Reflecting on four key transitions in early med-spa ownership.
I had no intentions of running a med spa. I had no intentions of becoming a skin health expert. I had no intentions of doing anything other than what I was trained to do: rural family medicine, with emergency and hospital medicine on the side.
Then, in 2017, a friend of mine told me I should get into Botox. She is a local aesthetician who captured the permanent makeup wave of that year in our area. Women were coming from all over the place for her makeup tattoos, which rang in at $400 to $700 per session.
It hit me as an awkward fit. I am a feminist. I was not a beauty junkie, and, like most doctors, I have a simple, practical approach to make up, hair and dress. I had never had Botox and I did not know anyone who had. I held old school assumptions about non-surgical aesthetic medicine. But I love beautiful things and I am an entrepreneur in my bones.
The idea kept niggling at me. So, I got my first Botox treatment in mid-town Toronto. I did not tell anyone. It was such a departure from my expectations for myself. But there was no denying it. It took one treatment for me to be quite certain that I would regularly get Botox for the rest of my life. It is incredible. It helps me see, think, and look better. It widens and relaxes my face. It calms the crevice that had started to bury itself in my forehead during the final year of residency.
I took an injection course. I have always been good with my hands in medicine and, in a different life, I would have become a surgeon. I built a website. I rented a room at my friend’s beauty studio. In the beginning, I did not even have a phone number. My business was mostly referral from other women entrepreneurs in the studio. I used an office chair as my treatment chair. I charted on paper. And people started to come. In my tiny little town, three hours north of Toronto, people slid through the doors to get their treatments. I offered just injectables: Botox, filler and deoxycholic acid. People told me that they were so pleased they did not need to travel anymore to the city for these procedures. I was so surprised to learn how many people in town were already getting Botox on the regular.
Now, in late 2020, my clinic, Fresh You Clinic Inc, has two stand alone locations in Bancroft and Haliburton. I have a team of three nurses and one dental hygienist who specializes in laser treatments. I have a business partner and co-owner. Sales are up 10 percent over 2019 year to date, even with a two- and-a-half-month pandemic closure. I have taken many, many, many more courses. And we have a phone number.
I wanted to share some reflections on the transitions I experienced in the first three years as an owner and non-core aesthetic doctor. I hope these are of value to the curious, the just-getting-started and the doctors in the trenches of the first three years in business.
Transition 1: Delegating procedures.
When I started doing neuromodulators, fillers and deoxycholic acid, I did everything myself. But I was also growing a family practice, doing extra ER training, picking up a lot of ER shifts and building a small addictions practice. As the first year unfolded, I realized that I needed to delegate my injectables to a nurse to free up my time for medicine. My community first needed me to do medicine, before they needed me to make them beautiful. So, I brought on an RN to start doing neuromodulators.
Because I was doing everything on my own, and I was learning so much with each new patient, I could orient my first nurse in a clear, methodical, and detail-oriented way. A lot of doctors are brought on as medical directors to established med spas, and their role is ceremonial. The nurses really run the show: they know the clients better; they know the anatomy better and they know the techniques better. That is not true of my business. This difference is critical. I can hold my nurses to account in a way that other medical directors cannot because they do not know the work – or the patients - as well.
Any mature med spa will have nurses doing most of the injecting. Delegation is inevitable for business success. However, for quality assurance, adherence to regulatory body guidelines, client retention and satisfaction, I recommend getting your hands dirty and know the work. I still inject every week for at least a half day. I love it. It is a fun, intense, rewarding part of my week.
Transition 2: Moving from selling procedures to championing skin health.
When I first opened Fresh You Clinic Inc. (formerly White Medical Aesthetics), I used injectable procedures to target lines, contours, and bulges. I was using chemicals to pull levers and pulleys in the face. My view of the work was narrow. Fix that line. Lift that cheek. Over the years, I have learned enough to step back and look at my work from the perspective of a skin health enthusiast. I do not want a client to give me $500 for Botox if they will not spend $45 on an SPF and take steps to quit smoking. It does not align with my business ethos, which is to help people feel like themselves again.
Because I know so much more, and see so much more, I can sell and earn more. I do not have to convince. I educate. Because I am not a dermatologist or a plastic surgeon, I did not leave residency with the knowledge I now have about skin health. I had to learn, patient by patient, and case by case. My skills in family medicine are much better because of my skin health anatomy, physiology, and pathology learning.
For those interested in starting out with aesthetic procedures, recognize that it is good for the industry if we all take skin health as our desired outcome. I did not realize that this is where I would end up, but I am glad I did. The work of aesthetic medicine feels way less awkward now because it fits my approach to medicine: explore peoples’ journeys, use science to solve problems and be of service.
This does not mean that your approach to the procedures does not need to be safe, exacting, organized and consistent. It does. But once you feel good about the procedures themselves, your work can start to be about something more. The business is hard. It can feel risky and fickle. And so, so expensive. But if you are grounded in the idea that you are working towards skin health, you will weather the entrepreneurial storm.
Transition 3: Acquiring laser technology and retail skin care.
After my first year in business, a nurse in my family practice approached me about offering laser hair removal. She felt it would be extremely popular and no one else was doing it. So, like I did with Botox, I went and got some laser hair removal. Sold! What a solution to the chronic problem of unwanted hair. I knew it would sell itself. But what machine should I get? From which company? Lease or buy with corporate credit? I studied the industry for a few months and spoke to a lot of sales representatives. I ended up leasing a device three times the price of my original budget. The device was from a tier one company with a three-year warranty, incredible customer service and good leasing and financing connections. The device also has radiofrequency and ablative skin rejuvenation applications and IPL. It is a sturdy, reliable work horse. It has served us well and the payments have always been easy to make with the revenue generated by the device (aside from pandemic).
But here is the thing: Once you offer injectables, and IPL, and hair removal and ablative skin rejuvenation...you are officially a med spa. And then you need a Laser Safety Officer. You need practice handbooks, manuals, and protocols. You need an electronic medical record. You need different insurance. And you need to retail skin care. For that, you need to learn about KPIs, ROIs and productivity metrics. You need to devote time and money to branding and marketing. You need to really know about skin health to figure out how all these things you do fit together.
As any reader will see, this business evolved in a way that reflects that I am an amateur businessperson. The business was entirely cash funded until the third year when we took on debt for the pandemic and to facilitate expansion. I could not get great discounts from the manufacturers of my injectables because I was not placing large initial orders. I was very wary of fixed expenses, so I accepted higher variable expenses. The business was set up so that I could cut and run if I needed to. Mistakes were made by staying small. They have, thus far, not been fatal.
By the third year, I realized that I really had something with Fresh You Clinic. People felt good in our space and loved being there. My nurses loved their work. I was good at it. But I was also the mom of an infant daughter with a husband that commutes to Toronto, the owner of a now-large family practice, part time in the ER, addictions, and medical assistance in dying. I was too stretched. And the joy was leaking out. I was forced into the fourth transition and it was the best thing that ever happened to Fresh You Clinic.
Transition 4: Handing over operations to a non-medical partner.
In June of 2020, on our way out of the first wave of the COVID-19 pandemic, I hired a clinical coordinator. I needed someone else to answer the phones, emails, DMs, and messages. I needed someone else to do HR, payroll, on-boarding, marketing, and everything else that was not medicine or teaching. I wrote a long list of everything I needed this person to do. Effectively, I needed a COO. I circulated the job posting, interviewed candidates and hired the most stellar one: Elizabeth.
Elizabeth took to the role easily. She was savvy, built trust with my nurses, played good cop to my bad, and had the patience to solve problems with strategy, as opposed to money, which is what I too often resorted to. Within six weeks of our return to work after the first wave of the pandemic, our highest grossing nurse took a maternity leave, and I had a crisis of confidence. I was afraid that our earnings would tank, I would not be able to pay my staff and I would lose everything. In retrospect, this all came from extreme fatigue. The numbers told a different story, but I was too tired to see it.
I decided that I needed a change. I love aesthetic medicine, but burnout had me willing to just walk away from this wonderful thing I had built, in exchange for my sanity and my family. I considered selling the entire business and spoke to several interested buyers. The right fit did not emerge right away. Then, one Friday afternoon, Elizabeth asked if she could become an equal partner. She would purchase half the company and take over operations. I could go back to doing medicine and being the public voice of Fresh You Clinic. Near instantly, I felt better. For the first time, I was able to let go of the gnawing weight of the obligations of marketing, reception, HR, inventory, supplier relations and banking. I was happy. The right solution came at the right time.
I think it is possible for an aesthetic doctor to run as a solopreneur for a long time, longer than three years. But only if it is their only job and they are gifted with busines acumen and operational skills. If that is not you, then consider a true business partner. I was fortunate to get to test out my partner by hiring her first. If your partner is an equal shareholder, they will be as motivated and as dedicated to success as you are and this is an immense relief. Going to proverbial battle with someone else is a vastly different, and better, feeling than going alone. Shared rewards are also sweeter.
If you are launching a business in this wild, fast, technical industry, you are brave and smart. But you also must ask for advice whenever you can. The four transitions described above are an effort to point out some forks in the road before you arrive at the split.
Dr. Ashley White, MD, CCFP, MPH is the co-owner and founder of Fresh You Clinic Inc. She has a one- year old daughter, and eleven-year old cocker spaniel and a wonderful husband, David. She loves skin health, teaching and helping people feel like themselves again. For more, visit freshyouclinic.com or drashleywhite.com.