Every few weeks someone reaches out and says, “Loraine, I want to open a medical spa. Where do I start? Can you tell me what I need and what training to take?”
I always smile because they’re expecting me to say, “Take an injection course,” or “Buy this type of laser.”
Instead, I usually say something that catches them completely off guard.
“Are you sure you want to own a business?”
Because here’s the truth.
Injecting Botox is probably the happiest part of my day.
Nobody ever posts on Instagram about bookkeeping, all the taxes (federal, state, social security, franchise, gross receipts, etc.), and the equipment maintenance.
Nobody makes a TikTok about what the struggle was to get a great team (which I’m so thankful for!).
Nobody shows themselves at night trying to figure out why the internet is down before patients arrive the next morning.
Nobody films themselves painting the office or cleaning the toilets (for real).
And nobody tells you that you’ll become part therapist, part accountant, part plumber, part IT department, part counselor, part marketing director and full-time thinker.
That’s medical spa ownership.
When I first started in aesthetics over twenty years ago, this industry looked nothing like it does today. There weren’t aesthetic conferences every weekend. There weren’t online memberships, injector influencers, or countless certification programs. There certainly wasn’t someone making Instagram reels telling you exactly how to become an injector.
In fact, I’ve been injecting since dermal fillers first entered the market. We were figuring things out as the industry evolved. I spent years working in plastic surgery before opening Charmed Medispa in Newark, Delaware, and for fourteen years I’ve had the privilege of training providers throughout the country.
Looking back, I think starting when I did made me a better injector because there wasn’t a shortcut. You learned anatomy. You studied constantly. You respected every syringe because patients were trusting you with something incredibly personal.
But becoming a good injector and becoming a successful business owner are two completely different journeys.
The business side isn’t glamorous.
Every single month there’s policies, procedures, payroll, payroll taxes, unemployment taxes, workers’ compensation insurance, malpractice insurance, general liability insurance, cyber insurance, property insurance, bookkeeping, accountants, inventory, software subscriptions, medical waste removal, OSHA compliance, HIPAA compliance, merchant processing fees, website updates, marketing bills, Google rankings, social media, equipment maintenance contracts, repairs, utilities, rent, supplies, linens, laundry, coffee, printer ink, light bulbs, cleaning products… and the list goes on.
Then there are the things you can’t put on a spreadsheet.
You’re responsible for people’s livelihoods.
Your employees (aka GREAT FRIENDS) trust you to provide a paycheck every two weeks. You can’t get hurt or not work.
Your patients trust you with their faces.
That weight never really goes away.
And then there’s something I don’t think enough people talk about.
The emotional side.
People don’t come to a medical spa just because they want Botox.They’re getting divorced. They’ve lost a parent.They’ve gained weight. They’ve lost weight. They’re recovering from cancer. They’ve gone through menopause.They’re exhausted from raising children.
They’re struggling with confidence after seeing themselves on Zoom every day. Sometimes they sit in my chair and tell me stories they haven’t told anyone else.
You quickly realize that you’re not just treating wrinkles.
You’re taking care of human beings.
Some patients are excited. Some are terrified. Some cry. Some are incredibly hard on themselves.
Some apologize for every little thing they think is wrong with their face, and it breaks your heart because you don’t see them the way they see themselves.
You carry a little piece of those conversations home.
That’s something no business course teaches you.
People also don’t see the decisions that keep you awake at night.
Is everyone happy? Could I improve anything? Oh, there’s another new technology I need to learn about.
Should I renovate? Are the plants watered? How do I make sure the experience at Charmed is the absolute best?
Then there’s staffing. This team is amazing!
Finding these kind, reliable, funny, honest people was hard.
Finding a team like this who treats your patients like family is one of the hardest things you’ll ever do. Good luck!
Skills can be taught.
Character can’t.
One person with a bad attitude can change the atmosphere of an entire office. Trust me.
The right team can make coming to work feel like home and I’m so grateful that I have that. But it wasn’t always that way. Lordy! The wrong team can make even the most beautiful medical spa miserable and make you not want to come to work even.
Here’s another thing nobody talks about.
You’re never really off.
Dinner gets interrupted by a phone call. I always answer my phone. What if a patient needs something?
Vacation includes checking schedules, answering emails, approving payroll, reviewing invoices, responding to Google reviews, ordering supplies, checking on equipment repairs, and making sure tomorrow’s patients are taken care of.
Even when you’re not physically at work…Part of your brain still is. But after saying all of that… Would I do it again?
In a heartbeat.
Because making people look in the mirror and smiling is so fulfilling! Every day! Someone hugs you because they finally recognize themselves again. Someone tells you they feel confident enough to date after a divorce.
Those moments are why I still love this industry after more than twenty years.
Owning Charmed Medispa in Newark, Delaware has never been just about Botox, dermal fillers, Sculptra, laser resurfacing, or skincare. It’s been about building trust. It’s been about creating a place where patients feel safe, heard, and cared for. If you’re thinking about opening a medical spa, my advice is simple.
Don’t do it because you think aesthetics is glamorous. Do it because you genuinely love people. Because if you don’t love people..The rest of it isn’t worth it.
And if you do start a med spa?
You’ll discover that changing someone’s confidence and showing love and kindness is one of the most rewarding careers you could ever choose.
