Upset at seeing the onset of crow's feet before he had reached his 30s, James "JD" Heffernan turned to a plastic surgeon for help. For the last two years he has been receiving regular injections of botulinum toxin type A, more commonly known as Botox, in his face every five to six weeks.
"I had a bunch of wrinkles, I felt, prematurely," said Heffernan, a nurse who recently moved from San Francisco to Tennessee to attend graduate school.
Having grown up in the South, "I was in the sun a lot as a kid," recalled Heffernan when asked what had caused the creases in the skin next to his eyes.
"I am sure it is vanity; we all want to look good," he said about opting for the treatments. "For me, I noticed more and more wrinkles in the mirror each day. I am only 31, it annoyed me."
The openly gay Heffernan is part of a growing trend in men, both gay and straight, using what has been dubbed "Brotox" to treat their wrinkles.
According to the American Society of Plastic Surgeons, Botox was the number one minimally-invasive procedure among men in 2012. It reported 390,000 men using "Brotox" that year, an increase of 7 percent from 2011.
The next most used procedure is laser hair removal, with 194,000 men seeking it out in 2012. That marked a 5 percent increase from 2011.
The society reported that facial rejuvenation procedures saw the most growth overall last year, with 6.1 million injections of botulinum toxin type A. The figure is the highest number of injections to date, according to the plastic surgeons group.
Among patients, procedures such as Botox are gaining ground with those in their 40s, 50s, and older. There was a 7 percent increase in 2012 among both 40-54 year olds and people 55 and over who had minimally-invasive procedures.
For people in their 30s, there was a 3 percent increase last year, while such procedures grew by 4 percent among twenty-somethings. The country's Mountain/Pacific Region, which includes California, accounted for the most cosmetic procedures performed in the U.S. in 2012 �" a total of 4.2 million.
Usage of Botox has been increasing faster among men than women for the last decade. Yet scientific studies have failed to catch up to this trend, as most research tends to focus on women who use the procedure.
"More men are seeking neurotoxin treatments each year and will probably continue to seek more of these noninvasive treatments as our culture becomes more accepting of the concept of male beauty," concluded a study published earlier this year in the journal Cosmetic Dermatology . "There is no consensus on exact dosing regimens, but as a general rule, men require higher doses of all currently available neurotoxins."
The study, "Neurotoxin Techniques for Men" whose lead author was Dr. Whitney P. Bowe from SUNY Downstate Medical Center, Brooklyn, noted that since botulinum toxin was first used in the 1990s to treat hyperdynamic facial wrinkles "an increasing body of evidence has supported the efficacy and safety of this cosmetic treatment."
San Francisco-based plastic surgeon Dr. Edward Miranda, who had been treating Heffernan, said he has noticed an uptick in men, mostly gay, seeking out Botox in recent years. He pointed to the improvement in the economy since 2008 and relocating his office from Laurel Village to near the Van Ness Muni station as contributing to the increase of gay male patients at his business.
"Our focus shifted to be able to accommodate more straight and gay men," said Miranda, 36, who is straight and has been in practice seven years. "We had more women when we first started; straight men are the least common here. Gay men are much more in tune with their appearance."
The majority of his male clientele who use Botox are in their 30s and 40s, said Miranda. The cost ranges from $350 to $700 per visit every four months.
He has also noticed more gay men seeking out rhinoplasty, liposuction, and facelifts. His office offers a new procedure called cool sculpting, which costs $2,500 and requires two treatments two months apart, that freezes the fat deposits at a person's waistline. Over time, the body will remove the frozen fat cells on its own.
As for facelifts, the cost can vary from $12,000 and up depending on the person. It is mainly men in their 50s and older who are opting for the procedure, said Miranda.
"We restore the fat and soft tissues to where it belongs. We don't like to pull people Joan Rivers tight," he said.
A nose job can cost $6,500 and up, and most men seek out a rhinoplasty either because they don't like the look of their nose or they injured it playing sports and it is now crooked.
"Fifteen years ago guys wouldn't bother to get that fixed," said Miranda, adding that the procedure is "sometimes" partly covered by insurance if done to correct a breathing problem.
Heffernan sought out Miranda to help improve his facial appearance because he had known him through the hospital where he worked. His partner of seven years, who is now 45 years old, had been getting Botox injections himself for the last five years.
"I could see how it worked on him," said Heffernan.
There is minimal pain, he said, but the Botox injection "hurts less than a flu shot."
Within two weeks of his treatments he can visibly notice a difference, said Heffernan. He also experiences fewer headaches at work, which he said were caused from focusing on paperwork during his 12-hour shifts.
"It's temporary, so it is a commitment if you want to do Botox, so that can be a good thing and a bad thing," said Heffernan, who expects he will not be able to afford the treatments now that he is going back to graduate school. "I am nervous about giving up Botox for the next three years."