To quote Bob Dylan, “You don’t need a weather man to know which way the wind blows.”

Hard times call for new ways of thinking, especially in the business of running a medical spa. The American Society of Plastic Surgeons (ASPS) has recently reported that $10.3 billion was spent on cosmetic procedures in 2008, which is down 9% from 2007, and analysts have stated that an increase in consumers’ disposable income may not occur for a few more years.

The reality of a struggling economy is sinking in as public spending on cosmetic procedures apparently continues to drop.

If you review the details of prior recessions, you may easily conclude that recessions can make businesses stronger and better suited for the future. As we have just witnessed during this short 21st century, bad habits are created when economic times are good and good habits are created when economic times are bad.

We must use this time to our advantage to critically assess our current practices, find our bad habits, and correct them, thereby making our practice more recession-proof in the future.

Although reassessing current business plans and adjusting to current trends are important in a clinical plastic surgery practice, financial discipline is even more important in riskier ventures, such as operating a medical spa.

Some clinical practices can still be very successful without a strict business model. However, when it comes to medical spas, there is little room for bad habits and loose business models.

Fortunately for medspas, according to the 2008 ASPS statistics it looks like those who are putting off more extensive surgery are nonetheless undergoing nonsurgical treatments. In fact, overall nonsurgical procedures grew 5% over the past year to 10.4 million. Botox injections grew 8% to 5 million, soft-tissue fillers grew 6% to 1.1 million, and chemical peels grew 2% to 1.0 million, but laser hair removal and microdermabrasion fell 2% and 6%, respectively.

The holistic approach of aesthetic surgery lies in integrating surgical and nonsurgical procedures. Determining how these different procedures can complement one another is the ultimate challenge and goal in our discipline.

This “comprehensive” cosmetic care is the wave of the future. This approach has made operating an ancillary medical spa in a plastic surgeon’s practice very appealing. And now, because of the new 2008 statistics suggesting that this venture could be slightly recession-proof, owning a medical spa has became even more attractive.


Determining whether a medical spa would be a good fit for your practice is a decision that you should not take lightly. Strategic planning is essential, and you should even consider professional consultation.

The easiest way to become affiliated with a medical spa is to become a medical spa director with no financial interest. The obvious benefit in this scenario is obtaining a patient base that will hopefully someday convert to your medical spa once it opens or convert to an actual surgical patient. Another way is to have a minimal financial interest in another medical spa, while day-to-day operations are managed by someone else and your individual overhead is low.

At this level, I think most of us have much more controlling personalities, and we may desire to have such a venture in our office—or at least attached to our office. I have been in practice for 5 years and started a medical spa in my practice 2 years ago. I did not purchase more real estate but rather converted existing space into a medical spa. This is a very conservative and economical way to begin a medical spa.

Once you purchase the expensive equipment needed for a medspa and hire ancillary staff, however, you have made a significant commitment to this new venture. Especially during these tough economic times, starting small is imperative.

You must have the right staff, equipment, and budget analysis in place before expanding the medical spa. For example, I hired one full-time aesthetician so she could do most of the spa procedures, which had a minimal impact on my time. I spent most of my time doing extensive research on various procedures/equipment before I made any significant purchase.

Focusing on consumer-pleasing services will build the spa’s reputation. Being the first in your community to offer a particular procedure/product is not that important, because many of these procedures come and go. However, you should be one of the first. That way, you demonstrate your cutting-edge ability but yet still give the procedure/product time to prove its worth.


When the economy improves, all the hard work and good habits you developed will pay off. It is during these current, “dark” times that expansion (and a new learning curve for you) could be considered. Expansion could entail using more clinical space for your spa or purchasing adjacent or distant real estate.

As insurance is becoming more expensive to the consumer and deductibles are larger, many people are focusing more on wellness programs. Combining wellness and prevention in a medical spa is synergistic and is currently very appealing to the public, large corporations, and hospitals.

A less risky investment is to collaborate with a local hospital on a project that focuses on community wellness. This lessens your capital investment and, in turn, any revenue generated. However, the collaboration could significantly increase foot traffic to your practice, especially if the hospital is close to or adjacent to your clinical practice. The hospital could even handle the physical operation of the project and provide staff, thereby reducing administrative headaches for the busy clinician.

When the economy is down, customers look for discounts. Although this should be considered in a medical spa, it has to be used very sparingly and judiciously.

A medical spa should definitely not get into “discount wars” with other spas. Discounting might immediately get patients through the door, but in the long term this can compromise your medspa’s reputation—a problem that may be difficult to reverse as the economy recovers. Patients are currently comparing surgical and nonsurgical prices more critically than they were a few years ago. In fact, quite frequently they just outright ask for a discount with a sense of entitlement. You don’t want to make it easy for patients to readily compare your services to those of your competitors by developing “custom” nonsurgical procedure packages.

A Good Fit?

Adding a medical spa to your practice:


  • Think strategically—consider hiring a consultant to help you set up your medspa.
  • Analyze your staffing needs and equipment, and put a budget analysis in place before you decide to expand into a medical spa.


  • Converting your existing office space is a conservative and economical way to begin a medical spa.
  • Consider become affiliated with an exisiting medical spa, by becoming a medical spa director with no financial interest.
  • A less risky investment is to collaborate with a local hospital on projects that promote community wellness.


  • Avoid discounting your services, even in a down economy.
  • Negotiating local sponsorships in conjunction with organizations or corporations, which ultimately reduce your marketing costs and garner good publicity.

In my practice, these packages have been very successful, as it is difficult for a patient to find a competitor who offers an identical package. Furthermore, adding one or two nonsurgical procedures to a surgery has also been very successful. These “surgical packages” are unique to our practice/medical spa. If our price for a breast augmentation is higher than a competitor, we can tell the patient that our price includes a complimentary peel and microdermabrasion. This approach makes it more difficult for the patient to simply choose the surgeon with the lowest price.

There are additional strategic ways to discount without compromising your medical spa’s image—for example, a referral program that includes a handwritten thank you card and a small gift sent to patients who have referred a new customer. Furthermore, thank you “gifts” to other referring medical practices/staff and local businesses are helpful, especially during present economic times when you may rely on them even more.

Many larger medical spas claim that 50% to 70% of their new patients are referred by existing patients. Because of this, many consultants claim that internal marketing is much more productive during down economic times. VIP cards and frequent user cards are also a nice token of appreciation to valued patients. In my practice, we instituted a 15% coupon in every surgical patient’s preop packet that can be used for any nonsurgical procedure in our spa for a specified time.


It is a well-known fact that sponsorships and donations decrease during a recession. Medical spas that are financially stable can take advantage of local community events by becoming exclusive sponsors of events and fund-raisers.

Currently in our community, many organizations are negotiating sponsorships, which ultimately reduce our marketing costs and garner good publicity. It is also easier to donate to community events and charities if you own a medical spa.

I encourage everyone to fully understand our Society’s Ethics Committee guidelines before embarking on such donations. As we all know, you cannot “donate” surgical services, but it is easier to “donate” some nonsurgical services. Nevertheless, participating in these events shows the community that you are committed to being involved.

During a recession, it is also necessary to stay in the public eye so that when the economy reverses your brand will stand out further. Some practitioners are not comfortable just marketing themselves as a surgeon or advertising discounts on surgical services.

Currently, we focus our medical spa advertising in conjunction with educational seminars, which are organized around important holidays, such as Valentine’s Day, Mother’s Day, and Christmas.

In addition, I try to include other related businesses, organizations, and/or practitioners in these seminars such as dieticians, fitness experts, and wellness professionals. These are the same individuals that allow us to cross-market with them in their individual businesses. This “clinical integration” lets my medical spa move more into the wellness realm, which is becoming more important to everyone.

Another area of important integration is your staff roster. Many well-qualified people are now looking for jobs, as evident by the national unemployment rate (which is at 8.5% as of this writing). These times are ideal to find those few overly qualified employees that you normally would not find. Provide incentives to employees, such as bonus plans and advancement opportunities. Treat them well, and you will create a positive atmosphere filled with happy staff and, consequently, happy patients.

Chad Tattini, MD, is a cosmetic surgeon in private practice in Bloomington, Ill. He can be reached at (309) 664-1007.