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On April 27, the American Society of Plastic Surgeons (ASPS) released the 2020 results of its annual trends report, revealing the extent of the pandemic’s ripple effects in reshuffling nearly every aspect of the industry, from toppling the long-standing most-requested surgery to the growing consumer eagerness to spend more on cosmetic procedures in 2021. But one question remains unclear: Will these emerging trends gain momentum and steamroll into 2022, or will the industry snap back into its pre-pandemic, business-as-usual routine?

The total number of procedures declined in 2020

As COVID gripped the nation in early 2020, most states imposed restrictions — and in many cases, a straight up pause — on performing elective surgical procedures in order to free up hospital space and to preserve the dwindling supply of PPE gear for front line workers. During this time, lasix new york many plastic surgeons shifted to work on the frontlines as well.

The world's largest plastic surgery organization, clocking in at nearly 8,000 members, reported that they stopped performing elective surgical procedures for an average of 8.1 weeks, or 15 percent of the entire year, resulting in an overall decline in procedures. And the consequences of these sweeping halts nationwide on the aesthetics field need to be kept top of mind to properly evaluate the 2020 findings, says former ASPS president Alan Matarasso.

"You've got to remember, in places like New York, we took at least a quarter of the year off, so if you [adjust for] a full year, [the numbers] wouldn't be that far off," Matarasso tells Allure.

A growing number of women view plastic surgery in a positive light

In a survey of more than 1,000 women nationwide conducted with market research firm Equation Research, the ASPS found that 11 percent of women are more interested in cosmetic plastic surgery and treatments than they were before COVID.

To really hammer home the growing lure of aesthetics, 35 percent of surveyed women who already have one cosmetic enhancement procedure under their belt are future tripping their next treatments in 2021, with plans to spend more on procedures this year than last. To New York City-based board-certified plastic surgeon Adam Kolker, it's not terribly shocking that "people who have experienced first-hand how an aesthetic procedure can enhance beauty, balance, youthfulness, confidence and self esteem, are likely to consider other procedures in the future."

Nose reshaping replaced breast augmentation as the #1 cosmetic surgical procedure

A total of 352,555 rhinoplasty procedures were performed in 2020, displacing breast augmentations as the top procedure — a title the surgery has held since 2006. As Allure previously reported, the pandemic stirred a boom in facial procedures, elevating eyelid surgery (352,112), and facelifts (234,374) to the second and third most-performed procedures, with liposuction (211,067) and breast augmentation (193,073) rounding out last year’s top five cosmetic surgical procedures.

One theory for the rise of the rhinoplasty is that we've been staring at our faces on video calls all day, so the focus has moved up from the body. Another theory is dependent upon the varying demographics that tend to book facial versus body procedures, although the survey didn't specifically note who was getting which types of surgery. "Traditionally, there are different groups of people who are interested in each of these procedures," explains board-certified plastic surgeon Lynn Jeffers, immediate past president of the ASPS, who as chief medical officer simultaneously led the COVID response at St. John's Regional Medical Center in California.

Jeffers points out that younger people more commonly book breast procedures than someone older, who are more likely to go for a facelift or eyelift. "It may very well be that the people who are interested in rhinoplasty, or facial procedures, are demographically different and have been, potentially, less affected by COVID, whether that’s from a financial standpoint or job uncertainty." She also points out that there are a higher proportion of men who get rhinoplasties than who get breast augmentation.

And what of the patients who have long seesawed the rhinoplasty decision, but always find themselves a little gun shy to make a permanent change? Enter: the wildly popular nonsurgical (or liquid) rhinoplasty. With the flash of a temporary and dissolvable hyaluronic-based filler, any unwanted bumps or dips on the bridge of the nose can be filled in to temporarily reshape and improve the profile, serving as an almost commitment-free rhinoplasty test drive to see how the real thing may look. By taking this baby step first, many prospective rhinoplasty patients feel confident making the leap to the real thing.

However, Jeffers isn't quite ready to forecast 2022 predictions just yet: "We'll see if this popularity continues, or whether this was a difference due to our COVID lifestyle and looking at our faces all day on a big computer screen."

But breast augmentations are still incredibly popular

Despite the breast augmentation's hard and fast fall from first place to fifth, all three surgeons Allure interviewed maintained the popularity of the procedure, and described the change as "not so much of a reduction in breast augmentations as an increase in the other procedures," explains Matarasso, highlighting the fact that the precise number of facial surgeries performed was much higher last year, thanks in large part, to our digital lifestyle. "We can explain the vast increase in [the facial procedures] by the Zoom aspect of things, by being at home and able to recover without going into the office."

Kolker adds that the specific number of breast augmentations between 2019 and 2020 "represents a roughly 10 percent change during a year that the average plastic surgery practice shutdown time was 15 percent," suggesting that "the 2020 data have either remained consistent or increased," if adjusting for an average 15 percent practice closure time.

Minimally invasive treatments dropped for the first time in four years

Amidst national stay at home orders in 2020, less invasive procedures — such as fillers and chemical peels — dropped for the first time in four years. And the decrease was a bit more than their surgical sisters, 16 perfect versus 14 percent, respectively.

Yet, in spite of the year's extended quarantine, injectables were still the most popular treatment, as patients clamored to reschedule months of missed appointments once doctors' offices reopened, and first-time patients explored the wide world of facial treatments and made the leap. Approximately 13.3 million smaller-scale treatments were clocked in 2020, with Botox (4.4 million) taking the top spot, followed by the family of soft tissue fillers, laser skin resurfacing, chemical peels, and Intense Pulsed Light (IPL) therapies, representing diverse interests in minimally invasive treatments.

Reconstructive surgeries were hit particularly hard

In terms of the pandemic, there were some fine lines there when determining which reconstructive procedures are considered essential or not, says Matarasso, adding that certain tumors can withstand a minor operation delay while others definitely cannot. "Often a big part of what plastic surgeons do are skin cancer and breast cancer reconstruction," he says. To his point: Nearly 7 million reconstructive surgeries logged in 2020, a 3 percent increase from 2019.

In pre-COVID times, tumor removal and reconstruction of the affected body part, whether it’s the breast, skin, or jaw, were performed on the same day, according to Matarasso. After the oncologist removed the tumor, a plastic surgeon would jump in to reconstruct.

But at the height of the pandemic when hospital beds were at a premium, "a lot of the cancer surgeries were delayed and almost all the reconstructive did not have to be done at the same time," explains Matarasso. "That was unfortunate, because if you had a bad tumor that [the oncologist] said had to be done," then they would proceed with the tumor removal, but not the reconstruction, meaning that "these people could be walking around for six months with [for example] a skin graft, or silver dollar-size lesion where the skin cancer was." Plus, he says, when reconstruction is performed separately several months after the tumor removal, there's now scar tissue coating the entire area, making it far more challenging to achieve a natural look.

"The downstream impact that this COVID has had on the world is terrible," says Matarasso.

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