The State of Aesthetics: Q3 2026

Existing patients drove much of the growth. On locations open in both Q3 2025 and Q3 2026 (a wider set than same-store, so the two rates don't reconcile), revenue from existing patients grew 8.4% at the median operator, while revenue from new patients fell 6.9% and new-patient counts slipped 1.8%. Existing patients bring in about 82% of revenue, so a point of growth there moves the total about five times as much as a point from new patients.

Newer locations also hide weakness at the bottom of the panel. About one in five operators did not grow at all. A quarter grew total revenue 1.8% or less, and a quarter saw same-store revenue fall 6.2% or more. Without newer locations, the bottom of the panel would look like a decline, not a slowdown.

Operators of every size grew: +15.2% for 1 to 5 locations, +17.1% for 6 to 20 and +18.2% for 21 or more. Same-store growth was +2.8% for 6 to 20 locations and +2.3% for 21 or more, against +7.3% for 1 to 5, and mid-size operators' new-patient counts fell 17.4% (Exhibit 2).

By operating model, wellness-integrated operators grew faster in total (+21.2% against +17.1% for pure aesthetics) but more slowly same-store (+5.1% against +7.3%). New patients set them apart: new-patient counts grew 7.4% at wellness-integrated operators and fell 7.6% at pure aesthetics operators (Exhibit 3).

In the bottom quarter of operators, new-patient counts dropped 19% or more. In the top quarter, they grew 11% or more.

New patients buy differently. Laser and energy is 13.3% of their revenue against 8.3% for existing patients, injectables are 39.9% against 43.4%, and wellness is 3.7% against 10.6%. Wellness is mostly something patients add once they're already coming in, which matches section 06.

A quarter of operators rebook 76.5% or more of completed appointments, and a quarter rebook 61.5% or less. The weak end sits further from the median (9.5 points below it) than the strong end does (5.5 points above), so there's more room to fall behind than to pull ahead.

For churn, lower is better. It was 44.6% at the median operator, with a quarter of operators at 40.3% or less and a quarter at 50.3% or more. First-time patients are the group to watch: of patients who first visited in Q2 2026, 45.2% came back within 60 days.

Lifetime value has a long upside. The top quarter of operators reach $2,578 or more per patient, 58% above the median, while the bottom quarter sit at $1,321 or less, 19% below.

Within the existing base, revenue concentrates in the high-value tier. Existing patients are split into thirds by what they spent on services and products in the 12 months before the quarter, set within each brand: high value is the top third, mid value the middle third and low value the bottom third. Existing patients who spent nothing in that window are a separate group. The high-value tier brings in 50.1% of revenue at the median operator, and those patients visit more often (1.79 times in the quarter, against 1.5 to 1.6 for the other tiers).

Operating model pulls retention and value apart. Wellness-led operators see each patient 2.40 times a quarter against 1.54 for pure aesthetics, and lose fewer patients (28.5% churn against 49.3%). But they do no better at bringing patients back a year later (39.2% against 39.8%), and their lifetime value is the lowest ($1,449 against $1,993). Recurring wellness visits keep patients active within the quarter, and so far that hasn't turned into more value per patient. The wellness-led group is small, so read this as a pattern, not a precise figure.

Member retention is high almost everywhere: a quarter of operators keep 76.2% of members or fewer, and a quarter keep 94.5% or more. Membership penetration varies far more, from 14.3% at the weak end to 40.7% at the strong end. Membership dues made up 4.7% of revenue at the median operator.

Members spend about 1.7 times what non-members spend in the quarter at the median location. Part of both gaps is who chooses to join, so treat them as an upper bound on what membership does on its own.

A strong ticket is $529 or more and a weak one $315 or less, but where you land depends on your model. The wellness-led ticket is likely lower because those operators see patients more often for smaller visits, such as weekly GLP-1 injections and lab draws. It's the average across all of their visits, not the price of a wellness service, and they still earn about the same per booked hour as wellness-integrated operators ($491 against $486).

The room to grow ticket sits with patients who already come in. At the median operator, about a third of wellness patients also buy aesthetics, and pure aesthetics runs the highest ticket of the three models. Section 06 covers where that cross-sell happens and where it doesn't.

Wellness share means weight loss and GLP-1, hormones and peptides, and IV and vitamin services as a share of total revenue. It sets each operator's operating model: pure aesthetics under 5%, wellness-integrated 5% to 30%, wellness-led over 30%.

Which lines

GLP-1 and weight loss is the largest line: 4.1% of total revenue at the median operator, ahead of hormones and peptides (1.3%) and IV and vitamins (0.3%). The mix shifts with operating model, and GLP-1 reaches 16.3% of revenue at wellness-led operators (Exhibit 10). Within wellness, the more wellness-heavy the operator, the more it's a GLP-1 business: GLP-1 is 47% of wellness revenue at the median pure aesthetics operatorOperating models are set by each operator's wellness share of revenue. Pure aesthetics: under 5%. Wellness-integrated: 5% to 30%. Wellness-led: over 30%. Full definitions are in Appendix D., 64% at wellness-integrated and 75% at wellness-led. For pure aesthetics operators, where wellness is under 5% of revenue, that's a share of a small line.

Who buys it

GLP-1 is mostly a cross-sell to existing patients. Among patients who bought GLP-1 in Q3, only 9.7% were new to the practice at the median operator. The rest were existing patients adding it to what they already buy.

Cross-sell runs mostly one way. 34.5% of wellness patients also bought an aesthetics service in Q3, but only 4.7% of aesthetics patients also bought wellness. Operators differ far more on the aesthetics side, where the middle half runs from 1.6% to 8.8%, more than fivefold, against 25.7% to 49.8% the other way. Part of the gap is structural, since some wellness-heavy operators sell few aesthetics services, but limiting the comparison to operators that offer both lines doesn't change the pattern. Where each line is at least 1% of patients and at least 20 patients, 34.1% of wellness patients bought aesthetics and 6.2% of aesthetics patients bought wellness (Exhibit 12).

Wellness is also a front door, though a small one. At the median operator, 3.2% of new patients first came in through a wellness visit, against 3.5% a year ago. That rises to 6.9% at wellness-integrated and 42.5% at wellness-led operators. Few of them cross over early: of patients who started with wellness in Q2 2026, 7.7% bought an aesthetics service within 90 days, against 34.5% of all wellness patients who bought aesthetics in the quarter. The cross-sell in Exhibit 11 builds over a longer relationship.

What it does to the business

Wellness trades ticket size for frequency. Wellness-led operators run a $276 ticket against $498 for pure aesthetics, see each patient more often and lose fewer patients (section 03). Operators with more wellness revenue lose fewer patients, and the relationship holds when we remove the most influential operators or look at aesthetics operators only.

Read that as a feature of the business model, not a lever. Wellness programs are built on recurring visits, which lowers measured churn by design. It doesn't show that adding wellness to a practice lowers churn.

LTV:CAC runs from about 5× at the weak end to about 36× at the strong end, a sevenfold gap.

Blended acquisition cost counts Google and Meta spend against every new patient, not just the ones ad platforms claim. At the median it's $95. A quarter of operators pay $44 or less per new patient, and a quarter pay $280 or more.

Meta takes 42.1% of paid media spend at the median operator and Google 57.9%, though operators range widely, from 26% to 67% Meta across the middle half. We don't report a year-over-year change in the mix, because the comparison depends on which operators are included each year.

Revenue per booked hour runs from $442 at the weak end to $682 at the strong end, so the 75th-percentile operator earns about 1.5 times the 25th. Utilization runs from about 18% to 39%. Pure aesthetics operators earn $608 per booked hour, against $486 for wellness-integrated and $491 for wellness-led.

Treat 29.8% as a floor on chair time. Scheduled hours include breaks and, in some systems, staff who aren't bookable providers. The median also covers all scheduled hours, so the gap between prime and off-peak hours is likely much wider than the headline suggests.

Utilization doesn't explain growth in this data, and turnover shows no reliable relationship with revenue per booked hour. With a panel this size, that doesn't rule out a moderate one. Across all operators the link between growth and revenue per booked hour is loose, but top performers earn more at the median ($599 against $527, section 12).

For no-shows, lower is better: the best quarter of operators lose 1.8% of revenue or less, and the weakest quarter lose 3.1% or more. Wellness-led operators run a higher no-show rate (2.8% against 1.4% for pure aesthetics). Fee charges equal 4.2% of missed appointments, down 0.5 points on operators present in both years, and even the top quarter of operators only reach about one in ten (10.3%).

Discounting is where the larger dollars go. The median operator gave up 16.6% of gross revenue to discounts, about flat on operators present in both years (up 0.2 points). The middle half runs from 11.3% to 24.2%, and the heavy end stretches further from the median (7.6 points above it against 5.3 below).

Operators that charge fees more often don't rebook more in this data. This compares operators with each other, so it doesn't test whether enforcing a fee changes patient behavior.

This is a snapshot on one date compared with the same date a year earlier, so treat it as an early read on Q4 demand, not a forecast.

Beyond dashboards: predict, model, act

What changed in Q3 is the mode of use, not just the volume. The top operators have moved past the dashboard era entirely. A templated report only answers the questions a reporting vendor picked in advance, for everyone at once, using the vendor's definition of every metric, whether or not it fits how your business runs. These operators ask their own questions, computed with their own definitions, bespoke to their service menu, their providers, their market, this week. And more people on each team are asking them, from owners to location managers and front-desk leads. These are real questions operators asked in Q3, verbatim from the query logs (names and places redacted):

Read the list again and notice what's not on it: nobody is asking for a report. No two of these questions would fit the same template, which is why templated reporting can't produce them. They are operating decisions in question form: a lapsed member to win back, a patient who left without rebooking, a campaign to compare, a provider conversation to have. And they move through three modes the canned-report world doesn't have: predict (how bookings are trending against last month), model (what share of patients cross between aesthetics and wellness) and act (a list of patients to call back today).

Turn this report into a plan

Questions worth asking your own data, by section of this report.

What top performers do

1. They win new patients, and win them efficiently. New patients bring in 19.3% of revenue at top performers against 15.9% for the rest. At the strong end, operators grew their new-patient count 11.3% or more while the median operator's slipped 1.8%. Cost matters as much as volume. Across the panel, the strong end runs an LTV:CAC of about 36 to 1, against about 16 to 1 at the median, and pays $44 or less per new patient. Measure it on every new patient, not just the ones ad platforms claim.

   Watch monthly: revenue from new patients, new-patient count against last year, and LTV:CAC.

2. They earn more per booked hour. Top performers earn $599 per booked hour against $527 for the rest, and the strong end earns $682 or more. Ticket is about the same in both groups ($404 against $388), so the difference is likely in what fills the hour, such as service mix and visit length, not a bigger invoice. Utilization doesn't track growth in this data (section 08), so raise what the hour earns first. Once it's well paid, filling more of it is the next lever: the median operator fills only 29.8% of scheduled provider hours.

   Watch monthly: revenue per service hour by provider, then utilization.

The trade-offs they make

1. They discount more. Discounts take 18.8% of gross revenue at top performers against 14.9% for the rest. At the strong end, discounts take 11.3% or less. If you use them to win patients, check that those patients come back.

   Watch monthly: discount rate, and whether discounted new patients rebook within 90 days.

2. They rebook less. Top performers rebook 69.8% of completed appointments within 90 days against 76.8% for the rest, and more of their patients visit only once (62.4% against 60.1%). At the strong end, operators rebook 76.5% or more. New patients add the most to growth when they come back.

   Watch monthly: rebooking within 90 days, especially for new patients.

What holds up at any growth rate

1. They run membership as the product. Membership penetration is about the same for top performers and the rest (25.5% against 26.6%), so it isn't what set growth apart this quarter. Members still come back far more often: 90.4% of members came back against 50.6% of non-members. At the strong end, operators enroll 40.7% or more of active patients, against 26.6% at the median. Sell it at checkout, starting with your most frequent non-members.

   Watch monthly: membership penetration, and member against non-member retention.

2. They put the whole team in the data. At 81% of operators, three or more people now ask questions of their data, up from 59% a quarter earlier. At the strong end, about 2.8 people per location do it, against 1.5 at the median. One person with a report login can't run the habits above. Managers who can check their own numbers can.

   Watch monthly: how many people on your team ask questions of the data, beyond leadership.

Top performers are operators above the median revenue growth; figures for them and for the rest are the median operator in each group. No-show rates are about the same in both groups (1.9% against 2.1%). Strong-end levels are each measure's 75th percentile, or its 25th where lower is better, so they come from different operators measure by measure and describe what good looks like, not one operator's playbook. Every figure clears the same privacy rules as the rest of the report. This shows association, not cause.