Surviving Market Saturation: Strategic Pivots, CapEx Defense, and Smart Scaling in a High-Density Market

Adeesha: Welcome back to the Business of Aesthetics podcast. Today, we are discussing the strategic evolution required to maintain profitability in a maturing, high-density market. I’m your host, Don Adeesha, and it’s great to have you here. As the aesthetic industry continues to expand, we are seeing a fundamental shift in how successful practices operate. In a landscape where patient options are abundant and competition is fierce, the growth at all costs mindset is being replaced by a focus on operational discipline and capital efficiency. 2026 isn’t just about acquiring more, it’s about optimizing what you have to protect your margins. To help us navigate this transition, we are joined by Rebecca Landriault, CEO of Apex Aesthetic Consulting. Rebecca is a highly respected strategist who acts as a Sherpa for practice owners, guiding them through the complexities of scaling operations, refining team dynamics, and building infrastructure that lasts. Today she is sharing her methodology on navigating a saturated market. We are discussing how to audit your practice for silent capacity leaks, the financial frameworks for evaluating expensive capital equipment, and the specific metrics that indicate a business is truly stable enough to scale.

So before we jump in, a quick thank you to our sponsor, Ekwa Marketing, the team behind this podcast and one of the most trusted names in digital growth for aesthetic practices. They’re offering our listeners a complimentary 60-minute digital strategy session, a one-on-one consultation with a senior strategist to help you map your 12-month high-value patient acquisition roadmap. You’ll get a personal diagnosis of your online presence and patient funnel, uncovering untapped growth levers across SEO, socials, and referrals. You will be walking away with a clear, actionable plan tailored just for your practice. It’s designed to give you clarity and direction from people who work with the aesthetic leaders every day. You can check availability and reserve your spot in under two minutes at www.businessofaesthetics.org/msm. That’s businessofaesthetics, one word, dot org forward slash msm. With that being said, Rebecca, welcome to the Business of Aesthetics podcast.

Rebecca Landriault: Thank you so much for having me back. I look forward to chatting with you tonight.

Adeesha: Absolutely. Let’s dive right in. So the market has shifted from demand-driven growth to a hyper-competitive environment. For an established practice, what is the single most critical strategic pivot required in 2026 to protect market share against the surge of new competitors?

Rebecca Landriault: Yeah, it’s really interesting, the shift that we’ve seen over the course of 2025. I mean, I think we’ve had some explosive growth in the industry post-COVID, especially with a lot of bedside providers looking to kind of leave traditional medicine after the COVID pandemic and looking at aesthetic medicine and cash-based medicine as a kind of way out of that burnout. And so because of that, we really have seen just an explosive amount of med spas opening in the last three years, and especially in 2025. I think a lot of that is some states are allowing more mid-level providers to have independent practice authority. And so we just have a larger number of providers that are able to go out on their own and begin these aesthetic practices.

So for my established practices, the ones who come to me and say, "What do I do now? When I opened my business, I was the only one in my town. Now there’s five on the same street as me. How do I compete?" The critical pivot to me is really service differentiation and operational maturity. And those are two very different things, but I think that they work very well together. And what I mean by service differentiation is not traditionally what we would say as being the person who’s the first to market with a new device, the first person to be doing the most recent treatment that is TikTok trending. That is not at all what I mean. I actually strongly advise against those types of behaviors driving your service menu. What I mean by differentiation is comprehensive consultations, lifetime treatment planning, and really working on becoming obsessed with your retention.

So I think the critical pivot is instead of asking yourself and being what I call "acquisition obsession"—how do I get more clients? how do I get more clients?—to instead look at your retention. Because new patients are expensive to acquire and your loyal patients are your most profitable. So for me, we stop acting like we have service menus and we have to start acting as if we have treatment systems with defined outcomes and continuity of treatment from one patient visit to the next. We want the patients that are coming in and sitting down and having a conversation with you about the overall look they are trying to achieve. They should be saying, "I’m looking for a lifetime plan where I can get to my aesthetic goals and I want to do them all with you."

Adeesha: So when a mature practice hits a revenue plateau, right, it’s rarely a marketing problem. If you audit a clinic today, what specific internal system, be it utilization rates or intake workflow, do you usually identify as the silent capacity killer?

Rebecca Landriault: Yes. So this is probably the thing that I get most passionate about. Almost always people reach out to me because they are looking for new client acquisition or they’re concerned about their marketing. And I tell everyone… I won’t discuss marketing with you. Not for a very long time, because there is almost always a leak or like I like to call it a "crack in the foundation." The first is, of course, that clinical confidence of your providers. It’s not just clinically confident in the outcome. It’s clinically confident in complication management. It’s clinically confident in selling the procedure that you believe is going to give the patient the best outcome. If we’re not clinically confident, we’re not going to educate the patient for what else is good for them besides what they’re coming in for.

The other thing I see is… we’re often not looking at whether or not our employees are profitable. So that’s probably the number one revenue leak that I see. When I go in and run reports, I often find that many providers are probably only booked 50% of the time. The hill that I die on when it comes to adding employees is that your existing employees need to be making a gross revenue number of 5x their payroll at the very minimum and need to be booked 80% of the time for six weeks or more on a six-week rotation. Only then should we discuss if it’s the right time to bring on another employee.

And then of course, my absolute number one thing… it is almost always the front desk. If somebody calls and says, "I saw on your website that you offer health optimization services. What does that mean?" And your front desk person says, "You know, I don’t really know much about that, but I’d like to book you with our provider," we start to lose our credibility. At the very minimum, your front desk staff needs to know how to credential the procedures that you’re doing. They should be able to credential the service, credential the provider, discuss why a consultation is so important and close that call converted to a consultation.

Adeesha: Now let’s get into another very interesting topic regarding expensive capital equipment. Before an owner signs a lease for a new device, what specific financial stress test or formula do you use to prove the ROI is real and not just sales hype?

Rebecca Landriault: So I love this question. I have been on the side of being a managing partner of a practice… and then I sold lasers as a capital equipment rep for three different laser companies over the course of 10 years. So I have seen the good, the bad and the very, very ugly. First things first, I would never ever purchase a device that someone else told me was the right fit for my practice. If you were a cardiologist and a rep came in and said, "You need this new device to scan the heart," but you already had a device that adequately scanned the heart, would you immediately sign a personal loan for a $350,000 device? I find this happens all too often in aesthetic medicine.

My first thing is before you even consider a device, does it fill a gap in your existing service menu? If whatever they’re selling you, you already have a solution for, we’re cannibalizing utilization. The other thing is… you need to do your own due diligence every time on whether you are able to properly run that device from a compliance standpoint in your practice, in your state. States vary wildly about who can fire certain devices.

And then my last question… Reps like to do a lot of napkin math. "You only need to see five patients a month." But if in your existing patient mix today, do you have five people a month who are going to buy this $3,000 treatment? If the answer is not yes, 100% every time, the answer is no. You really have to understand that it’s your monthly payment divided by your average revenue is the minimum number of treatments that you need to break even. But that’s the bare bones. You have to understand the overall cost of ownership. If you’re telling me that I have to use an entire bottle of ultrasound gel on every treatment… never mind the replacement hand pieces, the cost of the maintenance plans year over year. So the overall cost is so much higher than the numbers that they’re giving you.

Adeesha: Let’s get a little bit brief into perhaps one particular side, a very growing side of treatment planning, right? Especially around regenerative medicine. Regen medicine has a longer results timeline than fillers. So how should a practice structure its pricing and membership models to ensure cash flow remains consistent during the three to six month period while the patient waits for results?

Rebecca Landriault: So if you are doing the comprehensive treatment planning… you are talking to the patient about reaching their aesthetic goal from the inside out. When you do that and you have treatments where there’s longer time, if they are bought into that lifetime treatment plan, that’s not the only thing that they’re doing. We have also advised that client, if they’re going to do things like regenerative medicine, the only way to sustain those results is to come in on a semi-regular basis and see our esthetician for maintenance treatments in between. For me when I was in practice, I used to tell people: I’m the dentist, they are your toothbrush. You come to me, you’re getting your deep cleaning. If you don’t brush your teeth in between, you’re not protecting your investment.

So we’re building up that coming in with some regularity by doing that lifetime treatment planning. But when we structure our pricing and we do things like memberships… it doesn’t hurt you to give a perk to that membership once someone has purchased a really big comprehensive treatment plan. But I’ve also seen a lot of practices where their memberships are a revenue leak. I see in most cases, somebody has a monthly fee and then that monthly fee gives you a discount on toxin filler. That wouldn’t be my advice. Those are treatments where our margins are extremely tight. I really like if you are heavy in one department… then our membership should be for a treatment that is going to be complementary. Maybe that is monthly aesthetic treatments to complement your injectables. Maybe it’s a discount on laser packages.

Adeesha: I cannot express enough that people have said to me, I think I’m ready for another location and don’t have the ability to print reports. And to me, that’s just… premature scaling is the number one reason for financial collapse.

Rebecca Landriault: Absolutely. When you talk about wanting to then go from one location to the next, your existing business should have a net profit margin of 25% or higher. That’s the bare minimum for me. And then at the very minimum… six months of cash reserves. But even if you could answer all of those financial metrics with two thumbs up, I still would not ever open a second location or attempt to scale in any way unless you can tell me every provider is clinically confident in every treatment that you currently offer 100% all of the time. Your front desk is dialed in, can convert a call to a consultation, can check in and check out patients with excellent workflows. If all of those things are not dialed in, today is not that day.

Adeesha: Rebecca, you’ve really done a wonderful job here providing everyone listening about what it will take to look at the operational reality of running an aesthetic practice in 2026. As we wrap up the podcast, I would love to give you a small moment to share one key takeaway for our audience members. If they could only take just one, what would it be?

Rebecca Landriault: I think my favorite phrase is: Scaling or growth is not expansion. It’s a duplication of excellence. So if what you have today isn’t excellent, then we can’t duplicate. So I think the best way to describe it is opening a second location when your first isn’t excellent is like building a second floor on a house with no walls. That to me, you have to be airtight in your existing practice… or else it’s expansion without intention.

Adeesha: With that being said, thank you, Rebecca, for joining us on the Business of Aesthetics podcast.

Rebecca Landriault: Thank you for having me again. I appreciate it.

Adeesha: So with that being said, thank you, Rebecca. And if today’s discussion gave our listeners a new perspective on your P&L or your expansion strategy, share this episode with a colleague or practice partner who needs to hear it. And before we wrap up, a quick reminder, Ekwa Marketing is offering a complimentary 60-minute digital strategy session to help you map your 12-month high-value patient acquisition roadmap. You can always find it at www.businessofaesthetics.org/msm. You can check the availability and reserve your spot in under two minutes. I’m Don Adeesha and this has been the Business of Aesthetics podcast. Thank you for listening in and here’s to building a stronger, more profitable practice in the year ahead.