Aesthetic Dermatology in 2021

Some aesthetic societies and companies have reported that the demand for aesthetic procedures is on the rise nearly a year after the start of the COVID-19 pandemic forced many dermatology practices to temporarily close or reduce their hours and shift their practices to meet safety and social distancing protocols. Many are even citing a “Zoom Boom.”

AEDIT, the online portal that connects aesthetic patients and providers, says the rise of video conferencing for work and personal communications, as well as rapid growth in aesthetic technologies, has helped to strengthen demand for aesthetic treatments and procedures over the past year. In December 2020, AEDIT conducted an online poll of 1,000 men and women and found 50 percent of respondents expressed interest in non-surgical treatments while 53 percent were interested in surgical procedures. Nearly one-third of respondents regularly participate in video conferencing, 20 percent of whom reported an interest in treatments to look better on video.

Ahead, dermatologists discuss the trends they’re seeing in their practices and how things have changed in the last year.

Is the Zoom effect is real? How different does your practice look now since pre-COVID-19?

Michael H. Gold, MD: I think the Zoom Boom is very real, and we have seen this as the pandemic is playing out. When our offices were forced to close in March and April of last year, when we were able to open, we saw an immediate increase in the number of patients asking for and coming in for neuromodulators and for dermal fillers, mainly as a result of being on virtual platforms for work and other social activities. Patients had never spent as much time looking at themselves via a computer screen, and with Zoom and other platforms, this became and still is a main way for all of us to connect. I think we have all seen an initial surge in patients coming in for these procedures and now, months after we have been open, we are at similar levels as to what we were pre-pandemic. Our office has been having promotional events we call “above the mask,” “beneath the mask,” and “under (or below) the mask,” to treat patients with our injectables, but also utilizing energy-based devices and appropriate skin care. We also have seen a rise in body contouring and fat procedures—the Quarantine 15 or 20 weight gain has been seen in many patients, and they are coming in more and more for body contouring and fat reduction procedures. We also have several new hands-free devices for these procedures, which have become very popular as well. Overall, the cosmetic parts of our practice are back to pre-pandemic levels. And as a dermatologist, I always say, the virus does not know that there is acne, atopic dermatitis, psoriasis, or skin cancers out there–so med derm is doing very well; based on how many patients your practice can safely see, you should see med derm back to pre-pandemic levels at this time as well. This is predicated on the vaccine rollout and containment of variants we are seeing enter the US at this time.

S. Mangula Jegasothy, MD: I think the “Zoom Boom” is a clever marketing explanation, and certainly people do see themselves much more on Zoom than they did on conference calls. But it’s just a small contributor to the volume of patients I continued to see in my practice in 2020. A far bigger contributor was simply that my patients weren’t traveling/going to expensive social events and therefore not buying clothes/purses/shoes as much. So, their disposable income was accumulating as the year wore on, and a COVID-safe, valuable way to spend it was with us. And I am very grateful for my patient demographic and the trust they place in me. My numbers are still not at 2019 levels, because I have a decent number of international and multiple home patients who are simply not traveling to Miami right now.

Melissa Kanchanapoomi Levin, MD: Absolutely, and I think there’re multiple reasons for that. I think there’s that TikTok/Zoom phenomenon of folks seeing themselves in angles that, honestly, probably don’t really matter outside of the whole virtual world of angling your camera in a certain way and seeing yourself in a less than ideal light. So the lower face, the jaw, the lips, the jowls, the neck, those are all areas that we used to have to educate patients about, but now patients come in asking for that.

Sabrina Fabi, MD: I’m seeing about 25 percent fewer patients than prior to COVID because we’re still trying to respect social distancing. We can’t have as much staff in the office supporting us as we used to, but it is giving me more time to spend with my individual patients, which I appreciate. The demand is there, but I think it’s not just Zoom. I think it’s also that people don’t have other things to spend on. They can’t go on trips. In some places, like California, we really couldn’t go out to dinner for the last two months. People are taking that money and spending it on themselves, and maybe seeing themselves more at home is a motivating factor to actually now spend the money on themselves.

What are the most common treatments patients are seeking? Has this changed in the last year?

Dr. Levin: We’ve seen a big uptick in lower face procedures and neck procedures. And because more patients are working from home, they can afford more downtime. In New York, we have seasonality of procedures. In winter, with no sun exposure, people tend to be more focused on lasers and energy-based devices, and that’s huge right now. Normally it is larger than the injectable side during this time of the year, but I think it’s grown significantly now because of patients’ lifestyles.

It’s been a year that people haven’t had a normal life. The “Quarantine 15” is real. I see a lot more patients who have gained weight, haven’t kept up with their hair, their skin, their face. And that’s why I think people tend to focus more on the face and neck because of the Zoom effect. But I think as we come out of quarantine, we will definitely see a rise in body work.

Dr. Fabi: I am seeing more aggressive procedures. Patients have the downtime to do it—whether it’s laser resurfacing or neck lipo. There is definitely more of an emphasis on the face and neck.

Dr. Jegasothy: I fine-tuned my practice recently to not have any procedures that necessitate more than a two-day recovery. So my procedural breakdown and percentages have basically remained the same—even my pre-holiday injection “rush” happened, because Floridians are not as strict as the rest of the country, for better or worse.

Dr. Gold: The procedures we are seeing the most right now are anything to minimize lines and wrinkles and to smoothen the skin of the face—because of the Zoom effect—neuromodulators, dermal fillers, intense pulsed light, RF microneedling, and ablative non-ablative and ablative fractional lasers are all popular as is ultrasound with our newer devices.

What are some of the biggest challenges to offering aesthetic treatments now? Are there treatments you are not offering because of COVID safety measures?

Dr. Gold: We are now doing all of the cosmetic procedures again in our practice–as we opened our offices in May of last year. We kept ablative procedures to a minimum but after several months, we opened those procedures as well. All precautions are being taken. We limit the numbers of patients in the office at any given time; we limit others coming with our patients as much as possible; we have all our personnel in N95 masks and shields and of course gloves and gowns; and we clean things every other minute. We also take great care in making sure that the patients are kept safe, wear masks until we are doing any facial procedures, but if off the face, they always wear masks.

Dr. Jegasothy: The biggest challenge for us now is being heard when I consult patients through a mask plus plexiglas with air purifiers humming. I may have to take voice lessons if double-barriers become a procedural standard.

Dr. Fabi: There are no treatments we are not performing, but we still cannot see the same volume of patients because of social distancing. We have to check patients out in their room and try to minimize a lot of walking through the clinic. We don’t have a waiting room where people can wait—they have to wait in their car. There are six of us who practice in the same space, so we just can’t have the volume coming in.

Dr. Levin: Obviously in New York people are really careful and want to make sure that you’re taking the right protocol with cleansing. We still haven’t used our waiting room. We used to have a numbing room that was enough for two patients to sit in. Now we don’t use that room at all because we keep patients completely separate. The way that we used to overlap patients and schedule is significantly different. It’s hard because we have folks who really want to get in, but then we just don’t have the ability to see as many patients as we used to.

I think in health care, we’ve figured out how to really protect the team, protect the staff, protect the patients. My clinical staff is completely fully vaccinated. I still wear an N-95 and then a mask on top of that. We’re just very careful and we keep the office very uncrowded, very limited number of people, no guests allowed, and very clear communication before and after regarding safety protocols. We still do a good amount of teledermatology. We still do a good amount of virtual cosmetic consultations, virtual cosmetic follow-up. Everyone, obviously, is mandated to wear a mask and not allowed into the space without a mask, they do a questionnaire beforehand, so there are no procedures that I don’t do.

What new approvals or launches in aesthetics are you most excited about and why? Is there anything in the pipeline that you’re especially excited about?

Dr. Gold: I am most excited with some of the hands-free treatments we are seeing these days—the Evolve and Evoke from InMode, the FlexSure from Cynosure, and the Venus Bliss. These are all new and exciting. I also like the short pulsed 1064 nm laser from Aerolase where it is also touch-free and virtually painless for treating a variety of skin conditions. In addition, Sciton has the new HERO IPL rapid in-motion IPL where we are also seeing some phenomenal results. And the SofWave ultrasound is showing very nice skin tightening with their new technology.

One of the more exciting things in the pipeline is AI and robotics coming to our cosmetic world in a bigger way. We should see more and more in a very short period of time.

Dr. Jegasothy: I’m very excited about Qwo, the injectable collagenase with the new dimpled cellulite indication and its launch in March 2021. In sun-soaked and body-conscious Miami my aesthetic practice has always been equally face and body-focused, but since I avoid big recovery procedures, I never did Cellulaze treatments and so have only been able to successfully treat wavy cellulite until now. This treatment will fill a big unmet need with my patients!

In the pipeline, the Cytrellis device for skin tightening seems to be showing significant promise in its FDA trials, and I am always looking forward to evolving body contouring machines.

Dr. Levin: For the body, I think Qwo is exciting. I think that will be timely with us hopefully coming out of the pandemic in a more meaningful way, and the combination with doing more biostimulatory fillers, like hyper-diluted Radiesse and Sculptra on the body in combination with energy-based devices like Ultherapy and RF microneedling.

We’re starting to see more devices that are focused on removals of benign lesions. I’m pretty excited about CellFX from Pulse Biosciences, which just got FDA approval. My practice is one of the 40 practices that will be part of the KOL launch, so that’s really exciting.

And I’m excited about an update of a platform that’s really been a foundation for us: the BBL broadband light from Sciton. They introduced their Hero BBL, which is firing at a much higher frequency and is really designed for body as well. I think there’s going to be a lot more interest in body work.

Dr. Fabi: We’ve recently added the CoolSculpting Elite into our practice. We were one of the beta sites. Now with two machines, we can treat four areas in 35 minutes. It’s been really great to be able to save people time, and they feel more comfortable not having to sit in our office for that many hours to treat their whole body. We’re excited for Qwo. I’m participating in the launch, so I’m excited. I have been an investigator since 2012, so it’s nice to finally see it come onto the market and just in time for the summer. And I like the new Clear and Brilliant, which has remained very popular in our office.

What are some of the challenges to adding new procedures now?

Dr. Jegasothy: The big word that has overshadowed the Covid-19 pandemic also overshadows any new procedure or big investments in our practices—uncertainty. When will things be booming again? When will everybody return? Will I be too busy then to properly implement and market a new procedure? When, when, when?

Dr. Fabi: I think that our focus has been more about keeping people safe, and it’s gearing support protocols and clean rooms. Our mindset has been about not having people waiting in their cars for too long; the staff is not so focused on new procedures. The doctors may be, but the staff aren’t.

Dr. Levin: For me, it’s staffing because, our practice is still trying to very much socially distance the staff. I’ve kept some of my admin staff working remotely a couple of days a week, or one day a week, or one day a month, just so that admin time, they don’t really need to be on site. We also have been able to completely work remotely, which never has happened in medicine. There have been times where I’m the only one, or I have one staff member with me on site. It’s not ideal, but we figured out by harnessing technology platforms to be able to do that. But that’s also a challenge in terms of adding new procedures—the time and staff needed.

Dr. Gold: The biggest challenges that we all face is the cost factor as we are rebounding from a pandemic. Do you really want to spend a great deal of money on devices now or is it best to wait? One nice thing to mention is that the laser companies are producing more and more new machines—and that is a good thing to see that they are investing in the future.