Welcome And The Sweet Spot

Dr Andrew Greenland 0:00

So, welcome back to Voices in Health and Wellness. This is the podcast where I sit down with healthcare practitioners and practice leaders to explore not just what they do clinically, but how they think about medicine, the changing expectations of patients, and the realities of building a practice and a career that are both successful and genuinely fulfilling. And today's conversation is one I've been looking forward to because my guest actually gave me a phrase during our conversation before the podcast that captures much of what the show is about. He described it as finding the sweet spot between excellent clinical outcomes, patient satisfaction, and provider happiness. So my guest today is Dr. Scott R. Miller, a fellowship-trained, board-certified aesthetic plastic surgeon based in La Jolla, California, and founder of Miller Cosmetic Surgery. Scott has spent his career combining the technical and artistic demands of aesthetic surgery with a strong interest in the psychology of the patient experience and what it takes to build a thriving and fulfilling medical practice. And with that, Scott, I'd love to welcome you to the show. Thank you so much for joining me on this podcast.

Dr Scott R Miller 0:57

Oh, thanks, Andrew. It's great to be here.

From Art And Sport To Surgery

Dr Andrew Greenland 1:00

So I want to start with your journey because you've had obviously had a very long career in a very specialized area of medicine. What originally drew you into plastic surgery in the first place?

Dr Scott R Miller 1:09

You know, I as a kid I was really into art and then puzzles, putting things together, oil painting, composition. And so I was always trying to make things and create things. And then I kind of got sidetracked as a lot of young men do, deep into sports and competition and that world. And then, you know, they really came together with a company, you know, adding service to that component and surgery to the medicine part and plastic surgery to the creativity part. And, you know, not to continue to belabor the metaphor, but the sweet spot for me, uh, where all these things could come together and I could really just enjoy flexing the gifts that I've been given.

Dr Andrew Greenland 1:56

And um, when you think back to the physician and the surgeon you were at the beginning of your career, how different are you from the physician you are today?

Dr Scott R Miller 2:04

Oh uh well uh as a as a big boss, I'm calmer. Uh as a uh surgeon, I think I'm just got a lot of uh wisdom and um sort of lessons learned so that I'm I'm more patient uh and I'm more predictive. I'm also more uh firm and I know what I know. I know what I don't know, but I know what I know, and I'm less talked in by myself or my patient or anybody else into doing things that I know are unwise. I I can very confidently listen to patients first, understand what their concerns are, and then give them advice on the best way to get there safely and sagely without stepping in potholes along the way. And, you know, I'm happy to explain why I think what I think and believe, and I'm happy to listen to contrary views, but I also I know what I know, and I'm a little less likely to be swayed and do things that are essentially not great ideas.

Mentorship And Learning In Increments

Dr Andrew Greenland 3:19

Thank you. So I know you had the opportunity to train under Dr. Bruce Cornell, who had a significant influence on modern facelift surgery. What did that mentorship teach you that went beyond sort of mere surgical technique?

Dr Scott R Miller 3:31

Sure, I think that you you learn something from what people say, but you learn even more from what they do. And when you're around excellence at that level, you hopefully uh absorb some of that, um, both in terms of your uh surgical technique, surgical decision making, and and patient management and perspective. And I think that all of those I benefited from him. He uh again, he he was curious and always growing, even deep into his career, and but also growing in increments, never in massive steps. I think that's when we get into trouble, uh, maybe in medicine, certainly in surgery, um, when we try to take huge leaps rather than incremental growth. Um and incremental growth can add up to huge leaps, but I think doing that uh in that way is much more sage. Um yeah, he just he had a perspective. He the way he did everything was with um his main priorities top of mind. And I think going through your career that way, going through your day that way, is much more productive and much more satisfying.

Patient Psychology And The Five Whys

Dr Andrew Greenland 4:49

So I think when we talked before, you made a comment during our first conversation that really stayed with me. I think you said that plastic surgery, there's almost a psychologist or a therapist component to what you do. And I just want to know how much of being a good plastic surgeon is about that understanding of that psychology of the person who's in front of you.

Dr Scott R Miller 5:05

Oh, the key, the key element of your question is how much of a being a good plastic surgeon. And that's, you know, uh, it's huge, it's a giant part because you can be the best technician and you can be the best technician and artist. But if you're not painting the picture that your patient wants, you're not gonna be successful, you're not gonna have happy patience, you're not gonna have a thriving career. So that's a really critical part. Uh, you know, as a tennis player, again, bringing in that athletic part of my background, when I grew up and when I was learning, the The Inner Game of Tennis by Tim Galloway came out. And I think more people are aware of that book now, and it's extended into areas as it probably was intended, far beyond tennis. But as a young kid, I just read it as a, you know, as a book on tennis and the psychology of tennis. But the psychology of that goes so much further. And and that at underlies, just like the psychology of the game is so important, so is the psychology of our game and our practice. And understanding patients, where they're coming from, what their fears, concerns, and goals are is, I mean, you can't you can't achieve their their goals if you don't know what they are in the first place and you don't sort of understand the maybe the motivation behind them. So huge component of psychology. And I think that that's sort of mandatory study for anybody going into this field to understand people better and better serve them.

Dr Andrew Greenland 6:38

And so, with that, how do you distinguish between what somebody's asking you to change and what they actually hope it will do for their life?

Dr Scott R Miller 6:45

I think you just by being curious, I think you have to keep asking questions. What is it? Some people talk about the five whys, you know, why then they say it, then why, then they say it, then why. And you really have to dig in there and be just a curious soul when you're meeting with the patient and really try to truly understand what's behind the part that's behind the part that they're explaining and showing you. And sometimes it's as simple as I hate this jowl, and other times it's that I hate that I'm starting to look like my mom, and there's even deeper issues in there. And sometimes it's just a general unhappiness, and it's important to get at that because if it's a general unhappiness, you're not going to fix it with aesthetic plastic surgery. Um, but oftentimes it's just it's something that is a trigger for them. Um, and it's important to understand that so you can be more patient going through the process. Because, you know, if you just look at it superficially and you take care of something and somebody still has some discontent and you don't understand that, and you're like, I I don't understand what's your problem because we took care of what you wanted to take care of, but you didn't take the time to understand the problem behind the problem and be patient with them as they go through that process of adjustment. So there's all there's it's just uh having a curiosity with patients, for patients, and about patients um and about people is really critical in this field to uh enjoying it, understanding it, and being being able to serve, which at the end of the day, that's what we are. We're we're here to serve and help people achieve their goals, not our goals. And I think that's where a lot of plastic surgeons get mixed up and confused about whose journey this is.

Dr Andrew Greenland 8:30

Thank you. And I guess with that curiosity, there must have been times when you decided surgery probably wasn't actually the right answer. But how do you tell somebody no when they're convinced that this is what they want?

Dr Scott R Miller 8:39

Sure. And again, you talk about years of practice, and that's something you learn and get better at, hopefully, and still learning, still getting better. But um, you know, I think you just be honest with people and you say, My goal is to make you happy. And the question is, are you going to be happy with the results I can produce? And, you know, you do that humbly, and sometimes that is has to do with the technical ability to produce what they want to achieve literally and fig and physically. Other times that's will they be happy with the result that they think they want even after it's achieved. So both of those come into play. But um, you know, you don't, it's not, it's not personal, it's not an affront. It's a it's a can I can I satisfy your goals and desires? And if I can't, I'm ethically bound to pass. And if I think it's um, you know, a 70-30 proposition, I think that's certainly a discussion we need to have and make sure you accept uh subtotal, imperfect results, but improvement. And if I don't think I can get, you know, even halfway there, then we shouldn't even be talking about doing anything.

Dr Andrew Greenland 9:46

Thank

When Saying No Serves Patients

Dr Andrew Greenland 9:47

you. So when we spoke before, um, you described something I think really sits at the center of this entire podcast. You talk about this sweet spot where good clinical outcomes, patient satisfaction, and provider happiness all intersect. What does that sweet spot look like to you?

Dr Scott R Miller 10:01

And again, the essence of a sweet spot for anybody who's played coming back to the tennis is everybody knows that feeling when they hit the ball just perfectly in the middle of the strings, if it's a baseball player when the ball hits the bat just right, etc. Um, and so yeah, there's that sweet spot where where all the elements come together of your skills, your uh enjoyment of the procedure, the patient's needs and desires, the aesthetic of it and the beauty, which is a big part, um, and and part of the satisfaction of it. As Michelangelo said, the figure emerges from the rock. He said he never sculpted a figure, the figure was there and he just released it. And that's the way it feels in plastic surgery when you're doing these things is you're trying to release people's inner beauty to satisfy their desire for more self-confidence and self-esteem. And and when you hit that, you know, you kind of get that flow state where you're feeling great about what you're doing, but you have to, the psychology and the physical and the technical all have to come together to kind of get to that place. And that's the place where the patient's happy and the surgeon's happy and and everything is uh right with the world, let's say.

Dr Andrew Greenland 11:09

And when that sweet spot is off, I mean, what happens to patient care when the practitioner themselves isn't fulfilled by the practice they're building?

Dr Scott R Miller 11:16

Yeah, I think if you're not fulfilled, I think again, kind of getting to the title of my book, Authentic Beauty, if you're not fulfilled, then and you're not being authentic. If you're not doing something that you really believe in, at that point you're you're you're a cog in a wheel and it's not going to feel very good. And I think that gets reflected in in your satisfaction with your career. That gets reflected in your relationship with your patient, and that gets reflected in your just general uh enjoyment of the of the process and your days and your days make up your weeks, your weeks make up your months, and on and on and on until it's a life. And so that's you know, at this point in my career, I can say that with some confidence that these things all add up to how you spent a large majority of your days, and you want to be authentic to yourself so that you can uh enjoy that process, and you want to be authentic to patients so that they can know they sense that. They sense that maybe they don't sense it like a psychotherapist and name it and label it, but they can sense that, and that leads to uh sort of um um a disruption of that relationship, which makes the whole thing even less uh enjoyable. One of the things I enjoy the most about my practice is my relationships with my patients. And it's a you know, it's funny because in surgery, as you know, when you're going through training, uh people think uh, you know, internists and primary care people have this deep relationship with their patients, which they do. And then surgeons are people who don't care about their patients and don't have a relationship with their patients, but there's no deeper relationship than when somebody lets you take a scalpel to them, and and there's something deep and binding about that. And I'm very picky about who I want to have that relationship with. I think patients are are and should be picky about who they want to have that relationship with. And when you have that and and it's good and authentic and beautiful and and uh mutually uh beneficial and satisfying, that's a very deep, fulfilling relationship. And that's creates again deep, fulfilling days which add up to a deep, fulfilling career. So um hopefully that answers your question. But I I just feel like um that we my relationship with my patients at the end of the day is what I'll take away from this. Um, you know, you don't get trophies, you don't it's you know, at the end of the day, that's what you take away, is is the the sense of proportion and beauty combined with the satisfaction of helping people uh get where they want to go. And so if you don't think to relate to your last question, if you don't think that they can get where they want to go, you you ought to tell them up front and and hold true to that. And that's what I think I've gotten better at over the course of my career is you know, uh crystal ball seeing into the situation and and being able to you know pick those spots.

Dr Andrew Greenland 13:55

Thank

Integrative Medicine Without Vague Labels

Dr Andrew Greenland 13:56

you very much. So I tend to describe much of what I do in my practice as functional medicine, although the way I actually practice it is very integrative, taking conventional medicine and combining it with other evidence-informed approaches where they're appropriate. I think you said you prefer the term integrative medicine. Why does that distinction matter to you?

Dr Scott R Miller 14:15

I just think integrative medicine is more descriptive. I think you're you're really integrating the best of all worlds, modern medicine, eastern or ancient medicine, things that have held true through the ages, and and maybe we don't fully understand the science of, but we're learning more, combined with things that that are being discovered every day. And I love that idea of integrating those. Functional medicine, I think is a bit of a vague term. And I understand that it's it's um it's caught on, and you know, however people want to refer to it, but I think it leaves a lot of vagaries as far as um who's doing it, what's doing it, how it's being done, what it really involves. I think it's it's it's a bit like we talk about like what's a mini facelift? It's I don't know, anything less than a full facelift, what's a full facelift? Those are vague terms, so we try to be more descriptive in our discussions with patients. So that's why I favor the term integrative medicine. Um, and I think um I think the important thing is for patients to know what they're getting. I also think in in functional medicine, the variety and background of providers is even more vague. And I don't want to throw shade on any type of providers, but I do think patients should know the background and oriented general orientation of their providers. You can try to learn all you want from ancillary fields, but you know, the fundamentals that you trained and and learned and and were core imbued with in your training, I think uh tell somebody about where your kind of foundation is. And I think if you're coming from a different angle uh than your medical background, which is, you know, doctors, medical doctors trained, and then open-mindedly including other fields, I think that actually is um probably more straightforward of what you're bringing to the table than other fields where they come from other areas, and then they're trying to integrate the hard science and research and experience in that way. Or maybe they just don't even offer that. So I just find functional medicine to be a bit of a vague term that maybe can confuse patients. And we try, I mean, half our practice is spent trying not to confuse patients. So that would be why my general uh or my confusion about the term that I came to it as I learned more and more about the field. Um, and then so that's why I kind of suggest that to patients to seek out that kind of orientation.

Dr Andrew Greenland 16:41

And then I honestly, I mean, is is when we're talking about holistic care, and I think you mentioned before that holistic care should remain under medicine's roof, is that what you're kind of driving at? That the kind of the doctor has a because of their medical understanding, they're in the best position to have that kind of complete oversight while bringing other people in to help with that patient's management.

Dr Scott R Miller 17:00

Exactly, exactly. You're kind of, you know, whether you're captain of the ship or incorporating these other fields in your practice or in your own armamentarium, I think that um look, if you've got a bacterial infection, you still need antibiotics. You also need to bolster up your immune system. You also need to look at your how you're eating, moving, sleeping, breathing. Uh, you need to look at a lot of things. But let's not forget you need antibiotics. So I think that that's where that foundation in medicine and then opening up. So whether you're the captain of the ship or somebody who's incorporating all that into your own armamentarium, that's the that's the foundation that I would look for when I was seeking out that that integrative primary care kind of uh support for my own health.

Dr Andrew Greenland 17:47

I think you were sort of giving a sense of you know trying to be open-minded, but I guess there's always a danger with being open-minded that we can be compromised scientific standards or patient safety by just letting it kind of slip.

Dr Scott R Miller 17:58

Exactly. And if you don't have that deep, you know, foundation in those scientific standards, then it's I don't know if it's easier to let them slip or never have them in the first place. And there's so much out there to grab onto, and it's enticing. I mean, I I mean you I'm sure you know, as a you know scientifically trained medical doctor going through training, but hey, we all want to hear what we want to hear. And some of this stuff is very enticing and easy to fall into. But uh, I always tell patients, I have patients, for example, I'll have patients come in and they'll they'll not reveal some medicines they're on or some agents they're on or whatever, and then, or they'll tell me and they'll go, but oh, but that's just an herb or that's just a natural medicine or something like that. And I say, Well, why are you taking it? Well, because it's supposed to help with this and this. Well, how does it do that? Well, it affects this and this. I go, exactly, it affects it. And don't you think anything that can affect something positively can also affect something negatively? Of course, something can't be all one or the other. There's there's it's if it affects your system, it affects your system. And if you don't need it, it might affect your system wrong or push it too far one way or the other. So all these things are really important, and we can't just sort of like dismiss them as, oh, this is just an herb or this is just natural. They're serious things that that we're taking for a reason, and that's great, but they can also have negative effects. And I think sometimes there's a uh you people that gets lost in the in the message.

Dr Andrew Greenland 19:27

Thank you. I mean, does plastic surgery have that same duality between technical medicine and understanding the whole person?

Dr Scott R Miller 19:33

Sure. I mean, you can you can talk the talk and not be able to walk the walk. I mean, you have to have, you know, what I say, you know, a good head, a good heart, and good hands. And there you can have you can have really well intentions and really uh good vision of aesthetics and not be able to carry it out technically, and you can be a great technician and not have a vision and all those things that have to come together to to provide the results that patients are looking for. So absolutely, I think that bringing those all together into one package. So there are people who uh know how to market, know how to advertise, know how to talk to patients, and then patients come out and they're like, wait a minute, this isn't what I signed up for. And then there are good technical surgeons who uh don't have a good sense of aesthetics and art and beauty. And then there are good technical surgeons who have a good sense of aesthetics and art and beauty and don't communicate with patients, so they can go very efficiently to the east when the patient wanted to go west. So all those things have to come together, and that's maybe some of that sweet spot that we were talking about.

Authentic Beauty And Modern Aesthetics

Dr Andrew Greenland 20:38

Which I think brings us really nicely to your book, um Authentic Beauty. Can you tell us a bit about your motivation for writing it?

Dr Scott R Miller 20:45

You know, I I yeah, I know it's funny. It's a these things. Why do you do these things, especially when they're not, they're not, you know, that's not part of your core uh career, et cetera. But you know, I I think after a career of learning from giants and incorporating things and doing some innovation myself, uh, you get to a point in your career where you want to share some of the innovations and insights that you've gained, both uh technically, I share through meetings and teaching residents and whatnot, but also through uh the way you practice and the way you work with patients. Wanted to share that both with practitioners, but also with patients. Because I think patients can drive the process. I think the more educated and informed patients are, the more they can take control of their own health. And they'll make the field better by their demands for certain types of care. So telling patients what to look for, how to look for, giving them tools and tricks and checklists, and then also sharing that with providers so that they can say, hey, maybe this is a better way to set up my practice to better serve patients. So the idea of writing a book is obviously, well, for me, is to have an impact beyond the one to one. I love the one to one, I live for the one to the one. At the end of my career, that'll be the main thing that I'll have accomplished is. Affected these lives that go forward, hopefully, and affect these other lives. I just got a wonderful note from a patient who uh actually from her mom, and I did a uh breast reduction on this young girl, and she's she looks like a different person because she sort of yeah, we did it, it was such a large breast reduction, and it was um it was one of these ones where a lot of people to get into the weeds think you need to do uh a free nipple graft, and that would have left her with a numb, flat, uh, insensate nipple. And you know, we did it with uh a different technique that leaves her with three-dimensionality and sensation, and she her waist is longer and she has more space between her chin and the top of her chest, and she stands taller. And now I'm just trying to get her to throw her shoulders back because she doesn't have to be hunched anymore, and her mom notices the changes in her already. So that's that'll be the main satisfaction I take away from my career is that one-to-one-to-one. But, you know, to try to have a larger impact at this point in your career and not just take these lessons and fade off into the sunset with them and not share them uh both with patients and providers, uh, would be sad to me, and is something I really wanted to uh put out there and share.

Dr Andrew Greenland 23:06

Thank you. And what is it you think is um the kind of biggest misunderstandings that patients have about plastic surgery and aesthetics medicine that you've tried to kind of solve, perhaps to some extent, with the book?

Dr Scott R Miller 23:18

I think that the biggest misunderstanding is that it is uh there's one standard, that there's one result, and everybody should be trying to achieve that result. And that's not true. There's your result. There's there really a large part of it, getting back to that Michelangelo uh um paraphrase about the figure emerging from the rock, there's your best result that is really achieved by taking away objectionable features and revealing it. And that's the way I approach it. I don't think it's a matter of us constructing um something that has perfect uh proportions and measurements and and whatnot. I think those can be helpful in guiding the process, but um at the end of the day, beauty is a is is beyond the ruler and beyond the protractor, and and we know beauty when we see it and we feel it. And a surgeon has to have a sense of it and have a little artist in them and and to reveal it. And I think that's plastic surgery. I think the other huge misconception is that people feel like it has to be either undercorrected or overdone. And that's not true. There's a sweet spot in the middle where and where technique and artistry and experience all come together to produce what I consider modern plastic surgery that is proportional, balanced, and stands as a test of time. And that message I want to put out there so that patients seek and insist on that and and then achieve that because I think that's real beauty and that's real authentic beauty.

Dr Andrew Greenland 24:51

Thank you.

Building A Practice That Stays Ethical

Dr Andrew Greenland 24:52

So I'm gonna sort of switch gears a little bit now because um one of the things I like to do as podcast is talk about the stuff behind the consulting room door. And now you've gone from learning how to become a surgeon to building Miller Cosmetic Surgery, leading a team, and effectively building a business as well as being a physician. So, what's the biggest surprise about running a private practice that nobody taught you during medical training?

Dr Scott R Miller 25:14

It's a great question, and probably it was the hardest part for me because as you said, nobody teaches you. And again, we've already established that you know, my sports background came from tennis, which is a notoriously individual sport. And I would say the biggest uh lessons that I had to learn is that this is absolutely a team sport, and so um approaching it, building a team, all the things that go into leadership and managing people. And again, I'm certainly no uh I'm not managing a big company or anything like that. We have our tight, small team, and I've kept it uh within my capabilities, but within those capabilities, we have a very tight, experienced, um, long-established team that where everybody's in the loop. Uh, I treat my staff essentially like residents, where we're constantly educating and and teaching and learning. And I want them to, you know, they're not gonna do surgery, but they should know surgery, understand surgery, they should understand patients. And I'm at every every step of the way, I'm trying to make sure they understand the process and why we're doing what we're doing. Because then over time and over years, you create a staff that is extremely insightful and experienced and can help patients at a higher level. I would say that part um of you know, you want to have your aspirations for where you want practice to go, but you want it grounded in reality and in uh frugality when you start. And you don't want to set up um uh, I would say, like obligations that you can't keep based on overly optimistic um uh speculations of where you what you can achieve. Because you know what happens is if your overhead gets too high, you it pushes you towards bad clinical decisions that are bad for patients and bad for you and bad for your practice. So I my advice is for young surgeons is keep it simple, stay within your core uh abilities and capabilities, grow gradually, you know, the Japanese kaizen plus one, plus one, grow in increments and compound and grow, and don't try to uh grab you know the apples from the top of the tree right away because you're gonna then you're gonna stumble, fall off the ladder, and bad things happen to you and your patients. So that but I would say the biggest lessons that I learned is you know that that wasn't as hard to learn as the management of the team and management of people in it while you're also managing your patients, while you're also technically growing. So it's a it's a challenging but interesting uh career path, and that's what makes it fun, right? Is the the opportunities for for growth. But by growing slowly and incrementally, then you maintain the core thing, which is patient care, quality, integrity, safety, and service throughout for your patients.

Dr Andrew Greenland 28:08

So you've been doing this for a little while now, but there must be some things that are still um like ongoing challenges or bottlenecks for you. What kind of things are those?

Dr Scott R Miller 28:16

I would say however much better you get at uh reading patients, that's always a challenge because patients are humans and humans are incredibly complex. And when you're meeting with a patient, you have to determine which part is anxiety and which part is, you know, unchangeable and core. Is the patient irritable because they're anxious, or are they irritable because they're irritable? Like which who do you want to operate on? When, how? That's always been, I think if you talk to experienced plastic surgeons, you'll find that's always the the that that that you give a talk on that at a national meeting, you get the biggest audience because that's what people want to know and understand better is you know, we all want this this journey with uh surgical journey to go well. So um I would say that continues to be something that I continue to grow into. Um, I think how to adapt or rather incorporate uh technological advances, which we want to. We want to be open-minded and continue to grow, but doing it in a way that that is helpful for patient care and not turning patients into guinea pigs is super important. So um that is something that I think I've done well over the course of my career is bring things in in increments when they you know they make sense, do no harm, you find what's beneficial. If you find something doesn't make a difference, you can move on. You don't you don't, you know, come back from a national meeting and try some brand new procedure that you just heard about, and that's not in the best interest of the patient. And at the end of the day, it's not gonna be in the best interest of you. So so that's um something that's always a challenge is how to balance um growth with quality. And our patients are like gold, our patients are our practice, and we put them first and foremost and highest on the pedestal. So therefore, uh we certainly want to make sure everything we're doing is in their best interest.

Dr Andrew Greenland 30:10

And as a sort of owner founder, and probably somebody who wears all the hats at various points, is there anything that kind of keeps you up at night in this in the roles that you have?

Dr Scott R Miller 30:20

You know, I'm I probably would have I would live longer if I didn't care quite so much, but I don't know that I'd be as good a physician. So I care a lot. And uh anytime patients hit a bump in the road, um, I try to be um with them on that journey and know that to, you know, reassure them that we're not going anywhere and we're gonna we're gonna see this to the to fruition. When you follow good surgical principles, things are always uh manageable and you can get them to the place where you wanted to go. Sometimes it can take a little longer, but you get there. It's when you violate surgical principles that I think things, the wheels come off. So following surgical principles, being patient, uh being unsurgeon-like in terms of being patient sometimes is really key. So sometimes we have to, you know, take a deep breath, take off our surgeon hat that wants to get in there and do something about an issue and realize that that nature can help us too, as can uh the other supportive measures of medicine, which you're more knowledgeable than me, but you know, supplements and and and the other various uh holistic aspects of patient care. Um, so those are the things, you know, I just I just care about the patients. I want the patients to do well. Um, I find that if the patient, if you have to have the right practice paradigm. So given that caveat, asterisk, you have to have the right patient paradigm and patient right practice structure. But if you do, if you take care of patients well and you have happy patients with good results, the practice will take care of itself. I really don't lose sleep over the finances and and infrastructure and business aspect of the practice, but that's because that's with that asterisk that you set it up with the proper incentives and structures in the first place. So I my my anxieties are always more with right there alongside the patient.

Dr Andrew Greenland 32:10

Thank you. If you would have your time again tomorrow and do it all again tomorrow, would you do anything differently?

Dr Scott R Miller 32:16

I wouldn't. The only thing maybe that I would do differently. So I've I I did have um I did uh have a pretty good idea of what I wanted to accomplish when I started, what I wanted to achieve, what I what I wanted this practice to look like is a better way to put it. And and I actually did take the time to kind of write that down and and write that out and envision that. And when I've gone back and looked at that, literally a decade over a decade later, sometimes I go, wow, it's crazy how much of that exists today that really did happen. And if anything, I would revisit that more frequently. So I think I would basically, you know, I don't know if you have to paste it up on the wall and look at it every day, but I think I would revisit what what what I wanted to achieve, build, and and more frequently through the years, to so that I think that maybe you take an even more direct path there. I do think that even having done that originally has been hugely beneficial because when you know what you want to achieve and you know who you are, what your strengths, weaknesses, challenges are, then I think when you make, we make decisions every day, both in patient care, in practice, in what technology you want to bring onto the practice, in who you want to hire and not hire, et cetera. And all those decisions, first of all, you get a lot less decision fatigue when you know you have a core of why you're making those decisions. And second of all, you make better decisions that that make sure you're you're still going in the right direction that you want to go in. So I think the strength of what I did was doing that in the first place. It's amazing how much of that I did achieve. But if I was going to do it over, I'd probably revisit that on more of a regular basis. And I think maybe that would even have uh sped the curve a little bit because I look up now and I'm so happy and I love the practice that we've accomplished, which is one of the reasons I'm enjoying it so much and and and you know, for the foreseeable future uh going forward. Maybe, maybe you cut some years off of that growth if you do that sooner, but maybe not. Maybe maybe everything has its timetable.

Dr Andrew Greenland 34:29

Thank you. And final question: what's next familiar cosmetic surgery? Where are you looking to go in the future with all this?

Dr Scott R Miller 34:35

Right now, we're just supporting our patients in every way we can. We've brought on uh a couple of minimally invasive and non-invasive technologies that we think are supportive of patients and sort of do no harm technologies. I think those come, particularly in a surgical practice, with the the um the extra need to be very explanatory, because you know, there's things that have minimal downtime. That's great. They're also not going to make as quantum of improvements as surgery is. I think when people go into a med spa, they have one set of exploitation expectations. When they go into a dermatologist, they have another. When they come to see a plastic surgeon, sometimes the expectations for improvement or change are very high. And with these minimally and non-invasive approaches, that's not the case usually. Usually it's incremental. It doesn't make them bad, but it they're incremental. And I think it's in in contingent upon us to make sure and communicate that so that expectations are clear and straight. I think those technologies, though, can have huge benefit. We get people all the time. They go, okay, now I've invested in this. How do I maintain this? How do I keep this going forward? When am I gonna have to redo this? When am I gonna have to think about uh doing something in the future? And that depends on what they do. It depends on what they do. If they go out and sunbathe and hold a reflector uh up to their face every day and eat poorly, et cetera, et cetera, and not take care of their health, then yeah, things are gonna deteriorate faster. And if they do all the the right things in that regard, then they're gonna be healthier from the inside, it's gonna show on the outside. But there's also things we can do to kind of ebb that inevitable tide of aging that comes from just living in the world and and and stress and time, et cetera, and incorporating those things to help patients without turning into uh not trying to be a full med spa, um, where patients feel I don't want ever want patients to question what our intention is, what our goal is, what our priorities are. So that's always a balance of providing what pay uh more of what patients need. Uh, we also have a great referral network where we can help patients, you know, uh find resources. And and that's just as good to me. If somebody, if I know somebody who does something great, there's no reason for me to recreate that. What we try to bring in the office is fill needs that we feel like aren't being met. Um so, and then just continue to enjoy and refine the surgery, operating on people who appreciate what we can uniquely do for them.

Dr Andrew Greenland 37:04

With

Closing Reflections And Thanks

Dr Andrew Greenland 37:05

that, Scott, I'd have to thank you so much for joining me. I've really enjoyed this conversation because I really like where this has ended up, because we've been talking about plastic surgery, but really we've been talking about something much broader, how you combine technical excellence with understanding the person in front of you, how you remain open-minded without compromising medical standards, and how you build a commercially sustainable practice without losing the reason why you went into the medicine, and how you keep developing and um rather than just simply becoming comfortable. So it's been really enjoyable, very informative. Thank you so much for your time. Appreciate it.

Dr Scott R Miller 37:34

I appreciate it, I enjoyed it as well, and I think it's great uh sharing the information that you're sharing with the public and letting people know what the considerations are, what they can look for, and and what they can how they can best achieve their goals. They're the hero, and how they can go forward and and and be fulfilled by their interventions and with their health. So thank you very much.