THE PASSING OF A GIANT IN PLASTIC AND RECONSTRUCTIVE SURGERY

Dr. D. Ralph Millard, reconstructive surgeon, UM professor, specializing in cleft lips, dies at 92

While heading the University of Miami’s and Jackson Memorial Hospital’s plastic surgery divisions, he fixed thousands of cleft lips.

BY ELINOR J. BRECHER
ebrecher@MiamiHerald.com

Dr. D. Ralph Millard Jr., the Miami plastic surgeon who developed a method of correcting cleft lips that has saved children all over the world from living with deformed faces, died Sunday at his Sunny Isles Beach home.
Born David Ralph Millard Jr., on June 4, 1919, in St. Louis, he had recently turned 92. Son Bond Millard said his father died of heart failure.
Millard chaired the plastic surgery division at what is now the University of Miami Miller School of Medicine for 28 years, at the same time serving as Jackson Memorial Hospital’s plastic surgery chief.
He was best known for developing “rotation advancement’’ surgery in the ‘50s. The method conserves tissue that doctors had routinely removed when correcting a cleft lip, producing a natural-looking mouth in much less time.
Before he developed it, surgical procedures were performed on patients into their late teens. With his method, most children are operated on by 4 or 5.
Millard also made major advances in corrective rhinoplasty— nose surgery—for people disfigured by accidents, cancer, war wounds, even cocaine abuse.
“His work is considered pure artistry," Dr. Bernard Fogel, dean emeritus of the medical school, told The Miami Herald when Millard retired in 2000, three months before the death of his wife of 45 years, Barbara Smith Millard, orginally from Tulsa, OK. “He’s a giant."
That year, Millard was nominated as one of 10 "Plastic Surgeons of the Millennium" by the members of the American Society of Plastic Surgery. At the time, Plastic Surgery News called him “the most brilliant and creative plastic surgeon we have alive.’’
According to the World Health Organization, cleft lip, with or without cleft palate, is considered a serious birth defect affecting about one in every 600 to 700 newborns, meaning that a child is born with a cleft somewhere in the world every 2 1/2 minutes.
“Eighty to 90 percent of clefts are now done with his method,’’ said Dr. S. Anthony Wolfe, Millard’s longtime medical-practice partner. “He also pioneered [post-mastectomy] breast reconstruction when it was frowned upon, and certain types of facelifts. He operated on ... the wives, daughters and mothers of many prominent plastic surgeons.’’
A prolific author, Millard documented every one of his cases with pictures and notations, son Bond said.
Towering in both physical and professional stature, he was demanding, exacting and “not warm and fuzzy,’’ Bond added. “His students were scared of him.’’
But Millard was quietly generous with needy patients, and spent decades treating Third World children for free.
“He did so much pro bono and never told anyone,’’ Bond said. “He had set up an account for his wealthy patients to put money into for the poor.’’
“He bought cases of baby food for families,’’ Wolfe added. “If he really wanted to get a patient back [for a check-up], he’d buy the family tires.’’
Even those who could afford to pay top dollar didn’t, if Millard felt they needed his help.
Miami attorney Robert Josefsberg went to Millard in 1975 with a devastating wound: a hole in his palate caused by cancer. It affected his speech so dramatically that the sound of his voice became a courtroom distraction.
Millard, who fixed it in a 10-hour operation using a procedure he invented, “saved me and saved my career,’’ Josefsberg said.
When he got the bill, for $500, Josefsberg figured it was a mistake. Millard explained: “ ‘I pay for my fine wines and cruises with fees on elective surgery. When someone absolutely needs me on something that is very difficult, I charge the minimum.’ ’’
Millard, a lawyer’s son who served stateside in the World War II Navy, got interested in clefts as a chief plastic surgeon for the Marine Corps during the Korean War, discharging with the rank of major.
“Driving through little villages, I would see in the shadows of huts children with cleft not wanting to be seen, but to see," Millard told The Herald. He explained that he was “fascinated by the children and shocked by the pain of the parents,’’ and hit on the best way to help them late one night as he stared at the photo of a child with a cleft lip.
He focused on the “cupid’s bow’’ dimple in the top lip, which surgeons routinely excised during corrective surgery. Millard realized he could create a more natural mouth by saving and relocating the tissue.
As a young doctor, he described his new approach at the First Congress of the International Society of Plastic Surgery in Stockholm.
“There was this terrible silence because they saw for the first time how to use the cupid’s bow," Millard told The Herald. Among the few to laud him was Sir Harold D. Gillies, the legendary British surgeon, and a mentor.
“Everyone else,’’ he recalled, “looked like they had taken a cold-water enema."
Dr. Walter Mullin, another of Millard’s private-practice partners, once told The Herald: “Seldom do people truly invent new things in plastic surgery, but he did. In cleft lip, he figured out nothing was missing, it was just out of position."
Millard, an Eagle Scout, graduated from the Asheville School for Boys, Asheville, N.C. He received a B.A. in English in 1941 from Yale University, where he boxed and played varsity football.
His coach: Yale law student Gerald R. Ford, the future U.S. president.
Millard graduated from Harvard Medical School in 1944 and interned in Boston before joining the Navy in 1945. A year later, Lt.jg Millard joined a residency program at Vanderbilt University Hospital in Nashville.
In 1948, he left for England, where he trained under Harold Gillies. They would later co-author the first of his nine books, The Principles and Art of Plastic Surgery. He wrote 149 peer-reviewed journal articles and 53 book chapters.
The principles, both operational and intellectual, include “seek insight into the patient’s true desires,’’ “acknowledge your limitations so as to do no harm,” and “when in doubt, don’t.’’
“His principles have so many applications to any type of surgery,’’ noted Mullin, who practices in Dadeland. “Some of them were applicable to life.’’
Among Millard’s many honors: the American Society of Plastic and Reconstructive Surgeons’ highest award “in recognition of his development of the specialty of plastic surgery and his outstanding scientific contributions to the advancement of its practice,’’ in 1988.
In 1991, the Miami Children’s Hospital International Hall of Fame honored him with a bronze bust.
Dr. Seth Thaller succeeded Millard as the medical school’s plastic surgery chief in 1995.
Because of Millard, UM “was Mount Olympus’’ for the specialty, he said.
“He was a master, an innovator, and what he did laid the groundwork for [procedures] still in effect today,’’ Thaller said. “If not for his legacy, the division wouldn’t be thriving the way it is today.’’
An avid water skier with an affinity for cowboys, Millard would sometimes “show off’’ by roping with a lasso while waterskiing, son Bond said.
“He was very into his [three] children’s sports,’’ said Bond, who played football at Miami Country Day School, then Miami Beach High. His sister, now Meleney Moore, was a state champion in the 330-yard intermediate hurdles.
Millard’s letters to the editor published in The Herald ranged from a defense of UM football Coach Butch Davis in 1995 — “He is a winner, but more important than that, he is a man of principle ... He will eventually have a winning team, but he will not take short cuts to get there’’— to a diatribe against physician advertising in 1996: “It has always been unethical for doctors to advertise, because a reputation is gained by good results, honest and dedicated service to patients, and the respect of referring physicians. … Advertisements can claim merits unearned, skills not present, and results never attained. It can almost make a hero out of a bum.’’
Millard joined the UM medical school faculty in 1956, and was named chief of the Division of Plastic Surgery in 1967, near the start of what Wolfe called Millard’s “most productive period,’’ until the early ‘80s.
“He was very demanding of his trainees,’’ said Wolfe, who was one. “It was a philosophy of life, and most people were very grateful for that kind of attention. He would push everybody to the limit, and then stop.’’
“He used to say that he doesn’t like anything between the hammer and the nail,’’ Mullin added. “If you were good, he would say it, and if you were bad, he would say it.’’
After his wife died, Millard spent three years in Houston with his children before returning to South Florida. He travelled and continued to write into old age.
His autobiography, Saving Faces: A Plastic Surgeon’s Remarkable Story, was published in 2003.
In addition to daughter Meleney and son Bond, Millard is survived by son Duke, and six grandchildren.
A viewing will be held from 6-8 p.m. Friday at Caballero Rivero Woodlawn Funeral Home, 3344 SW Eighth St. A memorial service is scheduled for 1 p.m. Saturday at Miami Shores Presbyterian Church, 9405 Park Dr., Miami Shores.
In lieu of flowers, the family welcomes donations to The Millard Society. Go to www.millardsociety.org.





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