The field of plastic and reconstructive surgery continues to broaden its scope while other fields continue to narrow theirs. The inability to teach aesthetic surgery is often confounded by the absence of an aesthetic surgery clinic for the chief resident, a reduced number of procedures and cases available, and a lack of faculty staff involvement. A close examination of the 19 western United States-based plastic surgery programs was performed in order to determine the most useful methods in teaching aesthetic surgery. An aesthetic surgery survey was distributed to most recently graduated plastic surgery residents to evaluate their overall experience in aesthetic surgery during residency. Of the 40 residents' surveys, 31 were returned. As anticipated, greater than half (51.6%) of the western United States programs were without a chief resident aesthetic clinic. Also, greater than half of those surveyed (51.6%) felt that the quantity of aesthetic cases was insufficient. The residents' comfort in performing specific operations was quite variable. From data analysis it is apparent there is a greater requirement for "hands-on" experience with aesthetic surgical cases during residency training. Overwhelmingly, the responses indicated the need for a Chief Resident Aesthetic Clinic, greater faculty involvement, and an increased clinic population with attending staff assistance. A 6-month chief resident aesthetic surgery clinic rotation at Saint Francis Memorial Hospital has proven to be very beneficial in teaching all aspects including pre-operative evaluation, surgical technique, and postoperative care of the aesthetic patient.