On Los Angeles’s trendy West 3rd Street, between the fancy donut shops and designer boutiques, and not far from The Grove, you’ll find a space that looks like what I imagine Kim Kardashian’s private quarters to look like.
Powder-pink furniture lines the airy, bright space filled with marble counters, sleek vanities, and neon electric signs. An attendant brings you champagne and small bites, and an organic makeup touch-up counter beckons.
But this is no trendy spa or beauty salon—no one is getting their hair done or a makeover. It’s where those obsessed with keeping the effects of aging at bay come to get their face injected with Botox, facial fillers, or plumping agent. It’s essentially a glamorized medical office.
“It’s just like getting your hair and nails done,” says founder and CEO Nicci Levy.
Nothing here resembles the general practice of cosmetic injectables, wherein patients usually head to a dermatologist’s office. Busy doctors usually treat it like any other procedure, such as mole checks. Alchemy 43 welcomes clients to stay, linger, and enjoy what’s meant to be a memorable “self-care” journey.
Americans spent more than $16 billion on plastic surgery and elective procedures in 2016, reports the American Society of Plastic Surgeons (ASPS). Nonsurgical procedures accounted for 44%, with injectables up 10% from 2015.
“This is an industry where people are spending thousands of dollars, and there’s nothing experiential about it,” says Levy. “Beauty is so incredibly intimate and emotional. Why undervalue that?”
The Alchemy 43 experience starts with the booking: Clients can reserve a space with the Alchemy 43 text message platform, snagging a spot within a week’s notice, or just walk in. Doctor’s offices, in contrast, are usually booked weeks in advance.
Then there’s the services menu, which boasts cheeky names like “Smooth Talker” (a laugh-line treatment of Juvéderm and Restylane) and “Hello, Bright Eyes” (Botox to target crow’s feet and frown lines) that make the treatments sound less, well, intimidating. Prices are on par if not slightly lower than an average medical clinic. The average spend per visit is $485.
Founded in 2016, Alchemy 43 has two locations (the other is in Beverly Hills, natch) that are both situated on high-end shopping stretches where other beauty services are clustered. The point is to make it part of your shopping outing.
The reimagined, destigmatized experience appeals to investors, who see the opportunities in an outdated supplier landscape. Last December, the startup closed a seed extension round of $3.2 million, with backers that included Drybar cofounders Alli Webb and Michael Landau.
“We were really interested in the trends around injectables—and Botox specifically—that are becoming much more mainstream,” says Eurie Kim, general Partner of Forerunner Ventures, an early backer of Alchemy 43. “People used to be sheepish about it . . . The consumer is really evolving in how he or she is thinking about the entire experience.”
I give it a try
Whereas dermatologists rarely have the time to talk clients through their aesthetic needs, Alchemy 43 treats services like a fine wining and dining event. After I’m offered an array of drinks and nibbles in the lounge, an attendant takes 3-D photos of my face.
Soon thereafter, I’m escorted to what can only be described as the most unmedical-like appointment office: Light-colored wood lines the floor of the wallpapered pink room for my one-on-one consultation.
First, the physician’s assistant asks, “What would you like to change?”
A novice at changing my face, I defer to their expertise. What should I change, I counter?
She pulls up the 3-D renderings of my bare face: Fine lines border my eyes, sunspots dot my outer cheeks, and dark circles surround my eye sockets. It’s a nifty sci-fi look at my flaws.
It occurs to me, while staring at a blown-up screen of my head, that I do want to change some things. Maybe that stubborn line between my eyebrows, I counter, offering the first bid.
But the counteroffer far exceeded my humble expectations. Instead, I’m notified—very gently—that my cheeks show visible signs of sagging (they do?), with my left a few mini millimeters lower than the right. A bit of Restylane filler could perk them up to their high school standing.
The PA modifies the 3D rendering to show me what the new version of my face could look like. (“We always say it’s the ultimate try before you buy,” Levy later explains.)
Not only that, but the dark under-eye circles age me beyond my years. There’s a “simple” way to rectify that: A “tear trough” requires small incisions near the inner eye to insert hyaluronic acid with blunt cannula tubes.
“That sounds insane,” I laugh. “I need to get drunk or go home and emotionally prep myself for that sort of thing . . . Let’s start with the cheeks.”
The PA understands, reminding me I can always come back for more treatments. As she begins to prepare the syringe and numbing cream, I quickly close my eyes, notifying the staff that in no way, shape, or form do I want to see the torture tool. She sympathizes, replying, “There’s nothing normal about syringes coming at your face.”
But despite my 30-minute consultation, one filled with lengthy and patient explanations, I was not prepared for what came next: I can feel the needle forcibly push through multiple layers of muscle, as a crackling sound echoes through my head. Every second feels like a full minute.
My sweat glands erupt, and my palms clutch my thighs as I force back an equal amount of terror, shock, nausea, and betrayal. I feel woozy, the room spinning as I might just faint or scream. Is this what women have been doing to themselves in the name of beauty?
After the syringe is pulled out, I sink back into my recliner, demanding, “Actually, could we stop now? I don’t think I can handle this.”
“We can’t let you leave with just one side done,” responds my PA, attempting to calm my nerves by explaining that yes, there is some awkwardness involved in the procedure.
“Okay, I can try to muster the strength for the remaining shot on my other cheek,” I say.
The PA pauses before her reply: “That was just one of four shots on that side.” We’re not even a quarter of the way through. From there, I learn that following the treatment, I am to keep upright for the next 24 hours, including during sleep, lest the filler internally seep down my face.
How, exactly, is this like getting a Drybar blowout?
Know the risks
Alchemy 43’s staff are all licensed medical professionals–either registered nurse practitioners or physician’s assistants. In many ways, they are more experienced than MDs in that this is their sole practice, whereas dermatologists and plastic surgeons might only perform a few a week.
“There’s certainly an expertise that comes with doing one thing and one thing only . . . This is all we do all day, every day,” explains Levy. “In no way are we ever trying to trivialize the fact that these are needles in your face . . . we take that incredibly seriously.”
And yet, the casual, fun branding might not convey the gravity of the treatments offered for newbies such as myself. While some, like Botox injections, are considerably risk-free, facial fillers carry the minor risk of serious harm.
For example, at no point was I briefed on what could go wrong: If fillers are accidentally injected into a blood vessel, one could not only have a cosmetic deformity, but also risk permanent blindness or a stroke, explains Dr. Grant Stevens, president of the American Society for Aesthetic Plastic Surgery (ASAPS).
“If you look to [unregulated] China and look at the patients, you’d be horrified,” says Stevens.
ASAPs doesn’t believe a physician is needed to administer the injections, conceding that certified instructors can be just as skilled. However, in the case of a complication, it’s imperative that a physician be readily available onsite. “Otherwise, the results can be devastating,” warns Stevens. “This is something that can have absolute life-altering complications.”
Stevens takes issue with any doctor that also does not inform the patient of the potential complications, calling such medical practices unethical. With controlled substances, the client must know exactly what they’re signing up for.
“It’s not fair to the consumer,” stresses Stevens. “This is not getting a haircut. This is not getting your hair dyed. It’s not getting a manicure . . . It is a medical procedure, no matter how much you want to dumb it down and put it in spas.”
And yet, they are in spas. They’re available now at Canyon Ranch spa resorts. Heck, you could even get at-home service these days. In the majority of these places–and doctor’s offices–rarely does a practitioner go over the risks.
Alchemy 43 isn’t doing anything outside of the norm; if anything, they offer far more expertise. But to some degree, the client is expected to come fully prepared or quickly scan the consent form at check-in.
Such little consumer knowledge is what led Tom Seery to launch RealSelf, a digital space devoted to sharing the truth about cosmetic work. Each month, the site facilitates over 500,000 connections between doctors and consumers. Each treatment boasts a “worth it” rating in which users rate doctor’s services in relation to the cosmetic benefits, along with before-and-after images. It’s helpful for many consumers who really aren’t familiar with any brands beside Botox.
“Rarely is a ‘worth it’ rating ever going to be 100%,” says Seery, noting the many cautionary tales. But members can make informed decisions based on insight from others. “The industry so heavily relies on word of mouth . . . it’s an unregulated market, largely speaking, and that introduces concerns and questions that are good for people to have.”
Seery sees an industry quickly adopting digital trends, one wherein consumers want services faster, cheaper, and more readily accessible. Call it the Uberization of the aesthetic medical market. But without heavy oversight and differing expert opinions, consumers are often left confused. “There is not a real clear distinction, like, ‘This is quality, and this is not quality,'” explains Seery.
ASAPS’ Stevens recommends checking images of a space’s work, then asking the following questions: Is there a physician onsite? Who is going to inject me? Do they have certification? (Certification varies state by state.) How often do they do it? How many years have they done it?
Alchemy 43, for its part, features fully certified physician assistants who have over a decade’s worth of experience, as well as a medical director supervising the clinical staff, though not onsite. The Medical Board does not mandate that the medical director need be physically present where cosmetic injectables are being performed.
Starting next month, a double-board certified cosmetic surgeon will join the Alchemy 43 staff as the national clinical training director.
“We are extremely diligent on the medical regulatory aspects of our business and have a very by-the-book approach to ensuring that we are operating in compliance with all regulatory bodies,” explained Levy in a follow-up email. “Our medical director (who is an MD) and our practitioners are well trained in what to do if anything adverse were to occur.”
Reviews, so far, have been kind. On sites like Yelp, Google, and Facebook, Alchemy 43 clients gush about natural-looking results, detailed attention, and staff’s gentle bedside manner. “They make you feel comfortable through all the procedures,” wrote one fan. “They really care about you as a person and take the time to understand what you are looking to accomplish with your skin,” raved another.
Over half of Alchemy 43’s audience skews under 35, with millennials increasingly growing in numbers. “The industry is seeing a huge huge influx of younger users from the preventative and enhancing perspective,” notes Levy, with Botox and lip fillers leading the requests.
For them, Alchemy 43 is an “aspirational but accessible brand,” the kind of place one frequents before graduating to having a plastic surgeon on speed dial. Roughly 15% of clients are males.
In previous decades, cosmetic work was mostly reserved for the wealthy. Today, it’s become more readily adopted by everyday women–“everyone from working moms to the middle class in the Midwest,” states New Beauty magazine. More than half of patients are age 50 or younger. In the last year alone, over 9.9 million injectable and filler treatments were performed in the U.S., reports ASPS.
In the next year, Alchemy 43 will add two more locations in Los Angeles, with a plan to roll out 50 stores in the U.S. in 2019, starting with major cities like Miami.
Since these treatments require maintenance, the brand launched a membership program to benefit repeat customers. There’s also a product line on the horizon described as “GlamGlow meets Glossier with a dose of something you’ve never seen before” to complement the micro-treatments offered in house, says Levy.
“It’s a long-term relationship that you’re building [with the client],” Kim says. “That’s something people are going to want city by city across the nation.”