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Introduction: In orthopaedic surgery, limited research is available addressing how attire, including white coats (WC) and feminine attire such as skirts, affects patient perceptions. It is unknown how surgeon appearance is associated with identification as a surgeon and perception of clinical skills, nor whether this differs between male and female surgeons. Methods: An image-based survey was offered to all adult patients in four orthopaedic surgeons' sport medicine or foot and ankle clinics. Respondents viewed 10 photos of male and female models in varying attire and identified that individual's most likely role on the healthcare team. Then, in 10 photos pairs, respondents selected which surgeon showed more competence, ability to excel in performing the physical components of surgery, likelihood to provide a good surgical outcome, and trustworthiness. Results: Two hundred thirty-eight patients participated in the survey. Men were identified as surgeons significantly more frequently than women in similar clothing ( P < 0.05) for all attire except a business attire without a WC (men: 18.2% vs women: 11.2%; P = 0.252). Patients ranked physicians wearing a WC with any attire as more competent and more likely to give a good surgical outcome than those without (all P < 0.005). Patients found women in feminine attire significantly less likely to excel in performing the physical parts of surgery than women in scrubs ( P = 0.001). Discussion: Women surgeons who wear feminine business attire instead of scrubs may be perceived less able to perform the physical work of operating, but are otherwise rated comparably with their peers, both male and female. Surgeons wearing WC are generally perceived more favorably than those without WC, an effect that is magnified for perceptions of competence for female surgeons. Men are more readily identified as surgeons than women when wearing a similar attire, except for a business attire without WC. There are continuing differences in how patients perceive male and female orthopaedic surgeons based on their attire.