This review explores the current applications, benefits, and challenges of artificial intelligence (AI) in plastic, reconstructive, and aesthetic surgery. In recent years, AI has found its way into everyday life, including the healthcare sector. To deepen the understanding of the use and handling of AI in plastic and reconstructive surgery, this review provides valuable insights into modern practices, illustrated with real examples and potential future applications. While the advantages of AI are obvious, the disadvantages cannot be ignored. This review aims to highlight possible risks, dangers, and sources of error inherent in AI itself and its applications. Therefore, this paper seeks to address possible concerns and questions about AI in plastic surgery while offering a realistically neutral insight. Additionally, fundamental ethical and legal principles will be discussed, as well as possible “rules of the game” for the application and integration of AI in surgery. Innovations in this field are often hailed as miracles, making it crucial to evaluate them critically and objectively. Although progress in AI cannot and should not be halted, it is important to strengthen the trained approach and always look at the whole picture.