Winning Strategies for MedSpa Platforms

In the first episode of our Healthcare podcast series focusing on MedSpas, John Wheeler, CEO of Alpha Aesthetics Partners, joins Solomon Managing Director Brad Hildebrand to discuss the growth of the aesthetics industry along with top strategies for success in the sector.

Transcript

Outtake:

John Wheeler (00:03):

Once you see yourself with a smooth forehead, once you see yourself with a face that doesn't lack volume or a face that doesn't have jowls on it, you're going to do whatever it takes to preserve that, right? And so I just anticipate that this aesthetics market will continue to progress.

Brad Hildebrand (00:27):

I would like to welcome our guest today to the Solomon Healthcare Podcast focused on med spas and everything that's going on in that marketplace. I’m your host, Brad Hildebrand, a Managing Director at Solomon Partners, which is a leading financing advisory firm, where I focus on advising clients in the Healthcare services vertical. 

Today we’re speaking to John Wheeler, CEO of Alpha Aesthetics Partners, a leading platform in the space. John, greatly appreciate you joining the podcast and looking forward to a fruitful discussion. 

Maybe before we dive in, maybe I'll give a bit of an intro. There's been so much talk about med spa out there in the market today and in the investment community, but you've been involved in the market for many years before it was the hot topic. Maybe you could start by telling us a little bit about how you got into the industry, your background, and what led you to the role at Alpha.

John Wheeler (01:18):

First of all, thanks for having me. Kind of a non-traditional background. So I was a pastor for seven years. I had my bachelor's in theology, my master's in divinity; actually, while I was a pastor, for some of that time, I had a wedding DJ company. My wife's dad is a facial plastic surgeon, and so I had just married her and figured, hey, I should probably do everything I can to provide for my new bride. And so that's the idea that I had. And so I did that for a few years while I was in seminary and while I was a pastor. And then I sold that company in 2017, moved back home to Northern California, where my father-in-law was starting a new med spa. Like I said, he's a facial plastic surgeon, and so he asked me if I would do the marketing for him, and I said, yes, absolutely.

(02:05):

I was actually in a ministry school at the time with my wife. We were just trying to figure out our next step, and that turned into “Will you help manage the business?” 

And so I said, yes, absolutely. And a lot of this was just born out of a deep care for him and for what he was building and excitement around that. And then it turned into let's be partners, and we built a couple more locations, and actually it's kind of crazy how quickly things progressed. 

We opened that first med spa. We really opened our doors July 2nd of 2018, and then just about four years later, when we went to figure out this next step and we started talking with all these different PE sponsors, we had a $15 million business. And so we were able to grow the business to that extent in just a handful of years and met with a lot of different groups and ended up really connecting well and believing deeply in the Thurston team, Thurston Group. And so we officially partnered with Thurston in March of 2023, and now here we are today. We've created Alpha Aesthetics Partners together, myself as well as the Thurston Group. As it is today, the recording of this podcast, we have nine partners [in June 2024]. We have 20 locations across the US in six different states, and a lot of exciting things happening.

Brad Hildebrand (03:32):

Obviously, having been in this seat for the last five years, I think a lot has changed in the marketplace since you guys launched the first location. What are some of the key things that you've seen change? Obviously folks in these roles are being bombarded daily by investors, private equity funds, other strategics, saying" "come be a part of our platform." How has that changed over the last five years that you've been involved?

John Wheeler (03:57):

Yes, that didn't exist when I started. I don't really even feel like that existed until, call it 2021, where everybody you talked to says, "Oh yes.  I've gotten three emails this week from an investment banker or a broker trying to get me to sell my business to private equity." That definitely wasn't a thing. 

Just to give you an idea, in 2021, I'm just trying to think of the date here, 2021, our real goal as far as how do we scale this business when we had Esthetics Center, our real goal, I wasn't very familiar with private equity at all. My industry in aesthetics, it just wasn't really much of a thing. We really thought, hey, how do we get Massage Envy or European Wax Center to want to add aesthetics? How do we be the brand that they would stand behind as a strategic and become their aesthetics arm? So we really weren't even thinking about private equity until, I would say, early to mid-2022 is when it really started to hit in a profound way.

Brad Hildebrand (5:07):

By 2022, you'd made it through Covid. What did Covid look like for the business before you had a private equity partner?

John Wheeler (05:14):

People in my industry feel like Covid was some of the greatest days of their entire life. This was a time where people were not able to travel, they weren't able to go out to eat in a lot of places. They weren't able to do much with their money, and so they put it all into aesthetics. And so there was this massive user adoption that happened as a result of Covid, and we call it the “Zoom boom” because simultaneously everybody went remote. They were seeing their video in Zoom on their computer, and they were coming face-to-face with wrinkles and a lack of volume and poor skin texture. And it just really forced them to say, I'm going to get serious about my appearance, I'm going to start getting aesthetic treatments. And so every single person that you ask that's in our industry about Covid will tell you the same thing of that was really the heyday, and it was kind of a time of legitimacy actually, I think, in our culture, where it became acceptable and normal to get aesthetic treatments.

Brad Hildebrand (06:13):

John, do you think that that change is here to stay? We get this question all the time when we're trying to sell businesses in this space of things that changed temporarily with Covid. How rapidly will they go back to the way that they were before? And often the answer is it might never go back. What do you think about the trend in user demand as it pertains to the Zoom boom as you referred to it, and some of the other key changes that have come out of Covid? How tangible is that going to continue to be here over the next five or 10 years?

John Wheeler (06:43):

I would tell you that if you've ever had these treatments, they are addicting. And I don't mean that in a negative way. I just mean once you see yourself with a smooth forehead, once you see yourself with a face that doesn't lack volume or a face that doesn't have jowls on it, you're going to do whatever it takes to preserve that, right? And so I just anticipate that this aesthetics market will continue to progress. I think there's a lot of corollaries with the orthodontics industry, which is, for most people, braces are not functional. There are form, right, they are aesthetic, and it is just a part of growing up. Most kids get braces as they grow up. It's normal. And I think that with aesthetics, you're going to continue to see almost a rite of passage, just like braces are for adolescents. 

I think that aesthetics treatments like Botox, like filler, like lasers, like facial plastic surgery, as we progress as a society, these will become a rite of passage as we age. I think we'll also see a lot of continued advancement in aesthetic science that continues to allow providers to give natural results where people don't look fake, they don't look overdone. So this is here to stay. And by the way, we haven't seen the floor fall out since Covid, right? We've seen it normalize. We've seen a new floor in this whole entire industry, and that floor is a lot higher than it was in 2019.

Brad Hildebrand (08:23):

Interesting. Yes, completely agree with what you're saying. And I think it's here to stay, and we see it in our personal lives beyond our work in working with med spa clients, just people that I know personally are adopters of the service and they weren't before Covid. And you see the size of the market continue to expand, driven by that piece of it. 

Maybe we can shift gears a little bit, John, you could talk about Alpha and what you guys are doing that's different maybe than some others out there in the marketplace.

John Wheeler (08:59):

I think when you think about Alpha, the first thing that probably stands out is the brand. And so we're trying to redefine what it means to be a platform. If you go to our website partnerwithalpha.com, this is not something that's sterile. It doesn't feel like a bank, it doesn't feel like a typical platform. It feels loud, it feels ambitious, it feels aspirational, it feels relatable. The videos that we put out when we do these partner drops —  they're fun, they're engaging. And so there's just a lot of things that we're doing from a brand standpoint that I think is really exciting. It's really innovative. 

All of that would mean absolutely nothing, though, if we weren't integrating well, if we didn't have happy partners, if we didn't have a great PE sponsor, if we weren't industry insiders. And so those are all things I think are top of mind, especially the integration process that we have at Alpha — that is really at the center. That's the heart of what we're doing. It's just great integrations, great access to data. So I think that that's where our focus is: great operations. I know everybody probably says that, but then we really mean it. 

And I think coupled with this fact though of our partners are really happy, and I can't even understate the value of that, just having happy partners and building meaningful community and driving engagement clinically with our partners. So I think that's what really jumps to the top of the mind when it comes to Alpha.

Brad Hildebrand (10:34):

I know the integration process can be no fun, can be disruptive. How have you thought about navigating that process to make it as seamless as possible for partners and really to show them the value that's being created by the hard work that goes into that process and how it can really empower them to manage their practices going forward?

John Wheeler (10:54):

We try to do a few things with it. So we try to, first of all, really be super honest in the M&A process. And so I know there's maybe some groups out there that say, "Hey, we'll do whatever it takes to just get a deal closed, and then we'll tell them how it's actually going to be afterward." 

I hope there's not a lot that do that, but I know there are some. So for us, it's how honest can we be with people and just let them know, "Hey, here's what's going to stay the same, and here's what's going to change. This is what life's going to look like. Is this something that you're interested in?" And what we would never do is a bait-and-switch. So I think there's a lot of these integration conversations that start in those earliest days.

(11:38):

Conversation three or four with a new prospect a lot of times is, "Hey, just so you know, part of our process is we need all of our partners on one EMR, right? So we get all of our partners onto Zenoti. That's a part of our process. If this is something you want to do, if you want to partner with Alpha, this is what that means." 

And so then six weeks pre-close, after we have an LOI signed, we start the integration process. We have weekly calls with these really great decks that we've built as a team. We go on-site, we meet every single team member, we shake their hands and just tell them how excited we are to partner with them, because we are. And then we have a series of decks that we go through after close, and it's just this amazing tracker that we have to make sure every i is dotted, every t is crossed.

(12:27):

So that's just the blocking and tackling. But then we also have this phase two of integration that we call Alpha Accelerator. And that's really, "okay, we figured out the payroll, we figured out the insurance, we figured out the benefits, we figured out the AP, we figured out the banking." That's all just table stakes when it comes to integrations. 

But now, how do we go about building an amazing company together? And so that's our Alpha Accelerator program. It's very, very proprietary, but it's all around making the business better. 

And so there's a lot of things that we're doing beyond just the blocking and tackling to take our partners’ practices to the next level in ways that, honestly, they're really excited about and their teams are excited about because it's almost like their teams are getting this amazing business knowledge and this acumen that they wouldn't have gotten otherwise. They learn how to run a really buttoned-up business through this Alpha Accelerator. And so, yes, that's our integration process.

Brad Hildebrand (13:23):

Very helpful, John. On the front end of partnership with a new practice that may be coming on to Alpha, how sophisticated do those folks tend to be on the business side? 

What we've seen in other areas is it tends to be a very invigorating learning process for folks. And if you're able to choose the right partners that are growth-oriented and want to have a market-leading practice, they tend to really lean in to the business insights that can be provided, and you can only provide them if you do a great job on the integration front.

John Wheeler (13:55):

Yes,  it's just a different level of operational sophistication. Our partners are amazing. There are a lot of amazing people in our aesthetics industry, but when you're dealing with a private equity group like Thurston, and then when you have an ops team, for instance, our COO, Gary, he was the COO at Love’s,  this massive, dozens of billions of dollars in revenue company, that level of sophistication and insight. 

It’s just, I don't care who your local operators are, it's just a different level of execution. So yes, I would say though, as a different way to answer your question as well, the aesthetics industry in general is a lot less sophisticated than some of these other industries. Like you look at dent, dent versus aesthetics, it's just night and day, all of the data that you can get in the dental industry, the softwares that you have, the different tools that help within consolidation, it's night and day, and so there's just not a lot of sophistication in aesthetics as an industry at large, I would say.

Brad Hildebrand (15:10):

I think you refer to the services that Alpha provides to these practices as a menu, and some people may use different levels of the service. Somebody might need to use basically everything that's offered, and somebody might say, "we're good on X, Y, and Z, but we need a little bit of help over here." How much does that vary between practices in terms of the level of resources that are being utilized by the partner practice?

John Wheeler (15:36):

Yes, we have some of our offerings where everybody, we do that globally, if that's AP, if that's just a lot of back-office financial pieces. Those are real global add-ons that we do. 

But some of our partners are a lot more just dialed in on their marketing. Others haven't focused on it as much or haven't needed to. Others have traditionally counted inventory every few days; some have never counted inventory. And so it really is kind of a smorgasbord. 

By and large, though, I would say there's a couple different types of aesthetics practices that you see as an archetype. The first is the multi-location — I mean huge admin staff, a ton of providers. It's a true multi-unit business. And then there's the single location that is somewhere in the middle. Those are my least-favorite practices to partner with. But then there's this other type of practice that we've really been keen on — if you can find a practice where they're just really, really dialed on their sales process and on adequately dosing their patients, and they're not letting themselves get bloated on the admin side. There are some amazing businesses that we're partnering with, where it's like they're just kicking butt clinically, and they have a reception team member, and they run a really lean business.

Brad Hildebrand (17:14):

So John, we've seen consolidation similar to this — you just mentioned dental, but in a lot of other areas across healthcare services. And what we've noticed is a lot of attributes of commonality of what's important. It's generating alignment with clinicians, it's generating a best-in-class patient experience, retaining your staff, retaining your patients, some of the table-stakes things. What are some unique things to the aesthetics industry that you think are extremely important in developing a market-leading platform?

John Wheeler (17:47):

Well, number one is provider retention.

Brad Hildebrand (17:48):

No surprise there.

John Wheeler (17:50):

This is a different type of experience versus a dental rollup. I will tell you that a lot of these dental groups, maybe there's some big groups out there, but I would say by and large, a lot of them have a pretty limited number of dentists. Is that accurate? Maybe one to two or three?

Brad Hildebrand (18:09):

It varies, but there certainly are a lot of practices that may have just one or two providers.

John Wheeler (18:14):

Yes, in aesthetics, you're looking at a lot of these practices have five, 10, 20, 30 injectors, and these injectors are not like dental hygienists. They're actually a lot more like the dentist. And so, first of all, how do you retain great injectors? So for us, a lot of it is building alignment, and it's finding ways to share the love with injectors through, we have our Alpha Shares program, which we're the only company that I've heard of at scale to offer a meaningful, a very meaningful chunk of equity to providers. There's a lot of things like that that we're doing and that we're going to continue to announce. So I would say that would be the first big difference. 

The other would be, and again, I don't know the dental industry as well. I will tell you in aesthetics, there's just a lot of laws that vary state to state. Is that the same in dentistry?

Brad Hildebrand (19:10):

Not just dentistry, but across all of these different areas of healthcare services. It's sort of a silly thing in our system that you have such variability across different states, and it's an operational headache to keep track of everything.

John Wheeler (19:25):

So for instance, in aesthetics, it's who can do what in each state? And so that really comes down to who can inject neurotoxin in Massachusetts versus California versus Texas. For instance, in Texas, it's very lenient on who can inject neurotoxin, who can fire a laser in each state, who can operate a Class II medical device. 

So there's all of these different, what can aestheticians do, right? It's different in every single state. Some states obviously are the same, but it's just state-to-state, it is so different. And so that's another massive difference I think between aesthetics and some of these other industries. Other than that, I think that aesthetics also it’s just, it's so fun as an industry, and it's happiness medicine — patients are happy.

(20:18):

It's all about branding. It's very influencer-driven as well. It's just very much also B2C. And so a lot of direct advertising versus pipeline building. Some other forms of medicine might be more pipeline-building. 

Other than that, it's also a very, very tiny community. And I think that's what a lot of groups might not understand is, if you went to maybe somebody in the dialysis space, and you said, "how many people in dialysis are you following on Instagram? Give me your Mount Rushmore of dialysis Instagram follows." I think most people in that space would say, "I am following zero people in dialysis, unless they're a coworker that I follow on Instagram." Or maybe even in general dent — I'd just be curious how many other dentists some of these other general dentists follow. Maybe it's a handful, but I will tell you in aesthetics, the average injector is probably following, on average, somewhere between 20 and 40 other injectors, maybe more on average.

(21:29):

It is so small. It is so connected specifically through social media. It's almost like it's a high school where everybody knows each other. And so that's where there's a lot of impetus that I personally make sure we're doing right by people because it's the right thing to do, but there's also this idea of this is a tiny industry and news travels fast. And if you start messing with people in the wrong way, it's easy to have bad news travel. And so we do right by people at every single turn. And I think that it's important that people understand that.

Brad Hildebrand (22:09):

Yes, I think all the interconnectivity is unique to this sector, and it just makes reputation and maintaining your level of credibility paramount because, like you said, word tends to travel and can travel very quickly in this space. One positive attribute that comes out of that dynamic is where we've seen challenges for some other areas of multi-site healthcare has been staffing and being able to find mid-level staff. I'm not talking purely about doctors or, in this case, injectors, but to find support staff can be a real challenge for a lot of these practices. And I think what's unique in aesthetics is there are a lot of folks that are attracted to these practices and it tends to result in a pretty positive labor market environment. Do you agree with that, John?

John Wheeler (22:58):

Oh, a hundred percent. Yes. I remember vividly at Esthetics Center when I would create job postings. We're getting hundreds of applicants for every job. A lot of the jobs we throw up on our Instagram, and we have dozens of people within a few hours saying, "I'd love to come work reception or be an MA at one of these med spas." So yes, it is definitely the place to be. And a lot of that is there's some really fun benefits around free treatments and things like that being a part of trainings, specifically skin care. And I just don't think you can really recapture that type of enthusiasm to come work in a med spa probably in any other facet of healthcare. I truly believe that.

Brad Hildebrand (23:44):

We agree. It's a very, very attractive piece of this sector. Maybe on that topic, we've seen a variety of different strategies that are targeting the market in different ways, whether it's price points, staffing models, branding. 

How do you think about the model that you're operating versus some other folks, whether it's price point, are you the high price in the market? Are you trying to appeal to a broader base, a lower price point, a staffing model? Are you utilizing MDs in a way that others aren't versus not? How do you differentiate what you're doing versus some of the other folks that are out there on the market?

John Wheeler (24:25):

I think that on the pricing side, it's definitely not a “one size fits all” decision. You have some smaller med spas that would likely have a different pricing strategy than some of these larger med spas. It's a lot easier to have high prices when you're just trying to fill up one, two, three providers versus 20 or 30 providers. And so I would say there's really not a one size fits all, but I will say we are very diligent to make sure that we're not under the market rate for any of our services. 

We have a lot of systems around competitive analysis. And I think that our partners are so different. It really is a bespoke service that we have for our partners. We have, again, we have Esthetic Center and the Williams Center, these two partners;  the Williams Center is like a 25,000 square foot facility, and they have plastic surgery, they have hair, they have Med Spa Aesthetic Center has three locations and dozens of providers as well.

(25:31):

And then we have other partners that have just one injector. And so again, it really is a bespoke way that we think about every single partner and operationally how we maximize their production, what they're able to do. 

And I think that's another facet of this industry that can be highlighted as well, is there is a lot of variability, and you have a lot of med spas that are attached to a facial plastic surgery practice or to a derm office or to a general plastic. And you have some of these other med spas that are non-core, that are tiny, some that are non-core and, sorry — core is a facial plastic, an oculoplastic, a derm or a general plastic. 

Any medical director that's not one of those four, it's considered a non-core medical spa. So you have some non-core med spas that are tiny, a salon suite. You have others that are absolutely massive, and it's just not a lot of, hey, this is a normal med spa, this is what they usually look like. There's just a ton of variability.

Brad Hildebrand (26:38):

Maybe going back to why partners choose to partner with you. And I think obviously your alignment that you drive with the sellers is extremely important. Maybe talk a little bit about the JV model and how you think that that uniquely aligns Alpha with the practices that you guys bring on board.

John Wheeler (26:57):

Well, I think a lot of M&A is moving toward joint ventures, and I think it makes a lot of sense because it just creates so much more, like you're saying, so much more alignment, where we're not giving you this big check so that you can care less than you've ever cared and go on more vacation that you've ever been on in your life and to pass all your problems on to us. 

We've always described this as a partnership, and I think that almost every M&A company does, right? It's like almost every M&A company has partners in their name. And so if this is a partnership, what does that actually mean? What does that actually look like? Well, it means that we share in the upside. It means that you are as invested emotionally and mentally as you ever were. It just means that you brought on a capital partner and an operating partner that can now help really maximize the value of your business.

(27:50):

And so I think for us, the way we think about it is, we're going to buy 100% of your business over time. There's going to be two waves of that. On day one, maybe we're buying 60% of your business, and then we're working as partners to continue to grow your business over time and, over a handful of years, whether that's seven or 10 years, you have the option to sell us the remainder of your business at these equity events. 

There's some optionality there, too. And I just think it's a beautiful model, because it keeps people engaged and it creates a true partnership, and it creates a situation where people crave, yes, let's talk about the P&L. How's the business doing? And there's a financial incentive for them to do so on a quarterly basis. And so it matters how their business is doing. It matters how much vacation they're going on.

Brad Hildebrand (28:51):

How informed do you think folks are that are out there in the market and looking for a partner like Alpha around the whole JV structure? I think I would say it's likely that the market as a whole understands that structure a lot more than it did five years ago, but how much of an education exercise do those initial conversations around that structure tend to be?

John Wheeler (29:13):

What's funny is I think there are a lot of people in dentistry that are doing joint venture models. We are the first in aesthetics, and we believe in a year, in two years, we believe everybody's going to be doing JV. We feel like we're innovating in our space. We see really where things are headed, and we want to be early adopters in it. And so there's a lot of education right now that goes into it, a lot, because nobody else is talking about it, nobody else is doing it. But again, I think in one or two years it's going to be the norm. 

Brad Hildebrand (29:48):

We agree. I just think the importance of alignment here really does lend itself well to that structure. And I think, like you said, a lot of folks have “partner” in the name, but how you deliver financially also really lends credibility to that partnership. So, we agree. 

I think you're doing a lot of good for the industry to be out evangelizing the JV partnership angle. The folks out there doing JVs are a very prominent piece of the market. In terms of folks that are actively doing M&A, I would say it's an even higher percentage. It certainly is very material, not just in dental, but in other areas of retail healthcare as well. Sure. 

So John, I know you're a veteran podcaster. You've been very generous with your time today, but maybe that's just the last piece here — I'd give you an opportunity to get up on your soapbox and talk to folks that are interested in this industry and investors, and what else would you want them to know about Alpha or about aesthetics as a sector generally?

John Wheeler (30:49):

That's such a great question. When it comes to Alpha, I mean, integrations, operations, data, just a really well-built company, and that's what Thurston, our PE sponsor is known for, right? 

It's just building really great companies, and I think we're all really excited around Alpha. The leadership team is absolutely lights out. We also just have this flavor of industry insiders, given a lot of our backgrounds within this industry. You look at the podcasts that we're putting out, the content that we're putting out as well. We just have a major platform in aesthetics. And I just think that Alpha is poised in so many ways to just continue to grow in a way that's profound and meaningful for years to come. And then, as far as the aesthetic space in general, this is a rapidly growing industry. Obviously there's a lot to love, right? It's fragmented, it's cash pay, it's recurring, it's growing at 15% a year.

(31:51):

It's going to be $26 billion by 2026. And so there's just a lot to love. And I think right now, there's a lot of demand, there's not a lot of supply. And I think that, of the supply that there is, Alpha is just an incredible company, and I am really, really proud of what we're building. And I think it's exciting, and I can't wait to continue to see what we're building and the amazing partners we’re bringing to the table. Again, super happy partners. I think that's the most fun. 

We all went to AmSpa — it’s a big show in our industry —  in April. And it was so fun, because on our all-partner call — we do an all-partner call every month; we also have all of our partners in a Slack group — and so we said, "Hey, we're going to be at AmSpa, and a bunch of the partners are going to be there."

(32:42):

And our newest partners actually, at the time, Anne and AJ from Anne Therese Aesthetic Medicine, they said, "Hey, we live in Florida, but we hear some of our partners are going to be there." So they actually weren't even going to go to the show. They didn't even get tickets to the show. We had an Alpha party on Friday night at AmSpa, and they flew out just to come to the Alpha party, just to meet the partners and to celebrate.  And we had probably 35 Alpha team members and partners, and people that worked for the partners, at a big party Friday night, a big dinner. 

And I think that really, for me, was the magic of Alpha — is community, right, is tribe that is functioning and operating in an insanely high level that we're all wanting to get after it. We're all wanting to build a regional empire in each of our regions. And so, yeah, that was just a fun moment, and I think that there's a really strong sense of pride around Alpha amongst our partners.

Brad Hildebrand (33:44):

It's fantastic to hear, John. Congrats on the momentum, and congrats on all the success you've had getting the platform to this phase, and best of luck moving forward as you continue to build it. Once again, John Wheeler, CEO, Alpha Aesthetics Partners. Thank you, John, for joining us.

John Wheeler (34:00):

Thanks for having me.

Brad Hildebrand (34:03):

Thank you to the audience for listening to that discussion with John Wheeler. 

Additionally, I just wanted to mention that we did recently publish a white paper on the med spa industry. It's available at solomonpartners.com, and we will continue to talk to CEOs in this space, as well as others over the coming weeks and months on our Solomon Partners Presents podcast series. Thank you so much.

 You can access the MedSpa Market Overview Brad referenced here:
https://solomonpartners.com/2024/04/26/medspa-market-overview-trends-april-2024/