In my link on Skin and Appearance, I tell you about how to dramatically improve your appearance and decrease wrinkles using non-surgical methods, i.e. lifestyle and supplement-related solutions. However, for some of you middle-aged and beyond guys out there, this may not be good enough for you.
You may have extensive skin issues from smoking damage or sun exposure. Or maybe you are entering the market again and just want to look as good as possible. You may even want to Date Someone Younger.
Any of these reasons, and a dozen more that we could name, may require you to consider surgical alternatives. Below I have compiled a list of procedures that are tailor-made for males. It is a complete myth that cosmetic surgery and plastic surgery are for females only.
Yes, we've probably all known a female or two that have been obsessed with the subject. You may even know a female or two that have over-cupped themselves to the point of the absurd. Well, I'm not talking about anything weird here: I'm just talking about wrinkle-reduction so that you look and feel your best for whatever reason. Cosmetic surgery is about looking good and us males should want to look and feel just as good as the females in our lives.
Besides surgery, cosmetic or not, is science. Philosophically, what is the difference between taking Vitamin C or Alpha-lipoic acid to look and feel youger than using surgery? Obviously, one can go to an extreme here - think Michael Jackson - but the great majority of guys are not going to spend their money on cosmetic surgery unless it's really necessary. If you've got a lot of sun damage, your much more likely to consider foregoing a new set of clubs or that trip to Cabo in order to get a new face.
CAUTION: The only cosmetic surgery I caution you on is bariatric, or weight loss surgeries such as liposuction. These are the most common cosmetic surgery procedure for males by the way. In 2007 almost 60,000 guys had one! So why do I caution against it? Liposuction, or other weight loss procedures, can bypass your investigation into the root cause of your overweight condition if you have one. Peak Testosterone readers know that extra fat can be result from low testosterone, low growth hormone, overeating, underexercising, insulin resistance, an underactive thyroid or some combination of the above. These are all deadly and you need to know exactly what has caused you to put on those extra pounds. In addition, liposuction does not lead to any reductions in cardiac risk factors. This has surprised researchers, because the fat tissue is removed and yet heart outcomes do not change.  However, losing weight the "old fashioned way", i.e. gradually with diet and/or exercise, improves EVERY cardiovascular risk factor.
In addition, bariatric surgeries actually carry significant risks. A recent study  found that "about 4% had at least one serious complication (a life-threatening blood clot, the need for more procedures related to the weight loss surgery, or death)".  That's a 1/25 chance of a near death experience! Again, talk with you doctor, but wouldn't it be better to lose weight through exercise and proper diet with little to no risk of death? Regardless, realize that being Overweight is Deadly and it is literally life and death to defeat this issue in your life.
Below is a list of great cosmetic surgeries for guys, depending, of course, on your situation. I have also documented How Common Cosmetic Surgery is For Males.
1) Thermage. Thermage is a "monopolar radiofrequency" procedure. It essentially cooks your skin so that the skin rebuilds. Thermage for about two thirds of individuals does something magical: it actually can reduce facial and neck sag. The downtime is minimal, a couple of days on average although it can be longer, and the cost is in the medium range (~ $1,500). Again, most people get younger looking skin with less sagging but not dramatically so. CAUTIONS: Thermage can "boil away" subcutaneous fat and it can leave small burns that are slow to heal. Talk to your doctor about risks.
2) Bipolar Radiofrequency Plus Pulsed Light. Bipolar radiofrequency does not heat the skin as deeply as Thermage but when combined with Pulsed Light does achieve good results. Again, this can actually decrease skin sagging on the face and neck, although results are generally somewhat less than with Thermage. CAUTIONS: Side effects can still take place but are generally less than Thermage. Repeated treatments are usually require.
2) Dermal Fillers. This involves injecting substances into a wrinkle to reduce the appearance of the wrinkle, kind of autmotive putty for the face one might say. The classic use of dermal fillers is on the nasolabial fold, i.e the lines beside your mouth. The beauty of dermal fillers is that results last a long time, e.g. 18-24 months, and downtime is minimal.
3) Eyelid Surgery or Blepharoplasty. The eyes are the most revealing aspect of your body. Women stare into them longingly - well, hopefully - and few can argue that they are the "window to the soul". They also reveal your age better than any other part of the body. This is because the skin is very thin and easily damaged from the sun, lack of sleep and so on. The eyes instantly flash whether you are tired or well-rested. Blepharoplasty can remove the excess skin from upper and lower eyelids and remove the bags from the lower lids and, if done well, take ten years off your appearance in a matter of a few hours. You may want to read this link which has many reviews of those who have undergone the procedure.
4) Microdermabrasion. This one may be worth a try. It is, after all, the #1 procedure for Hollywood-types. Some stars have this procedure done every two weeks (or even more frequently) while filming. Lighting directors apparently go ga ga over the smooth finish that it gives skin. The important thing for guys to know is that it is sometimes called the "lunchtime peel", because there is almost no downtime. Better yet, the cost is low: just a few hundred dollars per session normally. It consists essentially rubbing a sandy material over the skin of your face in order to cause mild skin damage which then forces regeneration of new, improved skin. Unfortunately, the results are often not spectacular, but if you are one of the lucky individuals that respond well to microdermabrasion, it is an excellent alternative, especially for the price. CAUTION: It is uncommon but you should know that a few individuals respond with excess tissue inflammation and can come out looking a little worse, i.e. with increased wrinking in certain areas.
In addition, sagging on upper and lower eyelids is extemely common. And, unfortunately, once skin has sagged in a major way in the eye area, there is no good non-surgical way to re-firm it. (Thermage can do some firming in the eye area for some people but it generally not going to do a major improvement.) This is where an "eye lift" or blepharoplasty can come into play. It will take you out of commission for awhile, but there really is no substitute.
5) Peels, Laser Resurfacing and Face Lifts. These are much more invasive procedures with a more significant list of side effects. Of course, if you have significant skin damage or sag, then you may want to consider these.
6) Botox. The above procedures, for the most part, will only be partially successful on "motion wrinkles and lines". These lines, such as crows feet and glabellar lines (between the eyebrows), are caused by the expressions you make. Botox works by injecting a Botulin toxin into the muscle area involved, which "deadens the muscle" that causes the wrinkling. It works remarkably in many people and seems to actually allow the body to heal the wrinkles in many cases. Botox treatments generally last about four months and cost $300-400 per treatment. MONEY SAVER: New research shows that after you are a veteran, i.e. have had Botox for two years, you can go to treatments every six months (instead of the usual three) and still have reduced facial wrinkles. 
CAUTION 1: One should be aware that researchers recently found, to their surprise, that a minute amount of the Botulin toxin did actually migrate down the nerve. Most doctors do not believe the small amounts involved will cause any kind of permanent issue, but no one knows for sure of course.
CAUTION 2: Botox, if done incorrectly, can actually cause "new wrinkles" and can lead to ptosis (sagging).
CAUTION 3: One recent study found that Botox can actually lead to decreased emotional responsiveness.  The reason is simple: your facial expressions actually provide feedback that increases and validates your emotions. Without facial expressiveness, emotional responses are blunted and dampened. For this reason, still other research indicates that treating crows feet with Botox can increase feeling of depression due to the loss of neural feedback. 
CAUTION 4: 2009 study found that Botox results in an immune response, at least in mice. The long term consequences of this immune response have not been studied. 
CAUTION 5: Some individuals actually become Botox resistant over time.
CAUTION: Watch out for the new GFX procedure to handle facial wrinking, especially in the area between the brows. It has been approved for "overactive muscles" by the FDA but has not yet been approved for cosmetic purposes yet. And that may be with good reason: it works via the same radiofriequency used to Thermage, except in this case it's used to actually temporarily stun the local nerve. This produces a Botox-like effect, except that in the case of GFX, one does not know for sure if nerve function will be fully restored. In other words, if you don't like the results, it may be too late.
7) REX. There is another very new procedure called REX, or Relaxed Expressions Toxin-Free RF Treatment, that works by inserting a small needle and using radio frequency waves (kind of like Thermage) to deaden nerve function, essentially accomplishing the same thing as Botox, but without using any nerve toxins. It is first being pushed for glabellar lines between the eyebrows, but its proponents say it can be used for crow's feet and even forehead lines. Its practitioners claim that results are better and more natural. CAUTIONS: Results last for a year or more, which is both good and bad. If you like the results, its great. If you don't like the results for some reason, you're going to be waiting for awhile. This is still not FDA approved and no one knows long term effects.
8) Dysport. This is a brand new replacement for Botox and the results look promising. One recent study showed legitimate wrinkle reduction for frown (or motion) facial lines in 85% of participants.  Results appear to initiate and last in roughly the same time frame as traditional Botox. (Dysport is, like Botox, a botulinum neurotoxin type A.) Hopefully, this will drive down costs due to competitive pressures. (There are also a couple of other Botox competitors coming down the pike as well.)
9. Hyaluronic Acid Fillers. These, as the name implies, reduce wrinkles by "filling in the valleys". However, hyaluronic acid is a natural is a natural substance of skin and WebMD reports that there is some evidence that it actually promotes collagen formation. Collagen formation is the "backbone" of your skin and almost anything that promotes the protection or renewing of it is a good thing for your appearance. In other words, repeated injections of hyaluronic acid may very well help your body actually reduce its own wrinkles. Costs vary depending on the amount of filler used and are typically in the $400 to $1000 range with one treatment lasting, in general, for 6 to 12 months. Common brands are Juvederm, Restylane and Captique. Results in the brow area are excellent and can last up to two years in many cases. CAUTION: You want to get someone with good experience (and board-certified) because, if done incorrectly, you can get tiny mini-bumps on the skin.
10. Fraxel Laser. Traditional ablative laser treatments were effective but fraught with side effects: the problem being that these older lasers heated both the top and deeper layers of the skin. The Fraxel Laser changed all that by heating only the deeper layers of the skin which allowed for decreased side effects and downtime. However, there is generally downtime of several days to a week as the patient has an actual "sunburned" look during that time period. If you get treated on a Friday, for example, you might be ready by Monday. The good news is that the new skin that emerges is usually well worth the wait: wrinkling, blotching, age spots, pigment spots and other skin problems are usually substantially improved. If you want a new face to jump start your career or a relationship, Fraxel laser is definitely worth considering. It is one of the few treatments that is accepted as getting rid of fine lines around the eyes. Keep in mind, though, that it is quite expensive: about a grand per treatment and 3-5 treatments are usually recommended over the course of about a month. If you truly want a new face, though, the cost and inconvenience may well be worth it.
11) Tri-Luma. One of the most popular and successful treatments for skin discolorations is prescription-only Tri-Luma. If you have melasma and/or age spots on your face, you may want to talk to your dermatologist about Tri-Luma. It does have a fair number of side effects, but for the most part, are what you might expect, including peeling, dryness, redness and so on. In a small minority of people, it can create a bluish tint and, of course, should be discontinued immediately.
12) Liquid Face Lift. If you've got the money, then this procedure gives you the power to take ten years off your face in one afternoon. There is also minimal downtime, lengthy persistence and possible collagen-boosting properties as well. For more details, see this link on the Liquid Face Lift.
NOTE: Read here about the Most Common Cosmetic Surgery and Procedure for Guys.
Thanks to SmartSkinCare and Dr. Todorov for much of the above information.
1) Flum, D. NEJM, Jul 30 2009, 361:445-454; Robinson, M., NEJM, Jul 30 2009; 361:520-521
3) UT Southwestern Medical Center (2009, August 3). Dysport Deemed Safe, Effective Anti-wrinkle Treatment, Plastic Surgeons Say. ScienceDaily. Retrieved August 4, 2009, from Science Daily Dysport coverage .
4) Aesthetic Surgery Jour, Sep 2009, 29(5):414-418, "Type A Botulinum Toxin Induced Antibody Production: A Murine Model of Antibody Response"
5) Emotion, 2010 Jun, 10(3):433-40, "The effects of BOTOX injections on emotional experience"
6) Obesity, 2008, 16(12):2648 2651, "Long-term Effects of Large-volume Liposuction on Metabolic Risk Factors for Coronary Heart Disease"