AI images are distorting plastic surgery expectations

Patients Consult AI Image Generators During Plastic Surgery Planning

Before undergoing a facelift, Daina Jenkins reviewed an image generated by ChatGPT that depicted the planned procedures. The output showed poreless skin, a sharply defined jawline, and specific lip proportions that differed from her surgical outcome. Jenkins, then 60, had previously undergone other cosmetic procedures and selected a surgeon after two years of research. When the surgeon’s office reviewed the AI image, staff confirmed that the depicted results were not achievable through the planned operations.

Cosmetic dermatologist Dr. Rachel Westbay has observed patients presenting AI-generated images in her Upper East Side practice. One such image featured exaggerated lip volume and enlarged eyes relative to the subject’s facial proportions. Westbay compared the request to seeking features associated with animated characters. Plastic surgeons and dermatologists report that patients now use ChatGPT, specialized AI applications, and image filters to produce visual references for procedures including breast augmentation, body contouring, and rhinoplasty.

A survey conducted by Beth Israel Deaconess Medical Center and published in 2024 found that individuals who had previously applied AI enhancers to photographs reported higher expectations for surgical outcomes compared with those who had not used such tools. Plastic surgeon Dr. Steven Williams, president of the American Society of Plastic Surgeons, stated that patients may use AI images to explore desired appearances, provided they recognize anatomical and physiological constraints. Williams has received AI-generated references for breast, body, and nasal procedures and noted that digital pixels do not correspond directly to surgical tissue modification.

Jenkins asked ChatGPT to visualize a deep-plane facelift after her surgeon did not supply predictive images. The resulting depiction did not match her postoperative appearance six months after surgery. She described the final result as natural and stated that the AI version had not represented a realistic outcome.

Plastic surgeon Dr. Sachin Shridharani reported a consultation in which a patient in her seventies presented an AI-generated image showing features associated with someone approximately forty years younger. Shridharani explained that surgical techniques cannot replicate an individual’s appearance from decades earlier. Patients sometimes request changes that would affect nasal airway function or reduce space required for internal organs, according to multiple surgeons interviewed.

AI systems can produce plausible representations of certain non-facial features but frequently generate inconsistencies in facial structure, skin texture, and ethnic variation. Surgeons describe explaining these limitations during extended consultations, including cases where background distortion indicates post-processing or where proposed proportions would be incompatible with normal anatomy. Williams summarized the constraint by noting that human tissue and organ systems impose limits that digital rendering does not.

Requests for visual references predate AI tools. Reconstructive plastic surgeon Dr. Justin Sacks recalled patients arriving with printed magazine photographs of models. Subsequent technologies, including social media filters, produced similar patterns of reference images. A 2019 survey by the American Academy of Facial Plastic and Reconstructive Surgery documented that a substantial share of facial plastic surgeons encountered patients whose procedure requests were influenced by edited photographs or filters.

Surgeons also identify potential applications for AI within clinical practice. Sacks uses AI tools to record and summarize appointment notes. He described future uses in which AI could generate real-time simulations during reconstructive consultations, such as comparing implant volumes or soft-tissue overlays for breast cancer patients. Such visualizations, he stated, could clarify achievable results before surgery.

Williams advised patients considering procedures to examine their motivations. Requests linked to expectations of career advancement, relationship changes, or social status warrant additional discussion, he said. The article concludes with an invitation for readers to share experiences involving AI and plastic surgery by contacting the reporter.