S05E84 - The Dawn of Artificial Intelligence in Plastic Surgery

Step into the operating room of the future with hosts Dr. Sam Jejurikar @samjejurikar, Dr. Salvatore Pacella @sandiegoplasticsurgeon, Dr. Lawrence Tong @yorkvilleplasticsurgery, and Dr. Sam Rhee @bergencosmetic as we unveil the cutting-edge intersection of plastic surgery and artificial intelligence. Prepare to be amazed by stories of how AI is revolutionizing the way we handle the complexities of medical administration, from insurance authorizations to patient communications.

We've experienced firsthand the monumental time savings AI offers in creating operative notes, allowing us more moments to focus on what matters most—our patients.

But this episode isn't just about the back office; it's an insider's look at the revolution in surgical planning and execution. Journey with us as we navigate the transformative landscape of 3D imaging and AI models, changing the face of patient consultations. The precision of simulating outcomes for procedures like breast augmentations and rhinoplasties is nothing short of breathtaking.

But it's not all algorithms and predictions—we ponder the ethical side of presenting 'ideal' aesthetics, and the thought-provoking emergence of robots in the surgery room. It's a peek into a world where human expertise meets robotic precision.

For a grand finale, envision the surgical theater as a stage for AI's burgeoning role in autonomous decision-making. We explore the parallels between self-driving cars and the potential of AI in surgery, touching on Nvidia's Omniverse and its collaborative virtual environment.

Our conversation swings from the future of surgical training to the poignant use of AI in the arts, exemplified by the recreation of Chris Cornell's voice. As a treat to our listeners, we close with a delightful AI-composed poem about our podcast team—a charming reminder of the blend of technology and the human element in the art of medicine. Join us for a thought-provoking session that promises to be as informative as it is entertaining.

@3plasticsurgerypodcast #podcast #plasticsurgery #cosmeticsurgery #plasticsurgeon #beauty #boardcertified #aesthetic 3plasticsurgeonsandamicrophone ⁠#bergencosmetic ⁠#bestplasticsurgeon #beforeafter #aesthetics #realpatientrealresult #boardcertifiedplasticsurgeon #njplasticsurgeon #njplasticsurgery #nyplasticsurgeon #nyplasticsurgery

S05E84 - The Dawn of Artificial Intelligence in Plastic Surgery

TRANSCRIPT

[00:00:00]

Dr. Sam Jejurikar: Welcome to another episode of the podcast, formerly known as Three Plastic Surgeons and a Microphone, but now rebranded as Three Plastic Surgeons and a Fourth. As always, I am Sam Jejurikar in Dallas, Texas. I've got Sam Rhee in from Paramus, New Jersey, who's at Bergen Cosmetic. Lor Dr. Lawrence Tong, uh, from Toronto, Canada, who's at Yorkville Plastic Surgery.

And Dr. Salvatore Pacella, who is at San Diego Plastic Surgeon and practices in La Jolla, California. How are you guys today?

Dr. Salvatore Pacella: Good, good.

Dr. Lawrence Tong: see you guys.

Dr. Salvatore Pacella: We should call this the Rheemix, R H E E M I X. For Plastic Surgeons, Rheemix, son.

Dr. Sam Jejurikar: that. I like that.

Dr. Lawrence Tong: All right, Dad. That's

Dr. Sam Jejurikar: I mean, I liked it, but I thought it was good. Keep trying. Sometimes you strike out, but it's you always got to put in the effort.

Dr. Salvatore Pacella: Hey, you miss, you, [00:01:00] you miss 100 percent of the shots you don't take.

Dr. Sam Jejurikar: that's exactly right. That's where you don't make 100 percent of the shots you don't take. You don't actually don't. So, uh, we've got a little bit of a different topic today, and I think it's, it's sort of spurred by, um, what's been in the news and driving the stock market and just sort of all over the place these, uh, these days, and that's artificial intelligence.

Um, and I think it's going to be a really interesting discussion talking about applications of artificial intelligence in plastic surgery and in medicine at large. Before we get into the meat of our conversation, though, does someone want to read our usual disclaimer?

Dr. Sam Rhee: Absolutely. This shows not a substitute for professional medical advised diagnosis or treatment shows for informational purposes only. Treatment and results may. vary based upon the circumstances, situation, and medical judgment after appropriate discussion. Always seek the advice of your surgeon or other qualified health provider with any questions you may have regarding medical care, and never disregard professional medical advice or delay seeking advice because of something in this show.[00:02:00]

Dr. Sam Jejurikar: So, um, I think what kind of got my interest and Pacella's interest really sort of jump started in this topic in the last couple of weeks is sort of all of the conversations that have been happening about this company, NVIDIA, that's out there. And in this last week, NVIDIA had their big tech conference in San Francisco where they started talking about applications of their future chips.

And, um, there were some really cool ideas. One of the things that, um, that was really kind of big, not in plastic surgery, but in medicine was the company Medtronic, where they were talking about. Standard colonoscopies that people have and, you know, the rate of doctors missing lesions is somewhere between, like, 20 and 30%, um, and now with some newer technology using, you know, using, um, using imaging, they're going to be able to use AI in this to come up with a test that's going to be Far more accurate than what we currently have.

And so that got all of us sort of digging into, well, what are the applications of, of AI in plastic surgery? And there are [00:03:00] actually applications that are already starting, starting to happen. Um, so before we sort of get into examples that are out there, are there ways that you guys are using even now AI in your interactions with patients, in surgical planning, in surgery at all, or is this just something that's still way off in the future in your mind?

Dr. Salvatore Pacella: Um, yeah, so, um, I have found AI very, very helpful in saving a tremendous amount of time when it comes to insurance authorization or denials or pre authorizations, etc. So, you know, for those of you out there that know a little bit or don't know anything about the insurance process for approval, you know, we, when we evaluate a patient, we have to, Do a formal evaluation.

We have to put these series of diagnosis codes with what are called CPT codes for each procedure, and we submit these to the insurance company. And our hope is that they would approve those codes. Sometimes they deny several codes for [00:04:00] unclear reasons. You know, many times we have to appeal to the insurance company to accept a code.

So, for example, you know, let's say I have a lady with breast cancer who had breast cancer years ago and then has some complication related to that cancer. Well, sometimes the insurance company balks at doing a revision because they say, well, your cancer was years ago. But there is actually a federal law that protects women for this particular reason.

And so years ago, I used to spend an exceptional amount of time typing a long letter to the insurance company, reminding them to do this and that and the other thing, and it would be marginally successful. And now what I do is I include the So I don't put any patient information. I type up chat GPT and I said, give me a letter that's stern, but firm, um, but respectful for a patient who got denied breast cancer reconstruction.

Please reference the Women's Health Right Act of 1987, [00:05:00] which protects her right to have breast reconstruction. And it will spit, and it spits out an amazing. It's a relatively structured letter that we can just send off and sign. It saves an exceptional amount of time. The other place I use it sometimes is in operative notes.

If I have a relatively routine operation, I may kind of use that as a template and then edit my template from there. I'll oftentimes use it in patient correspondence to send patients letters. Here's the result of your biopsy or this or that or the other thing. Um, so I, I've used it mostly for correspondence.

Um, it's also great for poems too.

Dr. Sam Jejurikar: Okay.

Dr. Lawrence Tong: so good at that.

Dr. Sam Jejurikar: Yeah. And I, and I think what, you know, Pacella is sort of, um, is illustrating is how artificial intelligence in medicine in general can allow us to take tasks that would take, you know, X number of [00:06:00] minutes to do, and it cuts it down by a factor of 20 or 50 and allows us to do a lot more of the menial aspects of, you know, Of, of medicine in a much more efficient manner.

I use AI a lot for all of my notes. Um, for instance, I dictate my notes and just like, uh, patella, I leave out all identifying patient information, but instead of dictating my notes into, um, into my electronic medical record, I'll dictate it into chat GT four and just tell it to proofread it, um, and it put it into a bulleted fashion.

Um, and it'll generate a note that, that I can easily import into my electronic medical record. And it takes, it makes the documentation better than it ever was before. And the length of time it takes for me to do it has gone down by a factor of 10. Um, you know, what's interesting though, what really got my interest, so what we're sort of talking about too, is I think, are ways where in all industries, we're really, um, [00:07:00] You know, we're really, um, kind of Plastic Sugar is sort of following along what other industries are doing, where for documentation purposes, we can, we can generate notes or we can write letters.

What about Surgical Planet? Can you guys see any sort of role for AI in terms of, you know, How it might impact your consultations with patients or how you might be able to get patients to to envision what their surgery might look like.

Dr. Lawrence Tong: So I

Dr. Sam Rhee: I would Go ahead, Larry.

Dr. Lawrence Tong: oh, so I was just thinking about this, uh, topic and I'm pretty sure nothing's out there yet, but you know, when we do facial rejuvenation, facelifts, blepharoplasties, whatever, uh, patients will often come in and they go, well, I want to look like how I used to look like when I was younger. So, you know, could there be an application in the future where.

You know, a patient can bring in their old photograph, and you upload their current [00:08:00] photograph, and then the AI will say, okay, well, in order to get as close to this as possible, uh, you know, you should do a brow lift, a blepharoplasty, you should put the fat graft in this spot or this spot, and, uh, I think that would be, You know, very cool, uh, but also very helpful.

Um, most of us, I'm sure could do it on our own, but it could be a big time saver or just confirm, you know, your surgical plan. So, you know, something like that, that, um, could come along. I think that would be pretty cool.

Dr. Sam Rhee: I think, uh, and I was talking to someone, we're not that far off in terms of AI helping us with surgical planning, and I could certainly see, um, many, many surgeons use 3D imaging and scanning of, uh, faces and bodies, and it wouldn't take much to be able to say, okay, uh, What if this patient only had liposuction done for their abdomen?

Demonstrate what that might look like. How about a tummy tuck plus [00:09:00] this? How about fat grafting plus the tummy tuck plus this? How would you, you know, what would a face look if you just did one cc of filler? Four cc's of filler plus a rhinoplasty, chin augmentation. You could throw about 15 different scenarios and you could say how close does this look?

To an ideal proportion, um, in terms of what an, you know, uh, general population standards are in terms of waist, you know, bust size, hips, like how far off the standard deviation is this? And patients could get a ton of information in regards to, and I don't know, this cuts both ways. I could see it being helpful and also hurtful in terms of them saying, this is where You deviate from what normal population standards are or what, or what an ideal aesthetic standard might be.

And these are the different procedures that might help you achieve it. Um, that's pretty powerful. If you think about it, if you could [00:10:00] just show that to a patient, cause right now we're already showing patients lots of simulated surgery, but now you could show even more combinations of that and reference, um, say other people, maybe have other reference models that you wanted, you know, what do I, what do I look like compared to Angelina Jolie?

Like. You can have an AI say, you look the most like this famous person, and this is what you would need in order to sort of mimic, mimic that.

Dr. Sam Jejurikar: You know, to some degree that is already starting to happen, guys. Um, you know, I think I've mentioned in previous podcasts that we do a lot of 3D imaging, particularly for breast surgery and nose surgery, um, in our office. And the particular The company that I use about three years ago started using an AI model for those 3D images. So, so just to take a step back, AI implies that you have this repository of knowledge. It's sort of drawn out from all this knowledge that's out there. [00:11:00] And then there's a component of machine learning that's happening as well, where there's a neural network. And then based off of all the models that are happening, as you get a larger and larger sample size, the quality of information that gets spit out by the model gets better and better.

And that's what's happening with, um, what I'm using is Crystallix. Um, and in fact, Avagis sort of Um, in the last month, um, unloaded their most recent AI breast imaging models. And the quality of these images that come out literally just from three images from an iPad when you're doing it with breast in one measurement is ridiculous how much it looks like that.

For rhinoplasty, it's actually becoming very good now where you're even seeing intranasal anatomy that you can't really see that well with the iPad. But based off of these images, it's actually, So it's happening, it's already starting to happen. But what you said is it does cut both ways, Sam. It really does.

In some ways, when you create this model that looks so realistic for patients and you're able to do things on it, [00:12:00] if the post operative result doesn't look like that in the model, you do wonder, could this actually be setting up, like the pre operative modeling aspect of it is very accurate. We don't do post surgical scans on these patients to know whether or not the simulations are any good.

So could it be setting up false expectations for patients?

Dr. Sam Rhee: Yeah, that's, that is one of the biggest problems I always have is if you show them these pictures and they hang on to them and they're like looking at themselves afterwards and they say, this is not what you promised me. And, and we've talked about this before about guarantees, promises, expectations. Like you said, the realism now, and the fact that this is based on larger models, you know, They could say, listen, Alix is now saying this is the way it should look when exactly the way it should look when you put in 350 cc implants, and this is not the way I look. [00:13:00] Um, could be a problem.

Dr. Sam Jejurikar: All right, I have a, I want to pose a general question to you guys about surgery in general, but not necessarily plastic surgery. Can you envision a world in which, um, a robot would perform a laparoscopic cholecystectomy? with limited or no human interaction of any kind. Actually,

Dr. Sam Rhee: It could do it in,

Dr. Lawrence Tong: it'll happen. Of

Dr. Sam Rhee: it could do it in steps. So what you would have to do is, and this is sort of what they do already for say the Mako robot or guided like. Orthosurgery is you look at the image and you pick out like, here's the gallbladder, here's the cystic artery, here's the common duct, here's the, you know, cystic duct, and you like tag all these things in the image and then the computer would be like, okay, now ligate the cystic duct and it goes in and it does that step for you.

Done. And then you're like, okay, now like [00:14:00] start to peel the gallbladder off the liver. And then it starts to do that for you. And then you're like, stop. Okay. Go like 10 degrees more like in this direction. And then it'll start doing that. And you're like, stop. Okay. Like, keep going here. So I could see it maybe not like from start to finish, but I could see it sort of doing multiple steps as you're guiding AI and telling it like, The landmarks and what to identify and what to do, for sure.

Dr. Salvatore Pacella: I mean, I think it can absolutely go from start to finish. I mean, I mean, to me, don't you think that the, The AI can learn after looking at millions of CT scans, where the variations in every single person's anatomy could possibly be, you know, and then figure out exactly where the gallbladder is. I mean,

Dr. Sam Rhee: mean, it's like self driving cars, sort of, but like, there are going to be some catastrophic

Dr. Salvatore Pacella: right. There, there's some, there's some checks and balances that you have to oversee for sure, but I think it could plug and play. Um, I mean, they already do [00:15:00] manicures completely with AI. You put your hand in, boom, done, you know?

Dr. Lawrence Tong: That's a little different.

Dr. Salvatore Pacella: how is it different?

Dr. Sam Jejurikar: how is that different? How is that different?

Dr. Salvatore Pacella: It's a step process, right? I mean, it's not invasive, but

Dr. Lawrence Tong: You're not cutting

Dr. Salvatore Pacella: so if it,

Dr. Sam Jejurikar: Right.

Dr. Salvatore Pacella: uh, you're cutting nails.

Yeah, you're cutting, you're cutting, uh, the, the, the little cuticles out. They're doing all that, you know?

Dr. Lawrence Tong: Yeah, actually, you're right. I saw, I saw some video where they were like putting on these, uh, eyelash extensions with this, uh, robot. And I thought that was, that was freaking cool. So, um, yeah, I think, I think it'll happen for sure right now. It's probably, you know, in a sort of idealized situation. Um, that it can do it.

But as, as, as progress continues, they'll be able to.

Dr. Sam Jejurikar: it's not, it's not that far away guys, I think. And, you know, what Sam was talking about, the stepwise manner for doing it is just because until we have full proof of concept that We've had 100, [00:16:00] 000 cases where a robot has done this and not killed anyone. You need to have human oversight, human oversight of the process to make sure of it, to make sure there's supervision of the neural network.

But once that's over, you know, once you get past that, there's no reason why I couldn't go from beginning to end, which then leads me to this segue. What's the role of AI machine learning in plastic surgery? Because that feels different to us as plastic surgeons, where there is an art to it, as much of a, as much as there's the science or taking things out, what can you see robots doing in plastic surgery,

Dr. Sam Rhee: I, I definitely foresee the quote plastic surgery closure being obsoleted by, by robots. So if you take, um, we already have what, uh, certain like subcutaneous staplers and like not good things, but there's no doubt if you could run a robot to do skin closures, there's no doubt that. You can identify like how it works or, [00:17:00] you know, maybe even something more complex like microsurgical anastomosis.

But I would say even skin closures, you line up the robot, you tell it like where to go from here to here on your tummy tuck and it does the subcuticular stitch for you and it closes it up. And I can, I can guarantee you in our lifetime before we're dead, hopefully, we will see the ER like saying, Oh, we got a big laceration here.

Bring in the. The, you know, doctor, yeah, Dr. Jej, the surgical robot, and they wheel in the robot and it goes, and it does a really nice plastics closure for you and boom, you know, little Jimmy is out the door without a problem or whatever it is. So, so I, I could see that for sure. Like I could see that being a big thing.

Dr. Sam Jejurikar: doesn't seem like that big of a leap. Like do you, could you see a. Robots doing an operation in much the manner we were envisioning for a gallbladder. Could a, could [00:18:00] a AI machine learning, um, device do a breast augmentation? And have the aesthetic judgment that, Right now we'll see a patient that's gonna go to 10 of us, right?

And, and is gonna pick the surgeon that think most matches their aesthetic ideals and they'll pick us to do, to, to do an operation that we think is a relatively easy operation to do. Where, where does the art aspect of, you know, the comfort for patients come in versus the scientific aspect of a, of a closure?

Dr. Salvatore Pacella: I would argue that the art of it is irrelevant. It's all what the patient wants, right? So I could easily see a situation where a patient comes in, they get a 50 question, 50 image test for the patient's aesthetic ideal saying, choose these three breast augmentations from side to, you know, and there's sort of a qualifier of aesthetics that the patient sort of hones down to of what they want to look like.[00:19:00]

And then that's the, the model that the robot does for the breast augmentation. You know, I mean, it's, Son, we're out of a job.

Dr. Lawrence Tong: Well, it won't be in our lifetime. It won't be in our lifetime.

Dr. Sam Jejurikar: I think it'll be in our lifetime. I think it'll be in our lifetime. I don't know if it'll be during our career. Um.

Dr. Sam Rhee: um, a surge a surgical robot would be good enough to be able to make that incision, do the dissection, make the pocket the way a skilled person could do now? Like, tho that th that that takes a little bit of, uh, more judgment than, say, just, A gallbladder in my opinion. Honestly. Even something simple like a breast dog.

Dr. Sam Jejurikar: You know, we, we, we're not there yet, but, uh, you know, a few weekends ago when my self driving Tesla took me all the way from Dallas to Austin and literally I just kicked back the whole way and it even stopped me at Buc ee's to get me, which people outside of the South don't know what Buc ee's is, but it's, uh, it's the cleanest [00:20:00] I even said stop at Bucky's on the way, and my car stopped me at Bucky's so I could get some beaver nuggets, which was a delicious dessert, by the way.

A little

Dr. Sam Rhee: that what they're called?

Dr. Lawrence Tong: That sounds, yeah,

Dr. Sam Jejurikar: a little bit of a digression, but, but if a car, but if a, but if a robot already can drive me, From my garage to Austin, Texas with limited human interaction. Um, I do think there will probably be a time that, that yes, the robot will be able to do it as well as a human.

Dr. Salvatore Pacella: How many people did you hit along the way?

Dr. Sam Jejurikar: Just one, just one, but

Dr. Salvatore Pacella: Now, let me ask you this. How did you, how did you feel sitting behind the wheel while the car is driving itself? Were you

Dr. Lawrence Tong: freaky at first. No, it's freaky at first, but then once you get used to it, it's great.

Dr. Sam Jejurikar: It's style is different, right? Like, and this wasn't my first time doing this. This is probably the 10th time I've, I've done this. With the car doing that, so I've gotten used to it, but yes, it's style is different. Like what our impulse might be. Like, if you're in a blind spot for another car might be to speed up [00:21:00] to get past it.

The car might slow down. So that's behavior might be a little bit different in a situation than what than what ours is. But once you realize that the car recognizes. There's no blind spot because there's cameras everywhere, so the car knows everything that's happening around there. The car sees the lanes, the car knows how to follow directions, and, you know, it, it, I felt pretty relaxed.

It's, it's more helpful to me when there's somebody with me, so I have someone to talk to while I'm doing it. If it's just me in the car, I get a little bored.

Dr. Lawrence Tong: How many times you fall asleep?

Dr. Sam Jejurikar: Zero. It'll disable if you do that.

Dr. Lawrence Tong: I, I

Dr. Sam Jejurikar: what I do, what I do

Dr. Lawrence Tong: you have the full, you have the full self driving, you have the full self driving suite or which, which. Iteration, is it?

Dr. Sam Jejurikar: it's the full self driving suite, but, but to get back to plastic surgery, did you guys see anything about the NVIDIA Omniverse? Have you seen what this is? It was a big thing last week where they were talking about it specifically with the, the, with factory design and. [00:22:00] Car building. And where basically there's a scenario where NVIDIA has designed this design platform where you can kind of create a virtual environment and using something like Vision Pro Goggles, I know you've got a pair of them already, Dr.

Rhee, right? You've got to have a pair of Vision Pro Goggles. You don't?

Dr. Sam Rhee: I

Dr. Lawrence Tong: All Asians do.

Dr. Sam Rhee: That stuff Any of

Dr. Salvatore Pacella: Google Glass, Samir?

Dr. Sam Rhee: stuff makes me It just gives me horrible motion sickness. I can't, like, have that, like, stuff around. I I can't. It doesn't make me feel good.

Dr. Sam Jejurikar: Well, what NVIDIA was showing at its conference last week was there were people building a factory. They're all wearing in like wearing vision pro goggles from all over the world, and they're in this virtual environment where they're all sort of participating in the design of something. And I could see a situation where surgery is involved, where you can get input from people from all over the world to actually, you Help come consult on operations or you can train residents in this sort of manner using using the omnibus and I think AI machine learning is going to become [00:23:00] really important for surgical training in the next five years.

I mean, I can see that happening

Dr. Sam Rhee: Yeah. You know what? Let's see how it does with the porn stuff first, cause that's where all this stuff goes first, is porn. And then after that, like, after they do all the porn stuff, then they it might trickle down to surgery eventually. That

Dr. Sam Jejurikar: Ooh, nice play, nice play on words there. Okay. Anyways. Yes. All right, guys, I gotta, I gotta sign out. I'll be back.

Dr. Lawrence Tong: Yes, Sal, could you give us your comments?

Dr. Sam Jejurikar: yeah. So if I'm reading this correctly, Pacella is using AI a decent amount already for documentation purposes. Are you two using it even a little bit?

Dr. Lawrence Tong: using it zero.

Dr. Sam Rhee: Not, not for clinical stuff, like you said, for fun, not for, uh, you know, I, I listened to Pacella's, uh, um, what Chris Cornell versions of all these songs that he sends all the time, like the, the AI versions of that, that's, that's really about all I use it

Dr. Salvatore Pacella: That was fun.

Dr. Sam Jejurikar: you'll be happy to know that [00:24:00] I actually played your entire album in the OR.

Dr. Salvatore Pacella: people think?

Dr. Sam Jejurikar: They were all freaked out. So,

Dr. Salvatore Pacella: It's amazing, right?

Dr. Sam Jejurikar: so yeah, so, for our listeners, you want to tell them what you did,

Dr. Salvatore Pacella: Yeah, so, um, so first of all, um, I would love if our listeners went to my, to my YouTube channel. It's actually my YouTube channel and my son's YouTube channel called At Grady Arbor Films. Little plug for that. Um, it's got a bunch of videos on there he loves. But what I did was I was sitting around one day and I was, You know, I'm a, I'm a child of the grunge era, okay.

Um, the music that was around for five years and then left. Um, and so I was sitting around and I, I thought to myself, there's gotta be some AI generated Chris Cornell voice. Uh, he's the lead singer of Soundgarden. And you know, his voice is very distinct. He's got a high octave, octave range. Um, and it's a very unique voice.

And so I sure enough found this program called Jammable. where you can basically [00:25:00] take any clip of any song, um, you can take any song from YouTube and upload it to any voice you want. Frank Sinatra, Morgan Freeman, you know, anything. And so I found this Chris Cornell AI generator and I made a 17 song album on this and it was, um, I would say that about 60, 70 percent of the time it was a hit.

Uh, the other 34 percent of the time it sounded terrible, um, but I just kept trial and erroring it. And, uh, we upload, I uploaded this entire album to YouTube. I hope you can check it out. Um, on, at GradyArborFilms dot, there, okay. Um, but it, it's, it's, it's incredible how well it sounds, how close it sounds in.

It's not perfect, but it's,

Dr. Sam Jejurikar: It's good, yeah. It, uh, it, so yeah, so, we listened to it in the operating room, and it, it upset people. Like, it led to a lot of, it led to a lot of very philosophical conversations like, Is this [00:26:00] real music we're listening to? Because Chris Cornell never even heard these songs. Some, many of these were songs that were, that came out after he had passed away.

So, yeah, but um, Yeah, so, so I'm using it, just so you guys know, I'm using it probably 20 to 25 times a day for my plastic surgery practice. The documentation aspect of my practice has gone, has been simplified so much, and as opposed to spending an hour at the end of every day doing notes, I now can do it in real time very quickly, and it's given me an hour of efficiency back.

I'm using it extensively for breast surgery, not just augmentation at this point, but mastopexies, Breast surgery, breast reductions to simulate what different looks will look like for people. We're using it for rhinoplasty. Um, I think the, um, you know, there's a surgical robot used for hair transplant called Artaz that's made by Intuitive Surgical, the same company that makes the Da Vinci.

They're incorporating AI into it, and they're at a point now where they're not too far from letting it just harvest hair [00:27:00] from people to use. So it's, it's here sooner than, you know, uh, and patients should know that. The growth in AI. In plastic surgery and in medicine in general, it's not going to happen in a linear manner.

It's just going to explode over the next few years. So be on the lookout.

Dr. Sam Rhee: I'll be ready. I'll be ready to retire and go do something else, uh, once, uh, I get, uh, obsoleted out of my job. I'll be happy with that.

Dr. Salvatore Pacella: Well, listen, if we, if we're going to close this up, I, uh, 10 seconds ago, I just asked chat GPT to, uh, here, I'll put you what I, I'll let you know what I said here. So, um, write me a poem about four plastic surgeons and a microphone and this podcast, and here we go. In the podcast sphere, a unique tone. Four plastic surgeons and a microphone they own.

From California's sun to Toronto's grace, Dr. Sal, Dr. Sam x2, and Dr. Tong embrace. With each episode, stories unfold of [00:28:00] transformations both young and old. From Dallas to Jersey, their voices unite, guiding journeys. Uh,

Dr. Sam Jejurikar: was awesome. And how much information did you give it to write that?

Dr. Salvatore Pacella: the prompt was, let's see here. Um,

Dr. Sam Rhee: Wow. That's a lot better than what I could write.

Dr. Salvatore Pacella: write me a poem about a podcast called Four Plastic Surgeons and a Microphone. The surgeons are Dr. Sal from California, Dr. Sam from New Jersey, Dr. Sam from Dallas, Dr. Tong from Toronto. That's it.

Dr. Sam Rhee: Impressive.

Dr. Sam Jejurikar: Wow.

Dr. Lawrence Tong: Very

Dr. Sam Rhee: right. I, I'm, I'm definitely out of a job soon. I can tell with, uh, with that kind of talent for sure.

Dr. Sam Jejurikar: And on that note,

Dr. Lawrence Tong: will never replace the meticulous Asians.

Dr. Sam Jejurikar: this is where Dr. Pacella and I are just

Dr. Salvatore Pacella: it's It's a good thing for self driving cars.

Dr. Sam Jejurikar: Exactly. And, uh, we thank all our listeners as always. Take care,

Dr. Lawrence Tong: Alright, take it easy.

[00:29:00]