Upon hearing the news that the entire country was shutting down and all nonessential businesses were closing with no reopening in sight, a seemingly selfish thought crept into my head: What will happen to my Botox? In the midst of a worldwide pandemic, I quickly learned that I was not alone. According to a survey conducted by the American Society of Plastic Surgeons, 64 percent of plastic surgeons saw an increase in telemedicine consultations during the pandemic. The procedures that drew the most interest were eyelid surgery, rhinoplasty, facelifts, liposuction, tummy tucks and breast augmentations.

It didn’t stop at consultations. Despite the uncertainty about the future, The Aesthetic Society’s annual Aesthetic Plastic Surgery Statistics found that Americans spent more than $9 billion on aesthetic surgery in 2020.

“I’ve never been busier in my life,” says San Francisco, CA facial plastic surgeon David W. Kim, MD, who specializes in rhinoplasty procedures and has been booked through the year. “We shut down for a couple months just like everybody else last March. I was just bracing myself for having a really rough year, and then once we started opening up, the floodgates opened. This has turned into the busiest year I can remember.” What caused this surge in aesthetic treatments in a time when self-preservation was paramount? According to the experts interviewed here, the answer is multilayered, but whatever the reasons are, we know cosmetic treatments are up and showing no signs of tapering off.

Self-Improvement

In addition to the onset of mask-wearing, Dr. Kim counts the feel-good factor as a major motivator for his patients. “I think having more bandwidth to do something about a concern that bothers you is probably the biggest reason, but so many patients said that if it weren’t for the pandemic, they may not have done it. Even older patients who have waited their whole lives to have a rhinoplasty—the pandemic prompted people to take stock of their lives and what’s important to them. Many people have gotten more into fitness, nutrition and overall self-improvement, and plastic surgery is just a part of that.

Control Factor

In the United States, 42 percent of respondents to a CDC survey reported experiencing symptoms of anxiety or depression, an increase of more than 200 percent from 2019’s findings. Clinical psychologist and founder of COPE psychological center Dr. Rubin Khoddam says that much like getting a new haircut after a breakup, regaining control is one way to deal with anxiety and feel good again: “So much of our daily pleasures were stripped from us, and taking care of aesthetic concerns is one way of feeling pleasure, novelty and even control.”

“Improving how one feels about themselves is a very effective way to regain a sense of control,” says New York facial plastic surgeon Konstantin Vasyukevich, MD. “Many people find comfort in shifting their attention from external events they cannot control to their internal feelings about things that can, which sometimes manifests as their physical appearance.”

Fatigue Fighter

London plastic surgeon Yannis Alexandrides, MD says despite England’s three lockdowns, an increase in cosmetic surgery had a dual purpose for some of his patients. “It’s a twofold effect,” he explains. “You’re taking advantage of the fact that you’re not working, but it also gives you a psychological boost and you tell yourself, ‘Well, I’m not really wasting time if I’m doing something I’ve always wanted to do.’”

Confidence Boost

Chicago plastic surgeon Michael Byun, MD says self-esteem building is another reason for the uptick. For one of his facelift patients,61-year-old Silvia Rios, matching her outer self to a new confidence she had acquired with age was transformative. “Some women honor the lines on their faces because they tell the story of what they’ve lived through, but for me, it was more appealing to create a new story with the new emotions I was experiencing,” she explains. According to Dr. Khoddam, plastic surgery has been proven to have some positive psychological benefits: “Research has shown that most people who undergo cosmetic procedures express satisfaction. However, there is also a significant population of patients who have unrealistic expectations or have been previously unsatisfied with their surgery and have shown to have poorer mental health outcomes.”

Finding Balance

While some things like cosmetic treatments, vacations and retail therapy can provide us with a sense of “hedonistic happiness,” Dr. Khoddam stresses that smaller self-care strategies ultimately give us longer-lasting “eudaimonic” or content feelings. “Self-care is taking care of the outside and the inside,” he says. “While the outside can impact how we feel, I consider self-care strategies the small, momentary things that help us stay balanced. It’s the 10-minute walk, the five-minute morning meditation or reading a good book before bed.”

Improving how one feels about themselves is an effective way to gain a sense of control.

—Dr. Vasyukevich

Mirror, Mirror

While the “Zoom Boom” is often cited as the reason for the recent surgery surge, our obsession with looking at ourselves was prevalent long before Zoom, and a recent study identifies selfies and filters as the culprits for altered self-perceptions.

“In the past, people were used to seeing themselves in a mirror, but today people see themselv es in selfies so much that they have a distorted view of themselves,” says Chicago facial plastic surgeon Steven Dayan, MD. “The view of yourself in a selfie is the reverse image of what you see in the mirror, which is a completely different image from what we look like in a traditional photo or to someone looking straight at us. So, there are actually three versions of how we look: the mirror, the selfie and how other people actually see us.”

The study identified which version participants found more attractive: The subjects were asked to look at themselves in a selfie, a filtered selfie and then a standard photo taken 5 feet away. When asked to rate each one every participant chose their filtered selfie. When other people looked at the same photos, the most popular images were the ones taken from far away. “We learned that people like their selfies better than natural photos, but other people don’t find selfies to be as attractive,” says Dr. Dayan. The end result is an uphill battle for surgeons, he explains. “The challenge is then making the patient happy when they want to match a filter, when in actuality, that doesn’t make them look better.”