MedSpa Angle - Long Loneliness Thesis with BowTiedTiger

Level 2 - Value Investor

Welcome Avatar! We’ve got a guest post with BowTiedTiger here. If you’ve been following for a while you already know that selling to women is by far the most lucrative strategy. Time and time again, people try to re-invent the wheel targeting the 20% of consumer purchases instead of the 80% of purchases.

With that said, in the USA, women are more likely to be childless, not married and generating income well into their 30s and 40s. Declining birth rates is already a trend and women will be spending even more money to maintain looks and status later in life.

For this reason we’ve got BowTiedTiger here to talk about various business lines primarily targeted at Women.

About BowTiedTiger

I have been a long-time jungle lurker. When BTB reached out to ask me to write a guest post I was happy to oblige given how much value and sheer entertainment they have provided me over the years.

I am a serial entrepreneur who *rarely* sells any of his business assets. I continue to build because it is my nature. I currently own and operate 9 independent companies in unrelated verticals, all of which are brick and mortar (I know this is an E-Comm crowd but I did not start with those skill sets and I’m not certain it’s worth my time to learn them now).

I employ hundreds of people, which is quite a responsibility. I recommend if you find yourself in such a position that you take it seriously as you are responsible for providing those people a way in which to put food on their table.

Yes- I still work a W2 (tears flow from BTB eyes), but on my terms and never more than around 25-30 hours per week but it still pays extraordinarily well and I rather enjoy it- so I continue to go (most of the time).

Before We Go Further

The example and writeup I am tasked with today has to do with a very specific niche, which is non-surgical cosmetic practice or “medspa”. Always remember this is just ONE example of a business opportunity, and although I tend to believe and operate within the framework that all businesses are essentially the same; there are tons of opportunities out there and this would not be the easiest to start or operate for many reasons.

Next, before the triggered surgeons, physicians and medspa owners whose incredible egos preclude them from even considering the possibility that it could be done better…it can be and it is.

Additionally, I’ll tackle this now based upon some of the feedback in a prior short tweet: The rules and regulations surrounding operating a medspa and the responsibilities, supervision as well as training requirements are VASTLY different from state to state and unless you practice in all 50 states and are well versed in their respective regulations and rules *you don’t and you aren’t*- you’ll just have to take my word for it.

The Medspa

A growing market to be sure and will continue to be for years to come as the population ages. The attraction is, of course, a non-surgical approach to youthful appearance and cosmetic improvement by several means including injectables (Botox and the like, as well as Fillers), laser therapies, fat reduction therapies, hair removal, typical aesthetician procedures such as microdermabrasion, dermaplane, and sales of white label skin care products or branded with an affiliate agreement.

Is there competition? You better believe it. It almost seems like there is one on every corner in recent years.

Are you scared of competition anon? Hope not, or find somewhere else to hang out.

Do your market research, find out what makes you stand apart (customer service, pricing, membership agreements, ambience, location, quality of service/staff, etc). Market research means sending your girlfriend or her friends to recon for you- everywhere.

Sadly, most medspas are run unscrupulously. MOST patients can spot these and might visit them once or twice until a bad outcome or a bad taste in their mouth. So, although it seems saturated, as in most things in this life, the real competition is at the 0.1% or higher.

Ignore the trash and don’t bother with attempting the race to the bottom with them.

• WE don’t lower prices.

• WE provide better service, in better locations with better staff.

• WE want rich people, not poor people.

• RICH people come back constantly, don’t complain, and will bring their rich friends.

• POOR people want more for less, complain constantly, and often can’t maintain a schedule that is ideal for cosmetic outcomes, also leading to poor reviews.

What is required

Despite what you may believe, you do not need a “7 figure buildout” or some monstrosity in brick and mortar to sell these products and services effectively. You need clean, efficient, properly located demographically and pretty. These are not hard and they are not that expensive. Rent.

You set up shop in an area with a large density of high earning individuals who largely have kids that are in high school or later. Google is your friend. Think, near exclusive private schools, urban centers but the NICE side of town. Most of your marketing is organic.

You do not require a ton of space either.

• Small front desk area

• Waiting area

• Handful of treatment rooms at most (think your PCP office size)

• Rent maybe a couple thousand a month max

Staffing:

• Pretty, bubbly and exceptionally friendly receptionist ($15/hr)

• Depending on your volume (hire as you grow)- you will need *depending on the state* either RNs (more expensive) or Aestheticians ($20-22/hr). Either should be well trained.

In my state, Aestheticians can perform every single procedure that I will list.

You will need to become licensed in the state in which it resides and need a physician to be your supervisor. They do not have to be physically present. There is always a lot of red tape with healthcare endeavors so know what you are getting yourself into.

*I have heard every variation of how to compensate the physician from % of profits, % of gross sales, fixed amount to use the license and name- depends on comfort and experience level and how well you can negotiate. But stop and think… MAYBE you could offer to refer surgical cases to a plastic surgeon in volume, they make most of their nut there and you would reduce your operational cost via profit sharing...*

I always look at those things with a positive mindset. It is a significant barrier to entry- it limits real competition in the space.

Offerings

Injectables: Botox/Dysport/Xeomin/Daxxify

• Everyone essentially understands what these are used for- to reduce or eliminate wrinkles on your face.

• There are slight differences between brands and apart from Xeomin (cheaper) and Daxxify (more expensive and we don’t use) they are basically the same.

Financials: Our Markup is 100%. On average we pay $6 per unit and we charge $12. The average volume day for injecting these products would be about 15-20 per injector. Average cost would be somewhere in the $500-600 per treatment.

Risks: Inexperienced injectors can cause some mild droop, most listed warnings are nonsense and quite rare if performed properly. You can, however, develop some Botox resistance if you are receiving injections too often for too long. 2 years of constant q3 mo injections and you are at risk for serious muscle atrophy. For that reason, we discuss and document with the patient and we advise taking breaks every so often so as to avoid this.

B) Fillers: Juvederm/Restylane/Juvederm Voluma

- These are used to produce volume in the facial structure where there has been loss due to aging largely.

- Again, slight differences between brands but Juvederm lasts around 6 mo, Restylane we only use for tear troughs and lasts up to a year, and Juvederm Voluma (mostly used for mandible and malar eminence) lasts around 2 years or more (satisfaction still quite high at that time frame). These are Hyaluronic Acid products.

Financials: Our Markup is 100%+. There are slight differences in price but on average these cost around $400-475 per syringe and we charge $800-1200 per syringe. Most patients use 2 syringes per cheek and 2-4 for chin. nasolabial folds. The average volume in a day is a handful or so. Adds up quick.

Risks: There does exist a risk of granuloma formation with Voluma especially but any of these fillers (the more superficial the more likely). Post op care is important as with most things- massage etc. Skin necrosis is a real risk, DON’T BE GREEDY, anything over 2ccs in a site is super risky. Blindness and retinal artery embolism is insanely rare and I have never seen it.

Laser Therapy

• Many different types: HALO, Erbium, BBL, IPL, YAG, etc.

• They are all used for various skin conditions (aging, melasma, improve skin tone and complexion, and treat scars, large pores, sun damage and each has their own indications). Erbium lasers are the most efficient in my opinion for the ablation of skin (longer pulse width, penetration into the deep dermis)- better skin tightening, wrinkle improvement.

• You do NOT need to BUY these lasers, and if you do you are a FOOL. The tech changes rapidly – but you’ll have a very expensive place to hang your white coat, I guess.

Financials: Best setup I have found is leasing them (nominal % of profits for the days leased)- laser company brings whatever lasers you want on whatever days you want. So, you stack your schedule a few times a month and pack the day. Wide range in pricing- from $500 for small pigmented lesions to $2-3000+ for skin resurfacing etc. Volume on lease days is 40+ sessions. Usually 2 or 3 per month per site. Usually, people require several visits to desired effect.

Risks: Sun exposure post treatment- educate your patient (as always)

Fat reduction therapy

A) Coolsculpting

• Essentially using cold temperatures to freeze and destroy fat cells.

• Unfortunately, patient satisfaction is somewhat poor depending on the site of concern, but it does make a lot of profit.

• Requires 2-4 treatments per area of concern.

Financials: Each area of concern is on average 6-8K to complete. Volume is variable here but probably low double digits monthly. Some don’t return as the incremental change is hard to see. Same lease arrangement as the laser with % share. Face reality that a tummy tuck is likely a better option for slightly more cost.

Risks: PAH (Paradoxical Adipose Hyperplasia)- scary rare outcome- never seen it but basically overgrowth of fatty tissue months after treatment. Stated to be 0.5% of cases.

B) Kybella

• Submental fat destruction via injection of deoxycholic acid. 2 to 3 sessions (3 months between sessions)

Financials: Our Markup is 100%. Patients usually use 2-3 vials, their total charge is around $2000. Volume around CoolSculpting level.

Risks: Nerve injury with poorly trained injectors

4) Additional Aesthetician treatments:

• - microdermabrasion, micro-needling, skin rejuvenation, dermaplane, facials, laser skin peels

• - Laser hair removal

Financials: Incredible. Far beyond 100%. Paying an Aesthetician hourly as above, charging hundreds for all of this. Volume is high- ez stuff. As far as laser hair removal goes- people can pay per body part (500-$1000 one time but MOST buy the complete contract package: 12K Contract one time lifetime subscription to remove hair anytime anywhere unlimited- usually only need a year or so of a few treatments and they rarely return). These are cheap to own (mid 4 to low 5 figures). Different lasers for different skin tones exist as well.

Risks: Burns and discoloration.

5) Vaginal Rejuvenation

• Thermiva- Radiofrequency wand used on vaginal walls.

• Short term benefit, maintenance program, reported better sex post treatment, Tightens vaginal walls, 6 months max efficacy.

Financials: Machine is insanely cheap- I can't remember anymore but it didn’t move the needle. Charges are about $3500 for a complete treatment. Volume is a few a month.

Risks: Burns, Pain- RARE.

6) Product sales

• Skin care, moisturizers, serums, etc.

• Affiliate programs exist with all your known big brands- take a 10% cut usually. People empty the shelves.

• We don’t do this but I know a place that white label’s skin care products and sells them at a high margin (probably will do this at some point just been a bit busy).

So, there you have it. Some of the nitty gritty details of one of many business opportunities that exist. As always, clean operational management is key. Core systems in place. The players might change but the structure and operations are always the same in every business.

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BTB Note

We’re sure a small minority of people will take the time to read this. This is actually the goal. With crypto activity ramping people are more interested in trying to get an extra $100 to $5,000 from a random airdrop (will be covered of course).

Instead they should be doing something like this (building a scalable real biz). This would allow them to invest tens of thousands or even hundreds of thousands per month into whatever they like (making the airdrops rounding errors)

That said, we already know what will happen. A total of 2-4 people will run with this and make it. So this is for them!

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Disclaimer: None of this is to be deemed legal or financial advice of any kind. These are *opinions* written by an anonymous group of Ex-Wall Street Tech Bankers and software engineers who moved into affiliate marketing and e-commerce. We’re an advisor for Synapse Protocol 2022-2024E.

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