As the medical aesthetic industry enters 2018, it continues to achieve unprecedented success. But top businesses won't rest on their laurels—they are already evaluating a new set of emerging products and services that will help them set standards in the industry for 2018 and beyond. Following are a few of the trends that will likely play a role in shaping the future of the medical aesthetic industry.


Laser-based vaginal rejuvenation will likely continue to grow in popularity as people become more aware of it. This is a laser treatment used to address changes in vaginal health often caused by childbirth and menopause. It may also be used to treat side effects in women who have undergone a hysterectomy or chemotherapy. A vaginal rejuvenation treatment involves a laser handpiece that is inserted into the vagina, delivering controlled energy pulses into the tissue.

During 2017, it achieved phenomenal success in terms of patient satisfaction—the women who undergo this procedure tend to recommend it to their friends, and it transcends the aesthetic field by providing patients with genuine medical benefits, such as addressing incontinence, preventing leaking, and stimulating lubrication. Depending on the laser technique employed, its satisfaction ratings tend to be more than 90 percent, which is very impressive.

At the same time, however, vaginal rejuvenation hasn't caught on quite as much in the medical aesthetic space as some might have predicted, possibly because physicians, owners, and operators tend to be unsure of how to market it. Therefore, patient awareness of this procedure is somewhat lower than it needs to be to make it a highly profitable procedure with a good return on investment.

However, because patient satisfaction is so high, and because new treatments and technologies will make the procedure quicker and less invasive, vaginal rejuvenation once again seems primed to become a major part of the aesthetic industry. Sciton, for example, has introduced a fully automated product that performs vaginal rejuvenation in only three to four minutes; other manufacturers also are developing cutting-edge solutions designed to make this procedure more efficient and less intimidating. If technology continues to improve and patient satisfaction remains high, medical aesthetic facilities will likely begin to adopt this procedure more widely than they have thus far.

This is a trend that is still in its developmental stages, but it is certainly worth keeping an eye on.


In 2017, there was a notable increase in the amount of regulatory enforcement in all states. State boards have been going after people who they perceive to be bad actors with zeal that they haven't shown previously. For example, an employee of the Lemel Medical Spa in Surfside, FL, was arrested in November after she was accused of administering medical treatments without a license. This increase in enforcement likely will continue in 2018, so if you are not sure about the degree to which your medical aesthetic facility is compliant with national, state, and local rules and regulations, now is the time to clarify this with your healthcare attorney. (Author's note: The American Med Spa Association [AmSpa] works with a national law firm that focuses on medical aesthetic legalities and, as a member, along with a number of other benefits, you receive a discount off of your initial consultation. To learn more, log on to

Speaking of clarification, many states are working to better define which procedures can be performed by which individuals in a medical aesthetic setting. For example, state boards in Texas, Virginia, and Georgia are currently working to create certification processes that will allow non-physicians to perform laser hair removal without a doctor present, as well as to own their own laser hair removal facilities. The New Jersey Medical Board has also indicated it might be loosening some of its restrictions on laser operations. The industry is going to continue to see states examine their laws and determine how to regulate these treatments in ways that are prudent for both practices and patients.


In 2018, a fair number of very large medical aesthetic chains will emerge. The companies looking to make this move are very well financed and have aggressive, innovative business plans. They are beginning the process of franchising, which will give entrepreneurs who are trying to get into this lucrative industry an enticing opportunity to do so—they can latch onto an established brand and side-step some of the headaches associated with medical aesthetic facility ownership.

An example of this is Orange Twist, an emerging company co-founded by Grant Stevens, MD and Clint Carnell that has six locations in California, one in Washington state, and one in Texas. Additional examples include Beverly Hills Rejuvenation Center and Kalologie 360, which have locations in several states and are actively searching for new franchisees. Perhaps the largest chain is Ideal Image, a privately owned company that has dozens of locations in 31 states and British Columbia.

The expansion of chains such as these will provide more options for the public and more opportunities for businesspeople who wish to get into the industry, but they will also increase the amount of competition in the field. Although this trend has been somewhat slower to emerge than I expected (I mentioned this in my trends article last year, as well), I believe these chains will alter the landscape of the business in 2018.


Traditionally, the medical aesthetic industry has been the domain of physicians who are referred to as “core doctors”—plastic surgeons, facial plastic surgeons, oculoplastic surgeons, and dermatologists. After all, the people who work in these fields are uniquely well-suited to capitalize on the booming medical aesthetic industry. However, in recent years we have seen non-core doctors flood into the marketplace, and this is expected to continue in 2018.

As it stands right now, approximately 60 percent of all medical directors at medical spas are non-core. Of the 300 people that AmSpa has educated at its Boot Camps, 60 percent of them had not yet opened their practice or had just opened in the past 30 to 60 days, and of those, 90 percent were non-core doctors or entrepreneurs. There is a sizable influx of non-core doctors, entrepreneurs, and nurses coming into the marketplace, and their ranks will only expand as the popularity of medical aesthetic treatments increases and the public becomes more aware of these businesses.

Similarly, nurse practitioners are going to play an increasingly large role in the industry moving forward. Illinois recently amended its Nurse Practice Act to allow nurse practitioners to achieve full practice authority, and other states are expected to follow suit in the near future. As regulation increases and as medical aesthetic facilities become more compliant through education with associations such as AmSpa, nurse practitioners will become an essential and necessary part of the infrastructure of medical aesthetic practices. There is no doubt that more and more nurse practitioners will be entering the space as training becomes more readily available and people start to realize that there is a major need for mid-level practitioners. The same is true of physician assistants; however, nurse practitioners will likely start dominating the industry when it comes to performing treatments such as injectables and serving as de facto medical directors when doctors aren't on-site.


A number of the treatments that made waves in 2017 will continue to define the medical aesthetic industry in 2018. Microblading is a semi-permanent makeup technique that has become something of a sensation in the past year and, because it provides an extremely large return on investment, more and more medical aesthetic practices will offer it. If your facility does not offer microblading, it's certainly something you should consider bringing into your space.

Microneedling has been a popular service in medical aesthetic practices and medical spas for several years, but its expansion has been restrained to a degree because the FDA has raised questions about which devices are approved and who can use them. Thankfully, according to AmSpa's sources, the FDA is preparing to make some announcements regarding microneedling devices, which should help clarify the controversy and allow medical aesthetic practices to make better decisions and perhaps provide microneedling services in a more cost-efficient way.


In 2017, a lot of startups entered the medical aesthetic industry—more than in any other year in recent memory. These entrepreneurs raised money and helped create innovative products, including software, training, deliverables, and devices. In 2018, the industry is going to see even more new people and companies enter the marketplace with a lot of money, a lot of fanfare, and a lot of marketing power.

For example, a Silicon Valley biotechnology company called Revance has developed a longer-lasting botulinum toxin injection (DaxibotulinumtoxinA), which is currently in the final stages of the FDA review process. Other companies are designing new electronic medical record (EMR) and patient management software that capture the specific data that medical aesthetic practices want to have on hand in order to more effectively operate their businesses.

In addition, several companies are creating training programs specifically for the medical aesthetic space. These include not only training in treatments such as injectables and lasers, but also sales training that will help medical aesthetic employees better understand how to succeed from a business perspective.

The investment in new products and services by companies entering the medical aesthetic field is likely going to shake up the bedrock companies that have been entrenched in the industry for many years. Be on the lookout for—and be open-minded about—new products and services that can help give your practice an advantage over your competition.

Stay Awake

It's important for conscientious medical aesthetic practice physicians and operators to keep an eye on the ways in which the medical aesthetics industry is evolving. It's useful to understand everything that's happening and why some are choosing to change their businesses to keep up with these trends. Nobody wants their medical aesthetics practice to be the one that's behind the times.