Artificial Intelligence Versus Expert Plastic Surgeon: Comparative Study Shows ChatGPT "Wins" Rhinoplasty Consultations: Should We Be Worried?

Introduction: Large language models, such as ChatGPT, hold tremendous promise to bridge gaps in patient education and enhance the decision-making resources available online for patients seeking nasal surgery. Objective: To compare the performance of ChatGPT in answering preoperative and postoperative patient questions related to septorhinoplasty. Methods: Two sets of responses were collected for the questions: one from an expert rhinoplasty surgeon with over two decades of experience, and the other from ChatGPT-3.5. Seven expert rhinoplasty surgeons, blinded to the source of responses, independently assessed the responses using a 5-point Likert scale in four performance areas: empathy, accuracy, completeness, and overall quality. Results: ChatGPT outperformed physician responses in three of the four performance areas, earning significantly higher ratings in accuracy, completeness, and overall quality (p < 0.001). In addition, ChatGPT was overwhelmingly preferred over physician responses (p < 0.001), with evaluators favoring ChatGPT in 80.95% of instances. Conclusions: ChatGPT has demonstrated its remarkable ability to deliver accurate, complete, and high-quality responses to preoperative and postoperative patient questions. Although certain improvements are warranted, this artificial intelligence tool has shown its potential to effectively counsel and educate prospective septorhinoplasty patients at a level comparable with or exceeding that of an expert surgeon.

Minimally Invasive Techniques for Facial Rejuvenation Utilizing Polydioxanone Threads.

Cosmetic procedures to combat the effects of aging are increasing in demand. Surgical interventions, such as rhytidectomy, have long been the standard method of providing a more youthful appearance. However, these procedures are costly, often require general anesthesia, and have potential risks such as scarring and prolonged recovery. A safe, effective, alternative to surgery is the nonsurgical thread-lift. Nevertheless, proper patient selection is critical for optimal outcomes and for patient and provider satisfaction. Over the past decade, these treatments have gained significant popularity for patients to achieve a more rejuvenated appearance with less complications and minimal downtime.

The Role of Subcutaneous Radiofrequency-Assisted Liposculpture in the Facial Plastic Surgeon's Practice.

Importance: Percutaneous radiofrequency-based skin tightening procedures can offer patients an option to undergo a potential treatment for skin laxity and excess adipose of the face and neck with less downtime, lower cost, and decreased risk of complications compared with more aggressive open procedures such as neck lift, face and neck lift, and platysmaplasty. Observations: FaceTite and AccuTite can safely yet effectively deliver energy into the subdermal space, targeting the dermal collagen network and deeper fascial layer. Ideal candidates have early jowl formation, mild to moderate skin laxity, and submental adiposity. Relevance & Conclusions: From the perspective of facial plastic surgeons, these procedures can enhance the volume of an aesthetic practice by welcoming patients who may not otherwise present for face and neck rejuvenation out of fear from surgery. Furthermore, many of these minimally invasive patients will ultimately return for surgical rejuvenation later in life.

Transcutaneous Radiofrequency Microneedling in the Facial Plastic Surgeon's Practice: A Review.

Importance: Minimally invasive methods for skin rejuvenation are in high demand. A diverse array of minimally invasive devices has been developed for aesthetical purposes and should be considered to help patients achieve their goals. Observations: Radiofrequency (RF) microneedling is a safe and effective intervention for treatment of various aesthetical and dermatological conditions in all skin types. This review highlights Morpheus8 (InMode, Inc., Irvine, CA) and what differentiates it from other similar devices. Conclusions and Relevance: RF microneedling addresses aesthetical and dermatological concerns for a diverse variety of patients in whom surgical intervention may not be desired. Morpheus8 has unique technological properties and advances that make it the preferred device for many practices.

Minimally Invasive Techniques for Facial Rejuvenation Utilizing Polydioxanone Threads.

Cosmetic procedures to combat the effects of aging are increasing in demand. Surgical interventions, such as rhytidectomy, have long been the standard method of providing a more youthful appearance. However, these procedures are costly, often require general anesthesia, and have potential risks such as scarring and prolonged recovery. A safe, effective, alternative to surgery is the nonsurgical thread-lift. Nevertheless, proper patient selection is critical for optimal outcomes and for patient and provider satisfaction. Over the past decade, these treatments have gained significant popularity for patients to achieve a more rejuvenated appearance with less complications and minimal downtime.

A Multicenter Study to Evaluate Subject Satisfaction With Two Treatments of AbobotulinumtoxinA a Year in the Glabellar Lines.

BACKGROUND: Real-world re-treatment intervals for botulinum toxins vary, but most subjects receive treatment less frequently than the manufacturer-recommended minimum intervals. In subjects receiving treatment with AbobotulinumtoxinA (ABO) less frequently, high levels of satisfaction and psychosocial improvements in well-being, self-confidence, and quality of life are observed. OBJECTIVE: To evaluate subject satisfaction with a twice yearly re-treatment schedule. METHODS AND MATERIALS: This open-label, multicenter, interventional study evaluated subject satisfaction following injections of ABO 50 U in the glabellar lines at baseline and 6 months. The primary end point was subject satisfaction at 12 months. Secondary endpoints included subject satisfaction, FACE-Q scales, and glabellar line severity scale (GLSS). RESULTS: Ninety-five percent of the 120 subjects were "highly satisfied" or "satisfied" with their treatment outcomes at 12 months. FACE-Q total scores suggested that subjects were less bothered by glabellar lines and felt better about their facial appearance with each treatment versus baseline. Approximately half of subjects had ≥1-grade improvement from baseline in GLSS at 12 months. Median onset of effect was 2 days. CONCLUSION: The majority of subjects (95%) were satisfied with ABO treatment every 6 months; results were supported by high subject satisfaction, long duration, rapid onset, natural-looking results, and overall psychological wellness and safety.

New Frontiers in Skin Rejuvenation, Including Stem Cells and Autologous Therapies.

One of the greatest challenges in the progression of aesthetic medicine lies in providing treatments with long-term results that are also minimally invasive and safe. Keeping up with this demand are developments in autologous therapies such as adipose-derived stem cells, stromal vascular fraction, microfat, nanofat, and platelet therapies, which are being shown to deliver satisfactory results. Innovations in more traditional cosmetic therapies, such as botulinum toxin, fillers, and thread lifts, are even more at the forefront of the advancement in aesthetics. Combining autologous therapies with traditional noninvasive methods can ultimately provide patients with more effective rejuvenation options.

Analysis of Olfaction after Bilateral Nasoseptal Rescue Flap Transsphenoidal Approach with Olfactory Mucosal Preservation.

OBJECTIVE: To ascertain the impact of septal olfactory strip preservation and bilateral rescue flap elevation on the incidence of olfactory dysfunction. STUDY DESIGN: Case series with chart review of patients undergoing endoscopic endonasal skull base surgery (2012-2014). SETTING: Providence Saint John's Health Center and John Wayne Cancer Institute. SUBJECTS AND METHODS: The incidences of postoperative epistaxis, hyposmia, and anosmia were analyzed using the Brief Smell Identification Test (B-SIT), which was completed in 110 of the 165 patients. RESULTS: Seventy-eight patients required extended approaches. Bilateral nasoseptal rescue flaps were elevated in 144 patients (87.3%) and pedicled nasoseptal or middle turbinate flaps in 21 patients (12.7%). The neurovascular pedicles were preserved in all patients, and there were no episodes of postoperative arterial epistaxis. Normal olfaction was noted in 95 patients (86%), with new hyposmia noted in 5 patients (5.5%). Within the rescue flap cohort, new hyposmia occurred in 6.3% (P < .01) of patients, balanced by improvement of olfaction in 43% of patients with preoperative dysfunction (overall pre- and postoperative olfactory function: 85% vs 86%). Patients with pedicled nasoseptal flaps did not have new hyposmia, with a net improvement of olfaction (71% vs 86%, P = .07). No patients experienced new anosmia. There was no difference between flap type within either subgroup. CONCLUSIONS: Superior olfactory strip preservation during elevation of reconstructive flaps preserves olfactory function and maintains adequate surgical exposure. In addition, rescue flaps have significantly diminished the rate of arterial postoperative epistaxis while maintaining the ability to harvest nasoseptal flaps for future reconstruction.

The Benefits of Platelet-Rich Fibrin.

Platelet-rich fibrin (PRF) is a next-generation autologous platelet therapy with immense potential in several medical fields. In cosmetic medicine, for example, PRF is useful in wound healing and skin rejuvenation as a primary and a supplemental technique owing to its fibrin matrix, cellular components, and prolonged release of growth factors. PRF is simple to obtain, inexpensive, and may be administered topically, injected, or in conjunction with other esthetic procedures. In this regard, PRF possesses diverse, and increasingly pertinent capacities in esthetic medicine and surgery.

A single-center, pilot study evaluating a novel TriHex peptide- and botanical-containing eye treatment compared to baseline.

BACKGROUND: Topical treatments containing tripeptide and hexapeptide (TriHex technology) have been proven to contribute to youthful skin by clearing the extracellular matrix and stimulating collagen and elastin production. OBJECTIVE: Evaluate the efficacy of a novel eye treatment containing TriHex peptides and other synergistic ingredients for the daily treatment of fine lines/crow's feet around the eyes, under eye hollowing, under eye bags, and dark circles. PATIENTS/METHODS: In this study, 10 subjects (9 female and 1 male) aged 30-60 of Fitzpatrick skin type I, II, or III were selected to use an eye treatment containing TriHex peptides and active botanicals (Alastin Restorative Eye Treatment with TriHex Technology™, ALASTIN Skincare, Inc., Carlsbad, CA) twice daily for 12 weeks. Subjects were photographed and evaluated at baseline, week 4, week 8, and week 12 by a board-certified facial plastic surgeon. Using an adjusted Griffiths scale (0 = none, best possible condition and 9 = severe, worst possible condition), subjects were evaluated on severity of fine lines/crow's feet, under eye hollowing, under eye bags, and dark circles at each visit. Subjects completed a "Subject Questionnaire" at week 4, week 8, and week 12 pertaining to the subject's observations and perceived improvement of these measures. RESULTS: Based on the investigator's assessments, overall improvement in periocular skin was noted for all 10 subjects. Over the course of 12 weeks, raw scores significantly decreased indicating reduction of lines/crow's feet (41% improvement), under eye hollowing (29% improvement), under eye bags (48% improvement), and dark circles (39% improvement). Based on the "Subject Questionnaire," all subjects noted overall improvement of the appearance of skin around the eyes. CONCLUSION: Based on the findings of this study, this eye treatment containing TriHex peptides and active botanicals is an effective stand-alone treatment for the rejuvenation of periocular skin. When used twice daily, this product can reduce the appearance of lines/crow's feet, under eye hollowing, under eye bags, and dark circles.

Lifting the Lower Face With an Absorbable Polydioxanone (PDO) Thread.

Traditional rejuvenation techniques include chemical peels, rhytidectomy of the skin, laser resurfacing, injection of dermal fillers and neurotoxins, and invasive surgical procedures. Patients with brow ptosis, jowl formation, and deepening nasolabial folds currently seek antiaging procedures with no incisions and minimal downtime such as thread-lifting with barbed sutures. The present report describes a case in which polydioxanone threads were used to lift the lower third of a patient's face. Fillers were used to supplement the results achieved by the thread lift because often, when tissue has been lifted, volume deficits are revealed, which can be corrected with dermal fillers. The procedure was performed in less than 30 minutes and was well tolerated. Mild swelling at the insertion points and general treatment area resolved within 7 days without intervention. Bruising was not observed. The patient showed remarkable improvement 7 months after the procedure.

J Drugs Dermatol. 2017;16(9):932-934.

Avoidance of postoperative epistaxis and anosmia in endonasal endoscopic skull base surgery: a technical note.

BACKGROUND: Most endoscopic transsphenoidal approaches jeopardize the sphenopalatine artery and septal olfactory strip (SOS), increasing the risk of postoperative anosmia and epistaxis while precluding the ability to raise pedicled nasoseptal flaps (NSF). We describe a bilateral "rescue flap" technique that preserves the mucosa containing the nasal-septal vascular pedicles and the SOS. This approach can reduce the risk of postoperative complications, including epistaxis and anosmia. METHODS: A retrospective analysis was conducted of all patients who underwent endoscopic transsphenoidal surgery with preservation of both sphenopalatine vascular pedicles and SOS. In a recent subset of patients, olfactory assessment was performed. RESULTS: Of 174 consecutive operations performed in 161 patients, bilateral preservation of the sphenopalatine vascular pedicle and SOS was achieved in 139 (80 %) operations, including 31 (22 %) with prior transsphenoidal surgery. Of the remaining 35 operations, 18 had a planned formal NSF and 17 had prior surgery or extensive lesions precluding use of this technique. Of pituitary adenomas, RCCs or sellar arachnoid cysts, 118 (94 %) underwent this approach, including 91 % of patients who had prior surgery. Preoperative olfaction function was maintained in 97 % of patients that were tested. None of the patients had postoperative arterial epistaxis. CONCLUSION: Preservation of bilateral sphenopalatine vascular pedicles and the SOS is feasible in over 90 % of patients undergoing endonasal endoscopic surgery for pituitary adenomas and RCCs. This approach, while not hindering exposure or limiting instrument maneuverability, preserves the nasoseptal vasculature for future NSF use if needed and appears to minimize the risks of postoperative arterial epistaxis and anosmia.

Objective assessment of perceived age reversal and improvement in attractiveness after aging face surgery.

IMPORTANCE: Primary reasons why patients pursue aesthetic facial surgery are to look younger and more attractive; however, there is minimal literature about the effect of aesthetic facial surgery on perceived age and attractiveness. OBJECTIVES: To objectively and quantitatively evaluate the degree of perceived age change and improvement in attractiveness following aesthetic facial surgical procedures. DESIGN: Prospective evaluation by independent raters of preoperative and postoperative photographs of 49 consecutive patients who underwent aesthetic facial surgery between July 4, 2006, and July 22, 2010. The photographs of these patients were presented to 50 blinded raters, each of whom was randomly assigned to 4 rater groups. Raters were asked to estimate the age of each patient in the photographs presented and to rate the patient's attractiveness on a scale of 1 to 10. SETTING: Facial plastic surgery private practice in Toronto, Ontario, Canada. PARTICIPANTS: Patient inclusion criteria consisted of primary facial surgical procedures with a minimum 6-month follow-up period, use of standardized photographs, and no cosmetic procedures in the intervening period. Raters were chosen from the province of Ontario, randomly assigned to 1 of 4 rater groups, and blinded to the objectives of the study. MAIN OUTCOMES AND MEASURES: The mean "years saved" (true age minus guessed age) and change in attractiveness scores after facial aesthetic surgery. RESULTS: The mean overall years saved following aesthetic facial surgery was 3.1 years (range, -4.0 to 9.4 years). There was a small but insignificant increase in attractiveness scores in postprocedural photographs relative to preprocedural photographs (P > .54). CONCLUSIONS AND RELEVANCE: In this study, aesthetic facial surgery was effective in reducing the apparent age of patients but did not consistently improve their attractiveness. LEVEL OF EVIDENCE: 4.

Ethical considerations in aesthetic rhinoplasty: a survey, critical analysis, and review.

Although the practice of medicine is built on a foundation of ethics, science, and common sense, the increasing complexity of medical interventions, social interactions, and societal norms of behavior challenges the ethical practice of aesthetic surgeons. We report a survey of the opinions, practices, and attitudes of experienced and novice facial plastic surgeons. The survey consisted of 15 clinical vignettes addressing ethical quandaries in aesthetic rhinoplasty. The vignettes are based on the experience and observations of the senior author (P.A.A.) over nearly 30 years of practice and teaching. Fellowship directors and facial plastic surgery fellows of the American Academy of Facial Plastic and Reconstructive Surgery were surveyed anonymously. Five of the 15 vignettes demonstrated significant differences between the responses of the fellowship directors and the fellows. No single vignette had a unanimous consensus in either group. Aesthetic rhinoplasty surgeons encounter ethical issues that should be reflected on by both experienced and inexperienced facial plastic surgeons, preferably before being faced with them in practice. We present a practical approach to ethical issues in clinical practice. Our survey can also be used as a stimulus for further discussion and teaching.

The spectrum of isolated congenital nasal deformities resembling the cleft lip nasal morphology.

OBJECTIVE: To define the intrinsic (hypoplasia) and extrinsic (deformational) contributions to congenital nasal deformities and the potential of a carrier state for orofacial clefting. METHODS: Retrospective case series. RESULTS: The factors affecting 4 congenital nasal deformities are postulated after contrasting the patient's characteristics. CONCLUSIONS: The spectrum of congenital nasal deformities includes those that resemble the cleft lip nasal deformity, but careful inspection is needed for proper classification. Classifying congenital nasal deformities can be difficult in part due to the highly variable normal range. The most minor form of the typical unilateral cleft lip nasal deformity is the microform cleft. The potential of an isolated cleft lip nasal deformity without obvious cleft lip has been previously suggested to represent a carrier state for orofacial clefting. Definitive genetic studies and continued anthropometric documentation in relatives of patients with orofacial clefts are needed if we are to uncover previously unidentified associations, and a potential carrier state.

Patient analysis and selection in aging face surgery.

Advances in health, increased awareness of preventative medicine, and evolution have led to an increasingly older population worldwide. Surgical aesthetic facial rejuvenation has become increasingly popular, more accessible, and has lost much of the stigma that it once carried. This review will discuss proper patient analysis and selection for aging face surgery, including medical, anatomic, and psychosocial factors that are involved. Although the novice facial plastic surgeon typically focuses on facial analysis and operative techniques in aging face surgery, we caution that the patient's expectations, psychosocial comorbidities, and perioperative interpersonal experiences are the most important factors that yield patient satisfaction, which is the prime outcome that is meaningful in elective cosmetic surgery.

The efficacy of rhinoplasty alone in facial rejuvenation.

PURPOSE: The aim of the study was to demonstrate whether rhinoplasty alone is a rejuvenating procedure for the aging face. MATERIALS AND METHODS: Photographs of the right profile of 48 white females older than 55 years were recorded using standardized techniques. Each of the subjects' noses underwent computer-simulated rhinoplasty to conform to aesthetic canons of the ideal nose. Forty-eight evaluators, blinded to the purpose of the study, were shown either the natural right profile or the morphed image. The evaluators then estimated subject age. RESULTS: Evaluators were divided into younger and older cohorts. Computer-simulated rhinoplasty alone did not prove to be statistically rejuvenating (Hotelling-Lawley Trace, P = .203). This finding held true for both the younger and older cohort of evaluators (P = .98). Although not statistically significant, evaluators estimated the age of the morphed images to be 6.5 years (mean) younger than actual age for all subjects. CONCLUSIONS: Rhinoplasty alone is not statistically rejuvenating in the profile view of white females older than 55 years. However, age estimation may be less accurate than was hypothesized for the profile view, possibly because of other visual queues.