The tweaks, tucks and transformations of
Dr Tim Goodacre


Fembots, futurism and the opposing concepts of hi-tech perfection and the construction of beauty led us to collaborate with Dr Tim Goodacre on this season's must have Markings Print. As president of BAPRAS (British Association of Plastic, Reconstructive and Aesthetic Surgeons), who better to help us re-work pre-surgical markings into prints that outline and trace the curves of the body.

We recently shared a stimulating exchange with Dr Goodacre while he was enjoying the sweltering heat of southern India. Here exclusively is the extended version of our chat...

You began your amazing career as a surgeon in London before relocating to a remote part of rural Tanzania. What was your reason for this and what was the most important thing you took away from the experience?

This one might take longer to do justice to than I've really got time to write! However, I have had a huge heart for the needs of the poor - especially in sub Saharan Africa - since visiting eastern Nigeria soon after the Biarfran war had ended in 1971, when I was still a sixth former at school. I subsequently heard several moving presentations on the medical plight of many such African poor whilst a student, especially from some Christian speakers, and when my wife & I got married before my final year as a med student (she was a political studies student who shared many of my thoughts in the developing world and its needs) we headed straight for 4 months in Liberia west Africa. Unbelievably hot place, but again formative for our later thinking.

Once I had qualified as a doctor, I was faced with either pursuing my interests in psychoanalysis or becoming a surgeon which would give me more 'transportable skills' for use where I couldn't speak much local language (never have got much further than passing o level French with a single mark!). Once through basic early med training I was lucky enough to get a superb training post as an old fashioned registrar on hours you wouldn't these days believe. After 2 years at that and having had one young child, my wife and I felt able to volunteer our services to somewhere, and got posted by a Christian mission organisation to the middle of Tanzania. The rest followed from that... Although a pretty testing time in all sorts of ways, it shaped my life subsequently, and I guess I'm still enjoying travelling immensely as well as working to support the ever increasing surgical needs of the worlds poor.

I can't fully describe what I've taken away from all that past; guess more a changed perspective on what matters in life as it seems to me and my family.

What area of the body do you specialise in and what draws you to it?

My main ultra ultra subspecialty is repairing deformities of the lip and mouth. I guess I've been drawn to that area partly because it requires a lot of patience and fine work, and also because it is really a very long term project for the children and families I treat. There are whole series of operations, care in between, investigating, supporting and such, it is a very 'holistic' process.

Although I no longer do so much other reconstructive work, I still really enjoy 'fixing thngs' constructively with surgical techniques and methods, which is quite different from much of the more destructive work that treating cancer and other diseases with surgery involves. I also like the thought of what the long term outcome of my work might do to help kids affected, such as thinking of girls and boys sensitivities about their lip appearance when they first meet others, wedding days, and so on.

As well as all that, I really enjoy the cosmetic side of plastic surgery, and have got an immense amount of pleasure from restoring some women's bodies to shapes and sizes that enable them to more fully live fulfilled lives and potential. That might seem quite different from the pure 'beautification industry' which has become perhaps more associated with plastic surgery. It is, of course, really satisfying to reshape a nose to a truly beautiful proportion if someone wants that and I am really privileged to have been working in an area of medicine that enables me to have the joy of creating such things.

Which brings us to ask, what is your personal opinion on beauty?

Quite a question! I guess we all know it when we see it, but as I have become older myself and also worked with so many people of different races, ages, classes and styles, I have come to see beauty as a much larger and enriching concept than ever presented in the somewhat trivialised press that we are bombarded with. It is truly not a simplistic platitude to say that I can now see much more real 'beauty' in the lined and expressive face of an older person than in the expressionless, flat skinned and (to me always) so obviously botoxed features. I believe we would do well to celebrate more the incredible value of what increasing years brings us, rather than try to develop even more ways of enabling people to try and become Peter Pan. After all, none of us will be immortal!

But enough philosophising. I guess I love a beautiful persons face and body as much as any other. I simply hope we can begin to do better as a society when it comes to valuing diversity more than the narrow confines we seem to do now.


What influence do you see fashion or trends having on plastic surgery?

I see the world around us as enormously influential on what developments happen in health care. The drive towards adjusting our bodies one way or the other to fit in with societal norms or pressures is almost irresistible. Some of that is, of course, for good - We see body part transplants (faces, arms, etc) used to sort out previously intractable problems. We also see really novel ideas such as fat transfer being used not only to rejuvenate skin and body area which have lost fat or got lined, but also to fill defects which nature might have left or followed surgery (the big dents in breasts for example after breast lumps have been removed).

As fashion increasingly pushes the boundaries of what we like to appear as as human beings, I can see that invasive surgical techniques might be used more to fulfil those desires. We've seen years of use of breast surgery to change sizes and shapes of the breast as well as a lot of lower body plumping out in places where they love to have a big bum! I once came a cross a woman in Uganda who needed fat to be transferred to her breast to fill out a deformity, but completely refused to have it suctioned from her bottom (which was pretty generously endowed I can assure you!), if anything she wanted more down there! So there is huge cultural variation in what people want from plastic surgery, and it seems to remain despite the 'homogenisation' of the world as we see it.

At the extremes, I have had approaches from a young person asking me to change his facial features more in line with the Manga comic style. I have also had fascinating conversations with artists over the years about making abnormal body features as part of their conceptual art. That was where I came across Rachel Armstrong (Pernilla's colleague at the Bartlett school of architecture at UCL) who was a medical student in Oxford in days gone by and who introduced me to the work of Orlan and Stelarc. I've never done anything practically of that nature (though been really tempted and would in the right circumstances) but I can foresee a time when the relative risks of surgery and ethical boundaries might be acceptable and a few on the fashion fringes take the step of living with visibly different features. Scars are almost inevitable however, though the willingness of so many to subject their bodies to tattooing these days means that I guess the long term consequences of bodily interference are not perhaps as considered as I would imagine.

Having said all that, I hope that I can use my skills more to restore broken lives in those injured in ghastly conflicts like East Congo rather than the fringes of art, even though both aspects of life interest me to be honest!

How have advances in technology impacted on surgical techniques and outcomes?

New technology is incredibly important in our field, from the development of microsurgery and tissue expanders, to the new ability to take the head to bits and readjust the skull bone shape (the ones are almost like an Airfix kit in Craniofacial procedures!), we have seen enormous developments. We will have massive advances in transplantation in the next 5-10 years, mainly for significant health care demands after cancer, injury and so forth. More on the horizon is advanced tissue engineering to make new body parts, use of stem cells to rejuvenate ageing parts, new bio active materials such as polymers which might be substitute muscles and so forth.

However, we will still grow old and all die eventually. Eternal life on this earth has never been an appealing prospect (explored a lot in literature and even opera, see Janacek's 'The Makropoulos Case') and I suspect that one of the big areas we'll be developing in the coming years will be how we manage the whole subject of growing older in society. Fashion and the arts have a great place to play I feel and a mature approach that whole area will define a new domain of fashion I anticipate.


Describe your initial reaction when Geoffrey got in contact with you?

Just really fascinated and excited at the prospect of trying to 'think outside the box' again, and enjoy some time with the sort of world that I enjoy greatly and would love to have even more time to develop in my own creative life if time were no object!

There is a cross-section of different disciplines influencing this collection. What do you make of the relationship and similarities between aesthetic surgery and architecture?

I think we have a lot in common, our perception of space and form and the world we inhabit. The best architecture seems to me to have a deep understanding of the needs and desires of those who will inhabit/use/enjoy the space created. Likewise, the best plastic surgery also seeks to get under the skin (excuse the pun) of the patient and create changes that meet their needs, even if that sometimes means trying to work with the person when surgery really isn't right for them or wise.

Was this the first time you worked with a fashion brand? Are you pleased with the outcome?

This was the first time I'd done such work, and I was delighted with the end product - even though I was very nervous indeed. I realised how stereotyped we are as surgeons who don't have quite the ability to manipulate bodily tissues as easily and flexibly as brilliant fashion designers can do with their diverse range of materials!

Word is that you're also a passionate music lover. Care to share what your favourite song at moment is?

I'm fed a lot of great stuff by my architect son, currently love having Todd Terje's Inspector Norse on in the theatre as I operate. You should see everyone's feet begin tapping along and hips wiggling to the beat.

Shop Dr Tim Goodacre's Markings print.

Posted by Samantha Lim.

Friday, May 10, 2013