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Mensuration and Mitigation of Gender-Based Disparity in Aesthetic Academia: How Can We Do Better?
Suvethavarshini Ketheeswaran, Brea Wiley, Kristen Broderick
Johns Hopkins University School of Medicine, Department of Plastic and Reconstructive Surgery

Background: Females have long been underrepresented in all surgical disciplines, particularly plastic surgery. The subspecialty of aesthetic plastic surgery is uniquely predominantly female. In this study, we sought to characterize the state of gender parity in aesthetic surgery academia by comparing gender authorship ratios in published literature as well as a comparison of the current number of practicing female and male plastic surgeons.
Methods: We conducted a retrospective study of peer-reviewed publications relating to Aesthetic/Cosmetic surgery from the Journal of Plastic and Reconstructive Surgery (PRS) and Annals of Plastic Surgery (APS) from January 2009 to December 2020. The title of publication, senior and first authors' names were extracted and gender of the first and senior authors was assigned by a gender determination application (Gender API). Gender was manually determined by 2 reviewers if the application accuracy was <70% or if the authorsí gender was unknown. First author:senior ratios were determined and recorded as follows- Male:Male (M:M), Female:Male (F:M), Male:Female (M:F), and Female:Female (F:F). Temporal trends of practicing plastic surgeons stratified by gender from 2009-2020 was obtained from the ACGME. Univariate, Multivariable logistic regression and Spearmanís rank correlation tests were used as appropriate.
Results: We identified 1025 articles that met the study inclusion criteria. Sixteen percent (n= 169) of first authors and 20% (n= 202) of senior authors were female. Obtained ratios include 46 F:F, 156 F:M, 123 M:F, and 700 M:M. The number of practicing female plastic surgeons was lower than male surgeons at the start of the study period but has been steadily increasing, with a positive correlation between year and female surgeons r(3) = .99, p = 0.01. In multivariable logistic regression, female senior authorship (OR 1.60; 95% CI, 1.083- 2.343; p <0.0001) and publication year (OR 1.54; 95% CI, 1.119-2.129; p <0.0001) were independently associated with female first authorship. In univariate analysis, Journal type (APS) (OR 1.07; 95% CI .8065-1.403; p > 0.05) did not influence the rate of female first authorship.
Conclusion: As compared to male first authors, female senior authors were more than one and half times as likely to include a female first author. To achieve gender parity in aesthetic academic surgery, men should mentor and include more female first authors.


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