The 10th anniversary of the Archives of Facial Plastic Surgery is more than a publishing milestone, it is a reflection of the growth and evolution of our specialty and its culture. Therefore, it is appropriate and instructive to review the role of literature in the field of facial plastic and reconstructive surgery from the origins of the specialty to the present day.

The current Oxford University Dictionary² defines literature as "a body of written works related by subject-matter, by language or place of origin, or by dominant cultural standards." In the information age, we might paraphrase this statement to define literature as an archive of the cultural milieu of its creators, which includes documentation of the cultural elements and history of the creators, along with what today might be called their strategic plan. Accepting that it is impossible to ignore the factual and scientific nature of medical literature, I am nevertheless addressing far more than its utility as an evidence base for care in this article. An historic view of the literature of facial plastic surgery serves not only to document our scientific and clinical achievements as a specialty but also to give meaning to the people and precepts on which it has grown strong and vibrant. Also, by reviewing our contributions to literature, we can trace the circuitous path by which we have arrived at our current state.

Because literature is an expression of the cultural composition and complexity of its creators, examining the evolution of a given literature lends context to the life struggles and achievements of those who generate it. As described by Simons³ in the very first issue of the Archives, facial plastic surgery originated in the interests and innovations of general surgeons, otolaryngologists, orthopedic surgeons, oral surgeons, and anatomists—as unlikely a guest list as one could imagine at the ball that was early 20th century medicine. As the "geeks" of their times, our founders pursued sophisticated interests that were well out of the main stream of medical thinking in their own specialties; they achieved greatness through scientific methodology and intense dedication to causes and concerns thought trivial (or worse) by much of organized medicine a century ago.

The reasons for their collective interest in the form and function of the structures of the face, neck, and jaws were undoubtedly similar to our own. However, the lack of a defined specialty and the haughty attitude of much of organized medicine toward their pursuits made it as difficult to incorporate facial plastic and reconstructive surgery into their practices as it was later in the century to introduce casual dress to corporate America. Jacques Joseph, for example, was fired for performing what is considered by many to have been the first modern otoplasty, despite the success of the operation. Many cosmetic procedures were done clandestinely to avoid the scorn and scrutiny of those in medicine who felt that cosmetic surgery was somewhere between a waste of resources and blasphemy. As described in the Archives,⁴ "The early period of facial plastic surgery was shrouded in secrecy in the surgeons' combined attempt to guard highly prized techniques and ward off the public stigma of performing vanity surgery,"—the culture of facial plastic surgery could have no public voice.

Therefore, the pioneers of facial plastic surgery had to find outlets for their observations and hypotheses at a time in which publishing was difficult, circulation was expensive, access was limited, and most readers were uninterested at best and hostile at worst toward such writings. Joseph reported his first 2 surgical procedures, an otoplasty in 1896 and a rhinoplasty in 1898, to the Berlin Medical Society along with his concept of patient concern for appearance and desire to look normal (which he termed anti-dysplasia). Lacking a societal framework into which such views and concerns could readily integrate, the literature found limited interest, audience, and outlets. The culture necessary for coalescence of facial plastic surgery into a discipline had not yet formed. There was no resource base from which it could draw; it had not yet developed a voice of its own. And this was reflected in the nature of its literature, which was largely observational and lacked perspective (largely because of its then empirical nature). This early stage of our literature might well be termed the descriptive phase.

Despite increasing case volumes permitting publication of larger series with scientific analyses of theories, methods, and outcomes, the only outlets for expression of the thoughts and philosophy of facial plastic surgeons were "guest editorials" in the literature of other specialties. The classic writings of Becker,⁵ Wright,⁶ Farrior and Connolly,⁷ and other seminal figures in our history are found largely in the publications of otolaryngology well into the 1980s. Philosophy was beginning to accompany science, as seen in the very important articles on open rhinoplasty by Goodman and Charles^8-9 in the Journal of Otolaryngology, but facial plastic surgeons lacked a forum for free expression that was equal in stature and scope to those of other recognized specialties until the end of the next decade.

Literature must be more than simply descriptive if it is to reflect the breadth and depth of the culture for which it speaks. It must incorporate the views and contributions of the world in which that culture arose and developed. It must include art and science, and it must provide contextual enrichment lest the art be sterile and the science too abstract to have meaning in the "real world."

From the very first issue, the Archives of Facial Plastic Surgery has been the flagship of literature in our specialty. It has consistently included the elements that make it our cultural voice: historical perspective,³ original science,¹⁰ perspective from other specialties,^11-12 socially responsible commentary,¹³ and external information of interest and value to us as physicians and as individuals. It has addressed our role and that of our specialty in both organized medicine and society at large, expanding and helping us to understand our relationships with the world through art in general,^14-15 through art in medicine,¹⁶ and through art in society.¹⁷ It has addressed and fulfilled the need for ongoing formal education,¹⁸ and it has accepted responsibility as an ethical guide from the first publication,¹⁹ addressing seminal real-world issues, including the effects of physician behavior on legislation and regulation,²⁰ the use of the Internet,²¹ the nature of informed consent,²² and market-driven behavior.²³

With the emergence of our cultural voice has come the capacity for and practice of public self-reflection, along with a cultural transparency that could not reveal itself until the culture achieved sufficient solidity and permanence to highlight controversy rather than succumb to it. The Archives has published many statements that would have been found threatening by most facial plastic surgeons as recently as 25 years ago, such as:

• "In reality, the value of the CO2 laser as an incisional instrument has not changed greatly since its introduction in the mid-1970s. Only advertising campaigns, medical economics, and patient fascination have changed this instrument's value."²³
  
• "Insurers have been so bombarded with inappropriate claims that they are skeptical of all. Despite the fact that the insurance industry, on the whole, reimburses on an arbitrary and inadequate standard, physicians are not blameless in this regard. (Multiple articles have suggested, however, that significantly more than half of physicians charge in excess of the usual, customary, and reasonable fees used by insurers for specific procedures—rendering the usual customary, and reasonable something other than that.)"²⁴
  
• "Serious complications may result after laser resurfacing, however, and may be due to various factors, including surgeon inexperience, inappropriate or inadequate postoperative wound management, and individual patient characteristics."²⁵
  

In 10 short years, the Archives of Facial Plastic Surgery has brought much credit to our specialty by being its sound, rational, and impartial voice. Its virtues are those of the specialty, and its limitations are solely those of our imagination. Let us follow its example by remembering the importance of balance in our practices and our lives.

AUTHOR INFORMATION
Correspondence: Dr Reiter, Department of Otolaryngology–Head and Neck Surgery, Thomas Jefferson University Hospital, 925 Chestnut St, Sixth Floor, Philadelphia, PA 19107 (david.reiter{at}jefferson.edu).

Financial Disclosure: None reported.