American Society of Plastic Surgeons
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The future of plastic surgery: How artificial intelligence is revolutionizing aspects of the specialty

how artificial intelligence is revolutionizing plastic surgery

As plastic surgery's popularity continues to grow, innovative technologies – including artificial intelligence (AI) – are increasingly intersecting with this medical discipline. ASPS President-Elect Steven Williams, MD, and ASPS Member Surgeon Samuel Lin, MD, FACS, give their insights into the burgeoning influence of AI within the realm of the specialty.

The basics: understanding the AI-plastic surgery interplay

Computer systems have long been employed for patient safety and care, but challenges lie in understanding how today's AI "learns" and "adapts" in a way similar to the human brain.

"The application of AI in plastic surgery largely depends on one's definition of AI," said Williams.

AI's incorporation into the medical world is not new. It has evolved from rudimentary computer systems to the advanced software we see today. The distinction between traditional computer systems and what is commonly referred to as AI in modern terms is critical. Traditional systems were primarily designed to follow predefined rules and operations. In contrast, today's AI encompasses tools and methodologies that can "learn" from data and adapt over time.

"Historically, computer systems and specialized software have been developed to enhance patient safety and boost efficiency in patient care," said Williams. "However, when we discuss AI today, we are often referring to advanced concepts like machine learning and complex neural networks. These technologies are profound because they allow machines to process large datasets, run countless simulations and potentially devise solutions that may not have been previously considered by humans."

Machine learning, a subset of AI, enables the system to recognize patterns, make decisions and even predict outcomes based on past data. Complex neural networks, inspired by the human brain's architecture, can process vast amounts of information in parallel, mimicking how our brain processes and interprets information. For plastic surgery, this could mean more accurate predictions of post-surgery outcomes, personalized treatment plans based on individual patient data or even robotic assistance during procedures that require extreme precision.

The present: administrative enhancements with AI

When it comes to AI in plastic surgery, Williams offered a roadmap.

"The first phase involves administrative tasks," said Williams. "For instance, if you have a billing inquiry or a question about postop care, our AI chatbot can handle most of it. These responses are vetted by our surgeons, and we trust the AI with this responsibility."

A well-programmed AI chatbot can manage the majority of these concerns, freeing up humans to do other tasks.

"Following that, the next phase might involve diagnostics, like screening CT scans," said Williams. "The AI will screen first, and then a physician will review to ensure nothing was overlooked. That's likely the forthcoming frontier in AI's role in our field."

As for the future? Williams sees diagnostics as the next frontier, where AI will first screen results, followed by physician reviews to ensure thoroughness.

"For instance, there are studies on the best strategies for incisions or designing free fibula flaps – determining where to place osteotomies to shape the fibula," said Williams. "There are research papers currently exploring how AI can assist in these decisions."

Moreover, the advancements in AI won't just be confined to procedures. The patient-doctor interaction could change as well. AI could offer more personalized care recommendations based on a patient's medical history and genetics, thus ushering in a new era of tailored medical treatments.

"At the moment, there aren't any industry-standard AI tools directly used in surgical interventions," said Williams. "The field of AI in plastic surgery is still too new, and there are challenges, including AI's occasional problems with 'hallucinations' and ensuring the validity of its outputs. Direct application of AI to patient care isn't ready yet."

The potential: AI's role in surgical planning and postoperative care

Both surgeons acknowledge the potential role of AI in enhancing preoperative planning. Lin pointed out the intersection of AI with 3D modeling, especially for surgeries like breast augmentations and rhinoplasties.

"As AI models, like ChatGPT, become more advanced, they can provide almost indistinguishable information from human-generated content, especially in providing preoperative instructions," said Lin. "But it's crucial for professionals to review any AI-generated content before it's shared with patients to ensure accuracy and appropriateness."

Beyond 3D modeling, AI has the capability to analyze vast amounts of data in real time. This feature can be utilized to predict potential surgical complications based on a patient's history, genetics, and other relevant factors. Such predictive analysis can alert surgeons to potential challenges before they even make their first incision.

Yet, there is an undeniable emphasis on human oversight.

"Patients remain the ultimate decision-makers," said Lin. "While there's a lot of simulation software available now to provide individuals with a visualization of potential surgical outcomes, I'm not aware of any AI specifically helping patients make decisions. As of now, any preoperative conversations are typically held with office staff or the provider."

Williams is particularly optimistic about AI closing gaps, especially in regions with limited access to healthcare.

"In parts of the world or certain communities with limited access to healthcare, AI can be a bridge between the patient and the physician," said Williams. "AI can handle basic screening or routine postoperative analysis, providing broader access to postoperative care."

Additionally, for patients in remote areas, AI-powered telemedicine platforms can provide timely consultations, ensuring that expert advice is always within reach, even if a physical hospital isn't.

Furthermore, the integration of AI in postoperative care can facilitate better monitoring. Wearable devices that collect patient data can feed into AI models to detect signs of infections or complications. This can allow for faster interventions, reducing hospital readmissions and providing patients with peace of mind during their recovery.

Data collection: A double-edged sword

There are hurdles when it comes to creating AI knowledge, but Williams pointed to the immense public data in plastic surgery.

"The spontaneous sharing of experiences is especially prevalent in the world of plastic surgery," said Williams

Moreover, there's a significant concern surrounding privacy. Lin stresses the importance of operating AI responsibly, ensuring patient privacy remains paramount.

"When we think about modern AI models, we consider how they were initially designed," said Lin. "Some of these models, early on, had exposure to vast numbers of pictures. The pictures themselves might not seem identifiable on the surface, but if you have someone with distinct features or landmarks on their body, then those could potentially be used to identify individuals. Privacy is crucial."

There are other obstacles surrounding the use and interpretation of data, particularly, as Williams pointed out, when it comes to biases.

"Plastic surgery is unique in that there's a significant amount of publicly available information, particularly concerning patient preferences and the distinction between good and poor outcomes," said Williams. "This information is easily accessible to AI across multiple platforms online. The real challenge is determining how to evaluate this data, especially when trying to differentiate between dangerous and non-dangerous outcomes. Such assessments can be a bit tricky since they often require professional expertise and judgment."

The future: New frontiers in AI integration

AI holds promise for plastic surgery, and Lin speculated on its potential future use.

"Robotic techniques have grown in popularity over the years, and their software has evolved significantly over time," said Lin. "Hair transplantation using robots could become a reality, and I wouldn't be surprised if treatments involving blades or lasers were to be automated with robotic assistance in the future."

Yet there are obstructions. Williams pointed out the limited access machines currently have to the field.

"The physical world isn't just about data," said Williams. "We need to convert the tangible world into information that AI or machines can interpret. Translating tactile sensations, for instance, is challenging. However, these senses can be vital, especially when we're less familiar with specific situations. I might only witness 20,000 breast augmentations in my lifetime. Therefore, I require comprehensive data on what differentiates a successful breast augmentation from an unsuccessful one."

Venturing toward the future of plastic surgery

It is undeniable that AI will play a significant role as plastic surgery continues to evolve.

"AI is here to stay," said Lin. "When used accurately and ethically, it can be a powerful tool."

Yet, there are still complications in balancing innovation with safety, ensuring that while machines might augment processes, the human touch in medical care remains irreplaceable. Both Williams and Lin highlighted the vast potential of AI, especially in areas like administrative tasks, patient communication, diagnostics and preoperative planning.

Yet, they also cautioned against moving too hastily. Williams' emphasis on the potential challenges, like AI's hallucinations and ensuring the validity of outputs, underlines the need for rigorous oversight and validation.

Moreover, while technology offers promising advancements in fields like radiology and microsurgery, there is still a significant journey ahead for AI to be deeply integrated into the operating room. The importance of hands-on experience, tactile learning and the irreplaceable value of human interaction in medical training as well as patient care remains at the forefront of the discussion. As Lin pointed out, privacy concerns, especially when dealing with sensitive patient data, should never be sidelined in the race for innovation.

In the ever-advancing world of plastic surgery, it's exciting to think about the transformative potential of AI. The journey promises to bring many benefits, especially in enhancing patient outcomes and streamlining surgical processes.

"I'm excited about the future and what technology can offer in the next few decades," said Williams. "The challenge, of course, will be keeping up with these innovations while ensuring proper regulations. Medicine, by nature, has a lot of regulatory oversight, which is essential. Physicians can be slow to change, and patients might be hesitant to adopt new models of care. There's always a balance to strike to ensure changes aren't too rapid or unchecked."

AI is poised to revolutionize many aspects of plastic surgery. The collaborative approach between man and machine, underscored by expertise, ethics and caution, will determine the future landscape of this medical field.

To find a qualified plastic surgeon for any cosmetic or reconstructive procedure, consult a member of the American Society of Plastic Surgeons. All ASPS members are board certified by the American Board of Plastic Surgery, have completed an accredited plastic surgery training program, practice in accredited facilities and follow strict standards of safety and ethics. Find an ASPS member in your area.


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