Dennis Nigro says he knew when he was 15 years old that he would be a plastic surgeon and that he would use his skills to help people. Today he is a successful plastic surgeon and founder of Fresh Starts Surgical Gifts, a nonprofit organization that provides free reconstructive surgery to children with physical deformities. He has received numerous honors, including the President's Volunteer Action Award, and the Dr. Thomas A. Dooley Award from Notre Dame. Register correspondent Martha Lepore interviewed him at his office in Encinitas, Calif., at 7 a.m. — on the day his first daughter was born.

Lepore: What deformities do your patients have?

Nigro: Most of them are birth defects, such as large growths of neural tissues on the face, birth-marks, protruding ears, and webbed fingers and toes. Some have scars from accidents or abuse. For the most part we perform reconstructions in several stages over a periods of one to two years. One of the benefits for me in doing these operations is becoming familiar with them and finding better ways to do them. Often there is a trading back and forth of techniques between the reconstructive work of Fresh Start and cosmetic surgeries in my practice.

In your surgical outreach through Fresh Start Surgical Gifts, you bring the patients to your clinic — why?

We do this because I found out on a medical mission to Mexico that I didn't have the surgical resources I needed. We can serve them so much better in fully equipped medical facilities. In fact, we are opening another Fresh Start surgery center in Johnson City, Tenn., at the end of October. Plastic surgeon Jim Brantner, MD, will be in charge of that center.

What do you get out of this work?

There are a lot of problems in today's medicine. In my regular practice, surgeries are being shackled by the legal and health care systems and I can't practice like I would like. Fresh Start gives me the opportunity to do what I think is needed for patients. It never feels like work doing Fresh Start surgeries; I enjoy it and feel good doing it.

What difficulties do you face in directing Fresh Start?

We began the program in 1991 and it involves not only the surgeries but also finding transportation and housing for patients and their families. In the last eight years, we've coordinated and performed free surgical procedures for more than 200 children during intensive surgery weekends that we now conduct about every seven weeks. I've learned that this work is not something where you can rest on reputation. You have to be on top of it every day. This can wear on you and be hard to do, but it is more than worthwhile.

What are your plans for the future?

I don't ever see my self as retiring and I hope Fresh Start realizes its potential as an organization. More people are finding out about us since we started the Web site [www.]. In fact, many patients come to us through the Internet. I also have a weekly radio show and will continue to use part of my time to encourage volunteerism. I think it's very important and tell people volunteering isn't a burden, it's a privilege.

Martha Lepore writes from Coronado, California.