Artificial Intelligence-Generated Social Media Content Creation and Management Strategies for Plastic Surgeons.

BACKGROUND: Social media platforms have come to represent integral components of the professional marketing and advertising strategy for plastic surgeons. Effective and consistent content development, however, remains technically demanding and time consuming, prompting most to employ, at non-negligible costs, social media marketing specialists for content planning and development. OBJECTIVES: In the present study, we aimed to investigate the ability of presently available artificial intelligence (AI) models to assist plastic surgeons in their social media content development and sharing plans. METHODS: An AI large language model was prompted on the study's objectives through a series of standardized user interactions. Social media platforms of interest, on which the AI model was prompted, included Instagram, TikTok, and X (formerly Twitter). RESULTS: A 1-year, entirely AI-generated social media plan, comprising a total of 1091 posts for the 3 aforementioned social media platforms, is presented. Themes of the AI-generated content proposed for each platform were classified in 6 categories, including patient-related, practice-related, educational, "uplifting," interactive, and promotional posts. Overall, 91 publicly recognized holidays and observant and awareness days were incorporated into the content calendars. The AI model demonstrated an ability to differentiate between the distinct formats of each of the 3 social media platforms investigated, generating unique ideas for each, and providing detailed content development and posting instructions, scripts, and post captions, leveraging features specific to each platform. CONCLUSIONS: By providing detailed and actionable social media content creation and posting plans to plastic surgeons, presently available AI models can be readily leveraged to assist in and significantly alleviate the burden associated with social media account management, content generation, and potentially patient conversion.

Utility and Comparative Performance of Current Artificial Intelligence Large Language Models as Postoperative Medical Support Chatbots in Aesthetic Surgery.

BACKGROUND: Large language models (LLMs) have revolutionized the way plastic surgeons and their patients can access and leverage artificial intelligence (AI). OBJECTIVES: The present study aims to compare the performance of 2 current publicly available and patient-accessible LLMs in the potential application of AI as postoperative medical support chatbots in an aesthetic surgeon's practice. METHODS: Twenty-two simulated postoperative patient presentations following aesthetic breast plastic surgery were devised and expert-validated. Complications varied in their latency within the postoperative period, as well as urgency of required medical attention. In response to each patient-reported presentation, Open AI's ChatGPT and Google's Bard, in their unmodified and freely available versions, were objectively assessed for their comparative accuracy in generating an appropriate differential diagnosis, most-likely diagnosis, suggested medical disposition, treatments or interventions to begin from home, and/or red flag signs/symptoms indicating deterioration. RESULTS: ChatGPT cumulatively and significantly outperformed Bard across all objective assessment metrics examined (66% vs 55%, respectively; P < .05). Accuracy in generating an appropriate differential diagnosis was 61% for ChatGPT vs 57% for Bard (P = .45). ChatGPT asked an average of 9.2 questions on history vs Bard's 6.8 questions (P < .001), with accuracies of 91% vs 68% reporting the most-likely diagnosis, respectively (P < .01). Appropriate medical dispositions were suggested with accuracies of 50% by ChatGPT vs 41% by Bard (P = .40); appropriate home interventions/treatments with accuracies of 59% vs 55% (P = .94), and red flag signs/symptoms with accuracies of 79% vs 54% (P < .01), respectively. Detailed and comparative performance breakdowns according to complication latency and urgency are presented. CONCLUSIONS: ChatGPT represents the superior LLM for the potential application of AI technology in postoperative medical support chatbots. Imperfect performance and limitations discussed may guide the necessary refinement to facilitate adoption.

Complications Following Body Contouring: Performance Validation of Bard, a Novel AI Large Language Model, in Triaging and Managing Postoperative Patient Concerns.

INTRODUCTION: Large language models (LLM) have revolutionized the way humans interact with artificial intelligence (AI) technology, with marked potential for applications in esthetic surgery. The present study evaluates the performance of Bard, a novel LLM, in identifying and managing postoperative patient concerns for complications following body contouring surgery. METHODS: The American Society of Plastic Surgeons' website was queried to identify and simulate all potential postoperative complications following body contouring across different acuities and severity. Bard's accuracy was assessed in providing a differential diagnosis, soliciting a history, suggesting a most-likely diagnosis, appropriate disposition, treatments/interventions to begin from home, and red-flag signs/symptoms indicating deterioration, or requiring urgent emergency department (ED) presentation. RESULTS: Twenty-two simulated body contouring complications were examined. Overall, Bard demonstrated a 59% accuracy in listing relevant diagnoses on its differentials, with a 52% incidence of incorrect or misleading diagnoses. Following history-taking, Bard demonstrated an overall accuracy of 44% in identifying the most-likely diagnosis, and a 55% accuracy in suggesting the indicated medical dispositions. Helpful treatments/interventions to begin from home were suggested with a 40% accuracy, whereas red-flag signs/symptoms, indicating deterioration, were shared with a 48% accuracy. A detailed analysis of performance, stratified according to latency of postoperative presentation (<48hours, 48hours-1month, or >1month postoperatively), and according to acuity and indicated medical disposition, is presented herein. CONCLUSIONS: Despite promising potential of LLMs and AI in healthcare-related applications, Bard's performance in the present study significantly falls short of accepted clinical standards, thus indicating a need for further research and development prior to adoption. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Evidence of Hematoma Prevention After Facelift.

Hematoma is a common complication after facelift procedures. Multiple factors have been shown to increase the risk of hematoma formation, such as male gender, anticoagulant medication use, perioperative hypertension, increased intrathoracic pressure, and operative technique. The purpose of this manuscript is to provide an overview of existing literature to provide surgeons with evidence-based recommendations on how to minimize hematoma risk during facelift surgery. A literature search for hematoma and facelift surgery was performed that identified 478 unique manuscripts. Abstracts were reviewed, excluding articles not describing facelift surgery, those written before 1970, studies with a sample size of fewer than 5 patients, non-English studies, and those that did not provide postoperative hematoma rates. Forty-five articles were included in this text, with their recommendations. Measures such as the prophylactic management of pain, nausea, and hypertension, the use of fibrin glue tissue sealants, the use of local anesthesia rather than general anesthesia, and strict blood pressure control of at least <140 mmHg were found to significantly reduce hematoma formation. Quilting sutures has shown benefit in some high-risk patients. Measures such as drains, compression dressings, perioperative use of selective serotonin reuptake inhibitors, and perioperative steroids had no significant effect on hematoma formation. In addition to appropriate patient selection and careful intraoperative hemostasis, many adjunct measures have been shown to reduce postoperative hematoma formation in facelift procedures.

Complications Following Facelift and Neck Lift: Implementation and Assessment of Large Language Model and Artificial Intelligence (ChatGPT) Performance Across 16 Simulated Patient Presentations.

INTRODUCTION: ChatGPT represents a potential resource for patient guidance and education, with the possibility for quality improvement in healthcare delivery. The present study evaluates the role of ChatGPT as an interactive patient resource, and assesses its performance in identifying, triaging, and guiding patients with concerns of postoperative complications following facelift and neck lift surgery. METHODS: Sixteen patient profiles were generated to simulate postoperative patient presentations, with complications of varying acuity and severity. ChatGPT was assessed for its accuracy in generating a differential diagnosis, soliciting a history, providing the most-likely diagnosis, the appropriate disposition, treatments/interventions to begin from home, and red-flag symptoms necessitating an urgent presentation to the emergency department. RESULTS: Overall accuracy in providing a complete differential diagnosis in response to simulated presentations was 85%, with an accuracy of 88% in identifying the most-likely diagnosis after history-taking. However, appropriate patient dispositions were suggested in only 56% of cases. Relevant home treatments/interventions were suggested with an 82% accuracy, and red-flag symptoms with a 73% accuracy. A detailed analysis, stratified according to latency of postoperative presentation (<48 h, 48 h-1 week, or >1 week), and according to acuity of complications, is presented herein. CONCLUSIONS: ChatGPT overestimated the urgency of indicated patient dispositions in 44% of cases, concerning for potential unnecessary increase in healthcare resource utilization. Imperfect performance, and the tool's tendency for overinclusion in its responses, risk increasing patient anxiety and straining physician-patient relationships. While artificial intelligence has great potential in triaging postoperative patient concerns, and improving efficiency and resource utilization, ChatGPT's performance, in its current form, demonstrates a need for further refinement before its safe and effective implementation in facial aesthetic surgical practice. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Systolic Blood Pressure Less Than 120 mmHg is a Safe and Effective Method to Minimize Bleeding After Facelift Surgery: A Review of 502 Consecutive Cases.

BACKGROUND: Hematoma is the most common complication after facelift surgery. Hypertension is the major risk factor for hematoma following facelift. Measures taken to reduce systolic blood pressure perioperatively significantly reduce the risk of hematoma. There is evidence that treating systolic blood pressure of 140 mmHg or above reduces hematoma; there were no studies to date in which systolic blood pressures below 120 mmHg had been evaluated. OBJECTIVES: To assess the safety and efficacy of maintaining systolic blood pressures of 120 mmHg or less postoperatively to reduce hematoma after facelift. METHODS: A retrospective chart review of a single surgeon's series of facelift procedures from January 2004 to July 2018 was undertaken. Implementation of a more stringent perioperative blood pressure protocol (maintaining a systolic blood pressure of less than 120 mmHg postoperatively) was initiated in January of 2013, dividing patients into 2 groups. RESULTS: A total of 502 consecutive patients who underwent a facelift by F.N. were included in the study. A total of 319 patients underwent a facelift before 2013, and a total of 183 patients underwent a facelift in 2013 or later. Overall, a total of 13 hematomas occurred during the entire 15-year study period (2.59%), of which 12 occurred before the implementation of a strict blood pressure regimen (3.76%), and only 1 occurred after the new protocol (0.5%). There were no adverse events related to the lower blood pressure. CONCLUSIONS: Treating systolic blood pressure greater than 120 mmHg postoperatively is a safe and effective method for reducing the risk of hematoma after facelift.

The Effect of Wearing a Mask on Facial Attractiveness.

Background: The COVID-19 pandemic necessitated masking in public spaces. Masks may impact the perceived attractiveness of individuals and hence, interpersonal relations. Objectives: To determine if facial coverings affect attractiveness. Methods: An online survey was conducted using 114 headshot images, 2 each-unmasked and masked-of 57 individuals. Two hundred and seven participants rated them on an ordinal scale from 1 (least attractive) to 10 (most attractive). Parametric and nonparametric tests were performed, as appropriate, for comparison. Results: For the first quartile, the average rating increased significantly when wearing a mask (5.89 ± 0.29 and 6.54 ± 0.67; P = 0.01). For control images ranked within the fourth quartile, the average rating decreased significantly when wearing a mask (7.60 ± 0.26 and 6.62 ± 0.55; P < 0.001). In the female subgroup (n = 34), there was a small increase in average rating when masked, whereas in the male subgroup (n = 23), there was a small decrease in average rating when masked, but the change was not statistically significant (P > 0.05). For unmasked female images ranked within the first quartile, the average rating increased significantly when wearing a mask (5.77 ± 0.27 and 6.76 ± 0.36; P = 0.001). For the female subgroup with mean ratings within the fourth quartile, the average decreased significantly when wearing a medical mask (7.53 ± 0.30 and 6.77 ± 0.53; P < 0.05). For unmasked male images ranked within the first quartile, the average rating increased when wearing a medical mask but the change was not statistically significant (P > 0.05), whereas for the control male images within the fourth quartile, the average rating decreased significantly when masked (7.72 ± 0.18 and 6.50 ± 0.54; P < 0.05). Conclusions: While wearing a facial covering significantly increased attractiveness for images less attractive at baseline, and decreased attractiveness for those that are more attractive at baseline; it did not cause a significant overall change in attractiveness in the study population.

Incidence, Impact, and Management of Incidentalomas on Preoperative Computed Tomographic Angiograms for Breast Cancer Patients with and without Genetic Mutations.

BACKGROUND: Preoperative abdominal computed tomographic angiograms for free flap breast reconstruction improve operative safety and efficiency, but incidental findings are common and potentially affect management. In addition, the authors hypothesized that patients with genetic mutations might have a higher rate of significant findings. The authors present the largest series of computed tomographic angiogram "incidentalomas" in these two populations and an evidence-based algorithm for managing common findings. METHODS: All patients undergoing free flap breast reconstruction at Northwell Health between 2009 and 2017 were eligible. Medical history, perioperative details, and radiology reports were examined with abnormal findings recorded. Published literature was reviewed with radiologists to develop standardized guidelines for incidentaloma management. RESULTS: Of 805 patients included, 733 patients had abdominal imaging. One hundred ninety-five (27 percent) had a completely negative examination. In the remaining 538 patients, benign hepatic (22 percent) and renal (17 percent) findings were most common. Sixteen patients (2.2 percent) required additional imaging (n = 15) or procedures (n = 5). One finding was concerning for malignancy-renal cell carcinoma-which interventional radiology ablated postoperatively. Seventy-nine patients (10.8 percent) had a genetic mutation but were not found to have a statistically significant higher rate of incidentalomas. CONCLUSIONS: The authors' rate of computed tomographic angiography incidental findings (73 percent) is consistent with previous studies, but the rate requiring further intervention (2.2 percent) is lower. Incidental findings were no more common or pathologic among genetic mutation carriers. The authors also introduce an evidence-based algorithm for the management of common incidentalomas. Using these guidelines, plastic surgeons can reassure patients, regardless of mutation status, that incidentalomas are most commonly benign and have minimal impact on their surgical plan.

Postoperative Quality of Life in Patients with Hidradenitis Suppurativa Utilizing the Hidradenitis Suppurativa Burden of Disease Tool.

Background Hidradenitis suppurativa (HS) severely impacts patients' quality of life (QoL). Surgery has shown potential in improving a patient's QoL in severe disease. Previous studies have evaluated QoL after surgery, but lack a disease-specific questionnaire to better evaluate the unique burden of disease that patients with HS experience. Objective To measure postoperative QoL in patients with HS using a modified version of the disease-specific questionnaire, the Hidradenitis Suppurativa Burden of Disease (HSBOD) Tool. Methods A retrospective study was conducted using 19 patients who underwent surgery for HS. A demographic form and a 19-item disease-specific questionnaire were emailed to patients who consented to complete the survey. Patient-reported outcomes were recorded on a 0-100 scale (100 representing the highest burden of disease). Results Of the 24 patients that received the survey, 19 completed it in its entirety. The mean±SD Burden of Disease (BoD) score for each of the five domains assessed by the survey were: symptoms and feelings (62±27), daily activities (65±30), leisure (57±31), work and school (48±32), and personal relationships (56±27). Pearson's correlation between the number of surgeries each patient underwent and their reported BoD scores were not significant. BoD scores were significantly higher in the symptoms and feelings domain for complex closure compared to both secondary intention and split-thickness skin grafting (STSG). Conclusion Despite having surgery, patients with hidradenitis still report impaired QoL. Further study is ongoing to determine how these measures compare to baseline preoperative values. This instrument provides a valuable tool to determine QoL in patients with hidradenitis.

The Timing of Chemoprophylaxis in Autologous Microsurgical Breast Reconstruction.

BACKGROUND: Patients undergoing autologous breast reconstruction are at high risk of perioperative venous thromboembolic events. The efficacy of chemoprophylaxis in decreasing venous thromboembolic events is well established, but the timing of chemoprophylaxis remains controversial. The authors compare the incidence of bleeding following preoperative versus postoperative initiation of chemoprophylaxis in microvascular breast reconstruction. METHODS: A retrospective chart review was performed from August of 2010 to July of 2016. Initiation of chemoprophylaxis changed from postoperative to preoperative in 2013, dividing subjects into two groups. Patient demographics, comorbidities, and complications were reviewed. RESULTS: A total of 196 patients (311 flaps) were included in the study. A total of 105 patients (166 flaps) received preoperative enoxaparin (40 mg) and 91 patients (145 flaps) received postoperative chemoprophylaxis. A total of five patients required hematoma evacuation (2.6 percent). Of these, one hematoma (1 percent) occurred in the preoperative chemoprophylaxis group. Seven patients received blood transfusions: three in the preoperative group and four in the postoperative group (2.9 percent versus 4.4 percent; p = 0.419). There was a total of one flap failure, and there were no documented venous thromboembolic events in any of the groups. CONCLUSIONS: This study demonstrates that preoperative chemoprophylaxis can be used safely in patients undergoing microvascular breast reconstruction. The higher rate of bleeding in the postoperative group may be related to the onset of action of enoxaparin of 4 to 6 hours, which allows for intraoperative hemostasis in the preoperative group and possibly potentiating postoperative oozing when administered postoperatively. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Polyacrylamide gel breast augmentation: report of two cases and review of the literature.

Polyacrylamide gel (PAAG) injection remains an uncommon method of breast augmentation. Providers must recognize the clinical and radiological manifestations to optimize management. The clinical and radiological findings of PAAG injection may mimic malignancy and silicone breast augmentation. We described two patients with prior PAAG breast augmentation with physical exam and imaging findings concerning for malignancy. We reviewed the literature on PAAG breast augmentation and compare PAAG to silicone breast augmentation. The management of such patients is discussed.