THE SUNDAY PROFILE : In the Best of Hands : Here and around the world, Dr. Randy Sherman repairs devastating wounds inflicted by nature and accidents. Only family and flying, perhaps, bring him more happiness.

Unlike the others, the boy ridiculed by classmates as medio beso , or half-kiss, does not squirm as he gets closer to the operating room and Dr. Randy Sherman. Maicol Diaz has waited too long, prayed too hard for this day, and now that it is here, he is treating it like a big adventure.

Barefoot and dressed in hospital pajamas and an orange plastic visor, Maicol shoots smiles at the nurses and happily greets Sherman, a Los Angeles plastic surgeon who speaks to him in passable Spanish. Sitting on the surgery table on the fourth floor of Hospital Infantil, the children’s hospital, Maicol looks out the window and sees the tidy red-tile rooftops and weather-beaten brick and stucco walls of the small homes and businesses in the neighborhood. Beyond them are the scalloped shapes of the Andes, topped by a slate roof of low clouds. Maicol takes a last look, then lies back so they can put him under. He was born with a cleft in his lip: a large, ugly separation that has pulled up and stretched the right side of his mouth and nose for all his nine years, exposing gums and a cluster of badly aligned teeth.

Had Maicol been born in the United States, the congenital disability almost certainly would have been surgically corrected shortly after birth. But this is Colombia, and it has not been fixed. He has been forced to live with the deformity.

Tormented by classmates, Maicol quit school when he was 7, his father says. “He is a tough kid,” Gonzalo Diaz says. “But they kept calling him bad names, like medio beso. The names made him sad, angry. He got in fights. Finally, he quit school.”

As surgeries go, this one does not pose much of a challenge for Sherman, who sees himself as “a wound doctor,” rather than as a specialist in tummy tucks, nose jobs and face lifts.

“We take care of people’s wounds--congenital wounds, traumatic wounds, wounds from the ravages of cancer,” he says.

In Los Angeles, where he works out of USC University Hospital and teaches at the USC School of Medicine, he is acclaimed for his ability to repair badly damaged hands.

Drawn by the unique rewards of operating on children such as Maicol, Sherman regularly volunteers for missions like the one that brought him to Bogota. Past trips with Operation Smile International, a nonprofit group that exists solely to provide corrective surgeries for children, have taken him to Vietnam, China, Russia, Kenya, Ghana and Jerusalem.

Maicol is Sherman’s second patient on the first of five days of almost nonstop surgeries.

He begins by painting fine lines on the boy’s mouth in black ink, mentally rearranging the lips and mouth, imagining a perfect face. He seeks out physical markers, such as the Cupid’s bow, the little heart-shaped dip on the upper lip of a normal face. And he studies the nose, which has been pulled unnaturally to the right by the cleft in the lip.

Working intently, almost wordlessly, he spends just more than an hour on Maicol, cutting, sewing, taking apart, then rearranging. Sherman’s gifted hands are graceful and sure. They are hands that once molded Missouri River clay into bowls, that have played the piano with artistry. And now they are releasing Maicol from the face that has brought him so much pain.

After it is over, looking at the changes, Sherman nods his head approvingly. An immense smile creases his face as he studies the nose, the geometry, depth and thickness of the repaired lip. “See the rectangular shape of that nostril?” he asks. “It’s almost a perfect match to the other one.”

The success erases the fatigue of the 12-hour trip from Los Angeles, makes a memory of the start-up jitters that go with working in an unfamiliar hospital.

“It’s very wonderful to take a kid who has such an outstanding facial defect and normalize him,” Sherman says. “We don’t know whether the kid’s going to grow up to be the president or a criminal. . . . You have given them a little more of an equal chance. What more can you give someone?”

Then, it’s back to Surgery Room II, where the next patient is waiting.

Her name is Irma. A lively 6-month-old, she has big brown eyes that never seem to rest. Irma has been brought to the hospital from a local orphanage. Its administrators would like to place her with an American family, and they believe surgery will make that possible.

Inspecting the little girl, Sherman sees that she has a more serious problem than Maicol--a bilateral cleft, or two gaping openings on each side of the mouth that stretch to the nose. He knows that Irma will need follow-up surgeries. On the plus side, she has what he calls “fresh lips,” meaning no doctor has worked on them, and he can do the surgery right the first time.

“Let’s go,” he says, turning to scrub.

*

And so it will be as if all the stars were laughing, when you look at the sky at night. . . . And your friends will be properly astonished to see you laughing as you look up at the sky! Then you will say to them, “Yes, the stars always make me laugh!” And they will think you are crazy. . . .

--Antoine de Saint-Exupery in “The Little Prince”

*

Sherman, 43, says he caught the flying bug while reading “The Little Prince” in the third grade. He still loves the book and gives away copies to friends. He even calls one of his three dogs Saint-Exupery. The passage captures Sherman’s spirit, but it’s off in one respect: His friends would not be astonished to see him laughing as he looked skyward.

“He is the only person I ever met who learned to fly at night,” David Weininger, Sherman’s best friend, says approvingly.

The two became friends after meeting at the University of Rochester in central New York. Sherman, describing Weininger, may as well be describing himself: “He likes to fly. He likes to look at the stars. And he is very simple about life.”

One day this summer, weeks before leaving for Bogota, Sherman stood on a runway at Santa Monica Airport, where he had been giving rides to teen-agers in an open cockpit biplane as part of the Young Eagles youth aviation program.

“Flying is extraordinarily romantic,” Sherman said, wearing a brown leather bomber jacket, his head and face covered by goggles and a World War I-era flying cap. “When you are out over the Pacific, and the sun is low in the sky, and you are cruising along at 2,500 feet, and the wind is in your face. . . . Well, I mean, what’s better than that?”

Recalling flights to the Arctic Circle and throughout North America, he adds: “There is nothing like standing on the runway right before dawn, getting ready to get into the airplane to go to Vancouver or Anchorage or Aspen or Mexico or even San Bernardino. A runway is that kind of magic door.”

Santa Monica’s Museum of Flying, which loaned Sherman the biplane, figured in both the courtship of and marriage to his wife, Sandi, a real estate attorney.

She met her future husband while he was negotiating the purchase of the home they now live in, with 5-month-old son Max, atop Kenter Canyon in Brentwood.

Sherman, who had been married briefly during his surgical residency in San Francisco, offered her a helicopter ride. She passed.

“It was something she absolutely didn’t want to do,” Sherman says.

But Sandi, a volunteer for a group called Caring for Babies With AIDS, remembered the offer and called one day to ask if she could bring some children to the airport for a tour.

They began dating and were married at the Museum of Flying in 1992.

Although not thrilled by her husband’s flying, Sandi Sherman accepts it.

“We met when we were both sort of established. This was like a package deal,” she says, gesturing to her husband and the sky. “The flying makes me nervous, but at the same time Randy loves it. How do you take that away from him?”

When they were dating, Sandi remembers that her future husband, juggling surgery, flying and volunteer work, kept falling asleep. “My friends referred to him as the narcoleptic microsurgeon because he only has, like, full speed or stop. Every time we went out, he fell asleep. He sits down, he falls asleep--in movies, at dinners. I just thought he hated me,” she says.

Determined to get his pilot’s license, Sherman had taken flying lessons after the long shifts required by his surgical residency at UC San Francisco Medical Center.

After a lesson, recalls Weininger, a chemist who lives in Santa Fe, N.M., Sherman would sometimes play piano in a Haight-Ashbury jazz club.

“Randy balances one stress against another. As soon as something comes up, he puts something else on top of it,” Weininger says.

*

Knowing that Sherman is a plastic surgeon, people can’t help but wonder about the nose. They figure he has the resources to fix things, right, so. . . ?

Sherman’s nose, broken repeatedly while playing football, is mashed in, knobby, like a prizefighter’s. It also says something about his priorities, and sometimes causes trouble in a field long identified with cosmetic beauty.

“A woman once came in for a consult,” he recalls. “We were almost finished when she looked at me, then kind of turned away and asked: ‘I have only one question: Why don’t you have your nose done?’ ” He laughs at the memory. “I said, ‘I did, I had my nose done about four times on the football field.’ Needless to say, she didn’t book.”

Sherman does cosmetic surgery, but his specialty is reconstructive surgery--correcting birth defects, reattaching limbs, repairing the devastation caused by fire, gunshots or industrial accidents.

“There is this classic reaction I get when people hear my husband is a plastic surgeon,” Sandi Sherman says. “They say, ‘Oh, can he do my eyelids?’ I say, ‘No, no, chop off your hand and then we’ll talk.’ ”

Sherman’s march into the surgery room followed a twisting path.

He never knew his father, who died when Sherman was a baby. He and two older brothers, Andy and Farrel, were raised by their mother, Pearl. “She is an extraordinary woman,” Sherman says. “She lost my father when she was 33. She was left to raise three kids, all under 5 years old.”

Growing up, one important mentor was Dr. Bernard Jaffe, the physician for Sherman’s Clayton, Mo., high school football team. Now vice chairman of surgery at Tulane University Medical School, Jaffe helped Sherman through knee surgeries and broken noses. He became a role model and surrogate father.

“We love each other a lot,” Sherman says.

Turning down football scholarships to two Big Eight Conference schools, Sherman chose the small but academically demanding University of Rochester, Jaffe’s alma mater. There, he gained distinction as the barefooted punter who performed in frigid temperatures.

After two years at the University of Missouri Medical School, Sherman became restless and left. This was in the early 1970s, a prime time for what Sherman calls his “hippie phase.” He joined a commune on the banks of the Missouri River, lived in a tent and learned to make pottery.

“He was going through growing pains,” Jaffe recalls.

Within months, and without admonishments from Jaffe, Sherman’s interest in medicine returned.

At USC University Hospital, he heads the team of highly specialized microvascular surgeons who earlier this year performed the rare surgical feat of reattaching the scalp of a young woman, Patsy Bogle, who had been hurt in an industrial accident. Sherman oversees a 24-hour, 7-day-a-week countywide “replantation hot line,” which offers emergency services to people who lose limbs.

Despite his professional accomplishments, and the humanitarian award he received this year from the California Medical Center, Sherman believes he faces an uncertain future. For one thing, he wonders whether surgeons like him will have a place in the rapidly evolving world of medicine and managed care. Already, the third-party second-guessing of his treatment plans--by insurance companies mostly--infuriates him.

“You train doctors for nine years to know how to treat people and then you start having administrators tell them what tests they can order and can’t order, what procedures they can and can’t do,” he says. “I am seeing the deterioration of something that I hold dear, which is the quality of what I do.”

As a player in academic medicine, he spends much of his time overseeing the education of young plastic surgeons, lecturing at conferences and seminars all over North America, writing papers, helping to edit peer-review journals. But capturing a spot on the academic fast-track and keeping it can be tricky.

Even so, academic medicine, he believes, is something “you can’t hold on to forever.” One day you may wake up and find “everybody is moving one way and you’re moving the other,” Sherman says, and then “it’s time to get out.”

*

Sherman brought those concerns with him to Bogota, but he was soon too busy to dwell on them.

The beauty of the trip is the simplicity of the Operation Smile mission: to take care of children, each badly in need, one after the other, from sunrise to nightfall. He finds the rewards immediate and profound.

“Where else in the world can you go and do an operation, do anything for a person, and change them so dramatically, so drastically, so graphically?” asks Sherman, who stayed with a contingent of volunteers at a Spartan but supremely peaceful convent-turned-hotel run by the Sisters of the Poor. “The bottom line is, you help children. It’s that simple.”

That is the vision of Dr. Bill Magee, a Norfolk, Va., plastic surgeon who co-founded Operation Smile with his wife, Kathy, in 1982. Reflecting on the motivation for moving 4,100 pounds of medical equipment and more than 35 surgeons, nurses, anesthesiologists and others to Bogota, Magee offers the case of one of his first patients, a 35-year-old man with a hideously deformed mouth. “Try to imagine living 35 years of your life and never feeling the gentleness of a kiss,” he says.

On the day before Sherman is to leave, two things stand out.

First, Maicol Diaz comes back for a follow-up examination. The lip is healing perfectly and looks great. There are smiles all around. “ Bien, bien, “ Maicol’s father says. “With the operation and all your help, he will go back to school.”

The second involves the worst case Sherman comes across on this trip. Juan Vargas, 8, was in a Bogota factory looking for his father when a heavy automatic door closed on his foot. It was crushed.

Sherman meets the boy on Sunday evening, five weeks after the accident. The local doctors had just covered the wound and left it, hoping the microsurgeon due soon from Los Angeles would have some answers.

Sherman is appalled by what he sees. The boy, lying on a cot in a six-bed ward, is in such intense pain that he cries out in agony even as doctors reach down to take off his bandage.

The next day, having decided to put the boy under anesthetic before looking at the wound, Sherman finds the foot badly infected. A significant part of it is simply gone.

Sherman is confronted with two options, neither of which he finds attractive.

One is to attempt a complicated surgery known as a “free flap,” in which muscle and tissue taken from the boy’s shoulder and thigh would be attached to the missing part of the foot.

Sherman isn’t sure.

What troubles him is that, even if the proposed operation is successful, Juan would require follow-up surgeries, including complex bone grafts. Remembering the neglected state he found the boy in, Sherman has serious doubts that Juan would get the care.

Option two is to amputate part of the foot, with enough remaining so that Juan could walk freely. Sherman thinks this might be the cleanest, most humane thing to do. “He’d be back on his feet in no time and would never have to come to the hospital again,” he says.

Still, it is decided to try to save Juan’s whole foot. Sherman works for 3 1/2 hours, with the help of a Bogota surgical resident. Medical students peer over his shoulder, watching the meticulous microsurgery unfold. The sewing up of veins and arteries requires a high-powered surgical microscope.

Once the operation is over, Sherman spends several tense hours wondering whether the graft will take.

Around nightfall he holds a Doppler, a highly sensitive listening device, to the gauze-wrapped area just above Juan’s foot. Suddenly, Sherman hears a rhythmic “whoosh, whoosh, whoosh.”

The doctor smiles broadly. “That’s a great pulse,” he says.

Walking down the hall, free to relax after 12 grueling hours, the squealing babies, concerned parents, language problems and little crises behind him, Sherman is a happy, contented man.

“It always surprises me how well things turn out in the midst of all this chaos,” he says.

Dr. Randy Sherman

Age: 43.

Native?: No; born in Clayton, Mo., now lives in Brentwood.

Family: Married for two years to Sandi Sherman, with whom he has a 5-month-old son, Max.

Passions: Family, flying, medicine.

On becoming a surgeon: “The demands put on you are physical, intellectual, psychological, and they are unrelenting. There is never really a down time. People are always evaluating you, everything you do gets a mark, and just when you think you have it mastered, you get pushed up to the next level. That goes on year after year after year.”

On the appeal of flying: “For a driven individual, it’s the perfect kind of hobby, because you can always improve your skills, you can always improve your proficiency, you can always get more into it. It’s not the kind of hobby that you can say, ‘OK, I’ve mastered this.’ ”

On being raised by his widowed mother: “I never acutely felt the loss of a father, which means my mother was doing double duty. She was incredibly compassionate. You could just tell that she would never let you down. Never. I probably was used to every third night on call at the hospital, because I had every third night on call with the dishes since I was 5.”