Shared Decision-Making in Cosmetic Procedures and Aesthetic Plastic Surgery: A Systematic Review of Decision Aids, Clinical Benefits, Ethical Challenges, and Future Perspectives

Background/Objectives: Shared decision-making (SDM) is essential to patient-centered care in aesthetic plastic surgery, where successful outcomes depend on aligning interventions with patients’ values, preferences, and goals. Decision aids may traditionally support SDM by presenting information in a structured manner and facilitating patient–clinician collaboration, while the emergence of artificial intelligence (AI) may further support SDM through medical information delivery and patient counseling. Methods: A systematic search of PubMed, Cochrane Library, and Google Scholar identified English-language studies published between 2011 and 2026 examining the applicability and impact of SDM as well as interventions, tools, or technologies that may influence the decision-making process, relevant to preference elicitation, patient education, and risk communication in aesthetic plastic surgery and cosmetic procedures. Two reviewers independently screened records and full texts, with disagreements resolved by discussion. Risk of bias was assessed using appropriate frameworks. Limitations, ethical considerations, and future perspectives were also evaluated. Results: Of 5485 records identified, 108 underwent full-text evaluation, and 38 met the inclusion criteria. Decision-support strategies were variably associated with greater patient participation, understanding, satisfaction, and enhanced expectation management. However, standardized, validated decision aids remain limited, and substantial methodological heterogeneity and moderate-to-high risk of bias restrict the strength of available evidence. Studies exploring AI-based technologies evaluated mainly feasibility and accuracy, while limited evidence was available concerning patient satisfaction, improvement in SDM, or clinical outcomes. Conclusions: The use of standardized decision aids across aesthetic plastic surgery remains limited, while the adoption of AI in SDM should be considered as an adjunct to human counseling. Prospective comparable studies are required to determine their effectiveness in a clinical framework.