Role of an Aesthetic Physician - Not just the face!

Over the years, I have consulted clients with their aesthetic concerns.  Our role, as an aesthetic physician, is to perform a thorough history taking, examination of the client and setting up a management plan.  It is vital to use the knowledge of anatomy, physiology, medicinal and also surgical skills, in order to provide a holistic approach for my clients.

The following is a case study of a patient who was referred by another general practitioner in my practice.  This case highlights the importance of combining both aesthetic and medical knowledge.

A 55 year-old lady presented with concerns of her varicose veins.  She was referred by another doctor from my practice.  She reported that her veins started to trouble her for more than six months ago.  Occasionally, she would experience dull, dragging pain in her left leg and swelling of the ankle typically in the evenings.  She was otherwise quite fit and healthy.

On examination, it was noted that the varicose veins were present in her left leg only.  Her right leg appeared normal.  There was normal skin tone, vascular and hair pattern.  It was also important to examine her abdominal and lymphatic systems especially on the left side.  There was slight tenderness and swelling around her left groin (inguinal) region.  To her disappointment, I was not able to treat her varicose and spider veins on that day.  After a lengthy discussion, it was more important to look for a cause (usually higher pathology) and I decided to send her for a pelvic ultrasound and formal vein studies of both her legs.

Two weeks later after all the ultrasound studies were performed, the patient returned for a review.  The doppler vein ultrasound of her legs confirmed varicose veins only in the left leg.  Right leg was normal.  However, the pelvic ultrasound demonstrated an abnormal mass in the left pelvic region, around the left ovary and left fallopian tube.

She was referred to a gynaecologist, and was later then referred to an oncologist specializing in gynaecological surgery.   She had her left ovary and fallopian tube removed due to the findings of an ovarian tumour wrapping around the fallopian tube.

The patient made a full recovery and returned personally to thank me about one week ago.  This case highlighted the importance of clinical assessment and management.  

Our role of being an aesthetic physician also includes assessing the whole person, not just the leg!

Things are not always as they seem.