Most Aesthetic Practices Are Building Brands for Yesterday's Market

I spent a day at the IMCAS Economic Forum in Paris listening to industry analysts, BCG partners, and pharmaceutical executives present their market intelligence. Then as I flew home I reflected on how many medical aesthetic practice owners in the US do exactly what those executives warned against.

They’re chasing product trends. Adding services. Competing on price. Running paid ads to cold audiences.

Meanwhile, the entire consumer relationship just changed.

What I Heard in Paris

The numbers weren’t encouraging. North American market contraction. Category pressure across multiple segments. Single-digit growth replacing the 7-8% everyone got comfortable with.

But the actual insight came from how the speakers framed the problem.

Michel Brousset from Obagi put it directly: “We have consumers that are more and more informed. Consumers come to practices with already a point of view, already a point of view formulated on what they want and what they don’t want, and they are no longer passive in receiving information from practitioners.”

He continued: “I think the importance of brands, the importance of connectivity to a consumer, the importance of reaching out to the consumer directly and providing them with information before they find it on Google or on Wikipedia, or worse places is imperative.”

Read that again. Before they find it elsewhere.

Your brand matters before the consultation. Your positioning matters before they call. What you stand for matters before they walk through your door.

And most US practices are still organized around “show up and we’ll tell you what you need.”

The Breakdown

Here’s what I’m seeing back in the States:

Practices scrambling to add GLP-1 weight loss prescriptions because “everyone’s doing it.” Adding bio-stimulators because fillers are soft. Launching new service lines because growth slowed. Running Facebook ads to anyone with a pulse and a credit card.

Zero brand strategy. Zero market positioning. Zero understanding of who they’re actually building for.

Sergio Rossi from BCG asked the room a question that apparently nobody in the US is asking: “We are happy with the 5% growth of the market. But how can we double the size of the market from $30 billion to $60 billion considering this is a market with a lot of underpenetrated opportunities?”

His answer wasn’t “add more services.”

It was ecosystem orchestration. Consumer orchestration. Product orchestration. Wellness integration.

He presented data showing 50% of aesthetic consumers are already on nutrition plans. Not “should we add supplements?” but “if half our patients are already investing in nutrition, what does an integrated wellness-aesthetic protocol look like?”

Many practices are still trying to figure out which filler to discount this month.

What Actually Matters Now

The forum speakers kept circling back to three themes that almost no one in the US is executing on:

First: Direct-to-consumer brand building is not optional anymore.

David Moatazedi from Evolus explained their model: “We’ll partner with clinics and we co-brand every aspect of how we operate with them. Our advertising drives demand into the clinics that value the product. We advertise clinics locally, within a radius of their office.”

He added: “We put a beauty lens on our products because we believe for the consumer, as they get younger, they’re really looking for a natural look. They’re looking for approachable brands.”

Notice what he’s saying: They’re building brand affinity before the patient walks into a clinic. They’re creating preference in the market, not just driving traffic.

Most US practices think marketing means “run some Instagram ads and hope someone books.”

Second: The consumer archetype diversified and nobody updated their model.

McKinsey presented research showing that GLP-1s didn’t create one type of aesthetic patient, they created four distinct archetypes, each with completely different spending patterns and treatment preferences:

Maximizers (17% of market) aren’t budget-concerned. They want safe, luxury, high-quality outcomes. They’re open to surgical and non-surgical combinations. They’ll layer treatments. Highest spend, highest lifetime value.

Strategic Optimizers (24% of market) are selective. They’ll invest in high-value treatments requiring multiple sessions—think bio-stimulatory fillers. Primarily non-surgical. They want results, but they’re thoughtful about where they spend.

Value Seekers (22% of market) are budget-conscious but consistent. They focus on basic HA fillers and toxins. Similar to your average aesthetic patient. They’re not going away, but they’re also not upselling into premium protocols.

Surgical Resolvers (15% of market) are seeking body contouring. They require medical supervision. They have different aesthetic challenges that non-invasive treatments can’t address.

Here’s what matters: Across all four archetypes, HA fillers, neuromodulators, and skincare remain mainstays. But 25%+ are considering wider treatment ranges, fat grafting, PRP, various energy-based device options, surgical interventions.

Then a physician panelist added what he’s seeing with GLP-1 patients specifically: “More and more, my patients are micro-dosing. They’re not coming down from major weight loss. They want to just have a little bit of weight loss. They want to look their best and they want to maintain. These are patients who are saying, ‘Wow, I can feel and look better. I don’t have to do a lot, but now I want to look a little bit better too.’”

That’s a fifth emerging segment that doesn’t fit neatly into any of the four McKinsey categories.

Different motivations. Different spending patterns. Different lifetime value. Different treatment protocols. Different marketing messages.

One practice model cannot serve all five effectively.

But most practices are still trying to be everything to everyone.

Third: AI and ecosystem thinking separate winners from losers.

Michael Giaquinto from Wells Fargo laid it out: “AI is going to be a huge way to make this industry more effective and more productive. Physicians can leverage AI to help patients, help educate patients. Product manufacturers incorporate AI into their offerings to cement themselves in the offices of providers.”

But then he said the critical part: “There’s tailored education through AI, not through ChatGPT, but through tailored, programmed AI from the provider to the patient population.”

Not generic AI. Branded AI. Your philosophy. Your protocols. Your approach.

That’s ecosystem orchestration. That’s how you reach consumers before they form opinions through “worse places.”

What US Practices Are Missing

Back home, I see practices doing the opposite of everything discussed in Paris.

They’re reactive, not strategic:

• Filler sales soft? Run a promotion.
• GLP-1s trending? Add prescriptions.
• Competition increasing? Cut prices.

They’re transactional, not relational:

• No brand positioning beyond location and “we do everything”
• No consumer education before the consultation
• No protocols that differentiate their approach
• No ecosystem thinking connecting treatments to outcomes

They’re product-focused, not journey-focused:

• Selling syringes instead of transformation protocols
• Offering services instead of solving problems
• Competing on availability instead of philosophy

Sergio said it plainly: “We want to engage in a price war and compete on price, or we want to offer something more to providers and consumers. To me, this is the main thing.”

The US aesthetic market is overwhelmingly choosing price war.

The Strategic Shift

The practices that will dominate 2026 and beyond are asking different questions:

“Who are we building this for, specifically?”

Not “aesthetic patients.” Not “women 35-55.”

The practice built for Strategic Optimizers investing in multi-session bio-stimulator protocols looks nothing like the practice built for Maximizers wanting surgical-grade outcomes. And neither looks like the practice serving Value Seekers who want reliable toxin at fair prices.

Different brand. Different experience. Different team. Different everything.

“What’s our point of view?”

Because as Michel said, consumers are arriving with opinions already formed. If you don’t give them your point of view before they Google it, someone else will.

Your brand is the pre-consultation. Your content is the education. Your positioning is the filter that attracts your ideal patient and repels everyone else.

“How do we orchestrate the entire journey?”

Jeff Bedard (Revance) from one of the major manufacturers explained it: “That patient is a white canvas, and we as industry supply the paints and the brushes. The more that you can supply different colors, a fine brush, a broad brush, the more important within that ecosystem you’re going to be. But they all have to work together.”

Skincare + injectables + wellness + nutrition + energy-based treatments. Not as separate profit centers. As one coherent protocol with your philosophy baked in.

The Standard You Enforce

Here’s what separates strategic practices from reactive ones:

Stop adding services. Start building protocols.

More services without philosophy just means more things to discount when revenue drops. Protocols with scientific backing and measurable outcomes create defensible positioning.

Stop competing on convenience. Start competing on conviction.

“Easy to book” and “same-day appointments” are not differentiators. Having a clear point of view on aging, beauty, and transformation and attracting patients who share that view—is.

Stop marketing to everyone. Start building brand equity with someone.

As David said about Evolus: “We put a beauty lens on our products because the consumer is really looking for a natural look. They’re looking for approachable brands.”

That’s a choice. A positioning. A filter. And it works because it’s specific.

Choose your archetype. Build for them. Market to them. Repel everyone else.

The Punch

The aesthetics industry in Paris spent a day discussing how consumer behavior fundamentally changed and what ecosystem orchestration looks like in response.

The aesthetics industry in the US is still running Instagram ads for “$50 off filler.”

One group is building brands that reach consumers before they form opinions.

The other is competing for whoever’s left after they’ve already decided.

The market already separated these two approaches.