Shaping the Future: A 9-year National Analysis of Aesthetic Surgery Training in Plastic Surgery Residency

Background: Aesthetic surgery is a core competency within plastic surgery training. In 2014, the Accreditation Council for Graduate Medical Education (ACGME) raised the minimum required aesthetic cases from 50 to 150. Since then, no comprehensive national analysis of aesthetic case logs has been performed. The goal of this study is to characterize the aesthetic operative experience among US plastic surgery residents over a 9-year period. Methods: A retrospective cohort study of ACGME case logs was performed for all graduating plastic surgery residents from 2014 to 2023. Primary outcomes included total aesthetic case volumes, analyzed across aesthetic subcategories and stratified by training pathway (integrated versus independent), sex, underrepresented minority (URM) status, program size, geographic region, and relation to the COVID-19 academic year. Results: A total of 1902 residents (1043 integrated; 859 independent) were included. Average total aesthetic case volume increased from 493 cases in academic year 2014/2015 to 618 in academic year 2022/2023 ( P = 0.030). No evidence of a difference in total aesthetic cases was found between integrated and independent residents (560 versus 541, respectively, P = 0.319). Men and women logged similar total aesthetic case volumes ( P = 0.409), as did URM residents compared to non-URM trainees ( P = 0.400). No detectable differences in volume were found based on program size ( P = 0.296). Graduates of programs in the Northeast and South, and postpandemic trainees reported significantly higher case volumes. Conclusions: Aesthetic case exposure has increased over time with residents exceeding ACGME case minima. No evidence of a difference was found with respect to gender, URM status, training pathway, and program size, suggesting equitable aesthetic exposure in plastic surgery training.