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Portrait of a Medical Spa Owner, Part 3: The Nurse

Posted By Administration, Monday, November 25, 2019

emily tryon

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 Nurse

Six years ago, Emily Tryon, RN, reached a crossroads in her career. She had spent much of her time in nursing working night shifts at hospitals, but she also had a passion for aesthetics that was causing her to question how badly she wanted to continue working in that setting. So in a moment of what she calls “entrepreneurial insanity,” she decided to strike out on her own.

Her first experience in the industry was a disaster. She began administering cosmetic injections out of a room at a physical therapy center, which she said was “a terrible location, because everyone coming in was just grateful to be alive—they certainly weren’t interested in how they looked from a cosmetic injectable standpoint, that’s for sure.” This arrangement came to an end when the physical therapy practice owner was evicted for failing to pay rent to the building owner; Tryon had to fight tooth and nail to simply get into the building to reclaim her equipment.

Shortly thereafter, she set up her practice, Esthetic Solutions, in a 150-square-foot space in the basement of a hair salon in Scottsdale, Arizona. Against all odds, it was there that she became one of the top injectors in the country, eventually clearing more than $1 million per year in injections alone.

“By year three, I was in the top 7% of cosmetic injectors in the nation, according to Allergan Professional Consulting,” Tryon says. “By year four, I was in the top 3% of injectors in the nation, and as of August 2018, I am now in the top 1% of cosmetic injectors nationwide.”

In December 2018, she moved Esthetic Solutions into a 2,000-square-foot space and expanded its staff to provide a full range of medical aesthetic treatments. She also works as a trainer who specializes in aesthetic medicine and consultation skills.

“That’s where it’s really at for me,” Tryon says. “I finish my training day at 6 p.m., and when I walk out of that clinic and I have hugs and tears of joy from my participants, where they say, ‘Thank you so much—I now have confidence to inject and I know that I can do this. Thank you so much for giving me the tools to do that.’ That’ll get me on a plane at 4 a.m. any day.”

Tryon believes that having a background in nursing has played a critical role in her success in the medical aesthetics business, since the non-medical skills nurses have to develop makes them a natural fit for the retail side of the business.

“Every nurse is in sales,” she says. “When we call a doctor at 2 a.m. because we think a patient needs a blood transfusion, for example. That was my foundation when I became a nurse—I started in sales 20 years ago as an RN in the ICU.”

Ultimately, Tryon’s “entrepreneurial insanity” turned out to be a solid bet on herself and her skills, one that forced her to become a top practitioner and a better businessperson.

“I would say that being an entrepreneur is the biggest, most challenging, most intense game I have ever played in life,” Tryon says. “There are really, really great highs and there are really, really great lows. And being able to see all of it as pieces to a giant puzzle and put those pieces together, for me, it pulls from every one of my strengths and my weaknesses to continue to grow and develop myself and who I can be.”

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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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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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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What to Look for When Purchasing a Laser

Posted By Administration, Monday, October 28, 2019

laser treatment

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

Laser treatments are a staple of the medical aesthetic industry. According to the American Medical Spa Association’s (AmSpa’s) 2019 Medical Spa State of the Industry Report, laser hair removal is offered by 59% of medical spas, and it is the second-most common procedure for a first-time patient, so it actively brings patients into practices. Additionally, the report found that 29% of medical spas offer full-field ablative laser skin resurfacing. What’s more, 8% of medical spas that don’t offer laser hair removal and 5% of medical spas that don’t offer laser skin resurfacing are considering adding them.

In order to perform any of these laser treatments, however, the proper equipment must be acquired. And that can be more expensive and complicated than one might imagine.

Laser Overview

In recent years, a number of new companies have begun offering laser equipment designed for use by medical aesthetic practices, which has resulted in unprecedented competition. This equipment can be very expensive, costing as much as $250,000, so the stakes in the market are very high.

The representatives who sell this laser equipment typically are compensated, at least partially, on commission, and the commissions they can make are substantial. As is typically the result of commission-based compensation plans, the reps are very motivated to close the deal. Potential clients often forget this fact when they are shopping for a new machine, but savvy consumers always will remember that the sales reps, even at the most reputable companies, make most of their money when they actually sell a machine. Because of this, some reps can be very aggressive.

Although there are many reputable laser companies with very knowledgeable, considerate reps, some other companies employ laser sales reps who act in an unscrupulous manner because of the potential for lucrative commissions. This is the primary reason why you should work with reputable companies with established track records.

Unscrupulous reps often pressure potential customers to make a decision immediately, before they have a chance to truly evaluate their options. These reps will tell customers that they are on a tight timeframe or that they have limited-time discounts that expire soon. However, prospective clients should take a step back and evaluate their options. These are major investments and should be treated with a great deal of care. Good sales reps from trustworthy companies will understand the gravity of the decision and provide customers with the time, information and references they need to make an informed decision.

Prospective customers also should keep in mind that the only time they have leverage in this situation is before the contract is signed—when you can still walk away. This is the time in the process when they must do everything they can to negotiate the deal in their best interest. Therefore, when a representative offers a prospective customer a contract to purchase a laser, that customer must fully understand that contract, because this likely will be the only time that contract can be negotiated.

Preventing Problems

Taking the time to read and understand the contracts offered by the salesperson is the best way for laser customers to protect themselves. If provisions you don’t understand are in the contract, ask the sales representative to thoroughly explain them to you. A good rep will always make sure you understand the contract. But it is always a good idea to get an independent explanation. If your lawyer is familiar with negotiating laser contracts, you should consult him or her; if not, you should consider hiring an attorney with knowledge in this area. Laser contracts can be much more complex than contracts for other types of medical aesthetic equipment—they may include convoluted provisions on warranties, maintenance, technical support or authorized use, so enlisting the aid of someone who has experience with them can be tremendously helpful.

The amount of marketing support the manufacturer is offering is an aspect of a laser contract that should be carefully considered. Some laser companies offer excellent support; others say they will but offer nothing in writing to guarantee it. The inclusion of a well-developed marketing assistance program often will increase the price of the laser, but it can add substantial value to the deal. The customer must make sure that the contract he or she signs includes language that guarantees sufficient manufacturer support. With a purchase of this size, it is crucial to the customer to have as much support as possible.

It also is important to ask the representative to provide references from people who own the laser model you are considering purchasing. These should not be clients who just bought the laser and are still in the “honeymoon” period—these should be experienced users who know the highs and lows of owning the laser long term. Or, better yet, ask a group of medical aesthetics professionals you know to ensure you get an honest answer. For example, AmSpa offers a private Facebook group to its members, which acts as a forum for these and any other professional questions that come up in the course of your medical aesthetics business. A prospective buyer should ask about how the laser performs, its service record, its return-on-investment, manufacturer support and any additional relevant information. Good reps will have a large number of references from people they have dealt with throughout the years; if they don’t, that should be seen as a red flag.

Deciphering Laser Provisions

Some provisions that prospective customers need to carefully consider are often found in laser contracts. It can take hours to review and analyze all elements of contracts, but there are three provisions that I often focus on when representing clients in laser purchases.

Recertification fees. The most controversial provision deals with recertification fees. It dictates that the manufacturer must inspect a used laser device to “certify” that it is in working order and operating to the manufacturer’s standards before it can be resold on the open market. The fee that the manufacturer charges for this service can be quite high—$50,000 or more—and it must be paid before the machine can be supported at a new customer site, which not only cuts into the resale value, but also makes it difficult to resell on the open market. However, some manufacturers provide a warranty and clinical training as part of the recertification fee, which may actually enhance the machine’s resale value.

There are valid reasons for having this fee in place—ideally, it helps ensure safety for both patient and provider—but it still is a very significant cost that should be understood before the laser is purchased. This is one reason why it’s very important to make sure that the laser you’re purchasing can be supported by your market. If, after a few months, you decide that the equipment is not ideal, you might be stuck with an extremely expensive piece of equipment you don’t use and can’t easily sell— since the secondary market for lasers can be extremely volatile and tends to favor buyers.

Prospective laser buyers should know that they can, in some instances, negotiate recertification fees, and some laser manufacturers are sometimes even willing to waive them altogether, typically when a practice is introducing laser treatments in markets where they have not yet proven to be successful. In fact, some manufacturers will even offer to repurchase the machine after a period of time if customers can show that their market is not responding to the product offerings. However, these are all things that must be negotiated into the contract before the sale is finalized. If the contract is signed and these elements aren’t included, you are out of luck.

Resale restriction. A resale restriction dictates that the customer cannot resell a laser without the manufacturer’s approval, or that the laser must be sold back to the manufacturer at a discounted price. As with recertification fees, there are valid reasons for these provisions; however, they can limit a practice’s options when it purchases new technology. Horror stories abound of medical spas with functional laser technology that they don’t use anymore because newer models were released. I’ve seen practices that have more than $1 million worth of technology sitting in a room gathering dust because they simply can’t do anything with them due to contractual restrictions and a weak secondary market.

However, as is the case with recertification fees, a resale restriction can be negotiated. Again, it is extremely important that the customer recognizes these provisions prior to signing the contract in order to maintain leverage. Reputable laser companies stand behind their products and typically have no issues working with new clients to make sure they are satisfied. If nothing else, a good sales rep should explain this provision so that the customer understands why it is there and how it is designed to help the customer.

Service clauses and warranties. Although they are commonly found in medical spas and aesthetic practices, let’s not forget that these machines actually fire lasers. This technology was science fiction in the relatively recent past. These are very sophisticated, sensitive pieces of machinery, and no matter how reputable the manufacturer, the machine will need to be serviced at some point. Good companies ensure that the customer endures little downtime and expense in these situations, but it’s up to the customer to make sure that everything that needs to be covered is covered for a reasonable amount of time, and that service is guaranteed to occur in a timely manner. After all, every day that the machine is offline is a day it is not generating revenue.

Prospective customers need to learn about exactly what happens if the machine breaks, what is covered—and what is not—under the warranty, and what the included customer support entails. Moreover, they must get as much as possible in writing so that they are guaranteed to have efficient, cost-effective service.

Know What You Don’t Know

For a medical aesthetic practice, offering laser treatments can be extremely lucrative, but buying a laser is much more complicated than simply going down to the neighborhood laser store and picking one out. If you know of a lawyer who has experience negotiating laser contracts, it is in your best interest to hire him or her to help negotiate this transaction.

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

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Retail Rakes It In

Posted By Administration, Monday, October 21, 2019

retail

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

Not every medical spa offers retail products, but according to the findings of the 2019 Medical Spa State of the Industry Report, those that don’t are missing out. The report reveals that 92% of medical spas sell skin care products as retail and that, each time patients decide to buy these products—an average of 81 times per month—they spend an average of $134 on them.

“High-volume retail sales are absolutely imperative for the profitability and long-term success of a medical spa,” says Bryan Durocher, a medical spa consultant and business development expert who is president of Durocher Enterprises. “In today’s competitive market, owners must invest not only in the products and merchandise stocked on the shelves, but also in properly ensuring their staff is adequately trained in how to sell retail, so that the products move off the shelves and into their patients’ hands. Developing a staff into the ultimate retailing dream team is the best, most underexposed and underutilized investment one can make.”

If someone comes into a medical spa from a medical background, it might seem somewhat gauche to him or her to place such an emphasis on retail sales. However, selling is a key part of what sets the medical aesthetic industry apart from more traditional medical services, and it is important that all providers understand that they are part of the sales process.

“Having meetings and educating the staff takes up a lot of time, and it can be annoying and make the week a little hectic and frantic, but it’s really important,” says Tanya McDevitt, practice manager for NeoSkin Center Medical Spa and Acne Clinic, a multi-million-dollar medical aesthetic practice located in Hudson, Ohio, a suburb of Cleveland. “Everyone in our facility is trained, from front desk to Dr. [Tricia] Bedrick [the practice’s owner]. Everyone gets the same amount of product training.”

McDevitt estimates that approximately 20-30% of NeoSkin’s revenue comes from retail sales. Maintaining or improving upon this is a top priority, and communicating with sales representatives from suppliers and manufacturers helps her and her staff understand how to best sell these items.

“I’ve really learned to utilize the sales reps for the products that we carry here,” McDevitt explains. “I really had to change my mind-set on that. I feel like setting aside the time with the rep—whether it’s a one-on-one with me to give me updated product information or to give Dr. Bedrick a one-on-one with updated product information or a team training—is just vitally important. They’re the experts on that line. I think a couple of my product reps are in here probably every two weeks. I love having them here. We learn something new every single time they come in, and I just think the presence of those reps is really important. And I can’t believe I’m saying that, because, at first, it really irritated me. But I find that they’re very helpful.”

A provider with excellent product knowledge can confidently tell a client about the benefits of a particular product, and a happy, well-informed client will very likely recommend the product to others.

“Your existing patients are the best and most cost-effective advertisement opportunities your medical spa has,” says Durocher. “When your staff properly educates their clients, they are able to maintain their service results at home. This ensures their satisfaction and return to your medical spa, while creating enthusiasm to spread the word about  their experiences.”

Given this, medical spa owners and operators should try to sell products that are not widely available or easily obtained from other outlets.

“Most of the product lines that we carry are not available to purchase online,” says McDevitt. “I feel like that makes us a destination, and our patients know that they can’t just log on to Amazon or somewhere else and purchase them. I think that makes us unique.”

Branded merchandise is another growing aspect of medical spa retail. According the 2019 Medical Spa State of the Industry Report, 19% of medical spas offer products such as t-shirts and jewelry, and while these products don’t sell in as great quantities as the skin care products—the average spend per patient is $45, and med spas report 38 purchases per month—but because they are so cheap to manufacture, they represent a relatively low-risk way to add to a practice’s bottom line.

But even if you feel that selling t-shirts is a step too far, embracing the retail side of the industry in a meaningful way can lead to higher profit margins and greater awareness of your business.

“We’re in a very small suburb outside Cleveland that’s a high-income area, and our lobby looks just like a storefront would if you were on the street and you could walk in,” says McDevitt. “It is so exciting and fun when people walk into our new space—they’re like, ‘Oh my gosh, I can’t believe how beautiful it is.’ And it looks like you’re in a retail store.”

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

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A Booming Industry with Compliance Concerns

Posted By Administration, Monday, October 14, 2019

medical spa

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

Anyone involved in medical aesthetics can tell you that the industry has been absolutely booming for some time now. Whether you own a large medical spa, operate a small aesthetic practice, or sell devices to providers, chances are you’re making money. Good money.

And the industry has shown incredible resiliency and staying power, having remodeled itself after the 2008 recession into a larger, more profitable enterprise.

The numbers don’t lie. AmSpa recently released its 2019 Medical Spa State of the Industry Report, which details business, financial and treatment data relating to United States medical spas. The numbers are pretty impressive.

The report showed that the industry grew a whopping 50% in 2017 alone, with 2018 following close behind with 30% growth. Since 2011, when the industry really started to take off in its current form, it has grown an average of 28% every year. And it shows no signs of stopping. AmSpa forecasts nearly 20% growth every year for the next five years, projecting the industry will double in size from 5,400 medical spas in 2018 to more than 10,000 in 2023.

The medical spa industry is currently a $10-billion business that employs more than 53,000 people by itself (excluding other aesthetic practices such as plastic surgery and cosmetic dermatology). It is on pace to become a $20-billion industry in short order. This places it among the fastest-growing industries in America.

So what’s not to like? Strong growth, better technology, increased appetite for non-invasive techniques that make customers look younger—it all looks good, right?

Although all signs point to continued robust growth, one issue lurks beneath the surface that continues to nag at the industry as a whole. It is the one problem that the industry can’t seem to get its hands around and, until it does, it risks not only never reaching its full potential, but also causing the industry to crumble under its own weight.

I’m talking about compliance. AmSpa’s report also took a high-level snapshot of how the medical spa industry functions from a legal and regulatory standpoint. It’s critical to remember that this industry is made up of medical spas—businesses that are medical facilities governed by the same regulations that orthopedic surgeons, family practice doctors and cardiologists, for example, must follow. These rules are enforced by state medical and nursing boards, the U.S. Food and Drug Administration (FDA) and the Drug Enforcement Administration (DEA), as well as state attorneys general. These are mandatory regulations that, when broken—even if just a little bit—can result in loss of license, hefty fines and even imprisonment.

All of these outcomes have occurred at an increasing rate during the past five years, and enforcement efforts are clearly increasing. Don’t believe me? Try typing “Botox arrest” or “med spa arrest” into Google and see what pops up.

It’s understandable, I suppose, that this industry would be slow to get on track legally. After all, with entrepreneurs and pharmaceutical companies raking in billions of dollars, it stands to reason that some shady characters would operate on the fringes. And there is no question that the applicable laws can be difficult to find, are sometimes fuzzy, and almost always are antiquated relics designed to apply to a different era of medicine. With so much new technology and so many new opportunities coming together in one industry, it is not surprising that many providers have struggled to determine what rules apply, and when. Don’t believe me? Just try calling your state medical board or nursing board.

But it’s time to get serious—and fast­—because as the industry innovates, creates and adds zeros to its bottom line, more and more opportunists take notice. Turf wars are developing between medical providers and societies. Industry executives are carving out pieces of the pie exclusively for themselves. Scammers are emerging, as are get-rich-quick schemes. And state and federal authorities are opening their eyes and actually paying attention.

Here’s the bottom line: If the medical spa industry doesn’t get its act together and focus on becoming safe, compliant and trustworthy, a reckoning will come in the form of over-regulation, truly bad publicity and public distrust—none of which are good for consistent growth.

And let’s be honest with ourselves here: Many of the rules that are being broken are not terribly difficult to wrap our heads around. Should an aesthetician with zero medical training, no oversight or supervision, and no hospital privileges be performing lip injections that can cause a patient to go blind if side effects aren’t handled properly? Should lasers that can quite literally burn a patient’s skin off their faces be administered without oversight or medical supervision?

AmSpa’s 2019 Medical Spa State of the Industry Report found that 13% of medical spas don’t perform any medical consultation prior to treatment, and that 15% of medical spas have someone other than a registered nurse, nurse practitioner, physician assistant or doctor performing injectable procedures. Five percent of medical spas admit that they have employees with no medical training whatsoever performing injections.

Take a step back and really think about those statistics. There are close to 1,000 medical spas in this country where a patient can be injected with toxin or fillers—treatments with potential outcomes that, if untreated, have been scientifically proven to cause serious side effects—without ever seeing a qualified medical professional. Or where a technician can fire a laser capable of causing third-degree burns and permanent disfigurement without any medical supervision whatsoever. Now imagine the news coverage and subsequent legal and legislative action that would result from even one individual going blind from a filler injection from an unqualified provider, or one high-profile individual being permanently scarred from laser burns. The results won’t be pretty.

Physician oversight is crucial, as are minimum training standards. Basic requirements must be universally adopted and self-enforced. The public must be convinced beyond any doubt that all medical spas are just as safe—if not safer—than plastic surgery offices or dermatology practices. AmSpa, with its partners at the law firm of ByrdAdatto, has been working tirelessly for more than six years to educate the industry on the basic requirements needed to make it safe and allow it to grow to its full potential.

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

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What’s New in Microblading

Posted By Administration, Monday, October 7, 2019

microblading

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

Microblading is a semi-permanent beautification technique that typically is used to improve the perceived thickness of eyebrows. When performing microblading, providers create superficial cuts near the surface of the skin and fill them with pigment, creating the illusion of fuller hair. It is an increasingly popular treatment—in fact, according to the American Medical Spa Association (AmSpa) 2019 Medical Spa State of the Industry Report, 27% of medical spas offer microblading services, up 2% from the 2017 study, and a further 8% are considering adding microblading to their menus.

The growing success of this treatment suggests that the market has yet to reach saturation, so enterprising practices stand to make a great deal of money with this technique. Here’s what medical spa owners and operators need to know about offering microblading services.

The Treatment

Microblading is extremely inexpensive to practice owners—it only requires a disposable device that costs around $5. Also, a practice typically does not need a doctor or a health care provider to perform these treatments, which helps keep its practical costs low. However, medical spas typically charge up to $500 for microblading services, so they are realizing very high profit margins when these procedures are administered.

Patients like microblading because it is semi-permanent, which is much more palatable than the lifetime commitment that comes with tattooing, which has been used in the past to add body to eyebrows. In addition, microblading tends to look more natural than tattooing.

“It's becoming a much more popular procedure—it just keeps growing and growing,” says Maegen Kennedy, PA-C, of Fleek Brows Microblading and Training in Orlando. “There’s a lot of good that comes from microblading, but it just needs to be done the right way and with the right safety protocols.”

Unfortunately, the rapid growth of microblading has created some issues surrounding the procedure and its practitioners.

“I'm finding that microblading is becoming more of a commodity—it's becoming less about the artwork and more about the price,” Kennedy says. “There's such a high amount of potential revenue that it is extremely attractive to people who feel that they have artistic abilities or would be able to develop the artistic ability. When you have a $100,000 potential salary [that can become] up to a $500,000 potential salary or more from doing this procedure, it's like a gold mine.”

As the demand for the procedure has skyrocketed, so has the demand for trained practitioners. Since there are relatively few qualified trainers available to meet that demand, the void is being filled by some potentially bad actors.

“There are so many places that are now offering training, and there is no requirement to be a trainer at all in any capacity, and so anybody could call themselves a trainer,” Kennedy says. “A lot of these training academies are just popping up literally overnight. I find that there's a lack of medical-based training, and people are getting trained by various companies that really aren't good, truthfully, or aren't providing the type of training that they should be receiving to be able to actually do this procedure.”

The Wild West… for Now

Since the microblading process is so similar to that of tattooing, most states that have issued rulings on the matter of who can legally perform these treatments have stated that a tattooing or body art license is required. If your practice is located in one of these states, your aestheticians or unlicensed practitioners would need to get these licenses, if they don’t already have them, in order to perform microblading treatments in a medical aesthetic practice. This might sound like a bit of a hassle, but obtaining a tattooing license tends to be simpler than you might imagine—and therein lies the problem.

“The laws are way too lenient,” Kennedy says. “The procedure hides under the umbrella of a tattoo artist and, unfortunately, that means it just doesn't have a lot of requirements or regulations associated with it. There just needs to be much more oversight for safety because there's no medical degree required to do this procedure. You can be a banker one day and a microblader cutting on someone's face the next day.”

In recent years, several states have introduced legislation designed to more clearly define microblading and recommend registration and licensure procedures, but none have been signed into law. In Missouri, for example, House Bill 877 (2017) and House Bill 71 (2018) sought to modify the state’s existing definition of tattooing to include “new cosmetic procedures performed with the aid of needles or blades … .” Both bills died in committee. Similar measures were introduced in Massachusetts, Nebraska and New Mexico legislatures, but none were signed into law.

However, according to Kennedy, simply categorizing microblading as tattooing across the board might represent a step in the wrong direction.

“People don't realize that it's actually a real procedure—that you're cutting on someone's face,” she says. “They assume when they go to these places that they're using sterile techniques and they're in good hands, but it's a real procedure—they’re cutting their skin open, essentially.”

And although action has not been spurred by any high-profile bad outcomes, Kennedy believes that it’s only a matter of time before underqualified practitioners cause real problems for those who practice compliantly.

“Even when the procedure goes wrong and it looks bad, patients typically aren't taking any action against anybody,” Kennedy says. “I find that they just kind of hide out and they're depressed and they're sad and they're frustrated and they're angry. But I haven't seen or heard of many people who are taking legal steps with any of the artists when they have a bad outcome. But I don't think that's going to be the case for long, because as it becomes more widely available and people are getting it done left and right, there are definitely going to be some problems with managing infection, allergic reactions or much worse things that can happen.”

Kennedy says that she spends a lot of her time fixing problems created by unqualified practitioners.

“There's a lot of work I'm trying to correct from people who are putting brows too close together, too high, too low, or using the wrong color,” she says. “I probably get one phone call a day from a person who got microblading done, and they're very dissatisfied with their face. They feel ruined. It's a very serious procedure, and I think there's just a lot of people doing it that aren't qualified to do it or aren't doing a good job.”

Consult a local health care attorney to learn how microblading is regulated in your state. He or she also can tell you what is required to get a tattooing license where you live, if you or your employees need one, and may be able to recommend reputable trainers.

An Evolving Art Form

Thankfully, the popularity of microblading is also leading it to greater legitimacy in some circles.

“Medical spas are offering a lot more microblading than they ever have before,” Kennedy says. “Instead of solo artists going and doing their own thing, I'm seeing a lot more of incorporation into medical spas, which is a good thing. The environment is typically much more regulated. I'm also seeing people who open up solo microblading places and are doing really well start to include injectables, so they bring in injectors, and now that they have this patient base. They are opening med spas because they were successful in brows and they're now moving into opening actual, real med spas.”

Microblading is not going away any time in the near future. Even though it is likely going to face legal tests and evolve into different forms—"combo brows,” for example, are growing in popularity and combine semi-permanent microblading with actual tattooing—conscientious medical spa owners should consider offering this treatment.

To learn more about legal and business best practices to keep your med spa compliant and profitable, attend one of AmSpa’s Medical Spa & Aesthetic Boot Camps and become the next med spa success story.

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

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New York Nursing Board Says Microneedling Is the Practice of Acupuncture

Posted By Administration, Wednesday, September 18, 2019

microneedling

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

Over the last several years, microneedling has exploded in popularity, becoming a core procedure in medical spas. According to AmSpa’s 2019 Medical Spa State of the Industry Report, 84% of medical spas offer some form of microneedling. The majority of states consider microneedling that pierces the outer layer of skin—the stratum corneum—a medical procedure that must be performed by an appropriately trained person under the supervision of a physician or other independent licensed health care professional. But New York has taken the unusual position that microneedling is part of the practice of acupuncture.

The New York Board of Nursing has provided guidance that microneedling is not within the nursing scope of practice; however, the Board of Acupuncture confirmed that microneedling is within its license’s scope of practice. It is not unusual for a procedure to be within the scope of some nurse licenses but out of others based on the skill and training needed for the treatment, but it is unusual is that all levels of nurses are excluded from performing microneedling, regardless of training. Otherwise, nurses in New York are able to perform a broad range of services in a medical spa. For example, when registered nurses are acting under the authority of a valid provider, they may inject neuromodulators and fillers, fire both ablative and non-ablative lasers, use radio frequency devices, and provide skin peels and light treatments. However, they may not provide miconeedling unless they are separately licensed in acupuncture.

This is a somewhat unusual interpretation, as although the two techniques both employ needles to pierce the skin, their goals and methodology are entirely different. New York defines the “profession of acupuncture” to entail the insertion of needles or application of heat, pressure or electrical stimulation on a point of the body on the basis of the theory of physiological interrelationship of body organs with a point or points of the body. On the other hand, microneedling typically is the insertion of needles into the skin for the purpose of stimulating collagen production. While certain types of microneedling may use energy or injections to improve the procedure’s effect on the skin, its goal is only to improve the skin tissue to which the treatment is applied, while acupuncture is meant to improve or affect a different organ or portion of the body than the area treated. And while this interpretation is unusual, it is not unique. The Massachusetts Board of Registration in Nursing, in an advisory ruling, has similarly interpreted microneedling to be outside the scope of nursing; an acupuncturist license is required to perform the procedure in that state as well.

I do want to stress that this information all comes from informal correspondence with the nursing and acupuncture boards. There currently is no law, rule or official advisory opinion stating that nurses cannot perform microneedling and acupuncturists can, so carefully review your own practice situation before making any major changes. We will continue to attempt to get some clear guidance on this unusual interpretation. AmSpa members can check their state legal summary, or utilize their annual compliance consultation with the business, health care and aesthetic law firm of ByrdAdatto for more information on medical spa law.

If you live in New York and want more information on this and many other topics relevant to your medical spa, attend AmSpa’s New York Medical Spa & Aesthetic Boot Camp October 12 – 13 at The New Yorker Hotel (A Wyndham Hotel) in New York City. Click here to register today and become the next medical spa success story.

Tags:  AmSpa's 2019 Medical Spa Statistical Survey  AmSpa's Med Spa & Aesthetic Boot Camps  Med Spa Law  Med Spa Trends 

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Microneedling Joins Toxins and Fillers as a Leading Medical Spa Treatment

Posted By Administration, Monday, July 29, 2019

procedures

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

It should come as no surprise that injections of botulinum toxin and hyaluronic acid fillers are the treatments most commonly offered by medical aesthetic practices. After all, they provide good return-on-investment (ROI) and are constantly in demand. According to the 2019 Medical Spa State of the Industry Report, 88% of respondents’ medical spas offer botulinum toxin. Furthermore, 73% of respondents’ medical spas cite it as being among their top three most frequently performed treatments, and 56% state that it is the most common treatment for first-time patients.

Hyaluronic acid filler injections are similarly widely available—they are offered by 88% of medical spas—but are not quite as widely administered, appearing in 58% of med spas’ top three most frequently performed treatments.

In the 2017 version of this report, botulinum toxin and fillers were combined as one option, and they were found to be available at 82% of medical aesthetic practices, so their availability is still growing.

And while it finished fourth in terms of availability, microneedling’s ascent into the pantheon of medical aesthetic treatments is perhaps the biggest story of this report. In the 2017 survey, microneedling was mentioned on only a handful of responses; today, it is available at 84% of responding medical spas and is among the top three most popular treatments at 20% of them. 

AmSpa Basic Members receive an executive summary of the 2019 Medical Spa State of the Industry Report, while AmSpa Plus Members receive the entire report. Click here to learn about this and all the other great benefits of becoming an AmSpa Member, and sign up today.

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

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In Just 15 Minutes, You Can Help the Medical Aesthetics Industry

Posted By Administration, Friday, March 15, 2019

taking a surveyBy: Alex R. Thiersch, JD, CEO of the American Med Spa Association (AmSpa)

From now until March 28, AmSpa is conducting the 2019 Medical Spa State of the Industry survey, and if you’re the owner or managing business director of a medial aesthetics practice, your participation is vital to helping us gain a better understanding of what’s going on throughout the industry. The survey takes approximately 15 minutes to complete, and once you finish, you’ll be entered in a drawing for valuable prizes. Click here to take the survey now.

This survey is extremely important to AmSpa and its members, and the information you provide can help us determine emerging trends and topics of concern that affect everyone in the industry. The more data we can gather, the better—it allows us to determine what is happening with a greater degree of certainty, and it helps bring to light perspectives that might not have been considered before. In other words, your opinion is incredibly valuable to us and to everyone else in the industry.

If you complete the survey, you’ll receive a free executive summary of the results when the survey is completed, as well as a promo code for $100 off a ticket to any 2019 AmSpa Medical Spa & Aesthetic Boot Camp, so if you’re a qualified respondent and you’re considering attending any of these events, it’s certainly worth your while to participate. Additionally, you will be entered in a drawing to win one of two $500 Visa gift cards.

Participation in the survey is limited to owners and managing business directors of medical aesthetics practices, and we ask that only one person per practice respond; however, if you don’t personally have access to the information you need to answer a particular question, we encourage you to solicit that information from others in your organization.

The more information you have, the better decisions you’ll make. By participating in AmSpa’s 2019 Medical Spa State of the Industry survey, you’ll help yourself and others to become better informed about the trends and topics that are currently driving the medical aesthetics industry, which can, in turn, help the industry can become even healthier as a whole.

Tags:  AmSpa's 2019 Medical Spa Statistical Survey  AmSpa's Med Spa & Aesthetic Boot Camps 

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