Cosmetics & COVID-19: Exploring the Unprecedented Rise in Plastic Surgery

Dr. Greenberg:
While the whole world has slowed down due to the COVID-19 pandemic, demand for plastic surgery has gone up. On today’s program, we’ll be exploring factors, such as mental health that could be contributing to this unprecedented increase in demand for cosmetic surgery.

Welcome to DermConsult on ReachMD. I’m Dr. Michael Greenberg and joining me, today, to discuss plastic surgery during the pandemic and psychological considerations for dermatology patients, is Dr. Evan Rieder, Assistant Professor at the Ronald O. Perelman Department of Dermatology at NYU. Evan, thank you for being here, today.

Dr. Rieder:
Thanks for having me, Mike. I’m really excited to talk about what I think is a very important and interesting topic.

Dr. Greenberg:
So, you are a plastic surgeon or dermatologist-trained, cosmetic surgeon? What’s your background?

Dr. Rieder:
My background is a little complicated, and to save the time, I did board certification in psychiatry, first, I’m a psychiatrist and I practice a little psychiatry and then after psychiatry residency, I did training in dermatology, as well. So, I’m board certified in both dermatology and psychiatry. A lot of the focus of my practice is in aesthetic dermatology and, sort of, making links between the worlds of psychology and dermatology to, sort of, understand our patient betters improve things like quality of life and in addition to focusing on achieving really natural aesthetic outcomes.

Dr. Greenberg:
You say that you’ve been busier since the COVID-19 pandemic began, is that correct?

Dr. Rieder:
Yeah. In a word, yes, but it’s a little bit more complicated than that. COVID, I work in New York City and New York City was, you know the hotbed of COVID and we were hit really hard. Our entire practice shut down, except for emergencies for the months of March, April, and May. We basically saw very few people. I would supervise the residents, but there was not that much work going on except for, you know, the occasion abscess or if there was a skin cancer surgery that was really urgent, we took care of that. But once practice opened up again, we saw that people were coming in and they were coming in in enlarged numbers.

But I think my medical practice has taken a little bit of a hit and there’s a lot of reasons for that and I think people are, a lot of the older people who are coming in for skin checks if they’ve had skin cancers, they’re scared, and they feel like they’re at risk for getting COVID-19. And a lot of people from New York have the resources to go elsewhere. They may have gone out to the Hamptons or the Berkshires or Florida and they just have camped out during the entirety of the pandemic. However, I don’t think my cosmetic procedures have gone anywhere except for up. And I thought that was a very interesting phenomenon. They haven’t gone through the roof, but a lot of my plastic surgery colleagues say they’ve had incredible demand for aesthetic surgeries in a time when a lot of people were not really anticipating that.

Dr. Rieder:
It’s a good question. I think that, sort of unsurprisingly, it’s been a lot about the upper face. Most of us are wearing the mask or, all of us should be wearing the mask, but most of us are wearing the masks now, so we’re really scrutinizing the details of the upper face. So, the same procedures that we do on a routine basis in dermatologist’s office, mostly botulinum toxin injections like Xeomin or Botox or Dysport are going into the upper face muscles like the frontalis and the glabellar complex and then the crow’s feet, as well, but I’m also doing a lot of tear trough filler. I think that wasn’t as common of a procedure before the pandemic started, but people are sort of scrutinizing the details below their eyes and are starting to see these hollows coming and it’s an easy procedure to do, it’s really effective in both men and women if you’re the right candidate.

But there’s also a lot more invasive procedures that we’re doing. It sometimes takes a lot of convincing for people to sign up for an invasive laser resurfacing where you may have some drainage and bleeding and oozing and wound care to do for a week or two, but during the pandemic when people have the downtime,  they’re willing to do it. So especially around the periocular skin. It’s been a very high-yield procedure. And I can tell you from my plastics colleagues, it’s been a lot of people coming in to get major work that they had been delaying: breast implants, liposuctions, mommy makeovers, blepharoplasty, all because of having extra downtime, sort of, delaying these procedures into a time when they can actually squeeze them into their schedule.

Dr. Greenberg:
I noticed that even Zoom now, has some electronic retouching that you can do. You can change tone, you can change your eyebrows, you can do all kinds of stuff on Zoom.

Dr. Rieder:
Yes. It’s not surprising. I mean, I think anywhere where there’s social media, there’s people that want to have the ability to photo edit. I talk about this all the time, but I think, you know, you’re in an era now, where the tools that use to be the purview of the Vogue magazine beauty editor are now in everyone’s hands. And you can download that app for a dollar or maybe it’s free and you can blur away all of your wrinkles and make things look unrealistic. And so, it’s not uncommon that people will come into an aesthetic practice and show a filtered image of themselves or a filtered photo of a celebrity and ask to be made like that. And a lot of the times, people are looking at something that is not realistically achievable.

Dr. Greenberg:
Well, how much of this, Evan, do you think is about control? For instance, at the beginning of the pandemic, we all laughed that people were hoarding toilet paper and I would explain to people, like, well, since those people realize how out of control they are, this is one of the few actions they can take that gives them some sense of control. Do you think some of the response for plastic surgery is that? That at least I can do this, I can’t control he world around me?

Dr. Rieder:
100%. I think, like we were saying before, it’s sort of multi-factorial, but control is a big thing. And I think one of the things I try to tell people is, and I think people are dealing with the pandemic a lot better now than they were, you know, eight, ten months ago when everything was new and everything felt completely out of control, is that it can control the things you can and sort of, just, let the other things go that are causing you a lot of unproductive worry. But, yes, plastic surgery is something that you can do that gives you a great sense of control and a sense of accomplishment that you can feel better about yourself.

We know that we have data just showing that our aesthetic procedures, both non-invasive and invasive can improve peoples’ quality of life and their self-confidence and the way other people interact with them in very meaningful ways. And this is a very demonstratable way that people can take some control and it doesn’t require, like, going to the gym all the time and going on a big diet every, that forces us to act in ways that really restrict our daily lives. So, yes, I think control is a big component.

But I also think that there’s other things that are, maybe not as psychologically deep. People who are thinking about plastic surgery have a lot of financial resources, and can’t travel anymore, right? Can’t get on a plane. Can’t go out to eat. Nothing to get dressed up for, so there’s nothing to really spend the money on and they have all this potential to have the downtime, they can stay inside, they can hide the sequalae of bruising and swelling. I do think that the control plays a piece that’s just as big as that.

Dr. Greenberg:
For those just tuning in, you’re listening to DermConsult on ReachMD. I’m Dr. Michael Greenberg and today I’m speaking with Dr. Evan Rieder about the rise of plastic surgery during the COVID-19 pandemic.

Evan, let’s switch tracks a little bit, here. You’re one of the few physicians in the United States who’s board certified in both psychiatry and dermatology. I find that fascinating. What’s your perspective on, in general, how COVID-19 has impacted mental health?

Dr. Rieder:
I think it’s, impacted mental health pretty terribly. I think one of the worst plagues of COVID-19 after all the deaths has been the plague of social isolation. Those people who are not fortunate enough to have families to live with or children to live with or even roommates and are living alone, especially in a place like I live in New York, can be very isolating. Even when New York is bustling and there’s no COVID-19, it can feel like a very isolating experience to live alone in the city. But when you take out the social component, it’s very isolating. We’ve been seeing rates of depression and anxiety going much higher.

I will say that my primary practice is in dermatology, these days, but I have seen levels of anxiety that are really way above the range of normal for my patients, my dermatology patients. Way out of the range of normal even for us neurotic New Yorkers. Even things like extended waiting times in the waiting rooms, delays to see the doctors are enough to trigger people to have a panic attack or to get really irritable and upset in ways that they weren’t before, because I think underlying this is all this anxiety and loss of control and the fear of getting sick. And I think these times sitting in the waiting rooms, where, it used to be, you would just relax, you understand that sometimes doctors are running a little bit late, it’s a reason enough that people can sort of go off the edge.

Dr. Greenberg:
So, one of the things that’s important that I do in my practice, even when it’s not cosmetic is managing expectations. And under normal circumstances, that’s hard enough. It’s especially, for me, sometimes more difficult with cosmetic patients making sure they have a realistic expectation. Have you found that you’ve had to work a little bit harder or make sure that you are underlying their expectations because people getting these procedures under stress might be more prone to not like the results as much, or am I wrong here?

Dr. Rieder:
Yeah, it’s a good question and I think the general anxiety levels of all of my patients, both medical and cosmetic are higher, and I think that there’s a lot more hand-holding, assuaging, and really putting an ease to people who are coming in for aesthetic procedures, particularly people who are having something invasive done, or someonewho’s never had a procedure done before; even something as simple as a couple botulinum toxin injections. There’s a lot of concern about the vaccine, particularly because of literature that, that came out and was released in the popular media in sort of a buzzy way and people got concerned that the Moderna vaccine was going to be unsafe in people who had soft tissue fillers. If you read just the headlines to a lot of these articles, you’ve been given a misconception. It’s totally safe, there’s no contraindication and people with soft tissue fillers, very small percentage of them may have transient swelling in their fillers with coronavirus or the Moderna vaccine. It may happen with the Pfizer vaccine, as well, we just haven’t seen it, yet. So, I think that there’s a baseline level of anxiety because people sort of, know that there’s some potential for there to be some sort of inflammatory response.

But I think that the concept of setting realistic expectations is something that I do all the time in my practice. It’s very rare that I will do a cosmetic procedure on a patient if it’s the first time they’re coming to see me. Except if it’s something that’s very, very minimally invasive. Patients want to feel me out, I want to feel them out, see if it’s a good fit, see if they would be a better fit with one of my colleagues or if one of my colleagues has a better or more appropriate device that to be able to treat them adequately. And then I ask questions that other doctors may either don’t want to ask or are uncomfortable asking and sort of assessing for realistic expectations and sort of reality testing. I’ll ask people about the history of their surgical procedures in the past and cosmetic procedures, but, also things that sort of get to the underlying tendency towards Body Dysmorphic Disorder or depression or even sometimes things like suicidality.

Dr. Greenberg:
Awesome. So, any takeaways or lessons you’d like to share with our listeners as we continue to move through the pandemic? Things that you can relate from dermatology to even beyond our specialty to anyone as a psychiatrist?

Dr. Rieder:
Yeah, I think I can speak from our local experience here in New York and I can speak from what I’ve seen happening in the media especially since the government has turned over. It just seems like people are less glued to the T.V. which is really nice. I will say that what I’ve found to be really helpful for myself and a lot of my patients is to sort of focus on the little things, the real basics of life. Everyone’s been affected by the pandemic. Some in much greater ways than others. It’s really important to spend time on things that you can control and recognize that there’s many things that we can’t control. You know, I’m really cautiously optimistic about where we are with vaccinations and the federal government’s plans and I think the trend in 2021 is gonna be one that’s positive.

But I think that, I think just given the way that businesses change and even our practice as dermatologist has changed to a certain extent because I am seeing some patients, still, over video call, I think it’s important to spend less time looking at yourself, to remind yourself of the qualities beyond the superficial of what you see on the warped Zoom and video screens, or whatever you see on social media and, if you have to be on calls like this, all the time, to reset your focus, take your image off the screen, redirect your focus to the content of the call, take a moment to breath and just really use your social media with skepticism.

Dr. Greenberg:
That’s all the time we have for today. I wanna thank Dr. Evan Rieder for joining me to discuss the growth of plastic surgery during the COVID-19 pandemic and the psychiatric considerations that come with that. Evan, it was great speaking with you, today. Keep up the good work.

Dr. Rieder:
Thank you, Michael, it’s been a pleasure.

Dr. Greenberg:
For ReachMD, I’m Dr. Michael Greenberg. To access this episode and others from DermConsult, visit ReachMD.com/DermConsult, where you can be part of the knowledge. We thank you for listening.