Artificial Intelligence, Deepfakes, and Rhinoplasty: Navigating Legal Waters in an Era of Digital Alteration

Goals/Purpose:

The intersection of artificial intelligence (AI) and plastic surgery is a nexus of opportunity, as the field is inherently visual and necessitates pre- and post-operative photographs upon which AI can be deployed. Standardized photographs create a visual medical record of the surgeon’s work — a vital component of research, insurance claims, and evidence in legal proceedings, among other purposes. Today, there are well-researched and defined standardized procedures for capturing and editing these photographs that ensure consistency of visual elements such as brightness, contrast, and alignment. Consequently, patients may accurately compare the work of various surgeons, as providers often utilize photographs to exhibit their past work to potential clients, whether through face-to-face consultations or social media platforms. Providers may also utilize these photographs to analyze their operative results for medical research purposes.

Numerous technological advancements in plastic surgery have utilized AI to create applications for rhinoplasty procedures, including tools for pre-operative planning, post-operative evaluation, data extraction for research, and more. This article provides an overview of how AI technologies operate, tailored to its broader objectives of: (1) exploring the various existing and potential applications of AI technologies in rhinoplasty; and (2) examining the concerns surrounding the technologies and how current or future legislation seeks to address them.

Methods/Technique:

To explore the landscape of AI, deepfakes, and rhinoplasty, a medical and legal literature review was conducted. The literature review was conducted from January to July of 2024 and utilized a combination of the following terms: “artificial intelligence,” “machine learning,” “rhinoplasty,” and “plastic surgery.” PubMed and Google Scholar were utilized to identify the relevant medical articles, research papers, and scholarly publications. The Lexis and Westlaw databases were used to identify regulatory frameworks governing the use of AI technologies at the U.S. federal and state levels. The results underwent a subsequent thorough screening process; inclusion criteria included the following: 1) written in the English language; 2) within the U.S.; and 3) relevant to rhinoplasty procedures. Results were excluded if they were outside of the jurisdiction of interest or were not relevant to rhinoplasty procedures. Any conflicts were resolved through discussion and full-text review among the authors.

Results/Complications:

The intersection of AI and rhinoplasty presents both significant opportunities and ethical challenges. One key application includes pre-operative planning through predictive modeling. In a retrospective study comparing the pre-operative VECTRA® 3D renderings to the patients’ actual post-operative photographs, a blinded panel of physicians preferred the actual result in 77.5% of cases [1]. This suggests patients who see and approve their pre-operative renderings are likely to have greater satisfaction with their actual rhinoplasty results. AI has also have found a place in patient education through language models, such as ChatGTP, and have been found to outperform provider responses in accuracy, completeness, and overall quality [2]. However, the rise of deepfake technology raises concerns for data security and consequently patient privacy, of which are regulated under frameworks like HIPAA. Today, regulations are being proposed to address biases in AI outputs and ensure transparency in AI-generated medical content. As AI technologies evolve, specifically in the realm of plastic surgery, it is essential to innovate the technology alongside regulations to safeguard patient rights.

Conclusion:

As AI continues to permeate the world and the field of plastic surgery, exploring the legal landscape at this intersection becomes imperative for ensuring responsible practices. Despite the advancements and benefits AI brings to rhinoplasty, ethical and legal considerations persist, necessitating ongoing dialogue and regulation to navigate the evolving landscape of AI in plastic surgery. On the surface, proposed legislative changes do not appear to substantially hinder the use or development of AI technology in medicine. Instead, they advocate for solutions to many concerns shared by plastic surgeons worldwide [3]. Thus, policymakers navigating the complexities of regulating AI in healthcare, including plastic surgery, seem to be striving for a delicate balance between mitigating risks and harnessing the potential benefits of this rapidly advancing technology.