Your Best Injector Is Going to Leave. Build the Business That Profits When She Does.

1. Formatted Transcript

The episode opens on the scenario every multi-location owner fears: a top injector who knows her book is worth building on her own, held back only by a non-compete her attorney isn’t fully confident in.

Host Anji introduces Dr. Carla Pearson, co-founder and chief of business and operations at Smiley Aesthetics, seven locations across three states, eight providers, and past seven figures in its first year.

Anji outlines Carla’s background: nearly 12 years at HCA rising to director of nursing and clinical operations for their group purchasing organization, giving her a systems view of multi-site governance rather than “med spa folklore.”

The topics for the episode are framed: the mechanics of Smiley’s independent provider model, running medical direction across eight states without clinical drift, the 2025 tax-pricing squeeze, and where AI is genuinely cutting cost versus where it’s oversold.

The episode’s sponsor, Ekwa Marketing, is introduced.

[View Transcript]

Thinking about leaving, she’s looked at the numbers, she knows what her book is worth, and the only thing standing between her and her own med spa four miles away is a non-compete her attorney isn’t fully confident in. Welcome back to the Business of Aesthetics podcast. I’m your host, Anji, and today we’re going to rethink that problem entirely. We’re joined by Dr. Carla Pearson.

Carla is the co-founder and chief of business and operations at Smiley Aesthetics, seven locations across three states, providers serving eight, and past seven figures in its first year.

Before aesthetics, she spent nearly 12 years at HCA and rose to director of nursing, clinical operations, for their group purchasing organization. So she thinks about this business in unit economics and multi-site governance rather than med spa folklore.

And she built her entire company on the premise that the injector who wants to go independent isn’t a retention problem to solve, she’s the customer. Today we’re getting into the mechanics of that independent provider model and where the money actually sits in it. We’re talking about running medical directions across eight states without clinical standards drifting.

And we’re looking at what the 2025 numbers mean for owners watching tax pricing compress, plus where AI is genuinely pulling costs out of a practice, which is nowhere near where it’s being sold. This episode is brought to you by Ekwa Marketing.

Anji asks Carla to walk through the moment the model clicked: why Smiley moved away from trying to retain injectors with more pay or tighter non-competes.

Carla introduces her identical twin and Smiley co-founder, Mary Ford, and explains Smiley’s two-sided model: employed injectors across its locations, plus an independent provider platform where nurses and medical professionals own their own business under a pay-as-you-grow structure with no upfront fees.

Carla frames the model as a response to the compliance and business education gap nurses face coming out of school, and as a way to grow without directly employing everyone.

Mary adds that non-compete enforceability is state-dependent, and that a lot of the “non-competes don’t matter anymore” narrative from 2025 is overstated, many providers don’t actually want to run a business once they see what’s behind the curtain.

Carla notes Smiley has both directions covered: employees can leave and become independent providers within the ecosystem, or come in as independent from the start, but stresses non-competes remain enforceable and widely honored in states like Tennessee, and owners should check real case law rather than social media claims.

[View Transcript]

So the philosophy is clear, you stopped trying to hold on to people and build something they’d want to stay attached to. But philosophy doesn’t pay for medical direction or EMR licenses. Carla, let’s start with the moment the model clicked. Most owners respond to an injector who wants more independence by trying to retain her, more pay, more autonomy, a tighter non-compete. You went the other direction and built a structure where she leaves and stays inside your ecosystem. Walk me through what you were actually looking at in those early months that made you decide the traditional employment model wasn’t worth fixing.

Absolutely, Anji, first of all, thanks for having me. I also want to take a moment to introduce Mary Ford, who’s also on the podcast with us. She’s my identical twin, co-founder, co-owner, and CEO of Smiley Aesthetics. She built Smiley right alongside me, so we’ll bounce back and forth with our takes on things, because it’s interestingly different, albeit being identical twins.

As far as the injector who wants more independence, we address this in both ways. Our model is: we have employed injectors in our seven locations, about to be eight, and we also have an independent provider platform where nurses and medical professionals can own and operate their own business. We’re a pay-as-you-grow model, we don’t charge fees and all that other stuff. We’re hoping and banking on the injector growing and having a successful business where they go, we go, and we’re successful together. That really is the answer to your question in so many ways: how do we create a model where nurses and medical professionals own and operate their own business, and we provide them the compliance, the business, and all the things they need that we don’t get in school and aren’t taught, while they’re independently operating.

There’s nothing to leave. They make their own hours, they do their own thing, it’s their business. Coming from HCA, leadership did not want to employ a bunch of people, so Mary and I tried to figure out how to create something that nurses in particular could own without having direct employees. That’s really how the model was born. Wouldn’t you say, Mary?

Yeah. And to answer the non-compete question, depending on the state, of course, it’s tough for people. I think the stuff that came out in 2025 about it, that ended up not passing, put this “I can do whatever I want, I can just leave and do my own thing and make more of my profit margin” idea out there. That goes back to culture and what’s happening inside, a deeper conversation about maintaining your employees. But it’s also the fact that a lot of nurses and medical providers don’t want to be entrepreneurs. They don’t want to be business owners. They think, “I’m going to go out and make my own money,” and then they realize all the other stuff happening in the background is way more than they bargained for, when in reality they just want to care for clients and take care of patients. It’s an interesting dynamic, for sure, and we’ve tried to build something for both, an avenue for both.

I completely agree. And another part of this, a structure where she leaves and stays, we have a two-sided structure. Employees could, in theory, leave and start their own business with us, and we have independent injectors who are almost always former employees in our spas. We’ve had an injector come in as an employee and then, to your point Anji, leave and stay within our ecosystem. It’s a machine that’s helped solve this issue appropriately without straining anybody too much. However, the last thing I’ll say, non-competes are enforceable, and the idea that they’re not has kind of gone away, depending on where you are. Tennessee, for example, I was just sent this morning to someone openly violating a non-compete. Tennessee does, in fact, honor them, and honors them pretty widely. There’s case law. My recommendation for those listening: look at case law in your state before listening to people on social media who say non-competes aren’t enforceable. Look at the facts first and search real case law, you can see what’s enforceable and what’s being enforced in your state.