The State of Aesthetics Volume I; The Revolution, Recessions, and the Americana of MedSpa-Start Ups

The disruption started with the postponement and likely ultimate cancelation of all dominant annual physician societal meetings, including the American Academy of Dermatology (AAD), American Society of Plastic Surgery’s (ASPS) – The Aesthetic Meeting, and The American Society for Laser Medicine & Surgery (ASLMS). To be followed by key opinion leaders recommending colleagues to also temporarily close elective care operating rooms and medical spas. The closures have extended beyond these super-star board-certified physicians now to federal and state mandates for “Essential Only” and “Shelter In Place” orders for the entire industry.

Closure rates brought the first casualties to this ecosystem of patients, providers, entrepreneurs, and the Fortune 500 in the way of massive lay-off and furlough. Not only are there now hundreds of medical device and drug reps out of work, but thousands of nurse practitioners, laser technicians, and estheticians no longer operate in medical aesthetics.

Different from the financial crisis in 2008, in which some analysts deemed Aesthetic Medicine “recession-proof” due to an uptick in procedure rates and a growing trend to non-invasives, this global pandemic has shaken the ability for patients to receive these confidence invoking procedures and maintain their regular preventative maintenance. During the onset of social distancing, many surgical practices saw a rise in scheduled operations; it would only make sense from the patient’s point-of-view to take advantage of the downtime and address an aesthetic enhancement. However through the increase of confirmed (COVID-19) cases in the US, all elective care facilities have been deemed indeed non-essential; pushing many providers into Telehealth. While Telehealth or Telemedicine has proven successful in the growing trend of a ‘tele-consult,’ there remains little a medical device, scalpel, or cannula can do through a smart-phone. That sets this crisis apart from the dot-com bust and the ’08 economic downturn, whereas in those times our society found solace in social activity, indulgence, and botox, but today we can’t leave our homes.

The remedy is reliant on our economy returning to the status quo, but recent mentions of “re-entry” are challenged with the Center for Disease Control’s (CDC) little understanding of the infection, prolonging inevitable lowered income for most Americans. With fewer patients and fewer procedures performed, this ‘uncertain time’ continues to disrupt small businesses and medical providers, while it drastically impacts massive commercial companies that supply devices, consumables, and drugs.

The dominating trend toward non-invasive procedures has been mainly fueled by large pharmaceutical and medical device manufacturers. These companies pioneered direct-to-consumer marketing and led the charge on the growing millennial patient-base. Their revenue is significantly reliant on their continued development of new energy-based applications, and the repackaging and re-marketing of predicate technology. Comparably, to the automobile industry, they ask now, “Where does the 2020 inventory go? Can and should we make more?” followed by the perpetuating sentiment, “but we have to.”

With many of these deep-pocket companies shifting to consumable based residual incomes and bleak ‘box’ placement forecasts for the remainder of 2020, which of these publicly traded device and drug companies will sustain this economic crisis? The sector has been widely operated by competitive and intestinal key executives footing historical mergers and acquisitions, which reached an all-time high in 2019 with record-breaking multi-billion-dollar buy-outs. As consumable sales plummet, supply chain, and demand decrease, these industry titans are finding they are no longer challenging each other for market share. To further the blow, innovation could also take the back seat, matched with a circumscribed sales force. It is uncertain what the future holds for this young and growing industry.

Fortunately, this is one of the most dynamic and creative sectors of healthcare. It is composed of disrupters, scientists, and marketers that are no foe to battle. Do remember early cosmetic surgery was developed from skills learned during World War II exploring reconstructive surgery on battle scars. That military backbone extends to lasers designed initially to strip paint from fighter jets that were modified and applied to the most common skin conditions. It’s once again time to scrub in, push the fluence, and band together like never before.

Industrious leaders need to take note and pay homage to their clients, a community of small medspa and practice owners. These brilliant men and women are the aesthetic army on the front lines continually adapting, growing, and pushing medical aesthetics to the forefront of “normal” from the distant beginning of major medical operations. These providers regularly engage, educate, and enlist patients affecting everyone’s bottom line, dollars made on services and products sold. The fight to come is fought on the consumer level through patient awareness. It is vital that aesthetics not only sees 100 million dollar ad campaigns contributing to the “pop-culture” of aesthetics, but it braces those entrepreneurs who built their own American Dream of small business inside of healthcare. It is time to see the commercial industry genuinely support providers and think in care-packages and less in a solely capitalistic mindset. That is the only way the industry as a whole will realize sustainability and return to growth. In the same token practice and spa owners must continue to, as Steve Jobs said, “poke life”, embrace the change and make a mark upon it. The bull market may or may not continue to rage, but the Americana of making something from nothing will. The good news is that aesthetics already had something and was just getting started.

-Stay the Course.