Announcer:
Scalpel of Truth is presented for educational and entertainment purposes only. Leisa Krauss is a profit strategist and business consultant. She is not a licensed therapist, HR professional, attorney, or your mom. Strategies discussed are based on her extensive experience in the medical aesthetics industry and are not medical, legal, or financial advice. And with that, here’s your host, Leisa, the Bitch’n Beautician and Profit Queen.

Leisa Krauss:
Well, hello, my beautiful Bitchachos, and welcome back to another episode of The Scalpel of Truth. Today we’re going to have a conversation that is going to be enlightening for folks looking at getting into this industry. So if you’re thinking about opening a MedSpa, a cosmetic dermatology practice, an injectable clinic of any kind, I want you to listen very, very carefully.

My loves, this is not the industry it was five years ago, ten years ago. Hell, it’s not even the industry it was two years ago. And if somebody told you that opening a MedSpa is an easy way to make a million dollars, I suggest you ask them how many successful MedSpas they’ve actually owned or operated. Because buying lasers, hiring an injector, putting up some pretty wallpaper, opening a fancy Instagram account does not constitute a business strategy. And I hate to be the bearer of bad news, shit, but neither does having just a passion for Botox and skincare.

I have spent 30 years in this industry. I have watched it evolve from an emerging specialty into a massive, highly competitive business category. I have seen practices become wildly successful, and I’ve seen businesses spend an extraordinary amount of money creating something beautiful, only to discover what they built isn’t generating revenue or even profitable.

So today’s episode is for the dreamers, the entrepreneurs, the medical aesthetic professionals, and the investors who are thinking about entering into the space. And for those of you who have opened your doors within the last five years, Bitchachos, you are going to want to listen in to this, okay? Because some of you are about to discover that the rules have changed. While you’re busy playing the old game, the new game is in town. And that’s 2026 and beyond. So the new game, folks. That’s where we’re at. This episode is called So Ya Wanna Open a MedSpa? Well, welcome to the Hunger Games.

Folks, I’m gonna break this down. The gold rush in medical aesthetics is over. There was a time when getting into this industry was considerably easier. The competition was limited, the technology was emerging, patients had fewer choices. If you were one of the first practices in your market offering laser hair removal, skin rejuvenation, some cosmetic injectables, you had a tremendous advantage. Thirty years ago when I started, the MedSpa, the hybrid, didn’t even exist at that time. Now there’s one on every street corner.

Back then, you didn’t need to have the best marketing. You didn’t need a sophisticated digital ecosystem. You didn’t even have to create 47 Instagram reels convincing somebody you were worth visiting. You simply were one of the only places in town offering something that people wanted. Well, guess what? Those days are long gone.

Today’s patients have options everywhere. Injectors, laser clinics, derm practices, plastic surgery clinics, boutique MedSpas. We’ve got franchise concepts, luxury aesthetic destinations, and everything in between. And many of those practices are excellent. They’ve got beautiful spaces, they’ve got the most talented practitioners, they’ve established great relationships. They’ve got sophisticated technology and exceptional patient experience and marketing budgets that sometimes make your eyes water.

So when you tell me you’re opening another MedSpa, my first question is: why should somebody choose yours? And please, for the love of all things holy, don’t tell me it’s because you offer Botox, fillers, health and wellness, facials, and some laser treatments. Because everybody’s doing that. Literally everyone. You need to know what your key differentiator is going to be. Now, I’ve done whole episodes on differentiation, so go back and listen to those. But today I’m giving you the multi-million-dollar reality check.

First off, it’s the money, and lots of it. You’re gonna need lots of money. Okay. Lots of money. Money, money, money. One of the biggest mistakes I see people make when they enter this industry is underestimating how much capital they actually need. They create a business plan, they budget for the leases, they budget for equipment, furniture, staff, and then they assume the patients are going to come pouring through the doors. What money have you left over for marketing? Who’s paying the staff while the appointment book is half empty as you’re getting going? Who’s paying the laser lease during slow months? And this industry is slow in Q1 and Q3. Our moneymakers are Q2 and Q4.

What about your software? Your insurance? How about those medical supplies? Ongoing training. So many things, folks. The website, the social media content, who’s creating that? How much money are we gonna throw at it? All the little expenses suddenly become enormous expenses. And then your fucking laser breaks down. No, son of a… the laser broke down. Or your injector leaves to start their own practice. She’s gonna go be the competition, or maybe the competition offered her two extra dollars an hour and she’s leaving.

Even with a strong business plan, opening a practice takes more time, more energy, more resources than you ever could have imagined. And if your dream is to open a truly luxury medical aesthetic destination practice, you’re probably talking about a multi-million-dollar investment there, depending on your market, your footprint, technology, and staffing. If you can’t even fathom, oh my gosh, I’m gonna need a million dollars, this episode is for you.

You cannot position yourself as luxury and then deliver an experience that feels like a discount tire shop. Lots of folks out there are doing this. Oh, we’re luxury. And then it looks like you’re a walk-in clinic. The math has to match the ambition. The money has to match the ambition.

And here’s where people get themselves into trouble. They try to be everything to everybody. They buy every machine the sales rep puts in front of them. They carry six skincare lines. They offer 42 different treatments, and they haven’t figured out how to make a single one of those categories consistently profitable. And you don’t need to offer everything. You need to become known for something.

Your competition, I want to talk about this, is better than you think. I know everybody’s collaboration over competition, and I love that for you, but let’s real talk. Let’s talk about your competitors. They’re not a bunch of poorly run businesses waiting for you to swoop in and steal their patients. Some of them are extraordinary. They’ve been building practices since early, early. Ten years, 15 years, 20 years, some of them. Maybe some of them only have five years on you, but they have something on you. Maybe they have hundreds of five-star reviews. Maybe their providers are highly trained and have done this for years. Maybe their patient experience is impeccable. Their social media is exceptional. Their website converts. Their follow-up system is brilliant. And their teams know how to educate, how to recommend, and how to retain patients because they’ve taken my workshops. Shameless plug.

And now you’re arriving with a brand new logo, a shiny new laser. So congratulations. What’s your plan? Because you’re not simply competing on treatment results anymore. Your patients have likely experienced somebody else before they’ve ever come to you. They want to trust you before they walk through the door. They want an experience. Okay. Look at the experience. They want something to make them feel like they’ve made the right decision. And that begins on Google, on Instagram, on your website, when they call you, when they message you, when they try and book through your software, long before their ass ever sits in your treatment chair. And it continues long after their bills have been paid at your MedSpa.

So I want to make a prediction. I’ve been making it for the last six months to a year at least. I believe that we are going to see a meaningful shakeout in the medical aesthetic industry over the next one to three years. And not because people suddenly stop wanting aesthetic treatments, but because the cost of operating a successful practice is rising. The competition is fierce. And regulatory expectations continue to demand serious attention. Lots of changes in regulations in our industry. It’s crazy. Some practices entered this industry believing it was easy to make money. Those folks are going to discover just how difficult it is to survive right now. And some won’t. That’s the sad part. That’s my prediction. Not a confirmed industry-wide closure forecast. It’s not that, but I am predicting closures over the next year to three years.

And I want to be clear about something. There is absolutely nothing wrong with wanting to make money. I’m a profit strategist. I have built an entire career around helping practices become more profitable. But if money is your only motivation and you have no genuine respect for the clinical, operational, educational outcomes, the patient care responsibilities that come within our industry, you’re gonna find this a very difficult place to be. If it’s not in your blood, and if you don’t love getting ready every single day and showing up for patients, this business will test you. It will test your leadership, your financial discipline, your patience. And I mean your patience, not your patients. Okay. And it’s absolutely gonna test whether you’ve built a real practice or just purchased yourself a very expensive job. I see that a lot in this industry.

Let me tell you what’s behind the velvet rope for this episode. This is the general listeners’ portion. If you’re not a paying member, here’s what’s going on when you join for the full comprehensive consulting and profit strategy episode. Behind the velvet rope today, I am going to give you the blueprint. Not the fluffy, motivational, you-could-change-anything-if-you-believe-in-yourself version. The actual practice strategies. Strategies are going to be in store for you.

And here is what I have for you. We’re going to talk about what this industry is actually paying, so how much capital you should be considering, how to select your business model, why your equipment budget could be the very thing that puts you out of business. I’m also going to share the mistakes I would absolutely avoid if I were opening a practice today, 30 years into this industry. Because the opportunity is still there. It definitely is. But the margin for sloppy execution is getting much smaller.

So if you’re thinking about opening a MedSpa, hear me say this. I’m not telling you not to do it. Please know I am not telling you not to do it. What I am telling you is to do it properly. You gotta be strategic, financially prepared, you gotta be different, you gotta be exceptional. And understand that opening the door is the easiest part. Building a practice people love, trust, return to, and recommend, that’s where the real work begins.

So come join me behind the velvet rope of the Scalpel of Truth Inner Circle, aka Club Bitchacho, where you will get the details that separate practices that strive to be something and practices that are actually thriving out there. Because you don’t need another motivational speech, you need a strategy. And that’s what I’m here to give you as your profit strategist. And around here, Bitchachos, you know I don’t sugarcoat shit.

So what I want you to do is head to the show notes, where my fabulous producer Pete puts the link to sign up for the Scalpel of Truth membership for full episodes. And for my VIP listeners who are already members, guys, you know what time it is. Let’s go.