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Latin American individuals represented 8.8% of that group, African Americans represented 6.3%, Asian Americans represented 4.5%, and all other groups represented 1.9%. The ASPS president, Richard A. D'Amico, states that the plastic surgery patient profile is changing, and whereas the majority of patients remain Caucasian women, cosmetic plastic surgery procedures were performed on almost as many Latin American patients as on male patients.3 As a result of this surge, minority patients requesting cosmetic procedures are becoming an increasingly important patient base in aesthetic surgery.Moreover, the ASPS reported that between 2006 and 2007, ethnically oriented cosmetic surgical procedures grew at almost twice the rate of cosmetic surgical procedures at large (annual increases of 13% and 7%, respectively). This was primarily driven by strong growth in procedures customized for Latin Americans, African Americans, and Asian Americans (.3Source: American Society of Plastic Surgeons. Cosmetic plastic surgery procedures for ethnic patients up 13 percent in 2007. Available at: for-Ethnic-Patients-Up-13-Percent-in-2007.cfm. Accessed April 1, 2008.The most common procedures sought out collectively across these groups were liposuction, Botox® botulinum toxin type A, and chemical peels. Rhinoplasty was the most common in African Americans and in Middle Eastern ethnic groups, breast augmentation for Latin Americans, and blepharoplasty for Asian Americans. Increases in these demographic categories are considerably higher when compared with ASPS data from 2000. Since then, cosmetic plastic surgery procedures have increased 173% in Latin Americans, 129% in African Americans, and 246% in Asian Americans.3 The ASPS largely attributes these increases to improved public awareness and acceptance of the field (and its benefits) along with escalating economic power within ethnic groups. Historically, cosmetic surgery has not been as widely accepted in ethnic populations. This is mainly because in the past, many ethnic individuals believed that cosmetic surgery equaled sacrificing aspects of their ethnicity. However, for minorities, cosmetic surgery is no longer viewed as a sign of self-hatred or a rejection of racial identity.6 In fact, the goal of many ethnic women has shifted and is now to enhance their natural ethnic beauty.7 Non-Caucasian patients presenting for cosmetic surgery tend to have similar motivations and desires as those of their Caucasian counterparts, such as diminishing the appearance of aging, improving body contour and definition, enhancing symmetry, and modifying tissue volume. In fact, many of the commonly requested procedures do not vary significantly with race (i.e., liposuction, breast reduction, Botox, and injectable fillers). backgrounds included Asian, American Indian, black, Hispanic, and white, and were organized into white and nonwhite groupings. U.S. Census Bureau standards on race and ethnicity were used for regional ethnic classifications, with individuals of Latino or Hispanic descent classified singularly under the Hispanic heading.16 Documentation of faculty size and size of city of practice were made with continuous variables calculated from the total faculty size listed on program websites and city population noted on U.S. Census 2017 Population Estimates.17 Association of American Medical Colleges estimates of academic surgery representation were retrieved from the 2017 U.S Medical School Faculty Survey.18 Postresidency clinical fellowship training was organized into aesthetic surgery, craniofacial surgery, hand surgery, microsurgery, and “other.” Individuals who led their division or department of plastic surgery were grouped under the single term of “chair” to indicate their leadership position. Historical leadership data highlighting presidential leadership for professional societies were collected from website listings of the American Association of Plastic Surgeons, the American Society of Plastic Surgeons, and the Plastic Surgery Research Council. Leadership positions, including residency director and fellowship director, were confirmed for accuracy using San Francisco Match listings. Data collected at the program level included faculty size, population of co-located city, and size of academic organization (department or division). Analysis The t test was used to test comparisons of continuous faculty characteristics. Exceptions included year of residency training completion and number of years of postresidency experience, which were both assessed by Wilcoxon rank sum test because of their nonnormal distribution. Categorical comparisons of academic rank, advanced degree attainment, sex, leadership positions, race, region of practice, type of plastic surgery training, and subspecialty or research fellowship completion were performed by Pearson chi-square analysis. For categories that did not have enough observations 270 Plastic and Reconstructive Surgery • January 2020 to meet Pearson chi-square specifications, Fisher’s exact test was used. Additional calculation of odds ratio was performed for all Pearson chi-square and Fisher’s exact tests. Adjustment of odds ratios to compensate for unequal distribution of years of postresidency experience was completed by use of multivariate logistic regression models with measurement of the area under the receiver operating characteristic curve and area under the receiver operating characteristic Wald confidence intervals. Programs were further classified into those that had a white chair (n = 74) and those that had a nonwhite chair (n = 25) to measure the influence of leadership ethnicity on nonwhite hiring and advancement. Proportional nonwhite faculty representation was measured per program and comparisons between the white and nonwhite leadership groups were made by the t test. Assessment of the overall differences in nonwhite academic rank between programs with white and nonwhite leadership were conducted by Pearson chi-square test. Analyses for this study were considered statistically significant when p < 0.05 and performed using SAS University Edition 9.04.01 (SAS Institute, Inc., Cary, N.C.).19 The University of Pittsburgh Institutional Review Board determined this study to be exempt from review. RESULTS Using outlined search criteria of independent and integrated Accreditation Council for Graduate Medical Education plastic surgery training programs, 140 programs were identified. Forty duplicates were removed from this listing, yielding 100 individual institution websites for faculty search and assessment. Website listings identified 930 academic plastic surgeons meeting inclusion criteria for the study. Characteristics of Academic Plastic Surgeons Minority groups represented 24.7 percent of all academic plastic surgeons (Table 1). Among the nonwhite group, Asians had the greatest representation among academic plastic surgeons at 17.7 percent, followed by Hispanic (5.3 percent) and black (1.7 percent) individuals. When compared to the overall U.S. population, academic plastic surgery showed an 11.9 percent increase in Asian representation, in contrast to an 11.7 percent decrease in black representation and a 12.8 percent decrease in Hispanic representation. Demographic information and workplace characteristics of white and nonwhite plastic surgeons involved in the study are listed in Table 2. Overall, nonwhite academic plastic surgeons did not have a significantly different gender distribution (white female, 21.3 percent; nonwhite female, 19.3 percent; p = not significant), were significantly younger than their white colleagues (nonwhite, 46.1 years; white, 51.5 years; p < 0.0001), and graduated more recently (nonwhite, 2006; white, 2001; p < 0.0001). Minorities and whites in academia worked in programs with comparable faculty size (nonwhite, n = 14.8; white, n = 15.5; p = not significant) and served similar population sizes (nonwhite, 130,000 people; white, 120,000 people; p = not significant). Career Training and Qualifications of Ethnic Minorities in Academic Plastic Surgery Minorities in academic plastic surgery were significantly
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