Artificial intelligence (AI) is beginning to reshape the landscape of hand surgery, but most clinical evidence still originates from radiology and other surgical specialties. This literature survey provides a comprehensive overview of current and near-term AI applications in the field. Presently, AI enhances diagnostic accuracy by identifying subtle fractures, nerve compressions, and vascular anomalies on imaging that may elude human detection. Presently, AI contributes mainly to diagnosis/imaging (fracture detection; adjuncts for nerve/perfusion studies) and planning (AI-assisted 3D reconstructions), with intraoperative platforms such as augmented reality (AR) microscopes and robotics largely adapted from neurosurgery/spine and only emerging in hand surgery. While many of these visualization platforms themselves are not AI, they increasingly integrate AI-based modules for image processing and real-time data overlay. Early postoperative risk-stratification models (e.g., stiffness, infection, complex regional pain syndrome) and digital rehabilitation are promising but require prospective, multi-center validation. Additionally, AI-driven tools streamline operative documentation and empower patient education through conversational agents. Looking ahead, developments such as implantable micro-sensors for real-time anastomosis monitoring, AI-guided perforator mapping, and miniaturized AR-assisted visualization promise to further transform practice. However, challenges persist - from limited datasets and the need for external validation, to high costs, regulatory hurdles, and ethical concerns surrounding data privacy and algorithm transparency. Achieving the sub-millimeter precision required for safe surgical implementation remains one of the most critical technical challenges. Emphasizing explainable AI and maintaining the surgeon’s central role in decision-making will be crucial to safe implementation. Ultimately, the convergence of AI, advanced imaging, robotics, and microsurgical techniques holds significant promise to elevate precision, outcomes, and patient-centered care in hand surgery.

Aim: Gender-affirming rhinoplasty is a key component of facial gender-affirming surgery, aiming to align nasal aesthetics and function with a patient’s gender identity. While there has been a strong emphasis on the cosmetic outcomes of this procedure, rhinoplasty is also intended to improve nasal function. Few studies have assessed functional outcomes in this population using validated, patient-reported measures. This study aims to evaluate changes in nasal function and cosmetic satisfaction using the Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) in patients undergoing gender-affirming rhinoplasty.

Methods: A retrospective cohort of 20 patients (all facial feminization) who underwent gender-affirming rhinoplasty at a tertiary academic center was analyzed. SCHNOS-Obstruction (SCHNOS-O) and SCHNOS-Cosmesis (SCHNOS-C) scores were collected preoperatively and at approximately 3, 6, and 12 months postoperatively. Paired t-tests or Wilcoxon signed rank tests were used to compare pre- and postoperative scores, with subgroup analyses performed using analysis of variance. Statistical significance was set at P < 0.05.

Results: Statistically significant and clinically meaningful improvements in SCHNOS-C scores were observed at 3, 6, and 12 months post-operatively, compared to pre-operatively (P < 0.05). Among the subgroup of patients with baseline nasal obstruction, a statistically and clinically significant reduction in score was seen at 6 months post-operatively compared to baseline (P < 0.05). Patients without nasal obstruction at presentation did not show a worsening SCHNOS-O score at any post-operative timepoint.

Conclusion: Gender-affirming rhinoplasty is associated with significant improvements in aesthetic satisfaction as measured by SCHNOS-C scores, with significant improvements in nasal function seen among those patients with nasal obstruction on presentation. These findings support the use of validated, patient-centered tools in outcome assessment and highlight the need for further research to optimize both functional and cosmetic results in gender-affirming rhinoplasty.