by Krista Smith (AEDIT)
Understandably, the media attention surrounding the COVID-19 pandemic has primarily focused on the frontlines — particularly healthcare professionals, first responders, and those in the hardest hit communities. But this pandemic is affecting us all profoundly in so many ways.
For instance, how is this health emergency and subsequent quarantine impacting plastic, reconstructive, and cosmetic surgery — from surgeons and their staff to patients and the procedures still being performed? To get a glimpse of the current conditions, we spoke with Beverly Hills-based board certified plastic and reconstructive surgeon Michael Newman, MD, and UCLA board certified plastic and reconstructive surgeon Jason Roostaeian, MD, about their first-hand experience with coronavirus.
Testing Positive for COVID-19 as a Provider
In March, Dr. Newman and Dr. Jason both tested positive for COVID-19. Although each had mild symptoms, they were initially a bit surprised by the diagnosis. “I did surgery on a Wednesday and felt fine,” recounts Dr. Newman. “But by Wednesday night at home, I’d started feeling a little tickle in my throat and started to develop a cough.” Though it seemed quite mild, a feeling of tightness in his chest led Dr. Newman to err on the side of caution. He cancelled surgery the next day to avoid spreading whatever illness he’d contracted.
“It was difficult to find tests,” he shares. “So, I had to order some to our office and swab myself and send it to the lab.” By the time his results came back positive, Dr. Newman was already feeling much better — though, like many coronavirus patients, he did experience a resurgence of chest tightness and coughing around day nine and 10. All told, Dr. Newman spent nearly three weeks in quarantine (about six days longer than the current Centers for Disease Control and Prevention (CDC) recommendations) to be safe.
Compared to his colleague, Dr. Jason experienced a different set of symptoms in early March. “I had a low grade fever, achy joints, a feeling of malaise,” he recalls. “It wasn’t serious, but it was bad enough that I cancelled surgeries for the next morning.” Instead, Dr. Jason made an appointment at a UCLA testing site. Even though he never experienced a sore throat, cough, or shortness of breath, the nasal swab test proved he’d contracted the virus. Like his colleague, Dr. Jason self-quarantined per CDC guidelines and added an additional week before returning to work.
Based on advice from several doctors and his own research, Dr. Jason took the anti-malarial drug hydroxychloroquine for five days after his diagnosis. The antiviral drug’s ability to lessen the severity and duration of coronavirus has not been proven, though studies are currently underway. Dr. Jason points out that there’s no way to determine whether or not it aided his recovery.
DISCLOSING POSITIVE COVID-19 RESULTS TO PATIENTS
Upon their diagnosis, both doctors began notifying anyone they’d come in contact with in the days leading up to their first symptoms. “A lot of people were very appreciative that I’d called to tell them, and there were a couple who were alarmed,” Dr. Newman recounts — particularly, a patient with an elderly husband and one who’d recently finished chemotherapy. Fortunately, none of Dr. Newman’s nor Dr. Jason’s staff or patients contracted the disease.
RETURNING TO WORK AFTER RECOVERING FROM COVID-19
Now that both Dr. Newman and Dr. Jason have been cleared to go back to work, they’ve been able to operate only on patients who meet strict criteria. “We can only do surgery right now if it would cause the patient undo harm by delaying the procedure,” Dr. Jason shares. This includes cancer and acute trauma only — breast reconstruction that’s concurrent with mastectomy, oral, head, and neck cancer surgeries, abdominal tumors, and acute injuries from things like dog bites, fights, and car accidents.
“Those kinds of injuries, if not treated urgently, can result in things like deformities and scarring that can be very difficult to treat later,” Dr. Newman explains. Last week, Dr. Jason had a nasal fracture case that required immediate attention. “Especially for someone who’s had a prior rhinoplasty, it’s critical that you set it right away or it will cause problems down the road,” he says.
Plastic Surgery During the COVID-19 Pandemic
Hospitals and surgery centers around the country have put pandemic protocols in place to protect patients and providers alike. At UCLA, where Dr. Jason operates, prospective patients are required to be tested for coronavirus 48 hours prior to any surgery. Once a patient is cleared, Dr. Jason and his team have to follow strict guidelines before, during, and after surgery. “During the intubation, the anesthesiologist is the only one allowed in the room,” he shares. “They wear an N-95 mask, plus an additional face mask, at a minimum, or a PAPR [powered air purifying respirator].” After the anesthesiologist has placed the breathing tube, the surgical team waits 20 minutes before returning to the operating room.
When performing procedures involving oral airway or sinus work, Dr. Jason says surgeons are advised to wear a mask with eye shield protection. Post-surgery, day patients are still permitted to fully recover, but they are encouraged to leave the surgery center as soon as possible. Patients requiring an overnight stay are not permitted to have any visitors.
THE IMPACT OF COVID-19 ON PLASTIC SURGERY PATIENTS
Dr. Newman says this has been a very difficult time for patients, particularly those with cancer. “There’s already a lot to manage, especially for those who are getting chemo and trying to time it all,” he explains. “This adds complexity to the situation when they’re already going through so much.” Patients are understandably worried, he adds, about having to go to the hospital where they can potentially be exposed to coronavirus.
Perhaps the only upside, says Dr. Newman, is that reconstructive patients aren’t having to compete with any elective surgeries for time slots. “The surgery schedule is pretty much open for anyone who needs it,” he notes.
For patients who were looking forward to an elective cosmetic procedure that’s now been postponed (somewhat indefinitely), the COVID-19 crisis can be psychologically challenging. “This is impacting us all in different ways,” Dr. Jason points out. “Everyone is experiencing a range of emotions on a daily basis, and none is more or less valid than another.”
In the waiting period, both doctors agress that there are steps you can take at home to improve your overall skin health. “Now’s the perfect time to do a mild peel or double up on the retinol,” Dr. Newman says of socially distant downtime. Of course, you’ll need to consult your doctor before adjusting doses of any prescription medications or combining topical treatments. The good news? It might not be too hard to get a virtual appointment right now (more on that below!).
RESCHEDULING COSMETIC SURGERY PROCEDURES
At UCLA, Dr. Jason’s staff has been tentatively rescheduling cosmetic patients for mid-May — though everything could change depending upon the government’s ongoing response to the pandemic. He reports that about two-thirds of his aesthetic patients have opted to secure a new time slot, while the remainder are taking a wait-and-see approach. Dr. Newman’s office is currently rebooking displaced patients for May as well.
On the flip side, those patients who managed to slip in under the surgery cut-off are enjoying a more relaxed — and incognito — recovery. Dr. Jason says he’s seeing those patients for post-op visits only when absolutely necessary (think: removing sutures). Otherwise, everything is handled virtually.
CONSULTATIONS DURING QUARANTINE
Many surgeons are still performing consultations for patients — both for necessary procedures and cosmetic ones. Though all cosmetic consultations are currently being handled virtually, meetings for medically necessary patients may take place face-to-face or online, depending on the practice. Dr. Jason, for example, is conducting all of his consultations virtually, even those with patients who are approved for surgery. “Right now, I’m only seeing them on the day of surgery,” he explains. Even his staff is working remotely as much as possible, “as an extra layer of protection.” Dr. Newman, on the other hand, is seeing patients in person, but only those who have been pre-screened over the phone and are already approved for surgery.
Needless to say, both surgeons are taking extra precautions at their offices. Staff are all wearing masks. Sanitization processes — both in between patients and at the end of the day — have also been more aggressive. “We’re limiting the number of people in the waiting area and opening up the balcony to create more room and bring in fresh air,” Dr. Newman says. At UCLA, there are guard stations at every entrance point. “They’re checking for fever and any signs of illness before they let anyone pass,” Dr. Jason adds.
Long Term Effects of COVID-19 on Plastic Surgery
When asked to speculate about what might happen when the social distancing and quarantine guidelines are lifted, both surgeons predict an initial surge in patients. But, after that, the future is less certain. “I have had a noticeable influx of interest in cosmetic surgery because patients are stuck at home,” Dr. Newman observes. He thinks some patients may be able to take advantage of a window between the easing of restrictions and returning to work. “They might be able to put off going right back to work after the crisis and fit their procedure in,” he says.
It’s harder to say whether or not the pandemic will affect our cultural sensibilities surrounding cosmetic surgery. “In six months to a year, people could look back and say, ‘Life is short. I should do it while I can and enjoy feeling good about myself,’” Dr. Newman speculates. Alternatively, he says, the current focus on family and mindfulness could lead some to decide that cosmetic surgery isn’t as important to wellbeing.
Dr. Jason adds that, historically, demand for cosmetic procedures has waxed and waned with the country’s financial outlook. “There will be a temporary spike when the gates open,” he believes. “But, long term, it will depend on what the economy does.”
With so much uncertainty, both Dr. Newman and Dr. Jason stress the importance of adhering to the CDC and other governmental regulations as closely as possible, so that things can return to ‘normal’ as soon as possible. They’re hopeful that social distancing measures, combined with more accurate and widespread testing and effective treatments, will flatten the curve. After all, they both know the importance of proper testing. “Once you know you have it, you’re much more disciplined about staying home,” Dr. Newman says. “If more people could just get tested, they’d be more diligent about not leaving the house and unwittingly spreading the virus.”