A Pandemic of Dysmorphia: “Zooming” into the Perception of Our Appearance

Patient Selection, Outcome, and Unhappy Patients in Rhinoplasty

This article discusses the process of patient selection for rhinoplasties and the many different psychological aspects that come into play. It is important to identify the warning signs and apply a multidisciplinary approach to the surgeons practice, in collaboration with specialist rhinoplasty psychologists. Patients' motivations and surgeon factors are also discussed, as this can lead to unhappy and unsatisfactory postoperative outcomes. Potential reasons for adverse outcomes throughout the pre- and postoperative periods are also described. Finally, a brief guide is provided to reduce the risks of an unhappy patient.

Patient Selection, Outcome, and Unhappy Patients in Rhinoplasty

This article discusses the process of patient selection for rhinoplasties and the many different psychological aspects that come into play. It is important to identify the warning signs and apply a multidisciplinary approach to the surgeons practice, in collaboration with specialist rhinoplasty psychologists. Patients' motivations and surgeon factors are also discussed, as this can lead to unhappy and unsatisfactory postoperative outcomes. Potential reasons for adverse outcomes throughout the pre- and postoperative periods are also described. Finally, a brief guide is provided to reduce the risks of an unhappy patient.

Consumer attitudes toward aging skin during the COVID-19 pandemic

The impact of the novel coronavirus disease (COVID-19) pandemic on consumer attitudes toward their skin has not been well characterized.

Objective

This study investigated how consumers' attitudes toward their skin changed during the COVID-19 pandemic.

Methods

A cross-sectional survey was conducted using REDCap. A total of 1,434 participants were recruited and consented to participate online through ResearchMatch. The survey gathered demographic information and assessed participants' attitudes toward their skin using a Likert scale. An ordered logistic regression analysis was performed.

Results

Nearly one-third of participants felt unhappy with their skin. Forty four percent feel less happy about their skin compared with 5 years earlier. The top skin concerns were eye puffiness (86.5%), loose skin (85.1%), uneven tone (84.9%), uneven texture (83.5%), and dry skin (81.4%). Video conferencing (31%), wearing masks (23%), and increased stress (21%) during the COVID-19 pandemic affected how participants felt about their skin. Compared with men, women were 1.6 to 1.8 times (P < .01) more likely to "strongly agree" that all 3 pandemic-related factors-video conferencing, wearing masks, and increased stress-affected how they felt about their skin. Younger age groups were 1.5 to 2.8 times (P < .01) more likely to answer in the top category for all 3 pandemic-related factors compared with the oldest age group.

Limitations

Recruitment of participants was limited to English-speaking adults aged 18 years or older who were registered on ResearchMatch, which underrepresents minority populations. Further studies should be conducted to elucidate how the pandemic affected perceptions of skin.

Conclusion

Skin aging is a significant concern among adults of all ages. The COVID-19 pandemic has exacerbated skin concerns. Women and young adults are more likely to be affected by the COVID-19 pandemic in their attitudes toward their skin.

Objectifying the classroom: Examining self-objectification and its effects on cognitive resources within virtual class environments

Videoconferencing platforms (i.e., Zoom) allow for continuous appearance monitoring via the self-view setting - raising concerns about self-objectification. Prior research indicates that self-objectification is associated with diminished cognitive performance, which may affect learning. This experiment examined how videoconferencing camera settings affect body image and cognitive performance. Female college students (n = 167) participated in a Zoom call with various camera settings: camera with self-view (i.e., others could see them and they could see themselves on screen), camera without self-view (i.e., others on the call could see them, but they could not see themselves), and camera off. After random assignment to condition, participants completed a collaborative exercise, answered questions related to self-objectification and body anxiety, and took a math test. Camera settings had no effect on state self-objectification or appearance anxiety. Participants in the camera without self-view condition demonstrated worse performance on the math test than those who had their cameras off, but no other pairwise comparisons were significant. Surprisingly, high trait self-objectifiers were not more sensitive to self-view camera exposure, though high trait self-objectification was associated with greater appearance anxiety across conditions. State self-objectification did not predict cognitive performance. Still, findings demonstrate a meaningful effect of camera settings on cognitive performance.

Assessing the Impact of COVID-19 on Facial Aesthetic Surgery Search Interest

ABSTRACT

The global COVID-19 pandemic reshaped many components of modern health care practice. Before the pandemic, research was beginning to demonstrate the impact of self-facing cameras, selfie images, and webcams on patient interest in head and neck (H&N) aesthetic surgery. We sought to determine temporal changes in patient interest in aesthetic surgery of the H&N as compared with the rest of the body because of COVID-19, and the subsequent surge in Web-conferencing and telecommunication. The 2020 Plastic Surgery Trends Report produced by the American Society of Plastic Surgeons was used to identify the 5 most common aesthetic surgical procedures performed on the H&N and the rest of the body for 2019: blepharoplasty, face lift, rhinoplasty, neck lift, cheek implant, and breast lift, liposuction, tummy tuck, breast augmentation, and breast reduction, respectively. Google Trends filters, which provide relative search interest for greater than 85% of Internet searches, were applied to gauge interest from January 2019 to April 2022. Relative search interest and mean interest were plotted as a function of time for each term. Our findings demonstrate a sharp decline in online aesthetic surgery interest in March 2020, coinciding with the beginning of the COVID-19 pandemic for both the H&N and the rest of the body. Search interest increased shortly after March 2020 and reached values greater than those of the prepandemic year (2019) in 2021 for rest of the body procedures. After March 2020, there was a brief, sharp increase in search interest for rhinoplasty, neck lift, and facelift, whereas patient interest in blepharoplasty increased more gradually. There was no increase in search interest for H&N procedures as a result of COVID-19 when using the mean values of the included procedures, although current interest has returned to prepandemic levels. The COVID-19 pandemic caused a disruption of normal trends in aesthetic surgery interest, with a sharp decline in search interest in March 2020. Afterward, there was a sharp increase in rhinoplasty, face lift, neck lift, and blepharoplasty interest. Patient interest in blepharoplasty and neck lift has remained elevated compared with 2019. Interest in rest of the body procedures has returned to and even surpassed prepandemic levels.

The perception of plastic surgery during the COVID-19 pandemic-an analysis of online search patterns on a medical information platform

In 2020, the COVID-19 pandemic impacted global life and transitioned economies and societal perceptions of life as we knew it. Professional and social life mostly ground to a nadir during the first lockdown in Europe in March. As a consequence, measures aimed at preventing the spread of the virus were established in medical facilities also and elective plastic surgery procedures were temporarily suspended in our clinic and others. A majority of the population, including those potentially contemplating plastic surgery procedures, spent most of their time at home with ample time available to research information about surgical procedures and other topics online. This investigation analyzes the relevance of plastic surgery during the pandemic on the basis of online search behavior patterns. Online traffic data from the online platform http://www.mooci.org were extracted using Google Analytics over a period of 6 months. The parameters analyzed were: pageviews, session duration, and bounce rate. Additionally, differentiation by areas of interest has been obtained. The data were compared and analyzed before and after the beginning of the first hard lockdown in Austria, Germany, and Switzerland. There were no significant differences in regard to pageviews and session duration when comparing time points before and after the beginning of the hard lockdown. The bounce rate exhibited a significant decrease after the beginning of the lockdown, implying a more conscious search for information and greater absorption and retention. There was no difference that could conclusively be attributed to the pandemic in terms of specific areas of interest researched. Society's demand for information about plastic-surgical procedures continues to be steadily prevalent-despite, or even in particular, during a global pandemic. Providing reliable and readily available information about plastic surgery procedures is an important component of a functioning doctor-patient relationship and informed consent. This information may reflect society's increased interest in plastic surgery during the pandemic, or be simply reflective of more spare time at hand to allow for such research. Further studies should investigate the relevance of elective procedures over the entire course of the pandemic.

Reducing Risks for a Dissatisfied Patient in Facial Cosmetic Surgery

Patient selection in aesthetic surgery is the ultimate inexact science, a mixture of surgical judgment, expertise, ego, gut feelings, personality interactions, and a spin of the roulette wheel. Using our procedural skills as well as our interpersonal skills will enhance our professional satisfaction and improve the quality of life for others as we try to reduce the likelihood of dissatisfaction, both for our patients and ourselves.

Global Perspectives on Beauty

Beauty is a mystical and powerful, indeed existential, force. Beauty can be described philosophically, quantified mathematically, and defined biologically. Our individual attractiveness confers real benefits and impacts our reproductive success. Natural beauty is perceived similarly by all races and cultures yet has unique ethnic characteristics. Various artificial beauty interventions are used across all cultures to enhance natural beauty. The forces of globalization, especially social media and even the pandemic, are accelerating the evolution of attractiveness and beauty standards worldwide. Future neuropsychiatric and biopsychological interventions may allow us to change how we perceive beauty in ourselves and others.

Factors Associated with Likelihood to Undergo Cosmetic Surgical Procedures Among Young Adults in the United States: A Narrative Review

Introduction/Goals

Over the past decade, cosmetic surgical procedures have become increasingly popular. This trend has been driven by procedural innovations as well as access to Internet and social media. Consequently, patients have been seeking cosmetic surgical procedures at younger ages. In this narrative review, studies assessing attitudes towards cosmetic surgical procedures among college-aged young adults were evaluated.

Methods

A search identified 20 studies published from 2002 to 2021 that focused on cosmetic surgical procedures among young adults. Each study used survey-based data to determine attitudes, acceptance, interests, perceptions, and beliefs about cosmetic surgical procedures among college-aged students in the United States.

Results

The proportion of college-aged participants who had undergone cosmetic surgical procedures ranged from 1.3% to 6.4% with surveys reporting that between 21 and 43% were interested in procedures in the future. In general, young women were more likely to express interest in cosmetic surgical procedures than young men. Studies consistently demonstrated an inverse relationship between body satisfaction and use of aesthetic procedures among this patient population. Other factors associated with acceptance and approval of cosmetic surgical procedures included importance of appearance to self-worth, concern with social standing and attractiveness, investment in appearance, media influence on body image, and positive attitudes towards celebrities. Exposure to cosmetic surgery advertising was correlated with increased approval of cosmetic surgical procedures, especially the perception that advertising influences "others" more than survey respondents themselves.

Conclusion

Interest in cosmetic surgical procedures continues to grow among young adults in the United States. In the future, this cohort is likely to become an increasingly important demographic to target for education, advertising, and research regarding cosmetic surgical procedures.

Video Conferencing Dysmorphia: Assessment of Pandemic-Related Body Dysmorphia and Implications for the Post-lockdown Era

Background: The coronavirus 2019 (COVID-19) pandemic has led to global effects on human interaction and mental health. The most drastic changes are seen in ways people continue to stay connected with each other. Video-conferencing applications like Zoom gained popularity and have become the primary means of communication for social or work events and meetings. These applications have also in many places replaced face-to-face healthcare visits and have penetrated school-based learning. The long-term implications of this digital technology on self-esteem and body image require further study.

Main Body: Video-conferencing applications have led to people being more conscious of their appearance and this has resulted in increased cases of body dysmorphic disorder (BDD). There is increased focus on body appearance and cosmetic procedures to fix minor defects. Although the treatment for BDD is like depression, it requires the personalization of therapy specific to the needs of the patient.

Conclusion: In this review, we aim to highlight the impact of the pandemic on body image and the long-term implications of virtual conferencing. The review also highlights available pharmacological and non-pharmacological treatment approaches in the management of body dysmorphic disorder related to virtual video conferencing.

Facial Appearance Dissatisfaction Explains Differences in Zoom Fatigue

Viewing self-video during videoconferences potentially causes negative self-focused attention that contributes to virtual meeting (VM) or “Zoom” fatigue. The present research examines this proposition, focusing on facial dissatisfaction—feeling unhappy about one's own facial appearance—as a potential psychological mechanism of VM fatigue. A study of survey responses from a panel of 613 adults found that VM fatigue was 14.9 percent higher for women than for men, and 11.1 percent higher for Asian than for White participants. These gender and race/ethnicity differences were found to be mediated by facial dissatisfaction. This study replicates earlier VM fatigue research, extends the theoretical understanding of facial dissatisfaction as a psychological mechanism of VM fatigue, and suggests that practical approaches to mitigating VM fatigue could include implementing technological features that reduce self-focused attention during VMs (e.g., employing avatars).

Our Post-Zoom Reflection: Turning Off the Monitor

Over a year ago, the COVID-19 pandemic resulted in lockdowns and isolation, quickly shifting social interactions online. During this time, the authors cited worsening self-perception due to the altered and distorted image produced by front facing cameras, later called "Zoom Dysmorphia." A recent survey study was then conducted analyzing the mental health and self-image of people as they returned to in-person activities. Increased time spent online and use of filters, which provoked unrealistic expectations, correlated with worsening anxiety and worsening self-perception, especially in respondents under the age of 24 years. A large percentage of this cohort also planned to invest in their appearance to cope with this anxiety. After a year of being behind the screen, with the ability to enhance features with the click of a button, individuals are concerned about their appearance and their ability to return to a life in-person. Aesthetic physicians should be prepared to discuss the cosmetic concerns provoked by photo editing, filters, and videoconferencing to educate about realistic surgical goals and outcomes for patients.

Understanding the conversation around COVID-19 and eating disorders: A thematic analysis of Reddit

BACKGROUND

Current research has found dramatic changes in the lives of those with eating disorders (EDs) during the COVID-19 pandemic. We build on existing research to investigate the long-term effects and adaptations that people with EDs have faced due to COVID-19 related changes.

METHOD

We collected 234 posts from three separate time periods from the subreddit r/EatingDisorders and analyzed them using thematic analysis. The posts were examined for initial patterns, and then those concepts were grouped into themes to reveal the authentic experiences of people living with EDs during the COVID-19 pandemic.

RESULTS

Initially, we found "lack of control" and "familial influences (loved ones seeking support)" emerge as themes within our broader data set throughout all three timeframes. There were additional themes that were present in only one or two of the collection periods. These themes consisted of "symptom stress," "technical stresses and concerns," and "silver linings."

CONCLUSIONS

Our analysis shows that people with EDs have fought significantly during the pandemic. Initially, the (lack of) control and routine in their lives has caused symptoms to become more challenging, while being forced to move back home also caused significant stress. However, concerns transformed as the pandemic progressed, resulting in new pressures causing people to exhibit novel ED symptoms or relapse altogether. Also notable is the relatively few COVID-specific posts as the pandemic progressed, suggesting that people have accepted COVID as their "new normal" and begun to build resilience to the challenges associated. These are vital factors for clinicians to consider as they begin taking existing and new patients, particularly as face-to-face treatment options become a possibility again. Existing research shows that the COVID-19 pandemic has transformed the lives of people who live with eating disorders in various ways. First, the pandemic has placed barriers on the path to recovery by limiting coping mechanism (and sometimes removing them altogether) and changing their relationships with food and the people in their lives. Second, the pandemic has forced treatment options to change since ED patients can no longer seek treatment face-to-face. Finally, there have been unexpected benefits to the pandemic, such as allowing individuals time to slow down and focus on their mental health. Previous studies examined individuals in clinical contexts rather than in their natural environments. We explored an online forum for people with eating disorders for the various themes that were discussed at three points over the period of March 2020-December 2020 and found that many people with EDs report worsening symptoms or relapse. However, we also noted that, compared to the beginning of the pandemic, people seemed to be less frequently asking for support during the third data collection period, implying an adaptation to the "new normal" of life in a pandemic. We conclude with a discussion of the findings.

Bacteriostatic preserved saline for pain-free periocular injections: review

We review evidence regarding the use of 0.9% benzyl alcohol in 0.9% sodium chloride solution for periocular injections (‘preserved saline’) including botulinum toxin A injections and local anaesthesia. A literature search was undertaken using search terms ‘bacteriostatic saline’, ‘benzyl-alcohol saline’, ‘benzyl alcohol sodium chloride’ and ‘preserved saline’. Bibliographies identified further sources. There have been 62 studies published on the subject of preserved-saline since 1928. Significantly lower injection-associated pain levels for periocular/facial botulinum toxin injections reconstituted with preserved-saline rather than preservative-free saline are reported by 5 studies. Significantly lower injection-associated pain with preserved-saline diluted lidocaine and epinephrine solution for eyelid anaesthesia compared with unmodified or buffered lidocaine with epinephrine, and adequate anaesthesia, was reported by one study. Thirty-one studies have explored preserved-saline for anaesthetic and seven for bacteriostatic properties, with very low infection rates after periocular botulinum toxin injections, and reduced rates of infection in indwelling catheters when preserved saline is used to flush. A meta-analysis concluded that lidocaine-containing solutions are more effective at reducing pain from insertion of intravenous catheters. Patient-perceived pain related to periorbital injections of local anaesthesia is reduced when the anaesthetic is diluted with benzyl alcohol-preserved saline compared with other dilution or buffering options. Pain is similarly reduced for periocular botulinum toxin injections reconstituted with preserved saline compared with unpreserved saline. Benzyl-alcohol preserved-saline is inexpensive but costlier than unpreserved-saline, with minimal reported complications, particularly with periocular administration, and offers the opportunity to improve the patient experience.

Has the COVID-19 Pandemic Impacted Interest in Cosmetic Facial Plastic Surgery?: A Google Trends Analysis

Facial cosmetic surgery trends are evolving in the current climate of the coronavirus disease 2019 (COVID-19) pandemic. The aim of this study was to evaluate public interest in elective facial plastic surgery during the COVID-19 pandemic including the period of the COVID-19 vaccine distribution using Google Trends. A Google Trends analysis was completed using popular terms related to facial cosmetic surgery and procedures from March 2017 to August 2021. Three stages were identified (baseline, pre-COVID-19 vaccine distribution, and post-COVID-19 vaccine distribution). Descriptive statistics were calculated and two-tailed t-tests were performed between the pre-vaccine and the post-vaccine phases. Linear regression analysis was also performed to determine percent deflection of search terms. There was significantly greater interest in facial aesthetic procedure search terms, except for tear trough filler, during the post-COVID-19 vaccine phase compared with the pre-COVID-19 vaccine phase. There was greater interest in lower facial procedure interest during this phase compared with upper facial procedures (p-value = 0.0011). The search terms with the greatest deflection percentage during the post-vaccine phase were lip filler, brow lift, and lip flip. There continues to be high demands of facial plastic surgery and procedures despite COVID-19 pandemic.

The 10-Point Plan 2021: Updated Concepts for Improved Procedural Safety During Facial Filler Treatments

Dermal filler treatments require constant reassessment for improving and safeguarding the rapidly evolving aesthetic field. Suboptimal injection technique, patient selection and product knowledge have touted a concerning increase in filler complications, with new challenges such as the COVID-19 pandemic leading to new paradigms in the understanding, prevention, diagnosis and treatment of complications. The updated 10-point plan has been developed to curtail complications through consideration of causative factors, categorized as patient, product, and procedure-related. Patient-related factors include a preprocedural consultation with careful elucidation of skin conditions (acne, rosacea, dermatitis), systemic disease (allergies, autoimmune disease, underlying bacterial and viral disease (herpes simplex virus, COVID-19 infection), medications (antineoplastic drugs, recreational drugs) and previous cosmetic procedures (including fillers and energy-based devices). Patient assessment should include standardized photography and also evaluate the role of social media, ethnicity, gender, generational, and LGBTQ+ needs. Specified informed consent for both adverse events and their treatment is essential due to the increase in vascular complications, including the risk of blindness. Product-related factors include the powerful advantage of reversibility when using hyaluronic acid (HA) products. Product characteristics such as molecular weight and filler degradation should be understood. Product layering over late or minimally degradable fillers is still inadvisable due to the initial filler being teased into reactivity. Procedural factors such as consistent photographic documentation, procedural planning, aseptic non-touch technique (ANTT), knowledge of topographical anatomy and angiosomes, and technical dexterity including pinch anatomy and needle skills are of pivotal importance. The final section is dedicated to algorithms and checklists for managing and treating complications such as allergic hypersensitivity reactions, vascular events, infection, edema and late-onset adverse events (LOAEs). The updated 10-point plan is a methodical strategy aimed at further minimising the risk of dermal filler complications.

Financial Decisions and Reopening a Practice During the COVID-19 Pandemic: A Survey of California Plastic Surgeons

BACKGROUND

On March 11, 2020, the World Health Organization declared COVID-19 as a global pandemic. As a response, the United States shut down public gatherings and businesses in an effort to quarantine. This included the stopping of elective operations, which greatly affected plastic surgeons and their practices during the initial shutdown.

OBJECTIVES

We aim to study the early impact of COVID-19 on the financial implications and practice patterns of plastic surgeons in the state of California during the initial shutdown of elective surgery and provide guidelines for effective management during future crises.

METHODS

A 20-question survey was sent using Qualtrics XM software to 851 surgeon members of the California Society of Plastic Surgeons. The survey was open from May 13, 2020, to May 29, 2020. Standard statistical analysis was completed to compare private practice and nonprivate practice plastic surgeons.

RESULTS

We had a total of 140 respondents to our survey for a 16.5% response rate. The majority (77.1%) of the respondents were in a private practice setting. Private practice plastic surgeons reported a higher financial impact with a 79% reduction in financial income compared with nonprivate practice plastic surgeons at a 37% reduction (P < 0.0001). Additionally, private practice plastic surgeons demonstrated a higher reduction in case volume and were more likely to lay off or furlough staff, close their practice, and apply for loans (P < 0.001).

CONCLUSIONS

Our survey study showed that private practice plastic surgeons in the state of California faced the most financial hardship during the early shutdown of the COVID-19 pandemic. It serves as a valuable snapshot in our economic history and depicts the heavy financial impact of the stopping of elective surgery. Since the reopening of practices, new guidelines have been implemented to maintain safe elective surgery while the pandemic continues. Further follow-up studies on both the state and national level need to be completed to see the continued financial effects on private and nonprivate plastic surgery practices since the reopening and resumption of elective surgery.

The art of prevention: COVID-19 vaccine preparedness for the dermatologist

As COVID-19 vaccinations begin, dermatologists must be aware of the cutaneous adverse events reported in the clinical trials, including injection site and hypersensitivity reactions, and emerging evidence of dermal filler injection reactions after vaccination. The filler reaction may represent the development of a delayed-type hypersensitivity in the setting of another immunologic trigger (i.e., the vaccine). After conducting a literature review of similar reactions, their pathophysiology, and management, we present a set of timely clinical considerations for counseling, prevention, and management of possible cutaneous sequelae of the COVID-19 vaccine. We encourage documentation of vaccine-related reactions to aid the safety data collection in the Vaccine Adverse Event Reporting System and the American Academy of Dermatology COVID-19 Registry.

Zooming into cosmetic procedures during the COVID-19 pandemic: The provider's perspective

The COVID-19 pandemic has seen a massive shift toward virtual living, with video-conferencing now a primary means of communication for both work and social events. Individuals are finding themselves staring at their own video reflection, often for hours a day, scrutinizing a distorted image on screen and developing a negative self-perception. This survey study of over 100 board-certified dermatologists across the country elucidates a new problem of Zoom dysmorphia, where patients seek cosmetic procedures to improve their distorted appearance on video-conferencing calls.