Why evidence-based medicine matters to aesthetic surgery.

This issue of Aesthetic Surgery Journal marks the one-year anniversary of Dr. Foad Nahai's editorial heralding an increased focus on evidence-based medicine (EBM) in the pages of the Journal. 1 This year, the Journal will increase the visibility of EBM articles by showcasing the Level of Evidence (LOE) pyramid to identify pertinent articles with a ranking of Level 1, 2, or 3. Levels of Evidence are but one of the tools used in EBM to assess the validity of data presented in scientific studies, thereby enabling us to make more informed decisions and take better care of our patients. During the past year, as discussions about EBM have become more frequent, many plastic surgeons have questioned what exactly EBM is, why it is necessary, and how will it affect their practice and their patients. David Sackett 2 has defined EBM as " the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. " Several key words in this definition guide us toward not only what EBM is but, just as importantly, what EBM is not. First, EBM is conscientious. It is based on a concerted and thoughtful effort to apply information in a different way and, as such, requires as significant a change in our ways of thinking and our culture as a change in our daily processes. Second, EBM is explicit. When applying EBM principles, we purposefully and systematically seek out the most appropriate information, examine it in a critical way, and incorporate this information as we implement a balanced action plan. It is important to note that the information that we seek is the current best information—not the information that we wish we had or will have in the future—and is thus limited by research and clinical reports. " Judicious " hints at what EBM is not: EBM does not create algorithms that we are expected to follow blindly, nor does it define standard of care. Importantly, EBM does not replace the element of art and judgment that is revered within our specialty. Because EBM is applied to individual patients, it actually supports and enhances our art and judgment; we learn to target the information that is most applicable and translate it to the patient sitting before us, taking into account not only his or her desires, concerns, biology, anatomy, and resources but also our own skills and experiences …