Introduction

The term “metaverse” was invented by Neal Stephenson and first appeared in the science fiction novel “Snow Crash” in 1992 [1]. The metaverse can be described as a parallel experimental dimension that can be used to improve decision-making for the real world we live in, without replacing it. Park and Kim (2022) defined the metaverse as “a three-dimensional virtual world where avatars engage in political, economic, social, and cultural activities” [2].

The metaverse is used in the entertainment industry, in social networks (chatbots), in education, for optimising supply chains, in the real estate industry and in the tourism sector. Due to the significant increase in demand for telemedicine during the COVID-19 pandemic, the potential of the metaverse in medicine has also grown [3].

Metaverse technology encompasses the fields of virtual reality (VR), augmented reality (AR) and mixed reality (MR). Their integration into a virtual three-dimensional space enables comprehensive experiments in real time and in interaction with special equipment (Tab. 1).

Metaverse technology opens up the following potential main areas for further developments in medicine:

– Virtual comparative scanning (e.g. for CT or MRI to enable the best imaging for the individual patient),

– raw data exchange (e.g. for imaging procedures, laboratory data),

– augmented regulatory science (e.g. for medical devices with artificial intelligence) and

intelligence) and

– metaverse medical intervention (e.g. for therapy planning and implementation, surgical robots) [3].

Aesthetic medicine and metaverse

VR has long since arrived in surgical practice with robot-assisted precision surgery [4-6]. These developments also have potential for aesthetic surgery.

Interaction with atavars can be used to measure, predict and improve individual interpersonal effectiveness [7]. This plays a role in the evaluation of medical education and training and potentially increases patient safety.

Barriers to training and the practice of medicine due to physical disabilities can be partially overcome by metaverse technologies [8].

In fact, the introduction of computer-based testing for medical licensing in South Korea has led to better clinically orientated outcomes than the traditional written examination [9]. The extent to which examination results translate into better clinical practice needs to be further analysed.

The hot topics for training in aesthetic medicine using Metaverse technology are knowledge transfer, particularly in functional anatomy and robot-assisted surgery [10, 11].  Smith et al (2005) used two-dimensional histological cadaver sections and transferred them into Alias’s Maya, an animation software, in the form of stacked vertical sections. From this, a three-dimensional structure of the soft tissue anatomy of the face was created [12]. Mühlbauer and Holm (2005) developed a computer-aided procedure for planning rhinoplasty [13]. The computer model AYRA (Andalusia Department of Health, Andalusia, Spain) can convert CT scans into three-dimensional virtual models of the craniofacial skeleton and soft tissue. This allows surgical planning to be carried out [14]. In the context of reconstruction, this technique allows optimal planning of pedicled flaps [15].

Head mounted devices (HMD) such as special glasses or head sets can be used in the operating theatre to locate critical structures such as nerves and vessels. Systems such as HoloLens (Microsoft Corporation, Redmond, WA) are used in plastic and reconstructive surgery [16].

However, these techniques also have their limitations. HMDs and monitors can interfere with the surgical field and restrict the range of movement [17].

Conclusions

The use of metaverse technology in aesthetic medicine has only just begun. Currently, the technology is mainly used to train students and assistants and to develop surgical skills [18].

The hype is great and many perspectives are opening up [19, 20]. Questions of ethics, cyber security, legal consequences and financial viability need to be clarified. The patients’ view of the new technology has not yet been systematically analysed. How do colleagues work together under metaverse conditions? Initial pilot studies assume low utilisation of the potential for collaboration [21]. How does the technology affect users in the long term? There are still many unanswered questions.

Paquin and colleagues have made the following statement: “It is too early to indicate whether the metaverse will broadly be a greater risk or benefit to mental health than previous digital media. Undoubtedly, virtual worlds are unprecedented in the scope of experiences and behaviours they can afford, and as such, in their potential to take a greater place in our daily lives. To adequately counsel patients and guide policies around the development and implementation of the metaverse, there is a need for timely and nuanced research on its opportunities and risks for mental health” [22].