Q&A: Expert discusses rise of ‘Brotox’ as men seek more cosmetic treatments

Key takeaways:

• Wrinkles on the forehead and crow’s feet are the areas most commonly treated with Botox among men.
• For fillers, the most common areas treated are the nasolabial folds and midface.

An expert discussed the rise of “Brotox” and what this means for practitioners as the proportion of men seeking cosmetic treatments continues to increase.

Neuromodulator injections like Botox (onabotulinumtoxinA, Allergan) and dermal fillers were traditionally preferred by middle-aged women, but there is now a growing group of men seeking this rejuvenating treatment that the public has affectionately labeled as “Brotox” — a mix of “brother” and “Botox.”

According to 2023 procedural statistics released by the American Society of Plastic Surgery, Brotox grew by 5.55% since 2022, signaling an increasing desire among men to participate in this aesthetic perk.

In this interview with Healio, Sean McNally, MD, PhD, a plastic surgeon and the lead provider at Doctor PDX and Réviance Plastic Surgery & Aesthetic Center, provided insights into this trend.

Healio: Why are we now seeing the adoption of Botox among men?

McNally: Men are slower to adopt cosmetic treatments as there’s less emphasis and pressure placed on physical appearance for men compared with women, but I think in the age of selfies and social media we are seeing more and more of ourselves and we would like to look as good as we feel.

I also think that the increased time we spend on apps and Zoom meetings where we can see ourselves has had a profound effect on the number of people who seek cosmetic treatments — both for men and women.

Healio: What types of Botox and fillers are men requesting the most?

McNally: The most common treatment areas for Botox are the forehead and crow’s feet, whereas fillers are most commonly seen in the nasolabial folds and midface. These are both common in women as well.

However, I do suspect the focus on the upper parts of the face has quite a bit to do with the fact that men can hide aging on the lower parts of the face with facial hair. On the other hand, what we see less of in men are Botox lip flips and lip filler as there is less emphasis on this area for men.

Healio: At what age are men requesting Botox and fillers?

McNally: The standard age range is 40s to 50s, but just like with women, we are seeing an increase in the younger crowd, including 20s and 30s, seeking more preventative instead of corrective treatment.

I believe social media has quite a bit to do with the younger crowd seeking treatments earlier as they have learned Botox is more effective as a long-term preventative for aging than reversing the signs of aging once present. So, once wrinkles start to show, it is worth considering.

Healio: How do Botox and filler results differ between men and women?

McNally: The products still do their job; however, the end goal is usually different, and the products can have differing efficacy in men.

Take brows for instance. The goal eyebrow shape for men and women is different. Women’s eyebrow shape is higher and arched and when we treat women, we try to achieve that peaking of the brow. But, if you do that with men, it appears unnatural.

Practitioners also have to be acutely aware of Botox dosing in the forehead for men to avoid the “Spock” brow, when the eyebrow appears sharply and unnaturally arched. You have to use a balanced approach to the male brow. With women, we treat to achieve peaking of the brow, but if you do that with men it appears unnatural.

Healio: What special administration techniques and precautions should practitioners be aware of when treating men compared with women?

McNally: Typically, Botox dosing has to be higher in men to cope with their stronger musculature. I would say that a dose that is 20% higher than your standard dosing for women is a good start. Then, you can adjust the dose for that specific patient. Additionally, dosing gets adjusted for patients over time which is one of the reasons why having a consistent injector is helpful.

As far as precautions go, similar precautions are typically taken between men and women. Make sure you’re having your injections completed by a well-trained and well-regarded injector and follow their instructions both pre- and post-injection. Some of us men aren’t great at following instructions, and these instructions are something we shouldn’t overlook.

Healio: How can practitioners leverage this new offering in their practice?

McNally: Our practices are used to advertising and drawing female patients, but as an industry, we need to make sure we’re catering to this growing market of men with appropriate advertising materials, website information and patient experiences.

Reference:

• 2023 ASPS procedural statistics release. https://www.plasticsurgery.org/documents/news/statistics/2023/plastic-surgery-statistics-report-2023.pdf. Published Sept. 26, 2023. Accessed Feb. 18, 2025.