Purpose: Aboriginal and Torres Strait Islander peoples face significant health disparities. While general surgical inequities are documented, the Plastic and Reconstructive Surgery (PRS) landscape remains under-explored. This review maps literature regarding PRS access and clinical outcomes for Indigenous Australians. Methods: A scoping review of PubMed and Medline (2000–2025) was conducted, targeting PRS sub-specialties including burns, skin cancer, and hand surgery. Data was extracted on geographic barriers, waitlist times and postoperative complications. Discussion: Findings reveal a "paradox of need": Indigenous populations experience a higher burden of PRS-relevant conditions yet utilize elective services at significantly lower rates. Queensland data indicates persistent disparities in elective surgery waiting times based on Indigenous status.1 Furthermore, Indigenous patients often present with more advanced disease, resulting in longer hospitalizations and higher re-operation rates.2 Key barriers include geographic isolation from tertiary hubs and systemic referral hurdles. Enhancing outcomes requires culturally safe models; evidence suggests integrating First Nations perspectives into informed consent is vital for engagement. Successful models utilize Aboriginal Health Workers as surgical liaisons and provide "close-to-home" regional follow-up. Conclusion: Significant inequities persist in PRS access and outcomes for Indigenous Australians. Improving equity requires transitioning from metropolitan-centric care to culturally safe, decentralized pathways. Future efforts must prioritize workforce redistribution and Indigenous liaison-led surgical models to align with RACS health equity goals. References: 1. Gulyani, A., et al. (2025). BMJ Open. Rates and waiting times of elective surgeries in Queensland. 2. Arayne, A. A., et al. (2022). NT Health Digital Library. Surgical caseload and outcomes in Central Australia.