50 Red Flags in the Aesthetic Wellness World

Misconceptions and Mistrust in the Wellness Industry

Micheline Maxwell, PharmD

Collin Hart, MS

The wellness industry has come a long way since its origins but with the rise of readily available information through the internet and a steady stream of owners and potential owners looking for information and help to grow their business, there is also a steady increase of people looking to take advantage. My partner and I have owned an esthetic wellness facility since 2021 and have worked with roughly 100 different vendors within the space (not sure of the actual number). This document is not meant to call out any individual company or individual, rather, show the experience we’ve had to both warn and help identify red flags when you’re looking to work with a company (since we’ve worked with a ton). A blog like this would have saved us a lot of trouble, and by design we are as open as possible about what works and doesn’t work. We wanted to publish these learnings.?

To give some background about our company, we own Leg Up Recovery in Alpharetta, GA. We offer a multitude of therapies including wellness offerings, hair restoration, and body sculpting. We run our own marketing campaigns and pride ourselves in offering services that are clinically proven to help, and packages that we design for clients to reach their goals. Our metrics, results, and reporting is data driven so clients can see their results are actually working. This is what resulted in us creating a software subsidiary for proposal creation which will shortly allow customers to see their ideal body images.

?Our Alpharetta location, which is our model store, has one employee in a ~950 sq. ft. space that did roughly 25k in the last four days. I do want to stress that we weren’t always as efficient as we are today. It took a lot of trial and error to get to this point and working with a lot of companies showed us unfortunately we can do a lot of things better ourselves. On the other hand, we did gain a lot of helpful resources from some fantastic partners.

Our ultimate plan is to bring Leg Up Recovery nationally and make it a scalable franchise - which to do correctly / in a way that is honest takes a lot of work and frankly time with trial and error. We’ve been trying to make everything as efficient (and legal) as possible, which involved working with a comical amount of people within the wellness world, and the medspa world, and also had us do a lot of digging into competitors' businesses. Again, this is not intended to call anyone out so do not take it as such. If you think you are mentioned because you worked with us, you probably aren’t (but maybe change how you do stuff if the shoe fits). Let’s jump into it.

Red flags

1. If you are a franchise with no locations are you really a franchise (sarcasm)? I see these popping up and feel for the people who are getting bought into these as a result of salesmen not business folk. Anyone can be an expert at business in Excel / Google sheets but the execution of the plan is where 99% of the meat actually is. I see this with companies, ie. when they show you a sheet like “well if you only upsell 2% of leads it breaks even” type things when in reality that math just doesn't math.
2. If you are a customer and you observe a business with an exceptional amount of reviews left from the place's own employees - it’s probably a bad sign. This is gross - if you’re doing this, realize it’s fraudulent (just have them delete them). Ensure that the people you have leaving reviews for you have actually done services at your facility.
3. If you are using other companies before and after photos that were directly taken from surgical centers (where you are NOT doing surgery)…red flag. Taking these and acting as if they were your own, as well as performed with the same devices / techniques is a red flag to say the least. Not only is that fraud, but you’re ruining the industry perception as a result.?
4. If you are performing medical type procedures that are outside your scope of knowledge, this is a felony. Practicing medicine without a license is not something you want to be caught doing. This includes medical weight loss drugs like Semaglutide (or Ozempic). My rule of thumb is if it seems like a doctor should be doing it, a doctor should probably be doing it.
5. On the same note with Semaglutide, if you are purchasing your supply through a compounding pharmacy and claiming that it is the same thing as Wegovy?, you are either intentionally or unintentionally lying. I worked within the pharmaceutical compounding realm for many years specializing in non-sterile and sterile compounding. You are legally not allowed to compound a commercially available product unless there is a very specific reason to (like massive shortages or that a dosage is not readily available). You are also not allowed to create the reason for a compounding necessity like saying that patients need a very specific dose that is not available on the market just so you can supply it. Most of these pharmacies are using a different salt formulation than what is active in Wegovy? to compound it. It is not the same and cannot be advertised as such.
6. If you are an IV clinic and are not following USP 797 for your compounding needs, it will cause issues. USP 797 is a FEDERAL (I say this because I was told at a conference a few years ago that it was a state’s decision) guideline set forth to ensure that all sterile products are compounded correctly and within guidelines to ensure contamination is at a minimum. Most IV clinics that I have spoken to, including a few courses that I’ve sat in on, state that IV clinics don’t need to have a compounding hood in their facility because their products fall under “Emergency Use”. “Emergency Use” is a term that was meant to categorize sterile products used in emergency situations like mixing weight based medicines into IV bags for immediate life saving. It was not meant to include elective IVs given at a random clinic. I tell people if you cannot defend your actions in the worst case scenario then you need to change your approach. If your defense to someone dying from a bloodborne infection caused in your clinic is that you believed an elective IV on a healthy individual constituted “Emergency Use” so you did not use the more appropriate precautions then you may be on the hook for involuntary manslaughter.
7. If you are an agency advertising for semaglutide or “prescription” weight loss. There are very specific guidelines and laws that you have to follow and after seeing what’s in Facebook's ad library - I know you aren’t. For people running your own ads, have a lawyer who’s familiar with medical advertising double check your work. As a consumer, seeing ads for “Prescription Weight Loss” at a clinic that has no doctor on staff should raise a serious red flag.
8. Agencies like to brag about their revenue to get more clout. Realize if you are paying them for ad spend…that is pass through revenue. If you are paying them 5k a month in ads, you added 60k to their revenue (even though they are not making money from it…you hope). We say this to hope business owners are not struck by someone saying they run a 7-figure marketing company when really it’s a lot less.
9. Realize if you are a customer for a spa, there is a HEAVY chance that the sheets, towels, robes etc. you are using have not been washed between customers. This is appalling and honestly makes me weary of going to other places. There’s technically not a health code in a lot of states outside of food businesses that would check in to ensure cleanliness.?
10. There’s a bizarre amount of body sculpting machines on the market - however there’s only several decent ones. I say that because I see a lot of off brand, knock offs, and generally not proven machines being used. There’s a reason some of these machines are upwards of 100k. If you order yours from China, for $5000 brand new, realize it’s not going to be able to get clients the same results - and provides an exceptional use case for you to injure your clients. Top tier products have tons of sensors and safeguards to protect your client. Also good luck with training…
11. Let’s talk about those results. If you’re a call setter telling people on the phone your $199 service alone will transform their clients bodies just stop. This is something agencies love to do because many don’t know what it is they are even advertising for. They also have quotas to meet for their clients like getting 10 - 20 new clients through the door each month. They generally don’t care if the clients are good fits for you in the long run but they’ll spend $199 and never come back.
12. Back to agencies. It’s a red flag if an agency is putting more effort into getting new clients, then fulfilling their current clients. Lots of agencies are built around being sales people - not actually being good at being an agency or doing what they are selling. There’s a wild market where agencies don’t even do their own fulfillment and send all fulfillment to other companies without you knowing.
13. If the agency is bragging about their custom developed CRM (which is just a whitelabel), or says you will use the same offers as all their other clients…red flag. It shows dishonesty, and really doesn’t make sense for your business to be doing the same thing as everyone else (unless you’re into stale growth).
14. If an agency wants to charge you to change an offer you feel isn’t working…red flag. Is it really that time consuming to change a couple words? Not really. Not if they're doing it correctly within their CRM and just using variables for everything so they only need to change it in one place. This goes back to agencies all using the same offer (likely because the person you are talking to is not even the one doing it since they don’t know how). To be clear, not all agencies are like this but it’s a red flag when you see things like this.
15. If an agency guarantees you don’t pay unless they perform - it may be a red flag. Generally you pay regardless, just in ad spend (I’ve actually never seen an example where that isn’t the case). On their side, the worst case scenario you just increase their business revenue with that pass through revenue I mentioned earlier. If you already have business, it’s risky to try something that may result in less business / harm your reputation (there is absolutely a cost).
16. If an agency claims they can target your ideal customer better than other agencies using Meta - it’s probably a red flag. Meta now has Advantage+ audience targeting which is AI powered, and almost certainly the exact same thing your agency is using. It is also the same thing you would use if you were running the same ad yourself. Back in the day audience targeting was a big deal, now it’s mostly automatic.?
17. If you’re a business competitor and you comment nasty things on other businesses' advertisements - it’s a bad look, and a red flag for your business. It’s also a weird waste of everyone's time since hiding comments is super easy to do.
18. If your business goes years with just a handful of reviews, then goes a week and gets like 200 from many people who have never left a review before…it’s a red flag. Consumers (and your competitors) see it, and people can tell when reviews are clearly coached / paid for.
19. If you see someone talking about their revenue in a group, and it’s absurdly higher than it should be - it’s probably a red flag. I’ve seen this with people claiming they’re a cryo business or similar and you look deeper and see it’s like a 20 person operation, with MDs, and with multiple brick and mortar stores in A+ (expensive) locations. Then when you break it down you realize they’re actually probably losing money (revenue without cost is useless except to lenders ironically).
20. If you’re a customer, realize many operators for spas are NOT licensed to be doing spa treatments yet do them anyways. This is sketchy - but it’s also one of those things you can notice when you see places advertising esthetic services and look online and see they’re not even a licensed spa, let alone an esthetician.
21. Hyperbaric oxygen chambers can and do explode. The red flag is to know what you are being sold and using. Google search “hyperbaric chamber explosion”. Look into how many people have died in these (as of 1998 the number was 135) - if you’re a consumer, understand the risks you’re taking with these (they’re not a “totally safe” service)…or bare minimum realize they can and do explode. There’s a reason many fire departments (including ours) have a HARD stance against these.
22. Some manufacturers require you to use certain lotions or similar with their products. A great example of this is cryolipolysis gel that many companies require. You’ll take the training and learn you should NEVER use ultrasound gel. I challenge you to look at the ingredients of an ultrasound gel and compare it to the 3000x markup product you are using. Might look similar…
23. Alright back to ads. It’s a red flag if your ads are using celebrities. Did you get permission to use that? Chances are that the “A level” celebrity didn’t agree to be in your small business ad.
24. If you go to a contouring location and they are taking photos of you on their personal iPhone…it’s probably not ideal. Realize these photos can and do end up on social media for owners showing off their clients results. Most of these are people in their underwear or less - and if you are a business owner doing this, please don’t as it is a huge privacy violation.
25. Most devices can burn people if used incorrectly. This is something that I see as a red flag as it’s not discussed nearly enough. Generally they are described as only being able to burn someone if something malicious happens - but I can say this is far from the truth. If you are told the machines can never burn - and it’s a device that does cold or electric stim - red flag.
26. If you are purchasing a large piece of machinery to put in your spa, get deadlines and depending who you are dealing with, put the money in an escrow. I have heard many stories of certain people taking money (like 200k+) and never delivering. Ironically it’s something we are dealing with as of now (lower amount)? and I wish we had taken this advice.?
27. If you are a customer and you come in stating you will leave a bad review if you are not satisfied with the service before we even do the appointment, expect to not be offered anything and instantly blacklisted. I cannot elaborate how much of a red flag customers like this are. Have a good experience, but please do not come back. We’ve also had customers tell us they will leave a bad review unless we do XYZ for them, and normally this is before the service even has begun. Firing customers is completely fine to do to protect your business.
28. Nitrogen is dangerous. If you are using a cryotherapy machine that is running on nitrogen without having an oxygen sensor in your location it’s a red flag. This is particularly important for those who have the dewars inside - all it takes is a leak.
29. Carpet. I consider this something I’ve cursory noticed however seems to remain relatively true in that if a wellness center is using carpet on their floors, they will likely go out of business. Do a look online for businesses for sale / that went out of business and see how there is a weird correlation between carpet and business failure - so it’s potentially a red flag.
30. Some products are so wildly overpriced that I have a hard time even explaining how they even sell anything. Or more who has the means to buy that and would choose to buy it? Some cryo machines are more than 200k. Think about that…if you weren’t using cryo as a draw and legitimately were trying to make money with it, it would take over 5,700 sessions at $35 each to break even. What in the world…who would do that? Like just the math… that’s like 3 a day for 5 years assuming no acquisition cost, holidays, or any expenses. A lot of red light beds are in a similar boat. They don’t make a ton of money, why would someone pay 200k for that instead of something that had a service that cost more?
31. On that note, let’s talk about the next red flag - shipping and handling. While I understand there are some costs associated with shipping devices etc. There are also some companies that literally profit on these. Some cryo companies are literally 20 - 40k for shipping / installation depending where it’s being shipped. I wish I was making that up since it’s comical if you’ve ever seen one in person, or been on the receiving end of how they set them up. Or a speaker system upgrade for $3,500…let’s be real. $3,500 speakers are what are used at concerts, not something the size of a phone booth - I consider this a red flag.?
32. Businesses that offer unproven modalities always scream red flags. While I know much of this industry is holistic, there’s a point where some is just complete make-believe. What comes to my mind is a place I saw that had like 40 computer screens playing a special video to synchronize someone's mind or something like that (to be frank I have no idea what it was supposed to be doing). Some modalities have never been proven, don’t claim they do something they don’t.
33. Minimum pricing is a big thing for many modalities, and something that is required for your business to follow if you’re offering certain services. If your business is offering services for specific devices below minimum pricing - it’s a red flag - and may get you in trouble with the manufacturer.
34. On that note…if your agency is offering your services below the minimum pricing it is a major red flag. Why can’t they get people in the door unless it’s borderline free? Are they not good at the execution? Minimum pricing should be easy to hit.
35. I always cringe when I see the generic $199 sculpting and facial offer. It’s not related and won’t really work for the client by itself…be honest. Tell customers when they book that they likely won’t see huge results from one session instead of getting them in the door and springing a package on them.
36. One thing I hate seeing is agencies “activation campaigns” which generally have really bizarre promises. In reality what these do is take your contacts, and mass text them. I’d be careful of this…it’s a good way to get your number marked as spam and hurt deliverability rates. I consider it a red flag since if you have your contacts you can do the same thing faster than it would take you to have the intro meeting.
37. A lot of mail order pharmacies will sell specific drugs using a 503B license to offer it as “office-use” which means that the end facility doesn’t need to provide individual prescriptions for the facility to receive the drugs. The intent of this practice is to allow doctors to prescribe starting doses in office visits. This is not intended for weight loss clinics with overseeing medical directors that have never visited their facility to use. When it states “Office-Use Only” the pharmacies mean a doctor’s office.
38. Speaking of medical directors, if you have never met your medical director in person, it’s a massive red flag. In many states, it’s required that the medical director works or has direct access to the facility at all times. Most online medical director suppliers are using a network of doctors that may or may not even be in your state.
39. Please check your state’s requirements before opening any kind of business. I have seen a lot of people opening IV clinics or weight loss clinics without the proper licensure or without the correct personnel. I got an IV once at a clinic from a paramedic which I found out after it was started. In the state I live, paramedics aren’t allowed to insert IVs unless it is an emergency situation.
40. If you are opening a business and are either requiring sales goals when it comes to Semaglutide (or other prescription weight loss drugs), or have an overseeing franchise requiring you to hit certain sales goals it’s a red flag. Prescription drugs have a lot of laws surrounding them to keep them from being unnecessarily prescribed to protect the public. This includes not allowing sales goals at end facilities (i.e the opioid crisis). There are agreements that can be set up to legally set your business up including “operator agreements” or “operator / physician” agreements, but again everything should be looked over by a healthcare focused lawyer. If you are pushing Semaglutide on every client for the sole purpose of making revenue, it’s a red flag.
41. If your sole reason for bringing in semaglutide was to make money…and you have never used it yourself, or was bought into the idea from an agency, it’s a red flag. Think it through for a minute…as a consumer would you want to receive a literal prescription drug from someone who isn’t a doctor, and a literal knock off of the real thing? I’ve seen the “we can just give you the needles” bypass for the in office use requirement. Does that even sound right to you??
42. On the semaglutide rant still…places online are offering it for a couple hundred dollars. If your business is banking on the revenue from it, you may want to diversify fast. On that note do a quick search for “semaglutide compounding lawsuits” - you’ll see a bunch of medspas / clinics that are being sued for their knockoffs…just a matter of time.
43. A lot of owners are heavily relying on device manufacturers for training but then when you look at who the device manufacturers have on staff it’s just a salesman. The company doesn’t actually have estheticians or medical staff to provide training for services that are supposed to be performed by an esthetician or medically trained employee. A lot of training for these companies are outsourced entirely to third party companies that are paid to do the training. If the company you are buying from doesn’t have anyone on their own staff that can do the service, it’s a red flag.
44. Staff turnover with agencies is a massive problem I’ve experienced. I’ve done a lot of first time calls with great staff members and then when I actually sign on to use the agency, I’m paired with someone completely different to actually fulfill the service. That has led to a lot of disappointment when the services are actually being fulfilled.
45. If the salesman in your first demo meeting spends more than 15 minutes and hasn’t gone over what the product is, it will not end well. A lot of times these companies have an unnecessarily lengthy process to gather information before they even schedule a demo call with you. Then when you actually get onto the demo call, they spend the first 15 minutes asking you the same questions that were on the questionnaires. This is an exponential waste of time for business owners that already have small amounts of free time and generally leads to an overall disappointing experience.
46. If you’re talking to an agency or consultant that is supposed to be helping “Grow Your Business” but they have never owned a business before, they’re not going to give you good advice. As mentioned before, anyone can be an excel business guru but that doesn’t mean that they’ve ever actually had to deal with the problems you’re seeing first hand.
47. If your expert consultant is telling you the only way to get your name out there is to use sites like Groupon - run. These sites will hardly ever bring you clients that are good for anything other than a quick deal. They very rarely convert to long term clients or members. Groupon also takes 50% of the income generated by the sales that you put on their site. That means if you have a $100 service you’re discounting to $50 for Groupon, you’re really only going to make $25 off that service. People pre-pay so they are less incentivized to actually up-sell, and many are gifts.
48. If you as an owner are not working to constantly get more native Google Business Reviews, realize this is really hurting your business. It is wild how many businesses don’t have a Google page or even a website (it’s SHOCKINGLY higher than I would have predicted). If your spa has no online presence outside of social media, it’s a red flag.
49. As a consumer, if I walk in and am immediately allowed to go to a service without signing any sort of waiver, I’m suspicious. We have had a lot of customers say it’s the first time they’ve signed a waiver for the type of service we offer…concerning since we have a literal human freezer. It’s not just for the wellness services either, I’ve been told by a lot of clients that were surprised I had them filling out a waiver for a facial service. This concerns me because a lot of facials can cause issues for those that have had botox, filler, dermaplaning, or are pregnant.?
50. If your package / membership / walk-in pricing can’t be explained in under a minute to a brand new customer, you really need to work on that. The amount of places I’ve seen that have weird tokens or credit systems that make no sense or are deliberately confusing is very frustrating as a consumer. It shows things were sort of just added on without a lot of thought and is a red flag.

If you think you were called out, again you probably weren’t (we have worked with a LOT of people). With that said, we are also FAR from perfect and have our own red flags we’re likely just oblivious to. To be clear, this is all just our opinions and our experiences and may not even be accurate so take them with a grain of salt. Maybe some of the red flags we listed are not red flags for you and that’s fine. Our end goal is that hopefully this helps someone!