How much money can you really make starting a Botox® practice? And much more.
This is the first of a four part “Ask an expert” series with Suzanne Jagger, APRN, CRNA. Here we are focusing on how much money can you make injecting Botox? Check out part II of this series Who Can Inject Botox™?
Suzanne is the owner, medical director and aesthetic injector at Aura Aesthetics Med Spa in Portland, OR. She runs Aura Academy, a neurotoxin and filler training course specifically for APRNs. She is passionate about offering clients an individualized aesthetic service where her client’s needs come first. As my instructor, I first-hand witnessed her passion for teaching an anatomy-heavy and clear, simple approach to neurotoxin and filler injections. Suzanne, over a number of interviews, answered the most common questions about starting a botox business.
The answers to these entry-level questions are incredibly hard to come by, often for the sake of decreasing competition in this field. Suzanne openly and clearly provided so much insider information that anyone looking to get into this business would benefit from. Please read the next 3 blog posts to cover all of the answers Suzanne provided. I really cannot say enough wonderful things about her and her class. Please find out more about her and the courses she offers at https://aura-academy.com/
How much money can you make injecting botox?
When I asked Suzanne, “How much money can someone actually make adding botox only (not talking any fillers here) to their practice?” She initially answered my question with her own:
“What kind of practice are you hoping to achieve? Are you trying to replace your anesthesia income through botox or are you looking for extra vacation and shoe money? Most people fall into the extra money category. There are three tiers of a neurotoxin business.
Friends and family
The first tier of Botox businesses is friends and family and/or a Botox party or 2 a month. If you can treat 5 people on a regular bases (30units/person every 3 months), you will break even on your business which includes course, malpractice, everything. If you have your sister-in-law, neighbor, best friends husbands wife, etc., you can start a break-even Botox business and, for the most part, get your own product for free. This is a low bar for entry and you will be eligible for business tax deductions from your LLC.
The second tier is If you want to go beyond that. Scaling above your direct friends and family costs time and money to grow it. If you want to make a couple thousand dollars a month you need to be seeing about 5 people a week, which actually does take work. It sounds easy but there is something to that.
Then you move up to share a space, like one room in a spa. I recommend like a hair salon- like where you get your brows done in the back, those are perfect. Or split at a place like SOLA salon two or three ways with another provider. Or come in on the days that the hairdressers aren’t there and using the places. The third tier of Botox business is getting your own lease of your own space.
There are people who are quite successful in doing a neurotoxin-only business without fillers. If you make Botox your only business then you need to generate volume. Which means time and marketing.”
How much does a vial of Botox (and other neurotoxins) cost?
I asked Suzanne, “How much does a vial of nuerotoxin cost?” And here is what she told me (off the top of her head in May 2020):
“In order to know how much money you can make injecting Botox, you need to know cost of goods. Minimum amount of purchase for product is typically 2 vials. There are 4 different providers in the US of FDA approved neurotoxin. Prices range from the cheapest, Xeomin, at $482 a vial to Jeuveau at $618. Botox costs $601, Dysport $532. Some companies have different purchasing programs to bring down the price (Xeomin does not). Galderma and Allergan have a tiering where the more vials you purchase, the more discount you receive. Jeuveau has friendly tiering-buying 6 dramatically reduces your cost.
You need to have a few things-certain things in a certain order to even be able to open an account with an FDA approved supplier. And you only order from there-not from China, not from Canada, you go to the company and pay full freight. You will open an account with each manufacturer and, as I said, only order from there. They ship really fast.”
How long is the shelf life of unopened Botox and fillers?
Pharmaceutical companies reward placing large orders of product with discount. This means it is important to know how long can you keep a vial or syringe on the shelf before popping the lid.
When I asked Suzanne, “How long can you let unopened vials of neurotoxin and filler sit prior to using?” This is what she said:
“Expiration date is dictated by what the pharmaceutical company did during their FDA approval period. For instance Ravenesse Versa’s shelf life was just extended to 12 months. Originally it was approved for 6-8 months because it was faster to get it through FDA approval with a shorter expiration date. Radiesse has about a 3 year shelf life.
Nuerotoxins are typically very shelf stable- Dysport about 6 months, Botox 1-2 years. Also you need to account for what lot you buy and how long it has been sitting before it gets to you. So there is no guaranteed shelf life from when you receive your order in that respect. If stored properly (normal room temps) none of the products have a problem with degradation or infection. Amount of degradation on nuerotoxin and fillers is very minimal according to studies done. Part of the shorter shelf lives are to encourage more purchasing. Although we must always adhere to the expiration dates.”
How long is a vial of product good for once you pop the lid and reconstitute it?
There is a reason botox parties are common. That’s because there is less worry about wasting part of your product by having it unused. I asked Suzanne, “How long is a vial of product good for once you pop the lid?” Here’s what she said:
“Per FDA approval, all neurotoxins are approved for 4 hrs. There is literature showing its safety and efficacy opened up to six weeks. There has been literature that came out recently that suggests it can be longer than that. It’s supposed to be reconstituted with saline, not necessarily bacteriostatic. There is some debate if using bacteriostatic saline decreases the longevity of the product after reconstitution. It is reported among providers that it does not, and I feel the safety of having bacteriostatic in a multi-dose vial is important for obvious reasons. And it also stinks less! You never ever want to use sterile water-it doesn’t work. It messes up the Botox molecule and it will not last as long by about half. “
Should a clinician add fillers alongside of botox to their practice?
Most aesthetic clinicians would agree fillers are much more of an art than botox, requiring more practice and obviously additional training. Fillers also have more profound, longer lasting complication than neurotoxins. But, the profit margin is way higher on fillers, and you can achieve markedly better results combining neurotoxin and filler injections. When I’ve asked a number of people who would like to start aesthetic injections if they plan to incorporate fillers into their practice, many shy away from the idea. Entering into a fillers practice is more intimidating than botox-only. Is it worth it?
When I asked Suzanne, “Should dermal fillers be added to a botox business?” She replied,
“If you really want to start generating money then you need to start talking about filler. The whole goal of botox is the conversion into filler where the market really is. Nuerotoxin is a gateway drug-it is a bit of a lost leader. Botox gets people in, but it’s really there to drive sales for other services. Here is the caveat, I’m a big believer filler should not be done as a mobile business (unlike neurotoxin alone). Fillers are a sterile implant that has dire consequences when it goes bad. You are not equipped to deal with that in someone’s house. It is not considered industry appropriate to do that mobile. I know that people do- and I won’t teach it, I’ve refused to teach people who want to do it at their kitchen table. I can’t live with that. “
How do you know how much Botox you will need to use by just looking at someone?
The importance of a medical assessment is paramount in any specialty. In the medical field, often times half of our work is done before even touching a patient. A well thought out (and flexible) plan cannot be overrated.
I asked Suzanne, talk a little about the importance of being able to do an aesthetic assessment. Here’s what she said:
“It’s just like anything, it took you three years to get good at anesthesia. You’re inexperienced that first year, you don’t know what you don’t know. You are a novice and as you learn you can reflect on how far you have come on the learning curve. It’s the same thing with this. First do no harm, build on your knowledge, stay in your lane, build up incrementally and you will improve if you’re thoughtful about it.
Just like in anesthesia, with experience you can kind of know just by looking at someone and have a decent idea of how much narcotic or gas they are going to need. It’s the same with this. You just learn how to read their face better, you can eventually just look at someone and know how much one syringe of filler is going to buy you. It takes time. You can’t rush. That being said, just like anesthesia, people will come along and surprise you, and require more or less product than you predicted!