What Is Driving Paradigm Shifts in Plastic Surgery and Is Cosmetic Surgery Keeping Up?

The Aesthetic Surgery Education and Research Foundation (ASERF): A 30-Year Retrospective Analysis

Federal government research grants provide limited funding to plastic surgeon-scientists, with reconstructive research taking precedence over aesthetic research. The Aesthetic Surgery Education and Research Foundation (ASERF) is a nonprofit, 501(c)(3) organization that seeks to support innovative, diverse research endeavors within aesthetic surgery. A total of 130 ASERF-funded studies and 32 non-funded applications from 1992 to 2022 were reviewed. Kruskal Wallis, Fisher's exact, and chi-squared tests were utilized to assess the potential relationship between self-identified gender, practice setting, geographical location, and study type with individual grant amounts and grant funding decision. Although significant differences were observed between male and female grant recipient h-indices (P < .05), there were no differences in the amount of funding they received (P > .05). Grant amounts were also consistent between study types as well as principal investigator practice settings and geographical locations (P > .05). The subanalysis revealed that the practice setting of the primary investigator (PI) was the only variable to exhibit a significant association with the decision to award funding (P < .05). Further, of the 61 applicants between 2017 and 2022, only 2 PIs self-identified as female. ASERF serves as an excellent funding source for global aesthetic surgery. To promote further research diversification, increased emphasis should be placed on recruiting applicants from outside academia and those who identify as female or gender nonbinary.

Aligning Incentives for Surgical Innovation: Review of the Literature and Best Practices

Background: Innovation in the clinical surgical space is often generated by the insight and ideas of practicing surgeons whose ideas solve direct and relevant clinical problems with both novel products and reimagined processes. Despite some successes in both product and process development, innovation in the practicing surgical space does not occur with the frequency one might expect and does not consistently result in adoption of profitable or health-improving new products or processes. One barrier to successful innovation is the misalignment of incentives for early-stage innovation in the clinical surgical enterprise. This project was undertaken to determine best innovation practices for clinical Divisions and Departments. Methods: Best practices for innovation in industry were determined by company-specific examples, as well as literature review in the business and medical literature. Concepts were then integrated to determine a viable model that aligns incentives to encourage early-stage innovation. Proposal: The centralized Moderated Innovation Database (MID) of early-stage exploratory ideas integrates best practices of innovation in a low-cost, sustainable model. The MID must be executed in 3 phases to ensure viability in implementation. This model is likely to encourage innovation by both improving stakeholder satisfaction with and engagement in the process, and by increasing capture of early-stage innovation. Conclusion: Infrastructure for early-stage ideas will help align incentives for early-stage innovation, and the MID is consistent with best practices for innovation.

Aesthetic Surgery Research Funding: Where Does It Come From and to Whom Does It Go?

BACKGROUND

Recent data show that aesthetic surgery research is lagging compared with reconstructive surgery: research funding and institutional disparities within aesthetic surgery are potential factors in this trend.

OBJECTIVES

The authors sought to determine if disparities exist in aesthetic surgery research based on funding sources or practice settings.

METHODS

The authors reviewed Aesthetic Surgery Journal articles from 2009 to 2019. Chi-square, t test, bivariate, and multivariate regression analyses were employed to evaluate research trends.

RESULTS

A total of 2262 publications were identified, with 318 funded articles meeting inclusion criteria. The majority of studies (294, 92%) received external funding, with 281 (88%) being supported solely by external funds. Externally funded studies were financed by private industry (194, 66%), foundations/societies (53, 18%), government grants (23, 8%), or a combination of agencies (24, 8%). The majority of funded studies were at academic institutions (266, 84%), followed by private practice (46, 14%) and private industry (6, 2%). Analysis of annual publications revealed a rising percentage of academic-based research, which correlated with decreasing research from private practice (r = -0.95, r2 = 0.89, P < 0.001). Compared with academic institutions, private practice relied more heavily on industry funding (55% vs 87%, respectively, P = 0.001), exhibiting lower rates of foundational/societal (20% vs 2%), governmental (9% vs 0%), combined (8% vs 7%), and internal department funding (8% vs 4%). Article citations and level of evidence were unaffected by funding source, agency, or practice setting.

CONCLUSIONS

Lack of diversity in research funding among private practice surgeons may explain the reported discrepancies that currently exist between aesthetic and reconstructive surgery research.