Dr. S. Anthony Wolfe: In memoriam

Dr. S. Anthony Wolfe (Tony) died peacefully at home on December 26, 2023. He was born in Cleveland, Ohio, on July 30, 1940, to Thomas William Wolfe and Elisabeth Ann Wolfe (née Bobbitt). He attended elementary school and later boarding school in the Midwest and Northeast while his parents lived abroad due to his father’s role at the U. S. Embassy as the Air Force attaché. He later rejoined his family and lived in Russia, Germany, and France. As a result, Dr. Wolfe became fluent in Russian. He eventually mastered six languages, which would become useful for academic text translations. He earned his undergraduate degree in 1962 from Dartmouth College and, after 3 years at college, completed Medical School at Harvard University in 1965. During medical school, his class was taken to the Fernald School, originally founded as “The Massachusetts School for the Feeble-Minded,” which was closely linked to the American eugenics movement. It was standard practice then to institutionalize patients with severe facial deformities despite normal intelligence. His class was taken to an auditorium and on the stage were paraded a variety of patients with severe craniofacial anomalies, including Apert Syndrome, Treacher Collins, Crouzon Syndrome, Down Syndrome, and other facial malformations. In his senior year of Medical School, he was originally interested in neurosurgery. However, his interest waned after a rotation at the Mass General in neurosurgery, where patients did not seem to wake up. He also developed an interest in plastic surgery in medical school, where Joe Murray was on the faculty at the time. Dr. Wolfe then served in the U. S. Public Health Service from 1966 to 1968 in Dakar, Senegal. He then worked as a resident in Surgery and Plastic Surgery in Boston at the Peter Brent Brigham Hospital and the University of Miami, respectively. In his last year at Brigham, he had already been accepted into a plastic surgery residency and earned a scholarship to travel to Montreal to attend the meeting of the American Society of Plastic and Reconstructive Surgery. This was in 1971 and was the first time Paul Tessier spoke in North America. Dr. Wolfe knew immediately that craniofacial surgery was the type of surgery he wanted to do [Figure 1]. At the University of Miami, he trained under Dr. D. Ralph Millard, Jr., from whom he learned the Principles of Plastic Surgery. Millard had learned the Principles of Plastic Surgery from Gillies and had expanded on them. Dr. Wolfe learned the following principles from Millard, and applied them throughout his career:Figure 1: Dr. Wolfe early in his career, planning for a case at Jackson Memorial Hospital. He frequently drew on skulls and skull models to plan for cases and teach his fellows. While Dr. Wolfe staunchly adhered to the principles of plastic surgery and craniofacial surgery that he had learned from his mentors throughout his career, he also embraced innovation and new technologies, and adopted virtual surgical planning later in his career for preoperative planning, utilizing it for complex craniofacial reconstruction cases that he performed into his 80s Attention to fine detail. Being able to convince the patient to have one more minor procedure Respect for facial esthetic units Proper documentation with good photography The rotation advancement for unilateral clefts How to make and transfer a tube pedicle. In 1974, he completed a 1-year postresidency fellowship in Paris with Dr. Paul Tessier [Figures 2a-c]. This was a defining professional and personal experience. During this year, he cemented his medical interests in craniofacial surgery and began to innovate on many of the procedures pioneered by his mentors. During this period, he also began to forge lifelong relationships with colleagues, including his lifelong friend, Dr. Henry Kawamoto Jr. While working with Dr. Tessier, Dr. Wolfe learned the importance of the ideas, the principles, and the logic behind reconstructive work. With Tessier, he learned the importance of:Figure 2: (a) Dr. Wolfe observing Dr. Tessier in the operating room with Dr. Henry Kawamoto and Dr. David Matthews. (b) Dr. Wolfe with Dr. Tessier at the retirement celebration Dr. Wolfe arranged for Dr. Tessier. (c) Dr. Wolfe with Dr. Kawamoto at his retirement celebration in January 2023 Wide subperiosteal dissection to expose the facial skeleton Good power equipment and instrumentation and surgical syringes Good rigid fixation with wire, or increasingly, plates and screws The principle of the effective orbit is that the segment of the orbital framework, when moved, takes the globe with it, making possible the correction of vertical and horizontal orbital dystopias The classification of clefts (later to become clefts and ageneses) The forward movement of the midface by Le Fort 1 and 3 osteotomies and the monobloc frontofacial advancement The use of the temporal muscle, among others The importance of the use of autogenous bone in craniofacial reconstruction. In 1975, Dr. Wolfe established his practice in Miami, Florida, where he lived and worked until his retirement only a year ago. He became Dr. Millard’s colleague, as Dr. Millard “could use someone to do bones.” A variety of craniofacial cases had been collected for Dr. Wolfe while training with Tessier, and he was busy from the start, performing complex intracranial procedures at the very beginning of his practice up until the very end of his career, almost 50 years later [Figures 3a and b]. Dr. Wolfe treated both adult and pediatric patients. He was adept at complex facial and skull surgery in infants, and esthetic surgery in adults. He emphasized the balance between reconstructive and esthetic surgery. His primary commitment was to improve the quality of life for children with craniofacial anomalies. He was the chief of the Department of Plastic and Reconstructive Surgery at Miami Children’s Hospital since 1984. Dr. Wolfe took on cases that no one else would take on. He impacted the lives of countless children and their families.Figure 3: (a) At one point early in his career, Tessier is beside him giving him advice, which may have been, “Always use autogenous bone.” (b) The last case of his career - with the next generation by his side: Pedro Piccinini, MD, his last craniofacial fellow, now a craniofacial attending at Montefiore, and Erin Wolfe, MD, now a plastic surgery resident at University of Southern CaliforniaDr. Wolfe was accomplished and prolific, writing numerous books and journal publications. He also participated in many medical associations and societies over the course of his career. Dr. Wolfe was a founding member of the International Society of Craniofacial Surgery (ISCFS) in 1983. He served as president of the ISCFS, American Society of Maxillofacial Surgeons (ASMS), and Rhinoplasty Society. He was the recipient of many awards, including the American Association of Plastic Surgery (AAPS) Clinician of the Year Award and the James Barrett Brown Award for Best Paper in “Plastic and Reconstructive Surgery” (with Dr. Tessier). Recognized for excellence in his specialty, he dedicated his life’s work to advancing the science and practice of plastic and reconstructive surgery. He kept meticulous records of his own cases and was able to publish results on decades of long-term follow-up in craniofacial patients. He also chronicled the life and work of his two teachers, Dr. Millard, the master of soft-tissue surgery, and Dr. Tessier, the master of surgery of the craniofacial skeleton. Millard was a prolific author of books and publications. However, Dr. Tessier, because he was so self-critical, wrote very little. His early work, for instance on the treatment of enophthalmos, was in French, and therefore unknown and unappreciated by the English-speaking audience. Dr. Wolfe translated “The Report of the French Society of Ophthalmology”, from French so that it was available to others. He also translated the work of Dr. Limberg, “The Planning of Local Plastic Operations on the Body Surface,” which delved deep into local flaps in ways that few other surgeons ever have. His other books included Plastic Surgery of the Facial Skeleton, Facial Fractures, and various other translations on different areas of facial plastic and reconstructive surgery. His most meaningful work, to him, was his 2011 monograph on Paul Tessier, “A Man from Héric: The Life and Work of Paul Tessier.” In his last year of life, we wrote a book together, “A Tale of Two Teachers,” which he considered his swan song. It can also be considered a tale of three teachers, as it is a hybrid, both biographical and autobiographical. It documents the influence Millard and Tessier had on the specialty of plastic surgery, as well as on his career as a teacher from the generation that learned from the prior and broadened and deepened the scope of the specialty. Dr. Wolfe trained almost 80 craniofacial fellows and numerous plastic surgery residents and observers from around the world. His career goal was to pass on to the next generation what he learned from Millard and Tessier. He frequently espoused the use of autogenous bone and insisted that whenever possible artificial implants be avoided. He also built on Millard’s work with his innovations in cleft lip and palate repair. One of the technical innovations he was most passionate about was his technique for staged bilateral cleft lip and repair, which left patients with a normal-looking nose and good midface growth at mixed dentition and skeletal maturity, reducing the need for subsequent Le Fort I advancement. Dr. Wolfe’s knowledge, and the knowledge of his teachers, will live on through his fellows. Many of those he trained continued his expertise and teachings. Dr. Wolfe considered his biggest legacy his craniofacial fellows. He learned from his fellows as much as they learned from him. As Millard once said to younger surgeons in a video interview Dr. Wolfe made of him in 2000, “Plastic Surgery now remains in your hands.” His advice for trainees was as follows: The training of a Plastic Surgeon is a long process, and who your teachers were will have a lot to do with your capabilities, but having your own experience is capital. In the introduction of his book, “Plastic Surgery of the Facial Skeleton,” he relays advice to the reader that was given to him by his grandfather, Maxwell Ray Bobbitt, a urologist: “Son, make sure you get the best training that you can, no matter what field you decide to go into” Textbooks on Plastic Surgery are helpful, and watching another surgeon operate can be instructive A Good Plastic Surgeon will be sure that he has the best possible instruments, and that they are kept in ideal condition, and sharpened regularly. A Good Plastic Surgeon is highly critical of his or her own work, rarely content, and always trying to improve the Field For craniofacial surgery, in particular: pursue dental training. Dr. Wolfe would have preferred having 1 year of dental school to 5 years of general surgery training. When he was the president of the ASMS, in his presidential address, he discussed the nature of maxillofacial surgery. He had asked this question of Hugo Obwegeser, who responded that maxillofacial surgery is a medical specialty closely aligned with dentistry. Dr. Wolfe was adamant that plastic surgeons who perform orthognathic surgery require a strong background in dentistry. He advocated for incorporating 3 months of dental school into training for those pursuing craniofacial surgery, to learn dental anatomy, growth and development, and gnathology, as well as orthodontics, which is not taught in dental school. On Dr. Millard’s gravestone is his epitaph: “Principles, Discipline, Family.” Dr. Wolfe adhered to these principles throughout his life. He operated following principles he had learned from his teachers, continued to innovate and expand on them, and passed this knowledge on to his trainees. He was highly disciplined and never gave up on his “Impossible” cases. He continued to see patients in clinic and provide clinical advice after retiring from operating at the age of 81 years. The family was of the utmost importance to him. Dr. Wolfe forged lifelong relationships with his patients and took care of them as if they were his own children. Dr. Wolfe loved being a father, and it is fitting that his life’s work enabled his patients to live normal lives, becoming parents and pursuing successful careers themselves. He loved children, which was evident as he had ten children of his own. He once visited his son’s elementary school class and taught the class about plastic surgery, craniofacial surgery, and cleft lip repairs. He was always passing on his knowledge to the next generation and the generation after that. A force of nature both in and out of the operating room, Dr. Wolfe devoted himself to his career. Somehow, he made time for diverse personal interests. He was a true Renaissance man. In addition to being a prolific writer, Dr. Wolfe was an avid reader. He consumed knowledge ravenously. He was rarely seen without a book in his hand if he was not in the operating room unless he was completing the crossword, swimming, or cooking. He had a penchant for cooking, and once wrote, “There are many similarities between Surgery, in particular Plastic Surgery, and Cooking. Both specialties strive to make something beautiful, that will be savored and appreciated, particularly by the ones we love.” Dr. Wolfe frequently experimented in cooking cuisines from around the world and enjoyed traveling. He was extremely physically active and enjoyed traveling for both work and leisure, often visiting his colleagues, friends, and family around the country and world. He took on new hobbies throughout his life, including artistic pursuits such as sculpting and photography. Dr. Tessier once said of craniofacial surgery: “I don’t know if it is artistry. We are trying to make people, children, normal.” Dr. Wolfe did pursue artistry and perfection, though he was often self-critical of his results. He was always motivated to innovate, create, and improve. Dr. Wolfe was able to make time for work-life balance, by “hurrying up in the afternoon, so (he) could get out in time to see (his) kids.” He is remembered by his children, Andrew Wolfe (Hie Jung Yoon; Freddy and Henry), Julia Wolfe (Eric Moore; Theo and Naomi), Johanna Wolfe (Thorsten Wagner; Dahlia and Caleb), Olivia Wolfe (Neel Shah; Louisa and Bruno), Erin Wolfe, Thomas Wolfe, Laura Wolfe (Erika Parjus), Conor Wolfe, Anthony Wolfe, and Maxwell Wolfe, as well as his sister Ellen Brewerton and brother Tim Wolfe. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

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