Providers Need to Say ‘No’ to Zoom Dysmorphia

A disturbing trend, created by insecurities about self-image and fueled by the pandemic, has providers in medical aesthetics facing growing demand for unnecessary treatments. Education and training are first steps in dealing with an ethical dilemma.

In this age of Zoom, people have become more conscious of their appearance, with some obsessively fixated on what they perceive as flaws. Things like sagging skin, crow’s feet, thin lips, lines on the forehead and so on. This anxiety about self-image was exacerbated by the pandemic and more time on Zoom for work and social contact.

The result was anxiety and stress about returning to in-person activities, and a rise in the number of people suffering from mental health problems. A U.S. dermatologist and Harvard professor named Shadi Kourosh noticed another worrying trend. There was a marked increase in appointment requests for cosmetic surgeries and medical aesthetics. Everything from face lifts and nose jobs to Botox and fillers was suddenly in demand.

She was the first to call it Zoom dysmorphia.

Images courtesy of Jenn Izzarelli

Jenn Izzareli is an Acute Care Nurse Practitioner and Clinical Nurse Specialist in California. She is also chair of clinical practice committee for ISPAN. Jenn spoke about the dangers of Social or Zoom dysmorphia at the ISPAN annual meeting in Boston last year.  She recently discussed this issue with THMA Consulting members in a Professional Development Presentation. She again shares her thoughts, concerns and advice here.

What has led to this disorder we now call Zoom dysmorphia?

The pandemic really affected some people negatively. They were struggling at home, spending endless hours online and on social media, developing self-image anxieties as they obsessed over their own ‘flaws’ and insecurity.  For some, they were struggling with borderline depression or social dysmorphia.

What’s led so many people to believe they weren’t beautiful enough?

I think social media and reality TV have created havoc with people’s self-esteem. So-called celebrity social influencers have distorted what is beauty and what is normal. These celebrities have had tonnes of work done but don’t admit it. This has especially affected younger women who have grown up with these readily accessible but skewed images, and think they don’t look as beautiful or natural as a Kardashian.

How did you become concerned about Zoom dysmorphia?

My practice has always had an older clientele who just want to look natural and refreshed, and was not for millennials and 20-somethings who are already pretty.  But when 2020 happened, I started getting an influx of people who previously hadn’t previously considered aesthetics or plastic surgery. I was also getting requests from patients who wanted me to ‘fix’ the problems created in other clinics. I started to see this as a huge problem. Because of social isolation and being unable to do anything about, people began to believe that changing their face was the one thing, maybe the only thing, within their control.

How can we recognize that there might be a problem?

It begins with education and good training.  Thorough consultations will give providers the tools to root out problem patients. An intake form or questionnaire will collect information regarding the patient’s current thinking as to what is driving them to ‘fix’ the way they look. Initially, it is hard to detect people who may have problems with self-image if they are just looking for filler. That can seem pretty normal. But maybe they don’t want to wait the three months between treatments. Or they’ve come in with complaints about other injectors. Maybe they’re not happy that previous treatments didn’t fix this one little line. These sorts of things are definite red flags.

Do providers have an ethical responsibility in these cases?

It should be obvious all of us that this is a problem. You’re doing these patients with self-image issues such a disservice by continuing to fill them and Botox them and give them whatever they want but don’t need. Left unchecked, dysmorphia can lead to bigger problems, like depression, alcoholism, and even suicide.

What should providers do? 

The proper response in these cases is to say “No, I can’t do this for you.” Do it without worry about losing money. Do it with the knowledge you’re doing the right thing for this person. I would hope, and certainly want to believe, that most providers out there aren’t so greedy that they would do treatments that endanger patients.

Is that not easier said than done?

It shouldn’t be. But unfortunately, too many people aren’t properly training in medical aesthetics. They take a two or three hour class somewhere and are then ‘certified’ or ‘licensed’ to provide treatments. But they don’t know what they are doing. They don’t know how to assess patients or understand challenges and risks. A lack of education and proper training is literally giving these people a license to do harm.

What advice do you have for providers?

It’s difficult to tell a patient that maybe they have body dysmorphic disorder or some sort of psycho-social issue. We can’t. We are not psychologists. So, the hard ‘no’ is the best route if your consult exposes warning signs. You could say “I am not the right provider for you and I cannot give you the results you want and won’t be able to make you happy.” A patient who you know but has issues is a different conversation. If you have their trust and a treatment plan, you might have a more upfront conversation. Maybe you can suggest they find someone to talk to about their self-image and why they so badly want treatments.

What is the overall benefit of taking a firm stance?

It’s a terrible that these people, these predominately young people, feel unworthy or think they are not pretty.  You want to help them. But you have to be comfortable saying ‘no’. You are ethically doing the right thing. You are following your oath to do no harm to patients. In the big picture, if we learn how to say no, we are going to be helping these patients instead of hurting them.

Are you suffering from Zoom Dysmorphia? This Psychology Today article shows how to recognize the problem and how to address it.