With millions of Americans working from home and avoiding socializing outside of their immediate family and close friends, much has been written about plummeting sales for industries that thrive on people going out, like makeup, and clothing retailers.

That is not the case for plastic surgery. On the contrary, extra time holing up at home has provided a boom in cosmetic services practices that offer popular—and pricey—skin care treatments like Botox and dermal fillers.

Even before some lockdowns were lifted around the country this summer, interest in plastic surgery was already bubbling over as people were isolating. In June, a survey conducted by the American Society of Plastic Surgeons (ASPS) of more than 1,000 consumers found that 49% of those who haven’t had plastic surgery indicated they are open to cosmetic or reconstructive treatment in the near future. Another ASPS study published the same month found that 64% of U.S. plastic surgeons had seen an increase in their telemedicine consultations since before COVID-19 began.

Based on conversations with dermatologists on both coasts, there isn’t just one motivation for this surge, but rather a convergence of some of the pandemic’s most mundane but ubiquitous traits: plenty of time spent at home, empty calendars, less socializing, face mask mandates, and Zoom.

Dr. Marie Hayag, a dermatologist and founder of Fifth Avenue Aesthetics in New York City’s Upper East Side neighborhood, underscores what she calls “the Zoom effect,” explaining she has heard a lot of complaints from new and returning patients about double chins, wrinkles, and eye bags they noticed while videoconferencing. Among the most popular treatments at her clinic right now: neuromodulars (such as Botox) targeting fine lines and wrinkles, platelet-rich plasma (PRP) therapy for hair loss resulting from stress, facial treatment for “maskne,” and body sculpting and contouring with CoolSculpting and Emsculpt (because most gyms and fitness centers have been closed until recently).

Hayag suggests having the extra time itself might not be the only big scheduling factor; after being stuck at home, people are looking for various ways to fill and pass the time, too.

“More patients are working from home and can receive procedures that require them to ‘hide at home’ for a few days,” says Hayag. “There are no social events to worry about in terms of downtime. And it gives them something to do, and they look forward to it. It gives them a break from Zoom meetings and their kids at home. There are limited places they can go to and feel comfortable going. I’ve had patients come to me first before getting their mammograms.”

In the Before Times, one of the primary barriers to scheduling cosmetic surgery was that inability to have downtime, a necessity for both invasive and noninvasive procedures that often result in very visible bruising and discoloration while healing.

“Now that most people are working from home, that barrier has been lifted, and so more aggressive lasering isn’t as daunting as it once was,” says Dr. Dhaval G. Bhanusali, a dermatologist and laser surgeon at Hudson Dermatology and Laser Surgery, his private practice in Manhattan. “I think the countless Zoom meetings have forced us all to critically analyze ourselves, way more than we probably should.”

Bhanusali notes his practice has also turned down certain patient requests more frequently. “As physicians, it is our duty to also serve our patients responsibly, and if they are being overly critical of themselves or unrealistic, we need to do the right thing and gently let them know,” he explains. “Given the current environment, that does happen quite a bit, so we have to sometimes step in and intervene.”

Business at GoodSkin Clinics, founded by Lisa Goodman, was thriving before the pandemic started and still is. And they too have had to turn down patient requests. The company’s new Los Angeles clinic with five treatment rooms opened in March, but then closed as soon as California stay-at-home orders took hold, as did its New York office. After reopening in late spring, Goodman says the clinics received an influx of requests from clients inquiring about treatments they wanted performed at home, but she says they were adamant in not entertaining these to protect the health and safety of her team.

Dr. Lisa Cassileth, a plastic and reconstructive surgeon as well as founder and CEO of Cassileth Plastic Surgery in Beverly Hills, admits she expected business to drop as the pandemic and subsequent economic crisis continued. Pre-pandemic, Cassileth says business was good as patients had more disposable income, and were excited to do popular procedures like liposuction, breast implants, and tummy tucks.

After shutdown measures went into place in March, her facility was able to stay open only for breast cancer patients, with a skeleton crew on-site for patient care while everyone else worked from home. Doctors specializing in facial aesthetic surgery did not work at all. Although most patients wanted to cancel their procedures, Cassileth says a small percentage instead moved their procedures up or frantically tried to put them on the schedule right before the shutdown. “The few that were able to undergo their procedures are very proud of themselves today, as it turned out it was a great time to recover as the world was so separated and distracted,” she says.

“As people became more in touch with themselves at home, business increased and the patient type shifted,” Cassileth explains. Instead of quick fixes and impulse procedures, patients are asking for procedures they have thought about and wanted for years. Breast reductions for 40-plus-year-olds, abdominoplasty on mothers with teenagers, and breast implant removals are common consultation topics.

But not everyone has extra time these days. Since the school year started, Cassileth says there has been another round of cancellations and rebookings as many moms have increased responsibilities with kids doing remote learning. So they’re putting off their appointments until early next year when they expect (or hope) to be less busy. “The interest is up, but the free time is down.”

In the eye of the beholder

Perhaps not surprisingly, many patients have homed in on the area around their eyes as we’re all out and about wearing face masks. Goodman says under-eye fillers, quoted at $1,700 per treatment, are a top draw right now.

“I think that speaks to the fact that people are doing these treatments to feel more confident in their own skin versus impressing others, which is really great to see in my opinion,” Goodman says.

But if the most visible part of the face is now around the eyes and forehead because of face masks, it’s also thanks to face masks that cosmetic surgery patients are increasingly eager to get work done around their nose or lips—precisely because they’ll remain hidden while bruised and discolored during recovery.

“Masks can cover any temporary bruises and marks on the lower part of the face,” Hayag says. “Patients that delayed their maintenance treatments for months were desperate to begin anew their beauty regimen after seeing what a difference it made to their appearance.”

As the pandemic continues, Hayag posits that the upward trend for cosmetic procedures will continue for a multitude of reasons, including that the practices of social distancing and wearing face masks will likely continue even after a vaccine for COVID-19 has been approved. Patients have also become more comfortable with telemedicine and consults via videoconferencing software, and many people will probably continue to work from home, at least more frequently if not daily.

Cassileth is also expecting a greater focus on telemedicine, and says now the first meeting with a new patient is often done through a video call. “Interestingly, the closure rate on these visits is higher,” she adds. “Patients have told us that the doctor seems to be fully paying attention, and there is a better connection.”

Bhanusali thinks we are going to see more and more cosmetic procedures, but the trend will be toward a more natural look and aesthetic. “I also think this will fall more into wellness than anything else. Similar to that first haircut after quarantine, there is something therapeutic about taking care of yourself in a manner that makes you happy,” Bhanusali says. “In the pre-COVID world, we were always on the go and running from meeting to meeting, event to event. With this life pause, we’ve all thought more and more about what makes us happy. My hope is that we are all kinder to each other and most importantly, ourselves.”