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Facial Aesthetics in Artificial Intelligence: First Investigation Comparing Results in a Generative AI Study.

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Artificial intelligence (AI) can visualize facial plastic surgery results, but current models show varied realism and clinical value. Further AI development is needed for accurate patient expectations and surgical planning.

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Area of Science:

  • Plastic Surgery
  • Artificial Intelligence
  • Medical Imaging

Background:

  • Facial plastic surgery patients increasingly use AI for outcome visualization.
  • AI model variations and data limitations can lead to inaccurate simulations and unmet patient expectations.
  • The utility of AI-generated images for realistic patient expectations in surgery requires evaluation.

Purpose of the Study:

  • To assess the realism and clinical value of AI-generated images for facial plastic surgery procedures.
  • To compare the performance of different AI platforms in simulating surgical outcomes.
  • To determine if AI-generated images can provide realistic expectations for patients undergoing facial plastic surgery.

Main Methods:

  • AI platforms (Midjourney, Leonardo, Stable Diffusion) generated images for otoplasty, genioplasty, rhinoplasty, and platysmaplasty.
  • Board-certified plastic surgeons and residents evaluated images based on realism and clinical value using 11 metrics.
  • Statistical analysis included ANOVA and Tukey Honestly Significant Difference tests.

Main Results:

  • Midjourney showed significantly higher realism than Stable Diffusion (P < .01).
  • Leonardo demonstrated superior size and volume accuracy compared to Stable Diffusion (P = .02).
  • Stable Diffusion had significant underperformance in anatomical correctness, age simulation, and texture mapping; all models struggled with healing and scarring prediction, with some images exhibiting the uncanny valley effect.

Conclusions:

  • AI model performance varied, impacting realism and clinical value.
  • While some AI images were reasonable, many showed unrealistic outcomes or the uncanny valley effect.
  • Improvements in AI are necessary for accurate pre- and postoperative imaging; further research comparing AI visuals with actual surgical results is planned.