Evidence-Based Medicine Applied to Facial Plastic Surgery

Miguel Gonçalves Ferreira, MD, PhD

The term “Evidence-Based Medicine” (EBM) was introduced in 1990 by Gordon Guyatt of McMaster University as “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients.”

The concept of a controlled clinical trial was first described in 1662 by Jan Baptist Van Helmont about bloodletting. Van Helmont wrote: “Let us take out of the Hospitals, out of the Camps, or from elsewhere 200 or 500 poor People with fevers or Pleuritis. Let us divide them in Halfes, let us cast lots, that one half of them may fall to my share, and the others to yours; I will cure them without bloodletting and sensible evacuation; but you do, as ye know ... we shall see how many Funerals both of us shall have.”

The first published report describing the conduct and results of a controlled clinical trial was by James Lind, a Scottish naval surgeon who researched scurvy during his time aboard HMS Salisbury in the Channel Fleet while patrolling the Bay of Biscay. Lind divided the sailors participating in his experiment into six groups so that the effects of various treatments could be fairly compared. Lind found improvement in symptoms and signs of scurvy among men treated with lemons or oranges. He published a treatise describing the results of this experiment in 1753.

An early critique of statistical methods in medicine was published in 1835.

There so, we have lived for the last three centuries in a scientific era where the EBM principles are integrated into daily clinical practice.

The EBM cycle begins when a question arises while caring for a patient, and it aims to integrate the clinician's experience, the patient's values, and the best available scientific information to guide decision-making about clinical management. Incorporation of EBM into one's practice will not only make one a better clinician but also allow one to provide the best possible quality of medical care to patients.

Surgery is a unique field of medicine. The bias is enormous in each procedure, and validating the principles of EBM per se is more challenging. The bias introduced by the surgeon's skills may be a reason for not following the same principles of EBM. Despite this, Facial Plastic Surgery is done in large series worldwide so that the numbers can be studied and compared.

This issue of Facial Plastic Surgery is dedicated to papers with a high level of evidence and still some critical thinking on EBM and intellectual property versus ethics on new ideas/techniques in FPS.

The scientific method, probably started by Aristotle (384–322 BCE), is still the basis of each evolution in real science—(1) Observation/question, (2) extensive literature search, (3) hypothesis, (4) test with experience, (5) analyze data, and (6) report conclusions.

EBM is stratified into five levels, from the bottom (level V)—expert opinion—to the maximum evidence (level I)—meta-analyses, systematic reviews, and high-quality double-blinded prospective studies.

Is “expert opinion” still important? Of course, it is essential because it is mainly based on the experience of high-quality surgeons acquired over the years.

A panel of experts was invited to write a paper on credit for truly novel ideas? a critical approach to the intellectual authorship in surgery—in which it is discussed the actual state of the art concerning intellectual property in surgery.

At the beginning of the coronavirus disease 2019 (COVID-19) pandemic (2020), we started a group (using the Telegram platform) named Evidence-Based Rhinoplasty Research Group (EBRRG) devoted to rhinoplasty discussion based on high evidence-level papers. It has been a long and challenging way to drive surgeons on the EBM path and to fight some of the most orthodox that have purposely spread the wrong idea that EBRRG could be a new political group. The future is here, and there is no way to escape. Let us see the further evolutions and critical thinking in this field.

Defending good science is the most correct and logical way to fight fake information spread daily among patients and young surgeons in social media and other accessible platforms of this new digital world.

Publication History

Article published online:
01 June 2023