Skip to main content

Advertisement

SpringerLink
Log in

Ethics for AI in Plastic Surgery: Guidelines and Review

  • Review
  • Special Topics
  • Published:
Aesthetic Plastic Surgery Aims and scope Submit manuscript

Abstract

Introduction

Artificial intelligence (AI) holds the potential to revolutionize medicine, offering vast improvements for plastic surgery. While human physicians are limited to one lifetime of experience, AI is poised to soon surpass human capabilities, as it draws on limitless information and continuous learning abilities. Nevertheless, as AI becomes increasingly prevalent in this domain, it gives rise to critical ethical considerations that must be addressed by professionals.

Materials and Methods

This work reviews the literature referring to the ethical challenges brought on by the ever-expanding use of AI in plastic surgery and offers guidelines for its application.

Results

Ethical challenges include the disclosure of use of AI by caregivers, validation of decision-making, data privacy, informed consent and autonomy, potential biases in AI systems, the opaque nature of AI models, questions of liability, and the need for regulations.

Conclusions

There is a lack of consensus for the ethical use of AI in plastic surgery. Guidelines, such as those presented in this work, are needed within each discipline of medicine to respond to important ethical considerations for the safe use of AI.

Level of Evidence V

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Turing AM (1950) I.—computing machinery and intelligence. Mind LIX(236):433–460

    Article  MathSciNet  Google Scholar 

  2. Haug CJ, Drazen JM (2023) Artificial intelligence and machine learning in clinical medicine, 2023. N Engl J Med 388(13):1201–1208

    Article  CAS  PubMed  Google Scholar 

  3. Sahni NR, Carrus B (2023) Artificial intelligence in U.S. health care delivery. N Engl J Med 389(4):348–358

    Article  PubMed  Google Scholar 

  4. Davenport T, Kalakota R (2019) The potential for artificial intelligence in healthcare. Future Healthc J. 6(2):94–98

    Article  PubMed  PubMed Central  Google Scholar 

  5. Liang X, Yang X, Yin S, Malay S, Chung KC, Ma J et al (2021) Artificial intelligence in plastic surgery: applications and challenges. Aesthetic Plast Surg 45(2):784–790

    Article  PubMed  Google Scholar 

  6. Xie Y, Seth I, Hunter-Smith DJ, Rozen WM, Ross R, Lee M (2023) Aesthetic surgery advice and counseling from artificial intelligence: a rhinoplasty consultation with ChatGPT. Aesthetic Plast Surg 47(5):1985–1993

    Article  PubMed  PubMed Central  Google Scholar 

  7. Atiyeh B, Emsieh S, Hakim C, Chalhoub R (2023) A narrative review of artificial intelligence (AI) for objective assessment of aesthetic endpoints in plastic surgery. Aesthetic Plast Surg 47(6):2862–2873

    Article  PubMed  Google Scholar 

  8. Kenig N, Monton Echeverria J, Chang Azancot L, De la Ossa L (2023) A novel artificial intelligence model for symmetry evaluation in breast cancer patients. Aesthetic Plast Surg. https://doi.org/10.1007/s00266-023-03554-1

    Article  PubMed  Google Scholar 

  9. Berger MF, Winter R, Tuca AC, Michelitsch B, Schenkenfelder B, Hartmann R et al (2023) Workflow assessment of an augmented reality application for planning of perforator flaps in plastic reconstructive surgery: game or game changer? Digit Health. 9:20552076231173550

    PubMed  PubMed Central  Google Scholar 

  10. Koljonen V (2023) What could we make of AI in plastic surgery education. J Plast Reconstr Aesthetic Surg JPRAS. 19(81):94–96

    Article  Google Scholar 

  11. Ho D (2020) Artificial intelligence in cancer therapy. Science 367(6481):982–983

    Article  ADS  CAS  PubMed  Google Scholar 

  12. Reardon S (2023) Mind-reading machines are here: is it time to worry? Nature 617(7960):236

    Article  ADS  CAS  PubMed  Google Scholar 

  13. ChatGPT [Internet]. [cited 2023 Aug 1]. https://openai.com/chatgpt

  14. Seth I, Cox A, Xie Y, Bulloch G, Hunter-Smith DJ, Rozen WM et al (2023) Evaluating Chatbot efficacy for answering frequently asked questions in plastic surgery: a ChatGPT case study focused on breast augmentation. Aesthet Surg J 9:sjad140

    Google Scholar 

  15. Humar P, Asaad M, Bengur FB, Nguyen V (2023) ChatGPT is equivalent to first year plastic surgery residents: evaluation of ChatGPT on the plastic surgery in-service exam. Aesthet Surg J 4:sjad130

    Google Scholar 

  16. Gupta R, Herzog I, Park JB, Weisberger J, Firouzbakht P, Ocon V et al (2023) Performance of ChatGPT on the plastic surgery inservice training examination. Aesthet Surg J 2:sjad128

    Google Scholar 

  17. Stokel-Walker C (2023) ChatGPT listed as author on research papers: many scientists disapprove. Nature 613(7945):620–621

    Article  ADS  CAS  PubMed  Google Scholar 

  18. Rajpurkar P, Lungren MP (2023) The current and future state of AI interpretation of medical images. N Engl J Med 388(21):1981–1990

    Article  PubMed  Google Scholar 

  19. Beam AL, Drazen JM, Kohane IS, Leong TY, Manrai AK, Rubin EJ (2023) Artificial intelligence in medicine. N Engl J Med 388(13):1220–1221

    Article  PubMed  Google Scholar 

  20. Char DS, Shah NH, Magnus D (2018) Implementing machine learning in health care—addressing ethical challenges. N Engl J Med 378(11):981–983

    Article  PubMed  PubMed Central  Google Scholar 

  21. Gasser U (2023) An EU landmark for AI governance. Science 380(6651):1203

    Article  ADS  PubMed  Google Scholar 

  22. Kucirkova NI (2023) Ethics: fund an independent system to verify EdTech. Nature 618(7966):675

    Article  ADS  CAS  PubMed  Google Scholar 

  23. Zhang J, Hu C (2023) Adaptive algorithms: users must be more vigilant. Nature 618(7967):907

    Article  ADS  CAS  PubMed  Google Scholar 

  24. (2023) Why Nature will not allow the use of generative AI in images and video. Nature 618(7964):214

  25. Gaggioli A (2023) Ethics: disclose use of AI in scientific manuscripts. Nature 614(7948):413–413

    Article  ADS  CAS  PubMed  Google Scholar 

  26. Gupta R, Herzog I, Weisberger J, Chao J, Chaiyasate K, Lee ES (2023) Utilization of ChatGPT for plastic surgery research: friend or foe? J Plast Reconstr Aesthetic Surg JPRAS. 80:145–147

    Article  Google Scholar 

  27. Liverpool L (2023) AI intensifies fight against ‘paper mills’ that churn out fake research. Nature 618(7964):222–223

    Article  ADS  CAS  PubMed  Google Scholar 

  28. Jarvis T, Thornburg D, Rebecca AM, Teven CM (2020) Artificial intelligence in plastic surgery: current applications, future directions, and ethical implications. Plast Reconstr Surg Glob Open 8(10):e3200

    Article  PubMed  PubMed Central  Google Scholar 

  29. Espinosa J, Puerta-Romero M, Cobo R, Heredia-Combariza N, Solís-Ruiz LA, Corredor-Zuluaga DA (2023) Artificial intelligence in facial plastic and reconstructive surgery: a systematic review. Facial Plast Surg. https://doi.org/10.1055/a-2216-5099

    Article  Google Scholar 

  30. Choi E, Leonard KW, Jassal JS, Levin AM, Ramachandra V, Jones LR (2023) Artificial intelligence in facial plastic surgery: a review of current applications, future applications, and ethical considerations. Facial Plast Surg FPS. 39(5):454–459

    Article  CAS  PubMed  Google Scholar 

  31. Murphy DC, Saleh DB (2020) Artificial intelligence in plastic surgery: What is it? Where are we now? What is on the horizon? Ann R Coll Surg Engl 102(8):577–580

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Liu HY, Alessandri-Bonetti M, Arellano JA, Egro FM (2023) Can ChatGPT be the plastic surgeon’s new digital assistant? A bibliometric analysis and scoping review of ChatGPT in plastic surgery literature. Aesthetic Plast Surg. https://doi.org/10.1007/s00266-023-03709-0

    Article  PubMed  PubMed Central  Google Scholar 

  33. Couzin-Frankel J (2019) Medicine contends with how to use artificial intelligence. Science 364(6446):1119–1120

    Article  ADS  CAS  PubMed  Google Scholar 

  34. (2023) Stop talking about tomorrow’s AI doomsday when AI poses risks today. Nature 618(7967):885–886

  35. Bassiri-Tehrani B, Cress PE (2023) Unleashing the power of ChatGPT: revolutionizing plastic surgery and beyond. Aesthet Surg J 8:sjad135

    Google Scholar 

  36. Buzzaccarini G, Degliuomini RS, Borin M (2023) The Artificial intelligence application in aesthetic medicine: how chatGPT can revolutionize the aesthetic world. Aesthetic Plast Surg 47(5):2211–2212

    Article  PubMed  Google Scholar 

  37. (2023) Tools such as ChatGPT threaten transparent science; here are our ground rules for their use. Nature 613(7945): 612

  38. Drabiak K, Kyzer S, Nemov V, El Naqa I (2023) AI and ML ethics, law, diversity, and global impact. Br J Radiol 16:20220934

    Article  Google Scholar 

  39. Birch J, Creel KA, Jha AK, Plutynski A (2022) Clinical decisions using AI must consider patient values. Nat Med 28(2):229–232

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Kavian JA, Wilkey HL, Patel PA, Boyd CJ (2023) Harvesting the power of artificial intelligence for surgery: uses, implications, and ethical considerations. Am Surg 6:31348231175454

    Google Scholar 

  41. Wysocka M, Wysocki O, Zufferey M, Landers D, Freitas A (2023) A systematic review of biologically-informed deep learning models for cancer: fundamental trends for encoding and interpreting oncology data. BMC Bioinform 24(1):198

    Article  Google Scholar 

  42. Holzinger A, Langs G, Denk H, Zatloukal K, Müller H (2019) Causability and explainability of artificial intelligence in medicine. Wiley Interdiscip Rev Data Min Knowl Discov. 9(4):e1312

    Article  PubMed  PubMed Central  Google Scholar 

  43. Hutson M (2018) Artificial intelligence faces reproducibility crisis. Science 359(6377):725–726

    Article  ADS  PubMed  Google Scholar 

  44. Zhang K, Khosravi B, Vahdati S, Faghani S, Nugen F, Rassoulinejad-Mousavi SM et al (2022) Mitigating bias in radiology machine learning: 2 model development. Radiol Artif Intell 4(5):e220010

    Article  PubMed  PubMed Central  Google Scholar 

  45. Cho MK (2021) Rising to the challenge of bias in health care AI. Nat Med 27(12):2079–2081

    Article  CAS  PubMed  Google Scholar 

  46. Birhane A (2022) The unseen Black faces of AI algorithms. Nature 610(7932):451–452

    Article  ADS  CAS  PubMed  Google Scholar 

  47. Kenig N, Monton Echeverria J, Muntaner VA (2023) Human beauty according to artificial intelligence. Plast Reconstr Surg Glob Open 11(7):e5153

    Article  PubMed  PubMed Central  Google Scholar 

  48. Martinez-Martin N (2019) What are important ethical implications of using facial recognition technology in health care? AMA J Ethics 21(2):E180-187

    Article  PubMed  PubMed Central  Google Scholar 

  49. (2021) Am I arguing with a machine? AI debaters highlight need for transparency. Nature 592(7853):166

Download references

Author information

Authors and Affiliations

  1. Instituto Rubi, Cami dels Reis, 308, 07010, Palma de Mallorca, Spain

    Nitzan Kenig & Carlos Rubi

  2. Department of Plastic and Reconstructive Surgery, Albacete University Hospital, Albacete, Spain

    Javier Monton Echeverria

Authors
  1. Nitzan Kenig
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Javier Monton Echeverria
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Carlos Rubi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nitzan Kenig.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflicts of interest to disclose.

Human and Animal Rights

This article does not contain any studies with human participants or animals performed by any of the authors. For this type of study, informed consent is not required.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kenig, N., Monton Echeverria, J. & Rubi, C. Ethics for AI in Plastic Surgery: Guidelines and Review. Aesth Plast Surg (2024). https://doi.org/10.1007/s00266-024-03932-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00266-024-03932-3

Keywords

Search

Navigation