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Background The methodological quality of open access studies has long been questioned due to increasing popularity and accessibility. The objective of this study is to compare the methodological quality of open access versus traditional journal publications in the plastic surgery literature. Methods Four traditional plastic surgery journals with their sister open access journals were chosen. For each of the eight journals, 10 articles were randomly selected for inclusion. Methodological quality was examined using validated instruments. Publication descriptors were compared to methodological quality values using ANOVA. Logistic regression was used to compare quality scores between open access and traditional journals. Results There was a wide distribution of levels of evidence, with a quarter being level one. Regression of non-randomized studies indicated a significantly higher proportion of traditional journal articles were of high methodological quality (89.6%) when compared to open access journals (55.6%; p  < 0.05). This difference persisted in three quarter of the sister journal groups. No publication descriptions were associated with methodological quality. Conclusions Methodological quality scores were higher among traditional access journals. Higher degrees of peer review may be necessary to ensure appropriate methodological quality in open access plastic surgery publications. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Purpose This study aims to systematically assess body and facial aesthetic surgery before-and-after photography bias on Instagram. Methods An Instagram search using the term “plastic surgeon” was conducted on October 2020. The top 11 plastic surgeons’ accounts were selected, and the first 15 images were selected from these profiles pertaining to different anatomical locations. Each photo was analyzed by a blinded board-certified plastic surgeon utilizing a 5-domain clinical photography bias score. The domains covered: (1) photo quality; (2) photo background; (3) position; (4) exposure/coverage; (5) bias. Results The search strategy identified a total of 161 sets of before and after. The most common anatomical site posted was the nose ( n =47), followed by breasts ( n =37). The most common angles posted were anterior–posterior view ( n =61). The majority of images showed bias toward the post-operative image (70.8%). The main culprit with photo characteristics occurred due to there being a different post-operative background which was more flattering for the post-operative result ( n =46, p =0.006) and a different view or angle, which again, flattered the post-operative image ( n =36, p =0.02). Other factors that influenced the post-operative bias included photos of the patient covered with clothing ( n =15, p =0.014) or standing ( n =20, p =0.001), compared to a supine pre-operative image. Conclusion Before-and-after photography conditions in aesthetic surgery is biased toward the post-operative result on Instagram. This observation was noticed across all surgical anatomical areas. Accounts photographer tends to misrepresent the photo background, view of angle, patients pose or position, or covering certain body parts. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

A non-aesthetic post-abdominoplasty umbilicus is known to be a significant concern for many patients who consider this procedure, due to its central and visible location. The goal of this method is to minimize the visible scar and create a natural-looking and aesthetically pleasing umbilicus. In this multimedia article, we illustrate our technique that is both reproducible and easy to perform. It produces a scarless caudal aspect, pleasant depth, and natural superior hooding appearance to the post-op umbilicus. Limitations of this technique are discussed.Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.