Men more attractive but not more masculine from facial plastic surgery

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In the first of a kind study, plastic surgeons at Georgetown University Medical Centre found that when a man chose to have a nip or a tuck on his face, it significantly increased perceptions of attractiveness, likeability, social skills, or trustworthiness.

The study shows that men benefit from facial cosmetic surgery in much the same way as women: other people find more to like in that new visage. However, the study did not show a significant impact on perceptions of gender (masculinity), whereas a similar study performed with women in 2015 showed a significant increase in ratings of femininity.

“The tendency to judge facial appearance is likely rooted in evolution, as studies suggest evaluating a person based on appearance is linked to survival – our animal instinct tells us to avoid those who are ill-willed and we know from previous research that personality traits are drawn from an individual’s neutral expressions,” explains the study’s senior investigator, Dr Michael J Reilly, an associate professor of otolaryngology at Georgetown’s School of Medicine. Reilly is board certified in facial plastic & reconstructive surgery and sees patients at MedStar Georgetown University Hospital.

“Taken together, our findings suggest that both men and women undergoing facial cosmetic surgery can experience not only improved perception of attractiveness, but other positive changes in society’s perception of their persona,” he says.

In recent years, men in the US have changed their social attitudes about “appearance maintenance” from one bordering on narcissism to somewhere on a continuum of well-being, Reilly adds. Men are now 15-20% of the cosmetic surgery market, but many preferred male facial features are the opposite of what is prized on a female face. For example, it is believed that attractive male features include prominent cheekbones, a square jaw and prominent chin, while attractive female features are round cheeks, softer contours, wide smile and large, wide eyes.

“Our studies are deigned to see if this is indeed true,” Reilly says.

In this study, 24 men underwent facial cosmetic surgery by one of two Georgetown surgeons – Reilly and Dr Steven P Davison, who is also a co-author. The men had one or more of the following surgeries: upper eyelid lift (upper blepharoplasty), reduction of lower eyelids (lower blepharoplasty), face-lift, brow-lift, neck-lift, nose reshaping (rhinoplasty), and/or a chin implant.

These men, who paid for their own surgery, agreed to the use of their before and after photographs for research purposes. Six surveys were designed, each of which included eight photographs (4 before surgery, 4 after surgery. No survey contained both of a single individual).

More than 150 participants (mostly white, between the ages of 25-34, and with a college degree) who reviewed the photos were not told of the study’s intent. They were asked to rate their perception of each patient’s personality traits (aggressiveness, extroversion, likeability, risk-seeking, sociability, trustworthiness), attractiveness and masculinity.

The research team built a complex multivariate linear mixed model to be able to assess participants’ reaction to a specific surgical procedure – rhinoplasty (nose job), for example – while controlling for changes from additional procedures done on other areas of the face.

Researchers found that chin augmentation was the only procedure that did not have an effect on perceived attractiveness, masculinity or personality. The authors believe this was due to the low number of study patients undergoing this procedure.

The other procedures showed the following changes, among others: upper eyelid – increased likeability and trustworthiness; lower eyelid- decreased risk-taking; brow-lift – improved perception of extroversion and risk-taking; face-lift – increased likeability and trustworthiness; neck-lift – increased perceived extroversion and masculinity; and nose – improved attractiveness.

The statistically significant findings overall reflected increases in attractiveness, likeability, social skills and trustworthiness.

“It is really interesting that different anatomic areas of the face have varying degrees of contribution to overall personality perception,” Reilly says. “And it is also noteworthy that the study did not find a significant change in masculinity. Just one procedure, a neck-lift, was found to enhance that trait.

“This suggests that the current menu of cosmetic procedures for men are likely not as gender-enhancing as they are for women,” he says. Reilly’s study in women examined the same cosmetic procedures in 30 white females and found a significant increase in femininity for many of the procedures.

“Cicero described the face as the ‘mirror of the soul,’ meaning that a person’s physical appearance is the personal characteristic most obvious and accessible to others in social interaction — so it’s not surprising that subtle changes in neutral facial appearances are powerful enough to alter judgments of personality, “Reilly says.

Reilly says more study is needed in order for cosmetic surgery to reach its full potential. “Optimising patient outcomes will require a broader understanding of the potential changes in social perception that can occur with surgery.”

Importance: Facial cosmetic surgery has previously focused on improvements in perceived physical attractiveness and youthfulness. However, human beings are judged throughout life based on many other characteristics and personal qualities that are conveyed by their faces.
Objective: To examine the association of facial cosmetic surgery in men with perceptions of attractiveness, masculinity, and personality traits.
Design, Setting, and Participants: Cohort study with retrospective evaluation by blinded raters of preoperative and postoperative photographs of 24 male patients who underwent facial cosmetic surgery between January 1, 2009, and January 31, 2016. A total of 6 surveys were constructed with 8 sets of photographs each (4 preoperative and 4 postoperative). Each of these surveys was then sent to at least 36 lay people via the web-based survey tool Survey Monkey. Additional invites were sent for individual surveys until a minimum of 24 responses were received for each survey. Preoperative and postoperative photographs of the same patient were not placed in the same survey to avoid recall bias. Anonymous raters used a 7-point Likert scale to rate their perception of each patient’s personality traits (aggressiveness, extroversion, likeability, risk seeking, sociability, and trustworthiness), attractiveness, and masculinity based on photographs in their assigned survey. Raters were blinded to study intent. Data analysis was performed between August 2018 and March 2019.
Main Outcomes and Measures: Ratings of personality, attractiveness, and masculinity.
Results: This survey study included photographs of 24 men who underwent facial cosmetic surgery; the mean (SD) age of the patients was 49.3 (16.4) years. A total of 145 participants completed the survey; the majority of respondents were men (n = 81; 56%) between the ages of 25 and 34 years (n = 116; 80%). Score increases were significant for perceived attractiveness (0.29; 95% CI, 0.13-0.46), likeability (0.41; 95% CI, 0.24-0.57), social skills (0.25; 95% CI, 0.08-0.40), and trustworthiness (0.27, 95% CI, 0.11-0.44) when evaluating all facial cosmetic procedures together (upper blepharoplasty, lower blepharoplasty, face-lift, brow-lift, neck-lift, rhinoplasty, and/or chin implant). Upper blepharoplasty was associated with positive changes in perceived likeability (0.72; 95% CI, 0.06-1.50) and trustworthiness (0.74; 95% CI, 0.22-1.25). Lower blepharoplasty was associated with decreased perception of risk seeking (−0.78; 95% CI, −1.45 to −0.10). Face-lift was associated with increased perception of likeability (0.69; 95% CI, 0.08-1.30) and trustworthiness (0.66; 95% CI, 0.05-1.27). Neck-lift was associated with increased perception of extroversion (0.60; 95% CI, 0.10-1.09) and masculinity (0.70; 95% CI, 0.21-1.19). Patients who underwent rhinoplasty had improvements in perceived attractiveness (0.51; 95% CI, 0.03-1.00) and likeability (0.40; 95% CI, 0.03-1.00). Chin augmentation did not show any significant improvements.
Conclusions and Relevance: The results of this study suggest that men undergoing facial cosmetic surgery may experience changes in perceived attractiveness, masculinity, and a variety of personality traits. These findings complement those from a previous study on female patients, which together broaden the understanding of the association of cosmetic surgery with societal perceptions of persona.

Keon M Parsa, William Gao, Jack Lally, Stephen P Davison, Michael J Reilly

Georgetown University Medical Centre material
JAMA Facial Plastic Surgery abstract

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