AI-generated images – Plastic surgeons and dermatologists say AI image generators are changing what patients want—and how unrealistic those desires can become. From “Bratz doll” features to requests for impossible transformations, doctors are spending more time setting limits. Some
In Dr. Rachel Westbay’s Upper East Side office, a patient arrived earlier this year with an image that felt less like a request for surgery and more like a caricature. The picture was cartoonish—lips too full for her face and enlarged, doll-like eyes—and its creator, Westbay said, was ChatGPT.
“It’s like saying I want to look like Ariel from ‘The Little Mermaid,’” Westbay told Business Insider. “I was shocked.”
Westbay’s experience is part of a broader shift already visible in cosmetic care: patients are increasingly prompting AI image generators to craft their “after. ” rather than relying on clinicians to model outcomes.. Some use ChatGPT or Nano Banana, while others turn to specialized apps and AI filters.. The practice follows a familiar pattern in beauty technology—Snapchat filters and Photoshop reshaped standards before. and AI appears to be doing the same with greater intensity.
That change is forcing doctors to confront a familiar tension, but with new visual ammunition.. Westbay and other surgeons say consultations can become exercises in separating what an image can suggest from what surgery can safely deliver.. A survey published last year by Beth Israel Deaconess Medical Center found that those who had experience using AI enhancers on photos had “significantly higher” expectations for plastic surgery outcomes.
Dr.. Steven Williams. a plastic surgeon in the Bay Area and president of the American Society of Plastic Surgeons. framed the issue in practical terms.. “It’s not necessarily a completely negative thing for people to explore the look or the goal they want. ” he told Business Insider.. “The important thing is recognizing that there are still limitations.”
“Pixels are easier than surgery,” Williams added, describing patients bringing in AI-generated images of breast augmentations, body contouring, and rhinoplasties. He said the conversations that follow often center on what is surgically achievable or physiologically safe.
The gap between AI images and medical reality shows up in patient stories as well.. Daina Jenkins. now 60. decided to have a deep-plane facelift after years of considering it; she described her motivation bluntly: “If it’s sagging. bagging. or dragging. I’m going to lift it. suck it. or tuck it.” After two years of research and a consultation. she chose a surgeon—but Jenkins said the office didn’t provide images of what her after could look like.. So she turned to ChatGPT, explaining the procedures she was planning and asking the AI to visualize them.
The result, Jenkins said, looked nothing like her: she was shown pore-less skin, a sharp jaw, and a particular pout. But when Jenkins asked her surgeon’s office about the image, she said she was relieved to hear that even if she liked it, those results weren’t possible.
“It wasn’t reality,” she said. “I love that I look natural.”
Other surgeons describe recurring patterns in what AI generators produce.. Westbay said the image generators tend to spit out what she called the “Bratz doll” look: plumped lips. big eyes. and a defined jaw.. She said it also fails to account for an individual’s facial structures, different ethnicities, or balancing.
When the images go beyond aesthetics into mechanics of the body, the mismatch can become more urgent.. Dr.. Sachin Shridharani. a plastic surgeon in Manhattan. said that when a woman in her 70s brought an AI-generated photo into a consultation. it was “completely unrealistic.” The patient. Shridharani said. was looking for a “surgical time machine” to look like her granddaughter. forty years her junior.
“I explained that we can’t recreate what she looked like when she was younger, but she remained insistent,” he said.
Shridharani noted that while AI can visualize certain features—particularly nonfacial ones—quite well, it struggles with more complex procedures, such as nose jobs. In those cases, he said, doctors face long consultations in which they break down what is possible and safe.
Williams described the medical constraints in plain language. “Bodies aren’t clay,” he said. “There are physiological and organ systems that we have to protect when we’re doing these surgeries.”
In practice. that means doctors often explain that a warped background suggests a filter was probably applied. that a specific nose tip would make breathing impossible. or that a waistline so narrow would mean there wouldn’t be room for internal organs.. Even outside complex anatomy, Westbay said some AI-inspired changes simply can’t be translated into safe procedures.
“There is no procedure I can do to enlarge eye size,” she said. “Even if we could make it happen, it would have people looking at you like a cartoon.”
Still, the act of bringing inspirational images to an appointment is not new.. Dr.. Justin Sacks, a reconstructive plastic surgeon at Washington University in St.. Louis’ medical school, told Business Insider that years ago patients would come in with a cutout photo from Vogue.. He said that would be a red flag; “That would be like a red flag. if you walked into my office and showed me a picture of Gisele Bündchen or Claudia Schiffer.”
What has changed is the source and immediacy of those references. As social media expanded, requests inspired by filters or edited influencers increased, Sacks said.
A 2019 study by the American Academy of Facial Plastic and Reconstructive Surgery found that 72% of facial plastic surgeons had patients who underwent procedures to look better in selfies, part of a phenomenon known as “Snapchat dysmorphia.”
One pattern runs through the stories: AI images can raise expectations and then force surgeons to spend that momentum on education.. The same gap—between what a generator produces and what the body can safely do—shows up across Westbay’s “Bratz doll” examples. Shridharani’s “surgical time machine” request. and Jenkins’s relief that her AI visualization wasn’t possible.
Not everyone sees the technology as only a problem.. Sacks. who uses AI tools as digital scribes during appointments. argued that AI could also improve the image generators doctors themselves use over time.. He described imagining more precise reconstruction work for a breast cancer patient—directing AI to create live simulations such as “What would this patient look like with 400 milliliters of a silicone implant?” and “What about some soft tissue overlay?”
“Do you realize the conversation that you would have and the expectations that you would have after that clinic visit? It would be astounding,” he said.
Sacks and others acknowledge that AI—and edited images circulating on social media—has pushed the boundaries of what surgeons thought was possible. for better or worse.. Williams pointed to the kinds of dramatic requests patients bring. including doctors etching onto abdominal walls to create six packs and breaking ribs to achieve thinner waistlines.
Even with the upside, Williams said patients should slow down and ask why they want a procedure. “What’s your expectation?” Williams said. If it’s a new job, relationship, or social status, that’s a “red flag.”
For now, the technology has introduced a new kind of image into the consultation room—one that can be convincing at a glance, but still requires doctors to draw hard lines around realism, physiology, and safety.
AI image generators plastic surgery dermatology ChatGPT Nano Banana cosmetic procedures expectations Beth Israel Deaconess Medical Center American Society of Plastic Surgeons Snapchat dysmorphia