Crowdsourcing in Plastic & Reconstructive Surgery: A Systematic Review with Reporting Recommendations

Abstract

Background: Crowdsourcing uses online platforms to collect large data from laypersons and has been increasingly used over the past 5 years to answer questions about aesthetic and functional outcomes following plastic and reconstructive surgery. This systematic review evaluates crowdsourcing articles in plastic and reconstructive surgery based on study topic, participants, and effect size in the hopes of describing best practices. Methods: A systematic search strategy was developed with a licensed librarian and attending plastic surgeon to query all articles using crowdsourcing in plastic and reconstructive surgery. Covidence systematic review manager was used by two independent reviewers to import articles, screen abstracts, evaluate full texts, and extract data. Results: A search run on October 8, 2021, yielded 168 studies, of which 45 were ultimately included. Craniofacial surgery and aesthetic surgery collectively constituted over half of studies. Participants in plastic surgery crowdsourcing studies are more commonly from the United States, female, straight, 25 to 35 years old; have completed college; and earn $20,000 to $50,000 per year. Studies typically assessed aesthetic perceptions, cost approximately $350, ran a median of 9 days, included approximately 60 unique survey items, and included approximately 40 unique human images. Conclusions: Crowdsourcing is a relatively new, low-cost method of garnering high-volume data from laypersons that may further our understanding of public perception in plastic and reconstructive surgery. As with other nascent fields, there is significant variability in number of subjects used, subject compensation, and methodology, indicating an opportunity for quality improvement.

Real Face Analysis of Masculinity-Femininity, Facial Ratios, and Attractiveness

“…Perhaps unsurprisingly, ratios associated with femininity (lip vermillion height ratio and middle one-third ratio) were associated with rates of misgendering in males, and ratios associated with masculinity (nose width ratio) were associated with rates of misgendering in males. Misgendering certainly has implications for gender-affirming surgery and its impact on patients' daily, social interactions, with important considerations for stress and mental health, 31 and findings regarding misgendering from this study may inform future crowdsourcing investigations 32,33 …”

“…Misgendering certainly has implications for gender-affirming surgery and its impact on patients' daily, social interactions, with important considerations for stress and mental health, 31 and findings regarding misgendering from this study may inform future crowdsourcing investigations. 32,33 This study has implications for facial feminization and masculinization surgery in describing typical facial ratios for males and females (Table 2). Results in the present study further demonstrate how small changes in facial ratios may meaningfully independently predict male and female sex, underscoring the importance of relatively small changes in facial anatomy for identification with male and female sex.…”

Assessing Craniofacial Dysmorphology and Postoperative Outcomes: Past Perils and Promising Pearls in Plastic Surgery

“…4 Crowdsourcing, the practice of generating large volumes of ratings from laypersons, may also offer a unique strategy for appraising outcomes from clinical photography; however, previous studies demonstrate variable concordance between ratings from experts and crowds. 5 Future approaches will likely reap benefits from multidisciplinary collaboration with our colleagues in engineering, computer science, and imaging, among others. 4 Indeed, our clinical counterparts in radiology reproducibly leverage machine learning to identify complex patterns in clinical imaging datasets.…”

“…4 Crowdsourcing, the practice of generating large volumes of ratings from laypersons, may also offer a unique strategy for appraising outcomes from clinical photography; however, previous studies demonstrate variable concordance between ratings from experts and crowds. 5…”

The Ethical Debate Over Fair Treatment of Workers for Crowdsourcing Studies in Plastic and Reconstructive Surgery

“…4 Although our specialty has primarily used crowdsourcing to gather information or generate data, other fields have leveraged the technology to develop ideas or innovate solutions. 5 If our field begins to leverage the technology similarly, questions regarding intellectual property arise. In addition to legal considerations with intellectual property, participants may be unaware of the degree to which their contributions are used by an organization or company, and risk being undercompensated for the value they produce.…”