The Changing Face of Craniofacial Surgery: A 12-Year Analysis of Gender Representation and Academic Productivity.

ObjectiveTo evaluate trends in gender representation, academic productivity, and training background among craniofacial surgery fellows over the past 12 years and assess changes in the academic expectations for entry into craniofacial fellowship.DesignRetrospective cohort study of craniofacial fellowship graduates (2014-2025).SettingOnline public records review.ParticipantsA total of 194 craniofacial fellows.Main Outcome MeasuresGender distribution, lifetime publication counts (total, first-, second-, senior-author roles), conference presentations, training pathway, and time from medical school to fellowship.ResultsAmong 194 fellows, 35% were women. Female representation increased from 27% in the early cohort (2014-2019) to 43% in the later cohort (2020-2025). Overall, men had more total (30.2 vs 21.3, P = .038), second-author (5.7 vs 3.9, P = .011), and senior-author (4.4 vs 2.9, P = .040) publications. Gender gaps in publication output were not present in the most recent time period (2019-2024). More recent graduates had significantly higher prefellowship publication counts than earlier cohorts. Integrated trainees and U.S.-trained surgeons had higher preresidency publication counts and shorter training durations. Panel presentation rates remained modestly male-dominated in recent years, though overall conference representation showed no gender differences.ConclusionsThe most recent cohort of craniofacial fellows demonstrates encouraging progress toward gender parity in representation, academic productivity, and conference participation. This reflects meaningful progress over the past decade and suggests that equity at the trainee level is emerging. Continued investment in mentorship, visibility, and support will help carry this momentum into faculty advancement and leadership roles.