How to Open a Med Spa

To open a med spa, first find out who is allowed to own one in your state, then set up the medical side with a physician, choose the treatments you’ll offer, plan the treatment rooms around them, and get each license that applies to the services and the space. A medical spa is a medical practice that looks like a day spa, and the medical part decides most of the rules.

That’s the step people skip. The floor plan, the devices and the marketing all come after the ownership question.

Who Can Own a Med Spa?

This is the first question, and the answer changes from state to state. The rule behind it is usually called the corporate practice of medicine: limits on who can own a business that provides medical care. Each state sets its own version.

California is a strict example. The Medical Board of California says that if a med spa offers medical procedures, “they must be owned by physicians.” Its guidance on the business of medical spas adds that laypeople may not own any part of a medical practice, that a medical corporation has to be majority owned by California physicians, and that no more than 49 percent can belong to other licensed professionals such as nurses, physician assistants and nurse practitioners.

The same guidance says management companies, franchises or other setups that let an unlicensed person influence medical decisions break the law. Other states draw the lines differently. A healthcare attorney in your state is the right person to set this up, before you sign a lease.

Do You Need a Medical Director?

The medical side needs a physician who answers for it. What that looks like depends on the state.

In California, the Medical Board says a lay-owned business hiring a medical director is not allowed, and a physician who acts as medical director for a lay-owned business is aiding and abetting the unlicensed practice of medicine. Procedures there are done by a physician, or by a registered nurse or physician assistant under a physician’s supervision. The physician doesn’t have to be onsite but must be immediately reachable.

Texas handles it through delegation rules. Under 22 TAC 169.26, a physician, physician assistant or advanced practice registered nurse must either be onsite during a delegated cosmetic procedure or be immediately available for emergency consultation. Rule 169.28 requires posting the complaint notice and the delegating physician’s name and Texas license number in each public area and treatment room, and name tags showing each provider’s credentials.

Vagaro estimates the medical director agreement and state licensing at roughly $10,000 to $30,000.

How to Open a Med Spa as a Nurse

The honest answer is that your state decides. Under California’s rules, a nurse can’t own a medical spa alone, can’t set up a practice in a salon, and can’t hire a physician to supervise them. A nurse can hold a minority share of a physician-majority medical corporation.

If your state lets a nurse own the business side while a physician controls the medical side, the contracts have to spell that out. Whether it’s allowed where you live is a question for your state’s medical board, nursing board and a healthcare attorney. License type matters too. California’s Medical Board notes that nurse practitioners get more autonomy than registered nurses.

Whatever the structure, write down who examines patients, who orders treatments, who performs them and who supervises. California, for example, requires an appropriate prior exam before prescription drugs or devices are used, and says that exam can’t be delegated to a registered nurse.

What Rules Cover Med Spa Advertising?

Advertising is medical advertising once you sell medical treatments, and some states regulate it closely. California’s Medical Board says ads must carry the physician’s name or a registered fictitious name, even when nurses perform the treatment. Its guidance also lists practices it considers prohibited, including unlabeled models, retouched photos, unsupported claims of superiority, bait-and-switch discounts and “for as low as” pricing.

Texas takes a different angle on the same goal. Its posting rule puts the delegating physician’s name and license number in front of every patient in the treatment room itself.

Check your own state’s rules before you print a price list or post before-and-after photos. A healthcare attorney who reviews your ownership setup can review your marketing at the same time.

What Does a Med Spa Cost to Start?

Devices are the big number, not furniture. Vagaro puts a small med spa with one or two treatment rooms at $200,000 to $350,000, and three or four rooms at $350,000 to $500,000. A single laser hair removal device can run $50,000 to $200,000. The full breakdown is in how much it costs to open a med spa.

Pick your first services with that in mind. Laser and energy devices cost the most up front and take floor space, so read each device’s installation sheet for power and room needs before you place it.

How Do You Lay Out a Med Spa Floor Plan?

A med spa floor plan is built from treatment rooms. Plan these spaces:

• Reception and a waiting area that feels like a spa, with a reception desk in view of the door.
• A private consultation room for exams, consent and before photos.
• Treatment rooms. Each holds a procedure chair or an esthetician bed, usually 70 to 74 inches long, plus a provider stool and a cart. Buy-Rite Beauty advises leaving room to move around every side of the bed.
• A device room or a larger treatment room for the laser, with space for the machine and its cart.
• A clean supply and medication storage area that staff can lock.
• A restroom, and a staff area or back room.
• Walkways of at least 36 inches. The 2010 ADA Standards also need a 60 inch turning circle in some spaces and 30 by 48 inches of clear floor beside fixtures.

The med spa floor plan maker has a 10 x 10 ft treatment room block, a procedure chair, a facial bed, a lash bed, an equipment cart, a reception desk and a restroom. Drop in one treatment room, furnish it, then duplicate it until the space is full. That tells you quickly whether the suite you’re looking at holds two rooms or four. Export the plan as a PNG or printout for your architect.

In Texas, remember the physician’s name and license number go up in every treatment room. Plan a spot on the wall.

What Are the Steps to Start a Medical Spa?

1. Learn your state’s ownership and supervision rules, and hire a healthcare attorney.
2. Bring in the physician and agree on the structure, protocols and supervision in writing.
3. Choose your first services and the devices they need.
4. Write a budget. Devices and build-out lead the list.
5. Find a space with enough rooms, plumbing for sinks, and power for the devices.
6. Draw the floor plan, then get it designed and permitted.
7. Get each license that applies. Medical services fall under the medical and nursing boards. If you also offer facials, waxing or lashes, the esthetics side may need a state establishment license too.
8. Train staff, set up records and consent forms, and open.

If you’re weighing a simpler spa without the medical side, compare how to open a spa. For the non-medical services, how to get a salon license explains how shop licensing works.