'Your Face, Their Stage': A Global, AI-Enhanced, Mixed-Methods Survey on Public Perceptions of Live Educational Cosmetic Procedures.

backgroundThe global rise of live cosmetic procedure demonstrations particularly in non-surgical aesthetic medicine has prompted growing ethical concern. While often framed as educational, these public displays risk conflating clinical care with commercial performance.

methodsA multilingual cross-sectional survey of 16,950 participants from 43 countries captured public perceptions of live aesthetic procedures using both structured and open-ended items. AI-enhanced methodologies including natural language processing (NLP), sentiment analysis, and machine learning (ML) were applied to assess attitudes, emotional responses, and predictors of negative sentiment.

resultsRespondents exhibited high levels of ethical discomfort: 76.5% believed live procedures served self-promotional aims, while 69.7% perceived them as compromising patient privacy. Narrative analysis showed that 49.8% of open-text responses expressed negative sentiment, with dominant emotional tones being disgust (24.3%) and concern (22.8%). Topic modelling identified six core public concerns: commercial exploitation (22.5%), power imbalance in consent (19.3%), and surveillance culture (14.2%) among them. Predictive modelling using logistic regression and random forest classifiers (AUC = 0.82, F1 = 0.765) revealed narrative polarity, region, emotional tone, and prior cosmetic experience as significant predictors of negative sentiment. Respondents with no prior procedural history were more likely to describe feelings of exposure, shame, and loss of autonomy. Notably, nearly half of respondents expressed concern about the future of cosmetic medicine, citing risks of performance-driven care and ethical erosion. In response, we propose the INFORM-A checklist, an evidence-based ethical framework to guide the conduct of live or recorded procedural broadcasts.

conclusionPublic perception of live cosmetic procedures is characterised by scepticism and emotional discomfort, particularly when transparency and ethical safeguards are absent. The educational value of these practices is widely contested, with findings suggesting a misalignment between professional intent and public trust. Regulators, practitioners, and conference organisers must reevaluate the ethics of live procedural demonstrations in favour of consent-driven, accountable, and psychologically safe educational alternatives. LEVEL OF EVIDENCE IV: 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 .