Interview With Barbara Strafella: Permanent Makeup & Medical Spas

Permanent makeup has made an appearance in a number of medical spas and clinics. Does it have a place in your practice?

Permanent makeup spans a gamut from cosmetic eyeliner to aesthetic treatments like areola repigmentation after mastectomies. While not a medical treatment, there's always some interest about adding aesthetic treatments that patients may be interested in. In this interview we wanted to find out more about what permanent makeups offer, and where (if anywhere) they may fit inside a clinic.

Name: Barbara Strafella, DAAM, CPCT, LMTA
Location: Staten Island, NY

Can you tell us a little bit  of background about how you started working with permanent makeup in a medical setting?

The first medical procedure I performed was an areola re-pigmentation after a double mastectomy. When I completed the procedure the surgeon spoke about my creativity to her colleagues. That moment was the beginning of my career as a medical tattoo artist. I usually meet with the patient prior to discuss the treatment that will be needed after breast reconstruction.

As my knowledge broadened regarding the effect of tattooing on skin I learned that I am able to get positive results with scar revisions including surgical scars, burned skin and collagen induction.

In the beginning we were a day spa. Training became a priority in the late 80’s and early 90’s with all the developments in the spa industry, which led us into the medical spa field. Being affiliated with 6 doctors, including Cosmetic Surgeons, a Cosmetic Dermatologist, an Ocular Plastic Surgeon, Breast Reconstructive Surgeon, and a Pediatrician keeps us up on the latest treatments available. 

I am proud of my spa and the services I offer knowing that many of my clients have been coming to me for more then 20 years. I have treated them, their children and grandchildren. At I Wake Up With MakeUp we have a fund where gratuities are deposited and used to pay for the supplies and products needed to treat those who are medically in need and are not able to afford the services or services which the insurance companies will not cover. We offer skin care, peels, micordermabrasion, IPL treatments, electrolysis, lymphatic drainage, Infrared Sauna, eyelash and eyebrow tint, false eyelashes, permanent makeup, scar revision, spray tanning, fillers, Botox and retail products.

Since you are affiliated with other clinics, can you tell us how you are compensated?

In the past I was compensated, but since we all refer clients to each other on a regular basis no one keeps track any longer.

What challenges did you face when you started your clinic? 

The only challenge was getting my clients to follow my move from a doctor's office to my own location. When each of my clients came in for their first treatment at my new location I performed the procedure complimentary, but they didn't know until after I was done. I must say everyone was pleased, and most made a donation to my "fund" which benefits any cancer patient that can't afford to pay for a procedure that I offer. 

What have you learned in managing your employees?

Containing staff in a spa environment was a costly lesson learned the hard way. Working in a spa before starting my own business I thought I knew how to keep employees happy. Shortly after employing estheticians and massage therapists I discovered that it is not uncommon for a spa employee to have another business either in their own home or their client's home. When I began to treat my staff as if they were operating their own small business within my business the spa had changed for the better and was a benefit to all of us in the spa. This change included commissions, salary and compensations for retail.

I personally train my staff and require everyone to perform random treatments on me as a follow up. I have them apprentice with me until I feel that they are capable of doing the procedure on their own. I also have them work on me from time to time to be sure procedures are being carried out to my satisfaction.

I've tried commission, salary and both in the past. I've found that if I treat each staff member like a partner or small business owner I get a better work response. The reason it has worked for us is we all have a responsibility to our treatment rooms, clients and scheduling, and the staff rents the room by the day or week or month, which ever works best for all. 

What IPL or laser technologies are you using? What are your thoughts about the technologies you’re using now?

I currently own the Radiancy IPL. I make use of it daily for three different services: hair removal, rosacea and photorejuvenation. I’ve been very satisfied with the machine and had no problems with it mechanically. 

I have never been a fan of equipment salesmen. I have an advantage by working with so many different doctors because I can visit their offices during training sessions and sales meetings regarding lasers and IPL’s. Most of what I’ve learned is through the information that I get from them rather than manuals or a training session with a sales rep. The first training I had with a laser was by a sales rep in 1997 while he was doing a demonstration on me, and I have a burn on my face as a memory of the day.

I also use a microdermabrasion machine, electrolysis machine (both by SilloutetteTone) and lymphatic drainage GX99. 

How do you market your services to physicians?

I try to keep up with the services that my doctors are doing so that I don't duplicate them. I also meet with them and their staff yearly to talk about what I offer and how it compliments their services. A good example is mastectomy scar revision after their surgeries. I meet with the patient before the surgery, or at the post-op follow up to discuss a time frame of treatment after healing.  

Do you limit your treatments to less invasive or treatments like laser hair removal that are generally not performed by a physician? 

Yes and no, I do try to offer treatments that they don't offer, but when there are treatments we both offer I try to make mine have an add on or a follow up that they don't offer. 

What are your marketing tactics?

Over the years I’ve advertised in magazines, newspapers and television. Word of mouth is definitely the best form of advertisement, followed by a local newspaper that has a health section once a week. Magazines (New Beauty and NY Magazine) have come in third because of the repetition and recognition of my logo and ad. 

I recently offered a deal on Groupon, and planning on doing it again. The response is phenomenal and the new clients have been receptive to different treatments other then the one they purchased with the Groupon coupon.   

What treatments are the most profitable?

The most profitable treatment is one done with the IPL. Second is microdermabrasion. I recently purchased an Infrared LED Spa and plan to offer packages of treatment sessions.

What's the best part of your work?

As a cosmetic and medical tattoo artist I have the opportunity to see many different reasons for tattoos, ranging from cosmetic for eyeliner to breaking up scars from a hair transplant procedure. 

One of the most memorable treatments I’ve ever performed was on a double mastectomy patient who I treated at a doctor’s office 14 years ago. She filed her insurance for the procedure naming me as a non-medical provider but the claim was denied. She assured me that she would file again and at some point in time come up with the payment for the treatment. So much time had passed that I forgotten about it. Years later I was at a New Years Eve party at a friends home and I ran into this woman who reminded me that she had not paid for the procedure but told me that she finally received a check from her insurance company. I told her I didn’t want the check and that it made me happy just to see her there and cancer free! She insisted that she would come to the spa the following week and if I didn’t want the money would I please use it for the next person who needed a treatment but couldn’t afford to pay. That was the birth of “The Fund”. It has been in place for 11 years and helped so many children, women and men in need. From that day forward all gratuities are placed in the Piggy Bank for that use.  

What advice would you give to others based upon your experiences?

I was recently in a spa on Madison Avenue in NYC where the massage therapist had used a Poland Springs water bottle as her massage oil decanter. As I watched her use oil from the plastic non-reusable bottle all I could think about was the warnings printed on the label “do not refill”, the thought of that kept me from enjoying the treatment. My friend was in another treatment room having the same service that I had and her therapist also used a water bottle. Why didn’t the owner see this?  

The best advice I can offer is to have your staff work on you, your family and someone who your staff doesn’t know who is affiliated with you. Word of mouth can be as dangerous as it can be helpful. 

About: Ms. Barbara Strafella received her Cosmetology License in 1986 and continued her training to include specialized skin care which means working with cancer patients and those suffering with skin conditions that limited their social life. In 1994, she trained as a tattoo artist, opened “I Wake Up With MakeUp!” specializing in Permanent Cosmetics and scar revision. In the last 18 years, she has developed relationships with the American Cancer Society, The Alopecia Foundation and our local Burn Unit. She is affiliated with 6 medical offices, their doctors and staff, updating and educating them about the benefits of collagen induction therapy through tattooing, medical tattooing and Medi-Esthetics.

This interview is part of a series of interviews of physicians running medical spas, laser clinics and cosmetic surgery centers. If you'd like to be interviewed, just contact us.