The terms “dwarf” and “dwarfism” (generally applied to individuals with achondroplasia) have a relatively recent appearance in the medical literature [3, 9]. The terms were first used in a clinical manner in the late 19th [13] and early 20th century [12], but did not become established for this purpose until associated with the detailed descriptions of the genetically based condition of achondroplasia in the 1950s [8]. Regardless of when the first medical reference to dwarfism appeared, that date is far more recent than the descriptions depicted with incredible accuracy by Spanish painter Diego Rodríguez de Silva y Velázquez (1599-1660), under the patronage of King Philip IV [7]. Born in Seville, in southwest Spain, Velázquez was a descendent of tradesfolk from Portugal who probably were Jewish conversos (products of the Inquisition) [14, 15]. He pursued his passion for art with formal training prior to the age of 12. Before leaving for Madrid in 1622, Velázquez was already established as an outstanding artist in Seville. With the introductions and opportunities afforded by his regional fame and his demonstrated talents (and the recent death of King Philip IV’s previously favorite painter, Rodrigo de Villandrando), he quickly won favor at the royal palace. Approaching the end of his highly acclaimed career, and despite his humble lineage, Velázquez was knighted in 1658 [4, 6]. Velázquez’s portraits, with their outstanding detail and perspective that reflected both technical realism and emotional transparency, remained his primary focus toward the end of his formidable career. One of his most acclaimed portraits, Las Meninas (The Ladies-in-Waiting; [Fig. 1]), includes images of dwarfs, and serves as an incredible example of his observational skills [7]Fig. 1.: The portrait, Las Meninas is shown. (Published with permission from Leanne Ogasawara).Velázquez has likely contrived the scene depicted in Las Meninas, and done so to make several points [6, 10]. Most obvious is the insertion of the artist himself at the far left, as he is the largest figure in the painting. Depicted with brush, palette, and mahlstick in hand, he is in command of the content of the canvas by virtue of skill and observation. Indeed, Velázquez is making a statement about the control the artist has in the creative process of painting. The scene also provides commentary on the nature of the royal court, but his focus on the young infanta (Princess Margaret Theresa), absent the physical presence of King Philip IV and Queen Mariana (although their reflections are seen in the mirror on the back wall), allows an informality and relaxation unavailable, by convention, in formal depictions of adult nobility [5]. The young regent, in the center of the painting is surrounded by attendants, including a chaperone, body guard, the queen’s chamberlain and head of the royal tapestries standing in the doorway, as well as her dog and two dwarfs at the far right of the canvas (Fig. 2). The dwarfs, named Mariabárbola Asquin (left) and Nicolasito Pertusato (right), like all participants in this snapshot of court life, appear healthy, well-dressed, groomed, nourished, and valued [6].Fig. 2: Velázquez inserted himself into Las Meninas as the largest figure in the painting (far left). He is depicted with brush, palette, and mahlstick in hand. Mariabárbola Asquin (left) and Nicolasito Pertusato (right) are seen at the far right of the canvas. (Published with permission from Leanne Ogasawara).Velázquez goes on to provide convincing command of perspective and rich details of his subject matter through variations of color, tone, and modeling that are particularly appreciated in his treatment of embroidered fabrics and jewelry. In Las Meninas, Asquin appears to have achondroplasia, while Pertusato’s short stature probably reflects hypothyroidism, the second most common cause of dwarfism. His paintings of the dwarfs, Sebastian de Morra and Francisco Lezcano serve as further examples of his incredible observational and painterly skills. Velázquez’s keen treatment of the human condition is no less impressive. Our contemporary medical description of achondroplasia includes a characteristic facies with broad forehead, flared nares, and a head-size out of proportion to overall skeletal height. Limbs are short compared to the trunk, especially the proximal upper extremities. Hands are broad with stubby digits [8]. All of these defining traits are accurately rendered by Velázquez, more than four centuries ago. Importantly, the artist also captured the intellectual normalcy of his subjects—serene, comfortable, and productively engaged in their social surroundings [3]. In Las Meninas, we also are provided with a comparison of two distinct types of dwarfism, achondroplasia and, most likely, hypothyroidism. In the latter, the usual body proportions are maintained. By modern definition, dwarfs are under 4’10” and usually they average closer to the 4’ mark. Taking a step back from Las Meninas, and looking more broadly, it is remarkable how artists with a keen sense of observation can clearly and accurately describe features of the human condition, like dwarfism, long before, often centuries before, these same circumstances were recognized and reported in medical journals. The individuals we now refer to medically as dwarfs have appeared in the visual arts of many cultures and over vast periods of time. For example, Seneb, an Egyptian dwarf married to Princess Sentyotes and assigned several important oversight responsibilities in the royal household, was depicted in sculpture entombed in Giza around 2500 BC [2, 7]. Similarly, images of dwarfs are found on ancient Greek vases and Chinese ceramics, in Japanese prints, and as subject matter in stone reliefs from India and artifacts of the Mayan civilization [2, 7]. These previous societies appeared to recognize that dwarfs, while short in stature, were usually of normal intellect and generally skillful [5]. Dwarfs engaged in many aspects of the social and economic fabrics of society, from positions of servitude to respected professionals. These roles were frequently captured in Western art of the 16th through 18th centuries and included employment or service in the royal courts of Europe as jesters or attendants, as reflections of wealth, or as curiosities [11]. Dwarfs were generally depicted with a sense of dignity and value, at times with indifference, but uncommonly at odds with nature [1]. Some artists and artisans, themselves displaying dwarfism, also achieved notoriety; perhaps most famous in this regard was Henri de Toulouse-Lautrec (1864-1901) [16]. While the majority of dwarfs have achondroplasia, Lautrec’s dwarfism has usually been attributed to the X-linked recessive disorder of pycnodysostosiss [2]. As clinicians, we’ve been trained to identify as many relevant physical findings as possible, and use this information, along with other more objective tests, to form a diagnosis and plan of care. It is this power of observation, also essential to other disciplines, that is fundamental to our acumen and success as physicians and surgeons. It is the ability to see what others have missed that sets some apart as especially skilled.