Danny Paranik, 64, a personal trainer and tennis instructor from Carnegie, Pa., works out with weights four times a week, watches his diet and competes regularly in tennis tournaments. He is deeply tanned and tall, with impeccable posture.
His license plate reads "Stayfill." "I live in a very physical world," he said. "My life's mantra would be: Be the best 'you' you can be."
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So when he began to notice wrinkles in his face, Botox was the natural choice. "I was feeling very good inside, but my outside wasn't matching my inside," he said. When Paranik began receiving Botox treatments in 2000, he joined a group of American men getting cosmetic procedures that has since grown to 750,000 in 2010. While males are just a small portion of all patients -- statistics gathered by the American Society for Aesthetic Plastic Surgery show that men made up 8 percent of all cosmetic procedures in 2010 -- the number of cosmetic procedures for men has increased more than 88 percent since 1997. In 2009, Time magazine reported on the increasing numbers of men receiving Botox injections and termed the phenomenon "Boytox."
Botox is a brand name for Clostridium botulinum toxin Type A -- a sterile, purified form of the toxin that causes botulism which doctors inject into patients' faces to paralyze the small muscles there, giving them a smoother, lifted appearance. The product is available under several brands in Europe, but only Botox and Dysport in the United States.
The Food and Drug Administration approved Botox for use in smoothing wrinkles in 2002, and Dysport in 2009. Dr. Leo McCafferty, a Pittsburgh plastic surgeon, said men are drawn to Botox over other procedures because the process requires no surgery and its effects look relatively natural.
"Botox very subtly rejuvenates, and, in my opinion, that's what's most appropriate for most men," he said. "You don't want to feminize the brow or the eyebrow in men."
A brow lift, which is an alternative to Botox, can cause scars that are more difficult to hide for men with receding hairlines than for women, McCafferty said. For men who are less open about their cosmetic procedures than Paranik, the relative subtlety of the effects of Botox is crucial.
Mike, 62, a professor from Wheeling, W.Va., has received three Botox treatments at Dr. Paul Leong's Pittsburgh practice.
He asked not to be fully named.
"I don't want people to talk and think I'm vain," Mike said, "though I am." A Los Angeles native, Mike goes to the gym three times a week, eats vegetarian and always wears sunscreen. He said he has been good-looking all his life and so is used to the rewards of the "halo effect," the well-documented cognitive bias whereby people unconsciously attribute other good qualities -- such as intelligence and competence to those they find physically attractive.
As he ages, Mike said, he has begun to experience the reverse of this effect. He decided to get Botox because he found that indignity unbearable. "My wife tells me that I'm misperceiving this, but when I'm standing up in front of a class, I imagine they're thinking, 'He's old, he's frail, he doesn't know what he's talking about, he's on the verge of senility,'" Mike said. "I want to appear young." Mike said he will continue with the injections until he retires at 70. He plans to spend $20,000 on Botox over the next eight years.
"How do you put a price on a fountain of youth?" he said. Leong said he sees men in certain professions -- lawyers and salesmen who want to look unruffled, as well as those in the high-tech industry -- especially attracted to Botox.
At high-tech companies, he said, "there may be a perception of youth culture in these companies, and they look at this guy who may be 55 or older, and they say, 'What does Bob know about social networking?'"
Dr. Suzan Obagi, director of the University of Pittsburgh Medical Center Cosmetic Surgery and Skin Health Center, noticed men coming in for Botox during the recent recession to look younger and more energetic in an increasingly competitive job market -- and to do so through a procedure less expensive than surgery that wouldn't require them to take time off work.
Of course, more discretionary income is another economic reason men seek the procedure.
Dr. Lori Cherup of Radiance Plastic Surgery in Bridgeville, Pa., estimated that three times as many men come to her office for Botox now than at the height of the recession in 2009. Men also may get Botox for the women in their lives, Cherup said.
"There's a very handsome 60-year-old guy whom I met," she said. "He just came to me this afternoon because he wants to do some nonsurgical things to make his face look more youthful because he likes 40-year-old women." "Most men see that it's done something nice on their spouse, and they say, 'Hey, why not?'" McCafferty said. Still, men haven't invaded the traditionally feminine domain of cosmetic surgery without some awkwardness. "It's tougher for a guy," said Leong. "You can imagine -- you're at a bowling alley, you're at a golf course, and you say, 'I had a face-lift, check out these scars.' They tend to want to be as discreet as possible." He said one patient, a federal judge, drives half a day to his practice for Botox procedures so he won't be recognized nearer his hometown.
"This is not a thing that men will yak-yak about with their friends," Leong said. "They come in, they take care of it, and they go back." Mike makes the hour's drive from Wheeling with his wife, who also receives Botox treatments, usually on a Saturday afternoon. Other surgeons spoke of some men being blithely open about getting work done -- and Paranik, the trainer and tennis pro, is one of these. He was so happy with the results of his first Botox treatment that he never thought twice about going back.
"It's remarkable," Paranik said. "You walk in with wrinkles, and you walk out smooth as can be. Smooth as a baby's butt." At first he returned to Dr. Dominic Brandy's Mount Lebanon, Pa., practice, the Skin Center, nearly every three months, spending $300 to $350 on each session. He found that the effects of Botox lasted longer after several treatments so he later shifted to receiving injections about every six months.
Before beginning procedures, Paranik knew only women who were getting Botox, most of them friends of his wife. Now, he knows a couple of other guys who go for the injections. He decided to get Botox not to look more youthful at work or to please his younger wife, but solely for his "own personal satisfaction."
When he tells friends about his procedures, they respond positively. "I think people's response to getting plastic surgery of any type is getting much more accepting," he said. "It's a natural aging process for the baby boomers." A few months ago, Paranik treated himself to a QuickLift, a minimally invasive face-lift that tightens loose skin under the jaw, and said its effects mean he'll stop getting Botox as frequently -- though he still plans "a little perk-up" from time to time, he said recently as he waited to undergo Botox, serenely munching an apple.