The U.S. medspa industry is booming. According to the American Med Spa Association (AmSpa), there are now more than 10,000 medspas nationwide, generating $17 billion in annual revenue in 2023.
From Botox and fillers to IV therapy and weight loss injectables, medspas are seen as one of the most lucrative opportunities for entrepreneurs. But while the opportunity is huge, so is the failure rate. Many medspas close not because treatments don’t sell, but because owners made avoidable mistakes.
At Medical Director Co., we’ve worked with hundreds of medspa owners across the U.S. We’ve seen exactly what separates thriving clinics from failed ones.
Here are the top ten mistakes entrepreneurs make when opening a medspa and how to avoid them.
Mistake #1: Skipping a Medical Director
Too many entrepreneurs assume they can operate a medspa without physician oversight.
In most states, estheticians, RNs, and nonclinicians cannot legally operate a medspa without a medical director.
Without one, you risk board investigations, supplier denials, and forced closure.
At Medical Director Co., we place licensed physicians in all 50 states—starting at $799/month, with no placement fees and free MSO/collaborative agreements.
Case study: An RN in Georgia launched a medspa without a medical director. Three months later, she was fined $15,000 by the nursing board for practicing outside her scope. After coming to us, we placed a physician within 24 hours and helped her relaunch legally.
Pro tip: Hire a medical director before applying for distributor accounts or signing a lease.
Read our guide: How Much Does a Medical Director Cost for a Medspa?
Mistake #2: Using Free or Generic Agreements
Some owners download free “collaborative agreement” or “MSO templates” online.
These are almost always outdated, noncompliant, or missing state-specific language.
Suppliers and boards regularly reject them.
Attorneys may charge $5000–$15,000 for custom documents—and this is without providing a physician.
Case study: A California entrepreneur submitted a free MSO template. It accidentally gave equity to the physician, meaning she lost control of her own business. With us, we prepared a compliant MSO free, kept her at 100% ownership, and placed her medical director within 48 hours.
At Medical Director Co., our in-house legal team prepares state-specific agreements free with every placement.
Read our guide: MSO Agreements Explained
Mistake #3: Ordering Directly from Manufacturers
A common rookie error: trying to order Botox directly from Allergan or fillers directly from Galderma.
Problem #1: Delays. Manufacturers prioritize large national chains. Small clinics wait months.
Problem #2: Pricing. Direct pricing is often higher than that of distributors.
| Supplier | Pricing | Wait Time | Support |
| Manufacturer | Higher | 3–6 months | Low |
| Distributor (e.g., DeWitt Pharma) | Lower | 1–3 weeks | High |
Case study: A Dallas medspa ordered direct from Allergan and waited 4 months for their first shipment. Their competitor down the street ordered through DeWitt Pharma and launched in 3 weeks with better pricing.
Always work with a trusted distributor like DeWitt Pharma for faster setup and better pricing.
Read our guide: Can a Nurse Order Botox & Fillers?
Mistake #4: Not Taking Proper Injector Training
A medspa’s reputation depends on injector skill. Skipping training is a recipe for disaster.
Poor technique means complications, unhappy clients, and negative reviews.
Many boards expect injectors to show documented training.
Case study: An NP in Florida skipped injector training, injected filler into the wrong plane, and caused a vascular occlusion. The patient posted about it online, and her business reputation tanked overnight.
At the Texas Academy of Medical Aesthetics, the most successful entrepreneurs take more than just the usual Botox/filler course. They also complete the Business Creation Course, which covers:
- LLC formation & compliance.
- Scaling strategies.
- Shadowing real injectors.
- Injecting live patients for a week under supervision.
Pro tip: Education pays for itself. Clinics with trained injectors generate two to three times more repeat business.
Mistake #5: Underestimating Compliance
Compliance is not optional—it’s an ongoing system.
- State Laws: CPOM states (CA, TX, NY, NJ) require MSO agreements.
- Boards: Many states mandate chart reviews.
- Suppliers: Botox/semaglutide distributors demand proper documentation.
- Insurance: Malpractice carriers require oversight.
Build compliance into your foundation, not as an afterthought.
Read our guide: Collaborative Agreement Template
Mistake #6: Overpaying for a Medical Director
Some consultants charge $2500–$5000/month for medical directors.
Plus $2000–$3000 upfront placement fees.
Plus long-term contracts with penalties.
At Medical Director Co., it’s simple: $799/month. No setup fees. Month-to-month contracts.
Case study: A New Jersey medspa paid $4,000/month for a medical director through a recruiter. After switching to Medical Director Co., they cut costs by 80% and scaled into three locations.
Mistake #7: Choosing the Wrong Location
Even the best injectors can fail in the wrong market.
Review this checklist before leasing.
- Google “medspa near me” and count competitors within 5 miles.
- Check local household income (aesthetics require disposable income).
- Compare rent vs expected patient volume.
Case study: A Michigan medspa opened in a strip mall surrounded by budget salons. Clientele didn’t match pricing. They relocated six months later, burning $50,000.
Pro tip: Location research is a critical first step.
Mistake #8: Neglecting Marketing & SEO
Too many medspa owners think “word of mouth” will fill their chairs. It won’t.
Medspas are a hyper-competitive industry.
Without SEO, local ads, and reviews, you won’t rank on Google—and 80% of consumers search online.
Pro tips:
- Budget at least 10–15% of projected revenue for marketing in year 1.
- Launch a Google Business Profile.
- Build city-specific landing pages.
- Collect 20 reviews from your first patients.
Remember: Aesthetic medicine is 50% results, 50% visibility.
Mistake #9: Expanding Too Fast Without Structure
Early success tempts some owners to open two or three more locations too soon.
Each state has unique rules.
Each location needs its own medical director.
Expansion requires multistate MSOs/CPAs.
Case study: A Midwest chain opened four medspas in 2 years. They tried to use one MD across multiple states without proper licensing. Two locations were shut down.
Medical Director Co. specializes in multistate medical directors for scalable compliance.
Mistake #10: Forgetting Liability & Insurance
One of the most overlooked mistakes: skipping insurance.
Without malpractice insurance, one Botox complication can bankrupt your clinic.
Without contracts, staff disputes can turn into lawsuits.
Pro tip: Secure liability insurance before opening day.
Bonus Mistake #11: Treating Medspa as a “Side Hustle”
Some entrepreneurs underestimate the time and systems required.
Medspas need serious business planning.
Successful owners invest in compliance, marketing, and training.
Treat it like a business, not a hobby.
The Medspa Success Formula
To summarize, successful medspa owners follow this formula:
- Hire a medical director early.
- Use proper agreements (CPA + MSO).
- Train at the Texas Academy of Medical Aesthetics.
- Order supplies through DeWitt Pharma.
- Invest in SEO + marketing.
Follow this, and you’ll avoid the traps that sink most new clinics.
Free Medspa Startup Checklist (PDF)
Want a one-page guide you can print? Download our Medspa Startup Checklist: 10 Mistakes to Avoid.
📥 [Download Here]
Conclusion
Opening a medspa can be life-changing—but only if you avoid the mistakes that sink most startups.
At Medical Director Co., we’ve guided hundreds of entrepreneurs through this journey. With $799/month medical director placements, free agreements, and multistate coverage, we’re your compliance partner from day 1.
Hire your medical director today and launch your medspa with confidence.
Bolton M. Harris, J.D., is a seasoned attorney with a formidable background in criminal law and a focus on healthcare law and compliance. As the in-house legal counsel at Medical Director Co., Harris brings a unique blend of prosecutorial experience and regulatory expertise to support healthcare professionals across Texas. Her career spans roles as a prosecutor in multiple counties and now as a trusted advisor on the legal intricacies of medical practice operations.
Education & Early Career
Bolton Harris completed her undergraduate studies at Southern Methodist University (SMU) in 2013. During her time at SMU, she was not only a dedicated student but also a competitive athlete on the university’s women’s swimming team. She went on to earn her Juris Doctor from Texas A&M University School of Law in 2016 and became a member of the Texas Bar that same year. Armed with a strong academic foundation and discipline honed as a student-athlete, Harris embarked on a career in criminal law immediately after law school.
Prosecutorial Experience in Texas
Bolton Harris began her legal career in public service as a criminal prosecutor. She served as an Assistant District Attorney in multiple jurisdictions, where she quickly rose through the ranks and handled a broad spectrum of cases. Some highlights of her prosecutorial career include:
- Assistant District Attorney, Dallas County, Texas: Prosecuted a high volume of criminal cases in one of the state’s busiest DA offices, gaining extensive trial experience in both misdemeanor and felony courts.
- Assistant District Attorney, Ellis County, Texas: Continued to hone her courtroom advocacy skills, known for meticulous case preparation and a tenacious pursuit of justice on behalf of the community.
- Assistant District Attorney, Navarro County, Texas: Broadened her legal expertise by handling diverse criminal matters in a smaller county, working closely with law enforcement and community leaders to uphold the law.
Through these roles, Harris built a reputation for being a tough but fair advocate. She brought numerous cases to trial and developed an in-depth understanding of the criminal justice system. This distinguished prosecutorial background laid a strong foundation for the next phase of her career in the private sector.
Healthcare Law & Compliance at Medical Director Co.
After her tenure as a prosecutor, Harris shifted her focus to healthcare law, applying her legal acumen to the medical field. She recognized that the same attention to detail and tenacity that served her in criminal law could benefit healthcare providers navigating complex regulations. Embracing this new direction, Harris became well-versed in the intricate laws governing medical practices – from licensing requirements to patient safety and privacy standards – and is passionate about helping practitioners stay compliant.
In her current role as the in-house attorney for Medical Director Co., Bolton Harris oversees all legal and compliance matters for the organization and its clients. Medical Director Co. is a nurse-owned firm that connects nurse practitioners (NPs), physician assistants (PAs), and registered nurses with qualified medical directors and collaborating physicians, offering fast placements and comprehensive compliance support for healthcare practices. Harris ensures that each of these partnerships and clinical ventures adheres to all applicable state and federal laws. She is responsible for drafting and reviewing collaborative practice agreements, advising on regulatory requirements, and providing ongoing legal counsel as clients establish and grow their clinics. Drawing on her prosecutorial eye for risk management, Harris proactively identifies potential legal issues and addresses them before they escalate, giving healthcare professionals peace of mind.
Bolton M. Harris’s multifaceted expertise – spanning high-stakes courtroom litigation to detailed healthcare compliance – makes her a formidable legal ally. Whether advocating in front of a jury or guiding a medical practice through regulatory hurdles, she remains committed to the highest standards of the legal profession. Her blend of courtroom-tested skill and healthcare law knowledge ensures that clients of Medical Director Co. receive elite-level counsel and steadfast protection in an ever-evolving legal landscape.
