Background <p>Underreporting of race and ethnicity in clinical trials limits the generalizability of study findings and may contribute to inequities in treatment strategies for underrepresented populations. Although randomized controlled trials (RCTs) represent the highest level of clinical evidence, data on race and ethnicity reporting and gender diversity—particularly non-binary gender representation—remain limited within the plastic surgery literature.</p> Methods <p>A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. The PubMed database was searched to identify RCTs published between 2008 and 2022 in the top seven plastic surgery journals. Studies were assessed for reporting of race and ethnicity as well as representation of non-binary gender.</p> Results <p>Among the included RCTs, reporting of race and ethnicity was infrequent overall, although a gradual increase was observed over time. The United States had the highest rate of race and ethnicity reporting; however, minority groups remained underrepresented relative to national population demographics. Across all included studies, only one participant was reported as non-binary, reflecting the near absence of non-binary gender representation in plastic surgery RCTs.</p> Conclusions <p>Among the RCTs evaluated in this review, reporting of race and ethnicity remains limited. Although reporting increased over time, minority representation remained comparatively low. Non-binary gender was reported in only one participant, and socioeconomic and genetic variables were rarely documented. These findings indicate inconsistency in demographic reporting within the analyzed trials. Reporting frameworks such as CONSORT may support improved transparency and consistency.</p> Level of Evidence <p>Level II, risk / prognostic study.</p>