Treating the male upper face – Interview with Daniel Julien
On 18th January 2022, Dr Tim Pearce hosted a Live on Instagram and interviewed Canadian aesthetic nurse practitioner, Daniel Julien NP, who has a successful clinic, Danesthetics Medical Design in Ottawa, Canada. Dan also hosts his Danesthetics You Tube channel to over thirty-six thousand subscribers. The pair discussed the clinical and consultation aspects required to confidently treat men with medical aesthetic treatments such as botulinum toxin and dermal fillers, achieving and maintaining masculine looks to avoid feminising men.
In this blog – which covers part one of the interview looking at the upper face in men, focusing on the forehead and eyebrows – Dr Tim highlights some of the stand-out points from his interview with Dan Julien and invites you to catch up with the whole interview now hosted on You Tube as part of the Aesthetic Mastery Show.
Dr Tim will be discussing more medical aesthetic training tips as part of his upcoming webinar series, so if you’re looking to increase your CPD-certified learning and want to learn more skills to make you a better clinician, then step one is to register for the free webinars by Dr Tim.
How to maintain masculinity when treating men in the upper face with cosmetic injectables
It is true that most patients seen by aesthetic clinicians are female, but slowly as you grow your practice you will start to see more men coming for treatment – this can be somewhat alien territory for your archetypal ‘bloke’, so it is important to understand why they are sat across from you and what they are looking to achieve.
Dan explained that when men present to see him in clinic, they tend to be more straight forward and specific about what they want, they appreciate his attention to detail, when he is measuring and analysing their face and discussing the structures that make them male, all of which provides peace of mind that the results will be measured, not over-inflated, and will remain masculine in appearance, without feminising.
Dan is one of only a few nurse prescribers in his region of Canada and is triple certified by the Canadian Board of Aesthetic Medicine, as well as a faculty member and educator for the American Association of Aesthetic Medicine and Surgery (AAAMS).
Do botulinum toxin doses differ between men and women?
Dan agreed that doses of botulinum toxin (Botox®) do differ and believes that the upper face in most males requires one and a half times the dose for a woman because the muscles in the forehead and eyebrows are much stronger. He said simply getting your male patients to raise their eyebrows will highlight to you the strength of their muscles and their need for a higher dose. He suggested keeping an expressive and strong male frontalis muscle in check with 20 units of Botox and highlighted that most men have a strong glabellar area too that usually requires 30 units, although he is hesitant to deliver that quantity in one go, due to the fear of spreading, so he tends to split the dose across two sessions. For crow’s feet, including the tail of the brow, Dan opts for 20 units of Botox per side.
What is your experience with injecting the male forehead?
Dan noted that many of the men who come to see him with dissatisfaction with their foreheads are often concerned about the indentation that runs across the middle of their forehead. He is usually able to fill this using dermal filler via a blunt cannula, noting the caution required with treating this high-risk area. Dan pointed out a nice tip, that treating the indentation can also correct stubborn lower lines close to the brows, which may be a ptosis risk if targeted with botulinum toxin.
Tip for achieving projection by injecting filler into the male eyebrow
Dr Tim described seeing a previous video from Dan about injecting the periorbital ridge to make the brow more dominant and asked him to discuss his methodology.
He described how the tail of the male eyebrow tends to flatten out and you lose a bit of volume over time. Sometimes men will have a strong bony prominence that either goes away or opens out, and as a result the eyebrow tends to fall inwards. To compensate for this, he asks them to bring in a picture depicting their younger self to give him an idea of the former appearance of their eyebrow. This will usually show increased bone projection or a slightly larger fat pad in the eyebrow area that he feels confident to recreate with filler to achieve the projection that has been lost. Fanning the filler product across the area also helps to make the transition outwards from the eyebrow appear smoother.
To really make this treatment work for his patients, he also adds 6 units of Botox to each lateral eyebrow two weeks prior to the filler treatment so the eyebrow is in a natural position which allows him to proceed with the optimum filler placement. The result usually requires 3-monthly maintenance, and he said his male patients love it.
As a final thought, Dan noted that his Asian male patients desire more protrusion from the tip of the medial eyebrow all the way out laterally, thus he treats this using a linear cannula method (staying superficial to the supraorbital notch); however, Caucasian, and Black patients only want treatment from the mid brow out laterally and to not want projection forward of the mid brow line.
You can follow Danesthetics Medical on You Tube for more insight on treating male patients and more hints and tips from across the pond.
Look out for the blog on part two of this interview where the discussion moves on to using dermal filler and botulinum toxin in the male cheeks, lips, jawline, and chin.
Aesthetics Mastery Show
Why Botox makes celebs look perfect but you look plastic
This blog accompanies a recent Aesthetics Mastery Show, where Dr Tim Pearce discussed how celebrities keep their eternally youthful looks without looking fake look after Botox and fillers. Dr Tim outlines the 4 reasons he thinks this inequality exists, and explains how injectors can change their practice to keep their patients looking fresh.
Watch the full Aesthetic Mastery Show episode here:
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Dr Tim Pearce MBChB BSc (Hons) MRCGP founded his eLearning concept in 2016 in order to provide readily accessible BOTOX® and dermal filler online courses for fellow Medical Aesthetics practitioners. His objective was to raise standards within the industry – a principle which remains just as relevant today.
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