Last year, more men received cosmetic injections in their faces than ever before. That’s according to the American Society of Plastic Surgeons, which publishes an annual report compiling procedures performed by member surgeons.
While the report doesn’t account for procedures, including injections, that may happen at a dermatologist’s office or med spa, it can account for the minuscule but remarkably consistent fraction of all cosmetic procedures performed on men—about 7% for the past two decades. In 2023, men received half a million administrations of neurotoxin, like AbbVie brand Botox, while women received 10 million. Of course, in classic style, the movement was branded Bro-tox. About 200,000 men received soft-tissue fillers from plastic surgeons, compared to just under 100,000 in 2017. I was one of them!
Melissa Doft, a plastic surgeon in Manhattan, poked beneath my cheekbones, sculpting a new geometry. Her white coat was accessorized with an Italian belt and shoes. “For me, it’s about shaping,” she told me, “not necessarily adding volume.” She handed me a mirror. The face staring back at me was familiar but had also changed tectonically. Just a little filler. Light falling from overhead fluorescents now spilled down twin ridges, casting twin shadows. “I think it looks quite masculine,” Doft said admiringly.
It did. The aesthetic version of masculine is hard, angular, intrusive. We know this from history. Look at the kouros, his iliac furrows—known as something much more salacious in lustier circles—carved into hard, cool marble for all of history to admire. The ideal form emphasizes a sculpted musculature, bulked and cut. This goes for above the neck too. A caricature of male beauty is big in all the right places, from glutes to biceps to masseters. Gay men might conjure a Sean Cody model or Tom of Finland drawing; straight men might imagine a Chad, the typical alpha male of the incel imagination. We are all holding more or less the same image in our minds.
“I think straight men want what gay men want, except they’re usually less bold about asking for it,” Manhattan-based dermatologist Dan Belkin tells me one evening. I got in touch with Dr. Belkin after asking around about which New York City dermatologist catered to the injectable needs of the city’s elite gay populace; he does Jenna Lyons, makeup artist Hung Vanngo, and most of Chelsea. By and large, the goal for men of all kinds is to look more masculine by a single appointment’s end. “I think they just want to look fresher, healthier, and more handsome,” Dr. Belkin added. “Straight men are the lowest penetrance of being open to this stuff.”
There have been very few studies of clinical rigor on the differences between straight and gay guys when it comes to cosmetic surgery, though it has been posited that the latter population is more prone to lack self-esteem in their looks. Anecdotal evidence indicates that gay men are also more up-front about their interest in cosmetic procedures, while straight men begin the process with a familiar dance. “In the past, a lot of straight guys would come in with their wives or girlfriends,” said Jason Diamond, a plastic surgeon in Beverly Hills. “Then when they’re about to leave, they’ll say, ‘Oh by the way…’.”
Dr. Diamond began his career working in the office of a prominent gay dermatologist and spent three years treating an almost exclusively male, almost exclusively West Hollywood–based clientele. “Since then, I’ve become known as a face-sculpting specialist,” he said. He’s particularly known for his custom implants, as well as a technique known as Diamond Facial Sculpting, where filler is injected deeper within facial tissue to enhance bone structure. It’s part of how the makeup artist Patrick Ta remains pleasingly angled.
Today Dr. Diamond says he maintains a more equal proportion of straight to gay male patients: “Back then, the gay population was a little more up-front about what they wanted, but now I don’t see much of a difference.” Aesthetic trends may even migrate from gay to straight, as in the example of lip filler: Dr. Diamond’s gay patients were the ones who inspired his embrace of male lip filler, which he calls “way underdone.” “I recommend it to a straight guy, and they look amazing,” he said. “Most guys want to look masculine and handsome, whether they’re gay or straight.”
Still, a fear that injectables will feminize one’s features pervades, fueled by public examples of what bad work can do. “They think they’re going to look like Matt Gaetz,” Dr. Belkin said of the congressman who appeared at the Republican National Convention with fleeky arched eyebrows. A dermatologist hypothesized to Esquire that this was the result of bad neurotoxin placement. In his monologue, Stephen Colbert said Gaetz looked “like if the Joker worked at Sephora.”
A gleeful pile on ensued online as viewers speculated about the possibilities of his aesthetic intervention—vanity being the gravest of sins for any politician but especially a male one. Never mind that many of our nation’s presidents have been scaffolded by the cosmetic-surgical arts. “They’re worried that anything they do is going to feminize them,” Dr. Belkin said.
The feminine ideal refracts softness: pillowy lips, soft cheeks. Most fillers help accentuate these curves and contours and are distinctly reapplied in male faces. There are fundamental differences in facial topography between genders, Dr. Belkin explained. He reached out and drew two axes across my cheek, meeting on the ridge Dr. Doft had sculpted long ago. Men’s filler goes to the apple, while women’s filler sits higher up on the cheekbones.
The style of filler differs too. Those recommended to men often have a higher G-prime level, which makes them denser and more bonelike. Radiesse, a hyaluronic-acid filler made by Merz Aesthetics, is a popular choice, especially in the jaws. “It gives a chiseled look,” Dr. Belkin said. He may also dilute it with lidocaine and inject it in the hollows beneath the cheeks.
The ideal male work is invisible. Everybody thinks Brad Pitt is superlatively handsome at 60, but fewer invoke the possibility that he’s definitely had a lower facelift. Meanwhile, a photo of Miley Cyrus, 31, with hollows in her cheeks is enough to invite accusations of buccal-fat removal.
For men, a drop makes a splash. When I asked Dr. Belkin what injectables he’s tried, he seemed briefly surprised by the question. Then he spilled: regular Botox, some laser, a little cheek filler once upon a time. Recently, Dr. Belkin celebrated his 40th birthday with a trip to Europe and a tiny bit of filler in his jaws. “Super subtle,” he said, “but I like it.”