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Launching a Medical Aesthetics Practice: Key Factors to Consider

Posted By Administration, 4 hours ago

medical spa staff

By Terri Ross, Terri Ross Consulting

Launching a medical aesthetics practice can be an incredibly challenging but ultimately rewarding venture. Before opening the doors to your practice, there are several key factors to consider, including, but not limited to, market characteristics, population statistics, competition, potential resources and personal drive.


The status, pace and growth of your niche market is the most critical factor that will directly impact the success and profitability of your medical aesthetics practice. Take a pulse of what’s happening in your target area. Is the market already saturated? How many offices are currently in operation? How many have opened in the last five years? Are they expanding? What specialty treatments and services do they offer?

Identify practices that have demonstrated considerable success and learn from them. Take note of their infrastructure, marketing style, target clientele, etc. Your goal is to create a medical aesthetics practice that excels above the competition. There are a few ways to approach this goal. First, you can strive to meet the needs of your target clientele better than existing practices. This can be achieved by providing a superior patient experience: upscale office and treatment areas, knowledgeable and engaging staff, and personalized treatment plans. Conversely, you can strive to meet a new need in your target population by specializing in a new area or offering unique treatment plans. (Click here to read an article from Forbes about how to find and develop your niche market.). The key is to identify an area of the medical aesthetics market that is under-developed in your region of interest—and capitalize on it.

Population Statistics

Before launching your medical aesthetics practice, you’ll want to carefully and diligently define your target patient population. Where do they live? Where do they shop? Which restaurants do they frequent? Identify this population and research them extensively. Take note of their average household income and their average monthly expenditures on medical aesthetics services, among other expenditures. Consider what types of medical aesthetics services they are currently receiving and what types of services they might be interested in. Identifying and characterizing your target population links back to defining your niche market. If you can identify a need in your target patient population that hasn’t been met by the current market, you’ve accomplished the most important—and perhaps the most difficult—part of launching your new practice.


Identifying and understanding your competitors is a critical factor that will directly impact the success and profitability of your medical aesthetics practice. What types of services and treatment plans do they offer? Are there any specialty practices already in the market that have a main focus, such as body contouring? Be careful and diligent in your research. Identify three to five of the most successful offices in your area, take notes and visit the competition. How long have they been open? How fast are they growing? How many doctors practice in each? How extensive is their support staff? What is their patient retention rate, according to industry reps? By mapping out these details for each of your top competitors, you will begin to understand key elements you want to implement—or not—in your office.

For example, you might hone in on a particularly successful marketing strategy or identify treatment plans that maximize profitability in your area. By thoroughly examining the competition, you’ll be able to learn from their mistakes, streamline processes and shape a successful marketing strategy before ever opening the doors to your own office.

Potential Resources

Once you’ve identified your niche market and target patient population, you’ll want to make sure that the region you’re considering can support your vision. The area where you choose to launch is critical. It will affect your ability to staff, manage and grow your office. What are the local demographics? Your staff’s ability to listen, engage and communicate with your patients is among the most critical aspects that will shape the success of your office. This begins with hiring the right people and training them well. (Click here to read more about the LAER model I developed for effectively training your front office staff here.)

The accessibility of technical support for your medical equipment is another important resource you’ll want to consider. Your equipment and supplies will need regular and established maintenance and support to ensure optimal performance. Most laser companies offer a maintenance plan; however, while it is vital, it is also very expensive. How quickly can support personnel be onsite? Do they offer a loaner?

The potential for collaboration is one last element to consider before making the final decision on where to open your practice. Are there any practices in the area that offer services that would complement your services or specialty? Would a collaboration or referral system make sense? In some cases, it may be more beneficial to work with key competitors rather than against them. There may be an opportunity to offer patients a bundled promotion or personalized treatment plan that successfully incorporates the expertise of both practices. In this way, you are capitalizing on existing resources and building upon them to maximize your profitability and success.

Personal Drive

Your personal drive is another key element that will impact the launch of your medical aesthetics practice. This factor cannot be easily measured or analyzed, but it plays a pivotal role in the success of your practice, particularly in the launch phase. Undoubtedly, launching a new medical practice in any specialty requires not only expertise and knowledge, but also persistence and drive, in both the medical and business fields.

As the medical expert, you’ll be required to know and stay up-to-date on your clinical knowledge. This includes learning new technology, procedures and treatments as they become available, and implementing them in your space.

As the business leader, you’ll be required to make smart decisions and make changes that will support the growth and success of your office. This includes hiring and training medical and administrative staff, implementing efficient processes and protocols, creating and sustaining a successful marketing plan, and consistently achieving new goals in patient retention and conversion, ROI and room revenue assumptions.

Click here to take a look at some of the critical financial numbers that will affect the growth and profitability of your office. To launch and sustain a successful medical aesthetic office in the current market, you will need diligence, tenacity and a great deal of personal drive.

Launching a successful medical aesthetics practice is a challenging but incredibly rewarding experience. Do you have what it takes? Do you have attainable revenue goals and the infrastructure, protocols and staff in place to get you there? Click here to download the assessment and complete Terri’s 10 Point Checklist.

Terri Ross brings more than 20 years of sales and management experience to the field, having worked with leading-edge medical device companies such as Zeltiq, Medicis, EMD Serono, Merck Schering Plough and Indigo Medical, a surgical division of Johnson.

Ross’ vast knowledge and experience as a sales director managing upwards of $20M in revenue and successful teams has allowed her to become a renowned plastic surgery management consultant helping aesthetic practices thrive.

To optimize revenues and business performance, Ross’ practice management consulting services help physicians evaluate practice processes including, but not limited to, overall-operating efficiencies, staff skill assessment, customer service and operating efficiency strategies. The goal is to develop a comprehensive plan of action to improve productivity, quality, efficiency and return on investment.

Tags:  Business and Financials  Med Spa Trends  Terri Ross Consulting 

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Portrait of a Medical Spa Owner, Part 1: The Doctor

Posted By Administration, Monday, November 18, 2019

nicole norris

By Michael Meyer, Content Writer/Editor, American Med Spa Association

In the early days of the medical aesthetic business, it was more or less presumed that a medical spa would be owned by a “core doctor”—i.e. a plastic surgeon, facial plastic surgeon, otolaryngologist or cosmetic dermatologist. However, as the field has matured, the group of owners involved has become more and more diverse, ranging from doctors and nurses to entrepreneurs and even estheticians. In fact, it’s somewhat difficult to find a medical spa owned by a core doctor today—according to the American Med Spa Association’s 2019 Medical Spa State of the Industry Report, of all of the medical spas owned by medical professionals, only 20% owned by core doctors.

Today, it’s much more common to find doctors with backgrounds in family practice and emergency medicine owning medical spas—each of those specialties owns 23% of the practices owned by medical professionals, according to the report. Why is this? As you’ll read in this series, there seems to be a certain frustration with the way managed care has caused health care in the United States to evolve, and doctors, nurses and physician assistants are interested in providing more personalized care to their patients without having to deal with insurance and other payment issues.

However, doctors aren’t the only people involved in medical spa ownership—entrepreneurs are making their mark on the industry, as well. According to the report, 12% of medical spas owned by individuals and 24% of medical spas owned by groups are owned by entrepreneurs. It speaks to the broad appeal of the industry—and the amount of money people are making in it—that this many people from outside the traditional boundaries of it are willing to invest their money in medical aesthetics.

In this series, you will be introduced to four people—a doctor, a mid-level practitioner, an RN and an entrepreneur—who came into the medical spa industry from different backgrounds, but managed to find success because of their determination and love for the business. Each one is true success story and an example of how, in this industry, hard work and quality care are a winning combination.

The Doctor

Nicole Norris, MD, spent 12 years working as a family practice physician in Peru, a city of approximately 10,000 in North Central Illinois. During that time, she established a reputation as a caring practitioner who maintained close relationships with her patients. However, after moving from private practice into hospital employment, she discovered that her style of patient care was at odds with what was expected of her.

“Due to the way medicine has gotten mangled by managed care, I made the decision to find another option,” Norris explains. “The hospital was going to drop my salary a third time because I wasn’t seeing 30 patients a day. It’s impossible, with patients with chronic health problems, to see them, get them well and take care of everything. And with the opening of urgent care centers everywhere, the patients who come into the office for acute visits were few and far between. It’s easy to see 30 acute visits—colds, flus, that kind of thing—but not easy to see patients with multiple chronic health problems; that doesn’t happen in 10 minutes. I refused to change the way I practiced, and that was not rewarded. That was when I thought, ‘I have to find a different way to make people healthy.’”

Norris had been administering aesthetic treatments on a very limited basis at her family practice, and she found the experience to be extremely rewarding.

“I could not believe how these patients transformed, both physically and mentally, in just a few visits,” Norris says. “They walked taller and seemed happier and even healthier. I started to believe that my aesthetic procedures were superior to Prozac.”

In 2016, she decided to leave family practice and commit to medical aesthetics full-time. She opened Nicole Norris MD Medical Spa in Peru, and her commitment to attentive patient care has continued to pay dividends.

“Having those relationships basically encourages those patients to come in and see me now, even though I’m not their family doctor anymore,” Norris says. “We already had a relationship—they trusted and respected me. When I opened the medical spa, it helped me to have a good reputation. People already knew me and knew that I was a good doctor, so even though I was doing something really crazy, they still respected it.”

Norris initially approached the practice from a more medical standpoint, but quickly embraced the less traditional aspects of medical aesthetics.

“When I first opened, I was very focused on trying to keep my brand as a medical spa more medical and less spa,” Norris says. “I have since learned that luring patients in the door with spa services, such as facials, eyelash extensions and teeth-whitening, is very lucrative. These are ‘entry drugs.’ Then, by approximation, while in our office, they end up progressing to injectables and laser hair removal. Then they get a little braver and decide to try laser resurfacing, photofacial, SculpSure and even PDO threads. My brand is still very medical, but I am not too proud to emphasize the spa side of my practice, as well.”

Norris’s career move may have seemed risky at the time, but today she is delighted with her decision to leave traditional family practice.

“I love that I can make people mentally happier and, therefore, physically healthier without prescribing one pill,” Norris says. “It’s funny, but even though I work more now, I don’t feel like I go to work anymore.”

For legal updates and business best practices delivered straight to your inbox, subscribe to AmSpa’s email newsletter. For more information on how AmSpa can help your practice operate legally and profitably, contact us online or call us at 312-981-0993.

Tags:  AmSpa's 2019 Medical Spa Statistical Survey  Med Spa Ownership  Med Spa Trends  QP 

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Who Can Do What in a Medical Spa?

Posted By Administration, Friday, November 15, 2019

medical spa team

By Bala Mohan, JD, ByrdAdatto

As the new kid on the block, medical spas are breaking the mold of the traditional medical practice model. The merging of medicine and day spa services has created a new industry with multiple governing authorities to regulate it and the varying roles within it.

Most medical spas provide some combination of medical and aesthetic procedures—lasers, Botox, fillers, Kybella, microneedling, microdermabrasion, dermaplaning, chemical peels, dermabrasion and CoolSculpting. Often, this menu of services blurs the line between medical and spa treatments. While these procedures are considered medical in most states, exemptions exist in others. For example, the cosmetology boards of certain states allow aestheticians and cosmetologists to perform microdermabrasion and dermaplaning, as long as the procedure does not penetrate the dermal layer of the skin. On the other hand, more restrictive state regulating boards limit aesthetic and cosmetology practices to the topmost layer of the skin. This leads to the common question—who can do what in a medical spa?

The authority to administer medical aesthetic treatments follows a basic hierarchy:

  1. Physician;
  2. Nurse practitioner (NP) and physician assistant (PA);
  3. Registered nurse (RN);
  4. Licensed practical nurse (LPN)/licensed vocational nurse (LVN); and
  5. Aesthetician, cosmetologist and unlicensed personnel.


Physicians have the broadest authority and often fill the role of owner or medical director in medical spas. The delegation of medical treatments to the rest of the staff falls under the supervision of these physicians, and sometimes NPs and PAs.

NPs and PAs

Certain states grant independent practice authority to NPs, and in those states, physician delegation or supervision is not required. Independent practice NPs can provide medical procedures falling under their scope of practice. Where NPs due not have autonomy, state laws generally indicate the level of physician supervision required for both NPs and PAs. In most cases, NPs practice in collaboration with a physician. Depending on the state’s laws, collaboration commonly follows written protocols (e.g., a list of delegated medical tasks, restrictions or limitations, prescriptive authority and level of supervision). Similarly, PAs usually practice pursuant to a supervision or delegation agreement, addressing their scope of practice and any applicable restrictions.


The scope of practice of an RN is more limited and subject to stricter delegation and supervision than that of an NP or PA. Unless state law dictates otherwise, a qualified physician or independent practice NP may delegate medical tasks to RNs, as long as the procedure is within their scope of practice and competency has been verified. If required, written protocols are delineated and appropriate supervision provided. If state laws do not define the level of supervision, the delegating practitioner must use their professional judgement to identify and engage in it appropriately.


The scope of practice of LPNs/LVNs is more limited and subject to stricter delegation and supervision than an NP, PA or RN. State laws generally dictate the medical tasks that a qualified physician or independent practice NP can delegate to LPNs/LVNs, whether written protocols are required, and the appropriate level of supervision. Similar to RNs, if state laws do not define the level of supervision, the delegating practitioner must use professional judgement to identify and engage in it appropriately.

Aestheticians and Cosmetologists

There is much confusion in the medical spa world about who is considered licensed personnel. While aestheticians and cosmetologists are licensed by cosmetology boards, they are considered unlicensed personnel by medical standards. They generally are permitted to perform spa procedures—e.g., facials and certain types of massages—that fall under their cosmetology licensure, but prohibited from doing anything requiring medical training.

Unlicensed Personnel

In addition to estheticians and cosmetologists, medical assistants (MAs) are considered unlicensed personnel for medical treatments and can perform treatments in medical spas only as state law allows. With limited to no medical training, these staff members generally are not permitted to perform medical or invasive procedures. Even if state law allows delegation, it often requires that the delegating practitioner provide onsite direct supervision during procedures. Delegation of medical treatments to unlicensed personnel must be approached with extreme caution.

From state to state, laws related to medical spa treatments vary from the very detailed to the very sparse, leaving room for legal interpretation.

AmSpa members receive a complimentary 20-minute Introductory Compliance Assessment with a ByrdAdatto attorney. Click here to learn how to join AmSpa today!

Bala Mohan, JD, knew from a very young age that her choice of career would be related to science because she excelled in her biology and chemistry coursework. With a strong passion for genetics and the desire to find a cure for her mother—who was diagnosed with diabetes at an early age—Mohan obtained a Bachelor of Technology in Pharmaceutical Biotechnology. Having worked as a scientific researcher during her undergraduate studies, Mohan greatly values attention to detail and is a meticulous person. She then pursued a master’s in Entrepreneurial Biotechnology to gain knowledge about business and startups. This landed her a position with Cleveland Clinic Innovations, where she evaluated over 100 innovations and negotiated deals with potential investors. In this role, Mohan had the opportunity to interact with business and health care lawyers from multiple health care organizations, and she quickly realized that her real calling in life was to be a health care attorney. Subsequently Mohan obtained her JD and was able to pursue a career that combined all her interests—science, business, and law.

Tags:  ByrdAdatto  Med Spa Law 

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The Pros and Cons of Becoming a Medical Director for a Medical Spa

Posted By Administration, Wednesday, November 13, 2019

medical director

By Alex R. Thiersch, JD, CEO of the American Med Spa Association (AmSpa)

The medical aesthetic industry is booming. According to AmSpa’s 2019 Medical Spa State of the Industry Report, the annual revenue for the industry as a whole is estimated to approach or surpass $10 billion in 2019, which would represent an increase of more than 919% from 2010. The number of medical spas in the United States has more than quadrupled since 2010—from 1,600 to an estimated 6,582 in 2019—and the average medical spa brings in more than $1.5 million in revenue.

Thus, it makes sense that an ambitious dermatologist might be curious about joining or founding a medical spa as a medical director. And although it certainly seems to make sense to join a flourishing industry, there are also a number of reasons why you might not want to take that leap. Here are some pros and cons of becoming a medical director for an aesthetic practice.

Pro: Money

Dermatologists are among the specialists known in the medical spa industry as “core doctors”—doctors whose specialties align with the industry in fundamental ways. Core doctors tend to incorporate their medical spas into their existing practices, which is a less lucrative business model than running them as a business independent of their practices. However, the money still can be exceptionally good, especially if the dermatologist in question allows his or her medical spa to be run as an independent arm of the business by people who understand how to effectively market and promote a more retail-focused business.

Now is the time to earn your money in the medical aesthetics industry. AmSpa’s report suggests that the value of the industry is projected to double in the next five years, and given that it projects a fairly conservative rate of growth compared with those of recent years, the actual rate of growth could be even higher. Dermatologists are in a uniquely advantageous position to benefit from this.

Con: Compliance

When you are the medical director of a medical aesthetic practice, you are responsible for all aspects of the medical side of the business, and that includes compliance. You not only need to be sure that you are properly delegating and supervising the procedures being performed at the practice, but also create protocols for the non-medical employees of the practice in order to make sure they remain compliant with the regulations that govern medical practices in your state.

AmSpa members receive a complimentary 20-minute Introductory Compliance Assessment with a ByrdAdatto attorney. Click here to learn about this and many other benefits of becoming a member.

Pro: Referrals

As stated earlier, dermatologists who operate medical spas typically incorporate them into their existing practices. When this arrangement is properly carried out, a medical spa can create referrals to the dermatology side of the business. However, it is important to understand that creating referrals cannot be the primary reason to add a medical spa to the practice. As previously mentioned, a medical spa must be operated as a separate entity, since a medical spa is significantly different than a dermatology practice in form and function. A medical spa should be able to succeed on its own terms, regardless of what is going on with the dermatology practice.

This might be difficult to come to terms with. I’ve spoken with several core doctors who have had bad experiences with running medical spas, and they can hardly believe that the industry is as successful as it is. Invariably, they went wrong by viewing their medical spas as existing primarily to drive business to their main practices. This can’t be the primary reason you run a medical spa. Any referrals you receive from your medical spa should be viewed as a bonus.

Con: Hands Off

Serving as the medical director of a medical spa is more work than you might imagine, but it may not be the type of work you’re used to or prefer. An effective medical director needs to trust his or her staff to conduct most of the everyday treatments at a medical spa, and this may be difficult for a physician who is used to performing treatments and consultations with his or her patients. Unfortunately for dermatologists who enjoy this aspect of their work, it just doesn’t make sense to be hands-on with the high-volume medical spa side of your business when you could be doing more lucrative work at your dermatology practice. There are only so many hours in the day, after all.

This also speaks to the importance of maintaining a qualified, conscientious staff. You have to be able to trust the people who work under you, and that requires you to pay very close attention to who you hire and how they’re performing. At the end of the day, the medical aspects of the medical spa are the physician’s responsibility, regardless of whether or not he or she is on the premises.

Understanding the Commitment

Owning a medical spa is a great, fun way for dermatologists to supplement their income, but do not underestimate the amount of work you will need to do to make it a success. Serving as a medical director is a major commitment, and it’s best to approach it with realistic expectations.

For legal updates and business best practices delivered straight to your inbox, subscribe to AmSpa’s email newsletter. For more information on how AmSpa can help your practice operate legally and profitably, Contact Us online or call us at 312-981-0993.

Tags:  Business and Financials  Med Spa Ownership  Med Spa Trends 

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Home-grown Success

Posted By Administration, Monday, November 11, 2019

rejuv fargo north dakota

By Michael Meyer, Content Writer/Editor, American Med Spa Association

According to the U.S. Census Bureau, the population of the Midwest—which includes Ohio, Michigan, Indiana, Illinois, Wisconsin, Minnesota, Iowa, Missouri, Kansas, Nebraska, South Dakota and North Dakota—represented approximately 21% of the U.S. population in 2018 (the most recent year for which this estimation is available). However, according to AmSpa’s 2019 Medical Spa State of the Industry Report, the Midwest is host to approximately 24% of the medical spas in the country, an increase from 22% in the 2017 report. This represents the largest positive discrepancy between the population and the number of medical spas in any of the four census-recognized regions.

So why are there so many med spas in the Midwest, and why is the number growing? Simply put, demand is exploding. Consider the story of Radiant Divine Medical Spa, which opened in Brecksville, Ohio, in suburban Cleveland, in May 2017.

“After the first six months, we were at about $500,000 in sales, so I’m like, this is something—we’ve got something here,” says Ryan DeVault, Radiant Divine’s co-owner. “We had demand from other areas and other markets, so we opened up another medical spa about 25 miles away in Avon, Ohio. I signed that lease in January 2018. Then we had demand from another market that was about 25 miles south of us in Medina, Ohio. I signed that lease for new construction in June of 2018 and we opened up in October of 2018, so we turned one practice into three spas in the first 17 months.”

According to DeVault, Radiant Divine is on pace for $3.5 million in revenue across its three sites in 2019. (Author’s note: Read more about Radiant Divine in the “Cleveland Rocks” a little later in this article.) And although not every medical spa owner has the same ability to open new locations, many in the Midwest have discovered that the path to profitability leads to some far-flung places that one would not necessarily consider to be hotbeds for aesthetic services.

Dakota Dreams

Fargo, North Dakota, is the 222nd-largest city in the United States, with an estimated population of 124,844 in 2018, so it is not exactly a sprawling urban center. Its economy has traditionally been associated with agriculture, and farm families are not generally thought of as traditional medical spa customers. However, Fargo is growing—its population has more than doubled since 1980, and it has increased 18.3% since 2010—its economy is diversifying, and, perhaps surprisingly, it is home to one of the country’s most consistently successful medical spas.

Rejuv Medical Aesthetic Clinic opened in 2005 with 1,500 square feet and three employees. Today, it operates out of a 12,000-square-foot facility, has 40 employees and is on track for approximately $8 million in revenue in 2019.

“We’ve had 15 years consecutive growth at a minimum of 20% every year,” says Melissa Rogne, president and founder of Rejuv. “We really haven’t struggled in finding an audience, and we really have always defied what the typical aesthetic patient is supposed to look like. We’ll tell stories where some of our patients come in and they bring us eggs from their farms. We really feel like Rejuv has broken down the stereotype of what a typical aesthetic patient’s profile is.”

Conventional wisdom suggests that having a large population base is necessary for medical spa success. However, Rogne believes that being part of a smaller, more insular community actually works in the practice’s favor.

“Because of the tight-knit community, the referral network is alive and well, and we’re able to really capitalize on the good nature of the people in this area,” Rogne says. “The Midwest is known for having the friendliest people in the United States, and that’s true. Those people want to tell their friends, they want to see you succeed and they know you really genuinely care about them.”

However, despite its size and success, Rejuv is not the only game in town, which speaks to the medical aesthetic industry’s growth in recent years.

“One of the things that people think is that there’s no competition; it’s actually quite the opposite,” Rogne explains. “I did some research about a year ago, and we have essentially one aesthetic medical spa for every 5,000 people in this community. The competition is extremely stiff—it’s not what people think it is.”

Royal Treatment

To Rogne’s point, according to AmSpa’s 2019 Medical Spa State of the Industry Report, there are an estimated 6,582 medical spas in the United States, up from approximately 1,800 in 2011. Back then, it was possible to find markets in the Midwest that simply were not being served at all, and that is how aNu Aesthetics and Optimal Wellness in Kansas City, Missouri, came to be.

“Where we started, there was a really big void of providers,” says Cristyn Watkins, MD, founder, owner and medical director for aNu. “There was really nobody around us.”

For several years, Watkins and her partners—a nurse practitioner and two other doctors—kept their practice low-key, working evenings and weekends as time permitted and building up a devoted patient base.

“The nice thing was that, since we were all small-business owners and this was kind of our side job, everybody had our cell phone number, we e-mailed every single patient after we saw them, and we were our own schedulers,” Watkins explains. “Our patients really liked the fact that they had access to a physician who cared for them and who they had direct access to.”

During this time, aNu’s reputation grew via word of mouth, and when Watkins decided to dedicate herself to the practice full-time in February 2016, business “went crazy.” The practice moved to a new 6,000-square-foot location in November 2017, and it is projected to bring in $3.5 million in revenue in 2019. Watkins refuses to rest on her laurels, however—she is doing everything she can to spur on aNu’s growth, and that means doing everything she can to give her patients what they want.

“Between medical aesthetics and wellness, you have to be on the cutting edge all the time,” she says. “If there’s something I’m interested in or my staff is interested in, we usually implement it within about 90 days, if it’s got good ROI and I think it’s something we should be doing. You have to always be figuring out what the new thing is in order to make it [to the top], I truly believe. But I also believe that if you care about your patients and you take care of them, that they’ll take care of you.”

Cleveland Rocks

Compared to Rejuv and aNu, Radiant Divine is an overnight sensation; however, although the spa itself has only been open since 2017, its primary provider, Rachel DeVault, RN—Ryan’s wife—has been building a reputation in the Cleveland area for far longer.

“My wife became an RN in 2010,” Ryan says. “She was working just regular hospital jobs, and then a friend of ours opened up a medical spa in the back of his tanning salon. He knew she was an RN and introduced her to aesthetics. She just has a niche for it. She grew his injectable practice from zero to 200 people in about 60 days. She created the following for him.”

Since then, Rachel has become an expert injector. She is currently a Galderma GAIN trainer, and not surprisingly, her loyal clients from those early days formed the foundation of Radiant Divine’s success.

“We didn’t solicit any of her old people—they found us,” Ryan says. “We didn’t do really any forms of advertising. The website was not the strongest. But it just seemed to be that word of mouth and referral was our best source.”

Close to Home

The success of these practices demonstrates the value of establishing a reputation for exceptional service, particularly in places where members of communities are close and inclined to recommend businesses that provide what they promise. However, there are certain disadvantages to working in places that are off the beaten path for aesthetic professionals.

“For us, probably the biggest issue has been hiring,” says Rogne, of Fargo’s Rejuv. “It’s really difficult for us to find people who have experience in this industry in a smaller market like ours. We’ve really had to invest a lot in training people and bringing them up new in this industry. We don’t get to just hire a nurse injector—we have to create a nurse injector. Without a doubt, the biggest challenge for us is the availability of human resources and staffing.”

“It’s always staff,” agrees aNu’s Watkins. “It’s always finding a good front-desk person and a manager.”

However, dealing with issues such as these is a small price to pay for home-grown success.

“I’ve lived here forever, she’s lived here forever,” says Radiant Divine’s Ryan DeVault of his wife, Rachel. “It’s an area I’m familiar with. I know a lot of people here and I know the approach and I know what they’re looking for—the services they’re interested in. I feel we can accommodate our market because we’re familiar with it. Can we do this in different market? I don’t know, but we know this market. Cleveland’s home, you know?

Tags:  AmSpa's 2019 Medical Spa Statistical Survey  Business and Financials  Med Spa Trends  QP 

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Proposed Changes to Texas Rule §193.17 Now Available for Comment

Posted By Administration, Friday, November 8, 2019

texas capitol

By Patrick O’Brien, JD, legal coordinator, American Med Spa Association

As we covered previously, the Texas Medical Board (TMB) voted to officially propose a set of changes to Texas Administrative Code Rule §193.17—the rule that provides guidance of the delegation of nonsurgical medical cosmetic procedures. The TMB proposed some changes at a stakeholder meeting in early October (covered here) but did not publicly disclose the final version it approved for publication; it instead intended the publication in Texas Register to serve as the changes’ public debut. The wait is over—this week’s issue of Texas Register contains the TMB’s proposed rule changes (starting on page 6669).

These proposed changes are broadly similar to the initial version discussed at the stakeholder meeting in early October. However, this approved version makes significantly more minor adjustments than the original proposal would have. The prior version would have made significant changes to who can perform procedures and what supervision is needed; the proposed version maintains the current rule and permits physicians to delegate to both licensed and unlicensed people, provided they are “qualified and properly trained.” Similarly, the proposed rules still require that supervision be provided by an advanced practice registered nurse (APRN) or physician assistant (PA) who is onsite or by a physician who may be offsite. The current rule requires that the physician be available for emergency consultation, whereas the proposed rule would require the physician’s “immediate availability… for consultation.” The proposed language does clarify that supervision does not require direct observation.

This new proposal also makes a significant addition to the current rules by adding a requirement that the physician notify the board of their intent to delegate and supervise medical spa-type procedures. This notification would be made on a board-supplied form and would include:

  • Information on the business’s owner, location and phone number;
  • A list of all PAs, APRNs and qualified persons who will be performing procedures; and
  • The name and license information of the supervising physician.

This document would need to be updated within 30 days of changes, additions or terminations.  Additionally, the physician would need to secure an alternate supervising physician if they are unable to provide supervision. The proposed rules go on to state that all physicians who delegate and supervise procedures are responsible for ensuring compliance with all applicable rules and laws, and violations are grounds for discipline. 

It is important to remember that these are only proposed changes—they are not yet official or final. We are currently in a 30-day window during which members of the public can submit comments and feedback. At the end of the 30 days, the TMB, at a public hearing, will vote on whether to formally adopt the changes as they are currently written or to make modifications as a result of public comments. If you would like to submit feedback to the TMB, it can be sent to the attention of Rita Chapin at:

P.O. Box 2018
Austin, Texas 78768-2018

It also can be emailed to

For legal updates and business best practices delivered straight to your inbox, subscribe to AmSpa’s email newsletter. For more information on how AmSpa can help your practice operate legally and profitably, Contact Us online or call us at 312-981-0993.

Tags:  Med Spa Law 

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The Power of Patient Retention

Posted By Administration, Wednesday, November 6, 2019

patient retention

By Terri Ross, Terri Ross Consulting

Patient retention is a very powerful—and sometimes overlooked—way to rapidly expand your medical aesthetics practice. Why? Because once you’ve captured the interest of your patient population, the hard work is done. At this point, making genuine connections and encouraging them to take action are your primary goals. They can be achieved through engaging conversation, personalized treatment plans and intentional follow-up. Patient retention is directly correlated with how well your front office staff performs, their ability to educate and, more importantly, how well the consultation is conducted by the medical provider.

Is every staff member in your office engaging, direct and knowledgeable of the services and treatment plans you offer? (Click here to read more about the LAER model I developed for staff training.) Another key aspect of patient retention is related to your brand as a medical aesthetic office—i.e. the level at which you perform, as evidenced by a top notch facility, expertise, state-of-the-art equipment and marketing efforts that match the brand. Sophisticated and educational marketing materials relay a consistent message to your patient population—they should choose you for their medical aesthetics needs.

Why Is Patient Retention So Important?

Focusing on your current patient population is the best way to rapidly increase your profitability. Invest in high-quality staff, branding and technology, and gear these elements towards encouraging your current patients to take action. Research shows that increasing your patient retention by 5% increases your profitability by more than 25%. The concept is simple: your current patient population, including both new and established patients, has already expressed some level of interest in your practice. Your goal now is to capitalize on this interest, gain their trust and guide them toward taking action—whether that is scheduling a consultation appointment or moving forward with a personalized treatment plan that includes multiple treatments; this will do two things: ensure a better outcome and protect their investment.

Key Elements to Maximize Patient Retention

Engaging staff: Every member of your front office staff should strive to make a connection with your patients, both new and established. As outlined in my LAER model for staff training, it is critical that your front office staff listens, engages and responds to patient questions and needs. They should be proactive in their patient interactions. Ask a new patient if they’d like to read some new literature on the procedure in which they expressed interest. Ask an established patient if they’re interested in a new promotion that would extend their current treatment plan.

In addition to being proactive, your front office staff should be knowledgeable about all aspects of the treatments you offer and the aesthetics industry as a whole. Having had the pleasure of working with many practices, I know this is one area that is sadly overlooked. Staff members should know what procedures and treatments you offer, how they can be incorporated into a treatment plan, and how they compare to your competitors. It is critical that your staff is capable of discussing your technology and services, so that patients are encouraged to choose your practice over another. Patients want to feel like their needs are not only being met, but also being exceeded. This is what makes that lasting impression—the one that makes new patients commit to a treatment plan and keeps established patients coming back, year after year.

Consistent marketing: Be consistent in your marketing efforts. Find your niche in the market of medical aesthetics practices and commit to it. This applies to everything—from the font style of your website to your business statement to your appointment cards. Patients want to feel like they’re coming back to a familiar place when they visit your office or website. This familiarity is established by an inviting atmosphere, sophisticated décor, office-branded brochures and pamphlets, regular e-newsletters, and a streamlined and informative website.

  • Office space: The physical structure of your medical aesthetic office—including the building, exterior sign, interior waiting area and treatment areas—sets the tone of your patient’s experience. The waiting area is where your patient’s experience begins and ends. An inviting, sophisticated and well-conceived space can create a familiar environment to which patients want to return. Clean, accommodating treatment areas, equipped with cutting-edge technology, convey a clear message of expertise and professionalism to your patients. The bottom line is this: If a patient enjoys their experience in your office and receives top-notch, personalized care, they will return.
  • Technology: Commit to being the expert in your niche of the medical aesthetics field and acquire the equipment to make it happen. Align your passion and expertise with the newest technology and make it available to your patients. Patients don’t want to feel sold on any and every treatment out there, but if they feel that you are the expert in a specific treatment, and this is supported not only by your knowledge as a clinician, but also in the technology available in your office, they will be encouraged to choose you for this treatment.
  • Brochures and pamphlets: Devote a significant portion of your overall marketing budget to creating and maintaining office-branded literature. Develop brochures for each major treatment or service you offer, going through general information about the treatment, relevant technology and how your office excels above the rest. Include your office name, logo, statement and contact information on each brochure. Personalized brochures relay a sense of expertise and sophistication to your patients and encourage them to follow through with a plan of action in your office.
  • E-newsletters: Beyond office literature, it is important that you send out regular, informative and branded e-newsletters. Either monthly or quarterly, send a newsletter to your patients outlining new technology, promotional treatment plans, new staff and/or new expertise. Did you recently acquire a piece of technology that will greatly expand your treatment options? Did you hire a new team member who adds specific and impressive expertise? Highlight this information. Keep your patients informed and engaged. If they get the impression that your office is constantly growing, diversifying and moving forward in the field of medical aesthetics, they will want to choose your office. This will not only increase patient loyalty, but also will encourage current patients to try new options, leading to increased treatment appointments and increased profitability.
  • Website: Just as your office serves as the physical representation of your brand, an organized, streamlined and informative website defines your brand online. Make sure your office information, logo and contact information are visible on each page. Keep fonts and styles simple and sophisticated. Clearly outline the treatment and service options you offer, making sure the site is optimized so it ranks on the first page of Google during web searches—and emphasize what makes your office stand out among the competitors. Provide enough information to portray your expertise in the field while encouraging new patients to contact you for additional information. This will lead to increased patient conversion and patient retention. Your website is your virtual brochure—it’s the first place patients look so when they get to your site, so keep them there. Your website should generate more than 100 leads per month. If it’s not, something is wrong.

Personalized Follow-up: Your front office staff should make a proactive, regular effort to follow up with patients. Particularly after introductory or consultation appointments, when new patients may have unanswered questions or concerns, it is critical that your staff remains in touch. Make it a policy to check in with every new patient one week after their first treatment appointment to verify that the treatment was successful and to gauge their satisfaction. It is key that you address any patient concerns as quickly as possible. You want every patient to feel important; this is what will make them return. It’s important to stay in touch with established patients as well—inform them of any new technology, treatment plans or promotions available to them, and encourage them to take action.

If you want to quickly increase the profitability of your office, focus on patient retention. It cost eight times more money to gain a new patient than it does to nurture the ones that you have.

Schedule a strategy call with me and take the first steps towards optimizing your business and improving patient retention today.

Terri Ross brings more than 20 years of sales and management experience to the field, having worked with leading-edge medical device companies such as Zeltiq, Medicis, EMD Serono, Merck Schering Plough and Indigo Medical, a surgical division of Johnson.

Ross’ vast knowledge and experience as a sales director managing upwards of $20M in revenue and successful teams has allowed her to become a renowned plastic surgery management consultant helping aesthetic practices thrive.

To optimize revenues and business performance, Ross’ practice management consulting services help physicians evaluate practice processes including, but not limited to, overall-operating efficiencies, staff skill assessment, customer service and operating efficiency strategies. The goal is to develop a comprehensive plan of action to improve productivity, quality, efficiency and return on investment.

Tags:  Business and Financials  Med Spa Trends  Terri Ross Consulting 

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What Medical Spa Owners Need to Know About LLC Taxation

Posted By Administration, Monday, November 4, 2019

tax forms

By James M. Stanford, JD, Partner, ByrdAdatto

Fake or Real: My company is taxed as an LLC—Fake!

There is no such thing as being taxed as a limited liability company (LLC).

Clients, as well as tax and legal professionals, routinely confuse entity structure with tax classification. Quite commonly, we hear clients state that an entity is taxed as an LLC when, in fact, no such tax classification exists.

Many people do not realize that when forming an entity—such as a medical spa—typically there are two principle filings. Understanding the difference can alleviate a lot of confusion.

  1. The first filing is at the state level, which incorporates the company as a legal entity (i.e., filing as a limited liability company).
  2. The second filing—or filings—are with the Internal Revenue Service to obtain an employer identification number. This filing determines how the new entity will be treated from a federal tax perspective.

An LLC is purely a state-level entity structure. In turn, the LLC elects how it will be taxed: either as a partnership, an S corporation, a C corporation or a disregarded entity. Generally, when someone says they are taxed as an LLC, what they really mean is that they are taxed as a partnership.

AmSpa members receive a complimentary 20-minute Introductory Compliance Assessment with a ByrdAdatto attorney. Click here to learn how to join AmSpa today!

James M. Stanford is an attorney and partner at the ByrdAdatto law firm. From transitions, mergers, and acquisitions to structuring complex ownership arrangements, James enjoys the personal reward that comes from bringing parties together and making deals happen. James practices primarily in the areas of health care and corporate law with a focus on intellectual property. A proud father, Jim served in the U.S. Army and is fluent in Russian. In his spare time, he enjoys hunting, fishing, and spending time outdoors.

Tags:  Business and Financials  ByrdAdatto  Med Spa Law 

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California Continues History of Limiting LVNs and MAs in Medical Spas

Posted By Administration, Friday, November 1, 2019


By Patrick O’Brien, JD, legal coordinator, American Med Spa Association

Every state has differing rules about what types of tasks and procedures may be delegated to licensed vocational nurses (LVNs) or unlicensed medical assistants (MAs). Usually, LVNs and MAs have a more restricted scope of practice when compared to that of a registered nurse (RN). California, in particular, greatly restricts what MAs and LVNs may do, and it has a history of publishing information confirming this. Recently, it appears that the state’s licensing boards have been increasing enforcement of these restrictions through the use of undercover investigators visiting medical spas. So, in the interest of compliance, now is an excellent time to review what MAs and LVNs can and can’t do.

California defines the specific tasks that MAs may perform in statutes and rules; this leaves very little room for differing interpretations. This differs from the norm in that it the majority of other states only provide general rules or guidance. An MA in California is authorized to perform “basic administrative, clerical and technical supportive services.” Technical support services include listed tasks such as administering medication, performing skin tests and non-invasive specimen collection. The Medical Board of California (MBC) offers a number of resources to help determine what qualifies and what doesn’t. For general questions, it has provided a lengthy FAQ that provides very helpful guidance. You will note that MAs may inject medication in some circumstances; however, that does not include the injection of Botox, as the MBC makes clear elsewhere. MAs also are strictly prohibited from administering any type of laser, intense pulsed light, radio frequency, microneedling, microdermabrasion or chemical peel procedure. As such, MAs would be extremely restricted in a medical spa setting and unable to perform nearly any of the common procedures.

LVNs in California, by the nature of being licensed professionals, do enjoy a much broader and varied scope of practice. LVNs are licensed to perform “services requiring those technical, manual skills acquired” in approved vocational nursing courses. This permits LVNs to perform tasks such as injecting medication, withdrawing blood and starting IV fluids, when directed by a physician. Once again, however, LVNs are very limited in a medical spa setting in California. Like MAs, LVNs are not able to inject Botox, use lasers or light-based devices, or provide microdermabrasion services.

AmSpa also has become aware that the TMB is increasing its enforcement for these types of procedures by using undercover investigators who pose as potential customers. From the limited information available, it is not entirely clear if the investigators are acting based solely on the procedures offered or if they also are looking for insufficient or improper physician oversight. Regardless, LVNs who offer Botox and filler injections are subject to disciplinary hearings for practicing outside of their scope. If you want to learn more about the Board of Vocational Nursing’s Enforcement Division, you can read more here.

In the past, we have discussed the importance of remaining compliant and operating within each license’s scope of practice (here and here, for example). A board investigation such as those mentioned above can be a much greater problem than it appears. The LVN can be disciplined for acting outside of their scope of practice and may have their license suspended or revoked. The physician may also be subject to discipline from the MBC for aiding in the unlicensed practice of medicine or providing inappropriate supervision. They also can be subject to penalty, including suspension or revocation. If that were to happen, every other nurse or physician assistant at that medical spa would be out of a job unless there was another physician in the practice who could supervise.

If you would like to learn more about the practice and structure of medical spas, plus all of the latest trends and best practices, attend The Medical Spa Show 2020 in Las Vegas from January 31 – February 2, 2020.

Tags:  Med Spa Law  The Medical Spa Show 2020 

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How Forming an LLC Can Help Your Medical Spa

Posted By Administration, Wednesday, October 30, 2019


By Courtney P. Cowan, JD, ByrdAdatto

Beginning Labor Day Weekend through the first few weeks of 2020, you will find ByrdAdatto attorney Robert Fisher proudly wearing the same red fishing shirt imprinted with the distinctive University of Georgia “G” logo. That garish shirt signals to everyone in the office that college football is upon us. We take football seriously at ByrdAdatto—and in the state of Texas, generally—so it seemed fitting to compare the similarities of our two loves of college football and limited liability companies (LLCs). “What could these two things possibly have in common?” you ask. The answer is simple: absolutely nothing.

But that hasn’t seemed to stop people, particularly college football coaches, from using LLCs as a means of conducting business. Originally used as a way to circumvent the optics of making more money than prominent state officials, collegiate head coaches formed LLCs to function as depositories for the large amount of supplemental income they received in addition to their base salaries. A recent Dallas Morning News article detailed some of the reasons for doing this, including tax relief and liability protection.

While we appreciate the publicity the head football coaches bring to the LLC, these reasons are not novel to those familiar with this business structure. Many business owners, accountants and attorneys have long been proponents of the LLC due to the advantages offered by it, including:

  • Tax flexibility: The LLC can elect to be taxed as a disregarded entity, partnership or corporation (s-corporation or c-corporation). By default, an LLC is taxed as a “pass-through entity” (i.e., a disregarded entity or partnership, depending on the number of members), meaning all of the profits and losses of the LLC “pass through” the LLC to the members, who then report the profits and losses on their personal tax returns. The LLC itself does not pay federal income taxes, unless it elects to be taxed as a c-corporation.
  • Limited personal liability: The owners (members) of an LLC are protected from the liabilities and creditors of the LLC as long as the LLC is formed and operated properly. Moreover, LLCs provide protection against outside liabilities (i.e., the liabilities of the other members).
  • Perpetual existence: The LLC can survive the death of its owners. This means the business will survive even if its owners do not.

Whether you are a Power Five coach making millions or a small medical spa, virtually anyone can form and take advantage of the benefits of an LLC.

AmSpa members receive a complimentary 20-minute Introductory Compliance Assessment with a ByrdAdatto attorney. Click here to learn how to join AmSpa today!

As the daughter of a periodontist, Courtney P. Cowan has been fascinated by the health care field since childhood. She often accompanied her father to his office, where she developed an appreciation for physicians and their respective practices. Having absolutely none of the dexterity that is required to be a surgeon, however, Cowan instead decided to pursue a degree in business while attending Baylor University. It wasn’t until she was required to take a business law course that she discovered her passion for the law. After graduating from Southern Methodist University Dedman School of Law, Cowan serendipitously connected with ByrdAdatto and now assists clients by combining her business background with her enthusiasm for health care and the law.

Tags:  Business and Financials  ByrdAdatto 

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Phone: 312-981-0993

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AmSpa provides legal, compliance, and business resources for medical spas and medical aesthetic practices.

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