The evolution in communication over the last 18 months has been transformational leading to adapting to the use of video conferencing platforms in almost all fields, perhaps of most note, education and medicine [1,2,3]. Indeed, this increase in remote video interaction has also led to an upturn in the number of requests for teleconsultations with plastic surgeons in private practice (70% in the UK and 64% in the USA) [4,5,6,7,8]. There has been speculation surrounding the possible correlation between this increase in seeking cosmetic surgery being linked to the concept of “lockdown face” and whether constant exposure to one’s image in video conferencing has led to changes in the way we perceive our own image, perhaps even distorting it [7, 9]. This potential change in our self-perception, however, could be linked not only to the time spent looking at our own image and noticing one’s flaws but also the psychological impact of the pandemic on patients’ moods [7, 10].

Previous literature within the field of breast cancer and reconstruction has identified a clear correlation between mood levels and women’s body-image perception [10]. Moreover, the decision by the majority of healthcare systems to defer elective surgery during the pandemic, including breast reconstruction [11,12,13], has also likely worsened this psychological impact. Although a direct link between the psychological well-being of patients seeking cosmetic surgery as a result of the “Zoom Boom” and patients undergoing mastectomies and reconstructions [14,15,16,17,18,19,20,21] may not be immediate, particularly as oncoplastic patients face greater psychological challenges, self-isolation and lower moods during the pandemic should not be ruled out as potential motives for expressing a desire to enhance one’s appearance. Therefore, this study investigated the correlation between the pandemic era and seeking cosmetic surgery with a specific focus on the psychological impact of the pandemic on body-image perception.

An anonymous web-based poll was designed and distributed through social networks in both Italy and the UK throughout the month of May 2021. The questions were designed to gather responses on the following areas: 1. patient demographics (age, gender, location, highest qualification); 2. cosmetic procedure being sought; 3. reasons for seeking cosmetic surgery; 4. delays to cosmetic surgery caused by the SARS-COV-2 pandemic; 5. pandemic effects on mood; 6. the influence of video conferencing on body-image perception.

A total of 159 respondents completed the online poll (73% females and 27% males), and the mean age of participants was 43 years old; 56% were based in the UK and 44% in Italy; 57% of respondents had an undergraduate degree (minimum three years of study). The types of surgeries indicated were predominantly to the upper body and face (78%) with almost two-thirds of these opting for minor facial procedures (56% botulinum toxin injection; 32% filler injections; 12% both), and the other-third were evenly orientated toward breast surgery and other more invasive facial procedures (rhinoplasty and rhytidectomy). Other desirable procedures included lower body interventions (liposuction at 15% and abdominoplasty 7%).

Patients were more inclined to undergo cosmetic surgery during the pandemic mainly due to both their wish to improve their “lockdown face” for video conferencing (61%) and also due to the benefits of home recovery while in smart working (36%). Furthermore, although 81% of respondents stated that video conferencing had impacted on their body-image perception, delays and access to surgeons during the pandemic were perceived as having a negative impact on patient’s moods (95%) and participants claimed that their body-image perception and self-esteem were lower than in the pre-pandemic, particularly during lockdown (72%).

The data indicate that the majority of patients state they are seeking cosmetic surgery in order to improve their “lockdown face” and that video conferencing has indeed negatively influenced their body-image perception [7]. This is also supported by the figures regarding the type of surgery requested as 69% of patients indicated that they are seeking a facial procedure (either minor or major). This would therefore confirm the hypothesis that the influence of video conferencing has led to an increase in requests for consultations with plastic surgeons (even if these do not necessarily materialize into surgeries).

However, the cause for such an increase cannot purely be attributed to time spent on online meetings noticing flaws, but other factors should be evaluated. Indeed, the 31% of respondents who were seeking non-facial surgery were likely not influenced by video conferencing and it is pertinent to consider that mood levels were also one of the motivating factors. This is confirmed by the fact that almost all patients (95%) indicate that delays, backlogs and access to surgeons during the pandemic impacted negatively on their mood and 72% of patients confirmed that the pandemic caused both lower self-esteem and worsened perception of their body-image in general (not just facially).

Therefore, even though video conferencing would appear to play a key role in the increase in requests for cosmetic surgery consultations, our results suggest that a patient’s negative self-perception is also likely linked to the psychological impact of the pandemic on moods and potential levels of depression. It is thus paramount that plastic surgeons carry out a correct evaluation of the actual motivating factor which leads a patient to request cosmetic surgery and their overall well-being in order to fully meet patient expectations and avoid discontentment with the aesthetic outcomes. It would be advisable for further studies to be advanced in this sense in order to continue to guarantee the high ethical standards and safety of patients who undergo cosmetic surgery.