As cosmetic surgery becomes more mainstream in patient population, practitioners of cosmetic procedures are becoming increasingly diverse in background, level of training, and practices. Despite its elective nature, cosmetic surgery entails invasive procedures with morbidity or even on rare occasion the unfortunate mortality, and the need for objective evidence-based therapies and a defined fund of knowledge and expertise is critical to both patient safety and to preservation of a reputable professional identity for physician providers of aesthetic treatments and surgeries. Plastic surgeons bring the most comprehensive level of training and skills to the cosmetic patient in comparison to other avenues of training and therefore hold a unique responsibility and capability in contributing scientific research on procedures and materials used in cosmetic procedures. A review of the current literature in the primary specialty journal of plastic surgeons, Plastic and Reconstructive Surgery (PRS), was performed to determine the level of scientific data available to the practicing plastic surgeon with respect to cosmetic procedures.

METHODS:

A literature review of all articles published under the “Cosmetics: Original Article” section of PRS over a one-year period covering the current year (Oct 2006-Sept 2007), 5 years ago (Oct 2002-Sept 2003), and 10 years ago (Oct 1996-Sept 1997) was performed. Articles were evaluated for study type, study subjects, statistical power and analysis, and use of control or comparison groups. Case reports, communications, and innovations and ideas articles were excluded from the analysis.

RESULTS:

There were 60 original cosmetics articles from 2006-07, 51 from 2002-03, and 48 from 1996-97. For these same periods respectively, the average number of original cosmetics articles was 5/month, 4.25/month, and 4/month. The percentage of articles that were retrospective in design was 63%, 69% and 50% of the articles for each period, while 15%, 18%, and 27% were studies utilizing basic science or anatomic study designs. Only 22%, 6%, and 29% of the articles for each of the respective time periods included comparison or control groups.

CONCLUSIONS:

A majority of the original cosmetics articles published in the cosmetic literature of PRS are retrospective reviews of clinical experience without control or comparison groups. Studies that utilize prospective analysis are a minority. Regardless of whether a retrospective or prospective study design is used, the inclusion of control or comparison groups is low. The percentage of studies applying basic science or anatomical study designs to topics relevant to cosmetic surgery has declined by 44% in the last decade. Clinical phase trials are rare; only one was seen in this analysis, although interestingly, this study was published in the most recent time period and represents an area likely to be one focus of scientific investigation in the future. This review of the PRS cosmetics literature demonstrates a growing number of cosmetics articles, with a need for more prospective analyses, more basic science investigations, inclusion of comparison and control groups, and identification of outcomes measures and tools.