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Page 127 Treger et al. Art Int Surg. 2025;5:126-32 https://dx.doi.org/10.20517/ais.2024.66

INTRODUCTION
Will artificial intelligence (AI) replace the work of plastic and reconstructive surgeons? With the rapid
evolution and growing role that AI models are contributing to modern life, some people have come to
believe that medical doctors will face a forced, early retirement. Large language models such as ChatGPT
utilize machine learning and deep neural networks to capture the intricacies of human language. This
permits them to navigate specific prompts and generate contextually appropriate and accurate responses
[1]
even within specialized fields . While it is irrefutable that AI may significantly augment and complement
the work of plastic surgeons, it remains heavily debated if we will ever actually realize their full replacement,
at least anytime soon.

AI may grow to become a useful tool but not a comprehensive substitute for plastic surgeons. Surveys
gauging the attitudes of medical students, ostensibly a biased subgroup, have found that future doctors are
[2]
not concerned about their job security . Respondents suggest that the complexity and nuances of
healthcare delivery, especially in the case of surgical fields, will make it one of the last industries to fall into
obsolescence. AI may have numerous practical applications in medical education, diagnosis and treatment
[3,4]
plan formation, research, administration, and patient health literacy . Altogether, its role could be
described as a virtual assistant to healthcare professionals and laypeople alike.

Despite its potential applications, the use of AI in healthcare and plastic surgery poses major ethical and
legal concerns. This will be explored further within this commentary. Questions remain as to what extent
humans can impart their trust into a non-human entity, how we can protect patients from potential
negative consequences associated with AI use, what type of legislation will emerge to regulate and guide the
use of AI in healthcare, and what role, if any, will AI play in plastic surgery.

TRUST OF AI IN PLASTIC SURGERY
In exploring how likely patients are to trust the use of AI in plastic surgery, it is important to discuss the
concept of safety. With matters as sensitive as health, AI must demonstrate that it can reliably make correct
decisions regarding healthcare management so that humans feel comfortable with its implementation in
plastic surgery. Unfortunately, there is no current universal metric or threshold for this. Do we begin to
trust AI when it surpasses human plastic surgeon performance, or does it need to achieve some greater level
of utility?

To draw a comparison, it is worthwhile to examine the case of autonomous vehicles or self-driving cars.
This example serves as an apt analogy because it represents an application of AI that directly impacts
personal safety and, thus, health. According to the Centers for Disease Control and Prevention (CDC), car
[5]
accidents are the leading cause of death in the United States for people aged 1 to 54 . These accidents occur
countless times daily and are a direct result of human error. However, when a sporadic case of an
autonomous vehicle hitting a pedestrian or causing a motor vehicle accident occurs, it often makes news
headlines and triggers a media frenzy. Companies such as Waymo have demonstrated the capability of self-
driving cars, continually iterating to improve reliability. Yet, as a society, we remain hesitant to fully
embrace them. In fact, attitudes toward self-driving vehicles have worsened over time, despite
improvements in the technology .
[6]

Unsurprisingly, both clinicians and patients remain skeptical about AI in healthcare and plastic surgery.
This stems from uncertainty about both the data used to train AI models and the appropriate applications
of the technology. Pew Research Center conducted surveys to gauge American attitudes toward AI use
[7]
across various healthcare domains. This demonstrated an overwhelmingly negative sentiment . In fact,