What Happens Next?

On a recent episode of the video series “Coping with COVID-19” (co-produced by Practical Dermatology® magazine and Modern Aesthetics® magazine), Joel Schlessinger, MD; Joel L. Cohen, MD; Mark S. Nestor, MD, PhD; Doris Day, MD; Steve Dayan, MD; Michael Gold, MD; and Amy Forman Taub, MD put their heads together to ponder what cosmetic practices will look like after the COVID-19 crisis abates and aesthetic clinic doors are allowed to open.

Panelists all agree that the social and economic impacts of the coronavirus pandemic are much different than those of the terrorist attacks of September 11, 2001 and the financial crisis of 2008, both of which also affected the practice of aesthetic medicine. Yes, rates of cosmetic surgeries fell during and after these events with some geographic locales being harder hit than others. By contrast, coronavirus is ubiquitous and invisible, and its effects on public health and economics are wide-ranging.

Easing Waiting Room Phobia

In the aftermath of September 11, people across the country wanted to come together and were largely able to do so. This is not the case with coronavirus, and it won’t be for a very long time, which has direct implications for how aesthetic doctors will see and treat patients. In the pre-COVID-19 days, aesthetic waiting rooms were packed with eager patients waiting for their injectables, peels, or laser skin resurfacing treatments, but calls for social distancing will leave many reticent about any type of gathering, even ones that takes place in a doctor’s waiting room replete with hand sanitizer.

“After 9/11 people felt their mortality and wanted to look better,” shares Dr. Day, a New York City dermatologist. “They didn’t want to have surgery and take the bigger risk, but aesthetics grew. I worry that this will be different, because people will be afraid to go into a waiting room if other people are sitting in that waiting room.”

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Aesthetic Practice Status and Prognosis

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For these reasons, some physicians will take patient and staff temperatures with no-touch thermometers in addition to history and symptom screenings before appointments. If and when rapid antibody testing is available and reliable, these tests may assuage patient and staff fears and provide all comers with a sense of security.

Optics will matter more and more in the post-COVID-19 world. Some doctors with suburban practices may consider letting patients check in from their cars and/or provide pagers to let patients know when the doctor is ready, predicts Dr. Schlessinger, an Omaha, NE-based dermatologist and the founder of Cosmetic Surgery Forum.

Staggered appointment schedules can also help avoid crowds in the waiting room. Plexiglas or glass sneeze-guard shields for the front desk will be the new normal, and disposable branded masks with practice logos may well be the new give-away, replacing pens, water bottles, or ice packs.

“We will have to rethink and consider how we market,” says Dr. Schlessinger. “There are so many facets in what we do and how we do it that will have to change in the post-COVID era [including] some sensitivity that we have to consider for our ads.” He noted that shaking hands is no longer considered appropriate and shouldn’t be included in any marketing stills. In addition, patients and physicians should be wearing face coverings in these materials when and where appropriate.

Botox Boom

When clinic doors first (re)open, there will be a backlog of medical dermatology patients who will need to be prioritized. There may be a run on neuromodulators and fillers as patients will be past due and others have likely spent weeks examining their lines and folds during Zoom or other video conferencing meetings. In addition, with unemployment rates rising, many patients will be looking for jobs and want to hit refresh on their appearance to compete with younger applicants. Here in lies an opportunity for new practices or med spas to break in at lower price points to capture these patients.

“I won’t be surprised if we see med spas swell,” says Dr. Dayan, a facial plastic surgeon in Chicago. “Regulations are being reduced, and we may see med spas going crazy being able to inject and mobile spas showing up.”

Dr. Gold adds that dermatologists and plastic surgeons will have to educate consumers about risks associated with seeking treatment from unqualified and inexperienced injectors. “We will need to let cosmetic patients know that we are open and here and willing to work with them to offer added-value services,” he says. “Yes, you could go anywhere you want, but we have 20, 30 and 40 years of experience.”

First, do no harm

There are still many questions that need answers before cosmetic doctors can feel comfortable offering fillers and injectables to their patients in a post-COVID world. Even if a patient has no fever and antibodies that suggest he or she is no longer at risk, COVID-19 infection may represent a hypercoagulable state, and it is theoretically possible that soft tissue fillers could exacerbate vascularity in patients who are recovered but still somehow vulnerable, Dr. Day cautions.

“We have to position ourselves as looking out for our patients’ best interests,” adds Dr. Taub, Founder of Advanced Dermatology and skinfo Specialty Skincare Boutique in Lincolnshire, IL. It’s important to discuss potential and theoretical complications, she added. “It’s better to be safe than sorry and protect people.”

Procedures with less downtime and lower costs will likely also be quicker to make a comeback, says Dr. Cohen, Director of AboutSkinDermatology in Greenwood Village and Lone Tree, CO. Patients will not want to miss any more work than they already have due to shelter-in-place orders. “Patients will be less willing to do downtime procedures with the exception being people having a major event coming up,” he says. “Less expensive procedures that have cross-value, such as nonablative fractional lasers that make skin look better and will be doing something for skin cancer may be popular.”

Work from home will likely become more commonplace even when restrictions are lifted, adds Dr. Nestor, Director of the Center for Cosmetic Enhancement and Director of the Center for Clinical and Cosmetic Research in Aventura, FL. “This may be an opportunity, as now patients can do laser resurfacing since they don’t have to be at work.”

Paving the Way Forward

Teledermatology found its foothold during the pandemic and is likely here to stay. Cosmetic doctors will need to perfect the art of the online consultation, and medical dermatologists must develop protocols for assessing acne and atopic dermatitis and triaging skin cancer patients virtually. Still, these consults do have shortcomings and tend to lack that personal touch that sets many aesthetic physicians apart from their competition. In the future, care will likely be a hybrid model of teledermatology and in-office visits in the same patient.

While challenges remain, panelists are optimistic on the whole that this too shall pass and that America will rebuild and when this happens, patients and physicians will feel more comfortable seeking and providing care and aesthetic treatments.