What has the shift to virtual over the past year meant for dermatology and its patients? In an interview with The Dermatologist, Shadi Kourosh MD, MPH, FAAD, answered questions about her recent look into “Zoom dysmorphia” and the negative effects the pandemic has had on self-image for patients consulting for aesthetic procedures.¹

Dr Kourosh is an assistant professor of dermatology at Harvard Medical School and director of community health in the department of dermatology at Massachusetts General Hospital in Boston, MA, and director of the Center for Laser Surgery and Aesthetics at Brown Dermatology in South Kingstown, RI.

What is Zoom dysmorphia, and how has the past year has contributed to it?
Over the past year, many of us have been spending hours a day on video calls, which can impact how we think about our appearance. We’re viewing ourselves much more frequently, for longer periods of time and from strange angles with technology that distorts our appearance, leading many to think negatively about their appearance, focus on perceived flaws, and seek cosmetic care. With the term Zoom dysmorphia, we hoped to spark a discourse in the medical community about a phenomenon that we were observing unique to the living conditions of the pandemic, which we were concerned may trigger or worsen body dysmorphic disorder (BDD) in our patients. However, it is important to make the distinction between a term like Zoom dysmorphia that is useful for education and awareness and actual medical term such as BDD, which has its own criteria for diagnosis for which we would refer to a mental health professional.

What conversations should dermatologists have with their patients regarding BDD/Zoom dysmorphia? 
Our study² surveyed dermatologists across the country and found that the shift toward remote work and videoconferencing due to the pandemic has led people to scrutinize an unflattering and distorted image of themselves on screen and seek cosmetic procedures as a result. Dermatologists should be aware of this trend as well as the limitations of webcams and should encourage patients to have a discussion with a medical professional if concerns for appearance arise.

It may be helpful to remind patients to reconnect with the aspects of self-perception that grounded them before the pandemic, such as turning off front-facing cameras when possible and reconnecting with supporting relationships and interactions that affirm self-perception. It is of utmost importance that individuals consult a board-certified physician that cares about health and well-being and will tell them honestly if a procedure is in their best interest. Our hope is to encourage a discussion in the community of aesthetic medicine that will help us as physicians to be prepared to address this issue so we can take care of our patients as a whole person and support mental health and wellness. 

What trends in patient concerns and procedures are dermatologists/aesthetics specialists seeing in their practice post COVID?
In the midst of the pandemic, we surveyed over 130 members of a national organization of dermatologists and found that over 50% of dermatologists were seeing a relative rise in cosmetic consultations.² Of these, 86% reported their patients were referencing videoconferencing as a reason for their new cosmetic concerns. The most common patient concerns included features from the neck-up, such as upper face wrinkles (77%), dark circles under the eyes (64.4%), facial dark spots (53%), and neck sagging (50%), all of which may be exacerbated by camera angle, focal length, and shadow distortion.

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Neuromodulating agents, filler injections, and laser treatments were the most frequently requested cosmetic procedures. For those who were accustomed to receiving these treatments every few months prior to the pandemic, there was noticeable concern for return of dynamic wrinkles following months without treatment, especially in setting of videoconferencing where they were forced to look at them in an unnatural way for hours on end. Additionally, squinting and focusing on screen during videocalls can exacerbate dynamic wrinkles, leading many to be unpleasantly surprised by their facial lines seen on screen. Similarly, interest in skin tightening procedures of the neck also spiked during the pandemic, with concerns for neck sagging made worse by unfortunate camera angles and focused attention during video calls.

Do you have any thoughts regarding the “Zoom boom” in aesthetics continuing as we emerge from pandemic restrictions?
It is difficult to predict the net effect of all the changes that will happen as society re-opens, as many of the factors that had a negative impact on appearance should hopefully improve, such as the ability to exercise, reconnect with loved ones, and an improved sense of emotional well-being. At the same time, the demand for videoconferencing will also decrease, and people may have less impact of front-facing cameras on perception of appearances and will be spending time with loved ones who can re-affirm self-perception in both physical and holistic aspects. Connecting with friends and family in person may provide a source of emotional support that reassures a person with respect to self-esteem and reminds them that they are valued as a person completely apart from their appearance. 

We predict that people will look and feel better for many reasons, but as society reopens and people start attending more social events, it is possible there will be a continued enthusiasm for self-optimization, but hopefully in the setting of a healthy and balanced self-image. 

Is there anything else you would like to share with your colleagues regarding Zoom dysmorphia or cosmetic dermatology?
This study highlights that videoconferencing presents a constant, distorted image of a person that can be unsettling, and the medical community is seeing an increase in cosmetic consultations for perceived imperfections as a result.  We hope awareness of this phenomenon helps to avoid unnecessary procedures, especially if cosmetic concerns could be solved with simple changes such as a new webcam, better angles or a ring light, or more importantly, if the patient would be better served speaking to a mental health professional. 

References

1. Rice SM, Graber E, Kourosh AS. A pandemic of dysmorphia: “Zooming” into the perception of our appearance. Facial Plast Surg Aesthetic Med. 2020;22(6):401-402. doi:10.1089/fpsam.2020.0454
2. Rice SM, Siegel JA, Libby T, Graber E, Kourosh AS. Zooming into cosmetic procedures during the COVID-19 pandemic: the provider’s perspective. Int J Women Dermatol. 2021;7(2):213-216. doi:10.1016/j.ijwd.2021.01.012