How many times, looking in the mirror, have some girl dissatisfied with her image thought: I wonder what it would be like to have Salma Hayek’s intense gaze and Penelope Cruz’s sensual smile? The answer is: nothing special, at least judging by the result obtained by a ‘morphing’ expert, mixing the features of these two undisputed Latin beauties with digital effects. The outcome of their fusion is obviously the face of a beautiful woman, perfect on paper, but without the charm of either. How is this possible? And in the era of artificial intelligence increasingly present in medicine, will algorithm-guided touch-ups run this same risk? The goal of a cosmetic procedure must be to “eliminate the defect” that creates problems for the patient “while leaving the individuality, personality, and other characteristics of the person,” warns plastic surgeon Paolo Santanchè in an interview with Adnkronos Salute. “The perfect nose,” he explains, for example, “does not exist. There is a nose that suits that face and that person.”
And it is precisely in this that the pitfalls of AI could be hidden, about which the expert wants to warn. Retouching on paper that responds with the precision of a machine to the canons of symmetry and the ideal of perfection, but ‘beautiful without a soul’. “Surely artificial intelligence in all fields, if used correctly, can bring help and benefits. It will be able to present the doctor with all the possible differential diagnoses of some symptoms and allow no diagnostic possibility to be overlooked or underestimated. And much more. But in the field of cosmetic surgery I have some doubts”.
To explain his thinking, Santanchè takes a step back in time: “When I started my career in this field, there weren’t even computers. The masters” of plastic surgery “taught us to take pictures of the patient, and for example for rhinoplasty, then with a pencil we drew a new nose to show to the interested party. But the nose that the patient liked drawn on a photo was never the right one for the patient”. Following that design, the nose would have been “always too small, too fake, not suitable”. After the pencil came the computer with “software that allows you to modify the image”, increasingly realistic and precise. But there is a but, he warns: “Aesthetics has a component that is not only technical and psychological, but also artistic, which is fundamental. We could hardly ask artificial intelligence to create masterpieces like those of painters and sculptors of the past, because the soul of the artist will be missing”.
UNIQUENESS OF FACES AT RISK? – This is the expert’s fear: “I have never liked tools that seem like systems to convince the patient to do something – Santanchè reasons – Those who turn to the surgeon do so because they have a problem they want to solve, a defect they can’t live with. And this can happen to anyone, even the most balanced people. Those who want to change their appearance, and ask to have Brad Pitt’s nose rather than look like some actress must be guided towards the right choice, which is not that of being satisfied. The adventurous surgeon will be very happy to do one more operation and perhaps will use AI to make this easier for himself. Presenting a beautiful and ready image is much quicker than dedicating time to talking to the patient and understanding their problem. But we are doctors and our goal must be to cure a problem. If the plastic surgeon is not a good ‘psychologist’, it is unlikely that he will have a satisfied patient, even if he is technically very good”.
Returning to the promises of AI, asking the question of how it can be combined with plastic surgery is not far-fetched, considering that we are not talking about a distant future and some experiments have already been done. “Some time ago – says Santanchè – I saw an interesting operation: someone took photographs of people universally considered beautiful, such as Brad Pitt or Sandra Bullock, and subjected them to artificial intelligence so that it could perfect them. The result was absolutely insignificant perfect faces”. This is because, he analyses, “beauty is not perfection. Beauty is the alchemy of a set of small defects that marry with such harmony as to create a particularly pleasant, interesting result”.
THE HUMAN FACTOR BEHIND THE SCALPEL – “And it is unlikely that AI, at least from what we see today, will be able to have the soul to understand this – warns Santanchè – There is a risk of flattening, homologating, creating perfect copies without a soul. The surgeon has a person in front of him, he must see him, talk to him, understand his character, what his face wants to express. In place of that defect that creates discomfort, he should not create the perfect thing but the most suitable one. We are asymmetrical, irregular. But, many times, these defects put together give an exceptional result. If we then want to look at the technical and medico-legal and insurance side, when simulations are done by modifying a nose or a breast it must be clearly specified that that is only an idea, that it is impossible for it to represent the real result of the operation. It is one thing to do things on the computer, it is another thing to do them with a scalpel”.
Therefore – concludes Santanchè – if the surgeon, “instead of applying himself to obtain an improvement in the situation, promises a specific result and then does not obtain it, the patient can sue him. And the insurance will not pay”. The risk is therefore that the help of technology will transform into dangerous shortcuts, as well as enemies of uniqueness. “Instead, you have to talk to the patient. There is a psychological and interpretative component of his expectations that only a human with experience and patience can do”. With all due respect to the ‘robots’.
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