North America's medical aesthetics industry has grown rapidly over the past several years, with recent advances in minimally invasive technology and biohacking cosmetics growing the market from $18.4 billion in 2024 to $55.9 billion by 2033, registering a CAGR of 13.2%.
While the net positive for industry has resulted in the scaling of practices and the emergence of private equity investments, the expansion has also brought new questions around training, patient safety, clinical consistency and consolidation. As a result, many providers are asking whether growth can coexist with high standards of care.
Related: MedSpa Partners Launches Vos Collection: Medical Aesthetics Excellence Redefined
The Vos Collection, a physician-led network of premium medical aesthetics practices, is looking to close these gaps. After launching MedSpa Partners (MSP) on May 27, 2026, the collective positioned themselves as the standard of medspa excellence by providing patients consistent, remarkable outcomes that help make them feel more like themselves.
Following the public launch of the organization, MedEsthetics spoke with VOS Founder & CEO Dominic Mazzone about why the company spent six years building its network before going public, how it approaches physician autonomy, and why he believes the industry's biggest challenge isn't competition—it's maintaining quality as demand accelerates.
ME: The aesthetics industry has seen rapid growth and increasing competition. What market challenges or gaps convinced you there was a need for a network like Vos?
The industry in North America has grown dramatically from approximately 6,600 clinics in 2019 to over 13,000 clinics in 2026. The industry has traditionally been structured as fragmented, individual-provider-run clinics, entrepreneur-run locations and multi-location chains.
Though there have been many new clinics opening, the realities of the industry haven’t changed in that experienced, skilled injectors are difficult to find. This has resulted in a significant reduction of standards, compliance, safety and overall patient results. This has also created confusion for the consumer about where to go, what to expect and what’s possible.
Vos Collection is solving several patient pain points:
- To be a source of truth on the treatments, devices, skincare, etc.
- To be an idea of what good actually looks like.
- The place to get great results.
- The place that meets the intersection of individual high-end boutique results with institutional safety and compliance.
ME: Vos spent six years building before its public launch. What lessons emerged during that period, and why was it important to establish the network before introducing it publicly?
We always knew the individual brands were important. From the beginning, we believed the corporate entity should remain in the background and never get in the way of the patient experience. That is especially important when you're working with the caliber of premium clinics we have in the Vos Collection.
Over the past six years, we've refined our approach to patient care, our clinical philosophy, our culture, and our leadership model. Those years shaped who we are today and established Vos Collection as the premier medical aesthetics platform in North America.
The timing of our public launch was intentional. We had reached the point where the platform had truly become greater than the sum of its parts while still preserving the individuality of every clinic. At the same time, the market was becoming increasingly saturated with inexperienced clinics delivering subpar treatments. That created an opportunity to demonstrate the clear difference between the new, lower standard emerging in the industry and the level of excellence our physician partners deliver every day.
ME: Many organizations say they’re raising standards in aesthetics. What specific standards or benchmarks do Vos member practices commit to meeting?
This is an easy question to answer because the answer lies in one word: "no." In aesthetics, it's often the things you don't do that lead to the best outcomes and patient experiences.
Patients frequently ask for treatments that, in the end, would look unnatural or produce poor results. It's our job to be their aesthetic advisor. Sure, we enhance lips and cheeks, but there's a limit to what looks good. When patients want to go beyond that limit, we say no. It's not about the dollars—it's about the results and the ethics. A happier patient is more likely to return and create greater lifetime value, so ultimately, what's best for the patient is also what's best for the business.
The physicians in the Vos Collection are constantly pushing one another to deliver better experiences and outcomes. They don't just sit together as shareholders—they serve as advisors and mentors to one another, continuously sharing best practices. Dr. Doris Day recently visited Dr. Ava Shamban in Los Angeles to learn how she has been integrating peptides into her practice and merchandising her skincare offerings. We also hold regular virtual sessions across the network on a wide range of clinical and business topics. For example, Dr. Shamban led a session on her "signature feature" approach, and physicians including Dr. Ellen Marmur, Dr. Doris Day, and Dr. Shannon Humphrey all came away with new insights. Dr. Humphrey, an expert in 360 treatment planning, has also trained many of our healthcare professionals on her methodology. When you bring together exceptional experts who are committed to learning from one another, the exchange of knowledge is continuous.
Ultimately, that's how standards are raised. You can't change standards without changing behaviors, and you can't change behaviors without changing expectations. Our healthcare professionals hold one another to a higher standard, and that's something you simply don't see elsewhere in the industry. We know it's working because, according to Allergan, the industry average patient retention rate is about 40%. Across Vos Collection, our average retention rate is nearly 50% higher. In our business, retention is one of the strongest indicators of patient satisfaction.
ME: How does Vos measure success across the network beyond practice growth or revenue? Are you tracking patient outcomes, retention, satisfaction or other quality metrics?
Experienced, skilled injectors are increasingly difficult to find, which has contributed to a decline in standards, compliance, safety, and overall patient outcomes. It's also created confusion for consumers about where to go and what to expect. Many patients are unaware that standardized certification, mandatory training programs, and competency testing for aesthetic injectors do not exist across the industry. While there are regulations governing who can serve as a medical director and who can perform injections, the industry still operates in what can feel like a regulatory frontier.
We're also seeing some alarming trends—such as people purchasing black-market neurotoxins and injecting themselves—alongside encouraging ones, including continued advancements that are improving patient outcomes. At the same time, patients are beginning to recognize that not all injectors or clinics are created equal and that aesthetic medicine is as much an art as it is a science.
Everyone has access to the science, but the art is reserved for the few who have the experience and judgment to consistently produce exceptional results. The lack of standardized certification and stronger regulatory oversight remains a concern because it creates opportunities for unsafe practices, including the use of non-FDA-approved products and an overall decline in quality.
At Vos Collection, we focus on what we can control. The vast majority of our injectors are highly experienced, and new injectors are developed slowly, carefully, and methodically through structured training and mentorship. They don't just train within their own clinics—our mentorship program places them alongside physician partners and injectors across the network, giving them broader clinical exposure and a more well-rounded education.
ME: What are the biggest quality-control or oversight challenges facing the aesthetics industry today, and how is Vos attempting to address them?
Experienced, skilled injectors are difficult to find, which has driven a significant reduction in standards, compliance, safety and overall patient results and created confusion for consumers about where to go and what to expect. Patients are unaware that certification, mandatory training programs and testing for injectors doesn’t exist in the industry. Though there are rules about who can medical direct and who can inject, there truly is a frontier mentality and regulatory environment.
We are also seeing some shocking trends — such as people buying black-market toxin and injecting themselves — alongside encouraging ones, such as the potential for results getting better and better. Patients are starting to better understand not all injectors and clinics are not created equal, and that art is difficult to commoditize.
Everybody has access to the science, but the art is exclusive to the few. The lack of certification and government oversight is a red flag for the industry as it creates the potential for more illegal activities such as using non-FDA approved products as well as overall reduction in quality results. The way Vos is addressing this is based on what we can control.
The vast majority of our injectors are highly experienced and new injectors are being brought up slowly, carefully and methodically through proper training and mentoring. In fact, not only are injectors trained in their own clinics but our mentorship program takes injectors out of their clinics to train with other injectors to give them more well-rounded training.
ME: Can you share examples of clinical innovations, treatment protocols or best practices that have emerged through collaboration among member physicians?
Due to the strength of our physician bench, we are constantly pioneering not only better treatment techniques but also better ways to combine and integrate treatments to achieve superior outcomes. One of the most exciting areas of innovation is biostimulators, and there is no one more at the forefront of that work than Vos physician Dr. Shino Bay.
Dr. Bay's work combining biostimulators, micronutrients, and other treatment modalities to achieve extraordinary results has earned international recognition. He regularly shares his specialized techniques with physicians across the Vos Collection, and those innovations are delivering better outcomes for patients throughout the platform.
Dr. Ellen Marmur and Dr. Shannon Humphrey are also pioneers in developing combination treatment protocols that produce more natural-looking results, and they consistently educate and mentor physicians across the network. Meanwhile, Dr. Poleman in Calgary is conducting research on consumable collagen and its impact on collagen production in the face. Together, these advancements are helping patients achieve results that not only look more natural but also help slow—and in many cases, reverse—the visible signs of aging.
In addition, Vos has the largest cosmetic research consortium in North America, giving our physician partners early access to emerging treatments, technologies, and clinical insights. That access translates directly into better-informed decisions and, ultimately, better outcomes for our patients.
ME: How do you balance creating consistency across the network while preserving each physician’s individual approach, expertise and brand identity?
This has been our secret sauce when it comes to building a successful platform. The one thing I made sure to preserve when I started Vos Collection was that we would not create carbon copies. Every clinic has something unique that made it special, and it’s important that we don’t disrupt that.
Yes, we have to manage the back-office operations and implement a level of standardization, but those are changes that don’t impact the patient experience or the provider experience. We don’t force our providers to use certain products or sell specific skincare lines. That level of clinical freedom is a major differentiator because it removes barriers to delivering exceptional results.
We also don’t change the brands on the door, which has been a particularly successful strategy for preserving each clinic’s identity while allowing them to feel connected to the broader culture and community of Vos Collection.
ME: Private equity and consolidation continue to reshape medical aesthetics. How does the Vos model differ from traditional PE-backed or MSO-led approaches?
One simple philosophy I’ve held true to since the beginning is that I’m trying to run a highly standardized, disciplined operation while culturally creating the most un-corporate corporation possible for our providers. That philosophy has created a culture that is our greatest differentiator and is a true reflection of how we treat our HCPs.
Many private equity-backed consolidations become overly corporate. They lose sight of the fact that there are people at the center of these businesses, and that is an especially important consideration when working with physicians and nurses.
Physicians and nurses didn’t get into medicine because of quotas and sales targets. Medical aesthetics, in particular, has a significant art component, which makes a heavily corporate approach feel even more foreign to them. You have to treat providers with the respect they deserve and create an environment that speaks to their motivations, while still implementing the operational structure needed to run a successful business.
There have certainly been moments when those two priorities have been at odds, but for six years, we have proven that if you take the time to sit down, listen, and have thoughtful, collaborative discussions rather than take a top-down approach, you can build a platform like ours — one that creates an exceptional culture and work environment.
While Vos Collection improves and simplifies clinic operations, we also provide a community that has democratized best practices and enables providers to deliver real-world results. We don’t change the brands on the door, and we don’t dictate the products providers use. Instead, we give them the clinical freedom to deliver remarkable outcomes without feeling like they’ve been absorbed into a corporate machine.
ME: Do you believe physician-led collaborative networks represent a viable alternative to consolidation for independent aesthetic practices? Why or why not?
I think these are apples and zucchinis — meaning they aren’t even in the same family of options. There are currently plenty of study groups, buying groups, and other organizations that bring their members together periodically.
The real difference is that true partnership is fundamentally different from collaboration. In a partnership, destinies are tied together. The stakes are higher, the level of care for one another is different, and the accountability is greater.
Healthy conversations can happen in both environments, but real action only happens when everyone’s future is tied together. In today’s market, having an entire marketing department, procurement team, technology team, data analytics team, finance team, training team, retail product managers, and more — all working together with the financial resources and ability to execute — is vastly different from participating in a buying group or study group.
Those organizations can certainly provide value, but as an alternative to true partnership? No, not at all.
ME: What evidence can you provide that participation in the Vos network has improved patient care, clinical outcomes or practice performance during the six years it operated privately?
To be clear, we are very particular about the types of clinics we acquire. So, to say that we have improved patient care could imply that patient care wasn’t excellent to begin with — and that simply isn’t the case. It was, and continues to be, exceptional across almost all of these clinics.
Where we have been able to create improvements is in areas like enhancing the patient experience through loyalty programs and placing a greater focus on VIP patients. Those are initiatives we have implemented across the platform, and yes, we are seeing meaningful improvements there.
When it comes to clinical outcomes, it is clear that our collaborative model has elevated every provider in the platform in ways they haven’t experienced before. Even physicians regarded as among the best in the field, such as Dr. Sue Ellen Cox and Dr. Shino Bay, continue to learn from and exchange knowledge with others across the network.
There are many examples of this collaboration in action. Dr. Parker pioneered work in peptides and then collaborated with Dr. Shamban, who further advanced those learnings. Dr. Day has studied Dr. Shamban’s peptide rollout and skincare merchandising strategies. Dr. Shamban’s “signature feature” session provided insights that the broader provider group was able to apply, and Dr. Doris Day has shared her consultation approach with the rest of the platform.
However, perhaps the most tangible example is Dr. Shannon Humphrey’s 360 Training Program, which has not only trained HCPs on how to properly build comprehensive treatment plans for patients, but has also equipped clinic managers with the tools to support that process.
This program has helped drive greater patient satisfaction, increased revenue, and overall improved care by shifting away from a transactional approach and instead focusing on a thoughtful, sequenced treatment plan designed to achieve the best possible outcomes.
Lastly, our corporate infrastructure ensures that we maintain regulatory compliance across every aspect of the business — from the products and devices we use to proper patient consents, documentation, and follow-up protocols.
