Toward Transparent AI-Enabled Patient Selection in Cosmetic Surgery by Integrating Reasoning and Medical LLMs.

Abstract

Existing AI solutions-like the XGBoost tool by Li et al.-show potential for preoperative screening but rely on fixed questionnaires and opaque feature weighting. We introduce a hybrid framework that combines reasoning LLMs (OpenAI o3, DeepSeek R1, Google Gemini 2.5, Anthropic Claude 3.7 Sonnet) with specialty medical models (Baichuan-M1, Zhipu AI GLM-4-9B-Chat, OpenBioLLM-Llama-70B, MedLLaMA3-v20, Med-PaLM 2, SurgeryLLM). Patient inputs-structured and free-text-are ingested via a secure mobile app and processed through a retrieval-augmented pipeline. Reasoning LLMs expose chain-of-thought steps for full transparency, while medical LLMs validate each risk factor against clinical guidelines. An ensemble then delivers a composite suitability score, complete with an audit trail of data points and citations. We address key hurdles-model recency, hallucination control, data privacy, and fairness-and recommend a medical-device regulatory approach with independent validation, ongoing bias monitoring, and co-design with multidisciplinary stakeholders.Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .