
Some people can rarely have an allergy to vitamin C. Sometimes you can have a stinging, especially if you’ve been using a retinol. The retinol makes your skin sensitive to anything, even a moisturizer. Many people think the Vitamin C is causing the stinging but it is often the retinol they are using that is making the skin sensitive to everything. Generally, vitamin C serums usually has no significant side effects. For sunscreens, there are a lot of PABA free and non-chemical or physical sunscreens that you can use if you’re worried about the chemicals. There is also sheer sunscreen, like Neutrogena ultra sheer, that a lot of my male patients like because it goes on non-greasy, doesn’t feel like anything, and it doesn’t leave a white residue. The retinols definitely have possible side effects. Because you’re having a little mini peel with these creams, you can have burning, irritation or redness. I use it twice a week because I do get irritation. A lot of patients do get irritation with the retinols but it does go away over time. You can counter that irritation by moisturizing or mixing it half and half with whatever moisturizer that you have. That will help. But it definitely is very common to have some burning, irritation, peeling and/or redness from any of the retinols, both over the counter and the prescription.
Better Man Clinics
Does “pre-juvenation” ever require prescription medication or more invasive procedures?
Dr Yun
if you’re in your 30s, and you’re starting to see the lines of wrinkles, “pre-juvenation” also can mean that you get a little Botox, which prevents the deep ones from forming. So now we’re moving into the procedural “pre-juvenation” domain where you can have a few procedures and, while no one will know that you have anything done, it does definitely prevent those deeper lines from forming over time.
Better Man Clinics
Earlier, you pointed out a few areas of common for wrinkles. For men, what are those main areas? Do they differ from those found in women?
Dr Yun
I would say that the number one area that men want treated is the forehead. Those horizontal lines really bother a lot of men. Women commonly complain about the forehead and crow’s feet. Otherwise, another area that men don’t like are the nasolabial folds, the creases between the nose and cheeks. Now that we’ve been on zoom, and working from home, tech neck is a big thing for men as well.
Better Man Clinics
What is tech neck?
Dr Yun
Tech neck is saggy skin on the neck. Many men come in and they want this tightened a little bit. We have relatively easy procedures to manage this issue
Better Man Clinics
What happens when we are past the point of “pre-juvenation” and over the counter medications? What is the next step for the actual treatment of wrinkles?
Dr Yun
If you are using the over the counter retinols and you’re not peeling anymore or you’re not seeing as much glow into your skin or if you’re reaching your 30s or 40s, you may want to see a dermatologist. They can offer prescription Retin-A and other different types of prescription retinoic acids that are 10 to 100 times stronger than what you can get over the counter. But a cream can only get you so far. A dermatologist would probably also have a discussion about injectables. That would likely be the next step. Botox is our most common injectable. There are four different types of Botox that are FDA approved in the United States. They’re all types of botulinum toxin, which is a naturally occurring muscle relaxant. When used in the right ways and injected by the physician, they can reduce the appearance of fine wrinkles and also reduce those dynamic wrinkles that we have been talking about – the wrinkles caused by recurring facial movements like squinting or frowning or raising your eyebrows or smiling.
Better Man Clinics
You mentioned that Botox relaxes the muscles. Can you still make facial expressions after Botox if it relaxes the muscles of the face?
Dr Yun
Yes, you can still make expressions like smiling and raising your eyebrows, but you won’t see those lines, those deep lines, when you emote. The effects are also temporary. If you don’t like the outcome, it goes away in three to four months.
Better Man Clinics
How much does a Botox injection hurt? What does it feel like?
Dr Yun
It depends on how many areas you get injected. Botox is indicated for the upper face. It feels like little pinches. We use a 31 gauge needle, which is a very small. It feels like little mosquito bites in each area. Not bad, very tolerable.
Better Man Clinics
If I wanted to get Botox for my forehead, how many shots would be required on average?
Dr Yun
I would say probably around eight to ten little pinpoint shots
Better Man Clinics
Are there any restrictions after the procedure?
Dr Yun
The only restrictions that you would have are no exercising and no naps. The reason for this is to prevent the unwanted migration of the Botox from the site of injection. We usually give you a little bit of ice if you do have any bumps. But in about 15 minutes, no one will know that you had anything done. Bruising can occur in some patients. With an inexperienced injector, you can have ptosis or eyelid drooping so you have to be careful to avoid someone who doesn’t know how to inject. Some patients can have a little bit of a headache, but that usually goes away within 30 minutes.
Better Man Clinics
If you get treated with Botox, should you assume that you’re going to be treated every three to four months? Is it correct to say that it is not a permanent one time solution?
Dr Yun
Exactly. Actually, if you keep up with it, you tend to go fewer times a year, because your face starts to “forget” to make that “frowny” face. I have patients who’ve been getting Botox injections for five to 10 years who only need to come in once or twice a year, because it’s really maintenance at that point.
Better Man Clinics
You mentioned the importance of an experienced injector. What are the questions that need to be asked of the injector? What qualifications should they have?
Dr Yun
First, they should be a Board Certified physician. I would say they should be a dermatologist or plastic surgeon because that’s what we do all day long. That’s what we’re trained to do. A lot of these Medi spas have a Board Certified physician, but they may be an emergency room physician, or an OB GYN or even a dentist or dental surgeon or oral surgeon. Especially for your first time, I would make sure that you go to a Board Certified physician, preferably a dermatologist or plastic surgeon, and also ask if they have any before and after photos (like a gallery). Look at their reviews. A lot of doctors have a love hate relationship with the Yelp reviews. But if you see a lot of negative reviews, or horror stories or botched cases, I would probably avoid that doctor. If you can, go to somebody that your friend or your girlfriend or boyfriend or wife or husband has gone to. If you like the results that you saw in your in your loved one, you know you can truly trust that injector.
Better Man Clinics
What about shear experience? Is there a magic number of Botox injections that the injector should have under his or her belt before you feel comfortable with them? Is it important to ask that question from a potential injector of Botox before having them do the procedure?
Dr Yun
You know, I don’t get asked that. I think they just assume that I’ve done a lot. Again, if it’s your first time, avoid the Medi spas. Avoid going to maybe a physician assistant or nurse practitioner for your first time. Be wary of coupons and Groupons because they’re giving their services away for free for a reason.
Better Man Clinics
Botox gets the vast majority of the attention when it comes to the treatment of wrinkles. But there are other treatments for wrinkles as well that the dermatologist can turn to. Can you talk a little bit about those other options and their pros and cons.
Dr Yun
Botox is fast and it is easy. It isn’t very painful. You can go back to work that same day. You can do it at lunchtime. But Botox is just used for the upper face. When it comes to lines and wrinkles of the lower face, you start looking into fillers. Also, as we age, our skin loses its elasticity. It starts to sag. Also as we age, we lose the fat pads of our face; the kind of the baby fat starts to all move down. By injecting filler into the cheek area, we can lift everything back up as well as getting rid of what we call the marionette lines. So we use filler to “fill in” areas. Filler is usually composed of hyaluronic acid or calcium hydroxyapatite. They’re both naturally occurring substances that we make in our own skin. But we can use them to fill in lines and also replace the baby fat that we used to have when we were in our 20s and 30s.
Better Man Clinics
What are the most common fillers on the market that people should be aware of?
Dr Yun
Juviderm is probably the most common filler or popular filler. We use it in 30 to 60 year olds and it can give you great, soft looking results. Juviderm is a hyaluronic acid filler. Other fillers include Belotero, Voluma, Restylane, and, Radiesse. There are differences between each one, but, essentially, they all fill temporarily. They all last from anywhere between six months to two years, depending on the filler. They fill in lines of the lower face and fill in the cheeks to lift them a little bit. They’re very safe and they’re temporary. If you don’t like the result, they do go away. We do have the ability to remove them if you really don’t like the result, which is very uncommon. A lot of men are coming in for the bags under the eyes. We can definitely put a little hyaluronic acid filler in that area.
Better Man Clinics
What are the expectations with fillers in terms of pain and recovery?
Dr Yun
Because it is going deeper into the skin and you’re actually getting product into the skin, fillers can burn a little bit more. It takes me a little bit longer because we have to make sure everything looks right and is filled in nicely. The risk for bruising is a little bit increased with filler. The bruising goes away within about three to three to seven days.
Better Man Clinics
Do the same rules apply for choosing an injector for fillers as you had mentioned for Botox?
Dr Yun
Exactly. They apply even more so with fillers because some of the risks can be higher. For example, if you deliver a little bolus of filler into some arteries around the angular artery or on the nose, that can cause a big ulcer there. If you have an inexperienced injector inject around the eyes, it can cause blindness. I want to go to somebody who knows what they’re doing for filler, because the risk for the adverse events is much higher with filler.
Better Man Clinics
So sounds like Botox is good for the upper face and fillers for the lower face. What other treatments are available?
Dr Yun
For the zoom neck that we discussed, we have tightening treatments like radiofrequency. That is one of the newer treatments available. It includes treatments like radiofrequency microneedling and radiofrequency devices like Thermage. Thermage was developed in the 2000s and it works via radiofrequency energy going into the deep tissues. With radiofrequency, we are basically just heating up the dermis and melting the collagen so that it has to rebuild. When it rebuilds, the epidermis becomes straight. So you have smoother skin and tightening. Radiofrequency is great for sagging skin.
Better Man Clinics
How many radiofrequency treatments are required?
Dr Yun
You usually need three to five treatments. We apply a numbing cream and it is very tolerable. You might have a little bit of redness for three to five days afterward.
Better Man Clinics
How long do the effects of the treatment last? A few months?
Dr Yun
More than a few months. In the first year, you need three to five treatments, about a month apart. After that, you may need a touch up once a year.
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What about laser treatments? Do they work for wrinkles?
Dr Yun
Intense pulsed light (IPL), which is like a photofacial, can definitely help fine wrinkles. It also is a light that is kind of a wide range, so it can target hemoglobin. A lot of men are seeing a lot telangiectasias or broken blood vessels around their nose and their cheeks. They often say this makes them look old. IPL is a great treatment for these broken capillaries all around the nose. And it is intense pulsed light so it’s basically a light that targets that hemoglobin in the red blood cells. It can also target melanin. So if you have sunspots, it can it can also treat those as well. So IPL is good for treating fine wrinkles, telangiectasias, and sunspots. We treat the face or just the nose and the cheeks (whichever areas are affected) and it feels like little rubber bands hitting your skin . We protect your eyes with goggles. Some people can have redness and swelling for about three to five days. And, as I said, with any procedure you want to avoid the sun afterward. A lot of these patients are coming in for the laser treatments during the winter so that they don’t have to avoid sun during the summer. Then there is also major laser resurfacing with our fractional co2 lasers and Opus, which is a radiorequency resurfacing laser. Those lasers basically make you shed your whole skin. Fractional lasers can melt away the top layer the skin and treat the lower layer at the same time. So you’re remodeling the collagen and you’re getting baby new skin. With these treatments, your skin obviously sheds. You do have peeling and redness. The downtime for the resurfacing lasers is more like five to 10 days. Depending on which laser you choose, some patients do look pretty red and are peeling for those five to 10 days.
Better Man Clinics
These laser treatments sound like “big gun” treatments.
Dr Yun
Exaclty. That’s not “pre-juvenation” . We are using these lasers to potentially erase the effects of six years of biking and swimming, etc.
Better Man Clinics
Aside from the discomfort and the longer healing, are there any significant long term risks that people have to worry with these laser treatments?
Dr Yun
There are risks but not really long term. Again, if you get treated by an inexperienced physician, you can have hyperpigmentation and scarring. Some of that can be very, very serious. You can also get burns. So you want to make sure you trust the person. You want to make sure they’re board certified, to look at their before and after photos, and read their reviews online.
Better Man Clinics
It appears that there are many choices with regards to treating wrinkles – from Botox to fillers to radiofrequency to lasers. Do you mostly see guys coming in asking for a specific treatment for their wrinkles or just telling you what is bothering them and letting you make some suggestions?
Dr Yun
Most of my male patients do not know what they want. They don’t do the Dr. Google as much as women do. They say “how do I get rid of these(wrinkles)”? That is why you want to go to somebody who is experienced; someone who knows that “this patient is a good candidate for IPL, that patient needs filler etc.” You want to have a whole menu of services from an experienced practitioner. You don’t want to go to someone who tries to sell you something you don’t need.
Better Man Clinics
When does real plastic surgery come in when it comes to wrinkles?
Dr Yun
I tell my patients my honest opinion if they ask. I think our patients respect my partner and me because we don’t try to sell things don’t work. For example, if we see that the patient needs a blepharoplasty or an eyelid lift and we know we can’t correct that with Botox or lasers or filler, we will say you need to see a plastic surgeon. Also, if they are looking to lift their jowls way further than what I know I can do with filler or thread lift, I would refer them to a surgeon to consider a facelift. Similarly, the double chin is a major thing that men come in for me to see me about. There are things that I can do with radiofrequency to tighten a little bit but, again, it’s not a facelift. I will refer patients to a plastic surgeon if I believe they need liposuction or a facelift or a blepharoplasty (eyelid surgery).