Geoff Williams drives a dented and dusty 1992 Honda Civic, its partially detached rear panel bobbing with every dip in the road. When he goes home, it's to a paper-cluttered bedroom across the hall from his parents' modest master suite.
As a plastic surgeon, Williams could live in a sprawling house, cruise around in a snazzy sports car and wear custom-made shoes instead of the US$5 pair he snagged at the thrift store a few years ago.
Instead, he spends his money on hundreds of strangers half a world away. Grown men with rope-like tumours engulfing their eyes, noses, lips. Teenage girls with heads cocked permanently to one side because of burn-tightened skin. But mostly children with faces split up the middle like half-open zippers.
Williams invests in faces.
Originally it was art, not altruism, that drew him into the competitive business of plastic surgery.
"People think for my whole life I wanted to do something like this - working in developing countries - and it wasn't really like that," he says. "I like art, I like the form of the human face. Also, I wanted to be a doctor and do surgery, and plastic surgery was a way to put the two together."
His parents were thrilled, envisioning a life of traditional financial security and rewarding work for their eldest son. Not all of their wishes were fulfilled.
Williams' mother, Bev, shows off a watercolour of a mountain lake that hangs in her bedroom. "Geoff did this in high school," she says. "He's always been artistic."
Williams didn't develop his empathy for the disfigured from his childhood. He wasn't teased about his appearance in high school. There was no sibling with a cleft palate to defend from the harelip jokes of primary school students. He wasn't even the kind of kid who picked the mangy puppy at the pound over the purebred golden retriever or mowed his elderly neighbour's lawn for free.
Williams and his two brothers were average kids who played sports and got decent grades.
He worked his way through medical school with some help from his parents. He decided to specialise in children's deformities because he found that his scalpel could heal not only disfigured children, but also their broken-hearted parents.
He underwent cleft palate training at the Chang Gung Memorial Hospital Craniofacial Centre in Taiwan, considered a world-leading centre for cleft surgery. This birth defect, in which the roof of the mouth is separated - sometimes front to back - affects about one in every 800 babies.
Williams landed a lucrative job performing plastic surgery and teaching at the University of Texas. But as he worked and taught in expensive hospitals, he became preoccupied with thoughts of the hundreds of desperate mothers in Vietnam who had swarmed him during a volunteer training trip, thrusting their deformed babies at him and begging for help. Only 20 babies were treated on that trip; about 180 were sent away.
As his plane took off, he had been overcome with sadness. "Leaving, looking down at those lights, I knew these mothers were going home with total disappointment," Williams recalls.
"I remember making a promise to myself then, to those mothers: I may not be able to find you, but I'll find someone like you. I'll come back. I'll do more."
Several months later, he took another volunteer trip, to India. "I thought I'd do it a couple of times and get it out of my system. After about a year, it just hit me - it would not be easy to stop doing it. It took me a while to say, 'to heck with this sadness'."
Williams took a leave of absence from the University of Texas in 2003 to immerse himself in treating forgotten patients in developing countries. He never went back. He went to Peru, Kenya, Bolivia, the Philippines, Mexico, Pakistan, China and Thailand. And always back to Vietnam.
"A lot of the kids born with a cleft lip and palate never go to school. Their mothers keep them home as a way of protecting them from the cruelties of society," he says. "No education means little opportunity for work, for getting married, for everything in life that brings them rewards. Those little babies don't know what they're in for."
At first, he travelled with some of the many groups that organise medical missions to developing countries. But the trips bothered him. They often ended while children were still in the critical, post-operative healing period. Dozens - sometimes hundreds - of would-be patients were routinely turned away. And western doctors often had little time to train their local counterparts.
The turning point came during a trip to Vietnam in 1999. A child was turned away because it was the medical team's last day in the country - a day scheduled for sightseeing and shopping. Williams stayed and reconstructed the child's face. Hospital administrators quietly asked him to come back on his own.
He did, making trips to more countries at his own expense. He set up the International Children's Surgical Foundation in December 2005 to raise money so his work could continue when his savings ran dry. The foundation now manages to bring in just enough donations to stay in the black, covering Williams' airfares, hospital fees and a few other travel incidentals. He doesn't know when he'll get a salary. But he doesn't seem to care.
"His rewards from his work are infinitely preferable to what anyone would achieve doing standard plastic surgery," says Stephen Milner, a friend and board member of his foundation.
Some of Williams' friends say the fulfilment he has found in helping others comes at too high a price. At 53, he has less than US$200,000 in his retirement account, a paltry amount for a successful surgeon.
"I know some plastic surgeons who've retired with US$30 million in the bank, a private jet and a bunch of other toys, and they seem really unhappy," Williams responds.
He says he has found his life's work the most fulfilling career he can imagine. But keep prying, and he'll reluctantly confide something: the price of taming his adopted heartache for disfigured children and their parents is a different sort of pain - the pain of loneliness, a life of stress and solitude.
He would like to be married, but that means finding someone willing to work by his side and live an itinerant, often indigent, life.
"I feel like I'm never going to get married because of what I've chosen to do. No real chance for a social life," he says. "One reason I can do this job is because I don't have a bunch of little mouths to feed."
His lifestyle is beyond modest: abroad, he stays in hostels, in the homes of local doctors or even in the on-call rooms of hospitals. Yet the longer he spends on his work, the more alone he becomes.
"I've developed a bit of an anxiety disorder, because I'm always planning a few missions in advance, and I struggle with not having a steady, even-keel, solid routine in my life," Williams says.
But those feelings are transitory.
"Whenever I feel, 'poor me', I go on my next trip," he says. "When you find something you're meant to do, your life's work, you do it."
The rewards, although unusual, are priceless. One patient, Cassandra Castellanos, was just three months old when a gas tank exploded and burned her wood-and-reed home around her. Hospital workers told her mother, Maria Luisa Cruz, that her youngest child would not live beyond the next 24 hours. But Cassandra survived, her arms and face deeply scarred. Her wounded skin drew stares from strangers, and Cruz feared her daughter's life would be forever scarred as well.
"People like to stare," Cruz remembers. "They gave her such cruel looks."
As a single mother to four children, Cruz didn't have the money to pay for even one of the many surgical treatments Cassandra would need to reduce the scarring. But when Cassandra was six, they met Williams.
The first of her operations began with him inserting a tissue expander underneath the healthy skin near her burns. The expander was filled with water each week to force Cassandra's body to grow more skin over the device. Williams then surgically removed the expander, pulling the new skin up over her scarred cheek. He later moved her eyelid and right ear back to their correct positions and pulled her scalp forward to cover a bald area. He operated on her hand to relieve an area tightened by a scar, improving her mobility.
The work isn't done yet. Williams says he'll continue to "refine" the scars, and Cassandra is due for surgery next month in which he will use cartilage from her ear and rib to reshape her nose. Another procedure involves eyebrow grafts using hair follicles taken from the back of her neck. Williams hopes to avoid using skin grafts (on Mexican children grafted skin tends to turn darker than the surrounding area) but may have to on her upper lip.
Now 14, Cassandra grows closer every year to having the face she was meant to have. "The truth is, I'm really happy," she says. "Thanks to him I've had these operations. The way I was before and the way I am now - it's advanced a lot."
Her mother is also healing, seeing her daughter thrive. "She's so much better. She's not going to recover 100 per cent," Cruz says. "But 90 per cent - that's all right."
It all makes the austere lifestyle worth it for Williams.
In Vietnam, he casually mentioned that he liked mangoes and was soon inundated with the fruit by parents who wanted to pay him in any way possible for the future he provided for their children. In the Philippines, one mother presented him with a freshly butchered chicken, carefully wrapped in plastic netting.
His heart swoons as grateful mothers see him off on his next mission, waving their babies' tiny fists in the air so the infants can say goodbye too.
Moments like that lift any melancholy. They're proof that he's making a difference in someone's life. And for that, he says, his reward is the memory of all those faces.
