Videoconferencing Dysmorphia: The Impact on Self-perception and Desire for Cosmetic Procedures

J Clin Aesthet Dermatol. 2025;18(1):46–51.

by Payal M. Patel, MD*; Mindy D. Szeto, MS*; Kelly O’Connor, MD; Henriette De La Garza, MD; Kevin F. Kennedy, MS; Mayra B.C. Maymone, MD, DSc; and Neelam A. Vashi, MD

*Dr. Patel and Ms. Szeto share co-first authorship of this article.

Dr. Patel is with the Department of Dermatology at Massachusetts General Hospital at Harvard Medical School in Boston, Massachusetts. Ms. Szeto is with the Department of Dermatology at the University of Colorado Anschutz Medical Campus in Aurora, Colorado. Drs. O’Connor, De La Garza, and Vashi are with the Department of Dermatology at Boston University in Boston, Massachusetts. Mr. Kennedy is with St. Luke’s Hospital in Kansas City, Missouri. Dr. Maymone is with the Department of Dermatology at Warren Alpert Medical School of Brown University in Providence, Rhode Island.

FUNDING: No funding was provided for this article.

DISCLOSURES: Dr. Vashi is a consultant for L’Oreal, Procter & Gamble, Pfizer, Janssen, UpToDate, and Unilever. All other authors have nothing to disclose. 

ABSTRACT: Objective: The authors sought to examine the association between the increased use of videoconferencing and image-enhancing software filters during the COVID-19 pandemic and the corresponding rise in interest in cosmetic procedures. We aimed to discern if heightened exposure to one’s digital self-image correlates with a greater inclination toward cosmetic interventions.

Methods: In this cross-sectional questionnaire survey study, adult participants living in the United States were recruited on Amazon’s Mechanical Turk platform. Self-reported demographic data, videoconferencing usage, related behaviors, and attitudes concerning cosmetic procedures were assessed. Questionnaire prompts allowed participants to express in a Likert scale format their levels of agreement with certain statements. Frequencies and proportions of responses to each questionnaire item were collected, categorized, and recoded for comparison and analysis. Chi-squared tests were performed to examine associations between questionnaire responses and demographic characteristics, while significant predictors of videoconferencing and image-enhancing filter options were explored via multivariable logistic regression models.

Results: The majority of study participants (n=505, 505/545 = 92.7% completion rate) were 18 to 39 years old (80.1%), female (68.1%), and non-White (58.2%). Income levels varied, and 89.2 percent had completed college or graduate school. Videoconferencing was frequent, with 88.6 percent using it more than three days a week, and 68.1 percent using “touch-up my appearance” filters more than half the time. Videoconferencing influenced the desire for cosmetic procedures in 55.9 percent of participants, and 57.8 percent were influenced by filter use. Frequent self-viewing was reported by 67 percent, strongly associated with interest in cosmetic procedures. Significant predictors of filter use included higher income (OR 2.436, p<0.001) and frequent self-viewing behavior (OR 5.034, p<0.001). Notably, mask-wearing was associated with increased self-esteem (68.8%) and reduced desire for cosmetic procedures (67.4%) in frequent self-viewers.

Limitations: Recall bias and the demographic composition of the study participant population may limit the generalizability of these self-reported responses.

Conclusion: The data reflect the emergence of what may be termed ‘videoconferencing dysmorphia,’ indicating a significant association between videoconferencing, the application of filters, and the heightened interest in cosmetic procedures among users. This study suggests that digital self-viewing behavior instigates a distinct self-awareness that may drive individuals toward considering cosmetic interventions. These insights are vital for dermatologists in understanding patient motivations, managing expectations, and fostering realistic treatment outcomes.

Keywords: Zoom dysmorphia, videoconferencing, videoconferencing, filters, cosmetic procedures, body dysmorphia

Introduction

The COVID-19 pandemic led to an unprecedented rise in the use of videoconferencing platforms, such as Zoom, Facetime, Google Meet, and Microsoft Teams. Experts have likened the videoconferencing experience to watching oneself in the mirror—the more time spent in front of a mirror or viewing oneself on video may lead to a more heavily scrutinized body image.¹ Furthermore, many platforms include built-in filters and ‘touch-up my appearance’ features that enhance the user’s facial appearance with an airbrushed effect. ‘Zoom dysmorphia’ has been used to represent the phenomenon that describes patients who seek cosmetic procedures due to self-perceived flaws that were noticed during videoconferencing.² A study done during the COVID-19 pandemic demonstrated that medical providers reported increased cosmetic consultations and facial plastic surgery,³ during which patients attributed their dissatisfaction with facial appearance to videoconferencing.⁴

This aligns with the previously reported “Snapchat dysmorphia’”phenomenon, which also influenced patients to seek cosmetic surgery in hopes of replicating filtered versions of themselves.^5,6 Many social media outlets now offer users the ability to create and share these facial filters, giving rise to their prevalence and normalcy in modern society. In this study, we sought to evaluate associations between time spent videoconferencing and the use of facial appearance-altering software with attitudes toward cosmetic procedures. Dermatologists would benefit from understanding the factors that drive body dissatisfaction and the desire to match a digitally enhanced image to set appropriate treatment expectations and goals. 

Methods

Data collection. In this cross-sectional survey study, 545 subjects were recruited from Amazon’s Mechanical Turk (Mturk) platform on May 19 to 21, 2021. Participants were required to be at least 18 years old, live in the United States, and have a Mturk approval rating of 95 percent or higher. To maximize data quality, a remuneration of USD 1.00 was provided for completing the survey.⁷ An abbreviated consent form was obtained at the study’s beginning and offered in both English and Spanish. Demographic data on age, gender, race/ethnicity, annual individual income level, and highest education level were collected, as well as various survey questions regarding videoconferencing usage and attitudes about cosmetic procedures. The complete survey instrument is available in Table 4. The study received an exemption from the Institutional Review Board at Boston University (IRB exemption number H-41257).

Statistical analyses. Responses to the survey were tabulated and summarized; respondents who did not complete the study were excluded from further analysis. Descriptive statistics were examined to compare frequencies and proportions of responses for each survey question. Collapsing and re-coding Likert scale questionnaire item responses into dichotomous variables (eg, Always/Sometimes vs. Rarely/Never) allowed consistent comparison between survey items assessing respondent attitudes. Chi-squared tests examined associations between survey responses, especially for questions about interest in appearance or cosmetic procedures, and demographics or items about videoconferencing behaviors and frequency. Significant predictors of responses to crucial survey items of interest were also explored via multivariable logistic regression models. 

Results

Baseline demographic characteristics of participants who completed the survey (n=505/545, 92.7% completion rate) are described in Table 1. Participants were generally young (average age 33.9 years old), female (68.1%), and from diverse ethnic backgrounds (58.2% were non-White participants, eg, Hispanics, Indians, East Asians, African Americans, Native Americans, and mixed-race backgrounds). Most respondents reported annual incomes of $50,001 or greater (52.3%) and had completed college or graduate school (89.2%). 

Analysis of variables regarding videoconferencing behaviors and attitudes towards cosmetic procedures (Table 2) revealed that most of the respondents used videoconferencing more than three days a week (445/502 = 88.6%) and reported using “touch-up my appearance” filter options more than 50 percent of the time while videoconferencing (341/501; 68.1%). Approximately 67 percent (338/504) of the participants reported looking at their own image (self-view) more often than the speaker or presented material. More than half of the respondents agreed that videoconferencing use (278/497; 55.9%) and touch-up filter use (289/500; 57.8%) influenced their desire for a cosmetic procedure. Those who reported their desire for cosmetic procedures being influenced by videoconferencing or filter use were also highly likely to prioritize self-view (224/278; 80.6% and 237/290; 81.7%, respectively). Discussion of cosmetic procedures with personal contacts or practitioners was also strongly associated with videoconferencing, self-view, and touch-up filters. The majority of participants agreed or strongly agreed that cosmetic procedures would help their self-esteem (348/503; 69.2%) and interpersonal relationships (284/504; 56.3%). Among participants endorsing cosmetic procedure benefits to self-esteem, most were heavy users of self-view (271/347; 78.1%) and/or touch-up filters (280/347; 80.7%). Similarly, those reporting potential benefits to interpersonal relationships were also heavy users of self-view (251/315; 79.7%) and/or touch-up filters (259/314; 82.5%). Conversely, these respondents additionally agreed or strongly agreed that mask-wearing improved self-esteem (231/336; 68.8% frequent self-view users, 248/340; 72.9% frequent filter users) and that wearing a mask influenced their desire not to have any cosmetic procedures done (227/337; 67.4% self-view users, 256/341; 75.1% filter users). All associations between videoconferencing variables and cosmetic procedure variables reached statistical significance (p<0.05). Cosmetic procedures most considered by the survey participants included chemical peels, fat reduction, laser treatments, surgical reconstruction, filler, and neuromodulators. Participants also reported being more bothered by areas frequently viewed on videoconferencing, including their hair, dark circles under eyes, nose, and lips. Of note, only 0.4 percent of the respondents did not consider any cosmetic procedure. 

Race and age group were not significant predictors of videoconferencing frequency, self-view, or touch-up filter usage in multivariable logistic regressions (Table 3). However, a graduate-level education was a significant predictor of videoconferencing usage (Odds Ratio (OR) 3.016, 95 percent Confidence Interval (CI) 1.404-6.818, p<0.01), and an annual income of $50,001 or higher was a strongly significant predictor of touch-up filter usage (OR 2.436, 95% CI 1.557-3.845, p<0.001). Regression results also demonstrate that everyday use of videoconferencing was a significant predictor of both looking at self-view more than the speaker or presented material (OR 1.628, 95% CI 1.038-2.572, p<0.05) and touch-up filter usage (OR 1.703, 95% CI 1.072-2.728, p<0.05). Lastly, self-view was a highly significant predictor of using touch-up filters (OR 5.034, 95% CI 3.218-7.952, p<0.001).

Discussion 

While the restrictions imposed during the COVID-19 pandemic have been lifted, virtual communication remains in our personal and professional lives. The phenomenon, referred to as videoconferencing dysmorphia, has emerged, reflecting individuals’ dissatisfaction with their physical appearance as they spend more time seeing themselves on live video.^4,5,8,9 Our findings indicate significant associations between increased videoconferencing usage, the use of appearance touch-up filters during video calls, and a heightened acceptance of cosmetic procedures (p<0.001). Notably, these attitudes were particularly pronounced among respondents who reported focusing more on their image than the speaker or presented material. This suggests that prolonged self-observation during video calls, even without filters, can motivate individuals to seek cosmetic procedures.

Software features such as “touch-up my appearance” could contribute to the phenomenon and reveal a more nuanced understanding of users’ attitudes toward cosmetic procedures. We found that respondents who utilized these image-enhancing features displayed a favorable outlook on cosmetic procedures and reported a positive impact on their self-esteem. Interestingly, mask-wearing appeared to contribute to less favorable views of cosmetic procedures, emphasizing the range of factors related to public attitudes.

Chen et al⁵ also noted that the usage of filters (r=1.77, p<0.01) and increased self-viewing time during videoconferencing were associated with higher Acceptance of Cosmetic Surgery Scale scores (r=0.48, p<0.01). This suggests that the preoccupation with one’s image might be a more universal trigger for seeking cosmetic interventions. Additionally, self-objectification, as noted by Pfund et al,¹⁰ acts as a moderator, intensifying dissatisfaction with face and body among those who frequently compare themselves to others. These female participants were found to utilize features like “touch-up my appearance” more frequently and spend more time scrutinizing their own images during video calls.¹⁰

Our regression models suggest that income level and self-observation (self-view) were significant contributing variables, while race/ethnicity did not show any significant impact. This aligns with previous studies that showed a link between maladaptive social media use and body dissatisfaction across different ethnic groups.^11–13 Like our findings, they did not observe ethnic differences, implying the universality of psychological impacts of self-scrutiny and body image concerns. 

There may be other extrinsic factors outside our study’s scope that contributed to increased acceptance of cosmetic procedures. For example, social media users may be impacted by the concurrent rise in cosmetic treatment advertisements by influencers.^5,14,15 Exposure to advertising increases general awareness of cosmetic procedures and promotes cosmetic procedure-seeking behaviors.¹⁵ Additionally, the COVID-19 pandemic gave people more opportunities to schedule telemedicine consultations and to work from home while recovering from cosmetic procedures.^16,17 Google trends data also confirm a statistically significant association (p=0.028) between an increased search volume for above-the-shoulder cosmetic procedures, such as blepharoplasty, Botox, and lip augmentation, when compared to below-the-shoulder cosmetic procedures.¹⁸ 

Limitations. Our study limitations include its cross-sectional nature, which precludes the determination of causality. Moreover, the demographic composition, primarily consisting of younger and well-educated individuals, may affect the widespread applicability of our findings. Additionally, a self-reported survey methodology is subject to recall bias, influencing respondents’ recollection and reporting of their videoconferencing behaviors and attitudes toward cosmetic procedures.

Conclusion

Our findings illuminate the interplay between videoconferencing, self-image, and the willingness to undertake cosmetic procedures. Future research should focus on uncovering the specific psychosocial mechanisms behind this correlation, including the possible role of body dysmorphic disorders and their impact on treatment outcomes. This data holds clinical relevance for dermatologists when discussing patients’ cosmetic aspirations and setting realistic treatment expectations.

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