Development of a Novel Artificial Intelligence Clinical Decision Support System for Aesthetic Surgery: AURA

Abstract Background Aesthetic surgery requires integration of specialized knowledge with clinical expertise, yet traditional literature search methods are time-intensive when addressing specific clinical questions. While artificial intelligence has transformed various aspects of healthcare delivery, no AI clinical decision support systems have been specifically developed to enhance evidence-based practice in aesthetic surgery. Objectives We aimed to develop and evaluate AURA (Aesthetic surgery Using Retrieval Augmentation), a novel AI-powered clinical decision support system designed specifically for evidence-based guidance in aesthetic surgery. Methods AURA integrates a comprehensive database of 6,546 full-text open-access aesthetic surgery publications (January 2001-September 2024) with a commercial large language model using retrieval-augmented generation technology. System performance was rigorously assessed across 14 complex clinical scenarios spanning facial rejuvenation, body contouring, breast procedures, and general aesthetic surgery considerations. Evaluation metrics included faithfulness to source materials (0-1), answer relevancy (0-1), G-Eval correctness (0-1), SEM semantic quality scores and SEM confidence ratings. Results AURA demonstrated exceptional performance with mean scores of 0.94 for faithfulness, 0.86 for answer relevancy, and 0.77 for factual correctness. Semantic evaluation revealed strong results with average scores of 0.73 (SEM Score) and 0.80 (SEM Max Similarity), predominantly with moderate confidence ratings. Performance was notably stronger for established techniques and safety considerations compared to emerging procedures requiring comparative analysis. Conclusions We present AURA, the first specialized AI clinical decision support system for aesthetic surgery. This novel system effectively delivers relevant, accurate information across diverse aesthetic surgery domains based on peer-reviewed literature. AURA offers aesthetic surgeons an efficient, evidence-based resource for clinical decision support. Future development should focus on expanding knowledge sources and prospective clinical validation, with implementation emphasizing transparent source presentation to complement surgical expertise.