Cosmetic dermatologist Dr. Rachel Westbay’s job comes with unrealistic expectations. Patients regularly bring in photos of celebrities or of themselves when they were younger and ask her to work their magic on them.
But earlier this year, when a patient brought what Westbay described as a caricature into her Upper East Side office, she encountered something entirely new. The image was cartoonish, her lips too full for her face and her eyes as big as a doll’s.
Its creator was ChatGPT.
“It’s like saying you want to be like Ariel from ‘The Little Mermaid,'” Westbay told Business Insider. “I was in shock.”
Artificial intelligence is increasingly entering the doctor’s office.
Rather than having a plastic surgeon or dermatologist take care of the “after”, patients are encouraging an AI image generator to create their ideal version of themselves. Some use ChatGPT or Nano Banana, while others use specialized apps or AI filters. This is the latest example of how technologies like Snapchat filters and Photoshop before them are reshaping beauty standards and expectations.
The results can pose challenges for physicians who must confront patients about what is surgically achievable or physiologically safe.
A study published last year by Beth Israel Deaconess Medical Center found that people who had used AI enhancers on their photos had “significantly higher” expectations for the results of their plastic surgery.
Dr. Rachel Westbay tried out ChatGPT to create her own images. The result is a hand with at least six fingers. Provided by Rachel Westbay
“It’s not necessarily a completely negative thing for people to explore their desired look and goals,” Dr. Stephen Williams, a Bay Area plastic surgeon and president of the American Society of Plastic Surgeons, told Business Insider. “The important thing is to recognize that there are still limits.”
He had patients bring in AI-generated images of breast implants, body contouring surgeries, and rhinoplasty surgeries. His most important observation is: “Pixels are easier than surgery.”
“The body is not clay”
Dinah Jenkins wasn’t new to plastic surgery when she decided to have a deep plane facelift at age 60.
“If it’s hanging, bagging, or dragging, I’m going to lift it, suck it up, and push it in,” she told Business Insider.
After two years of research and consultation, she decided on a surgeon who would perform the surgery, but the surgeon did not provide images of what she would look like after the surgery. So she turned to ChatGPT, explained the steps she was planning, and asked the AI to visualize it for her.
As a result, the poreless skin, sharp chin and certain pouting mouth did not resemble her at all.
When Jenkins asked the surgeon about the image, he was relieved to hear that even if he liked it, such a result would not be possible.
Dinah Jenkins, pictured six months after her surgery, preferred her results to the AI-generated images. Provided by Dinah Jenkins
“It wasn’t real,” she said. “I like how it looks natural.”
Image generators tend to spit out what Westbay calls a “Bratz doll” look: plump lips, big eyes, and defined chins. It does not take into account an individual’s facial structure, ethnic differences, balance, etc.
This gap between expectations and reality is key to how AI will impact the industry.
When a woman in her 70s brought her AI-generated photo to her consultation, Manhattan plastic surgeon Dr. Sachin Sridharani said it was completely unrealistic. She was looking for a “surgical time machine” and to look like her granddaughter, who is 40 years younger than her.
“I explained that I couldn’t recreate what she looked like when she was younger, but she was adamant,” he said.
While AI can visualize certain features very well, especially non-facial features, it struggles with more complex procedures, such as rhinoplasty.
What follows is a long consultation in which your doctor explains in detail what is possible and safe. they are Explain that a distorted background probably suggests a filter has been applied, that a certain nose tip makes breathing impossible, or that a very narrow waistline means there’s no room for internal organs.
“The body is not clay,” Williams said. “There are physiological systems and organ systems that have to be protected when performing these surgeries.”
Beyond the reality that many AI images are impossible to reproduce on the operating table, many of their suggestions don’t look good in real life.
“There is no procedure I can do to increase the size of my eyes,” Westbay said. “Even if you could do that, people would still look at you like a cartoon.”
Of course, bringing in inspirational images is nothing new.
“Years ago, patients would come in with Vogue cutouts,” Dr. Justin Sacks, a reconstructive plastic surgeon at Washington University School of Medicine in St. Louis, told Business Insider. “If you walked into my office and showed me a photo of Gisele Bundchen or Claudia Schiffer, that would be a red flag.”
As technology changes, so do those references, and social media is flooded with requests inspired by filters and edited influencers.
2019 A survey by the American Society of Facial Plastic Surgeons found that 72% of facial plastic surgeons have had patients undergo procedures to make their selfies look better, part of a phenomenon known as “Snapchat dysmorphia.”
Benefits of AI
Although AI can cause headaches for patients, plastic surgeons and dermatologists see value in the technology.
Sachs, who uses AI tools as a digital scribe during consultations, said AI could also improve the image generation capabilities used by doctors themselves over time.
He envisions working on reconstructing breast cancer patients and instructing AI to create live simulations. What would a 400 milliliter silicone implant look like in this patient? What about the soft tissue overlay?
“Do you know what conversations you have and what expectations you have after visiting that clinic? It would be surprising,” he said.
Images generated by AI or edited and pasted onto social media have pushed the boundaries of what surgeons thought was possible, for better or worse. Doctors have etched her abdominal wall to create a six-pack and broken her ribs to give her a slim waistline.
While the results may be dramatic, Williams cautions patients to think about why they want the surgery.
“What do you expect?” Williams said. If it’s about a new job, relationship, or social status, that’s a “red flag.”
Do you have a story to share about AI and plastic surgery? Contact his reporter: mberg@insider.com.