Medical Spa MD is a community of physicians practicing nonsurgical cosmetic medicine. Join Us


2nd MD - Boarded US physicians work from anywhere.
Medical Justice
Relentlessly protecting physicians from frivolous lawsuits.

More control of your income, career, and lifestyle as a physician.
Newest Comments

Medical Spa MD is a world-wide physician community for clinicians in skin clinics, laser centers and medspas with thousands of physician members around the world. By using this site you agree to our terms of service and fine print.

Medical Spa Business Forum > Medical Spa Employee Salary & Comissions

Can anyone give me an idea of the going rate for employee's salaries in medspa setting. I was in need of help and hired an esthetician that worked for a plastic surgeon. She is certified as a laser technician and can do laser hair removal (for now). She demanded $19/hr and 10% of all her procedures and sales. AFter 2 months I am beginning to wonder how cost effective this is. Does this seem to be the going rate?

12.19 | Unregistered Commenterdc

DC: Compensation will vary a great deal depending on where your clinic is located AND the volume of treatments you do. My co-horts in California have to use nurses and payroll is a killer (usually about $35.00 per hour). In Minnesota I was between $15 and $20 for estheticians and $20 - $25 for RNs. With a high volume operation the 10% bonus will KILL you! Don't do it. The only way you can structure bonus comp (in my opinion) is to base it on achieving dollar volume thresholds. Most of us work on such a razor thin margin that we cannot aford ANY bonuses. It's rough out there!

$19 an hour seems fair- but 10% is a VERY high commission for services.Base her commissions on what medspa guy says: the total revenue of the business. That way she is vested in your WHOLE business and not just what she sells. I believe the techs work better and are easier to motivate if there is some type of commission structure.
10 % is outrageously high though-for example at ALC the manager made 5% on total gross revenue of the clinic but could not bonus unless the clinic hit 65K per month first. Where I am now the goal is 85K every two weeks (more services are offered here) and then the bonus is 5% of the clinic's gross revenue. The tech's made even a smaller percentage- something like 1%- because they had much smaller sales goals. If your esthetician is as money motivated as she sounds she will reconize the wisdom of putting the work in now to get the money later and she will partner with you in the business.
good luck!

Thats for the response. Was the comission based on the total earnings of the clinic or just what was reached after the set goal (65k) every month? In other words, if we met 65K and exceeded this, does she get % of the total or just what was above 65K?

12.20 | Unregistered Commenterdc

it was/is based on TOTAL from $0-to whatever you make in the month. If it's TOO hard to attain, she won't even try or if you make her commissioms off of the difference between 65K and 70K for example it will cause resentment. She'll think "hey I made $250 for all my hard work and he made $65,000 no fair!" not realistic I know but oh so true.
By the way the 65K was the supposed "break even point" when all of the bills were paid, the staff employed, the lights stayed on etc.It very well may be a different number for you.
I think that the chain of medspas I'm with now, plus ALC; didn't want to worry our pretty little heads with silly stuff like earnings vs. cost. I mean then we might suspect exactly how much $$$ is really coming in, and ask for a dreaded raise.
This way there's a little more privacy for you as to exactly what the bills are. As your lasers and other equipment is paid off, your costs will hopefully go down, but your staff doesn't need to know this so you can keep the numbers consistent for them to help you attain.

DC: If the clinic brought in $65K, what were the hours and on average how much staff was on hand for the "usual" day? thanks a bunch. BTW we pay our Estheticians 10% on products and 2% on services. So, our bonus is a total of 5% (2 Esthetician + 1 upfront booker that get 1%). They only get their bonus if they meet their "nut" also each must produce 40% of the gross (so no-one can slack off and get bonus'd on the work of others)

12.20 | Unregistered CommenterDermaRogue

I'm not sure who your question is for?
At American laser Centers the hours were M-F 9-7, Sat 10-3 sun closed total of 55 hours-2 treatment rooms, 1 IPL laser for both hair removal and for FotoFacials- the micro machine was in the other, so there could be some overlapping appointments.
If the center was only at 65K it was often just the manager and 1 FT tech (35-40 hrs) 1 PT (20-34 hrs.) Managers are required to work the 55 hrs. staffing is kept bare bones for payroll.

Our hrs are 10-7 M-F. I am very, very small with only 1 front person and just brought in this med. esthetician, which I am not sure was the right thing. In our very small town there are now 19 places to get laser hair removal. The laser companies have sold lasers to almost every MD. There is even a place in the mall. I am 2 and 1/2 yrs in but not sure day to day about the future thats why I am not sure that this 3rd person is going to be good. I have been a PA in this town for 20 yrs and everyone wants only me to do any of the treatments. The esthetician is getting 10% products and procedures and this is hurting my bottom line.

01.2 | Unregistered Commenterdc

DC: What I do is give the Estheticians 10% on products sold (not products AND procedures). Your overhead for the spa part should consist of the salary/benefits of the Esthetician, ads, rent, laser cost/ins/maint and your pay as a worker in the spa (20% +/- of the procedures you do personally). This is the financial "nut" that must be made to break even. Moneys over this amount are profits to be distributed to the owner (you). A fair procedures bonus to the Esthetician would be 1-2% of the procedures sold. I only pay a bonus if the "nut" has been surpassed. Jeff Barson states Surface doesn't use a bonus system.. there are pro's and cons. I feel like honest, motivated people will do better for themselves and you if they get paid more the harder they work..from my experience they also require less supervision.
Now with all you customers wishing to have only you do the procedures; you might try and introduce the Esthetician at their first procedure and mention that they will do the next treatments using your settings. The esthetician should market to local businesses (start w/ hair nail salons) if there is a big gap in their schedule. hope that helps !

Opinion? Do you think a small 2 room "medspa" doing injections and aethetics (skin care + laser skin tightening) can make $? A very small overhead, bare bones staffing and NO laser hair removal.
I am debating on getting hair removal. What do you all think?

01.6 | Unregistered Commentermwrn

The problem has taken care of itself with this med esthetician. We found out she was ordering and selling prescription-based products out of her home using my medical license and business name. I also discovered that she was editing tickets and adding commission on services and packages that she did not sell. Anyway, long story short, she is gone.

Answer to mwrn,
I am very small with only one staff and bare bones overhead but still need to generate over20k monthly to cover expenses. This does not include any salary for me. You have to consider malpractice insurance (800-1000k/month, rent, utilities, marketing, staff salary, leases for equipment, constant cash flow for Botox,fillers, products). Overall, even the smallest operation will need to generate every month to cover expenses.
Good luck.

01.7 | Unregistered Commenterdc

I work in NJ (only 10 mins.distance from NYC) with a well known plastic surgeon. I have been a licensed esthetician for over 5 years now. To get in the field, I worked as an inter with a plastic surgeon for the first 6 months of my carrer without any pay (no hourly rate, no commission). I went to post graduate education I the IDI and joined associations like SPSSCS and others related to plastic surgery/skin care.

When I began working with my current employer, I had 3 job offers from 3 Castel Connelly Top Doctors in New York.

I decided to write a contract and put in writting everything I thought it would be fair to the practice I chose to work with and for myself.

I began with $20 and hour and 20% commission. After 3 months this changed to $18 p/h and 35% commission on services and %15 on product sales. This was all part of the contract on a 30-33 hours a week basis (I am off on Fridays). Since in NJ we estheticians can't performe IPL as per the board of medical examiners and the board of cosmetology, I relay on my sales A LOT as well as on my services.

When I am not seeing patients, I work on the doctors marketing materials for events, his power point presentations, take most of the before and after surgery photos of patients working with Mirror Imaging and make sure all his photo albums are updated. Post-op hair wash (facial sugery),camouflge makeup, etc.

My 2007 income was 55K. My goal for 2008 is 65K-70K. This means I need to work harder for my goal. I work on marketing from home, I pay for my website and some of other promotions. I am involved with Look Good Feel Better as a volunteer and I am currently involved in possibly changing the "old fashion" law and regulation regarding IPL use by estheticians in the medical practice.

I feel it's iportant to deliver great work and get involved in many aspects of the practice/ job in order to get paid what you feel you deserve. This way both sides are happy.His previous esthetician was with my boss for 16 years. This was part of the reason for choosing this practice. I love what I do and I feel I am well compensated for my job.I can't wait to go to work everyday!

03.14 | Unregistered Commenterskinglow

In my opinion her requirements about dollar 19/hr are accept able but 10% commission is not acceptable.You can pay her 5%.Much commission can cause you trouble .
hockey equipment

Hello, I am a Florida RN, Certified Medical Electrologist and Aesthetician. I've been working in this field for 4 years. To give you an idea of what someone like me is making at a medical spa setting doing a little bit of everything with direct MD supervision (botox, fillers, Laser Hair Removal, Thermage, microdermabrasion, chemical peels, clinical facials, endermology) is the following:

I make a base $25 per hour for a 33-40 hour week.
I get a commision based on what our company is making monthly. I get it paid biweekly. I get $2.85 (2.3%) per hour worked if our company is making 40K/mo, $4.64/hr (2.5%) if we are meeting 60K/mo, $6.68/hr (2.7%) if the company meets 80K/mo, $8.97/hr (2.9%) if the company meets 100K/mo.
So with that I average out $28 - $35 per hour.
When I go to another location within our company a little further away from the main office, I get paid $35 per hour.
My health insurance is paid 100% by my employer and I get a yearly bonus.

I also work Part Time or on an On-Call basis at a Dermatology office doing skin care procedures like Microderm and Chemical Peels and I get 40% of treatments I do and 10% of product sales there.

I hope this helped...
Have a nice day....


02.8 | Unregistered Commenterhnk

I worked for a well known Physician on Park Avenue in NYC for many years.
I paid the Aesthetician(Medical) based on their experience and knowledge. I am also a licensed Skin Care Specialist practicing in the medical field. Aestheticians coming right out of school simply don't have the knowledge they need in this field. It is no fault of thier own it is just the way it is for now. If they fit our compnay I would hire them at a low hourly rate $15 per hour +10% commission on products. The more experience they gained and knowledge they took in the more they were worth to me. I have paid up to $20 an hour +10% commission on product sales. Also I gave them 10% of any referral of surgery, botox, lasers, or fillers. You can imagine how much that could add up to be in the end. My aestheticians were making 50 to 80,000 a year with benefits.

02.8 | Unregistered CommenterTV


I have a BSc background and i wanted to get into the laser hair removal and injectables industry.
You all sound so inspiring and profession wise I was wondering if I could get some advise.
Firstly, to administer injectables e.g. botox, restylene what kind of certification do i need? Do i need to be a nurse or a physician
Secondly, what is the usual hourly rate for someone who is a laser hair removal expert.
Thirdly how long does it take to get certified?

Thank you for your support guys!

02.12 | Unregistered CommenterMary

Mary: Most of your questions depend on the state you are going to try to work in. State laws and regulations cover most of these areas, and the "hourly rate" will largely depend on the location (i.e., Manhattan, Kansas vs. Manhattan, N.Y.). In most states, "mid level" providers need to be licensed medical personnel of some kind (i.e., P.A., R.N., etc.). It is a surprisingly complex and highly regulated field -- even though it operates like the Wild West in many places at present. You can get a great deal of free information combing through the archives of this weblog.

does anyone know what an entry-level cosmetic laser technician in CANADA (Vancouver BC) would be looking at in terms of salary? what is average salary for a laser tech in a clinic setting, what is the avg. salary in a spa setting?
there doesnt seem to be any salary info on the canadian tech's...

01.29 | Unregistered Commentersaraa

I am MD and doing my second year of residency in family medicine, and I have my laser hair removal certification, and I want to know if I work for a medical spa how much will be the salary hour rate if I work part time? Does anybody can help me with this question.


05.17 | Unregistered CommenterAlera

Doing what? As a medical director overseeing medical estheticians performing treatments ? or performing laser treatments yourself?

I am an MD in MA and was recently asked to serve as a medical director for a small medical spa offering botox, fillers, laser hair removal, and microdermabrasion. I have previously worked with the NPs who will be working there and am confident in thier ability to do a good job. Does anyone know how much a medical director is typically paid in terms of a percentage? If so, that information would be very helpful. Thank you.

06.1 | Unregistered Commenterjennifer

Typically, I have seen a FLAT fee paid to a medical director, anywhere from 1K-6K per month.

If they are start up, it probably makes more sense to go with a flat fee as that way you know what you are getting paid per month rather then getting 20% of zero dollars.

It will also be easier for them to calculate their payroll costs if it is a fixed flat fee, at least in the beginning.

Of course, you can always negotiate an agreement that says you will get a % of the business after they reach a certain revenue level per month.

What are they projecting their profit will be after 90 days?

As a rule of thumb, I try to keep payroll costs to 20% and with the medical director included no more than 30% of monthly gross revenue. Others may have a different formula, but this has worked for me.

I have 2 questions

I am a new nurse. I graduated MAY/ 2010. I was offered a position to provide laser treatments myself. Do I need to be under MD supervision for this?
This is a new office that will open in 4 weeks. I was offered 12 % of what I make as a salary only. Is that good for somebody that has no experience? (upstate NY)

08.4 | Unregistered Commenterceci


Since New York has no statutory text specific to medical spas, it is unclear whether a medical director is needed for a medical spa to operate under New York law.

However,since New York requires that all medical services be performed by or under the supervision of a physician, a medical director is required to oversee a medical spa. 8 NY CLS Educ § 6522 (2007).

Laser hair removal, microdermabrasion, botox, chemical peeling, collagen injections, etc. are all considered to be medical procedures in New York. See Cullinan v. Pignataro, 266 A.D.2d 807 (N.Y.S.D.2d 1999); Seung Ja Cho v. In-
Chul Song, 286 A.D.2d 248 (N.Y.S.2d 2001); Lynn G. v. Hugo, 272 A.D.2d 38 (N.Y.S.2d 2000); Rubin v. Sona Intern. Corp., 457 F.Supp.2d 191 (S.D.N.Y. 2006).

So yes, New York requires physician supervision of all medical procedures done.

Also, Medical directors are liable for a non-physician employee’s negligence in New York. See Cullinan v Pignataro, 266 A.D.2d 807 (NYS2d 1999) (holding that it still constituted malpractice where a doctor inadequately supervised or trained
office personnel who undertook medical treatment--chemical peel for removal of sun spots).

As far as your compensation is concerned, I am a little confused by your offer. Right now this new MedSpa is making $0, so your comp is 12% of $0? What is the 12% of? Is it a salary, where you would be making the same each week regardless of how many appointments you have OR is it an hourly rate?

Dear Ceci,

Please contact your nursing board and find out what your scope of practice is; this is one of your first responsibilities as a nurse This should be in writing on their website or in book form. Provding medical treatments without physician supervision is practicing medicine without a license.

12% is a great commission depending on how busy the practice is. When first learning to operate lasers, remember less is more. You can always provide another treatment. has a good course to learn the basics.

Good luck!

08.7 | Registered CommenterLZRCHK

I am an RN and newly in the cosmetic arena. I just started with a surgeon as an injector and using the laser. He offered me $25 an hour and 5% comission. I am in colorado, is this a good salary? Could use your advice. Thanks.

(RN Injector) Retail retail retail + $25/hr = fat checks!!!

11.7 | Unregistered CommenterMsE

I am a nurse injector in Canada making 28$ hourly with 6% commisions. Responsible for overlooking many things within large plastic surgery practice, as well as providing Botox and fillers, IPL and Thermage etc...Can anyone give feeback on what they may be making in Canada? Is this fair pay for 12 years experience?

12.1 | Unregistered Commenterwizard

im moving to san antonio tx and looking into school to do aesthetic lasers (ALS/CLS). does anyone know what i might be able to make anually? thanks in adavnce

05.6 | Unregistered Commenterhg21180

One day I'm hoping to open a medspa in Washington state. Does anyone know where
To find information on the laws and regulations for opening a medspa in Washington.
I was told that under Washington law, a NP can run a medspa without the supervision of
A medical director. I just want to clarify that. I checked the internet but didn't have any luck. If
Anyone can help me out that would be great.

06.16 | Unregistered CommenterFuture NP

"Future NP": The legal situation in Washington for treating patients with lasers and other devices is not crystal clear at present. It would be risky for a non-physician to try to purchase and operate lasers, IPLs or RF devices in the state. If you provide an e-mail address I can send you some information I have compiled about Washington's regulations on the subject.

"Future NP": The legal situation in Washington for treating patients with lasers and other devices is not crystal clear at present. It would be risky for a non-physician to try to purchase and operate lasers, IPLs or RF devices in the state. If you provide an e-mail address I can send you some information I have compiled about Washington's regulations on the subject.

hi! im considering taking the 14 day comprehensive laser course at natinoal laser institute in scottsdale arizona! does anyone know anything about this school? thanks!

08.3 | Unregistered Commenternick

I just graduated with my BSN and am looking to get a job in the cosmetic field as a cosmetic injector. I have been offered a job and am not sure if it is a good offer or not. I have no nursing experience other than clinicals, but have a prior bachelors degree in PR and was a successful sales person for 8 years prior to going back to school to become a nurse, so I have a lot of business and sales understanding which will be a huge plus in this position. I am located in Cincinnati, OH. I was offered $22/hour starting out (working 40 hours a week) during the 3-6 months of training, then when I am fully functional and able to do injections on my own, they would drop me down to $18/hour and I would get 4% of total sales of botox injections only from my understanding. It sounds like based on other peoples comments that they get comission off of several services provided. The place provides IPL, cooltouch and many other services that I know I will do a good job selling to my patients that would benefit from it. Insurance will not be provided and I need to go back and ask if I will get paid holidays, vacation, etc., but I am going to assume not. What I want to know is, a) Should I request that I stay at the $22/hour even after I start getting commission? I feel like $18/hour seems extremely low to have a Bachelor of Nursing degree, it sounds like I would be getting paid less if not the same as a esthetician, but I would have a medical degree and have the ability to provide more services for the practice. I also do not want to seem ungrateful or greedy, so would just love some input from people in this profession. Looking over the site, there is tons of great information, but these are in cities that maybe get paid more as a nurse in general, so I can't tell if I am getting WAY under paid or not. Nurses starting out in the hospital setting here get $21-$22/hour for day shift and a $4 shift differential if they work nights. I would really appreciate some help on understanding the typical structure of payment, as well as what services most practices pay their nurse injectors a commission on. Should I ask to have the percentage go up by 1% every year how are increases in hourly or percentages decided ?, etc. They also expect me to sign a non-compete, so I feel like I will be locked in to these rates even more so....Please help!

08.24 | Unregistered Commenterstephanie


I do feel your hourly rate should never go down especially after training and that adjustments should be made to the commission. Most companies expect you to negociate some. Make sure they provide you with an offer letter where all your questions are clearly answered and then once you agree you both sign it and you keep the original. Obviously you will eventually make more than your nurse counterparts in the hospital when you add in your commission but they will get good health benefits a 401 k plan and vacation/sick time so consider this "income" when haggling over pay. $18 is what an experienced laser technician/esthetician would make with no certification and no degree just a state license and around 300 to 600 hours schooling so stand your ground. I would also reach out to other nurses in the community in the field and ask these questions.

09.8 | Unregistered CommenterSu

I live in Dallas, TX and graduated from NLI back in June 2011. Out of all my classmates...1 person has found employment. The establishments are offering on avg, $10 hr and 3-5% commission. Is this normal? I can sell and thankful for commission but $10 hr??? REALLY?

09.13 | Unregistered CommenterCRT

@ CRT,
There are a couple of things that come up here that you should be aware of. First, each state is different but the majority do not have any regulation about who can perform IPL or laser treatments OTHER than the must be delegated to do so by a physician... So, your esthetician license means nothing when you're dealing with medical procedures. That means that anyone can perform these treatments and that increase in the available pool keeps the cost down. (Your esthetician license does allow you to perform facials etc and that is the reason that most medical spas employ estheticians.)

(My own staff never received commission on medical treatments since I think this is both unethical and unwise from a business standpoint.)

You're in a free market and the pay levels are what the market will support. The only way to make more money is to be better than everyone else at what you do and by making the business you work for more money.

I am in az currently I am a MRI tech no exp was thinking of taking a course to become a certified laser tech, is there a salary range for a new grad w/ no exp that I could expect? I would rather hear from you guys then school recruiter Thank you for your time!!

03.23 | Unregistered CommenterAzfun

Wages depend so much on your geographical locale and that economy. I wonder why you are considering going from MRI tech to a Laser Technician? I assume your salary is around $39,000 if you are newer to the industry. Which is on the high end of the spectrum for Laser Tech. Do you get benefits? It is unlikely you will in this industry even if you are full time unless you work for a larger company. What hours do you work? Do you want to work nights and weekends? You will in this industry.
Also, depending on your state, you may need other credentials to perform Laser Hair Removal and other laser treatments. For instance, I needed to be licensed by the state of Pennsylvania to be an esthetician to get into the laser business and I received my two certifications as a Laser Technician from the medspas that I worked for. I did not have to pay for the training or go to a school for the certification. The Laser training schools charge a lot of money for training that you can get on the job. In addition, these "certifications" are not legal credentials and do not always transfer across state lines.
I suggest, doing some real research regarding the local laws in your state including talking to people in the industry where you plan to work to find out the real deal! Good luck. Susan

03.26 | Unregistered CommenterLaztech

I am an RN who has 12 years experience as a nurse and just graduated from the National laser Institute with certification for lasers and injectables. I was offered a job making 10/hr plus 10% commision when I am ready which could be anywhere form 1 month to 2 months. I think it a ridiculous starting wage for not only a nurse but someone who has training specific to this field. Does ANYONE think this is a good offer for an entry level RN injector?

04.10 | Unregistered CommenterToughy

Dear Toughy,

I wouldn't even consider that "offer". The offer given is an indication of how the owners view your value to the business and therefore how they will most likely treat you once there. Obviously, they don't place much value on the role in the practice if they are only willing to pay you $10/hour.

I assume they expect you to make up for a normal nurses salary in commission, but ask yourself how much volume will you have to do to make that happen. If this is an incredibly busy practice and you are the only injector you may make money, but you will be viewed as a sales person. For example, our medspa did $21,341.00 in injectables last month (not a lot) so 10% is $2134.10 divided by 4 weeks in the month giving you $533.54 per week. Now divide that by 40 hours per week bringing your wage to $13.34 per hour plus the $10 giving you $23.34 per hour total - not great.

You didn't mention benefits. Did they offer you any?

04.10 | Unregistered CommenterLaztech

Toughy- ridiculous rate and I completely agree with everything Laztech has said. Simply not competitive, move along to a better offer.

Not sure where you are located but here in Boston I start new laser techs-not RN's- out @ $20 no commissions-bonus based on total performance of the clinic. Granted we pay at the top and Boston in general has higher hourly rate than other parts of the country but it gives you a ballpark.

I have had RN's & PA's injectors- typically we try and match the hospital's hourly rate so we don't lose them.

Toughy, if you are in the Phoenix area, come see me at Arcadia Aesthetics.

04.27 | Unregistered CommenterDaleAnn

I have 5 years of managerial, sales, and marketing experience with the last 1.5 of those years specifically in a medical spa setting. I am moving to PA and would like to know what you believe the salary, benefits, and commission package for a medical spa manager should be. I have my Bachelor's Degree in Public Health and am a certified Emergency Medical Technician. I also have SEO and website design experience to contribute. Thanks!

05.15 | Unregistered CommenterKaitlin

I got a job offer with a very low wage. The potential employer says that I will receive commision on top of that wage after the training period. Rate offered is $10/hr which seems incredibly low. BTW, I am an nurse with laser and Botox certification. Please help!

05.26 | Unregistered CommenterYTX

YTX- what state are you in?

yes that seems incredibly low to me too. What volume does the potential employer do? If they are a crazy, busy place and they are offering you commission plus a small hourly it *may* be worth considering -but the total comp would probably have to equal anywhere from $24-32 hrly depending on your state.

Do they employ other RN's? can you talk to them?

BetterOffNow, I am in Indiana. I just moved in last month. Do you have an idea on what I should expect as an entry wage here?

05.29 | Unregistered CommenterYTX

YTX- I have no clue as I'm on the East Coast. Try talking to a nurse recruiter or call around to some hospitals/medspas to get a better idea- good luck

Maybe I should entertain the idea of starting my own spa. Thanks BetterOffNow. I'm still looking around.

06.2 | Unregistered CommenterYTX

Join Medical Spa MD

Medical Spa MD

A community of dermatologists, plastic surgeons, laser clinics, & skin clinics world wide.

Medical Spa MD is a world-wide community of physicians and clinicians practicing cosmetic medicine. Please read our Terms of Service, Advertising Terms and Privacy Policy.

Copyright © 2011. All rights reserved.