State of the Art of Artificial Intelligence in Plastic Surgery

Introduction: Artificial intelligence (AI) raises a fundamental question for modern plastic surgery: will it enable personalized, patient-centered, efficient care, or lead to a dystopian, automated care that diminishes human autonomy, which is dominated by generic "AI slop" that eventually deteriorates the doctor-patient relationship? Methods: This study examines current applications of large language models, generative AI, and neural networks in plastic surgery, assessing AI's roles in surgical planning, automation of repetitive tasks, outcome evaluation, education, and patient communication, alongside associated ethical, legal, and practical risks and considerations. Results: AI has demonstrated utility in evaluating postoperative outcomes, predicting potential surgical complications, assisting with patient inquiries, providing preoperative guidance, and delivering patient education. However, significant challenges accompany these advances, including risks of algorithmic paternalism, cognitive debt, biased decision-making, misinformation, and the use of synthetic images that may create unrealistic patient expectations. Additional concerns include data privacy, accountability, environmental impact, equitable access to AI technologies, and potentially negative patient perceptions or interactions. Conclusions: AI can meaningfully enhance plastic surgery if integrated responsibly, with appropriate human oversight, transparency, and preservation of clinical judgment. The future of the field depends on balancing technological innovation with ethical responsibility while maintaining authenticity, empathy, and patient-centered care. Surgeons must develop AI literacy, monitor public perceptions of AI, establish ethical guidelines, and actively guide responsible adoption to harness AI's benefits while safeguarding human values, creativity, and trust. Future strengths for high-end or boutique practices may lie in emphasizing enhanced human presence, personality, and authenticity rather than excessive reliance on AI.