More men are getting botox. This Phoenix doctor explains the appeal of 'brotox'

We’ve had a number of conversations over the last year about the state of masculinity. As trans rights have roiled national politics, the question of how men should present themselves has been a subject of intense debate. And in the midst of all that, we’ve noticed this term popping up a lot: "brotox."

It’s obviously a riff on the word botox, an aesthetic medical procedure that’s been around for a long time. And after reading a few trend pieces about the rise of brotox, The Show wondered if any Valley doctors had noted this phenomenon.

Dr. Ryan Krch has an entire page on his website dedicated to brotox. Krch is based in Phoenix, and he came by KJZZ's studios recently to speak with The Show about this. They started with the basics.

Full conversation

SAM DINGMAN: Just for folks who — and I'm putting myself in this category — I sort of know what Botox is, but I don't really know what Botox is. And I think there's a lot of people who maybe think Botox applies to a whole range of procedures. But if I'm not mistaken, it's actually just one procedure, right.

DR. RYAN KRCH: It is — pretty much one use of it. And what it does is, it's called a neuromodulator. And what that means is it limits the function of certain muscles. And it's, in the aesthetic world, primarily used for the facial expression muscles to kind of tamp them down so they're not as active. The more expressive they are, then the more we see of wrinkles and things like that.

DINGMAN: And so would this be things like laugh lines around the mouth? ... Like forehead wrinkle — if you raise your eyebrows a lot, like I do.

KRCH: Yeah, yeah. I think we all have more things to raise our eyebrows about these days, but, yeah, definitely raising your eyebrows. The smile lines that we see.

DINGMAN: OK, and how is this distinct from procedures that we've also heard a lot about recently, like fillers?

KRCH: Yeah, fillers are occupying space, so they're not acting on the muscles. And what happens with the aging face is we lose skin thickness, we lose fat thickness. And that's pronounced in the face. And filler is trying to come back in and replenish those things, particularly with GLP weight loss medications that we've kind of seen a boost in doing more fillers to kind of — as people have lost fat in their face, they look a little gaunt. And adding some filler back in can kind of replenish what the weight loss from those meds has taken away.

DINGMAN: And what is the — sorry for these very basic questions — but what is the space being filled with?

KRCH: It's typically a hyaluronic acid, although there are other forms of fillers, too. And hyaluronic acid is kind of a natural substance in the skin anyways.

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KJZZ

SAM DINGMAN: So, have you seen in your practice an increase in young men coming in for these procedures?

KRCH: Sure. Yes, we have. Definitely more. And you know, really not only younger men, but older men, too. I think what happened back during the Great Recession was there were a lot of people out of work and a lot of older individuals reentering the workplace. And just not wanting to be disadvantaged because of their age or their appearance. So that was the primary thing that kind of drove increase in aesthetics and particularly among males, too.

DINGMAN: That's very interesting. So you started to see this — that would have been ... almost 20 years ago at this point. ... Is that something that your male patients would talk to you about? A sense of expectation that they needed to look a certain way on the job?

Because obviously, you know, speaking very broadly about cultural issues here, we know that women have often been held to a certain standard when it comes to physical appearance that we haven't heard as much about men being held to. But it sounds like, in your practice at least, that is starting to shift.

KRCH: Yeah, I think that, yeah, that is a growing awareness. We kind of realized that that was a growing demographic, an untapped demographic, and one that we want to serve. So we brought in some things with body sculpting and hair replacement that attracted more of the male gender.

DINGMAN: Did any of the men who came in to seek treatment for these matters ever express to you any self consciousness or nervousness, shame or anything?

KRCH: Yeah, definitely. And I think, you know, primarily that happens on the initial experience and the first time that they're reaching out and stuff. But, you know, as they see the changes and kind of grow into them, I think confidence is probably the most commonly expressed thing. ... Just a level of comfort that they're unfamiliar with.

When I was working in the preventative sphere as a practitioner and then also as a corporate wellness expert, too, we could generally get about 10% of the population to make the necessary lifestyle changes. Even knowing what was in the genetics in the lab work, all those things.

DINGMAN: And these are things like diet, exercise, these sorts of things.

KRCH: Yeah, you know, stress management, those kind of really important things. Once we were talking about prevention on the backside, on aesthetic procedure, we were closer to about half the people doing those lifestyle changes that we recommended.

DINGMAN: That is a tremendous swing — from 10% to about 50%.

KRCH: Yeah. I think it speaks a lot about human nature and how once we feel good about ourselves, what we are willing to take on.

DINGMAN: Hmm. That's really remarkable. I mean, and it's really interesting to — I realize this is not your area of expertise. But it's interesting to think about that psychologically, you know, the idea that it's not my area of expertise either, to be clear but —

KRCH: Not mine either.

DINGMAN: Just the idea that no matter how much you may want to take steps to live in a more healthy, sustainable way, sometimes you need to feel like your life is worth sustaining first.

KRCH: Yeah. You need to feel good about yourself again.

DINGMAN: One of the other theories that I have heard for why some men are getting more interested in seeking out these types of procedures is that — particularly for Gen Z folks and kids younger than that, I suppose — so much of your life is lived into a camera.

KRCH: Yeah, I think just as a society, we're much more conscientious about how we look. And during the pandemic, the dramatic increase in the number of virtual meetings and people were looking at themselves more, even if they weren't inclined to participate in social media.

So, yeah, I think that's a driving force. And that was probably the thing that the other shift that we saw in aesthetic medicine was more people wanting to seek out these procedures. I think it speaks to the fact how important social media is, the work culture.

DINGMAN: One of the things that we have talked about a lot here on The Show — and I'm curious to know if you feel like this is related to our conversation — is there has been such a shifting debate about the nature of masculinity in recent years. And this idea that there's a certain type of male jawline, a certain type of just male presentation that is desirable, just kind of crisp, "clean features" in general.

Is that something your male patients talk to you about at all?

KRCH: Yeah. In fact, in probably one of our broadest applications, or what we see the most with fillers is kind of creating a jawline for male individuals, something that is a little bit more pronounced. And even oftentimes when we do that, we want to work a little bit on the chin, too, just so it's a cohesive, kind of natural look to it.

I think it's kind of ironic that this largely female predisposition to aesthetic procedures is now kind of creeping into the male gender, and they're looking to have these more masculine features as a result of that.