Demand for Plastic Surgery Is Booming Amid the Pandemic. But Why?
Interest in plastic surgery is at an all-time high, but stigma and misinformation still surround the industry and its patients. Welcome to Life in Plastic, a series by Allure that provides all the information you'll need to make whatever decision is right for your body — no judgment, just the facts. Here, we're reporting on the recent demand for cosmetic treatments amidst a pandemic.
If you follow plastics in even a casual way, you've likely read reports of plastic surgeons and dermatologists seeing record numbers of patients since reopening their practices following the COVID-19 shutdowns. Several doctors reached out to me directly after stay-at-home orders lifted to discuss what they describe as an unexpected surge — with no end in sight.
"When we opened back up in May, people were beating down the doors to get in," says DiAnne Davis, a board-certified dermatologist in Dallas, who's been met with requests for chemical peels, arm liposuction, and cellulite treatments. In Philadelphia, board-certified facial plastic surgeon Jason Bloom, who specializes in rhinoplasty, recently cut short a family trip to the Jersey Shore to address his mounting wait list. "People want surgery so bad right now — it's crazy," he says.
Like Bloom, Patrick Sullivan, a board-certified plastic surgeon in Providence, Rhode Island, is booking into 2021, an eclectic mix crowding his calendar — everyone from local politicians and professionals to Hollywood actors seeking surgery far from the paparazzi's prying lens. In the past few months, he tells me, his schedule has been revised countless times due to borders opening and closing, but his patients — many of whom book surgery on the heels of virtual consultation — are utterly undeterred, flying in from as far as Asia for discreet face- and neck-lifts.
It's important to acknowledge, before we delve deeper, that this apparent boom is largely anecdotal: individual physicians in certain parts of the country are seeing an increased demand for their services (of this, I have no doubt), but the experts I interviewed aren't aware of any formal surveys or studies offering credible quantitative evidence of the trend.
Moreover, even though the uptick has been written about ad nauseam across platforms — and certainly seems newsworthy on the surface: Plastic Surgery Booming Amid Pandemic! — when you subtract sensationalism and really drill down, the phenomenon isn't all that surprising.
"Plastic surgery is, historically, at its busiest during vacation periods — this is when we always see the biggest spike in cosmetic procedures, because people aren't going into work," points out Los Angeles board-certified plastic surgeon Jason Roostaeian. While the pandemic hardly qualifies as a vacation, it has, by necessitating work-from-home, unintentionally granted us a glorious stretch for no-one-has-to-know recovery.
"When we opened back up in May, people were beating down the doors to get in."
Indeed, part of the reason why rhinoplasty specialists like Roostaeian and Bloom are booking so far out is because COVID-19 has restructured college calendars, providing students (who make up a large portion of those who commonly partake in rhinoplasty) with a lengthy Thanksgiving break that will keep them at home (and off the radar) until mid- to late January. Of course, should they venture out while healing, requisite face masks can neatly conceal splints, swelling, and shiners — no questions asked.
WFH, masks, and stalled social lives make it an opportune time to have work done — I get that. Still, when I first began hearing of doctors doubling or tripling their caseloads upon reopening, I couldn't help but wonder if it was merely the backlog masquerading as a boom. Wouldn't rescheduling hundreds of patients who had their springtime skin checks, IPLs, and CoolSculptings canceled create an instant influx on its own? Factor in the biannual bookers, who locked in their June appointment last December, along with the juggernaut who were clamoring for Botox throughout quarantine, and yeah — you've got some jammed schedules.
But does this throng of people competing for limited time slots — double-booking is a no-no during COVID — constitute an actual elevation in interest for treatments? Is the pandemic — our new normal in the upside-down — somehow whetting our appetites for cosmetic procedures?
Beauty in Crisis
Maybe. Beyond its heavy death toll and lingering threat to public health, COVID-19 ushered in unrivaled fear, anxiety, and turmoil. Our livelihoods were threatened, routines upended, rituals disregarded, and relationships tested. "COVID was devastating for all of us — obviously from a health perspective, but it also created a widespread uncertainty about what was going to happen next," says Lara Devgan, a board-certified plastic surgeon in New York City. "I had friends get sick, lose their jobs, relocate, lose their parents, get divorced."
Just when it seemed like despair had reached peak saturation, civil unrest erupted over the incomprehensible killings of those like Ahmaud Arbery, Breonna Taylor, and George Floyd, inciting protests, amplifying racial tensions, and contributing to our collective undoing.
Suffice it to say: We, the people, have been really freaking stressed — and it shows. Because, yes, our Botox wore off weeks — nay, moons — ago, and our frown lines and angry 11s are dynamic as hell. Our skyrocketing cortisol levels and mandatory face coverings have fueled an inescapable maskne epidemic. And, really, if your hair, unable to withstand the chronic trauma of 2020 for one brush-stroke longer, isn't falling out in clumps, are you even in a pandemic?
"No one has ever really looked at themselves in this way — for this long or this frequently."
Our physical appearances are — hello, microcosm — in crisis. And with all manner of beauty makers effectively sidelined for a time, there has been no one to manage it.
Meanwhile, we've been forced to confront our unvarnished, unfiltered reflections on incessant Zoom meetings — the bad lighting, unfortunate angles, and awkward crops exposing traits we never noticed before (or perhaps highlighting hang-ups we've long ignored). "No one has ever really looked at themselves in this way — for this long or this frequently — and I think that's driving a lot of the demand," says Jessica Weiser, a board-certified dermatologist in New York City. The comeback of aesthetic medicine — which largely predated that of nail, hair, and facial services — really presented folks "with their first opportunity for high-quality self-care," she adds.
Is it any wonder cosmetic doctors have been inundated? It took little more than a governmental nod to throw open the floodgates, primed as they were.
Procedures as a Panacea
"The global pandemic and concomitant political and social unrest have been strenuous for everyone, albeit in different ways, but we've all had disruptions to our daily lives and lost control of our routines," says Evan Rieder, a double board-certified dermatologist and psychiatrist in New York City. "For those of us lucky enough to still have our health and homes, investing in ourselves is a way to regain some semblance of control — [and] a return to aesthetic procedures is a way to invest."
To some, it may seem silly to engage in superficial pursuits during a pandemic — equivalent to the band playing on as the Titanic sunk — but there are plenty of reasons to do so. For starters, "we know from years of patient-reported outcome data that cosmetic procedures can make us feel better about ourselves, with increased confidence and quality of life," notes Rieder.
And who doesn't need a little pick-me-up right now? People are "worn out" and "craving a sense of normalcy," says New York City board-certified plastic surgeon Haideh Hirmand. "I hear from patients that they want to lessen the signs of quarantine from their faces — that looking tired and having their lines back reminds them of life's disruption, and it's depressing to them."
With serious carpe-diem vibes, people are "allocating funds and time to self-care and prioritizing things that they may have put on the backburner," she says. Knowing life can change in an instant, the pandemic patient is anything but wishy-washy, Hirmand adds: "They either book something or not — they don't take days or weeks to decide."
"Investing in ourselves is a way to regain some semblance of control."
In the Before Time, however, it was typical for patients to meet with doctors about procedures, and then just…wait. Now, in addition to juggling previously scheduled patients, says Sarmela Sunder, a board-certified facial plastic surgeon in Beverly Hills, "I'm having people who I consulted with a year ago for surgery, who didn't think they'd have the downtime, calling back and saying, 'OK, I'm ready.'"
Part of this act-now attitude springs from uncertainty: "There's still a little bit of fear about what fall and winter will look like," notes Weiser. "Are we going to see a second peak? Are we going to have another shutdown? I think people feel that this is their chance."
Doctors say patients are more ravenous than usual. "They're like, Well, I'm here now, so I mine as well get everything done," says San Diego board-certified dermatologist Arisa Ortiz. People who used to come in for baby Botox and a single syringe of HA suddenly want "the works."
Those who've managed to maintain a steady income may also be finding themselves more flush than they'd otherwise be. "I think a lot of people realize that [for months] they didn't shop, they didn't vacation, they didn't go to dinners with friends," Weiser adds. "And when they think of all the money they saved, there's a little less guilt associated with spending a couple thousand dollars [on procedures] — it just feels more attainable right now."
Particularly when you frame these fixes as a worthy self-investment. "Plastic surgery is more artisanal craftsmanship than a scalable commodity," Devgan notes. During a pandemic, "there may be fewer occasions to wear a sequined gown, but we all exist in our physical trappings, and you use your face every day" — a notion that seems almost intuitive right now. While aesthetic medicine, like any industry, ebbs and flows, she says, "the concept of people investing in high-quality, highly bespoke surgery and procedures is constant."
Devgan's faith in this fact no doubt buoyed her throughout the prolonged "nonessential" shutdown in New York City, as she was in the throes of construction on a new Park Avenue practice when the pandemic hit. "In some ways, the timing was terrible, but in other ways, we were able to take many of the learnings of this time and pivot the design of the office to create a temperature checkpoint in the lobby, a socially distanced reception room, an advanced cleaning protocol, and individual restrooms for patient exam rooms," she says.
ORs and Exam Rooms — Proverbial Ports in a Storm
Which raises an important point: even though filler is once again following freely and ORs are seeing more action than they have in months, physicians have not loosened the strict COVID-19 safety protocols they enacted upon reopening. With appreciation for these measures, "patients have come to realize that [cosmetic] procedures can be done in a very safe way," says Weiser — and this too is encouraging folks to visit their dermatologists and plastic surgeons.
"Unless you're going to lock yourself at home 24/7, [our surgery center] is probably the safest place you could go," Roostaeian says. "Anyone who's having a procedure done is tested; there are automated fever checks at every entry; everyone's walking around with a mask on; there's disinfectant everywhere; and employees have to fill out surveys every day about whether they have any hint of a symptom."
"Are we going to see a second peak? Are we going to have another shutdown? I think people feel that this is their chance."
For the record, he's had to postpone only one surgery due to a positive test — and none of the patients he's operated on during the pandemic have fallen ill to COVID-19 following surgery.
Some dermatologists also insist on testing patients prior to certain aggressive or time-consuming procedures, "like perioral or full-face resurfacing, where I'm spending an hour in the room with a patient who has their mask off," explains Ortiz.
In Sullivan's practice, the surgical "concierge" experience — the added perks, as it were — has been carefully COVID-ized. Beyond the standard protocols in place in his office and OR, his team ensures that the hotels where patients recover are COVID safe and even vets their food deliveries.
Weiser adds that, for some patients, getting to her SoHo office presents the biggest health risk, as most would normally take public transportation. "It's interesting to see how many people have driven a car in, or had their husbands drive and wait in the car — which is funny, because previously, some of them would never have told their husbands they were having procedures done," she says. "I've even had patients take helicopters in from out East or Connecticut."
The Hottest Pandemic Procedures? (Hint: All of Them)
So which procedures have garnered the most interest? There's been a lot of buzz about eyes, simply because they're a focal point when we're masked up in public. But face coverings haven't dampened the demand for other fixes. During lockdown, "I thought, well, if we're all wearing masks, no one is going to care what they look like — especially the lower face and mouth," Sunder says. "But there have been so many people coming in for lip and jaw injections."
Ortiz is seeing this in practice, too. "Patients still want lip filler," she says. "I think it's a really great testament to why patients do these procedures — it's not necessarily for others to see how good you look. It's more to make yourself feel better."
Necks have also captured our attention. "Everyone is being more critical of laxity and jowls and wanting tightening devices to help improve their appearance on Zoom," says Ortiz. While she admits that video — the angles, the shadows — can easily accentuate fine lines, "there's usually some truth to what patients are seeing."
"Patients are able to be more compliant with post-procedure instructions."
While body-contouring procedures, like CoolSculpting, Emsculpt, and liposuction, are soaring in some practices — presumably due to gym closures and sidetracked fitness routines — Devgan is "seeing a tremendous interest in the face," she says. "Facelifts, blepharoplasties, lip lifts, nonsurgical facial optimizations, suture suspension thread lifts, and injectables across the board are rising."
According to Sunder, "there's definitely been an escalation in terms of aggressiveness or invasiveness of procedures, because patients do have the extended downtime." Instead of coming in for microneedling every month, patients keen on improving their skin tone and texture are going for the one-and-done CO2 laser, which leaves skin raw and sloughy for a week or two. Sunder finds "patients are able to be more compliant with post-procedure instructions" as well, since, even in California, they're spending less time outdoors. Prior to COVID-19, convincing patients to avoid the sun following laser procedures was a struggle.
On the resurfacing front, "chemical peels are another procedure I've cranked up a lot," says Davis. "Before [stay-at-home orders], I had maybe done eight chemical peels total between November 2019 and March 2020. Now I'm doing seven or eight a week." She attributes the rise to yet another pandemic-propelled trend — the significant spike in Black patients seeking her services. "I have probably seen more African-American patients in the last three months than I saw in total during my three years of residency," she says. She credits the racial justice movement and outpouring of support for Black businesses (among other things) with the deluge.
"Before all of this, a lot of Black physicians were not getting acknowledgment or recognition — and now we are," she says. "It's sad to say, as all physicians should be embraced from the beginning, but that's not what was happening." The influx also underscores the importance of identity in dermatology, she adds: "Patients want to see a doctor who looks like them, someone who will understand their skin concerns" — acne and post-inflammatory hyperpigmentation being chief among them. "In our community, beauty is an even complexion, a clear skin tone," Davis adds. For patients aiming to achieve this goal, "chemical peels can be a game-changer, fairly instantly," she says. Again, it helps that "the recovery situation is on our side" right now.
"There's a direct link between what we see in the mirror and how we feel."
Which brings us back to WFH. For all the fuss about Zoom, no one has really tackled the issue of patients having to log on post-op. If screens are strong enough to magnify our issues and motivate our procedural decisions, can’t they also broadcast our stitches and swelling?
The aftermath of lighter treatments — fine flaking, blotchy pinkness, the coffee-ground flecking of Fraxel — is simply "easier to hide on Zoom," explains Ortiz, owing to the camera's distance and lack of clarity. More downtime-heavy tweaks — extreme resurfacing procedures and real-deal plastic surgery — require a bit more ingenuity. Sunder's patients have shared tricks for hiding signs of surgery on camera, so even those who get facelifts are generally ready to go live one week later.
"So many of them are like, 'Well, if I just put the light behind me, or wear my hair a certain way, you won't be able to see the bruises or whatnot,'" she adds.
The bottom line: "There's a direct link between what we see in the mirror and how we feel," notes Hirmand. With image and esteem so inextricably linked, and our reflections being integral to our revised way of life, cosmetic treatments suddenly seem more essential than ever.
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