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(1)
(2)
©The Author(s), under exclusive license to Springer Nature Switzerland AG2023
E. Tokgöz, M. A. Carro, Cosmetic and Reconstructive Facial Plastic Surgery
https://doi.org/10.1007/978-3-031-31168-0_9
Applications of Artificial Intelligence,
Machine Learning, and Deep Learning on
Facial Plastic Surgeries
EmreTokgöz1 and MarinaA.Carro
2
Whiting School of Engineering, Johns Hopkins University, Baltimore,
MD, USA
The Frank H. Netter M.D. School of Medicine, Quinnipiac University,
North Haven, CT, USA
MarinaA.Carro
Email: Marina.Carro@quinnipiac.edu
Keywords Artificial Intelligence applications on facial plastic surgeries –
Deep learning applications on facial plastic surgeries – Machine learning
applications on facial plastic surgeries
Emre Tokgöz completed two Ph.D. degrees, one in Mathematics and
another one in Industrial Engineering, at the University of Oklahoma along
with a master’s degree in Computer Science and two master’s degrees in
Mathematics. Due to his interest in biomedical engineering applications of
mathematics and engineering, he pursued an online biomedical engineering
master’s degree for professionals at Johns Hopkins University. His other
research interests include nonlinear optimization, game theory,
deep/machine learning, financial engineering, facility allocation problems,
vehicle routing problems, systems’ design and improvement, network
theory and analysis, inventory systems, and Riemannian geometry.
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Marina A. Carro is a second-year medical student at the Frank H. Netter
School of Medicine (Quinnipiac University). Prior to medical school, she
worked as a project manager at Clínica Esperanza Hope Clinic in
Providence, Rhode Island, where she organized and managed a satellite
COVID-19 vaccination clinic for underserved populations in the area.
Additionally, she has worked as a certified nursing assistant for 3 years in
the emergency department and intensive care unit at South County Hospital
in Kingston, Rhode Island. Currently, she is on the board for the Frank H.
Netter Wellness Committee, ENT Surgical Interest Group, and American
Medical Student Association at Netter. She hopes to continue exploring her
interests in clinical procedural research, healthcare business and
administration, and provide equitable healthcare for marginalized patients
throughout the rest of her career.
1 Introduction
Development of algorithms allowing to make informed decisions based on
patterns learned from data and mimicking human behavior by using
technology has been one of the goals of researchers for real-life applications
[70]. Machine learning (ML) algorithms are computer methods that can be
trained to find characteristic features and patterns in data. The idea of
artificial neural network (ANN) development follows the same footsteps of
the physiological neural networks. A multilayer perceptron is an artificial
neural network consisting of an input layer, an output layer, and several
hidden layers between the input and output layers. Neurons are the building
blocks in between each one of these layers that serve as computational
building blocks of the network. Neurons are interconnected in subsequent
layers, and output of each neuron is the product of its input with a learned
set of weights that is added to a learned bias. An activation function is used
for deciding whether a neuron should be activated or not. Training, testing,
and validation are three steps that can be used as part of a model
development in ANN. The training phase allows the model to
determine/learn the weights and biases of the ANN from training data.
ANN is expected to propagate a large amount of input data to properly
predict the values of the output layer during the training process. The size
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of the data has an impact on the attained results. The differences between
the predictions of the ANN and the desired output values are targeted to be
minimized iteratively by updating the weights and biases of the network
during training. A model that works at the best level is determined on the
training test with the goal of using on the testing set. Training and testing
sets are chosen independently for unbiasing the model’s accuracy. The
validation phase is used to ensure that the developed ANN didn’t memorize
the training data characteristics by attaining good results on other datasets
to validate its effectiveness of application on multiple settings. ANNs can
be used to automatically perform specific tasks, such as predictive
outcomes after optimizing the trainable parameters attained.
Facial traumas that have been seen in emergency departments include
traffic accidents, assault, and fall overs [72–74]. There can be several
reasons for a plastic surgery, and AI applications can be possible that
associate with these reasons that include, but not limited to, the following:
Fracture repair
Nerve paralysis/rehabilitation
Restoration and reconstruction
Septal deviation and reconstruction
Obstruction, scar revisions, and anomalies
Cancer reconstruction
Unidentified or untreated fractured facial bones have an important place
in an individual’s health; such fractures that are not treated properly can
result in complications and sequelae such as nasal canal rupture and eyeball
retraction. Manual methods used for such detection are good; however, AI
solutions can improve such detections through advance analytics.
Face recognition techniques have been developed by using a variety of
techniques including artificial neural network (ANN) approach in deep
learning as well as linear binary patterns histogram, local feature analysis,
local binary patterns, speeded-up robust features, geometric features,
principal component analysis, eigenface, and Fisher vector analysis [75].
Some of the optimization methods used included evolutionary-genetic
algorithm (GA), particle swarm optimization (PSO) and structural similarity
image maps (SSIM) that aimed to for good precision of the recognition.
Deep learning is implemented in a variety of facial plastic surgical
applications, including, but not limited to, aesthetic surgeons, to assess
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gender typing following facial feminization, and perceived age changes
following rhinoplasty and facelift [81–84]. ANN is utilized as early as 1991
in [80] to distinguish male and female faces. Deep convolutional neural
networks (CNN) are determined to be powerful tools for face detection and
gender classification. Recently, a facial recognition software called
DeepGestalt (FDNA, Inc., Boston, Mass.) is shown to be superior in the
recognition of known genetic syndromes based on facial features to the
capabilities of clinical experts [81]. Research on surgically altered face
recognition and face feature reading by using a variety of DL techniques
has been also studied extensively [84–89].
The next section focuses on AI/ML/DL applications on facial feature
recognition, which is determined to be one of the popular areas of interest
in the research community.
2 Facial Feature Recognition by Using Machine
Learning Applications for Facial Plastic Surgeries
Recent advancements in technology are utilized to analyze facial plastic
surgical outcomes. Analysis of facial structure for pathological or
dysmorphic issues is a typical part of plastic surgical procedures given that
it may be a reconstructive or an aesthetic surgery. Computed tomography
(CT) cephalometric radiography is used for 3D reconstruction with the help
of computer programming and advancements in image quality [20–24];
however, these applications are expensive with limited access to such
technology. Rapid progress on technological advancement of smartphone
applications is reflected onto facial recognition–related analysis after plastic
surgeries. Such applications are rare to see in practice, and further
development on these applications is limited to the developers’ updates on
the applications [28]. Machine learning algorithms are used for craniofacial
dysmorphology analysis, which focuses on diagnosis and measurement
analysis [25–27]. Integration of machine learning and cellular-based
technology is one way to advance plastic surgical outcome analysis.
Regarding facial landmark recognition, ML Kit by Google is an opensource application programing interface (API) capable of real-time facial
landmark recognition and provides extensive number of facial coordinate
points [19]. In the case when such an automation is not utilized, human
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