Trish
Hello, listeners. It’s Trish Hammond here from the Transforming Bodies podcast. And today, I’m joined for the second time with Dr David Kasenko, who’s the principal of Impress Skin, but he’s also the president of the Cosmetic Physicians College of Australasia. Woo hoo, I got it right. And today, we’re here at the NSS, and we’re just gonna have a chat about the fact oh, apparently, what he actually does in general. So let’s have a chat. So welcome Dr Kosenko.
Dr. David
Thank you so much for asking me to have a chat with you, Trish.
Trish
I feel like this has to be like a regular annual event. Don’t you reckon?
Dr. David
I think we should do that. I think it’s a lot of fun.
Trish
Yeah. I agree. I agree. So, tell me… why did I think today was really interesting? Because I know that, like, you’re a cosmetic physician, but not everybody probably knows about all the other things that you do. So I find it really interesting because I love talking to you about other things outside of cosmetic medicine. So I thought, well, let’s just talk about what you do. So you’re not just a cosmetic physician, are you?
Dr. David
No. I’m an old man.
Trish
And I’m an old woman.
Dr. David
No. I graduated in 1988. 87? 87.
Trish
But when you were five?
Dr. David
Yeah. Something like that. And I am primarily a general practitioner. I’ve been a fellow of the Royal Australian College of General Practitioners for thirty years now, in fact, so long that now I have life membership. So, yeah, a lot of my time initially was spent in general practice.
And over the years, I developed a special interest with regards to skin and management of skin problems, and that was probably close to twenty years ago. The root of that was and my wife won’t mind me saying this, but the skin problems she was having and the frustration she was having in trying to have them treated. And so that’s how I started going down the rabbit hole, so to speak.
Trish
You’re right. So what piqued your interest. But once that happened, how did you get started? Because, obviously, there’s no or there wasn’t probably any form of training in there. Like, how do you even pick up your nameplate and, you know, add a little extra to, like, cosmetic work.
Like, especially in those days.
Dr. David
Yeah. So we’re back in the mid 2000s at this stage. And in Australia, anything cosmetic was pretty young back then. There’s only a handful of people that I know that have been, you know, dabbling with BOTOX and things like that for longer than I have. And you’re right.
There was no formal training at that time. You know, you I was lucky enough to know a few people who helped me on the journey and had started with skincare initially. I learned about skincare and cosmetics in the beginning, And then I got some training in botulinum toxin. At that time, it was really all pharmaceutical company run courses, there really wasn’t anything else.
But again, through that, I met people like Stephania Roberts, and Gavin Chan, and they were very supportive and not really men toured me, but let me know what I should know and got me on the journey, I guess.
Trish
Okay. And so you did that and you just bought it as part of your practice and kind of just said to people, I do cosmetic treatments as well and kind of listed out a few things and kind of went from there.
Dr. David
Yeah. Look, initially, as probably a lot of people who’ve been doing this for any length of time, did I introduce some botulinum toxin into my practice? I did very simple, very basic sort of treatments. It was in the general practice setting at that time. It was for the first three years or so.
After, you know, within about six or twelve months, I’d started using some dermal fillers as well. Again, kept the treatments very, very simple. And as you did these things back then, you met people like I said who would guide you and offer advice. And Then I started going to conferences and I went to lots and lots and lots of conferences. So it’s really self directed learning as much as anything else.
Trish
Okay. And so also, you do other stuff as well. So because, obviously, these days, the Cosmetic Physicians College of Australasia wasn’t formed. So how did that even happen? You can tell us from the beginning because now it’s huge, but you can probably tell us when there was anyone with two people or what the thought came about. Tell us about that.
Dr. David
So initially, it was the CPCA, the cosmetic physician Society of Australia. And I think from memory it started in 1997, it was started in WA by a couple of doctors that were doing just cosmetic work back then. And you’re right, it was very, very small. But when I went and started going to the conferences in, you know, 2006 or something like that, 2007. I joined the CPCA and that’s where I met, like I said, a lot of the people who ended up guiding me down the pathway and you know, through discussions with them and conferences, you just learn stuff.
It’s much better these days because there’s a lot of formal education that you can undertake. There’s a lot more guidance and mentoring available. But then again, there’s a lot more expectations from the regulators, you know, from AHPRA as to what sort of experience someone needs to have before they do cosmetic work. So times have changed quite considerably. And I think we know a lot more now about the sorts of things that can go wrong, which back in the mid 2000, no one had really understood the fact that you could have vascular occlusions from dermal fillers and things like that. So it wasn’t on anyone’s radar. It really was the early days of that sort of work.
Trish
You know, on that, what are the requirements now for someone to become a cosmetic physician? Because, like, some people either do wanna go in that path and some people don’t and some people a little bit like you, they do wanna go in that path, but they also don’t still wanna keep that general practice practice up because you get to meet a lot of people, you’re helping people, and look, I totally understand. And that if I was a doctor, that’s probably what I would do as well. So what is a requirement now by the government regulators?
Dr. David
Look, there still isn’t any set requirement. If you read the APHRA guidelines, it says that you have to have training appropriate to your scope of practice. But it’s not defined specifically. I think personally that you need to have an absolute passion for the sort of work you’re gonna do, whether it be general practice or another specialty or cosmetic or aesthetics. I still do general practice, but my general practice is very much skewed towards skin problems.
So I see a lot of people with acne and rosacea and dermatitis and all those and skin cancers. I do many, many skin checks. So that dovetails really nicely into my aesthetic practice as well. I think, you know, after having that passion, you also need to look at undertaking some sort of formal education these days. I think the Cosmetic Physicians College of Australasia has got the graduate certificate of cosmetic medicine, which is run by a registered training organisation, and it’s recognised as an approved training course.
In cosmetic injectables. And that’s not the only course available in Australia, but that’s the one that I’ve got the most knowledge about because I’ve been involved with the college. Mhmm. And I think that that really gives you very solid grounding of the knowledge that you need to have to be able to practise with cosmetic injectables safely. I think then there’s a lot of other things that you can learn with regards to energy based devices.
And there’s so many different sorts of devices out there. It takes a long time to just get a basic understanding of what everything does and then trying to figure out what’s going to suit you and your practice the best, and then learn about how to use it and how to get the best out of it, you know, it takes a long time as well.
Trish
Yeah. Right. And and on that, I guess, in a way, it kind of enables you to have like a an arsenal of tools that you can use on cosmetic and probably even non cosmetic patients would have be right to say, for example, if someone wasn’t came to see you and they weren’t looking for a cosmetic treatment, but you were doing a skin check on them and you thought, okay, well, you’ve got some pigment and you would it would you’d be able to sort of say, hey, I can fix that for you or, you know, stop prevent it from getting worse or something like how would that how does that look?
Dr. David
Sure. Look, that happens all the time. I do many skin checks every day, and it’s not uncommon to see someone with redness or pigmentation on their face. Sometimes they don’t like the appearance of it and they would like to do something about it. Sometimes they don’t ask because they don’t know what to do about it.
And I I will often say, you know, if you don’t like this, there are treatments available that can help to improve the appearance of your pigmentation or, you know, you’ve got erythematous rosacea. So the red rosy cheeks and the red nose and the need to wear makeup every day because that bothers you. We can do something to reduce that so that you don’t have to. And so that’s part of an education process. And sometimes people are interested and they do wanna have a treatment.
Sometimes people will say, look, it doesn’t bother me. I don’t wanna do anything about it. And that’s fine. I mean, it’s a person’s choice.
Trish
Yeah. That’s true. I’ll see people where I think, oh, you could really fix that pigment really easily, but some of them don’t care and, like, in my mind, I think more power to them for not caring, but I come across that myself as well. I think as I’m gonna go up and it’s got quite a bit of pigment on my You should get that big. She’s just like, why?
I like those freckles. So
Dr. David
Yeah.
Trish
Yeah. It’s a personal thing. Hey.
Dr. David
It is. You know, there’s one lady that I traded with that has very pale skin type and lots and lots of freckles and we traded with BBL (Broadband Light). And she had a very good response. And after two treatments, I would say that freckles were, I don’t know, 60-70% lighter than they had been. And you could really see an obvious visible difference, but she didn’t wanna go any further than that because She knew that she had had freckles all her life, and her family knew we had freckles all her life.
And no one wanted her to get rid of all of them. But they understood that they were getting darker as she got older and they were becoming more noticeable and it was becoming the main feature of her face.
Trish
Yeah.
Dr. David
You know, they were freckles, and she didn’t like that. So you can improve things sometimes without having to get rid of them totally.
Trish
Yeah. I’ll see you soon. Even if you had a wouldn’t get rid of all the freckles unless you had, like, you could just keep having freaks until they were all gone, then they would not come back. Would that be right?
Dr. David
Oh, jeez. If it was only that easy, unfortunately, you know, if that’s your skin type and you’ve got Sunday, major, you’ve got freckles. If you stimulate the melanocytes in skin, the pigment producing cells in the skin by going in the sun again, they’ll come back. Yeah. So you need, you know, if pigmentation is something that bothers you and you want to improve it.
You can certainly improve it with treatments like BBL, but then you need to look after your skin. You need to use sunscreen. You need to we’re a hat, for example, to keep the sun off your face. And over time, it’ll eventually come back. And that’s why we also offer maintenance treatments.
Trish
Yeah. I can remember when I didn’t realise the importance of sunblock and stuff like that, I just used to, you know, gout in the sun and whatever now. I cannot go out in the sun. I haven’t got a hat on, and I haven’t got Sunblock on. I’ve got dark skin anyway, but I grew up in the sun, but I didn’t care, but now I really care.
Dr. David
Yeah. The things you would do differently if you knew what you know now when you were twenty.
Trish
Yeah. I’m not gonna stop eating chocolate though, but yeah. Yeah. Totally. So, Timmy, so with your clinic then, so I know you’ve got a great clinic there in Melbourne.
Can you tell me a little bit about, like, when you started because I know you do both. You do the GP and you do cosmetic work as well. But how do you actually like, how come you’ve grown so much? Like, what do you do with all those that, you know, you have other people working with you?
Dr. David
The general practice I work at is very large.
Trish
Yeah.
Dr. David
And it’s probably got about usually about twelve or thirteen doctors working there and there’s, you know, ten nurses plus a team of receptionists And I’ve deliberately kept my cosmetic practice very small
Trish
Yeah.
Dr. David
Basically myself and one other person. And that was because I didn’t want to have another big business. But that’s my choice.
Trish
Yeah.
Dr. David
It works well for me. It means, it gives me a lot of flexibility. And I guess as I’m getting older, it gives me the ability to go on holidays easily when I want to and I don’t have to worry about a lot of stuff. You know, I’m very familiar with running a large practice and having multiple staff then. It’s just something I didn’t want to duplicate and have another clinic like that.
Trish
Mhmm.
Dr. David
I can’t remember what you asked me. It was something about growth.
Trish
Yeah. Yeah. That’s I was just basically wanting to know how you grow it, we’re trying to hold it back. It’s kind of what I’m trying to say. Like, how do you hold it back?
Dr. David
We’re pretty flexible. I mean, there’s a few natural things that have happened in the last few years that have held practices back, I guess, you know..
Trish: COVID.
Dr. David
Like COVID. And now the way the interest rates have gone in Australia, there’s a lot of people with less disposable incomes, so they’re more careful with how they spend money. Our practice, we have a very loyal patient base, and they come back for treatments at pre regular intervals. Most of our growth has been word-of-mouth, which is my preferred way of growing practice. It’s a very organic way.
And people come to see you because of what they know about you and what they’ve heard about you. And what other people have told them rather than just what they see, say, on an Instagram reel or on some paid advertising. And I think again, for me in the estate practice, that suits me really really well because they often end up being very happy with the treatments they get initially and they keep coming back in the future. Look, sometimes we get really, really busy and we’re working our afternoons off. We’ve been known to come in on Saturdays and things like that. But at waxes and wanes, people don’t want the same thing all the time, and sometimes you find it busier and sometimes you find you quieter.
It hasn’t been too difficult to control things at the moment. Up or up until this stage, but, you know, it could easily change.
Trish
Yeah. And so just going back to the CPSAs. So if we were speaking to someone who was a doctor or was about to become a doctor or wanted to become a doctor so that we could actually do injectables and cosmetic work. What would be the process for them to follow, to hook up with the CPSA? And is there some sort like, can anybody join?
Dr. David
So you need to be a doctor to join the CPSA.
Trish
Mhmm.
Dr. David
There are not a lot of prerequisites. We don’t want fresh graduates. In medicine, we like to have people that have had some general medical experience because as you know, Trish, a lot of the things that we see that we consider aesthetic may have medical basis. And so it’s important for people to be able to understand how to treat things like acne and rosacea. We keep coming back to that sort of thing.
We need them to be able to confidently diagnose skin cancers
Trish
Mhmm.
Dr. David
And when not to say a light based therapy on pigmentation. When it might be skin cancer. So I think having that general medical knowledge is important.
Trish
Mhmm.
Dr. David
But once someone, you know, a several years postgraduate, then they’re welcome to join and they would join as a junior member and we call that a corresponding member.
Trish
Mhmm.
Dr. David
And that then enables them to join our journal clubs, our chat groups and interact with other members. And also for them to enrol in the graduate certificate of cosmetic medicine if that’s what they would like to do. Mhmm.
Trish
And what does that look like? Like, how long does that take? Or
Dr. David
If you’re doing it… look, it’s part time.
Trish
Mhmm.
Dr. David
It’s primarily online. And if you were doing it and determined to get it done quickly, you could finish it in about 6 months. Most people probably take about twelve months. Mhmm. It consists of 4 modules.
It covers really everything that someone entering cosmetic medicine needs to. It does talk about some of the history of it. It talks about how we started using botulinum toxin? And where did that come from? And it talks about the different dermal fillers, the ones that have been used in the past and what’s available now and why there’s been those changes.
It also talks about Australian laws and requirements and regulations with regards to cosmetics. Then it talks a lot about the anatomy of skin and the physiology of skin and how it works and why we do what we do. There’s a module that talks about cosmaceuticals and skin care and how that affects the skin. And then there are specific modules on injectables. And it talks about how to treat different areas specifically.
Keeping in mind that there’s no one area to treat a forward or a frown or crow’s feet. So it talks about the considerations when someone’s looking at treating those areas. And then finally, there’s some practical components as well. And all the way through, there are online examinations and also face to face examinations at the end where the candidates get to or the registrars get to demonstrate their skills. So, I mean, that’s a brief overview.
Trish
Board kind of yeah. And to maintain that, like, can you just join the society at, like, Wednesday, Like, is there something you have to do every year to maintain a level of proficiency?
Dr. David
Absolutely. Especially now, and that’s mandated by APHRA and the medical board. Yeah. In the guidelines that were released on the 1st of July or came into effect on the 1st of July 2023, it states that people need to do continuing professional development relevant to their field of practice.
Trish
Mhmm.
Dr. David
And with regards to cosmetics you’re expected to do continuing professional developments in aesthetics.
Trish
Because I did know that. I just didn’t relate to the cosmetic side, but yes, of course.
Dr. David
Yeah. Now again, they don’t specify exactly what you need to do. I mean, doctors in Australia are expected to do fifty hours of CPD per year.
Trish
Mhmm.
Dr. David
And it needs to be divided between educational activities, reviewing performance and measuring outcomes which you could also say it’s like an audit
Trish
Mhmm.
Dr. David
And you can decide what is most appropriate to your work. And what you do. So we’ve got a lot of flexibility with what we do, but there is a requirement that we need to do that. Mhmm.
Trish
That’s so interesting. And just lastly, I always think it’s really important when you go into something that you need to be thinking about your exit strategy as well. So when you do actually think about your exit strategy, are you something that you would just kind of like walk away or would you kind of get, like, teach someone what like what would you do? I I asked this question because I know we’re the same age. Yeah.
We had this discussion on high, but I always wonder about that for myself.
Dr. David
Yeah. Look at something I’ve spent a bit of time thinking about, you know, I am getting to the age where we start to think about retirement and what that’s gonna look like. And just to reassure everyone, I’m not thinking of retiring yet.
Trish
No. It’s saying. But when you hit over the fifty mark, you kind of start to think, hey.
Dr. David
Yeah. Yeah. Interestingly, I’ve always seen aesthetics as being part of my retirement planning. Yeah. So I can see myself slowly winding down the general practice and concentrating more and more on the areas that I want to concentrate on.
I think I’ll continue doing aesthetics for the foreseeable future. Mhmm. I guess eventually I’d like to be in a position where perhaps, you know, a doctor comes along and they would like to have a practice with an established, you know, clientele. Yeah. And we can come into the practice and perhaps we can do a handover changeover period where they get introduced to everyone and everyone becomes comfortable with them and then I can bow out gracefully one day.
Trish
But you know what? That’s what happens a lot. Hey. Yeah. Like, even with all specialties as well, like, you know, doctors, surgeons, everything.
And I can remember that happening with a plastic surgeon. I think he was in his eighties when I first met him, that was in two thousand thirteen. And that’s exactly what he was doing. He was just in the process of kind of handing it over to someone else. I think it’s pretty standard.
Dr. David
I think it’s a nice way of doing this. I think if you just one day close your door and we can empty the rooms I think that’s very unkind for everyone.
Trish
And you can’t because people, you know, can’t set the big data setting for a lot of people. Yeah. That’s absolutely what you’re gonna recommend. Absolutely. Well, look as always, it’s been delightful talking to you.
Thank you so much.
Dr. David
That’s like I hope I haven’t rambled on.
Trish
No. No. All that. And so at the same time next year.
Dr. David
Absolutely. Maybe well, yeah, at least next year.
Trish
Yeah. Exactly. Exactly. Alright, listen. Well, thank you so much for joining us.
And look, if you wanna check out Dr David Kosenko, just go to Instagram and it’s @impress_skin and you’ll find all of his stuff. Thank you so much for joining me.
Dr. David
Thank you very much, Trish, for the invitation. I wonder how possible you can have more.
