What Will Dermatology and Plastic Surgery Appointments Look Like This Summer? Doctors Share Their Plans

Jolene Edgar

Can you believe it's June? After navigating the strangest of springs, we've somehow arrived here. But what even is summer during a pandemic?

While the school's-out season usually signals a relaxing of schedules and easing of rules, this one has a decidedly different feel — particularly for our "nonessential" physician friends who've been sidelined for months due to COVID-19 closures. Instead of scaling back as they normally would to enjoy the fruits of their labors — their seaside homes in the Hamptons and family estates abroad — they're heading back to work this month, with a fresh-start feeling that's reminiscent of early September.

Confronting waitlists hundreds of patients long, complex new safety protocols, and extended hours, doctors are embracing a new normal. In the office, San Francisco board-certified plastic surgeon Carolyn Chang tells us, "We maintain perfect social distancing; masks are mandatory; additional visitors are restricted; and strict cleaning protocols are in place" — all reassuring customs for returning patients who are anxious to get their personal beauty regimens back on track, she says.

Given the crushing unemployment rate and economic hardships COVID-19 has ushered in — to say nothing of the country's mood at the moment — physicians expressed concerns early on in quarantine that we, the public, may not have the appetite or allowance for cosmetic procedures when life eventually resumed. "I expected people to hold onto their funds and not rush back in, but that hasn’t been my experience," says Sheila Nazarian, a board-certified plastic surgeon in Beverly Hills. From what she's gleaned thus far, "People are quite grateful to get back in and begin to look and feel their best again."

With the future anything but crystal-ball clear, we asked dermatologists and plastic surgeons — each informed by months' worth of virtual consults and calendars packed with patients — to share their post-lockdown predictions for summer. Here's how they see the pandemic transforming our beauty preferences and the aesthetics landscape at large.

Injectables will remain steadfast favorites.

Throughout lockdown, people were reportedly begging and bribing injectors to secretly top off their fillers and neurotoxins — "Botox speakeasies" were a topic of discussion — and that fervent desire for injectables hasn't eased with stay-at-home restrictions. "As the trifecta of nail, hair, and skin businesses closed, many people suddenly saw themselves looking significantly more aged with graying hair, pronounced wrinkles, deflated midfaces, and jowling," says New York City board-certified plastic surgeon Umbareen Mahmood. And now, "They really want to feel better about their overall appearance."

Botox is the most sought-after shot in most practices, because, "It provides the quickest transformation with the least downtime," says Caroline Chang, a board-certified dermatologist in East Greenwich, Rhode Island. After sheltering in place for three-plus months, nearly everyone has regained full muscle movement — a disconcerting sight for loyal neurotoxin users who perhaps haven't seen this version of themselves in years, if ever. For some, "The stress of COVID-19 may have even made them notice prominent forehead creases and glabellar furrows," adds Mahmood.

With masks now an everyday accessory, it's our upper faces that are in the spotlight, fully representing us when we're out in the world. "I had three consults just this morning — because of masks and Zoom, people are hyper-focused on their eyes," says Flora Levin, a board-certified oculoplastic surgeon in Westport, Connecticut. 

At home, when masks come off, people "want to look good on [virtual] meetings without a lot of prep time or makeup," adds dermatologist Caroline Chang — and Botox allows for this by making expressions more placid and skin smoother.

While injectable fillers require more planning and assessment than toxins, and can be trickier to give and get in the age of COVID-19, patients are undoubtedly eager to reclaim their pre-pandemic proportions. "I'm seeing a spike in injectable procedures, such as cheekbone contouring and midface sculpting," says Kay Durairaj, a board-certified facial plastic surgeon in Pasadena, California. "Patients immediately feel prettier when their cheekbones look structured — it beautifully elevates lower-face heaviness and jowling." She's also seeing an influx of injectable newbies who've spent quarantine researching desired fixes and becoming comfortable with the idea of preventative maintenance with injectables.

For filler virgins, work-from-home scenarios and social-distancing dictums provide a unique opportunity to discreetly test the waters, adds dermatologist Caroline Chang. "Those who've been hesitant about lip filler, for instance, are now wanting to give it a go, because [for the most part] no one will be seeing them [in person], and they can wear a mask to get through the awkward swelling and bruising phase."

Providers may limit their treatment offerings for safety's sake.

Despite the pent-up demand for fillers, some doctors are refusing to perform certain lower-face injections, as Allure recently reported. "The biggest concern for both patients and injectors is avoiding exposure to COVID-19 by removing face coverings and masks," Durairaj explains.

She is filling patients' lips, she adds, but only if they receive a negative COVID-19 test within 48 hours of their appointment and then isolate themselves between the time they get the test and receive their results. Assuming patients are willing to play by those rules, "I then do the lips with special protocols such as [antiseptic] povidone-iodine solution and mouthwash, and HEPA filters for the rooms — I'm being extra cautious and screening carefully." Most of her patients are opting to skip the swab and postpone lip filler, she says, "until we figure out the actual infection and exposure risk for injectors."

Every physician will approach mask-off — and especially mouth-focused — treatments differently. After carefully considering available data and industry guidelines, and consulting with peers in the U.S. and abroad, Nazarian has chosen not to limit treatment offerings. When it comes to popular oral procedures like buccal fat pad removal and lip filler, "I wear an N95 [respirator] and a face shield — and I do not believe there is any evidence to say that viral transmission [from these procedures] is any higher [than with others]," she notes. That said, "These are personal decisions every [physician] has to make for themselves, and there's no judgment of those who will or will not perform a procedure."

Lasers may be slow to get a reboot during the pandemic, but not because patients aren’t clamoring for them. "A lot of women who have been thinking about getting an ablative laser for a while are now asking to do it," says Heidi Goodarzi, a board-certified dermatologist in Newport Beach, California. "The challenge is that we don’t have clear guidelines on the safety of these procedures" — meaning lasers that produce what doctors call a plume.

"A plume is the vapor and particle debris released into the air from skin ablation," explains Levin. "Although the role of aerosol transmission of COVID-19 is not exactly clear, it may be possible that an ablative laser in an infected patient may lead to further spread of such particles."

According to Christian Subbio, a board-certified plastic surgeon in Newtown Square, Pennsylvania, "The evidence regarding laser treatments in the COVID-19 era is woefully lacking. I'd be surprised to hear that laser-induced smoke plumes actually conveyed any additional risk [because], unlike HPV and other viruses which target skin cells, COVID-19 makes its home in the respiratory tract. The smoke plumes generated by laser treatments are made up of destroyed remnants of skin cells, so that should not directly be an issue." That said, he thinks responsible practices will hold off on some of the more invasive laser and light treatments until processes can be fine-tuned.

While many offices are outfitting their laser treatment rooms with specialized air purification systems and germicidal far-UVC lamps to curb any potential threat plumes may pose, others are pausing laser procedures until there’s more data on their possible role in coronavirus transmission. In the meantime, they're offering microneedling and chemical peels in lieu of lasers, as they, too, can boost cell turnover and build collagen for a smooth, glowy effect.

Zoom will fuel a surge of face and neck surgeries.

While Zoom's stock may be skyrocketing, its users' esteem seems to be plummeting—at least according to the physicians we spoke to for this story. "People have spent weeks staring at themselves on Zoom and other teleconference platforms — and have scrutinized those unforgiving images," says Mahmood, who attributes a recent rise in under-the-chin liposuction requests to the "unflattering angles we see of ourselves in video meetings."

Our screens have become unavoidable magnifying mirrors, exaggerating issues we may never have noticed before. "Patients who work from home are definitely self-conscious about their appearance on camera — they complain about dull skin, shadows on their necks and under their eyes, and their eyelids looking uneven or weird," says Levin, whose summer will be spent fixing droopy lids, under-eye bags, and asymmetries between the eyes. "All of these findings, whether genetic or age-related, are very positional," she adds — they're accentuated by lighting and camera positions.

In the Bay Area, plastic surgeon Carolyn Chang tends to tech tycoons, but says even they aren’t immune to this screen-fueled scrutiny. "A lot of my patients are working virtually from home, and they're not liking what their faces and necks look like on video day in and day out." Their dissatisfaction is driving them to surgery. They want both small in-office procedures, like eyelids, and more extensive facial procedures, such as face and neck lifts, she adds, "And they want them immediately [while] the world is still mostly locked up and it’s easier to be under the radar."

Patients will demand real and lasting results — and accept more downtime.

Remember when "downtime" was a luxury? What used to be an impediment to treatment is now a motivating force. "Consultations I saw six months ago, who weren't sure when they could do their eyelid surgery, are now reaching back out and want to schedule it soon," says Levin. "There is still concern about how they will look on Zoom after the procedure, but they seem to be more tolerant since [signs of surgery are] probably less noticeable [on camera]."

With the bulk of society still working from home — and keeping a low profile, socially — "high-downtime procedures are definitely on the rise," says dermatologist Caroline Chang, whose practice has seen a spike in strong chemical peels since reopening. "Patients are looking for maximum impact with minimal time in the office."

Mahmood reports a similar trend: "We're choosing products and procedures that last longer and can help limit appointments," she notes, citing double-chin reduction as a prime example. In this scenario, performing liposuction under local anesthesia — "and getting great results in 30 minutes" — is far preferable to signing someone up for multiple rounds of hit-or-miss fat-dissolving injections.

Some doctors interpret our leaning into invasives as a collective priority shift in the wake of a crisis. "We're eschewing frivolous luxury and fast fads and moving back toward value, practicality, and timelessness," says plastic surgeon Carolyn Chang. In the cosmetic realm, "That usually translates to a surgical procedure that will provide a long-lasting definitive aesthetic correction."

Case in point: As New York City begins to reopen, plastic surgeons are being inundated with consultations for body-contouring surgeries, like tummy tucks, lipo, and mommy makeovers. "Patients may have gained weight from being restricted to their homes without gym access, or due to stress," says Mahmood. For some — mothers, in particular, she points out — "This forced 'pause' on life has allowed them time to reflect on what they want to do for themselves." 

Plastic surgeon Carolyn Chang has noticed an uptick in "mommy makeover" consults, as well, but says many women are having to shelve their procedures until home-school and child-care situations resolve and they can devote adequate time to their own care and recovery.

Small private practices will continue to suffer — and could shutter.

"I'm constantly thinking about how many more days I can stay closed without losing my practice," Goodarzi confessed during a phone conversation we shared mid-lockdown. Private practices like hers are small businesses, their solvency contingent upon continuous patient fees. "The overhead of dermatology practices is very high," she says. Beyond the expenses that automatically come to mind — rent, loans, medical supplies, payroll — there are incalculable other costs to consider. "I have seven to nine types of insurance: rental, malpractice, workers' compensation, employee disability." 

Independent derms also commonly owe what amounts to multiple mortgages on their six-figure lasers and devices. "Those costs don't stop during a shutdown," notes dermatologist Caroline Chang.

The financial threat lingers, even now that restrictions have lifted and many physicians have reopened, primarily because practices can’t operate at full capacity. With the current rules in place for social distancing, "Dermatologists will be seeing far fewer patients per day, but require a high number of staff to assist with patients," says dermatologist Caroline Chang.

"Even if you want to work a full day, you're seeing patients at 30-percent capacity — 50 percent at best if you have a large space," Goodarzi adds. "If you're doing it right, you will be suffering financially."

Compounding matters, some folks are reluctant to return to medical offices, fearing they'll pick up the virus. So even if derms are met with a major backlog when they first reopen, "I definitely expect it to slow down over time," says dermatologist Caroline Chang. "There's still a good percentage of patients who will defer coming in due to concerns over the virus, especially if they are immunosuppressed or living with an elderly person, such as a parent."

New safety protocols and policies — a biggie being that patients come solo to the office — may also make it difficult for people to patronize their favorite practices. "Most of my cosmetic procedures used to happen between drop-off and pick-up," says Goodarzi, but school closures have robbed parents of that precious window for self-care. With child-care arrangements likely to remain precarious through the summer, there's really no telling when caretakers will manage to eke out enough alone time to tend to non-urgent beauty needs.

With a second wave of COVID-19 looming and doctors bracing for an inevitable fall shutdown, now is the time: If you have the means, support your local dermatologist as you would any small business — because beauty and wellness simply cannot be canceled.

Read more on post-lockdown predictions:

Done Reading? Now, watch Skai Jackson's 10-minute makeup routine:

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Originally Appeared on Allure

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