How to ethically approach ‘Zoom dysmorphia’ in aesthetically-inclined patients

Key takeaways:

• Zoom dysmorphia is the fixation on self-perceived flaws from staring at one’s reflection in a computer screen.
• 86.4% of cosmetic consultations reference video conferencing as a driving factor for seeking advice.

The effects of the COVID-19 pandemic linger as patients continue to battle cosmetic insecurities associated with working from home, according to an entry in the Journal of the American Academy of Dermatology Ethics Journal Club.

In answering a dermatologist’s question about navigating a patient’s request for cosmetic procedures because of looking “ugly on Zoom,” Shari Lipner, MD, PhD, and colleagues explained that dermatologists have an ethical duty to recognize psychological impact when addressing physical concerns.

“Since the COVID-19 pandemic, the workplace environment has shifted tremendously, with some people working exclusively from home, and many in hybrid models. Video conferencing has increased exponentially,” Lipner, associate professor of clinical dermatology and director of the nail division at Weill Cornell Medicine, told Healio. “While work attire has generally become more relaxed, there is more of an intense focus on facial aesthetics, as people have become more self-aware by staring at their screen image for hours per day.”

The phenomenon is called “Zoom dysmorphia” and, like body dysmorphic disorder, it is characterized by a fixation on self-perceived flaws from staring at a computer screen reflection, often skewed by harsh lighting and unflattering angles, every day.

According to a survey of 134 board-certified dermatologists, Zoom dysmorphia has led to an influx of cosmetic procedure interest, with 56.7% of dermatologists reporting an increase in cosmetic consultations compared with pre-pandemic levels. Of those patients requesting cosmetic consultations, 86.4% referenced video conferencing as a reason they sought the meeting.

The primary interventions requested by these patients include usually small things such as neurotoxins, filler and laser skin resurfacing, but these procedures can have a sizeable impact on patients struggling with their mental health.

“While minimally invasive aesthetic procedures are low risk and can improve self-esteem, patients should be educated that the typical camera for teleconferencing is much closer than the distance from another person in real life situations,” Lipner explained. “Performing these procedures on patients with mental health conditions could exacerbate feelings of anxiety or depression and cause unintended harm.”

Lipner and colleagues wrote in the Ethics Journal Club entry that dermatologists must learn to balance respecting a patient’s autonomy while also adhering to their professional oaths to do no harm. One way to do this is to ask questions and then really listen to the patient’s concerns.

“When patients request cosmetic procedures, it is important to delve into their motivations for doing so in a nonjudgemental way and set reasonable expectations,” Lipner told Healio. “It is important to screen patients seeking cosmetic procedures for Zoom dysmorphia with an adapted Body Dysmorphic Disorder Questionnaire and refer to psychiatry or psychology when necessary.”

Other methods of steering patients away from cosmetic procedures, when “Zoom dysmorphia” is to blame, is recommending alternatives such as makeup, skin care and lighting adjustments during meetings. These subtle differences can help patients achieve their aesthetic goals without leaving permanent or semi-permanent effects.

As the digital age continues to influence patient decision-making in the cosmetic field, dermatologists must continually incorporate mental health into cosmetic consultations, the authors wrote. By educating patients on the realities of “Zoom dysmorphia,” physicians can help eliminate unrealistic facial expectations and promote positive self-perceptions.