Name: Dr. Alicia Teska                  
Clinic: Skin Temple Medi Clinic & Spa
Location: Melbourne, Australia
Website: skintemple.com.au
That's interesting: Dr. Alicia Teska is a founding fellow of the Australasian College of Aesthetic Medicine.

What is it like practicing cosmetic medicine in Australia?

Cosmetic medicine is much regulated for doctors in Australia, but completely unregulated for any other health provider. It can be very frustrating to find that your previously loyal client is now going to the home of a local plastic surgeon’s nurse to have their Botox injections.

Unsupervised (and uninsured) nurse injecting (of just about any substance at all) is quite rampant in Australia. I get a number of new clients coming in each week who have had treatments in salons or at the nurse’s home, with complaints about the outcome.

Australia regulates its own medical technologies independently of other countries. If the technology has been approved for a use in the USA, it definitely assists to get it through the Therapeutic Goods Administration in Australia a lot faster.

I have been reported for calling myself a "Cosmetic Physician". In Australia, there is a frightening holier-than-thou attitude towards medical practitioners who work outside of a “Royal College” setting. It is disturbing to see how ignorant many medical practitioners are of the work being done by Cosmetic Physicians. The regulatory body in Australia (AHPRA) would like to see the Cosmetic Physicians who are vocationally registered (Fellows of the RACGP, such as myself) call themselves Specialist GPs. This would be quite misleading to my patients, as I no longer practice the full spectrum of normal General Practice.

There is an opportunity to establish a subspecialty/special interest group of General Practice in Cosmetic Medicine/Dermatology. I think it’s likely that a group of us who work exclusively in that area will get together and put Cosmetic Medicine on the map in this country.. if the politics allow!

What's your offering like? I see that you're offering treatments targeted at men. How have you positioned that?

We do provide a number of treatments for men as well, including manicures, facials, waxing and massage. Interestingly, men also LOVE our hammam! And why not? It’s a very sexy space and popular with couples as much as singles.

I think the most important advice I can give on expanding into the wellness aspects of a medispa is to demonstrate your commitment to relaxation through your spa design. A well designed space allows people to relax as soon as they enter. Ongoing staff training is also very important. Clients may trust you, the doctor, but they won’t be as trusting of your staff. Medispa is very tough to do well (for anyone, not just doctors) and make profitable. I do think you have to have an absolute passion for it or it just becomes a ball and chain tied to your ankle. 

How do you compensate and manage your clinc's staff? 

My biggest headache in the spa has been with staff selection/training/retention. There have been times when I’ve wondered if opening the spa, with all of the staffing issues, has been worthwhile. The cultural attitude towards body treatments in cooler states for Australia, such as Victoria, is quite different from warmer regions of the world. We have certainly had to do a lot of work promoting the hammam initially as most people just didn’t know what it was.

Not all staff has been interested in the spa/relaxation side of the business either, which has been difficult to address. It is important to provide inspiration in all areas of the medispa, but if the cultural interest isn’t there, it is much harder! At the end of the day, I am a doctor, therefore my performance will affect my registration as such. Beauty therapy is an unregistered trade, therefore they do not generally have similar standards of training, professionalism or self-directed learning. Attitudes to these areas will vary, of course. I don’t use commission presently, as I don’t want the sales to be motivated by therapist vested financial interest, rather they should be about what is appropriate for the client’s concerns. In Australia, wages are much much higher than in the USA so commission is not as prevalent as it is in the USA. If I had a dedicated, well educated, ethical therapist who had already proven herself, over say a 12 month period, then I might consider commission to further reward her efforts, but I don’t think it is appropriate for junior staff.

Medical indemnity insurance is essential in Australia and a requirement of annual re-registration with AHPRA. 

I find that unhappy patients are thankfully very rare here. I am fortunate to have an unblemished insurance record. My only complaint since starting the medispa has come from a person I’ve never even met! She was treated (& burnt) by a local beauty salon. The owner of that business decided to deflect the complaint from the client by pretending to be me. That is, she passed herself off as me. I was very shocked to receive this complaint, but it was quickly withdrawn when the fraud was exposed. 

How do you market yourselves to patients and what do you do that your competitors aren't doing? 

Our marketing is based around our interest in restoring skin health. I also have a special interest in treating skin of colour. I find it rare for other clinics to be interested in skin of colour.

Marketing can be expensive but word of mouth is always the best method.

Our award for Best MediSpa 2011 and Best Spa Experience 2012 is largely testimony to the timeless design of our spa and focus on skin health/wellness. 

Are there any treatments or technologies that you're especially excited about that haven't hit the market yet? What do you think about new therapies (like stem cells or others) that are being developed?

Topical botulinum toxin and ATX 101 for lipolysis!

We’ve just introduced the HydraFacial to our spa which appeals to those who are unsuitable for microdermabrasion. I would like to explore Coolsculpting but have concerns about the licencing arrangements providers must enter into. Visia has been an excellent ommunication/education/marketing tool, and I’ve just purchased the latest Gen 6 version.

Where do you think will cosmetic surgery evolve? Will it be changed by technology? Do you see a time when plastic surgery is going to be replaced at least in part by nonsurgical technologies?

Plastic surgery has already been dramatically affected by the rise of non-surgical procedures. Many plastic surgeons are now trying to enter the non-surgical market. It will be interesting to see how successful they are.

Most people (>90%) don’t want surgery. Most people (>75%) would consider non-surgical treatments. The two areas do complement each other. The challenges for plastic surgeons are in acknowledging that cosmetic medicine is a very specialised area in its own right, just as plastic surgery is. I worry that most plastic surgeons delegate non-surgical technologies to nursing staff which undermines and limits the patient experience greatly. Nurses are not qualified to diagnose skin disease, however well trained or experienced they may be in the application of laser technology, and on several occasions I have had patients attend for second opinions about a rash (requiring prescriptive treatment) that has failed to respond to laser treatment in the plastic surgeon’s office. Most patients still want their medical procedures to be done by medically qualified doctors, who are expected to appropriately prescribe topical treatment and not over-service inappropriately.

What do you think that you do better than most other physicians that helps you to succeed?

1. Patient/client focused consultations, natural looking outcomes, wide range of treatments.
2. Strong interest in understanding skin barrier function (this is the cornerstone on which all of cosmetic medicine/dermatology is based) and dermo-cosmetics.
3. Strong interest in understanding skin of colour. The world today is much more interconnected than even 20yrs ago. We cannot truly look after skin well if we only extend our knowledge to the treatment of Fitzpatrick skin types 1-3.
4. I am very present in the business, which makes me available for staff support and is very reassuring for the patients.

What's the best advice you've ever received as a physician?

• Physician, do no harm.
• “Ancora imparo”. This was my university’s motto. It is Latin for “I am still learning”. Humility allows us to learn so much more compared to the arrogance of thinking that you know everything there is to know already.

What's the best business advice you've ever received?

Hire for attitude, train for skills.

I can’t teach anyone who:

• A)    Thinks they know everything already
• B)    Can’t handle constructive feedback
• C)    Isn’t also prepared to show initiative in their learning.

On occasions when I’ve come to regret an employment decision, it becomes imperative to “manage” the person out of the business quickly. I don’t like firing staff, but do it when absolutely necessary.

About: Dr. Alicia Teska graduated from Monash University with MB, BS (honours) in 1993. She initially trained in General Practice, intending to work in a rural area. Enjoying the procedural nature of rural general practice, she also gained a Diploma in Obstetrics and Gynaecology, Fellowship of the Royal Australian College of General Practitioners, as well as a Certificate in Dermatology. Subsequent part-time work as a Cosmetic Physician in a Dermatologist practice provided further procedural training in a variety of lasers. From there, she started her own business, providing injectable procedures and skincare advice to regional country areas.  It was very successful financially though lacked enough professional satisfaction so she established a central Melbourne office and gradually moved towards the medispa/wellness concept.

Skin Temple was opened in 2010, and they won the inaugural Australasian Spa Association award for Best MediSpa in 2011. Now, the clients come to her, which is much more manageable as the mother of a young child.

In 2013, she was approached by LÓreal to become involved in the launch of La Roche Posay into Australia, which is a great honour, as she's been a longterm fan of dermocosmetic ranges for many many years.

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.