When you see them at spin class with their patients, or wearing tank tops emblazoned with their stylish logo, the intention becomes clear: Alexa Nicholls Costa and Alex Rogers are building their business, LexRx, into a national brand, not just a Boston-based practice specializing in lips, lines, and lashes. These nurse practitioners weren’t looking to emulate a doctor’s office when they started LexRx in 2015.

Instead, they were looking at a business like SoulCycle for inspiration.

“We would liken ourselves to SoulCycle, where they only offer spin and they’ve built out an instructor base that is admired and followed on Instagram and viewed in that iconic light. We’re trying to do that with a team of nurse practitioner-only injectors for both our Boston location and future locations across the country.”

There’s another key difference that sets their practice apart from its competitors. Unlike other med spas that offer dozens of services, LexRx has a much tighter focus.

“We are an NP owned and operated, hyper focused dermatology practice. We are not a full-blown med spa. We only offer services that are injectables, BOTOX and dermal filler.”

Taming the Wild West

Furthermore, Alexa and Alex distinguish themselves by being NPs who graduated from a direct entry nurse practitioner program at Regis College (where they met) and who still work outside the practice during the week. Alexa works in emergency medicine two days a week at Mass General Hospital and Alex works at an urgent care clinic.

One might think this time spent outside their business would pull them away from their clients or hamper their ability to grow LexRx, but it’s had the opposite effect.

“I think our clientele appreciate the fact that our knowledge base expands beyond the injectable side. What we do is straightforward in terms of how to inject a filler, but on the rare occasion that somebody has a weird allergy or an unfamiliar medical comorbidity, it gives our patients an added level of comfort and safety.”

Having two NPs operate a practice specializing in injectables becomes a bigger selling point when you consider the med spa landscape in the U.S. In Alexa’s words, the medical aesthetics industry is like the wild west.

“Our industry is crazy. There are people who take a one-day class and then go open a shop, which is scary. There’s nobody mentoring or supervising them. It’s just somebody who thinks that they have the tools and skill-set to administer BOTOX and filler without understanding the possible repercussions of bad BOTOX and bad filler.”

A Laser Focused Niche

Alexa and Alex saw two things when they surveyed the medical aesthetics industry. The first was business owners with questionable skills and tools potentially jeopardizing people’s health. The second was various practices offering BOTOX as an add-on feature instead of the primary selling point, which seemed backwards to the duo.

“We hear about med spas, family practice clinics, and OBGYNs offering BOTOX as an add-on service to get people in the door, even though it’s likely the most medically driven procedure they offer. It should be the other way around. BOTOX and filler should be at the top with these other complimentary services as add-ons.”

Alexa and Alex stepped in to fill a need as a different kind of practice.

“We recognized a void in the market where you had these jack-of-all trades opening with BOTOX as one of a million things they offered. There was nobody claiming, ‘I’m the expert, I’m the go to brand, I’m the top practice for BOTOX and filler.’ We thought that deserved its own area of expertise.”

How Sweaty Marketing Led to Hot Profits

At the same time, they wanted LexRx to be about more than BOTOX. Alexa and Alex wanted their patients to feel like they were part of the LexRx family, which is why they offer their Sweat with Lex series. These are free workout classes around Boston that allow the duo to align with businesses that have similar client demographics.

“We understand our price point is middle to higher range for the market and we’re very conscious about finding ways to add value into the experience. We don’t want you to feel like you’re just getting BOTOX treatments. Outside of our injectable services, our patients are buying into the LexRx lifestyle. We don’t discount our services because we go after the right patients and look to give them an overall experience.”

Part of the reason Alexa and Alex offer their Sweat with Lex series is because it allows them to get in front of people who are likely to want BOTOX treatments at some point.

“We’ve tried to align ourselves with like-minded industries and businesses with the same demographic as ours. People who want to work out daily, take care of their body, look good, and feel good. They don’t mind spending money on a pricey spin class because they understand the value of a quality experience. We are strategic about who we partner with throughout the city. Boutique fitness studios are a good fit.”

The process of partnering with other businesses took a concerted effort during the duo’s first year in business.

Those partnerships and connections came in handy when it was time to launch Sweat with Lex. Alexa and Alex reached out to every fitness business they thought could be a fit, and in the process, they learned a good lesson: hearing “no” can be a good thing.

“A lot of the businesses upfront said no because they didn’t understand what we were trying to do. That’s valuable because we don’t want to partner with somebody who doesn’t understand our big picture goal. Though the class is free, the goal is that our clients are getting that value add to their experience as a LexRx client. Likewise, we hope the gym will get some new clientele from our events.”

Finding out how to build partnerships, launching a brand (and not just a practice), learning how to attract the right clients – these were all things Alexa and Alex had to learn after they started LexRx. Their undergraduate degrees of health science (Alexa) and biostatistics (Alex) combined with their training in grad school prepared them to serve their clients, but being successful business owners has not come easy.

Scaling a Lean Startup

Thankfully, their entry into the medical aesthetics industry was not a costly one.

“Here was our business plan: we launched with each of us contributing a couple hundred dollars to buy one box of BOTOX, and from that one box of BOTOX we would sell it and buy two boxes. We grew organically and that first year was a lot of figuring it out. We wanted to offer home services, but the busier we got, the more we realized it wasn’t realistic to travel door to door. There’s only so many people you can see in the course of a day when you’re spending that much time in the car.”

In their second year, the duo looked to put down roots in Boston. It was a move that, on the surface, seemed questionable. Now it’s easy to see why it was the right choice.

“Year two, we knew we wanted to be in Boston despite it being a saturated market. Our client base was gravitating toward us because we are millennials, which is also a market differentiator. If you look at the big names in BOTOX in Boston, a lot of them are gray haired physicians who don’t relate with the millennial demographic.”

Keeping a short menu of services is one way Alexa and Alex keep costs down. The other is refusing to pay for marketing. They insist on going the organic route.

“We have a publicist who’s a wonderful consultant for our business. We can bounce emails off her when we’re being approached for a quote to make sure it’s presentable to the public and for the media. She will pitch us proactively to media outlets, whether it’s print or digital or television, but with the understanding that we won’t partake in any sort of advertising feature that isn’t from an organic standpoint.”

The Foundation for an Aesthetics Empire

There are plans to add new locations, starting with Chicago. Franchising is a possibility down the road. That said, growing the business isn’t the only priority Alexa and Alex share. They want to help people interested in getting into injectables learn the ropes, which is why they started Inject with Lex. This branch of their business offers à la carte consulting services, plus didactic and hands-on training with injectables.

It’s meant to educate people on how to inject properly and run a successful business. Among the things they stress to future business owners is appropriate pricing.

“During the consulting program, we stress not selling yourself short in your pricing. You shouldn’t feel bad about your skillset and the fact that you went to undergrad, then grad school, paid to take a class, and pay for insurance. If all these things are worth something, drive that home in how you operate your business. Otherwise, you will get taken advantage of and it’s not a good look for any of us. It hurts our industry.”

In the future, Alexa and Alex would like to see NP schools focus more on the business side of their profession, as an adjunct to the clinical curriculum.

“As more states are allowing NPs to practice independently, there has to be more time spent in the classroom at NP school learning how to run a practice. Our model is 100 percent NP driven, so it would have been helpful if at some point in school they answered questions like: How do you create an LLC? What is an EIN? How do you open a banking account for your business? How do you file business taxes?”

Advice for Nurse Owners Starting Out

The ladies behind LexRx are excited about the future of their growing business. Just as important, they’re excited about seeing other NP entrepreneurs enter their industry. For those NPs, Alexa offers two pieces of advice: don’t doubt yourself and ask for help.

“You’ve got to believe in your idea. We faced a ton of pushback early on about only wanting to only do BOTOX and filler. We were told by many peers, many who were older than us, that we needed to offer a million services. We were always that annoying duo that said, ‘Why do we have to do more?’ I think it’s a pitfall of nursing. We’re stuck in our own ways of doing things because fifty generations before us have done things that way. The second part is to tap into your network. People you never would have expected to get advice from are the ones that often help you the most.”