The most popular treatment requests aren't what you'd expect.

By Erin Lukas
Jul 01, 2020 @ 2:45 pm
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Photo Illustration Kelly Chiello/InStyle.com; Photos: Getty Images, Adobe Stock

The year is 2020.

As of mid-March, both your personal and work life mostly take place online. During the first few days of working from home, you quickly discovered Zoom’s “Touch Up My Appearance” feature, a filter the video conferencing service describes as “a softening effect to skin to minimize the visibility of imperfections.” The filter diffuses your stress breakout, but as your boss is discussing WFH logistics during a meeting, you can’t help but stare at your own neck and the deep-set smile lines that definitely weren’t as prominent yesterday. As the weeks go on, you swear you’ve developed crow’s feet in quarantine, too. 

With the country slowly opening back up after months of being shut down due to the coronavirus pandemic, you can finally get filler and Botox to firm and tighten the areas of your face that age you on Zoom. That is, if you can get an appointment. 

Post COVID-19 lockdown, cosmetic dermatologists and plastic surgeons have been more in demand than ever, with some doctors booked up well into fall 2020.

“We’ve been so busy with surgical procedures, but there’s been the biggest uptick in non-surgical procedures,” says Dr. Sarmela Sunder, a double board-certified facial plastic surgeon in Beverly Hills. “Everyone has been cooped up and staring at themselves on Zoom or in the mirror. I thought after the first month or so things would die down, but I’m booked out longer than I have ever been previously.”

Dr. Sunder is currently taking appointments for mid-September. 

According to a survey conducted by the American Society of Plastic Surgeons on Americans’ attitudes towards plastic surgery in the wake of COVID-19, during the pandemic, 49% of respondents who haven’t had any plastic surgery say they are open to having cosmetic or reconstructive procedures in the future.

Dr. Suneel Chilukuri, a board-certified dermatologist and dermatologic surgeon in Houston is in the process of expanding his staff at Refresh Dermatology to keep up with the post-quarantine cosmetic facial procedure rush. 

“I really thought there was going to be a significant slowdown with COVID-19, because of people being scared to get procedures done and the high unemployment rate,” he says. “We even talked about the possibility of downsizing and providing payouts to the employees we couldn’t afford to keep. So, I’ve been quite surprised.”  

The most popular post-lockdown non-surgical procedures are predictably from the neck up. Of the most-requested treatments during telemedicine appointments, 65% were Botulinum Toxin Type A fillers such as Botox, Dysport, and Xeomin, and 37% were soft tissue fillers such as Juvederm, Radiesse, Restylane, Sculptra, and Belotero, according to the ASPS. What is surprising, however, is that in addition to requests for upper eyelid lifts, brow lifts, and non-surgical neck lifts, our experts say lip injections are as popular as ever, despite many states mandating that face masks be worn in public. 

“I thought everyone was going to be obsessed with their eyes and not care about their lips and jaw line because we’re all under masks,” Dr. Sunder says. “While it’s true that people are noticing their eyes more, because everyone is on Zoom, they are now noticing their jaw lines.” 

She has seen a 100% increase in lower facelifts, neck lifts, and jawline tightening procedures compared to her practice's pre-pandemic appointments.

“Back in February, we were seeing about 15 to 20 consults for lower facelifts, neck lifts, and jawline tightening procedures,” Dr. Sunder says. “Post-quarantine, we are seeing double that number! In addition, the patients that are consulting about these procedures are eager to get these procedures as soon as possible.”

Dr. Chilukuri points out that since everyone is wearing masks, it’s easier to cover up bruising or swelling from lip injections. “Normally I tell people that for three days you might not be able to go to certain functions. Now, patients say go ahead and do it because they have a mask on and can hide the bruising or swelling, he says. “They also have the excuse of turning off their camera on Zoom. They’ll call in from their phone ‘this one time’ or say their camera isn’t working, so no one at work will see them.”

Dr. Jason Emer, a board-certified dermatologist in Los Angeles says many of his patients who are on long-term treatment plans were lined up to come back once his office reopened in June. “They know every two months they get a facial and laser treatment, every quarter there’s a bigger laser or a peel, and every six months or so there’s fillers and Botox in-between,” he explains. “Those three or so months went by, and [then] everyone came in for filler, Botox, and laser.” Dr. Emer is not only busy touching up his regulars after quarantine. He’s booking appointments through the end of the year, specifically seeing an upswing of patients wanting these skin-tightening and wrinkle- and sagging-preventing treatments after the summer and ahead of the holiday season.

Before lockdown, people couldn’t see themselves while having face-to-face conversations with co-workers, family, or friends. It would be bizarre to whip out a mirror in a meeting to glare at your own face while your boss is talking next quarter’s strategy, and yet that’s how so many have been operating these last few months. Not only is staring at your own face distracting from the task at hand, but experts say it can be triggering for anyone who already had self-esteem issues before the pandemic and intensify their desire to fix these “flaws” with cosmetic facial procedures.

“You see yourself the way others do, but you are also adopting an alienating perspective on yourself. When we do this, we start imagining all the judgments people could make on us, and our insecurities can manifest in what we say to ourselves,” explains Dr. Sanam Hafeez, a neuropsychologist and faculty member at Columbia University. “One only has to look up phone camera comparisons to see how drastically different cameras on different phone models can make you look. For some, this is very uncomfortable, but for others, it's hard to look away.”

And data suggests we’re spending a lot of time over-analyzing what we see in our full-length mirrors, too. The ASPS says that there has been continued interest in surgical procedures during the pandemic, but, notably, the top two most-requested procedures during telemedicine appointments were breast augmentation and liposuction.

Dr. Melissa Doft, a double board-certified plastic and reconstructive surgeon and founder of Doft Plastic Surgery in New York City says that in addition to pre-booking filler appointments while conducting telemedicine appointments during lockdown, she received a lot of requests for breast augmentation and reduction consultations. 

“We’ve done a few breast reduction consults which I think is a great idea because we can do all of the measurements and photographs [from home],” Dr. Doft told InStyle in April. “Then, I can do the video consultation while looking at the photographs to explain how the breast reduction is done, what the post-op situation will be, and then I can submit everything into their insurance because usually that takes a month to be approved. It gives us a head start because everything is delayed because of COVID-19.”

As people begin to return to an adapted version of their life pre-pandemic, beauty routines — including cosmetic procedures — satisfy both personal and societal needs. Even though there’s still great uncertainty surrounding health and employment, people want to feel good about themselves and be respected and admired by their peers. 

Dr. Hafeez points out there are both productivity and self-esteem benefits to looking one’s best. “I don’t mean to say you have to work from home in a gown, hair, and makeup, but looking presentable for yourself as well as for work wires us for a more productive day and one where everything isn’t such a chore,” she says. “Some people might be relieved that they get to forgo these beauty routines to fit the ‘status quo,’ but some might really miss that. It's a very complicated but rationally validated coping mechanism.”

But these coping mechanisms come with risks.

Even though dermatologists and cosmetic surgeons are taking necessary steps to protect patients, themselves, and their office staff from COVID-19 exposure, the possibility of transmission is still present, as states in a rush to open, like Texas and Florida, are seeing cases spike

“Any procedure where you’re going to be face-to-face for longer than 15 minutes, there’s a risk," says Dr. Sandra Kesh, infectious disease specialist and deputy medical director at Westmed Medical Group in New York City. "[But] there are things that can be done to mitigate the risk.” 

While Dr. Kesh notes that there is enough evidence to support that the virus can be airborne, it’s still believed the majority of the spread is through droplets. “From that perspective, I would be more worried about any avenue that allows for droplet spread to happen with the eyes, face, and nose,” she says. “The respiratory tract is where you worry.”

That being said, it’s still hard to give definitive answers on the safety of certain cosmetic procedures because COVID-19 is an unprecedented strain of coronavirus that the world’s leading medical professionals are learning about in real time.

“The virus behaves in a way other viruses haven’t behaved in the past, so even something that should be as simple as antibody testing — [COVID-19] is not generating antibodies the way most other viruses do, which makes things tricky,” explains Dr. Kesh. 

While fillers and Botox don’t appear to pose any major additional risks aside from the common side effects, such as bruising and swelling, some cosmetic dermatologists and surgeons are altering some of their treatments for the time being.

Both Dr. Sunder and Dr. Chilukuri have stopped treating acne scars with CO2 and Erbium lasers. These resurfacing lasers essentially vaporize a layer of skin off the face and plume is emitted in the process. If the patient has COVID-19, there is the possibility that the doctor and anyone else in the room can become exposed to the virus.

“Out of an abundance of caution, I’m not doing it,” says Dr. Sunder. “Not just for me, but there are other assistants in the room with me. Once it gets in the air, we don’t know how long it’s going to stay there. I’m not doing those lasers until we have more information on that.”

Instead, Dr. Sunder is using light-based lasers, while Dr. Chilukuri is opting for radiofrequency (RF) microneedling. 

Dr. Emer also points out the importance of getting these procedures done at a dermatologist or plastic surgeon’s office during a pandemic as opposed to a med spa. “You need to be more comprehensive during this critical time,” he says. “Dermatologists and surgeons, such as myself, went through years of school and fellowships to understand anatomy and infections in the skin, so we’re not putting people at risk.”

VIDEO: Can COVID-19 Live on Your Beauty Products? 

Lockdown may be ending, but the pandemic is not. Until there’s a vaccine for COVID-19, or the illness somehow dies off on its own, there is always going to be a risk when getting cosmetic procedures. But, the chance of exposure isn’t going to stop people from wanting to present the world with the best version of themselves — even if it’s on a computer screen. 

“Vanity doesn't disappear just because the world is in a state of crisis,” says Dr. Hafeez. “On top of that, we're seeing a lot more of ourselves — whether it be virtually or in the mirror at home — and becoming harsher critics.”