Running a Medical Spa 8 Years Ago vs. Today: The Strategic Evolution of Vendor Partnerships, Compensation Models, and Unit Economics

Adeesha: Welcome back to the Business of Aesthetics podcast. Today, we are conducting an operational audit for the established practice owner. I’m your host, Don Adeesha, and it’s great to have you here. There’s a dangerous phrase in business. We’ve always done it this way. For a practice that has been open for 5, 8, or 10 years, success can breed complacency. You keep the same vendor contracts, you keep the same low margin services, and you keep the same staff, even when the data may say you shouldn’t. To help us break that stagnation, we are joined by Amy Engel. Amy is the owner of Sweet Spot Medispa and has spent the last eight years scaling her practice in the hyper-competitive Florida market. She didn’t just grow, she optimized. She pivoted to challenger brands like Evolus to maximize margins and launched her own training academy to solve the recruiting bottleneck. Today we are discussing the art of subtraction. We are going to talk about how to fire a legacy employee who refuses to adapt, how to kill unprofitable services, and why your vendor portfolio might need a complete overhaul. This episode is brought to you by Ekwa Marketing, the digital growth partner behind this podcast and a trusted resource for aesthetic practices looking to dominate their local markets. With that being said, welcome Amy to the Business of Aesthetics podcast.

Amy: Thank you for having me on. I’m so glad to be here.

Adeesha: Absolutely. We’re glad to have you here.

Adeesha: When you started eight years ago, the Allergan bundle was the standard purchasing model. Today, you have pivoted to become a top 50 partner with Evolus. Was this shift driven purely by clinical preference or was it a necessary financial calculation to protect your profit per unit as the market became more commoditized?

Amy: That’s a really good question. You are absolutely right. When I started eight years ago, it was the Allergan model, the Botox, the Juvederm, Kybella. That was just eight years ago. But since then, there’s been so many new products that have come on into the market. There are six neurotoxins on the market right now that are FDA approved in the U.S. One of those is called Jeuveau, and Evolus is the company that houses Jeuveau. They came out after I was in my business for about two, three years and I was introduced by one of the reps. I was really reluctant to use it because Botox is like the family name. Everybody knows that name. Whenever a new product comes out I always wait and see how it does in the market, see what patients are talking about, see what providers are saying, and also read up on the research and the data.

Amy: Jeuveau had been out for a while and one of my nurse practitioners said, hey, let’s try it. So she was my model. We tried it and she loved it. She said it worked faster than Botox, kicked in quicker, lasted just as long. The price point was lower than Botox as well. As a business owner that was a very good thing to see because it helped our bottom line. As I brought it on, I realized that Evolus not only provides a great product but they also provide marketing and rewards. Allergan has Allē. Get a Botox injection, receive 200 points, which is like $20 for your next appointment. Jeuveau gives the client $40 on the spot, plus every 90 days. That was a little more appealing. My client trying the product could get a savings immediately.

Amy: Then as I got into buying more product I realized they really have a great marketing program. If you buy so many vials in a quarter they give you tools to help you sell that product. Right now we have a billboard on one of the main roads here in town with our name on it and my picture on it, and I already have people coming up to me saying, hey, I saw you on the billboard. They’ve made a commercial for our business. That was really motivating to use the product more, because Allergan doesn’t do that. So I started converting my patients from Botox to Jeuveau. I made the price point a little bit lower; however the bottom line was better. They got a reward each time. I was happy with the marketing. So it just kind of exploded from there. Not everyone loves Jeuveau and not everyone loves Botox, but it’s great to have a variety. I do have some clients that have used Botox in the past and feel like it’s just not working as well as it used to. That’s a good opportunity to move them to Jeuveau. We still use Botox.

Adeesha: Being a top 50 partner with a challenger brand like Evolus, does that give you a seat at the table with their leadership that you never had with a giant conglomerate like Allergan? How does that benefit your bottom line?

Amy: What I love about Evolus is that they do show appreciation to their top 50. If you’re in the top 50, that means you’ve sold more, bought more of their products than others in the market. When we say top 50, we mean all the medispas, plastic surgeons offices, primary care offices that supply Jeuveau. We were top 14 about two years ago. That’s pretty neat, and that’s in the entire U.S., including Alaska and Hawaii. They do reward you. They send you to a training conference. They really go all out. They just really spoil us. But that’s not the reason, the reason is the product. I love it. It’s great for my clients. They love it. The bottom line is good. My providers love it. We carry five of the six on the market. When I walk into a room and a client asks me, so what’s the best one, I’ll say there is no best one, but there is a best one for you. You’ll have to try what works best for you. But if you want to know, I’m wearing Jeuveau. So I always say I’m wearing Jeuveau. That’s how I really present it in the spa.

Adeesha: Let’s get into the hiring side of things. Eight years ago, hiring was a pretty straightforward transaction. Today, with the rise of the injector influencer, compensation expectations have skyrocketed. How have you adjusted your compensation models or recruitment filters, even using your academy, to maintain healthy margins without losing top talent?

Amy: Eight years ago, it was just me in a little room. I had no idea my business would grow to where it’s at. We’ve had three locations; we have two now. Hiring is really burdensome. There are so many nurse practitioners, physician assistants, and nurses that want to learn how to inject. They get on YouTube, they get on Instagram, they watch videos. They get their information on social media and it might not be correct. It’s scary, because if we’re getting our information on how to be safe with a client on social media, I think that goes down the wrong road. We’re dealing with people and their bodies and medical concerns, it’s very important to have that one-on-one training.

Amy: When I hired back eight years ago, I brought on a nurse practitioner part-time and trained her myself. She’s still with me. I have two nurse practitioners and a physician assistant that have been with me the last seven years. They’ve never left. That makes me feel really blessed because it’s a revolving market right now. I’ve also hired nurses, NPs and PAs who I trained and who left after a couple of months. I spent all that time training, and they took it with them to another spa. The reason was I couldn’t give them enough hours, they were part-time, knew it when I hired them, but wanted full-time. It’s very tough in South Florida. There are a lot of medispas, but the new ones popping up haven’t been established, don’t have a lot of clients, don’t have a lot of experience. So I saw a need to train these NPs and PAs, even physicians, DOs, MDs, dentists. I felt like the information on social media is not fulfilling, it’s not safe, and I want to give back. I’m hiring right now. If I do hire, I will charge for my training. There’ll be a compensation payback when I take them on as an employee. I kind of learned my lesson. Don’t give free training. I got burned.

Adeesha: Do you now exclusively hire from your student pool to control culture, and how do you structure their contracts to prevent them from leaving with your patients after you’ve trained them?

Amy: I train all over the U.S. and globally. I do target students outside my medispa area. I’ve trained some nurses and practitioners that have spas starting up here, and I don’t really feel like it’s competition. There’s no guarantee they’re going to succeed, but I give them the foundation. I have a physician friend I mentored, he came on as my medical director and in return I gave him training, because he wanted to start his own medspa. It’s about a mile or two from mine, but it’s a different market. He sees different clients, patients I wouldn’t probably see, so I didn’t feel it was a conflict of interest. I also have a plastic surgeon friend. We share clients. He doesn’t have a medspa anymore and doesn’t like doing Botox, fillers, lasers. We have that relationship where we can send clients back and forth. I have clients all the time that come in and say, I know I need a facelift but I’m not sure if I’m ready, so then I will do treatments to help them feel young and youthful, and when they get to a point where they’re ready, I send them off just down the street. It’s all a mindset, if you’re comfortable and confident in your business model, you don’t really have animosity against other businesses in the area. It is a pick and choose; you have to be careful of who you send to.

Adeesha: And in 2025 are you incentivizing your staff on retention, rebooking rates, or production total sales? Which metrics have protected your margin a bit better?

Amy: Most of my employees are 1099. The reason they’ve been with me for a long time is, if they don’t have clients, our summers are very slow, then I am not paying them an hourly rate to sit and wait for someone to walk through the door. So they’re 1099 and that works out really good when building the business. I think that’s the best way to start your business, start with 1099s. And they have the opportunity to make so much more because they’re on a personal base. The more they work, the more they’re going to make. When you hire somebody hourly, you can give them a commission on top, that’s a good incentive. But if you’re not commissioning them, they have no skin in the game. That’s the mentality of the younger generation right now. They’re less motivated. So I like to hire 1099s from the get-go. If we get to a point where we need to add another FT, that’s another conversation. I do like to give commission to my full-times because that motivates. You can really kill a business by hiring full-time employees right from the start, when you’re not busy enough to generate that money. I’ve made some changes recently. I’m in the process of getting new software for our EMR so I can track better the services done, the new clients, the existing clients, returns, and what my employees are selling, then how to maximize that and increase sales for 2026.

Adeesha: Traditional medspa models rely on episodic revenue, a patient comes in every three to four months. But with the recent integration of weight loss programs, the GLP-1s, you have introduced monthly recurring revenue. How has this shifted your cash flow stability and changed your ability to forecast and invest compared to the early days?

Amy: Because of GLP-1s, that has really changed the market scheduling system. With toxin, Botox, it’s every three to four months; filler is every six to twelve months. With a GLP-1 client you’re seeing them every single week. Some online businesses just mail it to them and never see the client in person. I think that is not a good method. When I have a client that wants to go through weight loss, I have them come in every week. Eventually they can go home and do their injections and I see them every couple of weeks. Things change, people have GI symptoms, some people get dizzy. I keep a tight rope on my new GLP-1 clients.

Amy: Because of that, they’re coming in every week and I can introduce, hey, we have this other service that will help you through your weight loss journey. With GLP-1s we’re seeing hair loss, so I’ve brought in a whole hair-loss protocol. With any weight loss you get skin laxity, so I have a collagen protocol and a body-tightening and facial-tightening device. I have a lot of modalities around the weight loss services. It’s not just about weight loss either, it’s about feeling confident. I’ve had people come in crying and sad because they feel like they’ve lost all control. We’re not only there to help with the weight loss every week, we’re there to help with other things going through their head. We have all these modalities that encircle the weight loss program that we can farm out in the spa and not have to farm out, that’s what’s really helped drive revenue.

Adeesha: Have you successfully cross-sold these weight loss patients into high-margin laser or filler treatments, or do they usually stay in their own lane?

Amy: A lot of them stay in their own lane, I’d have to say. There are a few that look outside of "I’m just losing weight." But it does take time. If their mindset is, I’m here to lose weight, it takes them a little bit to be like, oh, maybe I should try some Jeuveau. They also do realize that because of the weight loss they see some things that change in their face and we can offer that. So it’s a slow process, not right away on their first day. It’s a lot of meeting every week, discussing their goals, then offering what we have to help them meet their goals.

Adeesha: Did introducing weekly or monthly recurring revenue allow you to make capital investments, a new device that you would otherwise have been too scared to buy?

Amy: Yes, absolutely. End of year is a great time to buy equipment, tax deduction. We just bought a skin analysis machine for both our locations. Even if someone comes in for weight loss, we’re going to get a baseline on that client, moisture, hyperpigmentation, large pores. All those things can be affected by weight loss. If your hair is affected, think about what your skin is being affected by. We have invested in a skin analysis machine so we can put all of our clients into it, get a full picture of their skin, and repeat in six months after they’ve lost weight or met their goal.

Adeesha: Did you buy it to look at performance, or to drive patient education?

Amy: Both. One reason is to see if our treatments are really providing results, you can see in the mirror so much, but when you look deep down into your skin with certain lights, you see so much more. I want my clients to say, yes, that IPL really worked, that CO2 laser made my skin healthier. I want my clients to see I am doing something good for myself. It can also help us diagnose and offer treatments we do in the spa to drive up revenue. It’s a win-win for the client and for us.

Adeesha: Before we continue, a quick message from our sponsor, Ekwa Marketing. Ekwa Marketing are offering our listeners a complimentary 60-minute digital strategy session. This is a one-on-one consultation with a senior strategist to help you map your 12-month high-value patient acquisition roadmap. You will get a personal diagnosis of your online presence and patient funnel, uncover untapped growth levers across SEO and social, and walk away with a clear, actionable plan tailored to your practice. You can check availability and reserve your spot in under two minutes at www.businessofaesthetics.org/msm. All right, back to the podcast.

Adeesha: In 2017, the market allowed you to sell Botox as a standalone product. Today, patients shop for price. How have you restructured your menu to sell proprietary protocols, bundled outcomes, rather than commoditized units to prevent patients from price-shopping you against competitors?

Amy: That’s hard. And there’s no way that you can prevent that. No way. So I would say my Botox pricing is a little more than my Jeuveau pricing, because Botox never really has good deals. When I buy the product, it’s usually the same price. It’s the highest priced product on the market. Jeuveau really helps me with marketing, so overall I get more out of buying Jeuveau, Xeomin, Dysport, Daxxify when it comes to the bottom line. When pricing units, if you love a product and want to use it more in your business, price it a little lower. My Botox is $14, my Jeuveau is $12 a unit. I don’t usually run specials on Botox, but I do have specials on my other products depending on inventory and rewards programs.

Amy: Another little secret I can give, I have Jeuveau days. Every one or two months, I’ll have a Jeuveau day because I want to sell more Jeuveau, because that’s the best bang for my buck and my clients love it. I’ll block out a full day of just Jeuveau clients. I usually have 20-minute slots, I’ll book them in 10-minute slots and they know that when they come in they’re getting a better price, and I don’t have a lot of time. It’s in and out. I usually don’t see new clients, these are clients I’ve seen before, so I know their dose. I’ve had 70 clients before in one day with another provider. So we can really maximize a big day of just having a Jeuveau day. I’d recommend doing it every one to two months. Don’t do it too often or your clients will get too comfortable with that. We usually book solid, we’re open longer hours. It’s a long day but very rewarding. I’ll drop the price a couple of dollars per unit, and they get the rewards on top. People look forward to those specials. I don’t put them on the calendar a year ahead, I usually announce a month before, and we start getting a lot of online bookings and calls and fill it up quickly. That helps even out our monthly revenue in those slow summer times.

Adeesha: At what revenue milestone does it become safe to leave the safety net of the Allergan bundle?

Amy: I don’t really think there is one. When you start a medical spa, you need to offer Botox. And you need to buy it from Allergan. If you don’t buy it from Allergan, you can’t offer your clients those rewards, you have to buy straight from that company. So I do believe you should always have Botox in your back pocket. If you just have Xeomin or Jeuveau or Daxxify, people might not know that name and don’t have that trust. So many people come in and say, well, I’ve always used Botox, so I’m going to use Botox. They get comfortable with one. But it’s okay to add another product. We’re seeing people become a little resistant to toxins they’ve used over time. Someone comes in and says, I’ve been using Botox for four years and it just doesn’t seem to be working very well, then if you have a couple of products in your reservoir, you can offer something different. Clients appreciate that. If you don’t have a group of products to offer, they’ll go down the street.

Amy: I do believe you should always have Botox, but it’s okay to start with another product, have two or three. If you’re starting out, have two products: Botox and maybe another where you feel you can get a better deal negotiating with the company through product purchasing. You need to know your reps. One thing about Allergan is that they do not have reps for small spas. When I started, I didn’t have a local rep, my rep was in Texas and I was in Florida. If I needed something I had to phone them and wait for something to be mailed. There wasn’t that communication like there is now. Even now, Allergan has changed a lot and I really don’t see my rep in the area. That has a lot to say about Jeuveau, Evolus, Galderma, Dysport, Xeomin, Daxxify, all the others except Allergan have reps in the area. They come visit me, tell me what the latest is on the products, what FDA is approved, bring ice packs. They support our spa. Allergan is just kind of out there. They’re not really connected to us at this point or to other small spas.

Adeesha: It seems like the bigger the player, the more complacent they get, everyone already knows Botox, they want Botox. Meanwhile the other great products are going that extra mile.

Amy: Yes, it’s the personal touch. It really does make a difference. If you’re not seeing your rep and have questions and it’s not easy to get in touch, you’re going to look to another company that gives you attention, that cares whether you’re successful or not. That’s really important. Allergan changed how they were doing their Allē points a year or so ago and clients did not like that, they were not using Botox because of that. Allergan listened and is back to the prior rewards program. At least they listened. I still believe they need to put some more personal touch in their markets.

Adeesha: For a provider who may one day strive to be a top 50 or top 15 partner with Evolus, Daxxify, or one of those great products, what was your mindset? Was it planned, or did it happen organically because you believed in the product and just hustled?

Amy: I would say all of it. When I first started, it was just me. I had no idea I would have 15 employees, two locations, be a top 50. That was not even in my wheelhouse. It just kind of happened organically. I would have to say what grew my business the most were Google reviews. Everyone that comes in that’s new, I’ll ask, how did you hear about us? And most of them say, I saw your reviews on Google. So I tapped into that, I’m like, wow, this is really amazing. People will come in and try to tip us. My rule in my spa is we do not take tips. The injectors do not take tips. But we would love a review. So I made a review card. We hand those out. We have a review display on our front desk. We’ll send emails out asking for reviews. That has really grown our business.

Amy: Going to top 50 was the passion, the hustle. I believed in the product. My providers believed in the product. We just started using more and more of it, getting more and more clients through our Google reviews. It exploded before 2020. After 2020, of course, there was the slowdown because of COVID. But then people were coming in about six to eight months after COVID saying, I’m on Zoom and I don’t like how I look. Can you fix this? There was an explosion in the market again for dermatotoxin. Even Botox had articles about their revenue going up because of people wanting treatment.

Adeesha: The Zoom effect, more than ever, people were getting screen time with their own face, looking at their own expressions.

Amy: Yes, you’re right. Because they’re looking at their expressions. When they get up in the morning, they just look in the mirror, they’re not expressing. But on Zoom there’s expression, and that’s where they were getting the Zoom effect.

Adeesha: Looking back at your P&L from the early days versus today, what is one specific service or operational expense that you happily paid for in 2017, but which is mathematically impossible to justify in the high-cost environment of 2026?

Amy: I started with Botox, Juvederm, and chemical peels. Those were the three things I did. I did chemical peels because I put it on Groupon and thought it would help get new clients in the door so I could sell Botox and Juvederm. Looking back, it was a great way to start, because Botox was a family name, Juvederm people know that name, and chemical peels are less invasive. So it was a good starter combination. Today, would I do that? No. Chemical peels, the bottom line is not very profitable for an advanced provider. They’re great for estheticians to do, they can do facials with them. I just did chemical peels to get people in the door. But chemical peels are not something an advanced provider can pay for their overhead with.

Amy: Botox is the most expensive product, neurotoxin on the market. Juvederm is one of the most expensive fillers on the market. I don’t use Juvederm anymore because there are other products that are less expensive, that I think are better, that are newer, that have newer research and are making strides in the market. So I have dropped the Juvederms. I have brought in RHA Revance fillers, which I love. And Botox, I just keep it around because of that name. People want that product when they come in if they haven’t tried anything else. I’ve changed to newer products to have lower costs and higher margins. I let my estheticians do their thing, they’re better at peels than I am. That’s how I started my business, and it worked. But we’re all grown up now, so I’ve changed the way we run business.

Adeesha: For my final question Amy, before we got started, you mentioned you do your own podcast, and you love getting those insights from your guests. What’s one of the best insights for a practice owner going into 2026 that you heard from one of your guests, where you thought, wow, that’s really great?

Amy: We just started the podcast in October. We post every Wednesday morning, so there’s one once a week. I’ve had marketing guests, one that works for Evolus, one that used to work for Galderma. I’ve had a biomedical engineer scientist for an exosome device company. I’ve had peptide specialists, other nurse practitioners, entrepreneurs. I’m always ahead about two months. I would say the best, I would have to say it was Georgia from Audacy. She gave me some great information on marketing, things I hadn’t looked at. She’s a marketing rep for the Southwest Florida area and she is also from a family, Beasley Broadcasting, a huge family in the U.S. that has been doing marketing for years. Her insight on how to look at the market was just fabulous. I never looked at it that way. We don’t learn that in nursing school, how to market yourself. That’s not part of our program. When you get out into the field and you’re an entrepreneur, you just have to learn on your own. Having these guests on has really helped me with my own business, and I’m hoping it’ll help others. I’m not going to say what Georgia said, you’re going to have to watch the podcast. We have very knowledgeable, intelligent people on. It’s just been a blessing to start. It is a lot of work. It’s one more thing on my plate. But I love it and I’m going to continue doing it because it’s also helping other injectors, other entrepreneurs, and patients who want to know why we use the products we use, how we do our injections, why it’s safe, who to go to, who not to go to.

Adeesha: Amy, I’ll take that. With that being said, we have arrived at the end of our podcast. Thank you so much for being here with us. I hope you had a good time.

Amy: Oh yes, of course. I always enjoy having podcasts and webinars with you. You’re so sweet, I really appreciate it.

Adeesha: That wraps up another episode of the Business of Aesthetics podcast. A huge thank you to Amy Ingle, founder of Sweet Spot Medispa, for walking us through what a real operational audit looks like. From the Allergan to Everless pivot, to a Juvot day that booked 70 clients in a single shift, to the hiring rule that stopped her training from walking out the door.

This episode was a masterclass in subtraction. Because sometimes, growth is not about adding more. It is about finding what is leaking, what is outdated, and what no longer serves the practice. If there is one thing to take away, it is this. The leak is not always in your top line.

Sometimes it is in the operational decisions you made when you opened and never went back to question. Amy ran her own audit, but she did not fix everything alone. The practices that keep growing are the ones willing to bring in an outside set of eyes. That is exactly why we created the Marketing Strategy Meeting. It is a 60-minute one-on-one session with Leela Stone, Equa’s Marketing Director.

You will walk in with the leaks you have spotted and walk out with a 12-month patient acquisition plan built specifically for your practice. No pressure, no commitment, just a clear look at what is working, what is not, and what needs to change next.

book your session at www.businessofaesthetics.org slash MSM. And if this episode was useful, share it with another practice owner who needs to hear it. Subscribe so you do not miss next week’s episode. Until next time, I’m Adesha. Thanks for listening.