**Background:** Conditions treated by surgery constitute a significant portion of the global burden of disease, with an estimated 2 billion people lacking access to basic surgical care. In low- and middle-income countries (LMICs), allocating resources toward the most cost-effective surgical procedures (essential surgery) and care delivery platforms is critical. Nongovernmental organizations (NGOs) and plastic surgeons play a significant role in providing surgical outreach to LMICs, but it is unknown whether their work aligns with existing global public health recommendations. This study aimed to systematically identify and characterize plastic surgical NGOs with respect to subspecialty areas performed, care delivery models, and geographic sites, and compare these results with World Bank recommendations.
**Methods:** A previously established internet-based methodology was used to identify NGOs providing plastic surgical services to LMICs. NGOs were defined as nonprofit, voluntary citizens' groups organized at local, national, or international levels. To qualify, an organization had to perform plastic surgery (therapeutic excision, incision, or manipulation of tissue in an operating room) in at least one LMIC. NGOs were identified through 15 databases including idealist.org, Operation Giving Back, and the Plastic Surgery Foundation Volunteers in Plastic Surgery. Information on subspecialty areas (burn, cleft lip/palate, hand, pediatric noncleft, trauma, general), care delivery platforms (continuous vs. intermittent; nonrotating vs. rotating), and geographic sites (classified by World Bank income level) was obtained through direct correspondence via email and publicly available data. The work of NGOs was compared with World Bank essential surgery recommendations (Table 1) and care delivery platform guidelines.
**Key Results:** A total of 96 NGOs met inclusion criteria, serving 67 LMICs: 15 (22.4%) low-income, 31 (46.3%) lower middle-income, and 21 (31.3%) upper middle-income. Geographic distribution by continent: 32 (37.7%) in Africa, 49 (57.7%) in Asia, 4 (4.7%) in Europe, 17 (20.0%) in North America, and 47 (55.3%) in South America; 42 (49.4%) NGOs served more than one country. Regarding subspecialties, 34.8% of NGOs performed plastic surgery within a single subspecialty, and 65.1% performed more than one. The most common subspecialty was cleft surgery (80.3%), followed by pediatric plastic surgery (46.9%). Of NGOs performing more than one type, the most common combination was cleft with pediatric plastic surgery. A total of 80.3% of NGOs performed procedures considered essential surgery, all related to cleft surgery. For care delivery platforms, no NGOs used a continuous model; all used an intermittent model (short-term surgical missions). Of these, 62.8% used a nonrotating model (returning to the same site(s) annually) and 37.2% used a rotating model (traveling to different sites each year).
**Clinical Implications:** The majority of plastic surgical NGOs perform cleft surgery, which is classified as essential surgery by the World Bank, indicating that NGO efforts largely align with global public health priorities. This suggests that despite operating independently, NGOs may naturally focus on cost-effective interventions. However, there is room for improvement: NGOs should consider focusing resources on other essential plastic surgery procedures (e.g., skin grafting, escharotomy, fracture management) and adopting more sustainable care delivery models. All NGOs used intermittent short-term missions rather than continuous care, which is less cost-effective and sustainable. The nonrotating model (used by 62.8% of NGOs) is preferable to rotating models because it allows for consistent patient care and local provider education, contributing to capacity building. The cost-effectiveness of cleft lip repair is approximately US $10–$110 per DALY averted, comparable to vitamin A supplementation ($10 per DALY averted) and more favorable than oral rehydration solution ($1000 per DALY averted). Future research should investigate the volume and outcomes of NGO work, cost-effectiveness of a broader range of plastic surgery procedures in LMICs, and alignment with other global health priorities such as those from the Lancet Commission on Global Surgery.