Plastic surgery and generation Z: A view from within

The Level of Evidence Pyramid: Indicating Levels of Evidence in Plastic and Reconstructive Surgery Articles

CONSORT

James Stanislaus Calnan

Perspective: committed to excellence.

Professional advancement in academic plastic surgery may depend on scholarly activity. The authors evaluate gender-based publishing characteristics in three international plastic surgery journals. A retrospective review of all articles published in 2016 in the following journals was undertaken: Plastic and Reconstructive Surgery, Journal of Plastic, Reconstructive and Aesthetic Surgery, European Journal of Plastic Surgery, Annals of Surgery, and New England Journal of Medicine. Data were collected on lead author gender (first or senior author) and differences in author gender proportions, by journal, by article topic, and by geographic location were evaluated. Overall, 2610 articles were retrieved: 34.1 percent were from plastic surgery journals, 12.8 percent were from the Annals of Surgery, and 53.1 percent were from the New England Journal of Medicine. There was a lower proportion of female lead authors among plastic surgery journals compared with the Annals of Surgery and the New England Journal of Medicine (31 percent versus 39 percent versus 39 percent; p = 0.001). There were no differences in female lead author geographic location in the Annals of Surgery or the New England Journal of Medicine; within the plastic surgery journals, there were differences (p = 0.005), including a lower proportion arising from East Asia (15 percent) and a higher proportion arising from Canada (48 percent). Within plastic surgery, Plastic and Reconstructive Surgery had the lowest proportion of female lead author (p < 0.001). The proportion of female lead author varied by article topic (p < 0.001) and was notably higher in breast (45.6 percent) and lower in head and neck/craniofacial-orientated articles (25.0 percent). There are gender disparities in three mainstream plastic surgery journals-Plastic and Reconstructive Surgery, the Journal of Plastic, Reconstructive and Aesthetic Surgery, the European Journal of Plastic Surgery-and there are lower proportions of lead female authorship compared with the Annals of Surgery and the New England Journal of Medicine. Further research should focus on understanding any geographic disparities that may exist.

Plastic Surgery in the Press

Plastic Surgeonsʼ Performance during the February 27 Earthquake in Chile

PURPOSE: Virtual and interactive learning are the future of plastic surgery education.1 This shift is essential in the COVID-19 era, as medical students have been displaced from clinical rotations into virtual classrooms resulting in losses of traditional opportunities to learn about plastic and reconstructive surgery. The impact of this pandemic is far-reaching and may adversely influence interest in surgical specialties, diversity in anatomic knowledge, and hands-on surgical experience. We aimed to provide medical students worldwide with a virtual educational opportunity and developed the Plastic and Reconstructive Surgery Virtual Curriculum (PRSVC), a structured, four-week, flipped classroom course with virtual clinical case discussions and surgical skills workshops. Additional programming was available for medical students applying to or considering applying into plastic surgery residency programs to socialize with each other and build community. METHODS: We designed and implemented a structured, four-week educational curriculum, which included curated learning modules that covered main topics within plastic surgery. Students were provided daily assignments from the American Society of Plastic Surgeons Resident Education Curriculum and DeckerMed Plastic Surgery Core Curriculum, which were available to all enrolled participants free of charge. As an adjunct to the educational coursework, students had opportunities to participate in biweekly, small group virtual flipped classroom case discussions and weekly surgical skills workshops. Pre- and postcourse surveys were administered and analyzed using SPSS. RESULTS: In total, 303 medical students and recent graduates (43.4% fourth-years) from 18 countries enrolled in the course in June 2020. An estimated 182 students completed the precourse survey (60% response rate), and of those, 50.0% (n = 91) completed the postcourse survey for paired comparison. About two-thirds were medical students in the United States and the remaining one-third of students were from Canada and other international countries. Over one-third did not have home plastic surgery programs, and almost half of the participants reported having an educational experience scheduled for June 2020 cancelled due to the COVID-19 pandemic. Students reported significant improvement in confidence discussing the relevant anatomy, work-up, and surgical approaches to clinical cases, as well as confidence in knowledge of all topic areas (P < 0.001). Confidence in suturing and knot-tying techniques significantly improved among workshop participants (P < 0.001). Students applying to residency programs this cycle felt significantly more prepared for sub-internships (P < 0.001) and significantly more connected to the community of applicants (P < 0.001). CONCLUSIONS: The Plastic and Reconstructive Surgery Virtual Curriculum improved knowledge, surgical skills, and community in the field among medical student participants. This course may serve to inform other surgical subspecialties in developing similar virtual educational opportunities and also serve to provide a paradigm for structured virtual learning activities for students interested in plastic surgery. REFERENCE: 1. Ali K, Colchado D, Davis MJ, et al. Online resources in plastic surgery education: a toolbox for modern trainees and plastic surgeons. Plast Reconstr Surg Glob Open. 2020;8(7):e2894. Published 2020 Jul 17. doi:10.1097/GOX.0000000000002894

Integrating artificial intelligence (AI) in cosmetic surgery presents both transformative opportunities and significant challenges. From preoperative planning to postoperative care, AI offers tools that enhance precision, efficiency, and personalization. However, concerns such as algorithmic bias, ethical implications, and the potential depersonalization of patient care must be carefully considered. This article explores AI’s impact on cosmetic surgery, addressing its benefits, risks, and ethical considerations while proposing solutions on evidence-based strategies for safe and effective AI integration into clinical practice. By evaluating AI-driven advancements in patient education, treatment planning, and postoperative management, we aim to equip surgeons with actionable insights for navigating the future of our field. To fully realize AI’s potential in aesthetic and cosmetic surgery, it is essential to approach its integration through a structured framework that balances innovation with responsibility. This includes identifying key risk areas, implementing mitigation strategies, and outlining best practices for clinical adoption. The following sections are organized around major challenges—such as bias, ethical concerns, and depersonalization—and we aim to offer specific solutions to guide surgeons in applying AI thoughtfully and safely within their own practices. A combination of keywords related to “cosmetic surgery” and “artificial intelligence,” such as “AI trends,” “AI risks,” and “AI in surgery,” was used for a literature search across PubMed and Web of Science. The search was focused on published articles in English, in the past 10 years, to point out the recent trends and risks arising due to the use of AI in cosmetic plastic surgery. The search showed a long list of potential risks and complications associated with the use of AI when not applied carefully. On the contrary, the search also showed its versatility and colossal potential in transforming the field of cosmetic plastic surgery. While AI offers promising advancements in cosmetic plastic surgery, it is essential to navigate its integration carefully. By addressing issues such as potential biases, ethical concerns, and the risk of depersonalization, the field can leverage AI to enhance patient care and outcomes. The future of facial cosmetic plastic surgery with AI holds great potential, but it must be grounded in principles that prioritize patient safety, inclusivity, and the preservation of the human touch.

So You Want to Be an Innovator?

Coronavirus disease of 2019 (COVID-19) has spread rapidly throughout the world, and the impact on global and national health care, including plastic surgery, has been dramatic and unpredictable. Plastic surgery departments and divisions went into limbo after the American College of Surgeons, American Society of Plastic Surgeons, and The Aesthetic Society, advised that elective and nonessential cases be canceled.1 All large plastic surgery meetings were canceled. Aspiring plastic surgeon trainees are among those affected by the pandemic; the Association of American Medical Colleges called for a halt in all clinical rotations of at least 4 weeks' duration in the 2020/2021 application cycle, a critical time for fourth-year medical students applying to integrated plastic surgery programs.2 Medical students typically dedicate April to September rotating as subinterns on the plastic surgery service at their home institution and at several "away institutions" throughout the United States. Away rotations play a significant role in the plastic and reconstructive surgery match process; 67 percent of successful applicants in a given year participated in a rotation at the institution they matched into.3 Students also attend national meetings for the opportunity to present their research, meet renowned faculty members across the country, and receive feedback on their application and performance. Often faculty, residents, and students at such events become lifelong colleagues and mentors.4,5 These opportunities are now no longer available for students applying in the current COVID-19 pandemic. Plastic surgery residency applicants applying in the 2020/2021 cycle era are facing the daunting unknown with more limited opportunities for meeting influential individuals in the field. Students at institutions that do not have a plastic surgery home program may be affected the most. Consequently, mentorship of future trainees is arguably more important than ever, as it provides prospective applicants with a unique opportunity to connect students with faculty across the country to discuss research and personal career development and to expand one's network of mentors and colleagues. In 2015, the Plastic Surgery Research Council established a formal mentorship program with the goal of facilitating relationships between trainees and senior figures and of fostering unique guidance regarding career development. Medical student members and plastic surgery applicants can be paired with mentors across the nation from diverse backgrounds, and mentors can provide invaluable advice electronically regarding research endeavors and residency applications. With the current restrictions imposed by the evolving COVID-19 pandemic, electronic mentee-mentor interactions may be the only chance that prospective plastic surgery residents have to appreciate and converse with faculty and residents from different institutions, We thus want to emphasize the value of mentorship relationships and formal mentorship programs such as that offered by the Plastic Surgery Research Council. It is critically important to connect medical students/trainees with faculty members to help them learn the nuances of plastic surgery programs in institutions across the nation. Reaching beyond the classroom and expanding our horizons can help us confront the realities we could not have anticipated. DISCLOSURE The authors have no potential conflicts of interest to disclose.

Research productivity is commonly used as an objective metric for applicant differentiation in the integrated plastic and reconstructive surgery match process. Few studies have examined the content, timing, and predictive value of peer-reviewed research output among matched plastic and reconstructive surgery applicants. In this cross-sectional study, first-year residents matched into integrated plastic surgery programs during the 2024-2025 cycle were identified. Research metrics were collected from PubMed, Google Scholar, and ResearchGate, and subspecialty focus and journal characteristics were categorized for all publications. Statistical analyses included Spearman correlation, Mann-Whitney U tests, and a multivariable logistic regression to identify independent predictors of matching at a top 20 Doximity-ranked program. Among 224 matched applicants, the median total publication count was 10 (IQR: 5-18), with 6 plastic surgery-specific publications (IQR: 2-12), 3 first-author publications (IQR: 1-5), and an H-index of 5 (IQR: 3-6). Most applicants had their first plastic surgery publication one year prior to the match (IQR: 0-2). General plastic surgery (67.4%) and education/nonclinical (50%) topics were the most represented subspecialties among applicants' research. Publications in craniofacial surgery (42.9%), microsurgery (29%), aesthetics (25%), gender-affirming surgery (17.9%), hand surgery (17.4%), peripheral nerve surgery (11.2%), and burn surgery (9.4%) were less common among applicants. Applicants most frequently published in Plastic and Reconstructive Surgery Global Open (240 publications), Annals of Plastic Surgery (213 publications), and the Journal of Craniofacial Surgery (196 publications). In multivariable analysis, no individual research metric independently predicted matching at a top 20 program, though the overall model demonstrated fair discriminative ability (AUC = 0.731). Among matched plastic surgery applicants in the most recent 2024-2025 application cycle, research productivity was high with a wide variety of subspecialty interest.

Where is Archives of Plastic Surgery Now? And Where is It Heading?

"Background: Robotic surgery currently offers a number of benefits in specific areas of plastic and reconstructive surgery such as head and neck and microsurgery, however, many subspecialties are yet to benefit from robotic operating techniques. In this paper we review recent developments in the use of robotics for head and neck, breast reconstruction, microneural, lymphoedema, craniofacial and aesthetic surgery. Methods: A literature review of English-only articles on the use of robots in plastic and reconstructive surgery was conducted using the PubMed and Web of Science databases along with a free text search using the terms ‘robotic surgery plastic surgery’, ‘robotic-assisted plastic surgery’, ‘robot-assisted reconstructive surgery’, ‘da Vinci plastic surgery’, ‘da Vinci reconstructive surgery’ and ‘supermicrosurgery’. No limitation was placed on time from publication. Results: Of the studies reviewed, the most beneficial to reconstructive surgery is the area of the head and neck, with the most common procedures being transoral surgeries and microvascular procedures. Robotic assisted breast reconstructive surgery is a promising field. The main current limitations are the lack of adequate microsurgical instrumentation and the prolonged setting-up and operative time. Conclusion: As technology improves the outlook for robotic surgery is optimistic. Areas like microsurgery, head and neck, cleft palate, breast reconstructive surgery, lymphatic and microneural surgery already demonstrate promising results. Further technological advances and evidence-based studies are necessary to address current limitations such as appropriate microsurgical instrumentation, high costs and prolonged operative time."

The Belgian Society of Plastic Surgery was founded in 1955. The five founding members were Dr. M. Coelst, Dr. A. de Coninck, Dr. J. Polus, Dr. A. Fardeau and Dr. C. Steenebruggen. Dr. Maurice Coelst was the initiator and first president, and later became the first honorary member. The purpose of the Society was the scientific study of plastic surgery and related specialties, and the organization of congresses and conferences to promote the development of plastic surgery. From a very small group of five members, the Society has grown to a considerable size: 80 full members, 20 associated members and 75 candidate members. The Society also counts 12 honorary members and 16 foreign members. Full members are officially-certified Belgian and Luxembourg plastic surgeons who limit their activities to the domain of plastic, reconstructive and aesthetic surgery and who have made significant scientific contributions to the activities of the Society. These activities have grown from informal evening meetings in the 1950’s to presently two full-day congresses every year, during which communications of high scientific standard are presented and discussed. Because of the expansion of plastic surgery, the name of the Society has been changed into ‘‘Belgian Society of Plastic, Reconstructive and Aesthetic Surgery’’ and comprises subchapters for the study of burns, microsurgery and aesthetic surgery. The Society sponsors a two-yearly prize, which is attributed to a personal scientific study of exceptionally high standards by a Belgian or Luxembourg plastic surgeon or trainee. The Society also sponsors the activities of the Collegium Chirurgicum Plasticum Belgicum. This Collegium organizes teaching days and yearly examinations for all plastic surgery trainees on a national scale. Successfully passing these evaluations has become a prerequisite for obtaining certification as a specialist in plastic, reconstructive and aesthetic surgery. Together with a training of 6 years: 2 years of basic general surgery and 4 years of plastic surgery in one of the seven certified training centers in Belgium and Luxembourg,this system ensures a very high standard of specialization in plastic surgery. Many members participate very actively in many scientific societies in Belgium and abroad. The Belgian participation in EURAPS is very strong, and the prize for the best presentation has been awarded to Belgian plastic surgeons several times. The Society has a close relationship with its Dutch sister Society. Every 2 years a joint meeting is held, alternately in Belgium and in The Netherlands. In 2005 the Belgian Society of Plastic, Reconstructive and Aesthetic Surgery will celebrate its 50th anniversary with a 2-day Congress in Brussels on May 6 and 7. On the occasion of the Congress, a commemorative book will be published highlighting and illustrating the history of the Society. Finally, the Society is very grateful to Ian Jackson for allowing its members to fill an entire issue of the European Journal of Plastic Surgery.