Skin deep: a cosmetic physician

Dr Gabrielle Caswell took cosmetic medicine to the bush and found a need that went far deeper than she ever imagined. Linda Peatling reports.

When self-confessed city slicker, Dr Gabrielle Caswell, left the emergency ward of one of Sydney’s busiest inner-city hospitals to marry a farmer and set up a cosmetic medical practice in the heart of rural Australia, many of her colleagues raised an eyebrow or two. Surely cosmetic medicine was far more at home in upmarket city suburbs than in down-to-earth country towns.

What they didn’t know, however, was that Gabrielle had discovered the world’s highest rate of melanoma right in the place she happened to be moving to, and saw a need that was far deeper than cosmetic. Two years later, she has more than 3,000 patients across four clinics in Northwest NSW, has detected over 200 benign and malignant skin cancers, and spends most of her time helping the people who live in one of the world’s harshest climates take care of their most vulnerable organ, the skin.

5am: Like all good farmers, Gabrielle’s husband Stefan is up at dawn, and Gabrielle has been right there with him ever since she gave up the city life to join him on his cotton and wheat farm in Moree, NSW three years ago. “Things start pretty early out here, but it’s a lot easier than working sixteen hours straight in an emergency ward,” she laughs. Even so, the decision to leave the hustle and bustle of the inner-city hospital wasn’t an easy one. “I’d only finished my medical degree a couple of years before and I loved the pace of city hospitals, so country life was a world away, but I knew I wanted to be with Stefan,” she smiles.

5.30am: The couple starts the day with a workout in their home gym and a light breakfast, rather than the quintessential hearty farm breakfast, as their four teenage sons are away. “Stefan has three boys and I have one. The house is lovely and full when they’re all here, but it’s definitely quieter when they’re away,” laughs Gabrielle. “Brenton is nineteen, and he is helping Stefan around the farm before he goes to college next year; then there’s Tom, who’s eighteen and joined a Buddhist monastery last year; James is our seventeen-year-old football star, who’s hoping to get an AFL contract this year; and Sam, fifteen, has a couple more years of school before he needs to make any decisions.”

6am: Stefan heads out to manage his 12,500-acre farm, while Gabrielle strolls into her beloved herb garden to relax and prepare for the day. “It gives me a chance to think, and it’s a green oasis in this drought,” she sighs. “I’d never really thought about the weather in the city, but out here it’s everything.”

7am: Gabrielle takes the short trip into the township of Moree, where she opened her first clinic three years ago. Although she knew it was a risk, she fitted out her practice with the latest skin technologies and equipment from around the world, as there was no other cosmetic clinic in the region. “I did eighteen months of research and knew there was a need because of the high rate of skin cancer and premature ageing, but I still had my doubts,” she recalls. “A lot of people see anything to do with cosmetic treatments as a display of vanity, whereas I view it as preventative medicine. People who live on the land are down-to-earth, so I did worry that I may not have any patients at all!”

To her relief, the local people were just as concerned about their skin as she was, and it wasn’t long before she had her first few patients. “I think that’s when I knew my practice would be different to any other cosmetic clinic I’d ever been to,” she says. “The people coming through my door were mostly men, and they were the big, burly, salt-of-the-earth kind,” she smiles. To this day, over 60 per cent of Gabrielle’s patients are men, compared with around 10 per cent in most city clinics. “A lot of people in this area have Celtic or Scottish ancestry, so there are quite a few red-headed, pale-skinned farmers around. When you mix that with the sun, it’s a dangerous combination.”

7.30am: Gabrielle likes to get to work well before her staff, so she can wade through her daily 100-plus emails. “I’m a bit of a glutton for punishment. I’m on a few too many industry committees and I’m currently editing the newsletter for the Cosmetic Physicians Society of Australia and helping to organise an international conference for cosmetic doctors,” she says sheepishly. “But I like to keep up with what’s happening and help maintain standards.”

8.30am: When Gabrielle’s four staff members arrive, she takes them into the conference room for a meeting about the skincare range she’s developing through a Melbourne laboratory. “Before I studied medicine, I finished a degree in biochemistry, so I’m a bit fanatical about the ingredients in everything,” she explains. “I get complaints from farmers who don’t like using sunscreens because they sting their eyes and make their hands slippery when they perspire, so I decided to see if we could improve the formulations. It’s been a long process but I know it’s the right thing to do, particularly if people use sunscreen more often.”

10am: Gabrielle’s first patient for the day arrives and happily greets her like an old friend. In fact, the 38-year-old man only met the doctor two months ago, and even then it was with a level of reluctance. “He came in with his wife, who’d noticed a strange little mark on his back and luckily convinced him to have it checked out, because it was a melanoma,” says Gabrielle. Today, there’s a 15cm scar where the little mark used to be and Gabrielle is helping it to heal. “I took a biopsy the minute I saw it and a week later he was in surgery having the rest of the melanoma removed,” she says. “The scary thing is, he hadn’t been sunburned since he was a teenager, but that’s when most damage is done.”

11am: Gabrielle’s next patient is here for treatment that’s associated with vanity more than any other. “Out here, Botox can really help with premature ageing, which is caused mainly by too much exposure to the sun,” she says. The woman she’s treating simply sees the process as a way for her to look her age. “My skin looks ten years older than it is because I’ve spent a lot of time working and living outside… I’m not here to look like a movie star, but I don’t want to look like an old lady either!” she laughs.

Gabrielle injects the Botox, a purified derivative of the bacteria botulism, into the frown and laugh lines around the woman’s forehead and eyes. The fluid will relax the muscles in those areas for four months, so the expression lines they normally create will be reduced. “It’s virtually painless and safe if it’s done by a qualified doctor who is selective about where and how much they inject,” says Gabrielle, who has Botox treatments herself.

12pm: Gabrielle breaks for lunch with a good friend she found when she moved to her new home town. “I feel blessed to have Helen out here… I’m a girlie sort of doctor, and with all those men in my house I need a woman in my life,” she laughs. “Helen is a local solicitor and she’s great fun – we have some good restaurants and cafes in town, so there’s always somewhere for us to meet up.” 

1pm: Gabrielle returns to her clinic to see a teenage boy battling the effects of acne. “I see a lot of teenagers with skin problems and once again, it’s not about vanity, but about feeling normal and good about yourself,” she says. “Men aren’t allowed to show concern about the way they look, but it can affect their self-esteem as much as it can women.” As a doctor, Gabrielle is able to prescribe hormonal treatments for acne and other internal medicines, when appropriate. “I think men feel a little more comfortable consulting a doctor, because the cosmetic industry is still very feminine. Even though there’s been a surge in magazines and products aimed at men, there are very few spas or clinics geared just for them.”

2pm: Gabrielle checks another man for skin cancers and will remove them if they’re benign or take a biopsy and refer him to a dermatologist if she finds anything more serious. “The medical profession is broken up into a number of fields, and we all complement each other,” she explains. “Cosmetic physicians, like myself, are doctors who are medically trained and spend the majority of our practice time treating cosmetic skin conditions with injectable and light technology (such as lasers). We’re often the first port of call for skin problems, as no referral is needed.”

2.30pm: Gabrielle will see a few other patients, who’ll be treated for a range of skin conditions, from scarring to cellulite. “The skin is arguably the most vulnerable organ we have, because it’s exposed to all the elements and also reacts to the things we put into our bodies,” she says. “Every person’s skin is slightly different, so I learn something new every day.”

4pm: Gabrielle walks down Moree’s main street to the local radio station, where she’ll conduct her biweekly radio show with local announcer Bob Taylor. “We started out educating people on skincare and sun exposure, but now we discuss a range of medical topics, from the eyes to the heart. It gives listeners a general overview about preventative health issues and how the body works,” she says.

5pm: As Gabrielle leaves the radio station, she notices it’s been raining in town and calls Stefan, as she knows he’ll be worried about the wheat crop, then drives out to meet him at the field. “It sounds strange, but sometimes rain is not such a good thing if it comes at the wrong time. The wheat is ready to harvest now, but if it gets too wet it will start to rot and that’ll be the end of it,” she explains. “I had no idea how scientific farming is nowadays – it’s been a very big learning curve.”

Words: Linda Peatling. Photography: Scott Hawkins.