The current COVID-19 pandemic has vastly impacted the health care system in the United States, and it is continuing to dictate its unprecedented influence on the education systems, especially the residency and fellowship training programs. The impact of COVID-19 on these training programs has not been uniform across the board, with plastic surgery residency and fellowship programs among the hardest hit specialties. Implementation of social distancing regulations has affected departmental educational activities, including preoperative, morbidity and mortality conferences and journal clubs; operating room educational activities; as well as the overall education of plastic surgery trainees in the United States. Almost all elective and semielective surgeries across the United States were suspended for a few months during the COVID-19 pandemic; this constitutes a significant portion of plastic surgery cases. Considering the current staged reopening policies, it may be a long time, if ever, before restrictions are completely lifted. In this paper, we review the multidimensional impact of the current COVID-19 pandemic on the training programs of plastic surgery residents and fellows in the United States and worldwide, along with some potential solutions on how to address existing challenges.

The global pandemic of coronavirus 2019, or COVID-19, has undeniably impacted all facets of healthcare, affecting both its function and provision. Due to the cessation of all non-emergent surgical cases in the USA and worldwide, the professional lives and practices of many physicians have been negatively affected. However, among different physicians and specifically plastic surgeons, cosmetic/aesthetic plastic surgeons have been disproportionately affected by the COVID-19 pandemic as the majority of their cases are semi-elective and elective. The ability to perform semi-elective and elective cases is dependent on state and local authorities' regulations, and it is currently uncertain when the ban, if ever, will be completely lifted. Financial constraints on patients and their future inability to pay for these procedures due to the COVID-19-related economic recession are things to consider. Overall, the goal of this unprecedented time for cosmetic/aesthetic plastic surgeons is for their medical practices to survive, to conserve cash flow although income is low to none, and to maintain their personal finances. In this paper, the authors review the financial impacts of the current COVID-19 pandemic on the practices of cosmetic plastic surgeons in the USA and worldwide, along with some potential approaches to maintain their practices and financial livelihoods.

A shared-decision making process that considers the patient's requests, the three-dimensional imagingbased diagnosis of the actual full-face deformity, and the risk-benefit profile of the existing surgical options could support the preoperative orthodontist-surgeon interaction when counseling patients and setting the surgical plan for maxillary repositioning. The difference between Western and Asian cultures regarding the aesthetic appeal of the zygomatic/malar region and facial profile should also be appraised.