Botulinum toxin is a neurotoxic protein often used for medical and cosmetic purposes; Botox is only one of the commercial trade names for the protein, but it is arguably the equivalent of Xerox within its industry in terms of brand recognition. Botox injections are the No. 1 cosmetic procedure requested by men, with 473,354 treatments administered in 2019 alone—a 5% uptick from 2018 and a 403% increase from 2000, according to the American Society of Plastic Surgeons (ASPS).

Colloquially referred to as “Brotox“—a play on the name for Botox—it remains the most-requested cosmetic procedure for men. With more and more men not only receiving Botox treatment but also being more open about it, experts are confident the trend will continue to grow.

“Guys, male-identifying patients are just as likely to want to look their best as their counterparts,” says Dr. David Shafer, a board-certified plastic surgeon in New York City. “As in-office treatments like Botox Cosmetic and Juvéderm fillers have become more readily available, and spoken about, they have also become more mainstream through social media.” Shafer adds many more male patients now come in for appointments with their wives or girlfriends, positing it is now viewed as a treat versus a few years ago when he’d often hear patients say, “My mom/wife/girlfriend made me do it.”

“Also, men are more conscious about their appearance and signs of aging after spending a year staring at their reflection on video conferences. When has there been a moment in time when anyone would see their reflection as much?” Shafer says, underscoring the “Zoom effect” of the pandemic.

“If we can find one good thing about the pandemic, it has been good for plastic surgery, in general,” Shafer says. “People are spending more time at home and looking themselves all day on Zoom. Men and women are noticing more wrinkles and coming in requesting treatments. Also, work-from-home schedules have allowed more flexibility to come in for appointments.”

Dr. Jaclyn Tomsic, an oral and maxillofacial surgeon at Ohio’s Center for Oral, Facial, and Implant Surgery, has seen this trend firsthand. In today’s world, she says, there is less stigma attached to cosmetic treatments for men and women.

“Men have always been associated with health and wellness related to athletics, strength training, and bodybuilding. These activities not only display skill but also focus on body image to a degree,” explains Tomsic. “Botox and other cosmetic procedures provide another avenue to achieve your best self. With more and more men not only receiving Botox treatment, but also being more open about it, the trend will only continue to grow, and I think that’s a great thing.”

With social media posts on Facebook, Instagram, LinkedIn, and dating apps, this has men wanting to put their best face forward. Additionally, competition in the job market and the focus on youth also encourage men to want to look younger than their chronological age.

“As with a number of cosmetic procedures, there continues to be a steady increase in requests during the virtual-driven pandemic, where a person’s face is on full display,” Tomsic says. “Botox is an easy first step for men seeking to explore the aesthetic medicine world.”

Social media, Shafer says, has given people the chance to see themselves in different light. If you like how you look with a filter, then why not have a procedure to achieve a similar effect?

“The stigma of receiving treatment is virtually nonexistent, but it’s not something men would open a conversation with at a dinner table or a night out with the guys,” Shafer says. “Society likes to paint a picture where we shouldn’t be perceived as vain or wanting to look pretty, but everyone wants to look good.”

The principles of Botox are the same for men and women, but due to thicker and stronger muscles, men often require more units than women. However, even with the higher doses, they do not come anywhere close to the toxicity threshold.

Given its quick treatment time—even full-face treatment takes no more than 30 minutes—between the lack of recovery time and the ability to return to normal activities essentially immediately, Botox is an easy sell, Tomsic says. And the treatment does not cause significant swelling or bruising for most patients.

“Many medical offices were forced to close at the beginning of the pandemic, and patients were getting desperate for the offices to open to get their next dose,” Shafer says. “This has seen a boom in treatments post-reopening, but also continued growth as more people are exploring options to look better, feel better, and to care for themselves.”