Plastic and Reconstructive Surgery at 75: Stronger, Better, and Always Changing

Field: Medicine (Health Sciences)

It is always wise to look ahead, but difficult to look further than you can see. —Winston Churchill As we celebrate the 75th year of our amazing journal, Plastic and Reconstructive Surgery (PRS), it is perhaps time to reflect on where we came from, who we are now, and where we are going. As the PRS Editor-in-Chief for the past 15 years along with my insightful and intrepid Co-Editor, Dr. James Stuzin, it has been my great privilege to lead a phenomenal team of plastic surgeons who constitute our editorial board, and an editorial office staff, led by Aaron Weinstein, that has no rival in medical publishing. I would also like to acknowledge the unwavering support of American Society of Plastic Surgeons leadership in encouraging the innovation and evolution that has made PRS the foremost global resource for information in plastic surgery. As 2021 marks my final year in serving as editor of this incredible journal and coincides with the milestone 75th anniversary of PRS, I feel it is appropriate to reflect on the evolution of PRS over the years to commemorate our great history and also set a course for the future of both PRS and all of plastic surgery (Fig. 1).Fig. 1.: The 75th anniversary of Plastic and Reconstructive Surgery. Continuously published by the American Society of Plastic Surgeons from 1946 to 2021 and beyond.CONSISTANCY OF LEADERSHIP: SIX EDITORS OVER 75 YEARS Plastic and Reconstructive Surgery boldly launched in 1946 when the American Society of Plastic and Reconstructive Surgeons had only 100 members (Fig. 2). The Society loosely formed in 1931 but formally organized as the American Society of Plastic and Reconstructive Surgeons in 1941.1 Three issues of the journal of PRS were published in 1946, with an emphasis on wartime and trauma injuries, cleft lip and palate treatment, and management of wounds. The inaugural editor of PRS was Warren Davis (1946 to 1947), who set our standard for editorial excellence; each of the subsequent five editors have left their personal imprint on the “White Journal” (Fig. 3).Fig. 2.: Volume 1, No. 1, July of 1946 issue of Plastic and Reconstructive Surgery. (Reprinted with permission from Goldwyn R. The early history of Plastic and Reconstructive Surgery. Plast Reconstr Surg. 2008;121:1489–1498.)Fig. 3.: The six historic Editors-in-Chief of Plastic and Reconstructive Surgery, from 1946 to 2020. (Above) Dr. Warren B. Davis (1946 to 1947), Dr. Robert H. Ivy (1947 to 1965), and Dr. Kathryn L. Stephenson (1965 to 1967). (Below) Dr. Frank McDowell (1968 to 1980), Dr. Robert M. Goldwyn (1979 to 2004), and Dr. Rod J. Rohrich (2005 to 2021). [Photographs of Davis, Ivy, and McDowell reprinted with permission from Goldwyn R. The early history of Plastic and Reconstructive Surgery. Plast Reconstr Surg. 2008;121:1489–1498; photograph of Stephenson reprinted with permission from Nagel GP. Kathryn Lyle Stephenson, M.D., 1912–1993. Plast Reconstr Surg. 1995;95:618; photograph of Goldwyn reprinted with permission from Haeck PC, Hait P. Into the twenty-first century: The history of the American Society of Plastic Surgeons from 1995 to 2006. Plast Reconstr Surg. 2006;118(Suppl):2S–31S; photograph of Dr. Rohrich courtesy of Rod J. Rohrich, M.D.]Over the next 20 years, Drs. Robert Ivy (1947 to 1965) and Kathryn Stephenson (1965 to 1967) continued to focus on cleft lip and palate, traumatic injuries, local flaps, and clarifying general reconstructive principles. Dr. Frank McDowell, who served as editor from 1967 to 1979, chronicled the rapid developments in myocutaneous flap surgery, breast reconstruction, and craniofacial surgery.2 As an aside, Dr. McDowell remained steadfast and explicit in his opinions—especially with regard to cosmetic surgery articles—and frequently amended “editor’s footnotes” to particular articles where he disagreed with the author. Peer review during this period began and ended with Dr. McDowell, who continued to broaden the spectrum of plastic surgery articles during his tenure. In 1979, Dr. Robert Goldwyn took over the reins of PRS and remained Editor-in-Chief for the next 25 years, through 2004. Dr. Goldwyn brought a collegial atmosphere to PRS, expanded the scope of the editorial board, and perhaps is most remembered for his incredible editorials, which were always beautifully written, insightful, and both humane and humorous. Under Dr. Goldwyn’s leadership, PRS was transformed to the modern impactful journal it is today, encompassing the wide breadth of focus, which is the hallmark of plastic surgery. PERSONAL REFLECTIONS: 25 YEARS WITH Plastic and Reconstructive Surgery I joined the PRS editorial board in 1995, followed by Jim Stuzin the next year. Although we had not known each other well, we quickly found that we shared an intense interest in peer-reviewed medical publishing, the Journal, and improving plastic surgery education. We have been on that same mission together for the past 25 years, and over that time, we have done our best to improve the quality and the delivery of educational content. In our attempt to deliver a better and ever-more-relevant PRS for our specialty and our readers, we journeyed onward, encountering unexpected challenges and struggles, working diligently with our publisher and American Society of Plastic Surgeons staff and colleagues, and ultimately achieved many lasting successes that most of today’s readers have come to expect. Color Photographs Under the guidance of Dr. Robert Goldwyn, our first mission was to colorize PRS. Plastic surgery is a visual specialty, and black-and-white photographs simply were not adequate. In 1995, authors had to pay a fee to publish photographs in color. Over the next decade (and after much discussion with our publisher), we gradually added more color to Plastic and Reconstructive Surgery, and when I became Plastic and Reconstructive Surgery Editor-in-Chief in 2005, we succeeded in offering our authors the opportunity to publish color photographs for free. Plastic and Reconstructive Surgery became a full-color journal, which truly revolutionized the way we were able to present and learn. Cosmetic Content Historically, PRS was replete with reconstructive advances but a bit light on cosmetic content. At our insistence, at the American Association of Plastic Surgeons meeting in Montreal in 1998, the editorial board met to discuss for the first time forming a subsection within PRS, fully devoted to cosmetic surgery. Some editorial board members were strongly against this, counter-proposing a new “Journal of Reconstructive Surgery.” Fortunately, the American Society of Plastic Surgeons president at the time, Dr. Paul Schnur, was quite prudent and saw the new horizons in cosmetic surgery and knew that it must remain within the scope of plastic surgery—especially within our Journal. Therefore, Dr. Schnur came to our PRS meeting and related that the managing committee of the American Society of Plastic Surgeons strongly desired a special section devoted to cosmetic surgery. He argued that an increasing number of plastic surgeons were performing cosmetic procedures and that a subsection of the Journal devoted to this important aspect of our specialty would serve all American Society of Plastic Surgeons members. Sectionalizing Plastic and Reconstructive Surgery Following the successful establishment of a Cosmetic subsection within the Journal, one of my first priorities on becoming Editor-in-Chief in 2005 was to continue sectionalizing the Journal. Dividing PRS into sections may now seem obvious, but change from the status quo does not always follow logic and is never easy. For Dr. Stuzin and myself, allowing our readers to quickly find the articles most relevant to their interests and practices was of paramount importance. With the support of our editorial board and American Society of Plastic Surgeons leadership, we were able to quickly overcome resistance to keep the Journal as it was, and completely reorganize the way PRS was read. I remember when my then-managing editor Dan Sullivan and I sat down with paint swatches from The Home Depot to pick the now-iconic hues that would make each color-coded section easy to find in the Journal. Suddenly the White Journal was made up of all the colors of the rainbow. Bringing the Peer-Review Process Online This major advance may also seem inevitable and easy in hindsight, but as I was taking over for Dr. Goldwyn, the peer-review process was still being conducted by means of multiple, mailed-in hard copies, CD-ROMs, and negatives. To send out a paper for peer review, we had to literally mail hard copies, a review form, and a return envelope to each reviewer. One round of peer review usually took more than 3½ months! Dr. Goldwyn had shipped from Boston to Dallas nearly 300 active and accepted articles in several large filing cabinets. With the publisher’s support—and with the hiring of additional staff including Angela Burch and Aaron Weinstein in 2004 and 2005, respectively, we set forth to wrap up any preexisting submissions in this old-school paper path. Simultaneously, we were learning, launching, and training on a new digital solution to peer review: Editorial Manager. I recall being told that cutting off paper submissions and transitioning to fully electronic peer review would immediately and irrevocably choke off submissions to PRS. During that first year using Editorial Manager (2004), we received just over 540 submissions electronically. Seeing these results, and noting that this was more than what he had received the previous year, Dr. Goldwyn told me that electronic submission was the right pathway for the future of PRS. In 2005, we received 2175 submissions. Through August of 2020 alone, PRS has already received more than 3000 submissions! Strategic Planning and the Transition from Print to Digital Publishing The first PRS strategic planning meeting in which we brought together our Editorial Board, American Society of Plastic Surgeons leadership, and our publisher, was held in 1999. It was at this meeting where we debated the need to establish a website for PRS to publish new articles online, archive past issues, and enable online searching of content. Again, change is never easy: there was great disagreement in terms of the timing and need to do this, in addition to concerns over cost and overhead. Nonetheless, PRS began publishing online in 1999 with articles initially archived back to 1996 (after years of hard work with our publishers, PRS in now fully archived back to 1946 and searchable online). During the ensuing years, online publishing and the accompanying digital media have become hallmarks of modern medical journals that have allowed PRS to maintain its global subscription readership. Fast-forward to today, and PRS is archived in over 2000 libraries around the world and is searchable through the OVID platform. PRS remains within the top tier of the 3500 medical journals searchable on OVID, and PRSJournal.com has grown to become a multiple–award-winning home not just to our current and archived issues, but to a robust video gallery, engaging podcasts, altmetrics, supplemental digital content, animations, content collections, and more. As of the most recent count, PRSJournal.com attracts more than 92,500 visitors every month. This engagement on OVID and PRSJournal.com stands as a testament to the success and relevance in transitioning from print to digital over the past 20 years. Our annual strategic planning meetings have continued since 1999 and have been at the heart of evolutionary (and sometimes revolutionary) change at PRS. The format and delivery of content, open access publishing, and expanding the reach of PRS to both plastic surgeons and the public through social media have all been initiatives conceived at our strategic planning meetings. Video Content One of the most difficult challenges we faced as I became Editor-in-Chief was adding streaming video to PRS. It was our feeling that, at its heart, plastic surgery is a clinical and technical specialty for which technique video is one of the key educational tools we wanted to deliver to our readers. There was simply no abounding technology available for easy video recording by surgeons nor ready video streaming in 2005. Remember, YouTube launched in 2005 and the iPhone did not debut until 2007. The major challenge noted by our publisher was that their electronic journals platform was used for over 300 journals and, at that time, PRS was the only journal demanding expanded ability to host video content. After many discussions, and with the help of thought leaders at our publisher, including Karen Abramson, PRS became the video beta test for all Lippincott, Williams & Wilkins medical journal publications. Over the next 13 years, PRS has continued to add thousands of videos to both cosmetic and reconstructive articles, in addition to the CME articles championed by our CME Editor, Dr. Donald Lalonde. The PRS-produced “Plastic Surgery Hot Topic Videos” (Fig. 4) series began primarily as a way to highlight content on the digital cover of each issue of the Journal on the now-defunct iPad app. The series evolved to meet multiple needs and has remained a prominent and popular part of the PRS homepage and social media channels. Our team has recorded, produced, and promoted 215 videos (and counting) over the years. These video shoots evolved from Dan and Aaron walking over to my academic office during lunch with cue cards, video camera, and tripod in tow, to monthly 6 am video shoots in our professionally lit, green screen video production studio with Aaron and Maddy Ramos. It has been my pleasure to shine the spotlight on hundreds of articles in PRS through this series of videos.Fig. 4.: Plastic Surgery Hot Topic Videos, established in April of 2011 (see http://bit.ly/PSHotTopicVideos).To broaden the discussion of plastic surgery research topics into other spheres within our own community and beyond, we also solicit, coordinate, edit, and produce with each issue of PRS a Video Discussion (Fig. 5), in which a plastic surgeon or area expert is asked to discuss a hand-selected article, adding context, counterpoint, and analysis. Each video serves as expert commentary not only for our readers, but for members of the general public by means of social media. We have asked more than 125 of our colleagues around the world to discuss almost 140 papers to date, and we are proud to use this visual medium to add to the dialogue around PRS articles.Fig. 5.: PRS Video Discussions, established in March of 2011 (see http://bit.ly/PRSVideoDiscussions).One of our most popular video projects has been the publication of standalone edited surgery videos from the Baker Gordon Symposium on Cosmetic Surgery, allowing our readers access to observe the techniques of masters in cosmetic surgery. These Baker Gordon videos remain the most-watched of our collection and account for between 10 and 15 percent of page views on our online platform, attesting to the continuing interest in cosmetic surgery and the power of video to deliver educational content. Highlights Since 2005, we have been hard at work striving to help PRS continue to evolve and transform to meet the needs of our specialty, our readers, and our authors. With the efforts, dedication, creativity, hard work, brilliance, and amazing teamwork of our American Society of Plastic Surgeons staff (including Aaron Weinstein, I. Donnell Moore, Angela Burch, Ed Tynan, Christina Carson, Darienne Dickey, Maddy Ramos, and Mike Stokes), our publishing partners (including Tom Pacific, Liz Durzy, Jeda Taylor, Michelle Rothenberg, Adam Nicely, David Penyak, and more), and you—our Editorial Board, reviewers, readers, and writers—we have been able to continually make PRS a journal that is as innovative as the field it represents, and one of which all plastic surgeons can be proud. Some of the more recent “highlights” that have transformed and defined PRS are discussed below. The list is far from complete; this is simply the “launch” editorial for a year-long series of editorials exploring each section of the Journal and some of the topics below in more detail. CME We vastly expanded the CME program for the Journal, using the American Society of Plastic Surgeons Education Network to allow for robust testing modules to accompany each PRS article. Since 2005, we have published over 200 outstanding CME articles and tests (in addition to a series of Maintenance of Certification articles and tests from 2010 to 2018). As the initiatives grew, so too did the standard of presentation, calling for the highest quality figures, videos, and test questions to support this program. This is no small part thanks to staff, including I. Donnell Moore, and our long-serving CME Editor, Dr. Lalonde. Supplements PRS began publishing standalone themed issues in 2003, with our very successful supplement introducing Botox as a neuromodulator. That issue was translated into Spanish and reprinted in 2004, which really began a golden age of peer-reviewed, sponsored supplements. These special issues have taken our readers on deep dives into wound healing, facial soft-tissue fillers, pain management, abdominal wall reconstruction, and breast implant-associated anaplastic large cell lymphoma. Coordinated by staff including Aaron and Christina Carson, and shepherded from start to finish by a series of fantastic guest editors including Drs. Jeff Janis, Allen Gabriel, Edward I. Chang, Amy Colwell, Maurice Nahabedian, and more, our supplemental issues have truly provided readers with laser-focused insights into some of the most important topics facing our field. Evidence Over the course of many summits and meetings in 2010 and 2011, we led a specialty-wide embrace of the concept of evidence-based medicine and implemented independent grading and presentation of levels of evidence in each article. Drs. Kevin Chung and Felmont Eaves, and Dan Sullivan were pivotal in this initiative3,4 (Fig. 6).Fig. 6.: The level-of-evidence pyramid.Outcomes In early 2009, under the guidance of Dr. Chung, PRS started labeling and promoting “Outcomes Articles” to highlight articles that used validated instruments, rigorous methodologic design, and evaluation of bias and quality-assessment tools. In 2018, Dr. Samuel J. Lin led the initiative to expand the PRS Outcomes assessment to four distinct subdomains: Prevention, Quality of Care, Patient-Reported Health, and (Fig. Outcomes articles in PRS, established in (see We started with our account in April of with the of peer-reviewed information plastic and reconstructive surgery in the social media PRS have grown to and with videos, animations, and The has remained the as many as around the content of the Journal. to team members as and surgeons who shared my personal interest in social media as Drs. and as a to help the public on the and of plastic the Journal was the With over the major social media we are to continue the With the March of 2011 issue of PRS, we began publishing from articles on the cover of PRS. The has continued to this and, it is still known as the “White we are to highlight on its This has the for all to PRS. 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