The Zoom Boom Is Real


Plastic surgeons are dealing with an unexpected spike in demand for cosmetic procedures fueled by patients who worked remotely during the pandemic.

The pandemic caused an abrupt shift in the work and social lives of Americans, who found themselves quarantined at home and forced to interact with colleagues and loved ones through calls on Zoom, talks on Teams and discussions on Duo. Many people apparently didn’t like what they saw.

Plastic surgeons are trying to keep pace with an unprecedented demand for cosmetic surgery from patients who are tired of looking at their video images on virtual platforms during countless hours spent logging into remote meetings.

Have I always had those wrinkles? When did my neck skin start sagging? Is my nose really that big? Do my ears stick out that far?

 During the pandemic’s quarantine, vacations were postponed, dinners out didn’t happen and cars sat idle instead of guzzling gas. Potential patients were suddenly flush with disposable income and remained at home, where they could recover in relative privacy. Homebound patients also spent more time on social media, seeing before-and-after images of cosmetic surgery and reading testimonials from satisfied patients.

It’s all led to the Zoom Boom, a nationwide spike in demand for cosmetic surgery. The top surgical procedures performed in 2020, according to the American Society of Plastic Surgeons (ASPS), were nose reshapings, eyelid surgery, facelifts, liposuction and breast augmentations. ASPS says demand for injectable treatments was also high throughout 2020. The most requested procedures among the more than 13 million performed were Botox injections, soft tissue fillers, laser skin resurfacing, chemical peels and intense pulsed light therapy.

A national survey of more than 1,000 women conducted by ASPS says 11% of the women who never had cosmetic surgery said they were more interested in the procedures now than before the pandemic, and 24% of the women who had undergone previous cosmetic procedures were more interested in scheduling another treatment. The increased interest in aesthetic procedures shows evidence of continuing, according to the survey, which revealed 35% of women who had undergone previous procedures planned to spend significantly more on cosmetic procedures in 2021 than in 2020. The surgeons interviewed for this story say increasing numbers of men are undergoing cosmetic surgery as well.

There could be another factor behind more patients wanting to look their best. “Zoom dysmorphia” is a term coined by Arianne Shadi Kourosh, MD, MPH, to describe the phenomenon of people developing a negative self-opinion after constantly seeing themselves on virtual platforms. This creates a dangerous cycle of self-criticism based on preoccupations with real or imagined defects that causes them to seek cosmetic corrections they wouldn’t have considered had they not spent months staring at themselves on a video screen.

Looking at self-images displayed on computer screens is like being forced to confront a funhouse mirror.
— Arianne Shadi Kourosh, MD, MPH

Dr. Kourosh, a board-certified dermatologist at Massachusetts General Hospital in Boston, wrote about Zoom dysmorphia in the journal Facial Plastic Surgery & Aesthetic Medicine. She says people see their faces speaking or displaying emotions during virtual calls — perspectives that are not seen during conventional conversations. Additionally, she says, the forward-facing cameras on laptops and phones distort video quality and create an inaccurate representation of true appearance. The closer people sit to the cameras, the more different their faces look. For example, research has shown that cameras positioned 12 inches away from the face instead of five feet increase perceived nose size by 30%. “It’s important for patients to recognize the limitations of webcams and understand that they are, at best, a flawed representation of reality,” says Dr. Kourosh.

Like many aesthetic specialists across the country, Dr. Kourosh saw a larger-than-expected influx of new patients interested in cosmetic procedures. She asked her patients why they sought treatment, and many told her they felt they looked terrible on video conference calls. Her dermatology colleagues had similar experiences with their patients.

Dr. Kourosh, as part of the Women’s Dermatology Society (the organization also includes male providers), helped survey members about the number of cosmetic surgery consultations they had scheduled throughout 2020. Half of the 130 respondents said consults had increased, and 85% of the respondents cited video conferencing as at least one reason patients were interested in having work done. “That’s when we realized the impact video calls were having on the increased demand among our patients was part of a broader trend,” says Dr. Kourosh.

AT FACE VALUE Surgeons must discuss the expected results of surgery with patients — and how long it will take them to recover from procedures, says Dr. Michael Wojtanowski.  |  Amy Castelli

Business was good at Chevy Chase (Md.) Facial Plastic Surgery before the pandemic hit, and Jennifer Parker Porter, MD, FACS, the practice’s medical director, was worried the elective surgery shutdown would have a lasting negative impact on case volumes. But when Dr. Porter began seeing patients after a three-month pause, she was surprised by the sudden increase in new patients who were concerned with how they looked on work video calls.

The sudden increase in case volumes continued into this year and throughout the summer. Dr. Porter secured privileges at a second surgery center to accommodate the demand for neck lifts, facelifts, skin-tightening procedures and rhinoplasties. She says demand for Botox injections is also on the rise.

Dr. Porter brought on a second surgeon at the start of 2020 and didn’t know if there would be enough cases to fill his schedule during the pandemic. The opposite has in fact been true. “I couldn’t have handled this amount of volume myself,” she says.

Elliot M. Hirsch, MD, a plastic and reconstructive surgeon in Sherman Oaks, Calif., has also seen a sharp increase in the number of patients who want facial cosmetic surgery, including touch-ups around the eyes and mouth. Dr. Hirsch says a second wave of increased demand has stretched into this summer. “Before the pandemic, we typically worked through a month of backlogged cases,” he says. “Now, we schedule procedures four or five months in advance.”

After a 13-week shutdown during the height of the pandemic, Frank Fechner, MD, a plastic surgeon in Worcester, Mass., says the number of new patient consults far exceeded his expectations, and has held steady into this year. As of July, Dr. Fechner has seen a 50% increase in requests for rhinoplasties, blepharoplasties and facelifts since the same time last year.

“The Zoom Boom is only one aspect of the increased demand we’re seeing,” he says. “Working professionals have often hesitated to dedicate their hard-earned vacation time to recovering from plastic surgery. Now that they’re working remotely — and had nowhere to go when the pandemic essentially shut down the nation — they see a once-in-a-lifetime opportunity to get the work done they’ve always considered.”

Michael H. Wojtanowski, MD, FACS, a plastic surgeon who runs office-based surgical suites in Westlake, Ohio, has experienced a rush of new patients who have told him they started noticing wrinkles and imperfections after spending hours on video calls. “During the pandemic, patients could remain at home while they recovered discreetly,” says Dr. Wojtanowski. “Masking mandates also helped. Patients could easily hide healing scars.”

The psychological aspect of elective aesthetic surgery has also played a significant role in the increased demand. “Patients undergo procedures to feel good about themselves,” says Dr. Fechner. “They might have a specific physical trait they don’t like or want to turn back the clock on aging-related changes.”

The pandemic accelerated the self-care movement that was already trending across the country. Patients whose personal and professional lives were shut down, or who experienced the isolation of quarantine, decided to focus on parts of their lives that made them happy. “If patients look better, they feel better about themselves and are more confident,” says Dr. Porter. “Cosmetic surgery is now seen as a form of self-care.”

But patients might also worry about what their neighbors, friends or family members might think of the work they get done. Dr. Fechner believes the pandemic reset priorities in people’s lives, however, and patients aren’t as worried about the opinions of others. “Many patients tell me they no longer care what others think — that they were having the procedure done for themselves and that’s all that mattered to them,” says. Dr. Fechner. “Patients who never thought they’d have plastic surgery aren’t making outlandish requests. They just want to look their best.”

The psychology of cosmetic surgery cuts both ways. Dr. Kourosh says Zoom dysmorphia is not a diagnosis, but a condition caused by the peculiar situation of the pandemic.

“It’s caused by the combination of having to excessively look at one’s own reflection on technology, and the distortion of those images caused by that technology itself,” she says. “Looking at self-images displayed on computer screens is like being forced to confront a funhouse mirror. Sub-consciously, patients might start to believe that’s what they look like. Imagine having to confront a negative self-image while isolated and without positive reinforcement from personal interactions.”

During the boom, plastic surgeons must balance the lure of new business with the responsibility of providing proper patient care. Board-certified physicians trained in an aesthetic specialty understand healthy facial proportions and are able to work with patients to establish realistic post-op goals, points out Dr. Kourosh.

“As physicians and aesthetic specialists, our primary concern is the overall well-being of our patients,” says Dr. Fechner. “We must be sensitive to elements of even mild dysmorphic disorder.”

Dr. Wojtanowski talks with prospective patients about the entire perioperative process, the length of recovery and the risks involved. “My goal is to find out if we’re a good match,” he says. “I’m not afraid to tell a patient that I can’t deliver what they want. I don’t treat consultations as a sales job. The procedure will sell itself with the proper level of patient education.”

He’s performing more eyelid procedures and administering injectables — Botox and skin fillers — and reports an uptick in otoplasties and rhinoplasties, as well as liposuctions and tummy tucks. Case volumes have increased by about 40%, forcing him to extend his office hours and surgical days. He can no longer be content with performing a single procedure and taking the rest of the day off.

“My days are longer, but that’s a good thing,” he says. “If the playing field stays level — COVID-19 variants don’t cause a nationwide spike and the economy remains stable — the number of people who have elective surgery will continue to grow.”

Dr. Fechner says surgical volume in his two-OR surgery center has increased by 20%, and he doesn’t expect the demand to slow considerably in the near future. “The economy has a significant impact on cosmetic surgery,” he says. “If people feel good about their finances, requests to look the best they can will continue.”

“Patients are realizing cosmetic surgery can result in subtle changes, that they won’t look like they’ve been operated on,” says Dr. Porter. “As more patients undergo successful plastic surgery and tell their friends and family about it, case volumes should remain high.”

Patients are more comfortable talking about the work they’re having done, according to Dr. Wojtanowski. “As more patients talk, more patients will have surgery,” he says. “As more procedures are performed, more patients will talk about them. The cycle will continue.” OSM

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