Background <p>For paediatric patients with visually noticeably hand differences, disparities between how a patient, parent, or treating surgeon might view the appearance of their hand can lead to discrepancies of satisfaction. Hand appearance after surgery is an integral success, yet little data exists on how to quantify hand appearance.</p> Methods <p>A systematic scoping review adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed using the Ovid MEDLINE, PubMed, and EMBASE databases looking specifically for separate measurements relating to the appearance outcomes after operative interventions for congenital hand differences. A total of 5014 studies were identified by the literature search. 67 met inclusion criteria and underwent data extraction.</p> Results <p>Methods of measuring appearance outcome fell into one of five categories: visual analogue scales, categorical scales, binary scales, patient-reported outcome measures (PROMs), and anthropometric scales. Eighteen of the 67 studies used the appearance measurement as part of a composite score which assessed multiple functional domains, such as the Tada or ALUURA systems. The most common assessor were the patients themselves, followed by patient proxies (usually a parent), and hand surgeons. </p> Conclusions <p>The aesthetic appearance and satisfaction after surgery for a congenital hand difference is judged by numerous different assessment tools, most of which are unvalidated. Of the tools that do exist, many are utilized for a single diagnosis and are not appropriate for more global assessment of congenital hand differences in general. Future promising tools include variations of PROMs, which may give a better idea of a patient’s personal satisfaction after surgery, but their widespread use with children remains to be adopted.</p> <p>Level of Evidence: Not ratable</p>