Background: There has been a recent shift towards evidence-based medicine in the medical and surgical literature. Objective: To determine the level of evidence of published plastic surgery articles. Methods: Online review of four major plastic surgery journal publications [1. Plastic and Reconstructive Surgery Journal (PRS); 2. Annals of Plastic Surgery (Annals); 3. Journal of Plastic, Reconstructive, and Aesthetic Surgery (JPRAS); 4. American Journal of Aesthetic Surgery (Aesthetic)] from January 1st to December 31st 2007. Results: Of the 1759 articles reviewed, 725 (41%) were included (animal studies, cadaver studies, basic science studies, review articles, instructional course lectures, and correspondence were excluded). The articles were ranked according to their level [Level-I (highest evidence, eg. randomized-controlled trials) to Level IV (lowest evidence, eg. case reports)]. The average level of evidence in each journal was: PRS (3.04), Aesthetic (3.11), JPRAS (3.14), and Annals (3.31). The evidence differed significantly between journals (p<0.05) except when JPRAS was compared to the Aesthetic Journal. Only 2.2% of articles were Level I evidence. Conclusions: The average level of evidence in 4 major plastic surgery journals was 3.15 (Level III). In order for the plastic surgery profession to become a participant in higher level of evidence-based medicine, greater emphasis must be placed on prospective randomized blinded trials.