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The review process can be completely open, double-blinded, or somewhere in between. Double-blinded peer review, where neither the authors’ nor peer reviewers’ identities are shared with each other, is thought to be the fairest system, but there is evidence that it does not affect reviewer behavior or influence decisions. Furthermore, even without presenting author names, authorship is often apparent to reviewers, especially in small specialties. In conjunction with Plastic and Reconstructive Surgery (PRS), the authors examined the effect of double-blinded review on review quality, reviewer publishing recommendation, and reviewer manuscript rating. The authors hypothesized that double-blinded review will not improve review quality and will not affect recommendation or rating.Traditionally, PRS peer review has been conducted in a single-blinded fashion. During a 3-month period of standard operation of the Journal, the authors examined reviews, recommendations, and manuscript ratings. Beginning October 1, 2014, PRS started conducting reviews in a double-blinded manner. The authors examined the additional reviews submitted during a 3-month period after the change. Review quality was assessed using the validated Review Quality Instrument.Double-blinding had no effect on reviewer publishing recommendation or manuscript ranking. Review quality did not improve after the implementation of double-blinded review. Blinding was successful 66 percent of the time. The most common reasons for blinding failure were reviewer familiarity with authors’ work and author self-citation.Double-blinding adds considerable work for authors and editorial staff and has no positive effect on review quality. Furthermore, the authors’ results revealed no publication bias based on author identity at PRS.