Meet the doctors behind the boom in male cosmetic surgery

“What we are seeing,” declares Amar, “is the booming of the grooming, non? There is a general change with men in their forties. Masculinity is different now.

“P’raps they divorced and they have a new, younger girlfriend and want to look good,” he suggests. “Yes, the cliché happens all the time.”

Amar is happy to admit he’s had work himself – fat transfers in the temple (done by his father), a “sprinkle” (the phrase du jour) of Botox. He wouldn’t shrink, if it were necessary, from having CoolSculpting on the flanks. “ ‘Love handles’ you call them in the UK, but I don’t know why. It’s not an attractive name.”

He’s 42, and I utter the obligatory, “No waaay! You don’t look it.” But it’s true. I can imagine seeing him bopping in a St Tropez nightclub and thinking he was decades younger.

In Harley Street, the choices get wider: brow lifts, tummy tucks, chin tightening, hair transplants – one of the fastest growing areas – to name a few. And, not for the faint-hearted, there’s “scrotox” (Botox to smooth the lines of the scrotum), and “P-Shots” (hyaluronic acid into the penis), although doctors who readily confirm the existence of these procedures sadly won’t confess to administering them.

So when did having a tweak, tuck or even suck, in the case of fat, become a thing for men?

While the overall number of surgical procedures for men and women fell by 40 per in 2016 after a record high in 2015, according to the British Association of Aesthetic Plastic Surgeons (BAAPS), the number of tummy tucks for men rose by an “impressive” 47 per cent, according to the former BAAPS president, Rajiv Grover. Anecdotal evidence suggested that the number of non-invasive treatments – filler, Botox, fat freezing and so on – was continuing to rise, as it has done for a number of years.

Amar is both a surgeon and a practitioner of “aesthetic” or “cosmetic” medicine. He’s noticed a real jump in the number of male patients “in the past couple of years”. Men are physically ageing quicker than they are mentally prepared to accept it, he says. “It’s not a midlife crisis like in the past. It’s just that they are 40,” says Amar. “They feel young, they exercise, they have a healthy life. The gentleman I had in here just before you exercises four or five times a week. People like him have teenage kids, a nice job and they watch what they eat. But he says, ‘I need a bigger change.’ In the same way that he is taking a personal trainer and watching his diet, he says, ‘Why should I not have a little lipo?’ This is very common. They say, ‘I am exercising and I look good, but I need to lose some of this belly for the summer.’ ”

To look hot in their Vilebrequins? “Exactly.”

But there are work pressures, too. In fact, this is the number one reason cited by all the doctors I speak to. Amar reports a stampede from the City: no one wants to look past it in finance, apparently.

“Also tech-sector guys and CEOs in their forties, where the majority of other employees are in their twenties and thirties – if you go to a sports company or Google or Apple, what do you suppose the average age is?

“Also in communications and the media. And, of course, banking. It’s not only traders; the average age overall is pretty low. Then you have men who face pressure socially. They have a lot of meetings, drinks ... They might feel they have some fat on the chest, abdomen, flanks, and although they exercise, they need a boost. The social pressure is as important to men as it is to women. Their concerns are the same.”

Amar argues work-based pressure means competition between men is intense. “When they have puffy bags around their eyes they come to me and say, ‘Look, I can’t look tired every day. I can’t have this face where everyone asks if I sleep, or says I look stressed, or they think I am a heavy smoker because I have dark circles and puffy eyelids in the morning.’ ”

In extreme cases, he will treat them with eye surgery. “Or you can discuss a mini-facelift or a mini-suspension, which helps the jaw to be more defined and lifts the neck.”

He also reports a surprise uptake from a new age group. “They are in their fifties or sixties and having a second life,” he says. “They’re on a second marriage and they come to us and say they want to feel more confident again. They’ll say, ‘Well, I want to look good for my new wife.’

“So they do some lipo or some double chin treatment, or some neck lift ... I have plenty of men who say their new girlfriend is encouraging them. I had a couple the other day – he had an ex-wife, a few kids and now he’s in his sixties and his girlfriend is 28. They just had a young baby and he said, ‘I can’t look like a grandad.’ ”

The younger generation have no qualms, says Amar. Those in their thirties “find it easy to push open the door of the plastic surgeon. They are fine with facials, having extractions [spots and blackheads squeezed]. They say, ‘I want to improve my skin so I want laser, PRP [platelet-rich plasma treatment].’ Maybe a bit of filler later ... But something very discreet. Something they can hide over the weekend.

“Fifteen or twenty years ago it was exceptional for men to use a face scrub, or put cream on at night or for the day. Now it is accepted.”

So when did it change?

“Ten years ago,” says Dr Tapan Patel of the PHI Clinic in Harley Street, “with the rise of the metrosexual male. Now there’s the idea that excessive sprouting nasal hair and eyebrows, well, you can do something about it. Hairy backs and shoulders can be waxed.”

Patel says footballers have helped pave the way for a change in culture. “In the Seventies, footballers all had big hairy chests, and then suddenly all the Premier League footballers, David Beckham et al, as they started to take their shirts off in goal celebrations, showed they had waxed chests. And that spawned a male market for laser hair removal.”

Dr Geoffrey Mullan, 42, has had Botox and fat freezing

MARK HARRISON

Dr Geoffrey Mullan, 42, has tried “pretty much” all the treatments on offer at his Medicetics Skin Clinic in Connaught Street.

“I had CoolSculpting on my lower abdomen, a few sprinkles of Botox to soften lines – but really lightly, so that there’s always movement.” I’m scrutinising his face in his basement clinic and – honestly – I can’t tell.

This, he says, is crucial to his patients. “I’ve treated a few quite high-profile sportsmen and they’re insistent that it has to be subtle.”

Thread veins on the face is another issue for some of Mullan’s patients, who fear being thought of as alcoholics. “Probably 70 per cent of the UK population have a degree of rosacea. There are lots of triggers – and obviously alcohol is the one that we associate with it. Some men are very sensitive about that and I’ve treated quite a few men in the City where that’s the only thing they want done.”

The laser treatment takes about five or six minutes. “It’s like a little flick of a band on the skin, just a little ping. Most women breathe through it; most men wince.”

The legal profession is also well represented at Mullan’s clinic. Perhaps more surprising is the idea that politicians, so-called “men of the people”, would dabble. Mullan, who trained as a surgeon in the NHS, has treated “one Tory, and I can’t say where the other one comes from, because it would be too obvious”. Pushed, he says, “I may have had a Labour politician at one time.” Where does he treat them? “It’s cosmetic: the face.”

Olivier Amar says that, like CEOs and actors, politicians work long hours and have to face the public a lot. He says everyone notices that Emmanuel Macron and Justin Trudeau “look good” (although there’s no suggestion from him they’ve had anything done).

When the first flood of cosmetic treatments happened, you couldn’t move for over-plumping and over-freezing. Simon Cowell admitted going “overboard” with his Botox. Wayne Rooney sparked Botox rumours after he was pictured with a tight, glassy forehead that made him look like a baby asphyxiated in clingfilm. Then a new, gentler era arrived. People started talking about “newsreader Botox” or “emotional Botox”, using less of the product, which allowed patients to move their face a bit (while also looking “refreshed”).

Gordon Ramsay had Botox and the lines in his forehead treated with filler. No one could accuse him of not being manly. Actor Martin Clunes, star of Men Behaving Badly and Doc Martin, attempted to claim an aesthetic treatment that softened his lines – most doctors point to Botox – on his tax return.

And it is the softer examples that Tapan Patel says have influenced the trample of men through the door of his own clinic. “They usually give the same spiel: ‘I want to look rejuvenated but I don’t want anyone to know.’ ”

They want Brad Pitt’s chin or Eddie Redmayne’s cheekbones or David Beckham’s jawline, says Patel. “They are realising there are procedures they can have that make their chin or jawline more prominent or defined.”

Surgery, he explains, involves breaking the jaw and rewiring it. Reshaping the same area with filler is done using a cannula, takes 30 minutes and only causes a bit of swelling.

“What I’ve seen in growing numbers is men coming in a little bit tentative, wanting to dip their big toe in. And the treatment they want to dip their big toe into is mostly Botox.”

As Patel talks I admire his smooth, perfect features. He’s 44 but could easily pass for thirtysomething. Has he had Botox?

“Yes.” Did he do it in the mirror? Patel laughs. “We’ve all tried to inject ourselves early on in our careers, but in reality it’s actually quite difficult. A member of my team treats me.”

He has also road-tested all the lasers (there are 25 devices in his clinic) and other treatments such as Ultherapy, a painful ultrasound treatment to tighten the jowls and chin, and Ultraformer (similarly ultrasound, but which doesn’t penetrate as deeply and hurts less).

Patel has clients whose names, he says, I would recognise. “There are so many people in the public eye who have had treatments but it’s not picked up on because it’s done in balance. I often hear people say, ‘So-and-so looks great on TV and they haven’t had anything done,’ and I’m thinking, ‘Er, yes they have.’ ”

Alex Karidis, a surgeon at the Hospital of St John & St Elizabeth in St John’s Wood, north London, is also a little irked by the numbers of high-profile men who deny having had work.

“It does slightly annoy me because if it was a haircut they wouldn’t mind saying, ‘Yeah, I had my hair done there.’ But they will never admit to any sort of intervention. They’ll say, ‘Oh, it’s good genes. Good diet.’ All the usual crap.”

Men make up 40 per cent of his patients and the weirdest request he had was from a man who wanted “bullet holes” created in his back. “He wanted four or five scars so that he could concoct a story around them saying he’d been shot,” says Karidis. “I declined to do it.”

Another presented him with blueprints for his rhinoplasty. “I said, ‘What do you do?’ He was an architect. He’d done a projection of the nose, the side profile, everything. I said, ‘That’s a lot of pressure.’ But he was happy in the end.”

Kambiz Golchin, one of Olivier Amar’s colleagues at the Cadogan Clinic, says, “We’re all victims of social media. There isn’t a day when I don’t have someone showing me some Instagram picture saying, ‘Could you make me look like this.’ Honestly.”

Kambiz Golchin, 47, has had Botox in his jaw, forehead and armpit

MARK HARRISON

Karidis agrees. “Men are now as conscious as women about the way they look. The difference I have found is, if men want to do something, they just get it done. They don’t prevaricate.”

The most sought-after treatment at his clinic last year was gynaecomastia, moob reduction, which costs from £5,500 and can really be a life-changing treatment for men who don’t even want to remove their T-shirt on the beach in summer for fear of being mocked. “You have to remove the fat cells and breast gland,” says Karidis. “We do it through tiny incisions, effectively keyhole surgery. It’s a 40-minute day procedure, you don’t see the scar and you can go back to work in a couple of days.”

Karidis practises what he preaches: he has fillers in his cheeks every nine months and Botox in the forehead more regularly. “Men tend to age better than women because we have thicker skin. But we age nonetheless. When you lose fat in the face, filler can counteract that. I see a lot of men who have lost a lot of weight suddenly. They are at the weight they want to be, but they have loose skin. Suddenly their face can look quite haggard and gaunt. Filler works very well for them.”

Another treatment Karidis has tried is cryolipolysis, marketed as CoolSculpting, and considered to be a revolutionary treatment for pockets of fat. (It’s certainly been revolutionary for the company behind it, Zeltiq Aesthetics, which was just sold for £2.4 billion.) It involves a rectangular box placed on unwanted flab, which is then sucked in and gripped. The machine gradually reduces the temperature of the area, which shrinks the fact cells allowing them to die over a period of two months.

“Everyone has diet-resistant areas of the body – love handles are a good example,” says Karidis. “That is where this comes in handy.”

One treatment that does not exist – one you would assume would be popular among men – is to eradicate beer bellies. These cannot be removed except with exercise, explains Norman Waterhouse, 62, a respected Harley Street surgeon.

“Sometimes patients come to me and say, ‘Suck this out, Doc’. They have that classic belly – a rock-hard paunch. If you grab their bellies, you can’t get fistfuls of fat. It’s like a drum skin. All that fat is internal fat and there’s no way you can treat that with liposuction. That is distinctly something you have to look at with lifestyle changes, exercise and diet. And it’s much more difficult.”

In Waterhouse’s experience there is no “standard male demographic” that seeks surgery (10-15 per cent of his surgical patients are men). “It’s not predictable who comes at all. Having said that, there is a tiny, tiny minority of completely unsuitable men who come for surgery with an established psychological condition. It’s a kind of dysmorphia phobia and they are known by the acronym Simon: single, immature, male, overly expectant, narcissistic. They often live with their parents even though they are 35. They seek surgery – and sometimes get it – but it doesn’t end well.”

With non-surgical treatments, the ratio jumps to 30 per cent male and they tend to work in finance, the entertainment industry, media, the law and advertising.

Shannon Leeman is a “cosmetic consultant” who works with high-net-worth clients in the United States and Europe. She has seen a steady rise in interest from men over the past decade. Her job is to meet and assess high-profile clients and get them directly to the best doctor, jumping any queues where necessary.

For this – and anonymity – they pay her a consultation fee and sometimes a retainer. None of her files has her client’s real names. She says this is common practice in the industry – one US surgeon keeps his patient files in a safety deposit box at Chase Bank.

Leeman says she first noticed an increased interest from men after the 2007-2008 financial crash. Men who were “alarmed by the real possibility of being made redundant [were] desperate to retain their ‘physical edge’ ”, she says.

Leeman tells me about a male-only surgery and beauty clinic called Marina Manland in the States – decorated, rather predictably, in leopard print and with flatscreens showing Sports Illustrated shoots on a loop. It shows how the market is expanding and bending to accommodate the burgeoning interest of men. And the male approach is different, Leeman says – more business-like.

“They just want the bottom line: ‘Tell me how to fix it and get on with it. Make the appointment and I’ll pay the fee.’ I’m not saying some of it isn’t driven by cost, but in a man’s mind, they just want it done.”

Her clients can call any time of day or night. Sometimes they skype; sometimes she has meetings in hotels, cars, on their boats or planes. “I’m in charge of his appointments, their doctor, their workout schedule, their diet. A couple are very high-profile and I take care of their every aesthetic need.” This even extends to helping organise a make-up room for one client “with cosmetics in the refrigerator. He has a whole section with just his creams and his oils and his potions.”

For Leeman’s clients, the five big issues are hair, eyes, jawline, moobs and waistline. “Once sorted, these are the things that make them feel vital, young, sharp, that they are not losing their testosterone edge.”

Testosterone itself is now being looked at in the fight against ageing. Norman Waterhouse says hormone doctors are examining the role of the male menopause, the andropause.

“Testosterone levels decline fiercely after the age of 30 and it’s thought that makes it more difficult for men to maintain muscle – and predisposes you to putting fat on in certain areas,” he says.

“In the same way that women, post-menopause, get a bit of waist thickening and it’s difficult to shift, men do too. They put on weight on their chest and bellies – internally. The classic appearance of the male torso in old age is skinny legs and a paunch. And that’s because you lose all core muscle mass.

“In the States there is a movement for everyone to go testosterone mad, but in the UK doctors take the view that unless you have a clinically very low testosterone level, you shouldn’t take testosterone replacement.”

He is happy to “out” himself about his own treatments – Botox for a few years, and “as I get older I will undoubtedly have my eyelids done”. He has also had a facial “thread lift”. This is another area where he predicts there will be developments. “Threading technology will get better, and I wouldn’t be at all surprised if the trend away from big surgery towards minimal gestures means in 20 years there may not be any facelifts. I think we’ll probably work out how to tighten muscle and soft tissue without making a big cut and lifting the face up.”

I enjoy a wonderful lunch with Olivier Amar (he has niçoise and chilled chablis; I have kale salad and water). He insists that male patients are very interested in his deeper explanations of “adipose-derived mesenchymal stem cells” and “trauma vascular fraction”, but although I take notes, I confess to being occasionally lost in the technical language.

So instead he shows me before and after photographs on an iPad. We coo over the restored cheeks of a very handsome man I vaguely recognise (is he a footballer? Or a musician?), and there’s another one who has had eye work. Put side by side, it’s easy to see the dramatic difference. But if you worked with these men in an office, you might think they’d just had a good holiday.

My 90-minute laser eye treatment
By Jeremy Langmead

JONATHAN DANIEL PRYCE

As I once was persuaded to have Botox for an article for this newspaper, my editor decided I should try one of the newer treatments for men. My boss told me to go and see Kambiz Golchin at Dr Rita Rakus’s clinic in Knightsbridge. “See how he thinks you could improve your face,” she said. She’s a real charmer.

It’s quite odd sitting in a chair while someone stares intently at you to see what could be enhanced. After a minute or so of looking at me from every angle, Golchin pointed out that growing a beard had been a clever move as it helps hides a multitude of sins. He also kindly informed me – although perhaps he says this to everyone – that I have youthful skin for a 51-year-old (the fact I’ve never smoked and have moisturised from a precociously early age has helped this happy outcome, I believe). But – there’s always a but – the area around my eyes was my weak point: the skin underneath them was a little crepey, and the eyelids above them could do with a little tightening. The solution? A TotalFX laser treatment.

This scary-sounding combo comes in two parts. Basically, the DeepFX part means a narrow laser microbeam – a pocket-sized version of the one that nearly castrates Bond in Goldfinger – is used to remove columns of tissue deep into the layers of your skin. Why? To stimulate collagen production, which apparently improves the appearance of fine lines, wrinkles and scars. Next up is the ActiveFX part. This involves a larger beam that targets the upper layer of skin to remove unwanted pigmentation, encourage new skin generation and again remove fine lines. How could I say no?

The procedure itself isn’t so bad. You sit for an hour with half of your face covered in a white anaesthetic cream, feeling a little self-conscious every time someone pops in to see how you are. Once Golchin is happy the anaesthetic has worked, the 30 minutes of laser treatment begins. You certainly feel the jabs of heat as the laser is applied, but it’s no more painful than a pin prick. It actually feels like someone is spitefully holding a small pen torch to your eyelids. Some people have their whole faces treated in one go; I was happy we were only doing my eyes.

I hadn’t really paid enough attention to how my skin would look and feel over the following few days. You are, of course, given written instructions, plus antibacterial spray, special cleansing gel and Vaseline-like ointment to apply post treatment. You also have to avoid sunlight for a few weeks, and after that use a high-level SPF cream. Back home, I looked in the mirror and it wasn’t as bad as I thought. I looked sunburnt and my eyes a little swollen, but it didn’t actually hurt. I went to bed early and arose the next morning eager to see what had happened overnight. Freddy Krueger was staring right back at me. My eyes had almost closed with the swelling, and the areas around them were red and oozing.

Fortunately, the face is quick to repair itself: 48 hours later, the oozing was replaced by scabbing; 24 hours after that, the scabs crumbled away to leave a raw-looking layer of skin. As the days passed, the redness paled to a mild baby pink.

The healing process takes three or four weeks to fully lose any pinkness, but the improvement to your skin, says Golchin, continues to evolve for six months – and the benefits last for years. It’s three weeks since my treatment and so too early to see the full effects. But there is no doubt that my eye areas appear tighter and that the skin underneath has fewer lines.

Would I recommend it? If you work in an office and don’t want anyone to know you’ve had such a treatment, well, for a couple of weeks it would be hard to disguise the fact since you’ll resemble an extra from Fight Club. And if you’re scared by horror flicks, you will need to avoid a mirror for a few days. But if, like me, you don’t care – or can’t care, because it’s going to be published in a newspaper – then go for it. I think.

TotalFX laser treatment costs £3,800 (drritarakus.com). Jeremy Langmead is the editor of The Times LUXX magazine

Shoot credits
Grooming Celine Nonon at Terri Manduca using Armani skincare and Kérastase Couture Styling