Touch-ups, Rejuvenation, Re-dos and Revisions: Remote Communication and Cosmetic Surgery on the Rise.

The way in which communication takes place has undergone significant change over the last year leading to alterations regarding the way we perceive our own personal image. Indeed, the increase in remote video interaction seems to have led to an increase in the number of requests for teleconsultations with plastic surgeons in private practice (70% in the UK and 64% in the USA), the so-called Zoom Boom. The reasons connected to this increase are still under investigation, but it is likely that patients' greater exposure to seeing their own image in online video communication for prolonged periods has highlighted what patients perceive as flaws and/or their self-image does not correspond to the same image that they see in the mirror. However, the motivations for seeking cosmetic surgery cannot be solely attributed to seeing ourselves online more frequently; the psychological impact of the pandemic (lower moods, isolation and greater concerns) may also be to blame. Therefore, the reasons patients hope to touch-up, rejuvenate, re-do or revise their "lockdown faces" need careful attention with a view to understand the extent of which the online distortion of one's own body image may be the underlying cause.Level of Evidence V "This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 ."

The way in which we communicate and how we go about our daily lives has undergone significant change over the last 12 months. The year anniversary since the first cases of SARS-COV-2 were detected in Europe now sees the vast majority of us interacting with others through some form of video conferencing be it for teaching purposes [1], research conferences or business meetings to name but a few. There has of course also been a rise in the use of telemedicine and teleconsultations [2-4] with a view to maintaining social distancing and reducing the spread of the virus and its variant mutations within hospital complexes.

Of particular note is that the increase in online video communication seems to have led to a specific increase in the requests for teleconsultations with plastic surgeons in the private sector. Indeed, the British Association of Aesthetic Plastic Surgeons (BAAPS) indicated a rise of 70% [5], a figure which is also reflected in the USA at 64% [6]. This phenomenon has been coined as the “Zoom Boom” and gives rise to several considerations as to the reasons why more patients are seeking cosmetic procedures during a pandemic [5].

One of the most striking reasons is most likely to be the prolonged periods of time spent looking at yourself during a video conference which is far removed from the reality of everyday in person meetings. This new way of interacting has led us to become accustomed to seeing ourselves speaking and participating within our “new” working environments and has quite possibly led to a more critical view of our own self-perceptions and of our own body-image [7]. It may well be that the view we have of ourselves online does not correspond to the same view that we see of ourselves in the mirror, particularly as the amount of time looking in the mirror is most likely much reduced.

However, it is paramount that further considerations are made into the correlation between the incidence of an increase in video conferencing and a rise in patients who are seeking cosmetic surgery. Within the field of plastic surgery, with particular reference to reconstruction and breast cancer patients, a clear correlation has been established between levels of mood and a woman’s perception of her own body image [8]. Indeed, the current pandemic has brought about the decision within most healthcare systems to defer all elective surgery, including breast reconstruction [9-11], which in itself is already signifying the psychological effects. Despite the fact that patients who undergo mastectomies and reconstructions in general [J Plast Reconstr Aesthet Surg. 2017 ">12-17] most certainly face greater challenges than patients who seek cosmetic surgery for aesthetic reasons, the psychological impact of self-isolation and the concerns connected to the pandemic cannot be ruled out as key motivators for requesting cosmetic surgery in this period.

Validated questionnaires which evaluate reconstructive plastic surgery procedures in terms of levels of satisfaction, body-image perception and levels of depression are already in wide use [7, 8, 18, 19]. Therefore, it would now be prudent to investigate the psychological impact of the pandemic on lower moods and potentially depression levels of patients and how this may or may not impact on a patient’s distortion of their own body-image online leading to them seeking cosmetic surgery. To our knowledge, there are no current studies in this vein and the ways in which our own self-perception may now be distorted in online communication should now be investigated. The concept of a distorted self-perception of ourselves online is most likely connected to the fact that the way patients see their flaws are accentuated or indeed they believe that these “flaws” are now more noticeable to others more than before.

Another final consideration put forward is that patients have greater accessibility to surgeons through teleconsultations [20] and/or feel that smart working would allow for them to have a more comfortable healing time without the need to take sick leave. Financial considerations may also be pertinent as people are now spending less on other luxuries during lockdown.

Overall, the motivations which underpin a wish to touch-up, rejuvenate, re-do or revise your “lockdown face” need careful attention and the psychological impact of the pandemic on patients should not be overlooked in any way. Further studies in this sense should now be advanced in order to continue to guarantee the high standards and safety of patients who undergo cosmetic surgery.