Perceptions about plastic surgery are a topical source of discussion. As a group of reconstructive surgeons who also practice aesthetic surgery, we are entering a period where we are trying to change public and peer perceptions of aesthetic surgery.1, 2, 3, 4 The accessibility of cosmetic surgery, the emergence of cosmetic ‘tourism’ and the decline of aesthetic procedures from the NHS have left us needing to define to those around us, peers, stakeholders and the public, what it is exactly that we do.5, 6, 7, 8, 9 The recent collaboration between BAPRAS and Forster highlights the significance we place on how we are perceived.10 Plastic surgery is fascinating for us as surgeons but equally it would appear fascinating to others for what we might consider to be the ‘wrong’ reasons.11 Cosmetic surgery and the world of ‘nip and tuck’ is an exaggerated aspect of the speciality but undisputedly is the side which most people are familiar and feel comfortable with. The reconstructive aspect, the side that gets most of us out of bed in the morning, it would appear, is easily forgotten or overlooked. For many patients reconstructive and aesthetic surgery go hand in hand, and we know that restoration of both form and function are usually the goals of our work. As Laing and Sachedina succinctly pointed out in a recent editorial
“we are undergoing a ‘makeover’ that is helping to change the mindset of peers, stakeholders and members of the public”.
An initial step to embrace the aesthetic sphere of the speciality saw the name change of this journal's host organisation from the British Association of Plastic Surgeons (BAPS) to the British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS).
With the demonstration of greater ownership of aesthetic surgery we wanted to assess the impact of this upon aesthetic publications in the most widely read plastic surgical literature. In other words, was the raised profile of aesthetic surgery by the body of plastic surgeons reflected in the literature through increased publication and academic activity. To investigate this, we undertook a study of publications in the three most widely read plastic surgical journals between 2003 and2007. Whereas previously there may have been professional ‘embarrassment’ in associating our work in any way with the ‘nip tuck’ we hypothesised that the shift in perceptions that has been taking place and the move towards embracing the aesthetic would result in increased aesthetic publications.
We defined aesthetic articles as those relating to the aspects of plastic surgical procedures, research or other studies that were devoted to the enhancement of appearance. We undertook an analysis of this journal, Annals of Plastic Surgery and Plastic and Reconstructive Surgery. In order to be included in this study the articles had to be an original aesthetic publication. All included articles were summarised and analysed to provide information on the following categories: The anatomical region of the study; the nationality of authors (Only the nationality of the first author was considered) and the type of institution (hospital, university hospital or private practice). Using this method, nine thousand four hundred and forty four articles were reviewed and six hundred and ninety nine articles fell within our definition of aesthetic surgery.
Our results from this showed that JPRAS devoted 8.2% of the total number of publications to aesthetic publications, followed by PRS (6.2%). The Annals of Plastic surgery had 9.2% of its publications dedicated to aesthetic surgery. Within JPRAS, the number of aesthetic publications prior to 2005 had been consistently falling. In 2005 this was corrected and has subsequently increased year after year (Figure 1).
Across all three journals over the five-year study period two hundred and nine articles (33%) related to aesthetic procedures on the face (rhytidectomy being the most frequently published subject in this group), closely followed by breast (28%, n
=197) (Figure 2).
One hundred and forty-one articles were from private institutions (20%). With respect to nationality most of the articles came from the United States (n=316) and Europe (n=197); Within Asia (n=114), Turkey (n=27) and Korea (n=33) were the countries with the most published articles (Table 1). Interestingly, Brazil, with its renowned reputation for aesthetic surgery only had nineteen publications. However, we did not review South American literature which may have considerably more.
Prior to this study we suspected that our desire to embrace and promote aesthetic surgery in a professional light would lead to an increase in aesthetic publications. We are pleased to report that this appears to be the case.
Historically and culturally there is a perception that status is associated with the demonstration of ‘science’ and not the more intangible characteristics of art, including ‘beauty.’ This isn't simply a historical point, but indeed is an attitude that is pervasive today. A simple example of how this pervades our thinking is the ‘Impact Factor’ attached to medical journals and the status that goes with being published in Nature Medicine (Impact factor 26 584) or the Lancet.12, 13, 14 Historically, attitudes oscillated between a self-consciously ‘medical’ model, which does not acknowledge ‘beauty’ as one of it's goals, to a competing model of aesthetic surgery, in which creation of a beautiful face and body is asserted as a legitimate medical goal. Those of us who know better, realise that reconstruction and aesthetic surgery, the ‘science’ and the ‘art’ are not in competition but more often than not walk hand in hand towards the goal of restoration of form and function.
Perhaps because of these oscillating attitudes towards aesthetic surgery, subconscious or otherwise, and a certain amount of professional bashfulness to be associated with anything perceived to be vaguely frivolous, we may have allowed the culture of the lunch-time facelift and BOTOX party to be promoted by less ethical and financially driven organisations. It is only through maintaining a raised profile of our involvement in aesthetic surgery that a robust framework of professional standards, built upon expertise and most of all, responsibility to our patients can be built upon. May this continue.
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