Over the last two decades, advanced technology such as artificial intelligence (AI), augmented reality, telemedicine, and robotics have emerged and gained prominence in medical learning and practice, according to an article published in The Journal of the American Society of Plastic Surgeons. Through increased precision and improved communication between plastic surgeons and patients, these advancements can improve patient outcomes. In an interview, Dr Jamil Al Jamali, Consultant Plastic Surgeon at Medcare Hospital Al Safa and Dr David Alessi, Founder and Medical Director of the Alessi Institute for Facial Plastic Surgery and Medical Director for Beverly Hills Wellness and Aesthetics in Dubai, shared insights on how technology is guiding innovations under the knife.
Information technology has become an important element of medical procedures, including the plastic surgery industry, according to Dr Jamali. He shares an example of the digitisation of manufacturing physical operation instruments to various information systems such as surgical information systems, telemedicine, or systems for scheduling operation teams. “This applies to surgical activities but also to the associated patient data-processing and accounting, which have been important issues for the last 20 years at least. With regards to plastic surgery, technology has allowed doctors and patients to create a visual idea of what the outcome of a surgery will be while digital advancements have in themselves, helped to advance the technologies and equipment used in both pre- and post-surgical procedures as well as obviously during the procedures themselves,” he says.
Shaped by technology
Dr David Alessi
Moreover, Dr Alessi comments on how the morphing technology can be key in not only helping patients preview the outcome of their surgeries, but also understand why the plastic surgeon is making certain recommendations. “Through the morphing feature, surgeons can make revisions even during a telemedicine consultation. There are common instances in which patients complain about their nose being too big, however, usually in such cases the nose appears larger due to their chin being small. Therefore, in a preview an augmentation can be made on the chin, creating facial harmony, which the patient is satisfied with. The goal is to ensure patients view the effects of any facial changes before proceeding with the surgery.”
Facial morphing technologies have been integrated in popular and mainstream apps, Dr Jamali explains that they play a key role in encouraging people to embark on various levels of plastic surgery.
“Instagram filters create the illusion of perfect skin or petite noses, which pushes them to explore botox or rhinoplasty. While apps that create the illusion of slimmer thighs or larger breasts encourages them to explore liposuction or breast augmentation. These augmented reality apps are making people more open to considering and accepting various levels of plastic surgery.”
However, Dr Allesi cautions that one of the biggest challenges with plastic surgery is identifying body dysmorphic syndrome. “The way that media has had an influence on what our definition of beauty is quite dramatic, and in the age of social media many young patients bring edited images as references. A classic example is a patient who has a different facial profiling to a celebrity reference. As plastic surgeons, we give options closer to what is possible. Our focus is to look at the patient and work on realistic enhancements. There is an old saying in plastic surgery that a good plastic surgeon knows when to operate, and a great plastic surgeon knows when not to operate. Most plastic surgeons are very well trained in terms of identifying patients who are not good candidates for plastic surgery or may require psychological support before proceeding.”
AI guiding personalised medicine
AI in healthcare delivery has become vital due to its rapid progression, it also lends to plastic surgery in a variety of settings. AI’s ability to predict prognoses and diagnoses can support plastic surgeons in decision-making. “AI is useful in identifying risks such as scarring and intensive intervention for patients suffering from burns. Laser is essentially a form of AI, once you enter the skin type of the patient and area to be treated and the laser will suggest the best setting to be used. AI can also be used to identify patients who have body dysmorphic syndrome ahead of time,” says Dr Alessi.
“As far back as the early 2000s, researchers developed a machine learning (ML) model that assesses burn depth and healing time based on data from a portable reflective spectrophotometer with some 86 per cent accuracy. The model could further tell which burns would heal before 14 days with an accuracy of 96 per cent and those healing later with an accuracy of 75 per cent. In practice, such insights could help guide physicians regarding which patients need closer follow-ups; as well as which ones can be discharged earlier,” adds Dr Jamali.
AR in the operating room
Augmented reality (AR) and face recognition technology are expanding into healthcare, as plastic surgery develops rapidly. The global aesthetic surgery market is also expanding. Furthermore, Dr Alessi details that augmented reality can support the surgery plan. “If a patient needs to have their cheekbones done, the surgeon can take precise measurements using augmented reality, and bring them to the operating room. Another technological advancement is for patients who need to have significant plastic surgery reconstruction. Candidates for this are patients who have had serious accidents, which altered their face. While in surgery digital tracking can be used simultaneously to ensure measurements are precise in complex reconstruction.”
To add, Dr Jamali tells us about ILLUSIO, an augmented reality app with a real-time simulation feature, that helps plastic surgery patients to choose the breast implants of the right shape and size. “Women are invited to wear a special bra compatible with this AR technology that helps the app create a highly-realistic impression of how their new body will look like after the surgery. All the changes can be seen in real time on the screen of an iPad.”
Enhanced future
Dr Alessi concludes that although AI in medicine has advanced, there is still a long way to go “Nonetheless, there have been many progressions, the use of stem cells in plastic surgery was unheard before. Surgeons now can also look at a CAT scan while in surgery to have real time identification for landmarks and be able to rebuild faces, this was not around 30 years ago. The use of telemedicine is more prevalent now as well, which has enabled greater accessibility.”
