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Staying at home, wearing masks provide cover for plastic surgery

Natalie Walters
The Dallas Morning News

Dallas — The pandemic is ruining summer travel plans and spoiling weekend socializing, but it’s giving cover to another COVID-19 phenomenon: pent-up demand for plastic surgery.

Felicia Cloke, 24, of Dallas knew she wanted breast augmentation before turning 25. When the pandemic canceled typical summer activities, it gave her the perfect opportunity. And because she works in a hospital, it was no riskier than going to work.

“I could recover and not feel like I was missing my summer,” she said.

Botox shot (Dreamstime/TNS)

The coronavirus quarantines are creating a window of opportunity for patients to hide bruising and swelling from minimally invasive procedures, such as Botox or filler, or from more intense surgeries like breast augmentation or liposuction without taking time off work or school. And if they must run to the grocery store, they can wear a mask without people questioning it.

Dr. Rod Rohrich, a well-known Dallas plastic surgeon, said he’s seen a significant increase in demand since being allowed to reopen his practice in early May. Summer months are typically a slow time for surgeries, but he’s had to extend his hours, even doing virtual consultations after work.

“People have the time and can recover at home and can’t go anywhere and have masks,” he said. “It’s the ideal situation.”

His office typically sees 75 to 100 patients a week. Lately, he’s seeing 100 to 125 patients each week along with three to five virtual consultations at the end of each day.

Some patients are looking for a grand reveal when society opens back up, amazing friends and family with their new look. Others are discovering they don’t like how they look on Zoom.

“I had a male patient come in for a face-lift because he said, ‘I’m on Zoom so much and see my reflection and it looks like I’m always frowning, even with Botox,’” Rohrich said.

For Cassidy Power, 29, of Grapevine, the mask mandate was a lifesaver when she got Botox and lip fillers this summer.

“My lips bruised so bad for about six days, so I was thankful for the mask when I had to go out. I was also thankful to not be able to see my dad and grandparents during that time,” she said with a laugh.

Rohrich, who previously served as president of the American Society of Plastic Surgeons, said he expects minimally invasive procedures to increase and surgeries to drop off when people feel comfortable traveling or socializing again.

Minimally invasive procedures have been growing nationally at a faster pace than surgeries, with 16.3 million performed last year. The total grew for the third straight year and far outpaced the 1.8 million cosmetic surgeries, according to data compiled by the plastic surgeons’ association.

Since 2000, minimally invasive procedures are up 169%. They’re affordable and make people look and feel good, according to a plastic surgeon in Fort Worth, Dr. Steven Camp.

“People like affordable luxury,” he said.

Texas is one of the top states for plastic surgery, with 477 active members of the association that represents 8,000 surgeons. That’s more than any state except California, which has 795 members.

Dr. William Adams, a Dallas plastic surgeon, said he thinks Dallas is the top plastic surgery hub in the U.S. thanks to a group of now retired surgeons who helped establish its reputation and train up the next generation. It has some of the best surgeons in the world, including many who specialize in specific procedures, he said.

People travel to Dallas from all over the world to see specific surgeons, including Adams, who is known internationally for his expertise on breast augmentations. His website includes a hotel guide for travelers.

“If you talk to people in Los Angeles or who are swept up in the world of reality TV, then they will say Los Angeles, Miami and New York are the hubs. But if you talk to people in the know, they will put Dallas at No. 1 or at least in the top three,” he said.

When the plastic surgery association surveyed its members, it came up with what it expects to be most popular procedures this year, along with the average cost.

Botox to minimize wrinkles: $408.

Breast augmentation to increase breast size: $3,947.

Soft-tissue fillers to create volume in the face: $653 to more than $2,000.

Liposuction to remove unwanted excess fat: $3,548.

Plastic surgery offices closed at the end of March when Texas halted elective procedures and were allowed to reopen again in early May.

During the closures, many doctors like Camp moved to telemedicine, offering virtual appointments. His website noted the following for those wanting to see him virtually: “Depending on your procedure interest, during your consultation you may be asked to disrobe. Please plan to be in a well-lit, private room at the time of your virtual consultation.”

Adams said most Dallas plastic surgeons offered virtual consultations for patients who planned to travel to see them. But with COVID-19, it became the norm. He had patients send pictures from multiple angles of what they wanted to be fixed, but he said it wasn’t the same.

“We tried to make it similar to an in-office visit, but there’s a critical 5% to 10% of the story that you miss until you can do measurements and assess the tissue,” he said, adding that in-person visits are the norm again now.

Plastic surgeries have always been by appointment only, which means the waiting rooms aren’t crowded and that eased the transition to social distancing rules when clinics reopened.

Ana Tichelaar, 28, of Dallas said she felt safe when she got Botox because it was just she and the doctor in the office.

“Restaurants and stores feel riskier than that,” she said.

Dr. Ben Tittle, president of the Dallas Society of Plastic Surgeons, said he’s been busy since Day One of reopening his two private practice clinics in Dallas and Frisco.

“I’ve been doing Botox left and right,” he said.

He’s also seen a rise in patients wanting liposuction to get rid of the “COVID-19,” a play on the “freshman 15” in reference to new college students often gaining weight. From the end of March, when shutdown orders closed many gyms and confined many to their homes, to the beginning of August, Google searches for liposuction in the U.S. more than doubled. They also increased by 24% in July compared to the same month last year.

Tittle said the pandemic gave people more time to think about their appearance and what they’d like to change.

“It’s introspection,” he said. “People are sitting at home thinking about things and looking at themselves on Facetime and Zoom and looking at their upper face not covered by a mask and concentrating their eyes on things they don’t normally think about.”

Tittle, 65, said he’s been doing plastic surgery since before Botox or fillers were invented in the early 2000s. Since then, the industry has boomed with cosmetic procedure spending rising from $10 billion in 2010 to $16.7 billion in 2019. It’s a bigger industry than the $11.4 billion U.S. computer manufacturing sector or the $15.4 billion online shoe market.

As life expectancy increases, plastic surgery allows older adults to age gracefully, Tittle said. Since 1970, life expectancy in the U.S. has grown from 71 to 79.

He loves his job because it lets him spread positivity, he said.

“People do well in life when they feel good about themselves,” he said. “But I also make sure people know I’m not the Wizard of Oz. I’m a physician, not a magician.”

Camp said he had to cancel 60 surgical appointments when his practice closed in March and April. When he reopened and could reschedule them, he expected many to cancel and ask for a refund.

But only one of the 60 canceled, he said. That meant in addition to his normal influx of patients, he had a backlog of 59 awaiting procedures.

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People working at jobs that are typically never remote saw working from home as a way to keep a low profile after surgery. For a typical nose job, he said, a patient is required to wear a nose cast for a week, something that could be awkward for an in-office job.

“People can get the surgery done in secret while not compromising on their income stream or job status,” he said. “It’s an extension of someone wearing shorts under the table on a Zoom call.”

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Like Tittle, Camp said he loves his job because fixing an insecurity provides something positive in people’s lives during a time when there’s been a lot of darkness.

“People look forward to the treatments that plastic surgeons offer,” he said. “People have to get surgeries for broken bones or to have their appendix removed, but they don’t want them. People want our surgeries.”