Field Of Plastic Surgery Research Articles

Generation Z in Plastic Surgery: Challenges, Solutions and New Horizons - A European and transatlantic overview.

The entrance of Generation Z (born 1997-2012) into professional life, including the practice of medicine, marks a transformational shift in priorities and values. This generation, shaped by digital immersion and a strong focus on work-life balance, is redefining the landscape of Plastic Surgery. Their preferences for inclusivity, innovation, and structured working hours challenge traditional models of mentorship, patient care, and surgical training. The aim of this survey was to explore the impact of Generation Z on the field of Plastic Surgery through insights offered by leaders of major Plastic Surgery societies in Europe and the United States, who together provide a comprehensive perspective on generational change and its implications for clinical practice, education, and healthcare systems in Plastic Surgery. In October 2024 eight leaders of national Plastic Surgery societies and associations were invited to complete a structured questionnaire with five open-ended questions. They provided detailed responses on challenges, opportunities, and structural changes needed to address Generation Z's influence. Key findings highlight a generational shift in the approach to professional life, with an emphasis on digital innovation, work-life balance, and the interaction with social media. Respondents noted an increased interest in aesthetic over reconstructive surgery and a preference for private practice among younger surgeons, raising concerns about workforce shortages in public healthcare. Advances in digital learning and simulation-based training were identified as opportunities to facilitate medical education. However, the ethical challenges of misinformation on social media and a decline in hierarchical mentorship were emphasized as critical concerns. Despite generational tensions, the integration of Generation Z's strengths in technology and advocacy for systemic reform holds promise for addressing burnout and enhancing healthcare delivery. The arrival of Generation Z in Plastic Surgery represents a possible pivotal moment to reimagine traditional models of surgical education, patient care, and professional priorities. Collaboration between generations and proactive adaptation to these changes is an imperative to ensure a dynamic, inclusive, and sustainable future for the specialty.

Mid-face Morphometrics and Sexual Dimorphism

This study investigates mid-face morphometrics and sexual dimorphism in a Yoruba population from southwestern Nigeria. A total of 300 participants (112 males, 188 females) aged 16-55 years were examined. Nine mid-facial measurements were taken using standardized anthropometric techniques. Independent samples t-tests revealed significant sexual dimorphism in most variables, with males generally exhibiting larger dimensions. However, nasal height and upper facial height showed no significant differences between sexes. A discriminant function analysis (DFA) was performed to assess the potential for sex determination using these measurements. The DFA model achieved a classification accuracy of 75.3%, with five key variables (left ear width, facial width, nasal width, right ear width, and nasal height) identified as significant discriminators. This accuracy is comparable to similar studies in other populations, suggesting the model's potential utility in forensic applications. The study provides valuable population-specific data on mid-face morphometrics for the Yoruba ethnic group, contributing to the fields of forensic anthropology, plastic surgery, and biometrics. The findings highlight the importance of considering population-specific variations in facial morphology and offer a foundation for future research in facial anthropometry and its applications.

What about the donor site morbidity - how invasive is the free latissimus dorsi flap?

The free latissimus dorsi muscle (LDM) flap represents a workhorse procedure in the field of trauma and plastic surgery. However, only a small number of studies have examined this large group of patients with regard to the morbidity of flap harvest. The aim of this prospective study was therefore to objectively investigate the morbidity of a free LDM flap. A control group (n = 100) without surgery was recruited to assess the differences in strength and range of motion (ROM) in the shoulder joint with regard to handedness of patients. Additionally, in 40 patients with free LDM flap surgery, these parameters were assessed in an identical manner. We measured higher values for all parameters assessing force in the shoulder joint on the dominant side of patients in the control group. Moreover, LDM flap harvest caused a significant reduction in strength in the glenohumeral joint in all functions of the LDM that were assessed, ranging from 9.0% to 13.8%. Equally, we found a significantly reduced ROM in the shoulder at the side of the flap harvest. For both parameters, this effect was diminished, when the flap harvest took place on the dominant side of the patient. LDM flap surgery leads to a significant impairment of the strength and ROM in the shoulder joint. Moreover, the donor morbidity must be differentiated with regard to handedness: harvest on the non-dominant side potentiates the already existing difference in strength and ROM. Conversely, if the harvest takes place on the dominant side of the patient, this difference is diminished.

Acellular dermal matrices in reconstructive surgery; history, current implications and future perspectives for surgeons.

Large-scale defects of body in the reconstructive surgical practice, and the helplessness of their repair with autologous tissues, have been an important factor in the development of artificial biological products for the temporary, definitive, or staged repair of these defects. A major advance in the field of plastic and other reconstructive surgery in this regard has been the introduction and successful use of acellular dermal matrices (ADMs). In recent years, not only the type of tissue from which ADMs are produced, product range, diversity and areas of use have increased, but their use in reconstructive fields, especially in post oncologic breast surgery, has become highly regarded and this has favored ADMs to be a potential cornerstone in specific and well-defined surgical fields in future. It is essential that reconstructive surgeons become familiar with some of the ADM's as well as the advantages and limitations to their use. This review not only provides basic science and clinical evidence of the current use of ADMs in wide range of surgical fields but also targets to keep them as an important backdrop in the armamentarium of reconstructive surgeons. Brief considerations of possible future directions for ADMs are also conducted in the end.

Epidemiology and Characteristics of Plastic Surgery Cases in Simpang Lima Gumul General Hospital, Kediri Regency During Covid-19 Pandemic

Backgrounds: Chinese Government found the first case of coronavirus disease 2019 (COVID-19) in Wuhan, China, in December 2019. The pandemic impacts the number of visits to plastic surgery clinics in many countries such as Italy and the United States following surgical limitations. This study was aimed to determine the impact of the pandemic on the field of Reconstructive and Aesthetic Plastic Surgery in Indonesia, particularly in Kediri Regency, East Java.Methods: The study design was an analytical cross-sectional study, using data obtained from the medical records of plastic surgery patients at SLG General Hospital in Kediri Regency. The data analysis included descriptive analysis and dummy regression analysis.Results: This study included a total of 29 observations, 14 before the pandemic era and 15 during the pandemic, with a total of 460 individuals from various diagnostic categories. Based on the findings, the number of patients diagnosed with Congenital Disorders, Skin, and Soft Tissue, and Aesthetic Surgery dropped by 7%, 2%, and 6%, respectively. Meanwhile, there was an increased number of patients with Maxillofacial, Burn and Wound Care, and Hand and Microsurgery by 5%, 4%, and 1%, respectively. Conclusions: The average number of patient visits for the Skin and Soft Tissue, Burn and Wound Care, and Hand and Microsurgery categories did not vary much during this pandemic.

Hands-On Robotic Microsurgery: Robotic-Assisted Free Flap Reconstruction of the Upper Extremity.

Background/Objectives: Robot-assisted microsurgery (RAMS) has been introduced into the field of plastic surgery in recent years. It potentially offers enhanced precision and control compared to traditional methods, which is crucial for complex microvascular tasks in free flap reconstructions. We aim to analyze our experiences with robotic-assisted microsurgery in the field of upper extremity free flap reconstruction. Methods: This prospective study evaluated the efficacy and safety of the Symani Surgical System for free flap reconstructions in 16 patients with upper extremity defects at our institution from February 2023 to March 2024. Operating times were compared to a matched, historical cohort. We collected data on surgical outcomes, operative times, and complication rates, following strict adherence to the Declaration of Helsinki. Results: Our cohort primarily involved male patients (81%) with defects mostly located on the hand (81%). The anterolateral thigh flap was the most commonly used free flap (14/16, 88%). The average operative time was 368 ± 89 min (range: 216-550 min). No complete or partial flap losses were observed, but one flap required revision surgery due to arterial thrombosis. Major complications occurred in 13% of the cases. The average anastomosis time was 31 ± 12 min (range: 20-35 min) for arterial end-to-end anastomoses and 33 ± 13 min (range: 20-60 min) for arterial end-to-side anastomoses. Venous anastomoses required, on average, 20 ± 6 min. Operating times were not significantly longer when compared to the historical cohort (p = 0.67). Conclusions: We were able to show comparable outcomes to conventional microsurgery, while requiring more time for the microsurgical anastomoses. The study highlights the need for larger, controlled trials to better understand the benefits and limitations of robotic assistance in microsurgical reconstruction of the upper extremity.

From Ancient Rituals to Modern Rhinoplasty: A Historical Evolution of Nasal Reconstruction

Background and aims: As surgical practices continue to evolve, the origins of these techniques and their respective indications are often lost over time, while in other cases they remain fundamental to modern utility. Rhinoplasty is a prime example of an operative intervention that has been heavily influenced by cultural beauty standards throughout different eras and civilizations to improve both aesthetics and functionality. By recognizing the historical context and evolution of this procedure, its modern-day application that integrates both form and function is better understood. This study aims to delineate the development of rhinoplasty from its genesis onward and demonstrate how the influences of different civilizations, eras, and cultural beliefs have shaped what the rhinoplasty is today. Methods: We performed a narrative review of various articles pertaining to ancient and modern contributions to the rhinoplasty. Articles were selected based on relevance and significance to the evolution of the procedure in a given era, highlighting pioneers and revolutionaries in the field. MESH terms, including but not limited to, “ancient rhinoplasty,” “evolution of the rhinoplasty”, and “modern-day rhinoplasty” were searched on PubMed, Google Scholar, and other major literature databases. Key sources included medical journals, historical texts, and surgical reports, supplemented by systematic reviews of existing literature. Results: Twenty-three sources were taken into consideration and categorized based on time periods. Their notable contributions, surgical innovations, and clinical impacts were expanded upon. Our analysis also explores the cultural implications of rhinoplasty and influential beauty standards across history, and how these have carried over to the present day. In a similar fashion, technical procedures were critiqued on whether they have withstood the test of time and their responsiveness to the aesthetic status quo. Finally, our analysis shows how the varied historical indications for rhinoplasty, whether functional or cosmetic, have persisted into modern practice. Conclusions: The historical evolution of rhinoplasty reveals more than mere advancements in surgical technique, as it reflects broader cultural values that influence its utilization. By examining its history, we gain valuable insight into how ancient practices have progressed through the middle ages, renaissance, and early modern period, continuing to shape the field of plastic surgery in the present day.

Leveraging ChatGPT for Enhanced Aesthetic Evaluations in Minimally Invasive Facial Procedures.

In recent years, the application of AI technologies like ChatGPT has gained traction in the field of plastic surgery. AI models can analyze pre- and post-treatment images to offer insights into the effectiveness of cosmetic procedures. This technological advancement enables rapid, objective evaluations that can complement traditional assessment methods, providing a more comprehensive understanding of treatment outcomes. The study aimed to comprehensively assess the effectiveness of custom ChatGPT model, "Face Rating and Review AI," in facial feature evaluation in minimally invasive aesthetic procedures, particularly before and after Botox treatments. An analysis was conducted on the Web of Science (WoS) database, identifying 79 articles published between 2023 and 2024 on ChatGPT in the field of plastic surgery from various countries. A dataset of 23 patients from Kaggle, including pre- and post-Botox images, was used. The custom ChatGPT model, "Face Rating & Review AI," was used to assess facial features based on objective parameters such as the golden ratio, symmetry, proportion, side angles, skin condition, and overall harmony, as well as subjective parameters like personality, temperament, and social attraction. The WoS search found 79 articles on ChatGPT in plastic surgery from 27 countries, with most publications originating from the USA, Australia, and Italy. The objective and subjective parameters were analyzed using a paired t-test, and all facial features showed low p-values (<0.05). Higher mean scores on features such as the golden ratio (mean = 5.86, SD = 0.69), skin condition (mean = 3.78, SD = 0.73), and personality (mean = 5.0, SD = 0.79) indicate positive shifts after the treatment. The custom ChatGPT model "Face Rating and Review AI" is a valuable tool for assessing facial features in Botox treatments. It effectively evaluates objective and subjective attributes, aiding clinical decision-making. However, ethical considerations highlight the need for diverse datasets in future research to improve accuracy and inclusivity. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The Effect of Medial Circumflex Artery Variation on the Success Rate of Gracilis Flap Procedures: A Systematic Review.

This systematic review examines the impact of anatomical variations in the medial circumflex artery (MCA) on the outcomes of gracilis flap procedures in reconstructive surgery. Incorporating 16 studies, this review analyzes how different MCA variants influence the success rates of these procedures. Findings highlight critical MCA variations, including cases of split and double pedicles and differences in pedicle length and branching patterns, which can complicate flap harvesting and vascular anastomosis. The studies consistently underscore the need for precise preoperative imaging and intraoperative adaptability to manage these anatomical differences effectively. Notably, variants with shorter or branched pedicles present higher risks of partial flap loss and complications, particularly in autologous breast reconstruction and lower extremity repairs. The findings support the adoption of advanced imaging protocols, such as high-resolution Doppler and CT angiography, to enable detailed vascular mapping. Interdisciplinary collaboration among anatomists, radiologists, and surgeons is essential for developing comprehensive strategies tailored to individual anatomical landscapes, optimizing both the success and viability of gracilis flaps. The review emphasizes that understanding MCA variability is crucial for enhancing surgical precision and improving patient outcomes. Standardizing preoperative assessment protocols and exploring alternative flap techniques may mitigate risks associated with MCA variations, advancing the field of reconstructive surgery.

The Influence of Facial Injury during the First World War on the Development of Plastic and Reconstructive Surgery in Britain and Germany.

In the First World War (WW1), different types of injuries became both political and economic factors for the main belligerent countries. This work illustrates the special role facial injuries played during and after the war and the profound impact they had on the field of Plastic Surgery in Britain and Germany.This is a historical work based on primary and secondary sources. English and German material was used to compile an overview of the development of Plastic and Reconstructive Surgery as a specialty during WW1 and up to the Second World War (WW2).Plastic and Reconstructive Surgery had the task of reconstructing male beauty and personalities, restoring the most intense, disfigured reminders of a terrible war in homes and the public. Looking at the significant role the specialty played during the war, remarkably, most of the contributors struggled to find financial support to develop designated specialized departments in the inter-war period. The specialty's connection to the emotional subject of facial disfigurement did not work in its favor at a time when people wanted to forget the horrors of the war.The developments in Britain and Germany during the WW1 were less isolated than often described and the inter-war period saw much effort for international collaboration. The different developments of WW2 further illustrate how essential the efforts of a strong group of individuals and support from authorities were for the evolution of Plastic Surgery as a specialty.

Energy-Based Skin Rejuvenation: A Review of Mechanisms and Thermal Effects.

Energy-based photoelectric and ultrasonic devices are essential for skin rejuvenation and resurfacing in the field of plastic surgery and dermatology. Both functionality and appearance are impacted by factors that cause skin to age, and various energy types have variable skin penetration depths and modes of transmission. The objective is to advise safe and efficient antiaging treatment while precisely and sensitively controlling and assessing the extent of thermal damage to tissues caused by different kinds of energy-based devices. A literature search was conducted on PubMed to review the mechanisms of action and thermal effects of photoelectric and ultrasonic devices in skin remodeling applications. This paper reviews the thermal effects of energy-based devices in skin resurfacing applications, including the tissue level and molecular biochemical level. It seeks to summarize the distribution form, depth of action, and influencing factors of thermal effects in combination with the mechanisms of action of various types of devices. Accurate control of thermal damage is crucial for safe and effective skin remodeling treatments. Thorough investigation of molecular biochemical indicators and signaling pathways is needed for real-time monitoring and prevention of severe thermal injury. Ongoing research and technological advancements will improve the accuracy and control of thermal damage during treatments.

The Need for Higher Levels of Evidence in Plastic Surgery.

Evidence-based medicine in plastic surgery is essential to provide optimal care to individual patients. Level of evidence (LOE) and number of citations are metrics used to gauge quality of research and impact within a field, respectively. The objective of this study was to determine an association between LOE and number of citations within recently published articles in Plastic and Reconstructive Surgery (PRS). A review of original research articles published in PRS from January 2018 to June 2022 was performed. LOE was identified through the PRS website, and the number of citations identified via PubMed. Articles were further divided into sections of their corresponding topic. A total of 965 articles were reviewed, of which 21 (2.2%) were articles assigned level I evidence. There were 147 (15.2%) level II articles, 360 (37.3%) level III articles, 377 (39.1%) level IV articles, and 60 (6.2%) level V articles. The average number of citations per article was 2.72, and the average LOE of all included articles was 3.31. Level I articles had an average of 4.95 citations, whereas level II, III, IV, and V articles had averages of 2.95, 2.54, 2.64, and 2.71, respectively. Breast articles were cited on average 3.85 times each, more than any other type of article. Our data show that articles assigned level I evidence in PRS trend toward higher numbers of citations compared with articles assigned lower LOEs. These findings should encourage investigators to publish high-quality research to advance the field of plastic surgery.

021. Outcomes of Adult Patients That Got Full Thickness Skin Graft with Skin Defects After the Surgical Wide Excision: Observational Case Series Study

Background: Full-thickness skin grafting plays an important role in reconstruction for excessive skin defects after the surgical wide excision. For closed defect consideration, full-thickness skin grafts can be used, The most common full-thickness skin graft donor sites include the retroauricular region, supraclavicular region, inguinal fold, buttock fold, hypothenar area, and anterior wrist fold. In this study. Methods: This is a single institutional, retrospective, observational case series study. We included 8 patients who underwent skin reconstruction using full-thickness skin grafts to close skin defects caused by the excision of skin tumor or trauma, between January 2024 and July 2024. Demographic data, including sex, age, location and photographs, and were collected. Results: the follow up for 8 patients that got full-thickness skin graft, we can make conclusion that full-thickness skin graft, can be the choice to closed the defect. The outcome of the patient is good with the defect is closed. Conclusion: Full-thickness skin grafting is a common technique for reconstructing skin defects after surgical wide excision. This case series demonstrates that using full-thickness grafts can effectively close these defects. Despite the challenges posed by the extent and location of the defects, the grafts provided a reliable solution when primary closure was not possible. Overall, this study highlights the importance of full-thickness skin grafting in the field of reconstructive surgery.

A Bibliometric Analysis of the Articles Published in the Aesthetic Plastic Surgery Journal (1976-2023).

Despite the important role of the Aesthetic Plastic Surgery (APS) journal in the field of aesthetic plastic surgery, there is a notable absence of literature that focuses exclusively on the bibliometric analysis of this journal. In recognition of APS's 48 years of publishing, this study aims to perform a bibliometric analysis of the articles published in the APS (1976-2023). Articles published in the APS were extracted from the Web of Science Core Collection database. VOSviewer was employed to perform bibliometric analyses. Microsoft Excel was utilized to analyse the publication and citation trends. From 1976 to 2023, 5134 articles were published in the APS. These articles were contributed by 12,963 researchers from 3354 institutions across 91 countries. The USA and China were the leading contributors. The most prolific author is Luan Jie from China. The co-citation networks highlighted the influence of the journal Plastic and Reconstructive Surgery. We categorized the articles into four groups, and the results show that articles with the highest publications and citations in the APS are related to facial cosmetic surgery. In terms of specific surgical procedures, breast augmentation surgery has garnered consistent attention from researchers over the past 48 years, ranking first in both the number of publications and citations. The findings of this study indicate that the APS is a significant scientific journal, is widely utilized by global researchers in the field of aesthetic plastic surgery, and spans diverse knowledge domains. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

S3 guideline: Diagnosis and treatment of epidermal necrolysis (Stevens-Johnson syndrome and toxic epidermal necrolysis) - Part 2: Supportive therapy of EN in the acute and post-acute stages.

Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) are rare, predominantly drug-induced, acute life-threatening diseases of skin and mucosae. SJS and TEN are nowadays considered as variants of one disease entity with varying degrees of severity called epidermal necrolysis (EN). EN is associated with high morbidity and mortality and constitutes a major disease burden for affected patients. The guideline "Diagnosis and treatment of epidermal necrolysis (Stevens-Johnson syndrome and toxic epidermal necrolysis)" was developed under systematic consideration of existing scientific literature and in a formal consensus process according to regulations issued by the Association of Scientific Medical Societies in Germany (AWMF) to establish an evidence-based framework to support clinical decision-making. The interdisciplinary guideline commission consisted of representatives from various specialist societies and of patient representatives. The guideline is aimed at specialists in the fields of dermatology, ophthalmology, plastic surgery, intensive care, and pediatrics in hospitals and offices, as well as other medical specialties involved in the diagnosis and treatment of EN. The guideline is also aimed at patients, their relatives, insurance funds, and policymakers. The second part is concerned with the topics of supportive therapy in the acute phase of EN and outpatient follow-up treatment.

Determination of Quality Indicators for Microvascular Grafts in Cranio-Maxillofacial Surgery-A Retrospective Analysis of 251 Free Flaps.

The use of microvascular grafts is the gold standard in oral and maxillofacial surgery for the reconstruction of soft tissue and bony and combined defects. Graft loss is one of the most serious complications in the field of reconstructive surgery. A comprehensive analysis of factors influencing this is, therefore, essential. This hypothesis-generating study analyzed 251 patient cases of oral and maxillofacial surgery at the University Hospital Düsseldorf from 2016 to 2020 regarding patient- and therapy-specific parameters for their impact on graft survival. Statistically significant influencing factors were found among the 80 parameters examined: treatment with antiplatelet medication and a BMI ≥ 24.5 at the time of surgery had a positive influence on graft survival, while existing diabetes mellitus, atrial fibrillation, tracheostomy, and a longer operation time had a statistically relevant negative influence. This work demonstrates the relevance of patient-specific risk stratification and the need for further research to develop a valid risk profile. Identifying high-risk patients with medium-sized defects, where alternatives to microvascular reconstruction are available, appears to be crucial for the clinical outcome.

Progressive Tension Sutures in Fleur de Lis Abdominoplasty: A Case Report

Introduction: As the field of cosmetic and plastic surgery progresses patient safety and comfort remain paramount. Over the past 30 years, multiple studies have demonstrated the effectiveness of progressive tension sutures (PTS) in drainless abdominoplasties and case series have been published evaluating the outcomes of PTS/drainless abdominoplasties in high-volume liposuction cases (liposuction with over 3 L of aspirate). To date, there have been no reports in the literature regarding PTS usage in Fleur de Lis (FDL)-type abdominoplasties. Materials/Methods: We describe our experience using PTS in a patient with a drainless FDL abdominoplasty and several patients in which PTS was used to limit the number of drains needed in an FDL abdominoplasty. Results: In our follow-up with the patient, she had no adverse events or seroma formation. Discussion/conclusion: The cases documented here suggest that FDL abdominoplasty can be performed without the need for drains or with minimal drains.

Machine Learning, Deep Learning, Artificial Intelligence and Aesthetic Plastic Surgery: A Qualitative Systematic Review.

This systematic review aims to assess the use of machine learning, deep learning, and artificial intelligence in aesthetic plastic surgery. This qualitative systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline. To analyze quality risk-of-bias assessment of all included articles, we used the ROBINS-I tool for non-randomized studies. We searched for studies with the following MeSH terms: Machine Learning OR Deep Learning OR Artificial intelligence AND Plastic surgery on MEDLINE/PubMed, EMBASE, and Cochrane Library, from inception until July 2024 without any filter applied. A total of 2,148 studies were screened and 41 were fully reviewed. We conducted article extraction, screening, and full text review using the rayyan tool. Eighteen studies were ultimately included in this review, describing the use of machine learning, deep learning and artificial intelligence in aesthetic plastic surgery. All studies were published from 2019 to 2024. Articles varied regarding the population studied, type of machine learning (ML), Deep Learning Model (DLM), Artificial Intelligence (AI) used, and aesthetic plastic surgery type. Of the eighteen studies, we included the following aesthetic plastic surgeries: augmentation mastopexy, breast augmentation, reduction mammoplasty, rhinoplasty, facial rejuvenation surgery, including facelift surgery; blepharoplasty, and body contouring. Image-based with AI, ML, and DLMs algorithms were used in these studies to improve human decision-making and identified factors associated with postoperative complications. AI, ML, and DL algorithms offer immense potential to transform the aesthetic plastic surgery field. By meticulously analyzing patient data, these technologies may, in the future, help optimize treatment plans, predict potential complications, and more clearly elucidate patient concerns, improving their ability to make informed decisions. The drawback, as with preoperative surgical simulation, is that patients may see an AI-generated image that is to their liking, but impossible to achieve; great care is needed when using such tools in order to not create unrealistic expectations. Ultimately, the old plastic surgery adage of ''under-promise and over-deliver'' will continue to hold true, at least for the foreseeable future. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 . Study registration A review protocol for this systematic review was registered at PROSPERO CRD42024567461.

Climbing the Research Ladder: A 25-year Analysis of K-to-R Grant Conversion among Plastic Surgeons.

We evaluate the performance of plastic surgeons in converting National Institutes of Health K grants in early career to R grants intended for established investigators. We also investigate characteristics that may positively predict successful transition from K to R grants. K08, K23, and R01 (or equivalent) grants awarded to plastic surgeons and physicians within the departments of ophthalmology, dermatology, and neurosurgery were collected. Analyses of successful conversion rates from a K to an R grant between plastic surgeons and physicians within the selected departments were performed. Cross-sectional analysis of characteristics among identified plastic surgeons was completed via logistic regression to elucidate possible predictors of successful conversion. Comparison of pathway initiation rates demonstrate that plastic surgeons receive significantly fewer K grants relative to the size of their field when compared with other specialties (all P < 0.01). Of the analyzed plastic surgeons, 52.9% successfully converted to an R-series grant within 5.4 years of beginning their K-series grant. Conversion rates were not significantly different between plastic surgeons and physicians within the selected departments. Logistic regression analyses revealed that the time-adjusted mean relative citation ratio of K series-associated publications is a positive predictor of successful conversion (P = 0.047). With regard to increasing National Institutes of Health funding via the K-to-R pathway, we believe the field of plastic surgery could benefit from an increased effort to pursue a pathway of K-to-R conversion with a focus on quality over quantity when publishing articles associated with a K-series grant.

Robert H. Ivy: The First Professor of Plastic Surgery and Cleft Palate Surgery Pioneer.

Robert H. Ivy significantly influenced the field of plastic surgery through his innovative techniques, leadership, and dedication to the science and art of surgery. His dentistry background and military experience shaped his approach to maxillofacial and reconstructive surgery. Ivy's pioneering work in cleft lip and palate surgery, along with his use of local flaps, advanced the field of plastic surgery. Ivy was a key figure in the professionalization of plastic surgery; he played a crucial role in establishing the field as a distinct medical specialty, becoming the first-ever professor of plastic surgery. He was instrumental in founding major professional organizations and helped set the rigorous standards that govern plastic surgery today. His legacy lives on in the Robert H. Ivy Pennsylvania Plastic Surgery Society, a testament to his exceptional dedication to plastic surgery. Ivy's career exemplifies the power of innovation, leadership, and humility in advancing the practice of plastic surgery; his contributions continue to inspire and guide future generations of surgeons and surgical researchers.