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As the COVID-19 pandemic swept across the U.S., millions of people turned to video conferencing for work and social interaction -- and many of them didn't like what they saw.

Most people go through life with an outward-facing perspective. During professional, social, or personal interactions, they look at other people, not themselves. The transition to remote working and interpersonal communication forced many people to spend more time -- sometimes hours a day -- looking at themselves on digital screens. For some, the experience has led to skewed perceptions of their appearance -- severely skewed in some cases.

Dermatologists, and to a lesser extent mental health specialists, have been on the front lines of this still-evolving phenomenon.

"As reliance on video calls increased, we started seeing the consequences of how prolonged time staring back at yourself significantly impacted our patients in a phenomenon we call 'Zoom dysmorphia,'" said Shadi Kourosh, MD, MPH, of Harvard Medical School and Massachusetts General Hospital in Boston.

Kourosh and her associates 134 board-certified dermatologists and found that 56.7% had seen a rise in cosmetic consultations while in the midst of a global pandemic. In 86% of cases, patients specifically cited video conferencing as the reason for cosmetic consultation.

"The increased time on camera, coupled with the unflattering effects of front-facing cameras, triggered a concerning and subconscious response unique to the times we're living in," she said. "In addition, many people were also spending more time on social media, viewing highly edited photos of others, triggering unhealthy comparisons to their own images on front-facing cameras, which we know is distorted and not a true reflection."

During the recent American Academy of Dermatology virtual meeting, Kourosh and co-investigators discussed the survey, as well as characteristics of Zoom dysmorphia and potential interventions to counter the adverse effects.

"From conversations with several dermatologist colleagues and with friends, as well as listening to patients, it had become a concern for us, that people weren't doing well and that they seemed to be overly self-conscious and preoccupied with their appearance on video conferencing," she told 乌鸦传媒. "It wasn't until we conducted the larger survey that we realized just how widespread the problem was and what an impact it actually had. That was the most eye-opening aspect of the survey: How pervasive the problem is."

The survey respondents said patients' most common concerns involved upper-face wrinkles (77%), dark circles under the eyes (64.4%), facial dark spots (53%), and sagging necks (50%). Cosmetic procedures most often mentioned by patients during consults were neuromodulating agents (such as Botulinum toxin), filler injections, and laser treatment.

The psychologic component of Zoom dysmorphia emerged from responses about patients' self-perception, as 82.7% of the dermatologists said patients had become more dissatisfied or unhappy with their appearance since increased use of video conferencing.

"This showed us that patients are really being affected by the shift toward virtual living and maybe developing a negative self-perception of constantly seeing their virtual reflection on video calls," said Shauna Rice, a clinical research fellow in dermatology at Massachusetts General Hospital and a medical student at the University of Massachusetts Medical School in Worcester.

Digital technology appears to be a major contributor to Zoom dysmorphia. Front-facing cameras, typically of computer displays, distort and degrade video quality, said Rice. Noses appear wider, eyes appear smaller and farther apart, and natural facial shadows may appear as flat darkened areas. During video conferences, viewers see facial expressions associated with emotions and take note of expression lines and wrinkles.

Viewers have side-by-side comparisons of their appearance with others on the call, Rice continued. Unlike some social media sites that offer editing and filtering functions, live video calls have few options for changing a person's appearance.

"I have a friend who is a successful business executive, and she told me she was really conflicted, as a woman trying to rise in the business world," said Kourosh. "She had noticed the self-consciousness, negative self-perception of being on video conferencing, from the beginning of the pandemic. She had a tendency to want to turn off her front-facing camera but at the same time she wanted to appear engaged and participating in remote meetings and to perform well to help advance her career."

A few simple changes can help, she continued. The closer a person sits to a front-facing camera, the more distorted the appearance is. Sitting farther away can make the appearance more normal. A higher-definition camera might be helpful, and better (or different) lighting and positioning might help eliminate some of the distortion. Less time on social media could also help, as increased social media use has been linked to body dissatisfaction and low self-esteem.

A clinical assessment by a dermatologist, followed by an honest conversation, can help patients decide whether a cosmetic procedure would be beneficial, said Kourosh. In some cases, referral to a mental health specialist might be appropriate. However, she and Rice emphasized that Zoom dysmorphia is not a recognized diagnosis and should not be confused with body dysmorphic disorder.

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