Current Patterns in the Scope of Craniofacial Fellowship Training: A Website-Based Analysis

Background: Craniofacial surgery specializes in the treatment of the craniomaxillofacial skeleton and soft tissues. Historically, craniofacial surgery fellowship programs have most often focused on the treatment of pediatric congenital anomalies. However, the scope of the discipline has evolved, and in a recent survey of early-career craniofacial surgeons, nearly 70% of respondents reported their practice was primarily focused on adult patients. The purpose of this study is to systematically analyze the conditions and procedures advertised on craniofacial fellowship websites to ascertain the scope of training opportunities currently available within craniofacial surgery fellowship programs. Methods: In November 2024, the American Society of Craniofacial Surgeons’ (ASCFS) Fellowship Directory was used to identify endorsed craniofacial fellowships in the United States and Canada. Each program website was evaluated for the medical conditions and operative procedures or techniques to which trainees would be exposed. Results: The search identified 36 ASCFS endorsed fellowships, all of which had a website available. From the 34 websites that listed conditions and/or procedures to which trainees are exposed, 69 themes were elucidated. The top 10 themes were cleft lip and palate (91%), craniosynostosis (85%), orthognathic/jaw deformity surgery (77%), acute and secondary trauma reconstruction (71%), pediatric craniofacial surgery (68%), pediatric plastic surgery (56%), microsurgery or free flap reconstruction (56%), distraction osteogenesis (50%), vascular anomalies (47%), and craniofacial syndromes (41%). The least reported themes were neuroplastic reconstruction, tooth extraction, canthopexy, facelift, fat grafting, torticollis, transplant surgery, congenital chest, muscle reinnervation, bone substitutes, adult facial reconstruction, dermatology, preservation rhinoplasty, adult reconstruction, and surgically assisted rapid palatal expansion. Conclusions: There is a discrepancy between the training advertised on ASCFS-endorsed program websites and what recent craniofacial fellowship graduates report practicing. Increasing exposure to non-pediatric craniofacial surgery may better prepare graduates for practice in the evolving landscape of craniofacial surgery.