It is always wise to look ahead, but difficult to look further than you can see.
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).
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).
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.
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.
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.
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.
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.
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.
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.
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.
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.
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).
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 Cost5 (Fig. 7).
We started with our @PRSJournal Twitter account in April of 2009 with the goal of sharing academic, peer-reviewed information about plastic and reconstructive surgery in the social media sphere. PRS platforms have grown to include YouTube, Facebook, and Instagram with videos, animations, boomerangs, photographs, infographics, live interviews, stories, and live discussions. The mission, however, has remained the same: engage as many interested people as possible around the content of the Journal. Thanks to team members such as Aaron, Christina, Maddy, and surgeons who shared my personal interest in social media such as Drs. Heather Furnas and Roy Kim, #plasticsurgery grew as a movement to help educate the public on the real risks and real benefits of real plastic surgery—and the Journal was leading the charge. With over 70,000 followers across the three major social media platforms combined, we are excited to continue shaping the #plasticsurgery conversation.
With the March of 2011 issue of PRS, we began publishing artwork from selected articles on the cover of PRS. The tradition has continued to this day and, though it is still known as the “White Journal,” we are pleased to highlight art on its cover. This practice has helped raise the bar for all artwork submitted to PRS.
In an effort to involve residents more actively in the Journal, we introduced “Resident Ambassadors to the Editorial Board” in 2014, and the larger network of the “Resident Advisory Board” ambassadors shortly thereafter. Many of the engaging initiatives of recent years have stemmed from the efforts of these brilliant, creative PRS Resident Ambassadors. Our first unofficial Resident Advisory Board meeting was a casual meet up with four residents in San Diego during Plastic Surgery The Meeting 2013. Today, we work with more than 70 active Advisory Board Members from across the world (Fig. 8).
PRS Global Open
There is much more to be written about launching the first open-access surgical journal in North America and its subsequent 7 years of growth, but I would be remiss to leave it off this list of accomplishments. The leaders of the American Society of Plastic Surgeons, PRS, and our publishers, felt strongly that we needed to develop a PRS family of journals. We were receiving too much good content to be able to publish in one journal alone. In 2013, we officially launched PRS Global Open, and I. Donnell Moore volunteered to take on the added responsibility of shepherding this new journal in the editorial office. He and I, together with the staff and our growing network of global plastic surgeons, gave this effort our all, and PRS Global Open has quickly become the gold standard for plastic surgery open access journals, helping to improve global patient, safety, outcomes, and care, one open-access article at a time.
Special Topics Series
Since 2014, with our limited-run “Regenerative Medicine” series, we have worked with many great thought leaders from our Society and Editorial Board including Drs. Robert Weber, Samuel J. Lin, and Heather Furnas on special topics series to explore important topics needing more in-depth coverage. Foundational series on Plastic Surgery Education, Technology and Innovation, and Women in Plastic Surgery sparked discourse in the field of academic plastic surgery that we still see represented in submissions to the Journal today. We hope that a new and upcoming slate of special topic series, including Business and Practice Management, Gender Surgery, and Ethics will do the same.
Not only have we greatly expanded the presence of expert discussions, often representing insightful counterpoints or differing perspectives within the journal itself, but we also publish recurring “departments,” to accompany articles and offer CPT Coding Perspectives written since June of 2015 by Raymond Janevicius, M.D. (Fig. 9) and Psychosocial Insights Columns written since April of 2017 by David Sarwer, Ph.D. (Fig. 10).
PRS Journal Club
The award winning PRS Journal Club (Fig. 11) is led by our Resident Ambassadors and powered by our active Resident Advisory Board. There are three ways for plastic surgery residents and others to join the #PRSJournalClub every issue: (1) read the three picks from each issue, all paired with classic content; (2) discuss one article each month with the authors on Facebook; and (3) listen and learn with the monthly podcast.
The 2016 PRS Resident Ambassadors, Drs. Amanda Silva, Sammy Sinno, and Raj Sawh-Martinez, surprised us when they took the initiative and proceeded to record a demo episode of a podcast to go along with the February of 2016 PRS Journal Club. Since then, the initiative has blossomed through the use of professional audio equipment and editing, but the initial resident-led spirit of these podcast discussions persists.
PRS Grand Rounds
With inspiration and perspiration from our 2017 Resident Ambassadors, Drs. Jordan Frey, Chad Purnell, and M. Shuja Shafqat, we launched PRS Grand Rounds (Fig. 12): a multipronged, multitopic live lecture and question-and-answer series. This social media makeover of the age-old, terrestrial grand rounds brings speakers directly to the screens of any interested party through the PRS Facebook page.
In December of 2017, we started classifying and labeling PRS articles for their adherence to promoting patient safety. By reading these articles, plastic surgeons could claim 1 hour of Category 2 Patient Safety credit. Launched by Dr. Lalonde and now coordinated by Dr. Michele Manahan, this initiative helps shine a spotlight on articles that focus on the safety of our patients (Fig. 13).
A lot has been written and more has been said about the impact factor’s strengths and weaknesses. We know it is not the sole measure of a journal’s impact. That said, I am exceptionally proud to see that our sustained efforts have resulted in the PRS impact factor increasing from 1.3 to 4.209 during my tenure! Each PRS article is now cited over four times on average. With more than 39,000 citations to PRS in 2019, the Journal is now ranked number 22 of 210 surgery journals. Thanks to amazing authors, peer reviewers, and readers like you, PRS has again earned the distinction of being the number one plastic surgery journal in the world!
As COVID-19 quarantines were initiated worldwide, the PRS team was rapidly converting all of our processes to continue our work remotely—and many of you were apparently taking the opportunity to submit papers. The result was a 40 percent increase in submissions from 2019 to 2020 that challenged all of our protocols, workflows, and systems. This not only required great patience and understanding from our authors and an increased workload for our Editorial Board and reviewers, but also necessitated continuous self-assessment, creative realignment, and nimble adjustment from our staff. PRS team members such as Darienne Dickey rose to the challenge every day as we worked through this influx to keep each article moving through the process swiftly and accurately. This demanding year made it clearer to me than ever before that the Editorial Board and American Society of Plastic Surgeons team we have assembled to produce PRS is truly world class.
Every Issue of PRS
The 30,000-foot view of major accomplishments and new initiatives offers a great vantage point to observe and reflect on all that we have done together over the years. But the ground-level view is also of vital importance. Each word in the Journal is written and peer-reviewed by people like you and edited by our long-serving Staff Editor Ed Tynan. Every compelling figure, illustration, and graph you’ve submitted has been assembled and polished by Staff Editor Angela Burch. This is the DNA of the Journal. Each original article, special topic, viewpoint, video, Ideas and Innovations, and more pushes the field and its discourse forward in its own way, and it is the true and ever-lasting foundation of plastic surgery. As I flip through the hard copy pages and scroll through each article on my laptop or phone every month, I am amazed at everything we—the global plastic surgery community—accomplish in every issue.
So where do we go from here? We must always remember that on the shoulders of giants, we can see more clearly what is next on the horizon. Although the past is gone, it leaves us a superb foundation for what is to come. As we move into the next transformation era in information technology, big data, the “Wild West” of social media and Google-like algorithms guiding patient education, and trends in medical publishing pushing toward data sharing and availability, preprint servers, calls to revolutionize how we measure journal impact, governmental mandates for open access, and untold horizons to explore, PRS remains one of the lone towers of trust and a pillar on which all of us in plastic surgery can stand tall and proud.
Never let the future disturb you. You will meet it, if you have to, with the same weapons of reason which today arm you against the present.
The authors wish to acknowledge Mike Stokes, American Society of Plastic Surgeons Staff Vice President of Communications, for all of his support over the years and for providing American Society of Plastic Surgeons historical data and copyediting services on this editorial; and Angela Burch who, as part of her role on the editorial staff, developed the graphic logos for many new journal initiatives over the years, including those seen in this article as Figures 4 through 12.