AI Vs. Reality Plastic Surgery

You know it used to be when patients walked into a plastic surgeon's office holding a magazine cut out of a celebrity's nose or jawline, but in the age of artificial intelligence, consultants have taken a dramatic turn. More and more people are showing up to clinics holding AI-generated photos of themselves with unrealistic proportions. So what happens when digital perfection meets human biology? That's a good question. Joining us now to break it all down is board-certified Beverly Hills plastic surgeon Dr. Samuel Gulpanian. Thank you for being here this morning. This is very important and I'm sure you've gotten a lot of requests from people coming in, right? Yeah, so what have people been coming in to see you about? I mean they bring in these like you know Chad GPT for example. You can show a photo of yourself, make me more beautiful, glassier skin, thinner, whatever it is. Snatched. And they show these photos to you and what do you say? Yes, so I do body mostly. I don't do any face and a lot of requests that patients come in with are regarding liposuction or rib remodeling and previously they used to bring in photos of celebrities, right? They take a celebrity photo, say look at this, I like this, make me like this, which is a little bit more doable. But now with AI, AI is showing unrealistic expectations and so it's they're bringing these pictures in that are digitally remastered. Just like Bratz dolls. Exactly, yeah. So it's not, it's a great guide but it's not a blueprint and what it's doing is it's making people not only ask for unrealistic things or unsafe things but it's also causing patients to look at themselves and say this is the standard ideal, which is not always the standard ideal. Yeah, how do you level set? Because I imagine there is sometimes even with you bring in a picture of an actual human being that's not AI generated and sometimes you have to say, okay, this is not realistic for you. But when it's not realistic for anybody because it's not real at all, like how hard are those conversations? I think they're pretty easy for me. I like to be very transparent with patients. I like to let them know, hey, this is a great guide. This picture that you're showing me is showing me what you're looking for and that's important because I want to hear from the patient what they are looking for. But it all comes down to, it all boils down to your own anatomy. For some patients, it may work. For many patients, it doesn't. More times than not, it doesn't because AI is moving pixels and as surgeons, we're moving tissue. AI is not limited by biology, by tissue quality, by safety, muscle anatomy, bony anatomy. Also, it's like you have to balance the person out, right? They might ask for this really unrealistic waistline, but it would look ridiculous because the rest of them wouldn't match it, right? So how do you tell them I can't really do that? Well, I let them know that proportions are necessary in surgery. You cannot look disproportionate. If you look disproportionate, there's something wrong or we're doing something unsafe. And I explain to them, I show them in a mirror. For example, these are your hips. This is how much fat we can put in. This is how much we can suction out fat from your waistline. Beyond that, we have to do, for example, rib remodeling, restructuring the ribs. Sometimes they want it even more snatched. Sometimes they want it super, super thin. And I explain to them, well, where are your organs going to go? You have organs, right? Slight detail. Exactly. Liver, intestine, and I'm not removing any ribs. So it's physically impossible, let alone unsafe, to create that shape that you're looking for. What's your, because I get sad when we're talking about this because I'm thinking like, you know, we all grew up in this age of the supermodel, like in the nineties, right? Where everyone was super waify thin. We grew up in the nastiest era. In the nastiest era, where we were just so mean to ourselves. And so now we're not even comparing ourselves against other people. We're comparing ourselves against something that doesn't even exist in the first place. So, you know, what's your philosophy on that? And like, where's the line here? I think that plastic surgery is great to use to enhance yourself. We're looking at a lot of patients that are coming in a lot younger than they used to. Previously, a lot of moms, for example, would come in after pregnancy, mommy makeovers. It's still pretty common, but now we're seeing the Gen Z population coming in for surgery. And, you know, if there's a fine line between something that you need versus something that may actually disrupt your native anatomy, there's a concept called prejuvenation instead of rejuvenation. It's prophylactic work that younger patients are doing coming in for surgery. Like preventative Botox. One example. Exactly. And I think that's fine. Preventative Botox, you know, wearing SPF, things to kind of maintain. But when you're really going to go under the knife, you have to think about long-term consequences. And I think there's a difference between someone that could really use it versus someone that just wants to look perfect because there's no such thing as perfect. And AI is making the younger population feel like there is. Well, then you get distorted. Like your mind is distorted. Dysmorphic. Yeah, exactly. Completely. But you're saying younger people are coming in. How are they paying for all of this? Oh, I don't ask. I mean, it's how much, like how, give me like a figure here. In pricing? Yeah. Like, I'm just curious. This isn't cheap. It could run anywhere from $12,000 to upwards to $40,000. There's financing options. A lot of patients do use it. And they may not make the best money, but you know, because there's like a credit card. They just run their credit, pay monthly. Now, whether or not it hurts their financials or their credit, I'm not really sure. But believe it or not, a lot of younger patients are making a lot of money as well because the new era of influencers. Right. You want to look impossible. And so you gain that following on social media, right? Which gets you clicks, which gets you money, which gets you even more money to do more procedures. Yeah. How young are we talking though? Like you keep saying younger. And I imagine over the years that people, the age range of people requesting work with the rise of the internet has dropped lower. Yeah. In my practice, I've seen as young as 19. Okay. I have colleagues that have seen patients as young as 16 for facial work, but it really depends on the practice. What is rib remodeling? I'm sorry. I have to know. Yeah. Rib remodeling is basically restructuring the thorax or the rib cage, specifically the lower ribs. And what we do is basically we make a hole in the back of the skin and a device called the piezotome, which is kind of like a little wood pecking device. It makes little holes on the back of the rib. And by making those little holes on the back of the rib, it weakens the outer layer of the rib. And we basically snap the rib. Oh, that sounds. Yeah. We angulate it. Okay. And the patient wears a waist trainer or corset for about three to four months. Oh my God. And that allows the rib to heal in that position. So somebody who has like a, like a more straight waist could end up with a waist that's more hourglass shape. Yes. That's mind blowing. Wow. Wow. But there are, I mean, there are, so, so the danger with this AI stuff, is it's not just pictures anymore. You can actually alter videos. You can alter videos to like, if somebody is like walking down the street and they have a really thin waist, honestly, it looks like their waist is actually that size, but it might not be. Yeah. It's many times. It's so deceptive. Very deceptive. There's a lot of filters, editing. I even get surprised a lot of the times, you know, and I see this every day, but I definitely think it's up to a plastic surgeon. It's their role to kind of set expectations and set what's real and not real because the worst thing and what you don't want is to tell a patient, Hey, what you're showing me we can do. And then that result is not achieved. And then the patient's upset. Well, also it's like a result of your work too, right? Like they're, they're like a walking billboard for you. Are you seeing more men or women? I see more women, but I do see men in my practice as well. Has that grown as time has gone? It definitely has. I think that, uh, previously it was a little bit more taboo or, you know, men just thought it was a female thing to do, but I think they all want six packs. Yeah. A lot of people want that. A lot of people have actually, you know, I, what's, what's your tip on like doing your research? Cause I imagine like there's a risk of like coming across some money hungry doctor who will just tell you, yes, I will do this for you. And then you end up looking crazy or you end up on botched. Like, so how, what type of research should people be doing to make sure that they're having a conversation with somebody who will level set with them and, and meet in the middle for what they need? I think first and foremost, you have to look at a doctor's before and after photos. I think that speaks a lot as to the results and consistency, not having one result that looks good and the rest look bad, consistent, good results. That's the first thing. The second thing is I think patients need to learn about the procedure, not to run down a rabbit hole, but to learn about it, learn about the risks, learn about the recovery, uh, other people's, uh, you know, um. Like their experience. Exactly. Their experiences. But the other thing that I think patients don't do too often is to see multiple plastic surgeons going on multiple consultations. Then you can really read the practice, read the surgeon and see who's really genuine and who's leveling with you. Any other trends you're seeing right now? Uh, I think rib remodeling is one of them. Okay. I've never heard of that either. Well, it's like, it's like when people say that they, they removed a rib, that's kind of what they really mean though, right? Yes. Well, no, not exactly. Previously, rib removal was done. That was a thing for real. I thought that was like a myth. Yeah. No, it was done. Segments of the rib were removed, but they found that there's a higher risk of doing it. And why do such an invasive procedure when you can do more minimally, minimally invasive procedure? And then rib remodeling came about. It's really big. I think it's very helpful. I don't think it really adds that much to recovery. Uh, and it, the biggest reason is the fact that your, your waist is defined by your fat muscle and bone and liposuction is only going to affect the fat part. Muscle you can't really affect unless you're getting a tummy tuck, which kind of that's a mild effect, but the bone structure, the bony anatomy is really what limits many patients. And so rib remodeling is very helpful. And they can lose all the weight they want, but if they're shaped quite frankly, if their structure is not amenable to that, then they have to, they don't have to, but that's what you would do. Exactly. Gosh, that's wild. Okay. Tell us what should we get? I'm just kidding. It's not about what you need. It's about what you want, but also what you'd be a good candidate for. Yeah. We're going to ask you a bunch of questions during commercial break, but where can we find you? Where can people find you? Dr. Samuel Goltanian. All right. I'm going to look at your before and afters because I'm obsessed with those. I love a before and after. I love a good jawline remodel. Thank you. I love seeing a video and somebody saying, okay, so she had a little of this, this, this.