By Madilyn Moeller, Editorial Assistant, American Med Spa Association

Medical aesthetics is a booming business, but getting into the industry isn't as easy as dropping off your application at the local medical spa. So how do you get into medical aesthetics? To find out, AmSpa spoke with someone who has nearly 20 years of experience in that area—Mary Beth Hagen, founder and CEO of Titan Aesthetic Recruiting.

AmSpa: How does someone get into medical aesthetics?

Mary Beth Hagen: It's not an easy field to get into, as I think people either know or quickly find out. And to get started, you have to first understand a couple of things.

Number one, you have to understand aesthetic math. You're not going to get rich right away when you start in this, because, unlike therapeutic jobs, where there is payment coming in from an insurance company, in aesthetics, if you're not bringing in services or providing revenue through services or products sales, there's no money to pay a new injector.

That's why so many new aesthetic clinics are very nervous or leery to hire someone with no experience—you really need to be able to either provide revenue in order to get paid, or be willing to really invest in yourself, both in terms of knowledge and preparation. And since you can't expect a lot of compensation, that means that you probably have to do a lot on your own as a new injector.

Keep in mind that in most places, you should start out by having one of three designations: registered nurse (RN), nurse practitioner (NP) or PA. In almost every state, providers with those three designations can inject, and their license allows them to do transdermal injections.

AmSpa: So how do you then get started?

MBH: The first thing you want to do is invest in yourself with knowledge about the market—not only about the industry, but also about the local market where you hope you're going to work.

You want to make sure you understand some history and the products, procedures and companies that provide the products you'll work with as an aesthetic provider. You also want to make sure that you invest in yourself and anatomy, and in understanding the clinical issues that you're going to be facing when you're working with patients in the aesthetic field.

AmSpa: How do you start by investing in yourself?

MBH: You first have to decide, do you want to be an injector, or do you want to be more of a full-service aesthetic provider? Many places will hire people and start them off doing device treatments, whether they be body contouring like CoolSculpting or, for example, treatments using the BTL products. A lot of times, they will want people to do laser hair removal, some IPL type of products, or maybe even microneedling and platelet-rich plasma (PRP) and things like that. Sometimes, having a broader awareness and studying more products and procedures on your own will allow you to provide more revenue production to a clinic sooner.

But most everybody really wants to get into injecting, which is doing fillers and toxins. And what people have to realize is that this is very much like a new or a different specialty in medicine—just because you've done a lot of injections or put in a lot of IVs does not mean that you're prepared for the specialty area of aesthetics.

I talk to people every single day who say, "I have 100 résumés from people who say, 'Oh my gosh, I want to get in this field so badly. I'm so excited about it. Please hire me, please train me, and I promise you I'll work really, really hard.'" The problem is, if you haven't done anything to invest in yourself prior to sending out that résumé, the employer really doesn't know that you will actually take it seriously and invest in yourself after getting hired. The best thing you can do to get into this industry is invest in yourself before you set to start sending out résumés.

Now, there are a couple areas that I highly recommend that people learn about or think about. The first thing you want to do as an aesthetic injector candidate is learn about the history of aesthetics in the United States. You want to learn about where we've come from and how we went from just having plastic surgery nurses injecting collagen to feeling like there's a medical spa on every street corner.

The second thing that you really want to understand is facial anatomy. You better know where you're putting that needle. There are a lot of really good cadaver and anatomy training courses out there. There are some free online courses, some great introductory courses, and an online app that is a fantastic introduction to facial anatomy. Christopher C. Surek, DO, and Jonathan Sykes, MD, both do amazing cadaver courses. They really give a lot of injectors a good introduction to where they're sticking that needle and where the product is going. Learning the facial anatomy from "what is it," "where is it" and "what's it all called" standpoints is really important.

You also have to understand the why behind anatomy—the why behind injecting, and not just the hands-on. A lot of people who just do a weekend training course end up struggling when they get out on their own, because they haven't been taught how to think through what they're doing and how they're going to create a treatment plan for each patient. You really want to understand why the aging process happens, what different modalities are available to treat it, and how you can think through the best choice of treatment plan for each individual patient.

Another thing—when you're thinking about becoming an injector, you have to think about how you're going to credential yourself to perspective patients. What are you going to say when someone says, "Tell me why I should trust you with my face?" All this preparation goes into credentialing yourself—not only to a prospective employer, but also to your prospective patients.

AmSpa: Are there any soft skills that you need to go into medical aesthetics?

MBH: That's a great question. There are actually a lot of soft skills you need, because I think people tend to think about injecting as just cookie-cutter. But, if you look around, no two faces are the same, so there are going to be no two treatment plans that are the same. I always say that to be a good injector, you really need to have three skills.

You need to have a good head. You have to be smart enough to learn all the material, but you also have to be able to talk to patients to communicate well, and you have to be able to be a little bit of a therapist as well. You have to be able to communicate, educate and listen to what a patient's expectations are to be good at this.

The second area you need to have is a good hand, because, a lot of times, you're injecting very minute amounts of product, and it has to go in very specific layers of the skin. You need to have the right amount of projection, the right amount of lift and the right amount of placement in order for that product to integrate well into the tissue.

But the third thing that people need to have—and I think this is overlooked a lot—is the aesthetic eye. Having been in the industry for almost 20 years, I've probably seen 3,000 people inject. And I will tell you, there are some that are, I'm sure, fantastic medical providers, but they just don't have that aesthetic ability to see symmetry and shape and balance, to see skin tone, or to see volume and how that affects light and shadows and curves and angles.

If a prospective injector doesn't have that aesthetic eye, they can probably be a very good provider with devices, with injections like Kybella or Qwo or toxins. But it's really, really tough to have a lot of skill with fillers if you don't have that innate aesthetic eye.

If you have those aptitudes, it's pretty easy. I mean, you can get up to speed relatively quickly if you've done the background training. Nobody gets up to speed quickly if they just do a weekend course.

So, you need to figure out what you want to do in terms of working in aesthetics. Once you've identified that, then you need to learn about the history, you need to learn about anatomy and you need to learn the clinical. Then, you need to think, "Okay, how do I develop mentors? How do I learn as much information as possible? How do I develop a foundation and resources so that as I'm learning, I have a place to go to for additional information or to double-check my knowledge?" You really want to make sure that you teach your brain to inject before you teach your hands to inject.

AmSpa: Do you promote continued education once you get past that step?

MBH: You never stop learning with aesthetics. Most of the good aesthetic injectors you talk to will tell you that they easily spend $10,000 a year of their own money updating their skills and learning, going to courses and society meetings.

Unlike the national physician organizations, there are no national professional organizations for our RNs, NPs and PAs. Aesthetically, you have the International Society of Plastic and Aesthetic Nurses (ISPAN), and I encourage every aesthetic nurse or nurse practitioner to join that, but that doesn't encompass the PAs. I really think it's important for anybody who works in the aesthetic field to make sure they go to at least one CME course every year where they can talk to other providers.

The beautiful thing about this industry is that almost every single experienced injector out there will talk to naive injectors and help them in any way they can. It's a very collegial industry, but I think the biggest thing for new injectors to understand is that you have to invest in yourself before others are going to invest in you.

I always tell everybody to think about their first year in aesthetics as being almost a residency program, because that first year you're going to be drinking from a fire hose and you're not going to bring in that much revenue to a practice. So, be willing to say, "I will start at a lower compensation rate if you will work with me to help me learn and grow."

People also need to learn that clinics will expect you to do your own a lot of your own marketing. It's pretty much expected now that you are going to do social media, that you are going to do patient education events—that you are going to invest in the time and effort to help build your own patient base. Nobody's going to just hand you a business on a silver platter.

So, if you really want to prepare yourself well, invest in yourself. You want an aesthetic job? Invest in yourself first.

AmSpa: How do you know if aesthetics is the right fit?

MBH: That's a great question. So, number one, do you see aesthetically? Number two, are you a self-motivated and continual learner? Because this is not, "I'm going to go to school for one weekend"; this is, "I'm going to learn and read and study and keep my skills updated every day for the rest of my life." You need to have clinical skills, sales skills and marketing skills. And if you're scared to sell—if you're scared to ask people for money—this is not the job for you.

Most of all, you've got to work as a new injector. You've got to work nights and you've got to work weekends. You're going to work Saturday if you're a new injector. So don't call somebody and say, "I want you to hire me, but I won't work Saturdays." We're in an industry where the only people who can really afford these treatments are people who have jobs and make money. And you have to be able to see them at a time when they can come in.

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Mary Beth Hagen founded Titan Aesthetic Recruiting to link injectors and employers. Working in aesthetics since 2005, She developed a strong knowledge base within the industry while working at both Medicis (now Galderma) and Allergan. Working with injector and physician key opinion leaders within the industry helped her develop the concept behind Titan Aesthetic Recruiting. Hagen created the Titan Aesthetic Screening protocol to identify potential injectors with innate aesthetic aptitudes and strong communication skills.