To call 2020 an unpredictable year may be one of the biggest understatements of all time, and the aesthetics industry, in particular, experienced a rollercoaster of surprises. To start, elective surgeries were put on hold across the country while people simultaneously adopted a digital lifestyle, spending more time looking at themselves on camera than ever before, along with an almost entirely at-home existence.
So when plastic surgeons and dermatologists got the green light to reopen and resume elective procedures, the demand was off the charts — from former patients and newcomers alike, and across all ages. But as more of the country gets vaccinated and our daily lives evolve, do we dare make predictions about what 2021 may hold for the aesthetics industry?
We asked four plastic surgeons and dermatologists about their most-requested procedures, how they are preparing for the year ahead, and if they anticipate the pandemic-spurred plastic surgery boom to continue.
Despite the hum of self-care persuasions, no one escaped the last year unscathed, says New York City-based board-certified dermatologist Paul Jarrod Frank. "As much as we'd like to think everybody has been at home, leaning into self-care, taking really good care of their skin and eating right, exercising more, the fact is, people have been falling apart a little bit," he says. "No matter who you are, it's been a very stressful time for everyone."
These sudden, unexpected — and for the most part, unwelcome — changes in our bodies and skin are spurring a higher-than-normal demand for procedures and treatments as people "are looking more and more to do things to rejuvenate," explains Frank, adding that some procedures have been more popular than others, but the surge at his practice has been undeniable.
On the opposite coast, San Francisco-based board-certified plastic surgeon David Sieber agrees, saying that he's "seeing the same requests, but just way more of them than ever, ever before," along with a newfound sense of urgency among those who were able to work from home to take advantage of that status. "On top of the huge uptick, a lot of people are calling and saying, ‘I want to get this done as soon as possible because I don't know when I’m going to have to go back into work physically.'"
"One of the big things that's beneficial right now is that people have time and money," says Sieber, while also acknowledging that many of his patients were fortunate to retain their jobs this year. "Prior to COVID, people had this money set aside that they were going to use to travel to France or to South America, or for a friend's destination wedding, or just something big, and now it's just been sitting in the bank — they didn't have to go into work or travel for work, so they're sitting at home with money that they didn't think they were going to have, and that's the perfect storm to get a cosmetic procedure."
On the dermatology side of the coin, Frank believes his patients are "now looking for the big-ticket items and people are looking to retail therapy," he says. "People are enjoying spending money right now."
Working from home has been one of the biggest drivers of increased cosmetic and plastic surgery demand, according to board-certified dermatologist Sameer Bashey, who expects to be booked solid as long as people are staying at home. "People are taking advantage of the natural downtime we have, and the procedures I'm doing now are the ones where people used to say, 'Oh, well, there's too much downtime.' Or 'I can't take off for that number of days,'" he explains. "So I'm doing larger procedures now — more intensive lasers or chemical-peel procedures that take a little bit more recovery time."
This trend is also mirrored with plastic surgery, as patients are able to freely and discreetly wear compression garments at home and simply turn their video off for Zoom calls, says Sieber. "Instead of needing to take two weeks off of work, they might be off three days because they aren't driving into the office and sitting at their desk," he says. "They can just hop back on calls with their video off, or if it was a body procedure, no one can tell they've had anything done from the neck up."
One of the most distinct differences between cosmetic trends now versus pre-COVID is the number of trips patients are willing to make in a short period of time, according to Frank. Instead, they are looking for one visit to encapsulate all of their needs at once.
"People aren't coming back for a few different treatments, like, 'Oh, I'll come for Botox today and laser next week.' No, that was pre-COVID life," says Frank. "People are coming in once saying, "Let's knock it all out. Give me my Botox, give me my filler, let's do Fraxel, let's do it all in one shot.'"
Despite seeing fewer patients each day, due to COVID-related protocols, the patients that Frank is seeing are spending several hours at his office at once; he estimates about 30 percent lower patient volume but at least double the number of treatments he's performing on each patient due to the combination of several procedures at once.
Given the strict limitation of patients that doctors are able to see daily, they likely will have to wait longer between appointments than before, meaning that dose-dependent treatments, like Botox, are trending to be administered in their standard dosage quantities versus a smaller injection that requires more maintenance, i.e., frequent doctor visits, to maintain the same appearance.
"Microdosing seems like a great idea because it's super natural, but the dose has to do with longevity; the more toxin you use, the longer it lasts," explains Sieber. "And right now, in the state we're in, it means a person might need to come in every one to two months instead of three to four."
Combine the shorter toxin lifespan with spaced-out appointments and increased demand, microdosing is "not something I'm really going to recommend right now," says Sieber. "It's more a recipe for frustration than anything else because the upkeep is constant, and there's kind of a safety component to that, too."
An injectable that Philadelphia-based board-certified plastic surgeon Jason Bloom is excited about for 2021 is DAXI (short for DaxibotulinumtoxinA for Injection), the first U.S.-developed and manufactured neurotoxic neuromodulator product. It's currently awaiting approval by the U.S. Food and Drug Administration (FDA), which was postponed from November 2019, due to the spread of COVID-19.
As a paid medical advisor and trainer for Revance, the pharmaceutical company behind DAXI, Bloom has had a front-row seat to the new toxin's development. "Studies really show this is a phenomenal product," he says, adding that its enduring power of six months, versus Botox's three- to four-month lifespan, is the hype characteristic, especially as fillers, on average, span six to eight months. "People love the idea of longevity, and another benefit is that you could consolidate your neuromodulators and fillers into one appointment and really time it moving forward," he says. "It just makes it more convenient for patients to be on one injectable cycle."
With the new ability to camouflage recovery while working from home, doctors have been witnessing patients opting to go all-in for a more intensive surgical procedure to resolve their concern completely and definitively.
"COVID has really reversed the idea of non-surgical solutions; people would much rather get the full surgery than dilly-dally with fillers," offers Sieber. "Even fiscally, it makes more sense to just have the operation than it does to mess around, getting a bunch of cycles of CoolSculpting or spending a ton of money on Sculptra, or fillers, or Thermage, when what you really want is just to have a face-lift or hi-def liposuction. They'd rather just get the full thing done right now, whatever it is."
According to the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS)’s 2020 member survey, 90 percent of facial plastic surgeons who responded cited an increase in bookings and treatments since last March of more than 10 percent.
At Bashey's Los Angeles practice, it's been the two busiest years he's ever had, and he chalks it up to our new 24/7, on-camera lifestyle, which, he says, is making people "much more self-conscious now than they were before," spurring a huge "push towards facial anatomy — things like chin, cheek and jaw" to sharpen the jawline angles and resolve a skyrocketing patient request: the "tech neck."
"I do a lot of things in the neck in terms of injections. I do a lot of platysma band injections with toxin. Kybella can be used to tighten the jawline. You can also inject Sculptra or hyperdiluted Radiesse into the neck, which I do all the time," Bashey says, ticking off the list. "And then thread-lifting, like pulling threads or the monofilament threads, helps a lot with the upper part of the neck as well, and radiofrequency devices improve the neck a lot, too."
Not to mention, notes Bloom, two of the most popular dermal fillers, Restylane Defyne and Juvéderm Voluma XC, have been approved within the past year to give a little projection to the chin. "Focusing on the profile, across the board, is really hot right now," he says. "Adding filler to the chin and anterior jawline to sharpen the jawline and improve the neck has been really, really popular."
As Frank succinctly puts it: Patients are requesting the face-lift effect without going through a face-lift or a neck lift. To jet around the face-lift-without-a-face-lift challenge, Frank performs FaceTite, "a modern-day version of micro-liposuction on the neck," is how he describes the quick, one-hour outpatient procedure to "get rid of the fat, tighten the skin, and improve the crepiness of the neck" with an almost unbelievably short —24-hour — recovery time.
Demand for plastic surgery and longer-recovery cosmetic procedures may be off the charts right now, but as more Americans get vaccinated over the next few months, they're not going to want to spend their newfound freedom in a doctor's office, or in recovery at home, anticipates the experts Allure spoke to. Frank expects his patients will want to be "partying like it's 1999."
As Sieber explains, "people have stayed at home for so long, they're going to want to leave, to start traveling, and doing all the things they haven't been able to do for the past year." And when is he preparing his practice for a slowdown? "I think as soon as people are vaccinated and can travel again, they're just going to go, they aren’t going to stick around to have a procedure."
On the flip side, the dermatologists we spoke with anticipate that as Americans become more comfortable resuming their old routines, skin care and injectables will take center stage. "Their purpose will change, and they'll want to be the best version of themselves with things that take more maintenance," reasons Frank, like injectables or a weekly series of lighter treatments, which have sharply dropped in popularity at his practice since the start of the pandemic.
"I think once the world opens up, people will be more apt to do treatments where I'll need to see them once every two weeks for five sessions," he says. "I think moving forward, people are going to be very enthusiastic to do things to make them feel good about themselves again, including their routine of skin care."
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