Quality of clinical studies in aesthetic surgery journals: a 10-year review

Evidence-based medicine (EBM) has earned increasing attention in all fields of medicine. However, the implementation of EBM is not yet universal, especially in surgery and its subspecialties. A critical assessment of the quality of scientific evidence in the aesthetic surgery literature is needed to promote the practice of EBM.

This study seeks to evaluate the research designs of aesthetic surgery studies published in 3 leading plastic surgery journals during the past 10 years.

All studies published in Plastic and Reconstructive Surgery, Annals of Plastic Surgery, and Aesthetic Surgery Journal between January 1, 1998 and December 31, 2007 were reviewed. Articles pertaining to aesthetic surgery were tabulated according to their study design into the following groups: randomized, controlled trials; prospective cohort studies; retrospective cohort studies; and "others" (case series, case reports, expert opinions, and noncritical reviews).

Of the 1419 manuscripts included in the study, 45 papers (3.2%) were classified as randomized controlled trials. Sixty studies (4.2%) were prospective cohort studies. Ninety papers (6.3%) were retrospective cohort studies. The remaining 1224 articles (86.3%) were case series, case reports, reviews, or expert opinions. The percentage of research representing levels 1 and 2 evidence increased from the first to the second half of the decade (from 10.1% to 16.8%).

Aesthetic surgery literature is inundated with uncontrolled case series, case reports, and expert opinions. Continued efforts are needed to provide scientifically rigorous data on which to base clinical practice in aesthetic surgery.