Revisiting the scientific method.

So wrote Ibn al-Haytham (Alhazen), who was born around 965 in Basra (now Iraq, but then part of Persia), lived most of his life in Egypt, and is credited with being an early developer of the scientific method. His road to truth took a wrong turn that almost cost him his life. After claiming that he could use mathematical principles to regulate the flooding of the Nile—and later realizing that this was, in fact, impossible to achieve—he found himself in deep trouble with the reigning powers. To escape execution, he feigned insanity. Placed under permanent house arrest, he continued his scientific explorations (most notably in the field of optics, writing his groundbreaking Book of Optics during this period of confinement) until his death at the age of 76.2 The foundations of the scientific method date back at least a thousand years. Most of us were first introduced to scientific thinking in high school. We were taught that scientific knowledge is based upon a process of gathering observable, empirical, and measurable evidence and then using our powers of reasoning to make sense out of these data.3 It is the scientific method that has enabled our education and training in medicine and plastic surgery. As practicing aesthetic surgeons, whether in the academic or private setting, these same principles must guide our approach to research and reporting of data. In this issue of the Journal, Chang et al present a fascinating analysis of aesthetic surgery clinical studies published over the past 10 years in several leading journals, including Aesthetic Surgery Journal, to determine the prevalence of evidence-based medicine. The authors conclude that, while some progress has been made in increasing the number of studies with high levels of evidence, the overwhelming majority of articles in the aesthetic surgery literature fall within categories exhibiting low levels of evidence. In their insightful Commentary, Gupta et al expand upon this finding, while also pointing out a number of important reasons why aesthetic surgery “has historically not been predicated on high-level evidence reports.” Among the reasons: (1) patient satisfaction often is considered more critical than the objective assessment of results; (2) aesthetic surgery necessarily involves customization of procedures for individual cases; and (3) positive outcomes in aesthetic surgery often are largely dependent upon the surgeon’s accumulated experience with a particular technique—a technique which he or she may be reluctant to abandon in favor of a scientifically validated but unfamiliar approach. However, both this Commentary and the article that precedes it conclude with the observation that the scientific method must be employed with greater frequency and commitment by aesthetic surgeons in order to further the goal of optimal patient outcomes. My background as an academic plastic surgeon has afforded me many opportunities to evaluate so-called “cutting edge” technology. In doing so, my goal has been to objectively separate fact from fiction. As all of us know, many of the devices and products being promoted to (and sometimes by) aesthetic surgeons ultimately fail to live up to the expectations of physicians and patients alike. The problem is that devices and techniques are often widely marketed before they are proven effective by valid scientific methods. There is a wealth of important research being conducted today in plastic surgery academic centers. A scan of the Plastic Surgery Research Council’s laboratory directory projects reveals that most of this research focuses on topics such as wound healing, adipocyte stem cell biology, tissue engineering and transplantation, gene therapy, and biomaterials.4 While these projects are primarily directed toward reconstructive surgery applications, one can easily see their relevance to aesthetic surgery. However, there are many other topics of specific interest to aesthetic surgeons that are in need of scientifically designed research. Aesthetic plastic surgery is unique in that many of the major contributors to the field are in private practice rather than an academic environment. This should not mean that techniques and technologies in aesthetic sur-