The Use of Robotic Systems in Aesthetic/Cosmetic Plastic Surgery—A Review

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Good article reviewing the robotic involvement in plastic surgery.

Highlight clinical relevance: Emphasize how robotic systems specifically improve patient outcomes in aesthetic surgery (precision, reduced scarring, faster recovery).
• Briefly contrast robotic vs. conventional approaches to underscore the unique value of robotics.
• Stress the importance of developing docking protocols and specialized instruments as prerequisites for widespread adoption.
• Economic perspective: Mention cost-benefit analyses or potential strategies (leasing, shared platforms) to address high acquisition costs.

Replace passive constructions (“were primarily performed”) with active ones (“surgeons primarily performed”).

• Parallel phrasing: Keep lists uniform (e.g., “minimize scarring, optimize access points, and ensure safety”).
• Concise conclusions: End with a forward-looking statement that ties challenges to opportunities (e.g., “With continued innovation, robotic systems may redefine aesthetic plastic surgery as safer, more precise, and more patient-centered.”).

Comments on the Quality of English Language

Mentioned above 

Author Response

Dear reviewer,

The authors want to thank you for your high regard of our manuscript, as well as the time and effort invested in it.

As requested, we have added the changes you requested, discussing the benefit of robotic surgery, we have also stressed the importance of developing docking protocols and specialized instruements in the discussion session and added cost benefit analysis and the different ways hospitals can aquire the robotic systems.

We want to mention that we sent our paper to author services for english language correction, which significantly improved the readability of our paper. We also replaced passive constructions as requested and ended the conlcusion with the useful phrase you provided.

 

Thank you for your time invested in our manuscript and for your valuable comments to help improve our paper.

Reviewer 2 Report

Comments and Suggestions for Authors

Dear Authors,

Thank you for submitting this manuscript on a timely and relevant topic. The overview of robotic systems in aesthetic plastic surgery is appreciated. However, in its current form, the manuscript remains largely descriptive and would benefit from substantial revision to meet publication standards.

Major Comments

1. Lack of Structured Methodology
   The review lacks sufficient methodological detail. The search strategy is only briefly mentioned, and there is no clear description of inclusion criteria, study selection, or critical appraisal of the literature.
   It would strengthen the manuscript if a more structured approach is adopted, such as a PRISMA-based framework, or alternatively, a more rigorous critical evaluation if the intention is to present a narrative review.
2. Limited Analytical Depth
   At present, the manuscript mainly summarizes existing studies without providing a deeper synthesis or new insights.
   The paper would benefit from a clearer analytical perspective, for example, by introducing a conceptual framework, classification system, or structured interpretation of the current evidence.
3. Limited Clinical Applicability
   While potential advantages of robotic systems are discussed, the manuscript does not clearly address how these findings translate into clinical practice.
   It would be helpful to outline more concrete guidance, such as procedural indications, patient selection, and scenarios where robotic approaches may be preferable.
4. Descriptive Data Presentation
   The tables are informative, but they remain largely descriptive. There is limited comparison or interpretation across studies.
   Further discussion of trends, differences, and the strength of available evidence would improve the scientific value.
5. Reference Issues
   There appear to be duplicated references, which should be carefully reviewed and corrected.

 

Minor Comments

1. Some sections could be more concise to improve readability
2. The Discussion would benefit from clearer key messages
3. Terminology should be standardized throughout

Summary

The topic is relevant and of interest. However, the manuscript requires substantial restructuring and deeper analysis to provide a meaningful academic and clinical contribution.

Sincerely,
Reviewer

Author Response

The authors want to thank you for your valuable comments, detailed insights and time invested in our manuscript.

We appologize for any confusion that may have arised during the submission of our manuscript. We believe that many of your comments were regarding a systematic review, we want to clarift that our paper is a narrative review and it is not a systematic review.

We would like to add that our paper was sent to english language editing services through MDPI, which greatly enhanced the readability of our paper as requested.

regarding questions 1, 2 and 4 and the PRISMA diagram, we understand that these comments are mainly about systematic review requirements, hense why we cleared the misunderstanding earlier

3) We added scenarios in which robotic systems are beneficial and mentioned the patient population it would be indicated for as requested

4) The tables are largely dependent on the available literature, since the robotic method is still in its early stages, more papers in the literature are still lacking, making deeper analysis more difficult to achieve due to the lack of data. 

We added information about trends and strengths as requested.

5) The references were corrected and improved, thank you for your valuable comment

 

Minor components

1) we improved the readability of english language and the paper was sent to MDPI author services for correction

2) The discussion section was improved as requested adding more precise key messages

3) The terminology was standardized throughout the paper

 

Thank you for your informative expert comments, vaulable time invested to help improve our manuscript

Reviewer 3 Report

Comments and Suggestions for Authors

• Please clarify the review type.
  At present, it is not fully clear whether the manuscript should be considered a narrative review, a scoping review, or a systematic review. This distinction is important because the structure, reporting expectations, and methodological transparency differ across these formats. The review design should be explicitly stated in the title, abstract, and Methods section, and the manuscript should then be revised consistently according to that choice.
• The literature search strategy needs to be reported in a reproducible way.
  The Methods section should provide sufficient detail on the databases searched, search dates, key search terms, eligibility criteria, screening process, and rationale for study selection. Without a transparent description of how the literature was identified and selected, it is difficult to assess the completeness and reliability of the evidence synthesis.
• The review should be more critical and less purely descriptive.
  Many sections summarize published studies, but the manuscript would benefit from a deeper evaluation of the strength of evidence, recurring methodological limitations, areas of disagreement, and the real level of clinical maturity of the field. A stronger critical synthesis would significantly improve the scientific value of the review.
• The conclusions appear broader than the evidence presented.
  The discussion and concluding section should be revised to better reflect the actual strength and scope of the cited literature. Claims regarding clinical applicability, safety, efficiency, or future implementation should be expressed more cautiously unless they are consistently supported by comparative or higher-quality evidence.

Author Response

The authors want to thank you for your valuable comments and time invested to help improve our manuscript.

We appologize for any confusion that may have arised during the submission of our manuscript. Regarding your comments about the type of article, we want to clarify that our paper is a narrative review and it is not a systematic review and thus why it does not contain some of the requirements you mentioned, we have also cleared the misunderstanding with the chief editor earlier, we appologize again for the misunderstanding. And so some comments do not apply for the narrative type of article.

We would like to add that our paper was sent to english language editing services through MDPI, which greatly enhanced the readability of our paper as requested, ensuring a clear narrative review.

Based on your informative recommendations, as you know, robotic systems are still in the early stages of adoption and the literature is rather limited still, making it more difficult to conduct a deeper analysis, thus we have compiled the literature to highlight more specific aspects of the field that are useful for surgeons seeking to use robotic platforms, setting their expectations and giving them a detailed overview of the topic.

Regarding the strength of evidence, discussion and conclusion, we have expanded the text to include more information about the strengths, clinical potential, financial aspects and other information while acknowldging the current limitations in the literature.

Thank you for your valuable time and effort invested in our manuscript, your comments helped significantly improve our paper.

Reviewer 4 Report

Comments and Suggestions for Authors

Dear Authors,

Thank you for the opportunity to review your manuscript addressing the role of robotic surgery in plastic surgery. The topic is undoubtedly of emerging interest; however, in its current form, the manuscript has several conceptual and methodological limitations that need to be addressed before it can be considered for publication.

First, the overall scientific contribution of the manuscript appears limited. Robotic surgery in plastic surgery remains in a very early stage of adoption, and the current literature is sparse and largely exploratory. The manuscript does not appear to provide novel insights or meaningful advancement beyond what is already known. A clearer articulation of the unique contribution of your review is necessary, particularly in terms of clinical applicability, future directions, or synthesis of evidence.

More importantly, there are significant concerns regarding the methodology. Although the manuscript is presented as a systematic review, several essential elements are missing:

1. A PRISMA flow diagram is not included, which is critical to demonstrate the study selection process.

2. The search strategy lacks transparency. Details regarding databases searched, search terms or MeSH headings, and inclusion or exclusion criteria are not adequately described.

3. It is unclear how studies were identified and compiled, especially given the limited number of publications in this domain. This raises concerns regarding completeness and potential selection bias.

4. There is no mention of protocol registration such as PROSPERO, nor any formal assessment of study quality or risk of bias.

Given the limited evidence base in this field, methodological rigor and transparency are essential to ensure credibility. Without these, the validity of the conclusions is difficult to assess.

To improve the manuscript, I would strongly recommend either:

• Revising the work to comply fully with established systematic review guidelines, including PRISMA reporting, detailed search methodology, and quality assessment,

or

• Reframing the manuscript as a narrative or scoping review, with appropriate acknowledgment of limitations and a stronger focus on expert synthesis and future research directions.

Addressing these concerns will significantly enhance the scientific rigor and potential impact of your work.

Author Response

The authors want to thank you for your valuable comments and time invested in our manuscript, it helped improve our paper significantly.

We appologize for any confusion that may have arised during the submission of our manuscript. We believe that many of your comments were regarding a systematic review, we want to clarift that our paper is a narrative review and it is not a systematic review, we have also cleared the misunderstanding with the chief editor.

We would like to add that our paper was sent to english language editing services through MDPI, which greatly enhanced the readability of our paper as requested, ensuring a clear narrative review.

As you mentioned, robotic systems are still in the early stages of adoption and the literature is rather limited still, making it more difficult to conduct a deeper analysis, thus we have compiled the literature to highlight more specific aspects of the field that are useful for surgeons seeking to use robotic platforms.

We believe our paper is clinically important, since it compares different variables and sets the expectations for new surgeons looking to use these systems. we have also added the clinical importance in the manusctipt as requested.

Comments 1, 2, 3 and 4 were regarding systematic review articles which would not apply in our case, which is why PRISMA and other requirements are not included in our paper, since it is a narrative review and not a systematic review, we have also clarified the misunderstanding earlier with the chief editor. 

As requested, we made sure that our article is understood as a narrative review by adding more text , acknowledging limitations, with more focus on future directions and others, as well as making sure it is corrected by the MPDI english language correction service.

Thank you for your valuable time and comments, they helped improve our manuscript significantly.

Round 2

Reviewer 2 Report

Comments and Suggestions for Authors

accepted as it is!

Reviewer 4 Report

Comments and Suggestions for Authors

Dear Authors,

Thank you for your response and for clarifying that the manuscript is a narrative review. This addresses the earlier methodological concerns.

The revisions have improved the clarity, structure, and clinical relevance of the paper. The emphasis on limitations and future directions is appropriate given the early stage of robotic adoption in plastic surgery.

Overall, the manuscript is now suitable for publication.

Sincerely,
Reviewer