While loss has been an inescapable theme of COVID-19 — loss of life, jobs, community, security, even our senses and hair — some have seen surprising gains during the pandemic. For video-chat giant Zoom, lockdown delivered an opportunity — and, within no time, a windfall — which had a curious sort of ripple effect on another industry: plastic surgery.
Zoom usage jumped 67% between January 2020 and mid-March, when nonessential businesses and schools shuttered for what was expected to be a two-week pause, intended to flatten the curve. What followed was the issuing of lengthy stay-at-home orders and a complete upending of our daily routines. Fearing the risk of infection, millions of people traded IRL interactions for screen time — navigating new platforms that forced us to face our reflections, or a slightly skewed version of them, for hours on end. Beyond the notoriously awkward angles and bad lighting, “with the onset of Zoom meetings, we were view[ing] ourselves not only in a still form, but also fully engaged in conversation,” says Corey Hartman, MD, a board-certified dermatologist in Birmingham, Alabama. We witnessed our faces take shapes we’ve never seen before — our expressions exposing unfamiliar lines, folds, and asymmetries.
When elective procedures were eventually greenlit last spring, dermatologists and plastic surgeons were met with an overwhelming demand for their services. As they hurriedly rescheduled months’ worth of backlogged patients — regulars who’d missed their annual skin checks and quarterly neurotoxin injections — an unparalleled influx of newcomers clamored for lip filler, eyelid surgery, nose jobs, and laser treatments. “I attribute the majority of the uptick to the Zoom phenomenon, because it truly provided a novel vantage point,” Dr. Hartman says. “We were seeing ourselves from a new perspective — and it was eye-opening.”
In Grosse Pointe, Michigan, board-certified dermatologist Fatima Fahs, MD, had many people coming in saying that they’d never spent so much time looking at their own faces — and how traits that never used to bother them have become distractingly apparent. In Providence, Rhode Island, board-certified dermatologist Tiffany Libby, MD, routinely heard complaints of RBF (yes, that’s “resting bitch face“) — first detected on Zoom — “as well as expression lines, wrinkles, and shadows that appeared with movement,” she says.
We were seeing ourselves from a new perspective — and it was eye-opening.
Corey Hartman, MD
And, thus, the “Zoom boom” was born — this unanticipated rise in cosmetic procedures propelled by the ubiquity of video conferencing. While the term quickly became a generic catchphrase for society’s heightened interest in pandemic plastic surgery, video chats were hardly the only factor nudging patients into exam rooms. “Seeing themselves in video certainly shined a light on some [issues] they may not have noticed before,” says Dino Elyassnia, MD, a board-certified plastic surgeon in San Francisco. “However, I truly believe the ability to work from home while recovering played a larger part [in the boom].” WFH and mask mandates allowed for discreet healing. And with vacations and social events on hold, people suddenly had the time and cash to invest in injectables and surgery.
Still, despite countless headlines announcing the Zoom boom, the craze has been largely anecdotal, based on the individual experiences of the dermatologists and plastic surgeons quoted in any given story. This led many to wonder: Is this for real? Have scores of patients really been altering their appearances based on nagging imperfections they may have spied during a virtual happy hour?
Recently, though, various plastic surgery societies have released statistics substantiating the reported boom. And new studies exploring our current appetite for aesthetic treatments — and the ways in which video apps ultimately feed it — have emerged in medical journals, providing proof of our insecurities and motivations. Ahead, we investigate how the success of Zoom precipitated a surge in injectable and plastic surgery procedures from the earliest days of the pandemic — and look at where we are now, a year later.
The Zoom Effect: Do I Really Look Like That?
Early on in lockdown, many of us came to realize that “the cameras on our computers were not designed to enhance beauty or project the best angles to highlight the contours of the face,” Dr. Hartman says. “If anything, they give a fishbowl view and cause the face to protrude more centrally, warping [certain] features.” A 2018 study actually confirms this fact, adds Dr. Libby, finding that noses appear approximately 30% larger in photos taken from 12 inches away versus a standard portrait distance of five feet. (For the record, there’s about a ruler-length of space between us and our MacBook right now.)
Virtual distortion isn’t limited to noses. “Zoom accentuates imperfections” on a grander scale, says Flora Levin, MD, an oculofacial plastic surgeon in Westport, Connecticut. Since our laptops are generally set on a desk or, aptly, in our laps, we’re fixing our gaze at a downward angle, which causes the skin on the face and neck to fall forward, collecting in folds around the mouth and in pockets under the chin. While “Zoom is what I call an equal opportunity offender, if I had to pick one feature which suffers the most, it would have to be the neck,” says Ashley Gordon, MD, a board-certified plastic surgeon in Austin, Texas. “Any excess skin and fat in the submental area [under the chin], along with a scalloped jawline from jowling, are really highlighted on Zoom.”
To boot, adds Dr. Levin, “the lighting in most rooms [comes] from above, not straight on, which creates shadows, highlighting under-eye bags and dark circles.” (Not surprisingly, “looking tired” has been a chief complaint of pandemic patients, our doctors say.) “A youthful face has little or no shadows, with smooth transitions from one part to the next,” Dr. Levin explains. “Artists draw aged faces by introducing shadows into the painting. Zoom, with its lighting, has the same effect, making the face look older.”
According to board-certified plastic surgeon Jason Roostaeian, MD, the Zoom effect has been strongest with the facelift set in his Los Angeles practice. “Facial aging is all lights and shadows,” he says, underscoring Dr. Levin’s earlier point. Whether 35 or 55, “what people see [on Zoom] are these new borders and crevices that break up the face and take away that smooth, youthful look.” Unless, of course they have a ring light, he notes, which “adds light to the valleys to wash out those deformities.”
The merciless Zoom grid not only encourages self-scrutiny, adds Dr. Roostaeian, but makes it easy to “constantly compare your face to the person next to you.”
Survey Says: The Boom Is Real
This confluence of factors — seeing yourself in animation, from awkward angles, poorly lit, through a wonky lens, surrounded by potentially prettier faces — can be profoundly galvanizing, it turns out. In a study published in the International Journal of Women’s Dermatology earlier this year, researchers surveyed dermatology providers from across the country about pandemic-era consultations and, more specifically, the frequency with which patients mentioned Zoom as an impetus for their visits. According to Dr. Libby, a co-author on the paper, “56.7% of providers reported a relative increase in patients seeking cosmetic consultations compared with prior to the pandemic, and 86.4% noted their patients citing video-conferencing calls as a reason to seek care.” Moreover, she adds, “82.7% marked their patients as either being somewhat more or significantly more unhappy with their appearance since using video conferencing during the pandemic.”
The researchers describe in the study the many ways in which Zoom contorts our image: “With webcams often recording at shorter focal lengths,” they state, “the result is an overall more rounded face, wider set eyes, broader nose, taller forehead, and disappearing ears, obscured by cheeks” — all of which, they say, may trigger a sort of Zoom dysmorphia that pushes patients to “seek cosmetic procedures to improve their appearance on video-conferencing calls,” explains Dr. Libby.
A separate poll of the general public — published in Facial Plastic Surgery & Aesthetic Medicine — reported that, of a select group of participants with no previous history of facial cosmetic tweaks, 40% now plan to pursue treatments based solely on appearance-related concerns arising from video conferencing.
In other words, evidence of a legit Zoom boom exists — and is mounting. It’s worth noting, however, that there are physicians who feel the platform’s sway over patients has been overstated. “People occasionally talk about how badly they appear on Zoom, but not as much as the numerous articles in the media would lead you to believe,” says Evan Rieder, MD, a board-certified dermatologist and psychiatrist in New York City. “Most patients have the wherewithal to turn off their camera or arrange a better lighting setup to provide a more realistic view of their appearance.”
And for all the buzz about Zoom dysmorphia — the inference that people are getting work done on maybe-imaginary flaws brought to their attention by face-morphing technology — our experts say the majority of patients who come in with an issue revealed by Zoom generally have a solid sense of their actual appearance. “They don’t come to me unless what bothers them shows up in multiple formats — photos, videos, the mirror,” says Dr. Elyassnia. “It’s rare for a patient to come in focused on a truly nonexistent issue that is a pure artifact of technology.”
Star Procedures Of The Zoom Boom
Rhinoplasty, eyelid surgery, and facelifts were crowned the top three cosmetic surgical procedures of 2020 by both the American Society of Plastic Surgeons (ASPS) and the American Academy of Facial Plastic and Reconstructive Surgery. In the nonsurgical realm, botulinum toxins, fillers, and lasers saw the greatest spike. The doctors we interviewed say these trends mirror what they’re seeing in practice.
Board-certified facial plastic surgeon Dara Liotta, MD, has seen the demand for nose jobs triple in her Manhattan clinic over the past year. “I’m operating pretty much every single day,” she says. “If there were an eighth day in the week, I’d fill it.” She’s currently booking into 2022.
People occasionally talk about how badly they appear on Zoom, but not as much as the numerous articles in the media would lead you to believe.
Evan RIeder, MD
Jason Bloom, MD, a board-certified facial plastic surgeon in Bryn Mawr, Pennsylvania, also specializes in rhinoplasty — retouching upwards of nine noses a week — and says that the procedure has grown so much that there’s never a lull in scheduling anymore. “With noses, of course, it’s much easier to camouflage the recovery when you’re wearing a mask,” he notes.
Dr. Levin has seen eyelid surgery “skyrocket,” she says, acknowledging that droopy lids look even heavier on Zoom (again, those angles). And a range of eye-related fixes — lid surgery as well as wrinkle-relaxing shots intended to “open the eyes, lift the brows, and improve the lines between the eyes” — have also been enormously popular in Dr. Bloom’s practice, he tells us.
Indeed, much has been written about the eyes since the start of COVID-19 — primarily how masks have contributed to the soaring interest in periocular procedures by thrusting eyes into the spotlight. But video conferencing has played a role, too, by showing us what we look like in animation. From the eleven lines that erupt between our brows when we’re perplexed or concerned to the crow’s feet that appear when we laugh or smile, “people see these expressions on Zoom and want to relax those wrinkles,” says Dr. Fahs.
Dr. Hartman says he’s been injecting loads of neuromodulator not only across the upper face to quiet exuberant expressions, but also into the masseters, or chewing muscles, to treat stress-associated TMJ and teeth-grinding.
Always-hot fillers have become even more desirable, largely because they have a knack for lessening the pesky shadows that Zoom is famous for accentuating. “Many people have been noticing their nasolabial folds and marionette lines, as they see these areas cast shadows while on video,” says Dr. Fahs, “so lifting and revolumizing the face [with fillers] has become very popular.” In those young and older, the under-eye hollows and pre-jowl sulcus — the indents on either side of the chin — tend to suffer a similar fate. “If you’re Zooming in a poorly lit area, suddenly these features become painfully obvious,” she says. Burgeoning lip lines, which dig in when we speak, adds Dr. Levin, have also been driving people to injectables.
Hardcore energy-based treatments blew up this past year. Dr. Rieder tells us that aggressive laser procedures, once reserved for those with a surplus of personal days, have become fairly routine in his office, particularly for resurfacing around the eyes and mouth — “areas which belie people’s true age and often require more substantial downtime to improve,” he says.
While the Zoom boom is usually painted as a neck-up phenomenon, Dr. Roostaeian says he’s been “getting more inquiries [for procedures] across the board” — not only for nose jobs and facelifts, which are his bread-and-butter, but for body work, too. Likewise, Dr. Gordon, whose surgical calendar is ordinarily jammed with breast augmentations and body-contouring procedures, has seen a significant uptick in eyelid surgery and face and neck lifts — though, she stipulates, “breast and body are still my number one.” And she’s not alone: The 2020 statistics report from The Aesthetic Society lists liposuction, breast augmentation, and tummy tucks as the top surgical procedures among its members. “Big combination cases are also up,” adds Dr. Gordon. “People want to treat their bodies and faces, and knock it all out at once, while they’re still working from home” — a convenience made possible by Zoom.
How It Started —> How It’s Going
Pandemic life, marked by phases and stages, has been anything but static — and the Zoom boom is evolving right along with it.
In early COVID, “patients were definitely citing Zoom as motivation for surgery,” says Dr. Liotta. “But eventually they figured out that their computer has to be [set] a little higher, that they need lighting from behind the screen, and that they can have Zoom touch up their image” — which, she says, has diminished the platform’s influence over her millennial-heavy patient base. “Now I’m hearing, ‘I have to go back to seeing people soon’ — they’re worried that they’re going to miss their window to get rhinoplasty.”
People are coming in with a desperation that I did not see before. It’s all been turned up a notch emotionally.
Dara Liotta, MD
Dr. Liotta raises the intriguing point that folks who don’t love their noses have actually benefited from pandemic-prescribed face coverings and virtual living. “They’re experiencing, with masks, a lot more mental freedom, because they’re not thinking about their nose,” she says. “It’s something I’m hearing more and more: ‘I don’t want masks to go away, because they cover the thing I don’t like.’” To the profile-averse, Zoom, too, was more help than hindrance, granting them a blissful period of control over their image by allowing them to be viewed only straight-on during every interpersonal encounter.
According to Dr. Liotta, the relaxing of mask mandates and imminent return to a pre-pandemic way of life are sparking a sort of last-gasp surge in plastics. “People are coming in with a desperation that I did not see before,” she says; “it’s all been turned up a notch emotionally.”
Across the country, doctors are registering this same sense of urgency. “As the world is reopening and weddings, reunions, work meetings, and vacations are ramping back up, everyone seems eager to get procedures done [in order] to present their best selves as they emerge from their proverbial cocoons,” Dr. Hartman says. The initial boom of spring 2020 is being reprised, or even trumped, by the crush providers are currently facing. “I’m seeing a similar surge, as people use this hopefully last opportunity to do more aggressive procedures under the protection of a mask,” Dr. Rieder says. Out in Los Angeles, Dr. Roostaeian credits vaccines for the latest wave, noting that many people who were reluctant to book procedures early in the pandemic finally feel safe doing so, since they’re now fully protected.
Motivations aside, our preferences have changed some, too, since lockdown orders first lifted. “Last summer, there was a big spike in injectables, probably because people hadn’t been able to maintain them [while sheltering in place],” says Dr. Levin. But more recently, she’s seen surgical and minimally invasive procedures outshining shots. In Dr. Hartman’s office, “the injectable business has been off the charts, with no sign of letting up,” he says — but his patients’ focus has shifted from refreshing the tired upper face to sharpening the jawline and balancing the profile.
Dr. Liotta’s patients, having mastered the nuances of Zoom, have “become a lot more concerned with how light hits them,” she says — and are commonly requesting “structural procedures,” like jawline and cheek filler, chin implants, and submental liposuction. “Seeing yourself on Zoom does change the way you think about light and shadow — and it’s our bony structures that affect how light hits the face,” she explains. “Having enough chin projection, having high cheekbones — [these things make] people look a little sharper and more angular and that reads better on Zoom.”
On The Horizon: When Will The Boom Fizzle?
Even with an end to the pandemic in sight, many companies are extending WFH privileges indefinitely — which means virtual meetings and unofficial downtime are here to stay. The derms and plastic surgeons we spoke to are all booked through the fall and beyond, and none foresee a major break in the action. A return to travel, however, could cause “a slight dip,” says Dr. Elyassnia, as more folks begin to devote money and time to leisure activities rather than aesthetic pursuits. In most cases, “you’re going to take a vacation or get a facelift—not both,” adds Dr. Roostaeian.
Others predict that impending tropical getaways may actually boost the desire for body procedures, especially for those hoping to tighten up post-quarantine. Dr. Hartman has patients “jumpstarting their weight-loss efforts” with fat-freezing sessions, he says, and toning various body parts with biostimulator injections and RF microneedling treatments. Dr. Bloom is fielding more and more requests for cellulite-smoothing injectables from folks aiming to airbrush their bottoms before swimsuit season.
More hotly anticipated than any single trend, one could say, are the fresh, uplifted looks — Zoom-inspired and otherwise — we’re sure to see as the pandemic slowly wanes and masks fall away.
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