"I'll treat you to a little mani-pedi-Botox," is one of many "Sex and the City" quotes that will randomly pop into my head from time to time. (Watching the HBO series non-stop in high school and college apparently did something irreversible to my brain.) But I literally couldn't stop thinking about it in June when I met with Nicci Levy, the founder of Alchemy 43, which aims to become the "Drybar of Botox" by making it easier and more affordable than ever to get a quick hit of injectables at one of her four (with more to come) locations in Los Angeles.
Samantha Jones (Kim Cattrall) delivers the above line to Carrie Bradshaw (Sarah Jessica Parker) during a season-5 episode, at which point the ever-practical Miranda Hobbes (Cynthia Nixon) jumps in: "You say that like everybody's doing it." Jones's confidently prophetic response? "Everybody will."
Sixteen years after that episode first aired, Jones's dream of an America in which such medical beauty treatments are as normal as a visit to the nail salon has become reality. Services like Botox, fillers, lip injections and laser treatments that used to be done behind the closed doors of dermatology and plastic surgery offices, and rarely spoken of, are now being done in brightly lit, beautifully decorated storefronts on lunch breaks, and then shared on social media. Sales of Botox alone have risen 800 percent since then.
One pioneer of this movement, which seems to be gaining the most steam in Los Angeles right now, was Kate Somerville. The skin-care guru and businesswoman's Melrose Place clinic offers medical aesthetic treatments involving injectables and lasers in conjunction with custom facials in an environment that deliberately feels more like a Hollywood star's glamorous home (there are chandeliers in about every room) than a doctor's office, right next to Alfred Coffee and The Row.
"I helped pioneer paramedical esthetics when I opened the clinic and I always felt that having services like injectables would create more success for us," explains Somerville, who began her career working with doctors and plastic surgeons. "At first, it was difficult because I was paving the way for the first clinic of this kind, but the support and interest in its success has always been extremely positive."
At Kate Somerville, however, the full range of services offered are expensive and marketed as a luxury experience, whereas a new wave of clinics/spas/salons/whatever you want to call them focus on just one category of services and aim to make them accessible to all with a scalable business model.
With Alchemy 43, which launched in 2016 but is currently in expansion mode, clients can easily book a last-minute appointment online or even walk in and choose from a menu of quick "microtreatments" that make sticking needles in your face sound like the least medical thing you could do. There's "Hello Bright Eyes," with the description "Say hello to enticing eyes with this simple treatment that kicks tired eyes to the curb," and "Perfect Pout," explained thusly: "Get the lips you've always wanted with this easy, artful treatment." The actual space has all the trappings of millennial Instagram bait: pink walls, neon signs, marble countertops and velvet seating with gold accents.
Levy says she was inspired by Drybar, and how founder Ali Webb took a service that was one part of another experience — getting a haircut at a salon — and created a whole scalable business around it. Levy plans to add 50 locations over the next six years. "Our goal its to be the place consumers think of when they think of getting these things done," she says.
"It's certainly luxurious but very in-and-out; you don't have to have your entire day disrupted," is how she describes the experience. "Not an indulgence, but a ritual — something you do on a routine basis." To encourage those routines, and to make them more accessible, Alchemy 43 offers a $99/month membership program. According to a 2017 report by the American Society of Plastic Surgeons (ASPS), the average fee for Botox is $385. The membership fee goes towards treatments, which come at a discounted price for members who also get a variety of other perks, like a $100 gift card after three months. So while Alchemy 43's prices aren't inherently cheaper than what you'd find in a doctor's office, the program allows members to effectively pay more gradually, in addition to getting discounts.
Skin Laundry, which you might call the Drybar of facial laser treatments, offers bundle deals to keep prices low and encourage repeat business, and operates out of 20 clean, comfortable, convenient salon-like storefronts throughout the country and even internationally. Soon, it will begin popping up in select department stores like Nordstrom.
It offers a limited menu of just three services: a 15-minute "laser and light" facial for $75, a 30-minute "carbon peel" for $150 and a newly added "ultra fractional" facial with more powerful lasers that promises similar benefits to Fraxel without the downtime for $250. Per the ASPS report, Fraxel costs, on average, $1,114. "I wanted to make medical grade laser solutions that have been tried and tested in doctors' offices for more than 10 years directly accessible to the consumer," explains founder Yen Reis of her inspiration for launching the business. "I didn't understand why such beauty solutions had to be so expensive and so inaccessible to the market."
Skin Laundry's limited menu and the brevity of its services are not only meant to simplify things for clients, but they're also integral to its business model — uniform treatments are easier to scale and keep consistent across many locations — and ability to keep usually-pricy laser services relatively affordable.
In addition to affordability and convenience, this new wave of clinics do something else that most doctors do not: PR and social media marketing. Skin Laundry and Alchemy 43 both offer complimentary services to influencers in the hopes of getting shout-outs; the former has amassed over 40K followers on Instagram while the latter employs a growing group of nine ambassadors who act as evangelists of the business. Given the subject matter, Levy didn't feel that typical pay-for-play influencer partnerships would make sense, and instead looked for "ambassadors who are interested in educating the world about these treatments in their own voice."
Le Jolie Medi Spa, which has two popular Los Angeles locations, more than 30K followers, and just held a pop-up in New York to prep editors and influencers for Fashion Week, was literally designed with Instagram in mind. "The first thing I told my designers when creating Le Jolie was that I wanted my space to be completely Instagramable from every corner," says Co-Founder Brian Nourian. "No matter where a patient takes a photo, from our waiting area with our signature neon pink 'Pick-Me-Ups' sign to our outdoor patio area, the background and ambiance is aesthetically pleasing in every shot."
Nourian thinks it's a combination of social media, celebrities like Kylie Jenner (who supposedly stopped using lip fillers recently) and places like those mentioned in this story that are contributing to an overall normalization of medical beauty treatments — and not just among those concerned with reversing signs of aging. "We're able to leverage such platforms like Instagram to broaden our reach and scope, while demystifying the medi spa industry by highlighting our technology, techniques, and expert staff, which helps reduce the intimidation and fear factor often associated with medi spa services," he says. "Absolutely the stigma is gone. We have patients of all ages either coming in for preventative measures or to gain a boost of confidence."
Each business owner I spoke with said millennials make up a substantial — and growing — portion of their customer base. "We definitely have seen younger clients come in for injectables over the past few years," says Somerville. "It is so much trendier because of social media and people are much more open with what they are getting done."
More than half of Alchemy 43's client base is under 35, and nearly 40 percent were first-time injectable users when they came in. Such is the power in making these services more accessible. "I've enjoyed the on-boarding that we've had with our millennial clients," says Levy. "They're a fun group of users; they have no stigma or shame around these treatments," hence their willingness to talk about them as just another aspect of their self-care routines.
The preventative benefits of Botox on the faint forehead lines I've recently developed were emphasized to me during my visit to Alchemy 43, the idea being that it's easier to prevent than reverse wrinkles. While I did not ultimately partake, I did undergo a lengthy consultation, during which I was shown a simulation of what I'd look like with strategic Botox and fillers on a giant 3-D image of my face. After the initial horror of seeing my face that close up in such high resolution subsided, the experience was incredibly convincing. Without pressuring me to do anything or making me feel bad about myself, the friendly, relatable women made their services seem like total no-brainers, and I believed their dedication to achieving natural-looking results. Suddenly, it was easy to see why Botox, cheek fillers and lip injections have become so popular, even among people my age (almost 30) and younger.
But even though an actual doctor was talking to me, and completely willing to answer my questions about side effects, the environment and casualness of our discussion also made it easy to forget that these were medical treatments during which a number of things can go very wrong when done improperly — something that could likely become easier to forget with every subsequent maintenance visit. One of the reasons I opted not to get Botox was essentially the same reason I don't dye my hair — because I could see myself returning again and again (repeat business is integral to all of these clinics' success) each time it wore off, and I'm not sure I'm ready for the commitment.
Levy does seem to be taking the medical aspect of these services seriously, and wants Alchemy 43 to be reliable not just for convenience, but also for safety. She lamented the lack of a nationally recognized certification for injectable practitioners; even those with licenses could have learned the process from a friend or mentor or, in some cases, simply taught themselves. So, she's working on developing the Alchemy Academy, a nationally recognized training and certification program for injectables that includes ongoing training to ensure trainees are kept abreast of advancements in technology and technique.
In most cases, with the types of clinics covered above, the staff is overseen and instructed by a medical doctor, while the person administering the treatment likely is not one. One downside to not having an MD onsite is that there may be no one equipped to treat a client on the off chance something goes wrong.
"When performed properly, these procedures are generally safe; however, how you deal with potential side effects can be the difference between permanent scarring of the skin and proper healing," warns Dr. Joshua Zeichner, director of cosmetic and clinical research at Mount Sinai in New York City. "Injectables like Botox and Dysport must be properly placed to ensure optimal outcomes. Using too much or putting it in the wrong place can mean droopy eyelids or flat eyebrows." Worst-case scenario, if fillers are accidentally injected to a blood vessel, it can block blood flow to your face, which is obviously very bad and would require immediate medical attention.
Another concern is whether the quality of these services suffers in exchange for convenience, affordability, scalability and the profits of the entrepreneurs and investors behind these businesses. The more uniform their services are (see: limited menus), the easier it is to expand and train new employees. For business models like Alchemy 43's and Skin Laundry's to work, they need to treat a lot of people and get them in and out relatively quickly. Thus, you may not get as individualized a treatment as you might in a doctor's office. At Skin Laundry, they administer the same lasers at the same frequency in the same patterns on every client (though clients can request extra "passes" of the lasers). "Lasers and injectables are a very personalized treatment," said Zeichner, diplomatically. "I say that every face is different and should be evaluated by a board-certified dermatologist or plastic surgeon to ensure the optimal outcome."
Ultimately, it's up to us as consumers to be well-informed and not believe everything we see on Instagram. Without calling out any specific businesses, Zeichner admitted he is wary of the way some are shifting attitudes around medical beauty treatments. "These procedures are plastered all over social media and have become household names. I feel that many people approach these medical procedures much too casually," he says. "Cosmetic treatments are much more accessible than they used to be. If it sounds too good to be true, then it likely is."
His advice? Make sure the injector is experienced and board-certified; ask to see before and after photos and don't feel pressured to have the procedure that day. And lastly, "Remember that social media is about creating a narrative and what you see on your telephone may not accurately reflect the experience that the doctor truly has."