Introduction In spring 2020, the COVID-19 pandemic required far-reaching changes and measures of unprecedented extent. These measures were implemented to reduce virus spread and to ensure the continuity of nation-wide medical care, in particular with a view to having sufficient intensive-care capacities in case of a large caseload of patients infected with COVID-19. With regard to surgical specialties, this implied a temporary hold on elective cases for an indefinite period of time. The aim of this study was to assess the impact of these measures on the caseload of a level-three plastic surgery unit. Methods This study retrospectively assessed the caseload at the Division of Plastic, Aesthetic and Reconstructive Surgery at Medical University Graz during the so-called lockdown from 16 March 2020 to 27 April 2020 (6 weeks) as well as two weeks before. The data was compared with the corresponding time period of the year 2019. Surgical spectrum, procedural urgency, medical indication of surgical procedures as well as complication rates were compared. Results The suspension of elective cases led to a significant reduction in caseload of 57.5 % (2019: 353, 2020: 150 cases). There was a significant increase in emergency and acute case procedures performed during the lockdown compared with the previous year (2019: 41, 2020: 58 cases, p < 0.001). Furthermore, the number of self-inflicted injuries and suicide attempts increased significantly (2019: 0, 2020: 16 cases, p < 0.001). With regard to private and work-related injuries, there was no significant difference. Also, there was no difference in complication rates (2019: 6.8, 2020: 10 %, p = 0.219). Conclusion A significant amount of surgical procedures in plastic surgery at a supraregional academic health centre consists of emergency, acute and urgent medically necessary cases. During the lockdown, surgical procedures were performed without a significant increase in complication rates. Despite challenges during the pandemic, high-quality patient care was provided throughout. To process less urgent yet important cases accumulated during the lockdown in a reasonable amount of time and maintaining the same level of high-quality care, additional capacities regarding operating rooms, hospital beds and outpatient care are needed. These results point out the importance of plastic surgery for medical care, in particular during times of crisis.