Men have a growing interest in cosmetic dermatologic treatments. Botulinum toxin type A (BTX-A) treatment offers a minimally invasive approach to improving facial lines and is often the first cosmetic procedure chosen by male patients. In general, men can be treated with the same techniques as women, but often require more units of BTX-A. Glabellar lines in the male have been the most well-studied with a recommended starting dose of 40 U. Some men may require up to 80 U in the glabellar complex. The most common cause of an inadequate result in male patients is under-dosing. Forehead lines require care, as many men with horizontal lines have low-positioned eyebrows, and excessive relaxation of the lower frontalis muscle can drop their brows further. Special consideration should be given to the male brow when treating men. Lateral orbital lines can be treated with a starting dose of 15 U per crow's foot. Men may need additional injections to the orbicularis oculi muscle as many men have a broad circumferential orbicularis. The lower face is amenable to BTX-A treatment in men. BTX-A can be used to reduce axillary sweating and improve armpit odor. BTX-A shows promise in treating benign prostatic hyperplasia, and may in the future become a first-line treatment.
