ArticlePlastic and reconstructive surgery. Global open2013
Levels of Evidence in Cosmetic Surgery: Analysis and Recommendations Using a New CLEAR Classification.
Article in Plastic and reconstructive surgery. Global open, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 1 of them a synthesis that pooled it.
What it found
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
13 citing papers in PubMed, 1 synthesis or guideline pooled it.
- A Systematic Review of Radiofrequency and Helium Plasma Radiofrequency Alternatives to Mastopexy.Aesthetic plastic surgery · 2026Pooled it
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- A Rebuttal of a Meta-analysis Supporting Breast Implant Pocket Antimicrobial Irrigation.Annals of plastic surgery · 2025Article
- Conflict of Interest and Recommendations for Explantation in Asymptomatic Patients Concerned About BIA-ALCL Risk.Annals of plastic surgery · 2025Article
- Reply: Comment on BIA-ALCL: Comparing the Risk Profiles of Smooth and Textured Breast Implants.Aesthetic plastic surgery · 2024Article
- The Case Against Betadine Irrigation of Breast Implant Pockets.Aesthetic plastic surgery · 2023Article
- The 100 Most-cited Articles in Abdominoplasty: A Bibliometric Analysis.Plastic and reconstructive surgery. Global open · 2021Article
- Reading between the Lines: A Plastic Surgeon's Guide to Evaluating the Quality of Evidence in Research Publications.Plastic and reconstructive surgery. Global open · 2019Article
- The Past Informs the Present, Academic New Media Pitfalls: A Primer for Plastic Surgeons.Plastic and reconstructive surgery. Global open · 2019Article
- Response to "Lessons Learned from a National Cosmetic Surgery Insurance Database".Aesthetic surgery journal · 2016Article
- Psychometrics: Essential for Valid, Reliable, and Responsive Measurement in the Development of Patient-reported Outcome Instruments in Plastic Surgery.Plastic and reconstructive surgery. Global open · 2014Article
- Outcome studies in plastic surgery: knowing the objectives and avoiding pitfalls.Plastic and reconstructive surgery. Global open · 2014Article
- Validity, reliability, and the questionable role of psychometrics in plastic surgery.Plastic and reconstructive surgery. Global open · 2014Article
Corrections and comments
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Authors and funding
1 author.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe Level of Evidence rating was introduced in 2011 to grade the quality of publications. This system evaluates study design but does not assess several other quality indicators. This study introduces a new "Cosmetic Level of Evidence And Recommendation" (CLEAR) classification that includes additional methodological criteria and compares this new classification with the existing system.
methodsAll rated publications in the Cosmetic Section of Plastic and Reconstructive Surgery, July 2011 through June 2013, were evaluated. The published Level of Evidence rating (1-5) and criteria relevant to study design and methodology for each study were tabulated. A new CLEAR rating was assigned to each article, including a recommendation grade (A-D). The published Level of Evidence rating (1-5) was compared with the recommendation grade determined using the CLEAR classification.
resultsAmong the 87 cosmetic articles, 48 studies (55%) were designated as level 4. Three articles were assigned a level 1, but they contained deficiencies sufficient to undermine the conclusions. The correlation between the published Level of Evidence classification (1-5) and CLEAR Grade (A-D) was weak (ρ = 0.11, not significant). Only 41 studies (48%) evaluated consecutive patients or consecutive patients meeting inclusion criteria.
conclusionsThe CLEAR classification considers methodological factors in evaluating study reliability. A prospective study among consecutive patients meeting eligibility criteria, with a reported inclusion rate, the use of contemporaneous controls when indicated, and consideration of confounders is a realistic goal. Such measures are likely to improve study quality.
Identifiers
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.