A Systematic Review of Applications, Challenges, and Future Trajectories of Artificial Intelligence in Cosmetic Surgery.

The global demand for cosmetic procedures is accelerating, with over 1.6 million aesthetic surgical procedures performed in the US in 2023. Concurrently, AI is transforming surgical practice through advanced analytics, predictive modeling, and computer vision. Cosmetic surgery, characterized by subjective outcomes and limited standardized metrics, presents a unique opportunity for AI integration to enhance precision, objectivity, and patient communication. Following PRISMA 2020 guidelines, we systematically searched MEDLINE/PubMed, Embase, and the Cochrane Library (January 2020-July 2025) for studies applying AI, machine learning, deep learning, computer vision, or large language models to cosmetic or aesthetic procedures. Eligible designs included randomized controlled trials, observational studies, diagnostic accuracy studies, feasibility studies, and prediction model development. Two reviewers independently screened titles/abstracts, assessed full texts, extracted data, and evaluated risk of bias using ROBINS-I for non-randomized studies. Of 3941 records, 38 met the inclusion criteria. AI applications spanned preoperative planning (predictive risk modeling, 3D outcome simulation), intraoperative guidance (augmented reality overlays), and postoperative monitoring (smartphone-based complication detection, objective aesthetic scoring). Benefits included improved patient-surgeon communication, enhanced risk stratification, and standardized outcome measurement. However, most studies were early-phase, with limited external validation, heterogeneous datasets, and inconsistent outcome metrics. Risk of bias was moderate to serious in most studies. AI in cosmetic surgery shows significant potential but remains in early clinical adoption. Progress requires multicenter validation, standardized datasets, explainable algorithms, and clear regulatory frameworks. Large language model-driven tools may accelerate development and integration, provided ethical, equitable, and patient-centered principles guide implementation.