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Long before stay-at-home orders forced millions of us to talk to each other online, most people weren't all that keen on what they looked like on Zoom. Heather Schwedel was one of them.

At one of her Zoom meetings, "a gargoyle" stared back at her from her laptop screen, Schwedel, who works for the online magazine Slate, wrote in December.

It was her face, which somehow looked a "dull shade of greige (you know, gray-beige)."

And, was one of her eyes "wonky"?

"I don't think it's especially vain of me or anyone else to worry about my on-camera grotesquery; video conferencing awakens the vanity in all of us," wrote Schwedel, who, it must be said, exaggerated with that unkind assessment of her face.

Seeing our faces in full Zoom, in fact, has been enough of a shock during the pandemic -- when Americans are visiting with family, working, going to school, dating, getting married and even throwing a national political convention online -- to send some of us to the plastic surgeon.

Members of the American Society of Plastic Surgeons across the country report increased demand for cosmetic enhancements, especially Botox injections and fillers that erase lines, wrinkles, crow's feet and all those telltale signs of aging on the face. Patients are also inquiring about more invasive surgical procedures, including tummy tucks, breast augmentations and liposuction.

As Dr. Michelle De Souza, a plastic surgeon for the University of Kansas Health System, and her colleagues cleared a backlog of procedures after covid-19 stay-at-home orders were lifted, she also began fielding "all these cosmetic consults."

One possible reason?

"It is a Zoom thing," De Souza said. "They are commenting on their appearance on the webcam or the computer, that they look tired, they look mean.

"I just think the camera sometimes is not flattering."

EYES AND FOREHEADS

Wearing masks has people focusing more closely on their eyes and foreheads -- the parts of their face not hidden. "With a mask on it's harder to express your emotions," De Souza said. "So if all you're seeing is just your brow that may be furrowed or scowling, you probably don't look as happy as you feel."

She said patients who were already curious about plastic surgery told her, "They're at home not doing anything. They can't go anywhere. They're still, for these people, working, so they are making money but they can't spend it.

"So with the downtime that's kind of built-in from them working from home, or not traveling, they're like, 'Well, let's get this surgery done ... this seemed like the right time.'"

Schwedel recalled seeing a meme a few months ago suggesting that Zoom's slogan should be something like "it's you, but ugly."

"That kind of says it all to me: Everyone feels this way," she told The Star recently. "When there's a thumbnail version of you on screen, it's really hard not to look at it and start critiquing your face.

"I'm a little skeptical about whether that alone drove anyone to plastic surgery, but for anyone who was already contemplating Zoomoplasty, it's not like the loneliness and anxiety of this crisis was going to improve anyone's self-esteem.

"It seems like having the time to recuperate while healing is just as or if not more important than the Zoom uglies as a motivating factor."

IT'S ALL ABOUT THE FACE

Before covid-19, Botox and other minimally invasive cosmetic procedures were growing at a slightly higher rate than surgical procedures such as face-lifts, the plastic surgeons society says, up 2% from 2018 to 16.3 million performed last year.

The five most popular minimally invasive procedures: Botulinum toxin type A (Botox is one brand name), soft tissue fillers, chemical peels, laser hair removal and intense pulsed light treatment, a skin treatment that works similarly to laser therapy.

"It's been an increasing trend for years now," said Dr. Lynn Jeffers, a plastic surgeon in Ventura County, Calif., and president of the American Society of Plastic Surgeons.

"I think part of it is ... some people aren't quite ready to have a procedure like a face-lift, yet in the meantime, they can use Botox and fillers and peels and lasers and all the things that are out there, minimally invasive procedures, as a bridge.

"Also, some people don't need surgery yet but they can still start to see the signs of aging, so they walk in and say, 'What can you do with this?'"

One California plastic surgeon, Dr. Scott Miller, who sent out a news release about this pandemic trend, reported that people are bringing him screenshots from their Zoom calls, anxious about how their necks and jowls look on small screens.

'PICK UP ON THINGS'

"Working from home, being seen a lot (and seeing themselves) via company video conferences, and having mask-wearing bring increased focus to certain facial features, I think a lot of people have had a tremendous amount of time to be super-critical of themselves," Miller said. "They pick up on things they want to improve about their appearance."

But do we really look that bad on Zoom (or Webex, Google Hangouts or whatever online mode our meetings take)?

"Zoom especially has shown many of us that it does matter, for example, the quality of your camera, the lighting, the position of your camera, which angle it's looking at you from," Jeffers said.

"Of course, many YouTubers could have told you that a long time ago, but most of us weren't recording ourselves or putting ourselves out there as much as we have during this entire crisis.

"If you talk to any of them they can tell you straight off the bat where the camera should be, what the lighting should look like. And now, of course, there are YouTube videos about that. But I think many of us have sort of gotten a crash course on that with all the Zooms we've had to do.

"And it does matter if the camera comes from above or below. If it comes from below it really accentuates that double chin, right? And if you have your lighting not quite right then it accentuates every bag and every shadow and every jowl, so it looks worse than if you used different types of lighting.

"So I do think people, especially if you set up Zoom in gallery view, you can see yourself as well as everybody else and you think, my gosh I didn't know I looked like that!"

NOT COVERED BY INSURANCE

Cosmetic procedures are not covered by insurance. The national average physician fee alone for one Botox injection is $408, and more than $2,000 for a nonsurgical skin-tightening procedure, according to the plastic surgeons' group.

Plastic surgeons who shut down their offices earlier this year after covid-19 hit weren't sure what was going to happen when they reopened, Jeffers said.

A June survey of more than 350 members of the plastic surgeons' society predicted what the top plastic surgery procedures for 2020 will be, based on what they're heard from clients via telemedicine consultations, which have boomed during the pandemic as they have in other medical fields.

Botox injections so far have been this year's most-requested treatment, followed by breast augmentations, soft tissue fillers, liposuction and abdominoplasty, or a tummy tuck.

"Anecdotally, I would say across the country there seemed to have been a pent-up demand, more than we expected," Jeffers said.

"Also many of us were working from home, people who were waiting until the holidays or later to do their surgery were like, 'This is a great time because now I can recover at home and still work and (no one has) to see me recovering," Jeffers said. "Whereas before they might have tried to wait for a holiday or wait for some time off or some vacation time.

"I think no one knows for sure why the anecdotal reports are the way they are, and no one knows for sure if it's going to stay that way or whether that was just a pent-up demand and it will go back to normal or even dip."

Much of that, Jeffers said, will probably depend on the economy and what else happens over the coming months.

"I think people are still expecting there to be a time when we can go into offices again," Schwedel said. "Isn't the beauty of getting Botox to look better on Zoom, that it will probably also improve how you look in real life?"

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