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Face Value - September 2004

Members of the American Academy of Facial Plastic and Reconstructive Surgery convene in New York City this month to help their organization commemorate advances in patient services from years past. Interestingly, the cochair of that event has been at work on a plan to enhance services for his own patients for some time now.

It is the vision of Philip J. Miller, MD, FACS, to one day make routine use of what are currently perceived as unconventional techniques to minimize postoperative pain, reduce swelling and bruising, shorten recovery time, optimize results, and, above all. maximize patient satisfaction.

"My goal is to make the plastic surgery experience as pleasurable, comforting, and exciting as possible," says the Manhattan-based surgeon. "If that goal is met, then in all probability the patient will recommend my services to friends and family. To meet that goal, I'm moving forward with a mind-body approach to cosmetic surgery where I'm no longer delivering treatment, but, rather, acting as a physician in the fullest sense-a doctor who takes care of the patient physically and emotionally. I foresee having a practice capable of helping patients make the most of their newfound feelings of confidence. of greater self-esteem, arising from aesthetic procedures."

Miller. however, acknowledges there are limitations to what he alone as a plastic surgeon can do to awaken patients to their inner potential. Accordingly, he is in the process of establishing or strengthening relationships with other practitioners in the fields of mental health, nutrition, exercise, grooming, and personal development to whom he can refer patients. In this model of practice, Miller would function almost as a primary care physician, a gatekeeper if you will. "I'm convinced," he insists, "that this kind of approach to plastic surgery is the wave of the future-not just for my practice, but for my col-leagues across the country."

Increased consumer demand for spas. Next to come will be in-office holis­tic and integrated comprehensive care services because that's what the patients are going to expect."

Miller contends he achieves outstand­ ing results for his patients in part by taking steps to physically and mentally prepare them for a successful surgery. He tidily labels this process with the acrostic AIR. which stands for avoidance, incorporation. and relationship-the foundations of his forward-thinking approach.

"Avoidance means that, prior to sur­gery. patients are advised to avoid certain medications, supplements, beverages, and food ingredients known to physiological­ly contribute to less-than-optimal results, " he says.

Incorporation. the "I " in his acrostic, is what Miller does to reduce patient stress. "Putting patients in a relaxed frame of mind before and even during surgery is crucial because it helps minimize the release of epinephrine and cortisone. hor­mones that can increase the body's propensity to swell and bruise and there-by increase postoperative pain and pro-long recovery," Miller notes. "It could be that what relaxes the patient is a certain type of music. If so, I then incorporate that into the surgical experience. That requires the patient select music from her library at home and make a tape or CD of it ahead of time. When she arrives for the surgery, we'll play that recording in a loop that continues throughout the entire time she's here."

In the event a patient isn't sure about just what will relax her, Miller suggests a list of possibilities that include aromathera­py, meditation, and acupressure. He'd like to add to that list hypnosis, acupuncture, and homeopathy, but won't until after he has rigorously held those up to the scrutiny of Western critical analysis and can demon­strate their validity.

The "R" in AIR-relationship-refers to Miller's interactions with the patient, and vice versa, as well as the dealings of the patient with Miller's staff, the anesthesiolo­gist, and the operating room support team.

"I want patients to recognize that we all work together cohesively, that we're not strangers who are in the process of trying to get accustomed to one another's ways of doing things in the OR," he says. "I find that knowing this helps patients be more calm and relaxed."

Miller recently moved to a plush new 3,400-sq-ft office that was designed to enhance patient satisfaction even as it ramps up Miller's efficiency.

Notably absent is a traditional waiting room. Not necessary, Miller explains, because the sched­ule the office keeps is tightly structured and scrupulously adhered to. As a result, a patient arriving for an appointment can be promptly led to a consult, prep, or pro­cedure room.

The reception area, by the way, is devoid of any-thing that might give it a clinical feel.

"You see no charts. You see no medical equipment. All that's there is a receptionist's telephone and computer ter­minal. A second phone and terminal are available for use by the patient, should he or she want to make a call or check email. Coffee, other beverages, and light snacks also are served-and we keep track of the food and drink each patient likes so that we can make sure to have those particular items waiting. Even the receptionist isn't a receptionist, but more of a concierge whose purpose is to greet the patient and make sure that his or her comfort needs are met during the time he or she is in our office," says Miller.

Miller saw to it that the office also was built for flexibility. For example, there is a section flanked on one side by clinic space and on its opposite by the operating room. This in-between area can be uti­lized either as an additional exam room or as extra square footage for the operating room, depending on any given day's case volume and requirements.

"A fair amount of our preoperative work is performed in this space," he says.

"Sometimes we use it as a recovery room." The OR, with features like in-wall lines for gas and suction, plus high-tech monitors galore, replicates the sophistication of hospital-based surgery facilities. "It's totally state-of-the-art," Miller beams.

Miller is not in surgery all the time, obviously. So to make his investment pay off, he rents out the OR to colleagues on those occasions when he is not using it himself.

Computers play a vital role in the smooth running of the OR along with the other departments around the office. "I've configured my computers in such a way that they will remind me when it's time for me to do certain activities, and to automatically do others that I don't have time for doing myself," Miller says. "To illustrate, I've got a tracking module on my computer that cre ­ ates to-do lists for each person in my office, myself included. You log on in the morning, and the system tells you, for instance, here are four new patients who need to be sent letters of welcome, here are three others who need to receive follow-up calls, here are all the supplies that need to be ordered, and so on. Additionally, the names that appear on the to-do list are hyperlinked so you can click on them to have the system pull up all the pertinent information for each patient."

As would be expected, Miller finds his practice today vastly different compared to the way it was in the beginning, roughly a decade ago.

"Originally, I performed mainly recon­structive procedures," he says. "Now it's primarily cosmetic. And that's by design. It's where my interests are, it's where my energies are. My practice was gradually tai ­lored to reflect that."

Born in Hazelton , Pa , and raised in Newton , Mass, Miller credits his painter mother with providing the first spark that eventually set him ablaze with passion for a career in plastic surgery.

"I inherited her gift of artistry," he says, adding that it also helped him develop into a serious amateur photographer by the time he was in high school. But Miller also enjoyed working with his hands as a shop tinkerer. Most of all, though, he loved sci­ence-biology and human anatomy in par­ticular. As a premed student at Wesleyan University in Middletown , Conn , he inves­tigated the options and discovered to his delight how plastic surgery offered the best of all worlds: opportunities for artistic cre­ativity, making repairs and improvements, putting to use that keen eye for photograph­ic imagery.

Determined from that point to be a facial plastic surgeon, Miller entered the University of Massachusetts School of Medicine, followed by general surgery resi­dency and otolaryngology training at New York University School of Medicine. He then performed a fellowship in facial plastic surgery at Oregon Health Science University under the tutelage of Ted Cook, MD, and Tom Wang. MD.

At the conclusion of the fellowship, Miller was recruited to the faculty of New York University School of Medicine. His position there entailed teaching residents and performing research but also afforded him time to see patients in a quasi-private practice arrangement.

Not long after joining the American Academy of Facial Plastic and Reconstructive Surgery, Miller was elected to its board of directors. His term on the AAFPRS board is now drawing to a close. Looking back on the academy's accom­plishments during that period, he says the most significant was a push to update its information systems and use that as a launchpad to develop a stronger presence on the Internet. Miller also points with pride to the AAFPRS's public-service initiatives, including one wherein so far more than 250 members of the academy have donated their time and talents to performing life-changing procedures on victims of domestic violence.

Miller asserts that one of the smartest career moves a newly minted plastic sur­geon can make is to become active with the AAFRPS.

"It's an organization that's not exclu­sionary; it's an organization where young practitioners can comfortably interact and exchange ideas with the giants of the pro­fession," he says. "One of the great strengths of the academy has been its extraordinary openness to exploring areas with potential for becoming the future of niques then coming into vogue.

"The topic was minor procedures that could go a long way toward making you look good and feel better about your-self," he recalls. "[Botulinum toxin] at the time was little known to the public; that was one of the things I talked about. I also discussed collagen filling agents, and resurfacing through laser or chemical procedures. My intention was to dispel the misconception that cos­ metic plastic surgery always has to be a major, expensive procedure."

The appearance (you can watch a clip of it at Miller's Web site, www.drphilipmiiler.com) gave Miller two important things: exposure and credibility. In short order he was del­uged by inquiries from other media who to this day continue to seek him out as a reliable source for comment about developments in the field. The attendant publicity resulted in an upsurge of new patients.

"I guess I'm just fortunate to have a great practice," he demurs.

facial plastic surgery, such as was the case with laser skin resurfacing when most other organizations consid­ered that to be something out on the fringes and unlikely ever to be a main-stay of practice. The same has been true of the acade­my ' s willingness to explore the role of antiaging and complementary medicine in facial plastic surgery.

"I ' m incredibly indebt­ed to this organization. If not for [AAFPRS] and the ground-laying work it did years ago, I would not be in the position I'm in today: I would not be privileged to be able to do what I do-and will be doing in the future-for the benefit of my patients."

You have found Dr. Philip Miller, MD, FACS, a plastic surgeon, New York City, considered one of the best plastic surgeons in New York. Browse the site to learn more about the his plastic surgery procedures.