COVID-19 Will Change Cosmetic Dermatology & Plastic Surgery Forever

The proverb "necessity is the mother of invention" was hammered into our heads in high school with anecdotes about products and technologies born and bred from war and pandemic, from tea bags and tissues to newspapers and the internet. Its lesson is simple: Society adapts quickest when put under pressure to survive.

Those words will ultimately define the coming years, as every industry around the world is forced to respond to the COVID-19 pandemic. The impact it has on non-essential areas of the health-care sector, like plastic surgery and cosmetic dermatology, will be profound. These businesses hit a fever pitch over the past decade — popularity of cosmetic procedures alone grew by 163% from 2000 to 2018 — but COVID-19 is on course to not only disrupt the industry's innovation, revenue, and popularity, but how it’s practiced, as the very foundation of what we perceive as beautiful adjusts to fit our new reality. “Coronavirus has affected every aspect of my practice and the entire fabric of our community,” says Lara Devgan, MD, a New York City-based board-certified plastic surgeon.

On the opposite coast, Karyn Grossman, MD, a board-certified cosmetic dermatologist based in Santa Monica, predicts a change in the trajectory of the aesthetics industry that will impact just about everything, from office visits to investment money. “People need to prepare for at least a two-year shift in the way we do things, and as time goes on, things may shift again.” In an era where medical equipment is precious and a hospital visit holds new meaning, the potential for judgement of those who return to using those resources "too early" — celebrities with changing faces, influencers boasting fresh injectables — could also add a new layer of taboo.

Things change quickly in the COVID-19 era, so to gather some early predictions as to how the pandemic will impact the world of cosmetic medicine, we checked in with industry-leading female doctors across the country for their thoughts.

Every doctor we spoke to has cancelled or rescheduled cosmetic procedures for now, and the majority of them have limited their practices to essential visits like facial injuries and lacerations, which helps to ease the burden on emergency rooms. To bridge the gap in care, telemedicine has become commonplace to treat acne and rosacea, check in with patients who need prescription refills, and do consultations. “We have been closed since mid-March, so I've had to pivot my practice to providing online medical consultations,” says Nancy Samolitis, MD, board-certified dermatologist and co-founder of Facile Dermatology in West Hollywood.

As doctors work out the kinks of HIPAA-compliant telemedicine and patients become more comfortable seeing their doctor through a screen, more and more treatment options will become available remotely. “It’s a new frontier for me and my work, seeing as I’m someone who really relies on that IRL interaction to maintain a personal and white-glove experience for my patients,” says Chaneve Jeanniton, MD, FACS, a board-certified oculofacial plastic surgeon at Brooklyn Face & Eye in New York. “In this new world, I have had to stay nimble and pivot with the times. It’s been incredible to reconnect with my patients in any way that I can.”

As the pandemic loosens its grip on the US and businesses like tattoo parlours and hair salons reopen, face masks and plastic gloves will make artist and client look more like doctor and patient — so you can only imagine the measures doctor's offices will need to take to ensure everyone's health and safety.

“We've changed so much in our office already,” says Dr. Grossman, noting that patients will get the full download before their appointment, which includes new policies (no guests, immediate temperature checks, and gloves and masks are required), office updates (touchless everything, sanitiser stations, air filters in every room, and new barriers at check-out desks), and much more. 

"We have all these protocols in place so we're ready,” she says, but notes that things will inevitably shift further as we learn more about the virus. "The vaccine is 18-24 months off, so we have a long time to think about this.”

In fact, it might increase — but it could become hush-hush again. Every doctor we spoke to agreed that while some patients are hesitant to reschedule their cancelled appointments, the majority of them are eager to get back in for a wrinkle-reducing re-up. "I'd estimate that two-thirds of patients want to be rescheduled immediately, and the rest are waiting to see what's going to happen,” Dr. Grossman says.

“My patients are reaching out to me often these days,” says Dr Jeanniton. “They clearly want to get back into the office and they are ready to resume their Botox and filler treatments.” 

Annie Chiu, MD, board-certified dermatologist and owner and founder of The Derm Institute in Los Angeles, predicts an initial rush when state closure mandates lift. “There may be a pent-up demand for treatment,” she says, “but there is no doubt overall it will change elective procedures for the near future.”

The “I just came from the cosmetic dermatologist” aesthetic — like the overfilled lip-and-cheek trend and, most recently, lifted eyebrows — will fall out of vogue, and the openness around undergoing cosmetic procedures could become more taboo as public opinion shifts over elective medical services.

“The global pandemic has forced all of us to live with our grey hairs and worn off Botox, to become reacquainted with what we actually look like, and to put our lives in greater perspective,” says Dr Devgan. “This will translate into a more subdued aesthetic focusing on balance over size for features like lips, breasts, and even buttocks — rather than the extremely large, almost caricature-like proportions that were popular five years ago.” 

Dr Samolitis agrees: “Going through this experience may lead to many people rearranging their priorities, including being less interested in enhancing their features cosmetically,” she says. Dr Grossman notes that the overdone look made ubiquitous by social media has been slowly fading from popularity over the past few years, and this pandemic is likely to be its death sentence — at least where the mainstream is concerned.

Dr Grossman predicts that cosmetic-focused pharmaceutical companies, like the ones that manufacture fillers and neuromodulators, will shift resources from creating new products to helping failing practices — but she doesn’t necessarily think a dip in innovation is a bad thing. “I have been doing this for a long time and I’ve seen a lot come and go,” she says. “I think it's okay to have a little slowdown in R&D. Do we really need another filler or laser?” She believes that the next few years could mirror the great recession, a time where investment money temporarily dipped and many practices closed. One dermatologist we spoke to off the record says that this could hit medspas the hardest.

But more than just surviving temporary closures, offices will need to adjust to new protocol, which will impact revenue as well. “There will be more deep sanitising, PPEs worn for even injectable procedures, and a spaced out clinic schedule to still observe social distancing,” says Dr Chiu. “For practices, this means increased overhead and decreased revenue, and it will be hard for a lot of small businesses to weather that.” She also finds a parallel to 2008: “Reputable, strong, patient-based practices were able to withstand the economic downturn,” she says, “but offices that relied upon a lot of marketing and promotions had to shutter.”

The fact of the matter is that, until there is reliable, widespread COVID-19 testing, going in for surgery will be a whole new ballgame — and even then, surgery might still be unappealing for many who considered it before the pandemic. “There will be more of a shift towards non-invasive procedures like injectables, fillers, and threads while people push out surgery a little further down the line,” says Dr Chiu. 

When to operate is a tough decision for doctors as well. “Once I can feel confident that I am not putting patients, staff, or myself at risk for a nonessential service, then I will happily return to the operating room,” says Dr Jeanniton. 

Dr Devgan shares similar thoughts. “Elective surgeries will resume when disease is controlled in a given area, the supply chain for hospital resources is back at baseline capacity, and the societal disease curve is under control,” she says, noting that that could be anywhere from weeks to months from now, and varies from city to city. “We will start with the lowest-risk procedures in the lowest-risk and healthiest patients.” 

On the West Coast, Dr Grossman predicts that new protocols could cause surgery rates to dip for the next two years. "At the moment — and it's important to note that things change quickly — if you want to have cosmetic surgery it will probably require a negative COVID-19 test, two weeks of total isolation, then surgery, followed by two more weeks of isolation,” she says. “You don't want to put someone through a big surgery with this because you might make the COVID worse from a weakened immune system after surgery.”

Dr Grossman adds that, as of the time of our interview on April 30th, testing is still too unreliable to determine something as important as surgery. "There will be a lot of societal discussion about what the best tests are to determine if someone is free from disease to operate on — and what's enough proof."

But Dr Devgan notes that while these complications could shift trends, demand will never fully fade. “On some level, people today want to avoid surgery if it is possible,” she says. “Now that COVID-19 has raised additional questions about hospital resources and sterility, that may impact people‘s choices overall. That being said, my operating room schedule is booked far into the future and is busier than ever."