Abstract
As we enter the 40th year of publication of The American Journal of Cosmetic Surgery (AJCS), official journal of the American Academy of Cosmetic Surgeons (AACS), it is appropriate to reflect on our history, how the journal has matured over the years, what articles were the most memorable, and which ones were among our favorites.
First, the History
Gaylon McCollough 1 wrote about the evolution of our specialty in 2011. Gaylon was the fifth president of the American Association of Cosmetic Surgeons, a preceding organization to AACS. In 1980, he created a “Journal of Cosmetic Surgery” that was published by EBSCO media. The editors covered the cost of printing and mailing, but the effort was too great, and ceased publication 2 years later. The idea was reborn by the American Society of Cosmetic Surgery, a competing organization. During this period, in the early 1980s, several organizations devoted to specific areas of cosmetic surgery emerged. (For a timeline of the formation of these organizations, see Table 1.) These included the following: The Liposuction Society (Richard Dolski, Fred Berkowitz, Michael Elam with support from Pierre Fornier and Yves-Gerard Illouz which was soon joined by Richard Webster and Julius Newman), the Association of Cosmetic Surgeons, and the American Society of Cosmetic Surgery. These groups began merger talks and in 1984 formed the American Academy of Cosmetic Surgery. This group shared members with the newly formed American Board of Cosmetic Surgery (ABCS).
Timeline of Predecessors of to AACS Organizations in the United States.
Source. (Ref Petro JA, McMenamin P. “Twenty-Five Years: Now What?” American Journal of Cosmetic Surgery 25 (2008): 179-183).
The AJCS arose from the same enthusiasm that sparked the formation of the AACS and the ABCS. 2 Founding members included Richard Aronsohn, Robert Franklin, Richard Webster, and Harold Robbins. Through the efforts of these founders, the first issue of the AJCS was published in 1984. This was a herculean effort, as Aronsohn served as author, editor, copy editor and managed the small publishing company that produced the journal. Aronsohn also paid for the costs of printing the journal. The rapid growth of the AACS, to 1200 members by 1986, provided additional support for the journal. 3 When Dr Aronsohn developed health problems in 1986, Dr Julius Newman assumed the role of Managing Editor and the journal transitioned from the office of Dr Aronsohn to Russell Till Publishing in Philadelphia. Dr Melvin Shiffman became Editor-in-Chief in 1993. Under Dr Shiffman’s direction, the journal expanded and reorganized, including an abstract section for each paper and the creation of sections, including Original, Review, Brief articles, Case Reports, Law and Medicine, and Literature Review and Correspondence. With time invited commentaries on the articles were also included. In 1995, the journal applied for inclusion in the Index Medicus and was denied. During Dr Shiffman’s tenure, the journal migrated to Allen Press who published the AJCS until 2015. Jane Petro assumed editorial responsibility in 2007. As had Dr Shiffman, Dr Petro reorganized the structure of the journal, creating an editorial advisory board, and broadening the peer review panels. 4 Dr Petro saw the transfer of the AJCS from Allen Publications to SAGE. With this move, the journal, as part of the publisher’s agreement, became a fully accessible digital publication, easily searched, with all back issues available. This has been transformative in bringing our authors valuable attention. With this change, all articles can be searched via the usual online search engines, including Google Scholar. In 2017, Elie Ferneini assumed editorship. Past editors have included cosmetic surgeons who were general surgeons, plastic surgeons, and now, an oral maxillofacial surgeon, recognizing the diverse specialties that practice cosmetic surgery. Of note, Dr Shiffman was also an attorney with a JD degree.
The Inaugural Issue
From the beginning, the AJCS has reflected the AACS diverse membership, with articles relating to all aspects of facial, breast, and body cosmetic surgery. Here is a brief look at some of the early issues and the key articles that have appeared in the journal.
The inaugural issue of the AJCS featured articles by Julius Newman, Ronald Shippert, Richard Aronsohn, Richard Webster, Michael Elam, and Richard Dolsky, among others, covering topics such as silicone injections, liposuction, and malar augmentation. 5 As these were not subjects often found at that time in other journals, this reflects the unique role of a cosmetic surgery journal.
In the second issue, Frank Rubin 6 described his unique rhinoplasty technique. The article is very detailed and accompanied by numerous photographs illustrating his approach, as well as preoperative and postoperative photos. Rubin’s approach was uniquely his own, such that the “Rubin” nose could be easily recognized in Massachusetts, much as a Dr Howard “Diamond” nose be recognized in NYC. While today a natural nose is expected, in the 1990s, a patient who did not get the recognized nose was often disappointed.
Volume 1 Issue 3 included an article written by Nathan Pritikin with Nan Cisney, 7 “Maximizing the Benefits of Cosmetic Surgery with the Pritikin Diet.” This article, with no references, reads from today’s perspective mostly like a promotion, but the dietary advice, and admonitions to exercise as well as eat healthy food, remains good advice. But such an article would certainly not be published today in a peer-reviewed journal.
Issue 4 began the series of “Firsts in Cosmetic Surgery” authored by Harrison M Robbins 8 detailing the first Face-Lift. This article is a classic in the history of surgery, with extensive references and illustrations of the writings of such luminaries as John Staige Davis and pioneering cosmetic surgeon CC Miller. While Davis was an early academic plastic surgeon, Miller has often been considered a charlatan. He developed several cosmetic procedures, including the mini facelift, well before Davis. 9 Histories related to cosmetic surgery, and especially the AACS and ABCS, have continued to be well represented in the AJCS, despite Robbin’s failure to continue his promised series.
In reviewing the origins of the AJCS, and assessing the publications contained in the journal, the issue of access and availability must be addressed. In the early years of publication, multiple attempts to see the journal listed in the National Library of Medicine Index, PubMed, were thwarted. Being unlisted meant that the most common literature searches excluded any paper in the AJCS unless the author publicized their paper. A singular exception is Jeffrey Klein’s 10 1987 paper introducing the concept of tumescent anesthesia for liposuction. The AJCS was regularly publishing papers on liposuction when Jeffery Klein chose the journal to report his concept of tumescent anesthesia for liposuction. With the introduction of safe, effective, local anesthetic–based liposuction resulting in significantly reduced blood loss and the other benefits, liposuction moved into the mainstream of American medicine. As of January 30, 2024, this unique, original paper has been cited almost 1000 times, the most for any paper published in the AJCS.
The authorship of the AJCS reflects the diverse clinical backgrounds of the AACS membership from including nearly all surgical as well as medical specialties. Papers have covered broad cosmetic surgery topics and subspecialty identifications in hair transplantation, genital cosmesis, liposuction, fat transfer, the use of Platelet-rich plasma (PRP), platelet-derived growth factors, stem cells, various glues, fillers, and topical antiaging products. We have divided a sample of our publications into specific categories for ease of discovery. These can be found in the tables in this section (Tables 2-10). AACS member innovators, including Dolsky, Newmann, Asken, and Shiffman, were practicing and teaching liposuction on the heels of the European innovators, Fischer and Fornier, who were also contributors to the AJCS. Note the number of papers prior to 1990. In later years, stem cells and platelet derivates were presented by Mark Berman and others. Mark’s forward thinking and advocacy are sorely missed after his premature demise in the covid epidemic.
History of Cosmetic Surgery and Specific Procedures.
Liposuction and Fat Grafting.
Cosmetic Surgery Safety and Innovation.
Lasers.
Arguments for Cosmetic Surgery as a Distinct Specialty.
Hair Transplantation.
Breast Surgery.
Unique Reports.
AJCS Articles With Significant Citation Recognition.
Women Cosmetic Surgeons
The emerging voices of women in medicine particularly in the underrepresented fields of surgery have pointed out how few women surgeons exist in all areas of practice, leadership, research, and publishing. The role of women in cosmetic authorship was reported by several female authors in 2021. 11 The trend of female authorship shows a disproportionately male authorship during the 10-year period surveyed. The AACS and the AJCS have been purposeful and successful in their promotion of women within the organization, and within the journal as well. A recent article addressed the history of female cosmetic surgeons. 12 The author names the usual figures, Drs James Barry, Mary Walker Edwards, Elzabeth Blackwell, and goes on to note the increasing proportion of women across the spectrum of medical practice. The role of parenting and finding a satisfactory “work/life” balance are cited as barriers for women entering a surgical field. The article reviews much of the evidence of disparate representation, especially the persistent pay gap. It also notes the advantages of being a female physician, noting better outcomes, lower complication rates, and patient preferences. These advantages have not all been documented by cosmetic surgeons specifically, an exploration that should be done.
One effort to increase representation by women cosmetic surgeons in the AJCS was the introduction of the “Women’s Issue” encouraging publication by the women participants in the AACS.
Conclusion
The AJCS has played a major role for the AACS and the ABCS, providing an outlet for opinion, research, and education to the cosmetic surgery community. While the goal of reaching international recognition through the National Library of Medicine PubMed engine has not been reached, the open search engines now available and widely used make the journal a visible and valuable contributor to the science and safety of cosmetic surgery. As Drs Thompson and Roser once said, “Do the science, own the field.” As our journal continues to strive to advance the field of cosmetic surgery, our contribution to the field cannot be ignored.