Plastic Surgery Societies Research Articles

The use of Google Trends and Twitter data as a tool for evaluating public interest in hyaluronic acid eyelid filler

Google Trends and the Twitter Academic Research Product Tract (TARPT) are free, online tools that can be used to evaluate public interest in plastic surgery procedures. The aim of the study was to evaluate the correlation between online public interest in hyaluronic acid eyelid filler on two popular web platforms (Google and Twitter) and hyaluronic acid filler procedure volumes in the United States. The Google Trends database and the TARPT tool were used to calculate the number of annual Google searches and Twitter tweets, respectively, related to 10 search terms associated with hyaluronic acid eyelid filler injections from January 2010 to December 2020. Annual procedure volumes for hyaluronic acid filler injections were obtained from the American Society of Plastic Surgery (ASPS). Univariate linear regression was used to correlate Google searches to ASPS procedure volumes and Twitter tweet volumes to ASPS procedure volumes. Significant positive correlations were found between Google Trends data and ASPS procedure volumes for 8/10 search terms and between Twitter tweet volumes and ASPS procedure volumes for 6/10 search terms, respectively. Online public interest in eyelid filler related search terms increased significantly over time according to an exponential model (P < 0.0001). We observed statistically significant positive associations between public interest related to eyelid filler on two online platforms, Google and Twitter, and hyaluronic acid soft-tissue filler procedure volumes. The Google Trends and TARPT databases represent free information sources for surgeons that may be used to inform marketing and advertising decisions and to anticipate patient inquiries during the patient encounter. Information provided by the Google Trends and TARPT tools can be used by surgeons to (1) inform marketing and advertising strategies and (2) gain insight into which procedures patients are researching during a given time period, preparing them to best address the evolving needs of patients.

Effect of the COVID-19 Pandemic on Nonsurgical Cosmetic Procedure Interest

The COVID-19 pandemic caused many shifts in the national economy, job market, and healthcare sector, especially elective procedures such as in cosmetic plastic surgery. While there has been research in the changes in cosmetic plastic surgery since the start of the COVID-19 pandemic, there have been no study to date determining the changes in distinct sectors, such as nonsurgical plastic surgery procedures and the popular trends that may be more sensitive to changes to general public interest. The Google Trends tool was used to determine these changes in interest. Nonsurgical procedures were retrieved from the American Society of Plastic Surgery (ASPS) website, grouped into categories, such as neurotoxin, chemical peel, filler, hair removal, dermaplaning, skin laser treatment, skin tightening, and thread lift, and used as Google Trends search terms. Search term weekly data were collected from March 2018 to March 2020 and March 2020 to March 2022, divided by the start of the COVID-19 lockdown, and compared. After the start of the COVID-19 pandemic, the majority of nonsurgical procedures showed an increase in interest, with the most significant changes including neurotoxin procedures especially lip Botox, filler in the chin, cheek, jawline, tear trough, lip, and nose, skin-improving treatments, non-invasive forms of body contouring, and thread lift. Brands like Dysport, Radiesse, Restylane, Sculptra, Versa, Emsculpt, and Morpheus8 showed increased interest. Most nonsurgical procedures increased in interest after the COVID-19 lockdown, with facial and skin-improving procedures showing the most increase in interest.

Teaching Unilateral Cleft lip Repair: Lessons from Simulation-Based Mining of Trainee Strengths and Performance Gaps.

To identify specific areas for improvement in cleft lip repair teaching. Secondary analysis of prospectively-collected, blinded data. Three residency programs rotating at a single academic children's hospital. Plastic surgery residents, and craniofacial/pediatric plastic surgery fellows. Mean scores for each skill in an 18-item Unilateral Cleft Lip Repair competency assessment tool (UCLR) (1-3 scale for each item) were rank ordered. Correlation between level of training (PGY) and performance on steps of the procedure was examined using Pearson R. Simulation participants (n = 26) scored highest on skills in the "Marking" subscale (2.38-2.63 mean score). Procedural steps that scored lowest were: closing the nasal floor (2.00), repairing oral mucosa (2.15) and avoiding over/under-dissection (2.19). Interestingly, none of these skills correlated with PGY, suggesting they do not improve with training. These results suggest that marking cleft lip repair is taught well in our current teaching environment, while steps like closing the nasal floor and repairing the oral mucosa are taught less well. Improved teaching of these steps could be achieved with deliberate instruction, video, digital simulation, and high fidelity simulation.

Warren B. Davis and the Birth of Plastic Surgery in Philadelphia: A Historical Vignette.

The field of plastic surgery, formally organized in 1931 with the founding of the American Society of Plastic and Reconstructive Surgery, was shaped in many ways by a small practice of Philadelphia physicians. At the center of the practice was Warren B. Davis, a Philadelphia otolaryngologist and plastics pioneer whose innovations in cleft palate surgery would lead to significant improvements in functional and cosmetic outcomes in his time. In addition to his own innovations, Davis was responsible for the training of John Reese, the inventor of the Reese dermatome that changed the face of burn medicine during World War II. Aside from his contributions to surgery and the founding of the American Society of Plastic and Reconstructive Surgery, Dr. Davis was also the founder and first editor of the Plastic and Reconstructive Surgery journal which to this day is the premiere, authoritative journal of plastic surgery. Lastly, Dr. Davis established a plastic surgical practice, now Jefferson Plastic Surgery. Unique in its longevity, this practice would continue to shape the field of plastic surgery and continues to improve lives today-109 years after its founding in 1913.

Gender Disparities and Differences Among Urologists Included in Top Doctor Lists

To understand gender trends among urologists included in "Top Doctor" lists as more women practice urology, we (1) Evaluated whether Top Doctor lists reflect a contemporary distribution of urologists by gender; (2) Describe regional differences in gender composition of lists; (3) Report similarities and differences among men and women Top Doctors. All urologists in regional Top Doctor Castle Connolly lists published in magazines between January 1, 2020 and June 22, 2021 were included. Physician attributes were abstracted. American Urological Association (AUA) census data was used to compare the number of men and women Top Doctor urologists to the number of practicing men and women urologists within each list's zip codes. Log odds ratios (OR) and (95% confidence intervals) were used to compare likelihood of list inclusion by gender overall and by region. Four hundred and ninety-four Top Doctor urologists from 25 lists were analyzed, of which 42 (8.50%) were women. Women urologists comprised 0%-27.8% of each list, with 7 lists (28.0%) including zero women urologists. Using AUA census data, OR for list inclusion of men urologists compared to women was 1.31 (1.01, 1.70) overall, with OR=0.78 (0.36, 1.72) in the West, OR=1.39 (1.03, 1.89) South, OR=1.46 (0.8, 2.67) Northeast, OR=1.90 (0.50, 7.18) Midwest. Women top urologists completed fellowship more often than men (66.7%, 55.1%) and were significantly more likely to complete female pelvic medicine and reconstructive surgery (FPMRS) fellowship (P <.001). Men urologists were significantly more likely to be included in Top Doctor lists than women urologists. Top women urologists were significantly more likely to complete FPMRS fellowship.

Orbital Compartment Syndrome in Severe Burns: Predictive Factors, Timing, and Complications of Intervention.

Severe burn patients require high-volume fluid resuscitation, which increases risk for orbital compartment syndrome (OCS). We aimed to understand surgeons' practice patterns and to examine risk factors for OCS, timing of lateral canthotomy and cantholysis (LCC), and complications of intervention. A survey of American Society of Ophthalmic Plastic and Reconstructive Surgery and North American Society of Academic Orbital Surgeons' practice patterns in burn patients was undertaken. In addition, a retrospective analysis was conducted of 107 patients with burns greater than 20% total body surface area at 1 institution from January 1, 2009, to June 1, 2018. Patients with Stevens-Johnson Syndrome or Toxic Epidermal Necrolysis, frostbite, or no ophthalmologic consultation were excluded. Risk factors for OCS, timing of LCC, and complications of the intervention were examined. In the survey, 37 of 54 respondents had treated burn patients, of which 29 followed no protocol. Threshold intraocular pressure for intervention varied widely, and nearly all reported having seen complications from LCC in burn patients. For the retrospective analysis, 107 patients met criteria, of which 22 (20.6%) required LCC. Renal failure, inhalation injury, eyelid burns, higher total body surface area, elevated lactate, increased number of escharotomies, and greater total fluid required were significantly associated with the clinical decision that the patient was at risk for OCS requiring LCC. Fluid resuscitation in excess of the Ivy Index (250 ml/kg) increased odds of LCC 8.6 times. Average time of LCC was 15.8 hours after burn. LCC patients experienced higher rates of complications including eyelid retraction, exposure keratopathy, and corneal ulceration. Severe burn patients should be monitored closely by an ophthalmologist during the first 48 hours for signs of OCS. Further studies should aim to recommend protocols guiding evaluation and intervention.

SBCP Mission to Macapá, Brazil

In 2012, the Brazilian Society of Plastic Surgery (SBCP) planned two missions to Amapá state in the northern region of Brazil to assess and treat women who had suffered scalp avulsion from boating accidents. Under the leadership of Drs. Pedro Martins and Luciano Chaves (the coordinators of the

Calf Augmentation and Volumetric Restoration: A Systematic Review and Meta-analysis

PURPOSE: According to the American Society of Plastic Surgery (ASPS) National Clearinghouse of Procedural Statistics, 655 documented calf augmentation cases were reported during 2018 in the United States, representing a 27.43% increase from 2015. Due to the recent attention that has been brought to the aesthetics of the leg, outcomes in the literature are underreported and require further investigation. We summarized the available evidence on the surgical techniques to augment the volume and dimension of the calf based on clinical outcomes and satisfaction rates METHODS: An electronic search was conducted across PubMed MEDLINE, Web of Science, Scopus, and Ovid MEDLINER(R) in accordance with the PRISMA statement. Data collection included the patients’ characteristics, surgical techniques, and postoperative outcomes. Satisfaction among patients was determined when satisfaction was stated above a numeric threshold in a score or when a patient was explicitly reported to be ‘satisfied’. Pooled estimates were calculated with a random-effect meta-analysis using the DerSimonian-Laird model. RESULTS: Forty-eight studies were included in the systematic review. We included 2455 patients. 508 were males (20.7%) while 1176 were females (47.9%). The average age and follow-up were 33.15 years and 33.58 months, respectively. Unilateral calf augmentation was reported in 446 patients (18.16%), while 1565 patients (63.74%) received a bilateral calf augmentation. The indications for calf augmentation were aesthetic concerns in 1196 patients (48.7%) and reconstructive in 558 patients (22.7%). The most common technique for calf augmentation was subfascial implant placement (70.2%) followed by fat transfer (17.6%), submuscular implant placement (10.1%), fasciotomy only (1.71%), reconstruction with free flaps (0.12%), dermal-fat graft (0.04%), subcutaneous implant placement (0.08%) and non-specific implant (0.04%). Overall, the pooled satisfaction rate following calf augmentation was 95.4% (95%CI 93.7%- 97%). The pooled satisfaction rate for implant placement and fat transfer was 96.7% (95%CI 94.4%-97.9%) and 87.2% (95%CI 78.5%-96%), respectively. The most common complications following subfascial implant placement were seroma formation (3.83%), hyperpigmentation or hypertrophic scar formation (2.9%), and pain or discomfort (2.14%). The most common complications after lipotransfer were asymmetry or contour irregularities (4.16%) and pain or discomfort (2.54%). The pooled incidence of implant removal was 1.3% (95%CI 0.7%-2%). The pooled estimate for additional fat grafting procedures following initial fat transfer was 54.1% (95%CI 38.3%-70%). From the patients who underwent reconstruction with a free flap, one patient required the revision of the anastomosis (33.33%) and one had significant blood loss (33.33%). CONCLUSION: Overall, calf augmentation is a safe procedure. Subfascial placement of the implant was the most common technique as it is less invasive and reproducible. However, the rate of minor and major complications may be higher in comparison to other procedures. Fat grafting can be used to improve the outcomes following implant placement. When fat grafting is implemented as a single surgical modality the volumetric expansion is modest versus implant placement, and further fat grafting is required in almost half of cases to achieve satisfactory outcomes.

Pediatric septorhinoplasty: Current attitudes and practices by facial plastic and reconstructive surgeons

ObjectiveThere is hesitation to offer pediatric patients rhinoplasty due to concerns about postoperative effect on midface growth. A cross-sectional survey of members of the American Academy of Facial Plastic and Reconstructive Surgery was conducted regarding practice information and attitudes towards pediatric septorhinoplasty. The goal of the study is to describe the current attitudes on pediatric septorhinoplasty. Study designCross-sectional survey. SettingCommunity members of the American Academy of Facial Plastic and Reconstructive Surgery society. MethodsA 19-question survey was distributed to surgeons surveying background information and current attitudes towards pediatric septorhinoplasty practices. Fisher's exact tests were implemented using Monte Carlo methods. ResultsThere were 94 total respondents. A majority believed septorhinoplasty is safe in patients <16 years of age (n = 68, 72.34 %) with most choosing either 16 years (n = 30, 31.91 %) or 14 years (n = 29, 30.85 %) as the minimum age to consider the procedure. A majority of respondents would not perform any nasal procedures in patients ≤12 years (n = 40, 43.48 %). ConclusionTrends in pediatric rhinoplasty practices have evolved overtime. Despite prior beliefs and studies cautioning against performing septorhinoplasty in pediatric patients (<16 years of age), a majority of practicing facial plastic surgeons believe that pediatric septorhinoplasty can be performed in patients >14 years old.Level of evidence.IV.

Proposal of an informed consent form to obtain audiovisual material from patients

An informed consent is mandatory to obtain any clinical audiovisual material from patients. Although there are some documents created for this purpose, there are some barriers for their application, such as the context in which they were created, the language and download availability. To create a proposal for an informed consent form (ICF) for the capture and different uses for audiovisual material from patients. A bibliographic search was carried out to obtain different ICFs in Spanish and English, which were subjected to a process of translation, counter-translation and fragmentation. Subsequently, a panel of experts was formed by members of the Chilean Society of Plastic Surgery with extensive experience in social networks. Delphi methodology was applied to reach a consensus about the definitive content of the ICF based on the previously selected fragments. ICFs available for download were identified. The panel was made up of seven Plastic Surgeons and two Delphi rounds were carried out through electronic surveys. At the end of the process, an ICF proposal was obtained for therapeutic, academic or scientific purposes and another for dissemination or education in the mass media. The proposed ICFs were liberated for their use among health care professionals in Chile, who could use them, provided that they are approved by the local healthcare ethics committees.

Differences in Applicant Perceptions of Virtual Interviews Between Integrated Plastic Surgery and Subspecialty Fellowship Applicants

We aim to survey and compare integrated plastic surgery and plastic surgery subspecialty fellowship applicants on their experiences with virtual interviews and to determine if there are differences between them. An IRB-approved survey study was conducted using the Qualtrics platform. The study was conducted at the Johns Hopkins University and the R Adams Cowley Shock Trauma Center in Baltimore Maryland. Applicants that applied to 1) the Johns Hopkins/University of Maryland or the University of California San Diego integrated plastic surgery residency programs, 2) craniofacial surgery fellowship, and 3) microsurgery, hand surgery, or burn surgery fellowship at the Johns Hopkins University were selected to participate in the survey. A total of 94 surveys were completed by residency applicants and 55 by fellowship applicants. After the interview season, 80% of fellowship applicants recommended virtual interviews compared to 61.7% of residency applicants (p = 0.03). Fellowship applicants reported significantly less issues with self-advocacy and did not view the virtual interview process as significant of a detriment when meeting program residents/staff, viewing the hospital/surrounding area, and learning about the program (p < 0.05). A higher percentage of fellowship applicants interviewed at multiple programs during a single day compared to residency applicants (56.4% vs 27.7%; p < 0.001). A higher proportion of fellowship applicants prefer virtual interviews, which associated with key differences in perceptions, expectations, and priorities. Our data supports that fellowship programs may wish to continue virtual interviews even after COVID-related restrictions are lifted, because fellows are equally able to self-advocate in a virtual format while benefiting from cost and time savings; fellowship programs would also gain the cost and time savings from this model as well.

Editorial introductions.

Editorial introductions.

ESPRAS Survey on Continuing Education in Plastic, Reconstructive and Aesthetic Surgery in Europe.

Specialty training in plastic, reconstructive and aesthetic surgery is a prerequisite for safe and effective provision of care. The aim of this study was to assess and portray similarities and differences in the continuing education and specialization in plastic surgery in Europe. A detailed questionnaire was designed and distributed utilizing an online survey administration software. Questions addressed core items regarding continuing education and specialization in plastic surgery in Europe. Participants were addressed directly via the European Leadership Forum (ELF) of the European Society of Plastic, Reconstructive and Aesthetic Surgery (ESPRAS). All participants had detailed knowledge of the organization and management of plastic surgical training in their respective country. The survey was completed by 29 participants from 23 European countries. During specialization, plastic surgeons in Europe are trained in advanced tissue transfer and repair and aesthetic principles in all parts of the human body and within several subspecialties. Moreover, rotations in intensive as well as emergency care are compulsory in most European countries. Board certification is only provided for surgeons who have had multiple years of training regulated by a national board, who provide evidence of individually performed operative procedures in several anatomical regions and subspecialties, and who pass a final oral and/or written examination. Board certified plastic surgeons meet the highest degree of qualification, are trained in all parts of the body and in the management of complications. The standard of continuing education and qualification of European plastic surgeons is high, providing an excellent level of plastic surgical care throughout Europe. Die Facharzt-Weiterbildung für Plastische und Ästhetische Chirurgie ist eine Grundvoraussetzung für sichere und effektive Patientenversorgung. Ziel der vorliegenden Studie war die Darstellung von Gemeinsamkeiten und Unterschieden in der Weiterbildung für Plastische Chirurgie innerhalb von Europa. Ein internetbasierter Fragebogen wurde mit Hilfe eines kostenlosen Formularerstellungstools erstellt und verteilt. Die Fragen betrafen Kernpunkte der Weiterbildung für Plastische Chirurgie in Europa. Die Teilnehmer wurden direkt über das European Leadership Forum (ELF) der European Society of Plastic, Reconstructive and Aesthetic Surgery (ESPRAS) kontaktiert. Alle Teilnehmer hatten weitreichende Kenntnisse über die Organisation und Struktur der plastisch-chirurgischen Weiterbildung in ihrem jeweiligen Land. 29 Teilnehmer*innen aus 23 europäischen Ländern nahmen an der Umfrage teil. Die Weiterbildung für Plastische Chirurgie beinhaltet grundlegende Prinzipien und Techniken zur Wiederherstellung von Form und Funktion innerhalb der verschiedenen Säulen der Plastischen Chirurgie, sowie in allen Körperregionen. In den meisten europäischen Ländern ist eine Rotation in der Intensiv- und Notfallmedizin und die Behandlung kritisch kranker Patienten obligatorisch. Voraussetzung für die Facharztbezeichnung ist die mehrjährige, national organisierte Weiterbildung, der Nachweis einer festgelegten Anzahl selbstständig durchgeführter Operationen, sowie die mündliche und/oder schriftliche Abschlussprüfung. Fachärzte für Plastische und Ästhetische Chirurgie sind hochqualifiziert und auch im Umgang mit Komplikationen geschult. Der Standard der Weiterbildung der europäischen Plastischen Chirurgen ist hoch, so dass innerhalb Europas eine hohe Qualität plastisch-chirurgischer Versorgung gewährleistet ist.

Continuing Education in Plastic, Reconstructive and Aesthetic Surgery in Europe and its Relevance for Patient Safety

Dear Readers,In this issue, the European Society of Plastic, Reconstructive and Aesthetic Surgery (ESPRAS) has dealt with the quality of continuing education in plastic surgery in Europe in the form of an “ESPRAS Survey”. An overview of the high quality criteria that are necessary in all countries in order to successfully complete specialist training in plastic and aesthetic surgery is summarised clearly and in detail. In Europe, as in Germany, specialist training generally includes training in all body regions, a training period of about 6 years, a rotation in intensive care units for the care of critically ill patients as well as surgical catalogues and specialist examinations.

Impact of the Virtual Format on Plastic Surgery Residency and Fellowship Interviews: A National Cross-Sectional Study.

The 2020 to 2021 residency and fellowship application cycles were profoundly affected by the introduction of virtual interviews. The authors investigated the impact the virtual format had on plastic surgery residency and fellowship interviews from the perspectives of program directors. Surveys were sent to program directors of integrated plastic surgery residency and fellowship programs to ascertain their perspectives regarding the virtual format's impact on residency and fellowship interviews. Program directors were stratified into residency and fellowship cohorts, and comparative analysis was performed. Ninety-two program directors, 28 from integrated plastic surgery residency programs and 64 from fellowship programs, completed our survey (35 percent). Compared to in-person interviews, virtual interviews were reported to be more economical and time efficient by program directors of residency (100 percent and 46 percent, respectively) and fellowship programs (97 percent and 48 percent, respectively). Consequentially, 36 percent and 47 percent of residency and fellowship programs were able to interview more applicants, respectively. Program directors of residency and fellowship programs reported that virtual interviews hindered their ability to assess applicants' fit with the program (75 percent and 63 percent, respectively), personality and communication skills (75 percent and 64 percent, respectively), and commitment to the field, along with their ability to function as a trainee (57 percent and 50 percent, respectively). Overall, 71 percent of program directors of residency and 58 percent of program directors of fellowship programs preferred in-person interviews. The majority of residency (71 percent) and fellowship (56 percent) program directors intend to conduct both in-person and virtual interviews in future application cycles ( p = 0.12). Despite preferring in-person interviews, program directors intend to host both in-person and virtual interviews in future application cycles. It remains to be seen how virtual interviews will be used moving forward.

Perceived Barriers to Increasing Diversity within Oculofacial Plastic Surgery.

Purpose Physician diversity is limited in ophthalmology and oculofacial plastic surgery. Determination of barriers within the application process for oculofacial plastic surgery may help target efforts to improve the recruitment of underrepresented groups. This study aimed to illuminate perceived barriers to increasing diversity in oculofacial plastic surgery trainees, according to the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) fellows and fellowship program directors (FPDs). Methods During the month of February 2021, we sent surveys out to 54 current oculofacial plastic surgery fellows and 56 FPDs at 56 oculofacial plastic surgery programs recognized by the ASOPRS nationwide using a 15-question Qualtrics survey. Results Sixty-three individuals (57%) responded to the survey: 34 fellows (63%) and 29 FPDs (52%). Eighty-eight percent of fellows and 68% of FPDs identified as non-underrepresented in medicine (UiM). Forty-four percent of fellows and 25% of FPDs identified as men. FPDs most commonly noted, "Not enough minorities applying to our program" and "The objective data (Ophthalmic Knowledge Assessment Program score, United States Medical Licensing Examination Step scores, clinical honors, Alpha Omega Alpha status, letter of recommendation) for minority applicants often do not meet the threshold required to offer an interview or to be ranked to match" as barriers. Among fellows, the lowest-rated considerations when applying to oculofacial plastic surgery were "Racially/ethnically diverse faculty" and "Perceptions of minority candidates by fellowship programs," whereas "Likelihood of matching in program of choice" was ranked highest in considerations. Fellows identifying as men indicated greater concern for "Financial factors related to fellowship (e.g., loans, salary, cost of living, or cost of interviewing)" compared to fellows identifying as women who noted greater concern for "Program or preceptor acceptance of starting or having a family during fellowship." Conclusion Responses from FPDs suggest that efforts focused on recruiting and supporting diverse students to medicine and ophthalmology, mentoring applicants interested in oculofacial plastic surgery, and restructuring the application process to decrease bias, may improve diversity within the subspecialty. The lack of UiM representation in this study, 6% fellows and 7.4% FPDs identified as UiM, shows both the stark underrepresentation and the need for further research into this topic.

An Analysis of Ophthalmic Plastic and Reconstructive Surgery Fellowship Program Directors in the United States.

PurposeThis study aims to examine the demographic features, academic backgrounds, and scholarly achievements of ophthalmic plastic and reconstructive surgery (OPRS) fellowship program directors (PDs) in the United States.MethodsIn this cross-sectional analysis, publicly accessible sources were accessed in March 2022 to collate the demographic and academic profiles of PDs of American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS)-accredited OPRS fellowships. Differences by gender and program rank were assessed using the Mann-Whitney Utest.ResultsFifty-four PDs were identified, the majority of whom were males (88.89% (n = 48)). The average age was 58.48 years. Of the PDs, 96.3% (n = 53) obtained a medical degree, and all completed residency training in the United States. In addition, 9.26% (n = 5) had another degree, either a Doctor of Philosophy (n = 3) or master’s degree (n = 2). A substantial proportion of individuals completed medical school (20.37% (n = 11)), residency (20.37% (n = 11)), or fellowship (31.48% (n = 17)) at an institution affiliated with the program where they were PDs. The most common additional fellowship obtained was neuro-ophthalmology (16.67% (n = 9)). The average h-index was 19.30 (range, 0-60), average five-year h-index was 4.85 (range, 0-36), and average m-quotient was 0.63 (range, 0-2.22). A significant difference in the median five-year h-index was observed between females and males (7 (range, 3-36) versus 4 (range, 0-10); p= 0.038).ConclusionsThis analysis indicated that OPRS PDs in the United States were principally males with extensive scholarly productivity. As women remain underrepresented in OPRS, increased gender parity at this leadership position should be encouraged in order to expand the recruitment of women into the field.

Linguistic Differences by Gender in Letters of Recommendation for Female Pelvic Medicine and Reconstructive Surgery Fellowship Applicants From 2010 to 2020.

Linguistic differences suggestive of gender bias have been detected in letters of recommendation (LOR) for female and male residency and fellowship program applicants within multiple medical specialties. The aim of the study was to determine whether linguistic differences exist in LOR for female and male physicians applying to female pelvic medicine and reconstructive surgery (FPMRS) fellowship. A retrospective analysis of FPMRS fellowship applications submitted to a university-affiliated academic center from 2010 to 2020 was performed. Linguistic Inquiry and Word Count, a text analysis software, was used to characterize the linguistic content of letters. Multivariable analysis was used to compare letter characteristics with applicant and letter writer demographics. Of 306 applications reviewed, 221 (72.2%) applicants were female and 85 (27.8%) were male. Of the 1,062 letters analyzed, 457 (43.0%) were written by female letter writers, 586 (55.2%) by males, and 19 (1.8%) were a combination. Multivariable analysis controlling for race, Step 1 score, and letter writer gender demonstrated more frequent use of affiliation words for female applicants compared with males (3.1% ± 0.3 vs. 2.9% ± 0.3, P = 0.02). No additional differences were noted in average letter length or all other linguistic categories analyzed. Multiple differences were detected between writing styles of female and male letter writers, including average letter length, use of multiple word categories, and use of communal (relationship-oriented) language. Data were stratified into 2-year periods and no longitudinal trends in linguistic differences were detected. No linguistic differences, suggestive of gender bias, were found between female and male applicants to FPMRS fellowship.

A Descriptive Analysis of Integrated Plastic Surgery Residency Program Directors in the United States.

The role sex plays in surgical leadership positions is heavily discussed in the literature; however, there is an absence of research looking at plastic surgery program director (PD) demographics and the differences between male and female PDs. A cross sectional study of publicly available online resources of all integrated plastic surgery residency programs was performed. Demographic and academic data of integrated plastic surgery PDs was analyzed focusing on the differences in PDs based on sex. Eighty-two integrated plastic surgery residencies were analyzed. Fifteen PDs (18.3%) were female. Fifty-six (68%) PDs completed general surgery residencies, whereas 24 (29%) completed an integrated plastics residency. All female PDs were fellowship trained, whereas only 46 (68%) male PDs pursued additional training after residency ( P = 0.02). Research output among male PDs was greater with 49.9 publications and a higher average H-index, at 13.3, compared with women with an average of 27.5 publications ( P = 0.008) and an H-index of 8.7 ( P = 0.02). When comparing male to female PDs, there was no difference between age at PD appointment ( P = 0.15), or in the amount of time between completion of plastic surgery training to PD appointment ( P = 0.29). Male PDs were older (52.2) compared with female PDs (46.5) ( P = 0.02). Male PDs served longer terms (4.98 years) than female PDs (2.87 years) ( P = 0.003). The majority of integrated plastic surgery PDs are men with a Doctor of Medicine degree who completed a general surgery residency and a plastic surgery fellowship. Most PDs also completed fellowship in a plastic subspecialty. Male PDs had higher research output, which may be attributed to their older age on average. Although women make up only 18.3% of plastic surgery PDs, this percentage is similar to the 17.2% of active female plastic surgeons in the United States. As more women train in plastic surgery, it is possible that the percentage of women serving academic leadership roles will increase. By gaining a better understanding of the demographics and diversity in plastic surgery residency program leadership, efforts can be made to increase the representation of minority groups in academic leadership roles.

2. A Descriptive Analysis of Integrated Plastic Surgery Program Directors

Background: The role gender plays in surgical leadership positions is heavily discussed in the literature, however there is an absence of research looking at plastic surgery program director (PD) demographics and the differences between male and female PDs. Methods: A cross sectional study of publicly available online resources of all integrated plastic surgery residency programs was performed. Demographic and academic data of integrated plastic surgery PDs was analyzed focusing on the differences in PDs based on gender. Results: 82 integrated plastic surgery residencies were analyzed. 15 PDs (18.3%) were female. 56 (68%) PDs completed general surgery residencies, while 24 (29%) completed an integrated plastics residency. All female PDs were fellowship trained while only 46 (68%) male PDs pursued additional training after residency (p=0.02). Research output amongst male PDs was greater with 49.9 publications and a higher average H-index, at 13.3, compared to women with an average of 27.5 publications (p=0.008) and an H-index of 8.7(p=0.02). When comparing male to female PDs, there was no difference between age at PD appointment (p=0.15), or in the amount of time between completion of plastic surgery training to PD appointment (p=0.29). Male PDs were older (52.2) compared to female PDs (46.5) (p=0.02). Male PDs served longer terms (4.98 years) than females (2.87 years) (p=0.003). Conclusion: The majority of integrated plastic surgery PDs are male with an M.D. who completed a general surgery residency and a plastic surgery fellowship. Most PDs also completed fellowship in a plastic subspecialty. Male PDs had higher research output, which may be attributed to their older age on average. Although females make up only 18.3 % of plastic surgery PDs, this percentage is similar to the 17.2% of active female plastic surgeons in the U.S. As more women train in plastic surgery, it is possible that the percentage of females serving academic leadership roles, will increase. By gaining a better understanding of the demographics and diversity in plastic surgery residency program leadership, efforts can be made to increase the representation of minority groups in academic leadership roles.