Art, Artificial Intelligence, and Aesthetics in Plastic Surgery

Since the boom of plastic surgery in the 1920s, this specialty has been strongly affiliated with art.1 Today, it still holds true to its foundations, as it frequently engages beauty and enhancing aesthetics. Many plastic surgeons have artistic tendencies, or even actively practice creative arts, and some plastic surgery residency training programs have incorporated art lessons into their curriculum.2 It is evident that all medical specialties have been or soon will be affected by the rise of a new scientific enigma, artificial intelligence. This influence has generally been investigated from a clinical or scientific perspective. Plastic surgery may be unique though, in light of its creative and artistic connection, especially in the field of aesthetics. The art world is constantly changing and adapting, and even in this world, artificial intelligence has exerted its influence and in cases has been shown to augment the skill of the artist, from portraits to modern art. This leads us to consider that not only will the scientific, clinical component of plastic surgery be affected by artificial intelligence, as numerous studies have shown,3 but perhaps too the artistic nature of the specialty will be affected. Artistic insights and decisions are required by plastic surgeons. Here, artificial intelligence could lend a helping hand when needed. A review of the literature was done, and the following notable capabilities of artificial intelligence were discovered that favor this concept. When an artificial intelligence classifier of facial beauty was trained, its scores were comparable to those of human referees. Artificial intelligence was used to design cleft lip and palate operations, using patient-specific predictive markers. With feature extraction from facial images, the algorithm could identify the most suitable surgical markers for patients.4 It can design highly realistic photographs and videos seen in a portrait that was auctioned for an exuberant price. Artificial intelligence has the capability to microanalyze facial features and can predict postoperative outcomes.5 This is useful to the "artist"; if one can see the outcome, one can change the current inputs to create a more desired likely finishing aesthetic output. These examples portray how artificial intelligence has, or will soon have, the abilities to recognize and evaluate aesthetic beauty, identify patient-specific markers, create its own outputs, and predict the postoperative outcomes. For plastic surgeons who do not have vast experience, or a heightened artistic eye, the creative insight of artificial intelligence could prove invaluable for use to various degrees, be it for complete design or just to provide guidance and confidence. Patients can be at ease with the result of their aesthetics before an operation and, together with the surgeon, can design their desired appearance, augmented by artificial intelligence. This is important, as it would push this specialty to render outcomes of procedures more aesthetically pleasing for patients. It would also streamline the efficiency of training, as more focus could be put onto the pure clinical surgical procedure, as the artistic guidance of artificial intelligence could act as a strong base and reference point for plastic surgeons to fall back on if need be. ACKNOWLEDGMENT The author thanks Valeriano Vinci, M.D., for insight and guidance on this article. DISCLOSURE The author has no financial interest to declare in relation to the content of this article. Dakota Russell WheelerDepartment of Biomedical SciencesHumanitas UniversityPieve Emanuele MI 20090, Italy[email protected]