The American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS), the world’s largest association of facial plastic surgeons, has just released its 2020 member survey results and reveals exactly how COVID-19 impacted facial plastic surgery trends, consumer influences and the professional aesthetic community.

2020 was anything but predictable. Here’s what changed.

Over the past few years, use of non-invasive procedures to forestall the signs of ageing have been steadily on the rise. The pandemic flipped the switch, creating a surge in surgical demand not seen in recent years. Despite the fact that many non-essential surgeries and aesthetic services were put on hold for months during the pandemic, AAFPRS members note that demand is now higher than ever.

A full 70 percent of AAFPRS surgeons report an increase in bookings and treatments over the course of the COVID-19 pandemic, with 9-in-10 facial plastic surgeons indicating an increase of more than 10 percent. Surgical procedures are the most common procedures as part of this upsurge, perhaps cancelling out any decreases that might have resulted from the economic crisis and lockdowns.

The AAFPRS members who experienced higher patient volume almost unanimously (96 percent) indicate that it is because men and women have more time and flexibility to recover from treatments due to social distancing and the benefits of working from home. Rhinoplasty (78 percent), facelifts (69 percent), eye lifts (65 percent) and neck lifts/treatments (58 percent) have increased most notably, likely due to more time spent on digital devices and an unprecedented virtual lifestyle.

For the first time in years, AAFPRS members report non-surgical treatment demand decreasing in 2020. The average amount of minimally invasive procedures was down by 9 percent compared to 2019, driven by a decline in skin treatments (down 29 percent) and fillers (down 8 percent). Neurotoxins remained consistent with 2019 demand. Supporting this, three-quarters of the work done by AAFPRS members in 2020 was facial plastic surgery.

Zoning in on ZOOM dysmorphia

Why the drastic shift? AAFPRS members point to the “ZOOM effect” as a major contributing factor in changing behaviours (according to 83 percent of respondents), while patients having more disposable income due to not spending it elsewhere is a strong second (64 percent) in patients changing behaviours.

“These factors, combined with masks, less travel and people being able to work from home without missing a beat in their career has led to a marked increase in surgical procedures,” states AAFPRS President, Paul J. Carniol, MD. “Last year presented completely uncharted territory for our industry, and these statistics point to a strong desire to look and feel confident that has not wavered despite major lifestyle changes and obstacles.”

As the first organisation to identify the “selfie-awareness” trend highlighted from previous annual surveys, the AAFPRS is now spotlighting an evolution of this hyper-awareness of one’s own on-screen image; only this time, it’s live and via video. Deemed “ZOOM dysmorphia” in a recent study published in the AAFPRS’ journal Facial Plastic Surgery & Aesthetic Medicine, the pressures of a virtual lifestyle had a huge impact on the way we view ourselves according to AAFPRS facial plastic surgeons.

From students stuck at a computer all day to adults working and socialising from behind a screen, the constant bombardment with one’s own image was responsible for significant self-perception shifts and could account for the intensified demand for facial plastic surgery. The number of teens seeking rhinoplasty is up from 2019, with 41 percent of surgeons identifying this as a rising trend along with the desire to look better on video conferencing (a new trend, reported by 16 percent of AAFPRS members).

“Real-time video cannot be FaceTuned or photoshopped to smooth out a bump on the nose, crow’s feet or a sagging neck,” shares Dr Carniol. “Unlike selfies and video editing apps like TikTok and Reels on Instagram, the video conferencing used for school, work and ZOOMing with family and friends does not allow for filtering capabilities, making it a particularly easy lens for self-scrutiny.”

While staring at yourself on screen all day became normalised in 2020, it follows that people asking for eyelid procedures to look less tired was highlighted as trending by 56 percent of surgeons.

The annual member survey also finds that many patients are still after that real-life filtered look, with 75 percent of surgeons detailing patients seeking cosmetic procedures to look better in selfies – up 33 percent overall since the AAFPRS first identified this trend in 2016.

The more things change, the more things stay the same…

The most common procedures were similar to 2019, despite the disruption caused by COVID-19. The three most common surgical procedures performed by AAFPRS members in 2020 were rhinoplasty, facelifts (including partial facelifts), and blepheroplasty.

Women continue to be the most likely patients for facial plastic surgery, with neurotoxins (72 percent), fillers (61 percent), and rhinoplasty (52 percent) topping the 2020 wish list. Hair transplantation is the only procedure for which men far surpass women. While most neurotoxin treatments were for female patients, last year saw a 27 percent increase in AAFPRS members reporting these injectables as one of the top three treatments for male patients.

Otoplasty (surgical reshaping of the outer ear) has the most gender equality, with 55 percent of survey participants saying the procedure is gender balanced. Coincidentally, “We’ve been hearing from a lot of patients that ears are a feature that stand out to them on video conferencing calls,” shares Dr Carniol.

The most common procedure among patients under 34-years-old is rhinoplasty, which remains consistent from 2018 and 2019. As for celebrity influence, 83 percent of surgeons indicate that everyone from A-Listers to vloggers to reality stars have a moderate-to-high level of influence on patient requests for facial plastic surgery – about the same as 2019, which saw an increase of 21 percent compared to 2016.

The lasting impact of COVID-19 concerns

2020 may have marked the full Millennial takeover of the aesthetic industry. Patients aged 56 or older represent a lower percentage of patients overall in 2020, perhaps due to concerns about COVID-19, while demand in the under 30 age group remains strong, even during a pandemic. Holding steady for three years in a row, the pandemic solidified that self-care remains top of Millennials’ priority list.

Patients’ top concerns regarding going under the knife changed a lot in the last year, with cost topping the consideration chart for the first time. Other top concerns included looking unnatural and recovery time, which was unsurprisingly down from 2019 as people worked from home and socialised less.

Safety first – now, more than ever

“Finding the right, most qualified, physician to perform any procedure should ALWAYS be a patient’s first priority,” says Steve Jurich, CEO and Executive Vice President of the AAFPRS.

Concerns about non-medical staff performing procedures poorly may be on the rise, with 42 percent of members citing this as a potential future trend.

The 2020 AAFPRS annual member survey was conducted in December 2020 by ACUPOLL Precision Research, Inc. through an online survey from a select group of the organisation’s 2,200 members.