Is aesthetic surgery being left behind? Irish trainee perspectives and proposals for reform

Aesthetic surgery remains a core domain within plastic surgery training in the UK and Ireland. However, limited operative exposure has led to concerns about trainee preparedness. This study aimed to assess Irish plastic surgery trainees' perspectives on aesthetic training and identify practical solutions to address current deficits. A national cross-sectional survey was distributed to all 26 plastic surgery trainees in the Republic of Ireland, achieving an 85% response rate (n = 22). Data were collected anonymously via REDCap and analysed descriptively. Eighty-one percent of trainees desired more aesthetic exposure, yet only 18% felt confident in reaching the required aesthetic competencies by completion of training. The principal barriers included a lack of aesthetic procedures in public hospitals (86%) and difficulty attending private lists due to service commitments (82%). Half of the respondents rotated through posts with private sector aesthetic exposure, but access was ad hoc and variable. Aesthetic surgery was the most commonly chosen subspecialty interest (50%), and 68% expressed interest in a funded national fellowship. Despite the inclusion of aesthetic surgery within the Intercollegiate curriculum, the mismatch between training structure and trainee aspirations risks producing underprepared graduates. International models-such as resident-led clinics and private sector rotations-have improved confidence and competence abroad and may be adaptable to the Irish context. We propose three strategies: structured collaboration with private providers, development of resident-led clinics, and a national aesthetic fellowship. These findings underscore the need for targeted reforms to improve training quality, align with certification standards, and support future workforce needs in aesthetic surgery.