Background Plastic surgeons are not as diverse as expected in relation to the increasingly diverse patient and medical student population. The authors assess the state of diversity in 8 primary surgical specialties in the United States and evaluate trends in research interest in diversity over the past 30 years. Methods Articles regarding diversity in surgery from 1990 to 2020 were systematically reviewed. The Association of American Medical Colleges Physician Specialty Data Reports and the Accreditation Council for Graduate Medical Education Data Resource Books provided resident/fellow and faculty data from 2011 to 2016. Trends were analyzed over time per specialty. Results From 1990 to 2020, a total of 199 publications related to diversity were identified among the various surgical specialties. Orthopedic surgery had significantly more publications per year compared with other specialties (P < 0.05). Every specialty demonstrated a significant increase in publications about diversity over time (P < 0.05). A majority of publications were related to sex rather than underrepresented in medicine topics. The proportion of female surgeons was significantly higher for plastic surgery than for orthopedic surgery and neurosurgery (P < 0.001). Plastic surgery exhibited the highest growth rate in female residents (+1.6% per year, P < 0.001). The proportion of underrepresented minorities composing surgical trainees has not significantly increased in any surgical specialty between 2011 and 2016 (P > 0.05). Conclusions Although diversity representation in surgery has somewhat improved, the rate is too slow to match the growing diversity of the US population. Outcomes have been disparate between specialties and demonstrate greater increases in sex equality relative to ethnic/racial equality. Evidence-based interventions need to be developed and implemented.

Background: Crowdsourcing uses online platforms to collect large data from laypersons and has been increasingly used over the past 5 years to answer questions about aesthetic and functional outcomes following plastic and reconstructive surgery. This systematic review evaluates crowdsourcing articles in plastic and reconstructive surgery based on study topic, participants, and effect size in the hopes of describing best practices. Methods: A systematic search strategy was developed with a licensed librarian and attending plastic surgeon to query all articles using crowdsourcing in plastic and reconstructive surgery. Covidence systematic review manager was used by two independent reviewers to import articles, screen abstracts, evaluate full texts, and extract data. Results: A search run on October 8, 2021, yielded 168 studies, of which 45 were ultimately included. Craniofacial surgery and aesthetic surgery collectively constituted over half of studies. Participants in plastic surgery crowdsourcing studies are more commonly from the United States, female, straight, 25 to 35 years old; have completed college; and earn $20,000 to $50,000 per year. Studies typically assessed aesthetic perceptions, cost approximately $350, ran a median of 9 days, included approximately 60 unique survey items, and included approximately 40 unique human images. Conclusions: Crowdsourcing is a relatively new, low-cost method of garnering high-volume data from laypersons that may further our understanding of public perception in plastic and reconstructive surgery. As with other nascent fields, there is significant variability in number of subjects used, subject compensation, and methodology, indicating an opportunity for quality improvement.

Background: Facial proportionality and symmetry are positively associated with perceived levels of facial attractiveness. Objective: The aims of this study were to confirm and extend the association of proportionality with perceived levels of attractiveness and character traits and determine differences in attractiveness and character ratings between "anomalous" and "typical" faces using a large dataset. Methods: Ratings of 597 unique individuals from the Chicago Face Database were used. A formula was developed as a proxy of relative horizontal proportionality, where a proportionality score of "0" indicated perfect proportionality and more negative scores indicated less proportionality. Faces were categorized as "anomalous" or "typical" by 2 independent reviewers based on physical features. Results: Across the ratings for all faces, Spearman correlations revealed greater proportionality was associated with attractiveness (ρ = 0.292, P < 0.001) and trustworthiness (ρ = 0.193, P < 0.001), while lesser proportionality was associated with impressions of anger (ρ = 0.132, P = 0.001), dominance (ρ = 0.259, P < 0.001), and threateningness (ρ = 0.234, P < 0.001). Mann-Whitney U tests revealed the typical cohort had significantly higher levels of proportionality (-13.98 versus -15.14, P = 0.030) and ratings of attractiveness (3.39 versus 2.99, P < 0.001) and trustworthiness (3.48 versus 3.35, P < 0.001). Conclusions: This study demonstrated that facial proportionality is not only significantly associated with higher ratings of attractiveness, but also associated with judgements of trustworthiness.Proportionality plays a role in evoking negative attributions of personality characteristics to people with facial anomalies.

Background: The authors’ group characterized the cranio-maxillo-facial workforce 10 years ago, revealing high levels of career satisfaction but significant gender disparity. This study provides an updated profile of the international cranio-maxillo-facial workforce. Methods: A 30-question electronic survey was distributed to 387 cranio-maxillo-facial surgeons with membership in the American Society of Craniofacial Surgeons, American Society of Maxillofacial Surgeons, and international Society of Craniofacial Surgery. Questions related to demographics, training background, practice setting, surgical volume, career satisfaction, and perceived discrimination. Independent samples t test was used to compare continuous variables. Results: The authors received 91 responses (response rate = 23.5%). The majority of respondents were White (n = 73, 80.2%), non-Hispanic (n = 85, 93.4%), heterosexual (n = 72, 79.1%), cisgender males (n = 74, 81.3%). Practice setting was primarily academic, 65.9% (n = 60) and group/hospital-based 88.3% (n = 68), with two-thirds of respondents practicing in the United States. Female surgeons reported earlier planned retirement (66 versus 70 years, P = 0.012) and more personal encounters with discrimination of any kind (69% versus 29%, P = 0.033). US craniofacial surgeons reported more racial and sexual orientation-based discrimination compared with non-US surgeons (P = 0.049 and P = 0.048, respectively). Older surgeons (>55 years old) reported less perceived gender discrimination (P = 0.041). There was no difference between subgroups in career satisfaction or likelihood of repeating/recommending a cranio-maxillo-facial fellowship. Conclusions: Female representation in cranio-maxillo-facial surgery on an international scale has increased over the past decade, but this study demonstrates persistent, disparate perception of workplace discrimination by gender, practice region, and age.

Cleft and craniofacial conditions often present with a variety of functional and esthetic sequelae optimally treated by a multidisciplinary approach. Diagnosis of such conditions pre- or postnatally may evoke parental uncertainty and anxiety, and an important primary consideration is the selection of a cleft and craniofacial team. Identifying an optimal team may be particularly important for developing long-term relationships with clinicians who will ideally work intimately with the family from diagnosis to adulthood. While families, parents, and providers should consider several factors, a dearth of evidence-based suggestions preclude critical appraisal of cleft and craniofacial teams. In this article, the authors summarize medical, surgical, and social considerations for selecting a cleft and craniofacial team to optimize patient outcomes and the family/caregiver experience.