AI face is taking over — and driving plastic surgeons crazy

• Patients are turning to artificial intelligence for inspiration in plastic surgery and dermatology.

• Doctors say the results are often physically impossible or unsafe.

• It’s the latest example of how technology is widening the gap between beauty expectations and reality.

In the practice of cosmetic dermatologist Dr. Rachel Westbay, unrealistic expectations are commonplace. Patients often bring her celebrities or photos of themselves when they were younger and ask her to perform magic.

But earlier this year, she encountered something entirely new when a patient brought what Westby described as a caricature to her Upper East Side office. The photo was cartoony, with lips that were too thick and eyes that were bigger than her face and looked like a doll’s.

Its creator is ChatGPT.

“It’s like saying I want to look like Ariel from ‘The Little Mermaid,'” Westerby told Business Insider. “I was shocked.”

Artificial intelligence is increasingly making its way into doctor’s offices.

Instead of leaving plastic surgeons and dermatologists responsible for the “after,” patients are prompting AI image generators to create ideal versions of themselves. Some use ChatGPT or Nano Banana, others use specialized apps and AI filters. It’s the latest example of how technology (like Snapchat filters and Photoshop before it) is reshaping beauty standards and expectations.

The results can be a challenge for doctors, who must confront patients about what is achievable or physiologically safe with surgery.

A survey released last year by Beth Israel Deaconess Medical Center found that those who had had AI enhancers used on their photos had “significantly higher” expectations for plastic surgery results.

“It doesn’t have to be a completely negative thing for people to explore their desired look or goals,” Dr. Steven Williams, a Bay Area plastic surgeon and president of the American Society of Plastic Surgeons, told Business Insider. “It’s important to recognize that there are still limitations.”

He has patients come in with AI-generated images of breast augmentation, body contouring and rhinoplasty. His most important point: “Pixels are easier than surgery.”

“The body is not clay”

Daina Jenkins is no stranger to plastic surgery, and at the age of 60, she decided to have a deep plastic surgery.

“If it’s drooping, bagging, or tugging, I’ll lift it, suck it up, or tuck it,” she told Business Insider.

After two years of research and consultations, she chose a surgeon for surgery, but he provided no pictures of what she would look like after surgery. So she turned to ChatGPT, explaining the programs she was planning and asking the AI ​​to visualize them.

The result—the poreless skin, the sharp chin, the distinctive pout—looked nothing like her.

Jenkins asked her surgeon’s office about the photo and was relieved to learn that even if she liked it, these results weren’t possible.

“This is not reality,” she said. “I like that I look natural.”

Image generators favored what Westby calls a “Bratz doll” look: full lips, large eyes and a chiseled jaw. It does not take into account an individual’s facial structure, different races, or balance.

The gap between expectations and reality is key to AI’s impact on the industry.

When a woman in her 70s came to a consultation with an AI-generated photo, Dr. Sachin Shridharani, a plastic surgeon in Manhattan, said it was completely unrealistic. She is looking for a “surgical time machine” and one that looks like her granddaughter who is forty years her junior.

“I explained that we couldn’t recreate what she looked like as a young girl, but she persisted,” he said.

While AI can do a good job of visualizing certain features — especially non-facial features — it struggles with more complex procedures, like nose jobs.

What follows is a lengthy consultation where the doctor breaks down what is possible and safe. They explained that the distorted background suggested a filter might have been used, that a specific nose tip would have made breathing impossible, or that such a narrow waistline meant there was no room for internal organs.

“The body is not clay,” Williams said. “When we perform these surgeries, we have to protect physiology and organ systems.”

In addition to the reality that many AI images cannot be recreated on the operating table, many of its recommendations don’t look good in real life.

“I can’t do any surgery to enlarge the size of my eyes,” Westerby said. “Even if we could do that, people would look at you like you were a cartoon.”

Of course, introducing inspiring images is nothing new.

“A few years ago, patients would come in with a photo of a cutout from Vogue magazine,” Dr. Justin Sachs, a plastic surgeon at Washington University School of Medicine in St. Louis, told Business Insider. “If you walked into my office and showed me a picture of Gisele Bündchen or Claudia Schiffer, that would be like a red flag.”

As technology has changed, so have these references, and social media has brought with it a flood of requests inspired by filters or edited influencers.

A 2019 study from the American Society of Facial Plastic and Reconstructive Surgery found that 72% of facial plastic surgeons’ patients underwent surgery to look better in selfies, part of a phenomenon known as “Snapchat dysmorphia.”

Advantages of artificial intelligence

While using artificial intelligence may cause some headaches for patients, plastic surgeons and dermatologists see the value of the technology.

Sacks, who uses the AI ​​tool as a digital scribe during appointments, said that over time AI could also improve the image generators used by doctors themselves.

He imagined reconstructing a breast cancer patient and directed the artificial intelligence to create a real-time simulation: What would this patient look like with a 400-ml silicone implant? How about some soft tissue coverage?

“Do you realize the conversations you’re going to have and the expectations you’re going to have after a clinic visit? It’s going to be shocking,” he said.

For better or worse, images generated by artificial intelligence or edited to be posted on social media push the limits of what surgeons thought was possible. Doctors are etching six-pack abs into the abdominal wall and breaking ribs to achieve a slimmer waistline.

Although the results may be dramatic, Williams warns patients to think about why they want to undergo surgery.

“What were your expectations?” Williams said. If it’s a new job, relationship, or social status, that’s a “red flag.”

Do you have a story to share about artificial intelligence and plastic surgery? To contact his reporter: mberg@insider.com.

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