A day in aesthetics medicine

09.00

I arrive at the clinic with my wife Vicky. She has a client for 3D-Lipo (this is a non-invasive fat removal system). I have a follow-up for a client who received cryotherapy to a number of skin lesions two weeks ago – I used a pen device, which delivers focused, high-pressure nitrous oxide to avoid the need for liquid nitrogen. I always offer a face-to-face review of patients undergoing interventional procedures to ensure effective outcomes and patient satisfaction. 

09.30

I have a 45-year-old lady who has booked a thread facelift. The non-surgical skin- lifting threads are made of polylactic acid, just like some dissolvable stitches used in surgery. They have anchoring, soft, cone-shaped attachments that help create a firm and younger appearance. The process takes me around 60 minutes and a lot of concentration, but has an immediate positive effect. 

11.00

A consultation with a 21-year-old who wants her lips enhanced. A discussion of lip shape and size and the benefits and risks of dermal fillers takes 30 minutes. She is happy to proceed and books it.

Just as in any clinical scenario, the consultation is a very important aspect of aesthetic practice. It is a time to assess the client for signs of body dysmorphic disorder and to understand expectations. Unrealistic or inappropriate expectations are likely to lead to dissatisfaction and possible complaint.

I like to allow my clients time to go away and consider the implications, risks and benefits of any invasive procedure. Considering individuals as clients rather than patients is also a difficult concept for me and involves discussion of value for money and fees for treatment.

11.30

A 35-year-old lady arrives for her botulinum toxin facial treatment. She has had this treatment from me on three previous occasions and came a week ago for her pre-procedure consultation. The botulinum toxin has already been prescribed and dispensed for her, and after assessing the facial wrinkles again and taking pre-procedure photographs and getting consent, we agree together to go ahead with injections.   

12.30

My wife in the meantime has seen two further clients for chemical peels, and a HIFU treatment (High Intensive Focused Ultrasound) to stimulate collagen and induce facial lifting and an anti-ageing appearance.

13.30

Since today is my admin day I rush back to my GP practice to meet the manager, dictate referral letters, review pathology reports and sign EPS prescriptions.

Stepping outside of primary care with its low morale and endless demands has given me a sense of sustainability. The scientific basis of aesthetics is an entirely new field to me. It is an exciting and energising subject and helps me feel better about the challenges of primary care, which I still value and enjoy. 

14.30

I am back in the clinic with a 19-year-old lady for lip fillers.   

16.30

I get a call from a 24-year-old chef who suffers excessive underarm sweating at work. He has seen his GP, but has not found any benefit from treatment so far. I advise him about the effectiveness of botulinum toxin and he makes an appointment for next week. 

17.00

We’re done for the day. I discuss with my wife and business partner the possibility of buying a laser device for the treatment of skin pigmentation and hair removal, which is the number one aesthetic treatment in the UK. We decide we need to employ an aesthetics technician, since neither of us is keen to spend our day doing hair removal.

I just have time to eat before dashing off to my band practice – I play the bagpipes in a Celtic rock band. We’re playing at the RCGP annual conference in Harrogate this year, no less.