Shikhar Saxena – Building Milan Laser as CEO – Ep.196

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(00:00:00) Intro

(00:03:59) The Milan origin story

(00:13:07) Verticals to pursue in the Med Spa space

(00:14:43) Improving the customer experience

(00:21:05) Studying companies to learn about consumer experience

(00:23:59) Changing clinic management through scale

(00:26:33) Key executive roles

(00:28:44) Hiring and interviewing

(00:33:51) Disseminating core values across locations

(00:37:08) Dealing with stress

(00:41:59) How PE changes processes

(00:45:15) Predictions for the industry

(00:46:17) The decision to focus solely on hair removal

(00:50:42) Future growth plans

(00:53:54) Shikhar’s book

(00:58:29) Final thoughts

Alex Bridgeman:  Shikhar, thank you so much for joining the podcast. I’ve really enjoyed getting to chat with you and I’m excited to chat again. Your story is really interesting. Our first conversation, you talked about sharing a parking lot with the first Milan location. I’d love to kind of recap that story again because that was really, that was a great origin story.

Shikhar Saxena: Sure. Yeah, we had an urgent care. When I was doing my cardiology fellowship, I had an urgent care that I owned, and why that story is important, it was across the street from the first Milan Laser Aesthetics. So it was kind of actually a busy street, but we were across the street from them. Opened the urgent care, and the very first day, when we opened the urgent care, a doctor drove up into our parking lot, walked into the urgent care, and said, “Hey, do you want to buy my practice across the street?” And I didn’t even believe he was a doctor. And I was like, “Geez, I don’t know.” My wife and I are both physicians. We have a lot of student loan debt. We have our third- a fourth kid was on the way at the time. We just had put money into the urgent care. But I went over to the business, and it was a traditional med spa. It was running 11 different services at the time, which included laser hair removal, and I just really loved the business model. I thought the business model was very attractive in terms of the services that they offered, in terms of the consumer base, and then in terms of the financials as well. So, I ended up calling my best friend, Abe Schumacher, who is an MD MBA, so he had run various businesses himself and then he was practicing as a hospitalist. And I said, “Hey, do you want to do this with me? Do you want to partner with me?” And it took us about a few months of diligence and negotiation and things of that nature. We ended up buying the practice in 2012.

Alex Bridgeman: So, what was that first year or two like owning one practice? Because you guys expanded pretty fast after that, right?

Shikhar Saxena: Yes and no. It was incredibly busy. So, in 2012, when we first had Milan Laser Aesthetics is what the name was, I was in my third year of cardiology fellowship, so I super busy there. And then I was running the urgent care, which I was very, very busy there. And then I was doing various moonlighting gigs because we were just starting out our family. My wife was a practicing pediatrician. But just in terms of ensuring that we were paying off debt, that we were getting our kids set up and all of those things, so I was working quite a bit, and just in terms of Milan Laser itself, was very, very busy. So when we first started, there was very few employees. We had a PA, we had a receptionist who kind of worked as our office manager as well, and then we had Abe and myself. So, we did basically every job that you could imagine. So, I was a receptionist. I was the provider. I was a sales manager. Abe coded our first website. We did all of our marketing ourselves. We did all the financials ourselves. Every job that you could imagine from taking care of the customer to cleaning toilets, we did it. And it was kind of crazy because there were times when the clinic wouldn’t have anybody to work. So myself and Abe would be- I would call him and I’d say, “Hey, we got to do this together.” And he was like, “Yeah, absolutely.” And we would just tradeoff between who would be the receptionist and who would be the sales manager and kind of do it that way. There were actually times where I was running- I was working at the urgent care and Milan at the same time. So, what I would do is I would treat customers at Milan Laser, and then they would call me. The urgent care was never that busy. It was not that successful of a venture. But they would call me from the urgent care and be like, “Hey, somebody came in, you have to stitch them up.” And I would literally run across the street with my white coat, treat the patient at the urgent care, and then run across the street with Milan Laser. So, yeah, we started with one location. It was invaluable for us to do kind of all the different things in the organization because we understood the product, we understood the business model, we understood what the consumers were asking. So, we were able to go from that. We had that one location for about a couple of years before we purchased our second location in 2014. And then, although we grow very quickly now, we grow anywhere from 75 to 100 locations per year now, that was a stepwise approach. So we grew, but we grew- one year, we opened three locations, then five, then seven, then et cetera. And then we got up to the location number that we have, that we open every year now.

Alex Bridgeman: So how long did you run that first location for? Like, how long were you actually working in that one?

Shikhar Saxena: I was probably in and out of it until about 2015, something like that. We opened our second location in 2014, so we had stepped back a little bit by hiring, our receptionist who was our office manager managed both the locations. We would intermittently be the providers in both of our locations in Omaha, but we had the ability because cashflow was, at least the business was cash flowing, so we could hire some nurses and providers and stuff like that. Physically in the business, I would say we kind of stepped out completely probably around 2016. I don’t know. It’s hard because sometimes the days mesh together. So, I remember still doing things inside the clinic intermittently until 2017, but it would be things like being the medical provider and things of that nature, or the medical director, I should say.

Alex Bridgeman: So, your job’s changed a lot since then. You have 1900 employees and 300 plus locations today. But is there anything you miss about or think fondly about in those early years?

Shikhar Saxena: Absolutely. Yeah. It’s interesting. There’s a lot of things that I really, really enjoyed. The number one thing I enjoyed was having interactions with the customers. The customers were- it was very different from my medical practice. So, when I was practicing as a MD inside the hospital, people would come in and they would be sick or they would be scared, they would be- Generally, they were not the happiest. Nobody really wants to come to the hospital and be seeing the doctor. It was a completely different experience in the med spa. People came in. They were wanting to look good and feel good about themselves. And we were having products and services that allowed them to do so. And when you’re doing laser hair removal or any sort of laser treatment with a consumer, you have a little bit of time. So, you have 15 minutes to upwards of an hour sometimes doing treatments or services with people, and they routinely come back. They routinely come back for these services. So, you get to know these people quite well. So, you kind of just get to chew the fat with consumers. And it was really enjoyable. And it was just fun people who are, well, what do you think about this? What do you think about this? And then we’d talk about the services, but then we’d also talk about just the kids and stuff like that. The other thing that I miss is it’s fun being an entrepreneur. It’s fun starting a business. And now as the company has grown, it still obviously has different things that are fun, but it’s kind of fun to be grinding. It’s fun to kind of take something from nothing and really start iterating on businesses. And now we have 300 locations. To have the whole company, have a very giant ship move, you really have to be thoughtful about how you’re doing things. When you’re first starting out and you have one clinic, we iterated literally every single day. Abe and I would talk in the morning and be like, that didn’t work yesterday. Let’s try this today. You could actually do that rapidly and test, and once again, grind. It was just that type of stuff I really enjoyed and I thought it was very fun.

Alex Bridgeman: So how do you get that today? Where does that iteration and more entrepreneurial energy come from? Where does that originate today?

Shikhar Saxena: Yeah, there’s a couple different ways that we’re able to do that within the organization. So, it’s really interesting. You get creative about other things within the business. I get very excited about things that people think are probably very nerdy. I get very excited about processes. I get very excited about operations and how to improve systems and to streamline operations. I get very excited about that, building efficiencies. So that’s incredibly exciting. Secondly, our business is one of incessant testing, and I mean that in the most positive way possible. We’re constantly testing in every aspect of the funnel to try to improve, improve obviously overall profitability but also try to improve the customer experience throughout the way. If you improve the customer experience, you’re ultimately going to improve profitability. So, there’s a lot of ways that I still get to be incredibly creative in terms of ideas or thoughts about the interactions that we have with consumers. And it’s kind of nice because previously when our company was small, we would test, and we would have, we would kind of have some data points but not as significant as we do today. Now we can test and we have a lot of data points where we can feel very confident about statistical testing on these data points to know that we’re being successful. And then the final thing is our organization we’re very excited about, we actually had started, I along with Abe had started business development within our organization about three years ago. And our goal is to try to build new verticals underneath the Milan Laser brand. So that has allowed me to continue to keep my sort of entrepreneurial mind set and creativity still going while we’re still, while I’m still able to help run a very, very large organization.

Alex Bridgeman: And what kind of verticals would those be? Like, which ones compliment a med spa business really well?

Shikhar Saxena: Yeah, it’s interesting. We are very focused on service-related businesses. And the reason I say it’s interesting is I feel like we have the ability to do, I didn’t say medical service, I said any service. And I think we are incredibly talented at doing multi-unit retail that’s service based. So that could be anything that you can imagine. Right now, we’re thinking about things that are within kind of the medical space, whether that be we started hair transplantation a little over a year ago, very excited about that one. The procedure has been very effective. And the consumers have really responded very nicely to the service offering. There’s a whole host of other medical services and other services alike. What we had planned on when we started Milan Laser was to build out infrastructure to help support our clinics. And we have built out a very nice corporate team that is all the proper corporate teams that you can imagine. They’re so incredibly talented in being able to support our Milan laser stores, I thought it made sense to build kind of a shared service model where our corporate staff is able to help any other verticals that we have. So once again, our corporate staff is incredibly talented at being able to support service-related clinics. So that’s the kind of businesses that we’re looking for.

Alex Bridgeman: Gotcha. And you talked about a lot of your patients or perhaps most of your patients, will have multiple meetings and multiple sessions with any of your clinics. I know you focus a lot on consumer experience. Can you talk about what that means and what your goal with, when someone walks in the door, what’s your kind of goal for their experience at your clinic?

Shikhar Saxena: Yeah, great question. Our number one core value in our business is to wow customers with world class customer experience. And we specifically use the word wow. Actually, Abe wrote that line. That’s how he felt so strongly about customer experience. It’s our first, number one core value. So, what I want is when the customer comes in, that they feel very comfortable. They feel it’s not a pushy environment. They feel that it’s- They’re coming in and they feel very sort of like these Midwestern core values that we started with our Omaha clinic, that you come in and you’re a guest in our organization. That’s what I want the customer to feel like. I want them to have a tour of the clinic, say that this is our facility, this is where you’re going to get laser hair removal, make sure that you’re very comfortable. We’re trying to take the fear out of the experience. Whenever you’re doing a medical procedure, you’re always having a little bit of angst, whether realized or not. So, we want people to feel very relaxed. But the initial consultation process takes about anywhere from a half hour to an hour. And really the goal is to understand what the consumer’s needs is, have a sit down one on one conversation where we can really make a connection with these customers and understand what their needs are that laser hair removal obviously can help support. But then just in general, how laser hair removal works is an average customer may need anywhere from 7 to 10 treatments, but some customers are going to need more than that, some customers are going to need less than that. But what the nice thing is, with customers coming in periodically, we’re able to know these customers really well, how their treatments are going. Actually, I tell our clinic managers when I do our state of the union, what I want them to actually do is let’s say they’re coming in on their third treatment. They’re getting, whatever, their underarms done. I want the clinic manager not to only go, “How are your underarms?” I want them to actually have a real connection with our customers basically to the point of, “Oh, how are your kids doing? Oh, didn’t Billy graduate from- Weren’t you having that party? How did that go?” And really have an authentic interaction with our customers. That’s what we mean by wowing customers with world class customer experience. If I can actually even go one step further, we want that for every aspect of the funnel, every single aspect. So, whether you’re interacting with our website or our call center, just one of our call center KPIs that I think really underscores the point is when we first started out our call center, I was very hesitant because when I hear about call centers, I’m like, ugh, vomit, because you’re on hold, you have AI telling you to press buttons. And I was like that absolutely cannot happen at our organization. So we have a KPI that when a lead is formed on our website, an employee at the call center needs to be interacting during our regular hours within five minutes of that customer interacting on the lead site and not via some AI or some computer, the actual human being is interacting with this person. And we usually start out with a text, being like, we got your lead form. Would you like to continue this conversation via text or via phone call? And just depending on what the customer wants, we can interact with that customer. That type of wowing experience of customer service, that’s what we’re looking for in every aspect when we’re interacting with these consumers.

Alex Bridgeman: So what are some other tactics in person that your team can do? Or across 300 locations, what is that playbook for maybe just even the first 10 minutes of a new patient walking in? What are some things that your team does that help create that moment of ease or relaxation?

Shikhar Saxena: Yeah, it’s a great question. Believe it or not, and forgive me for doing this, but it actually even starts upstream from that. So, after the lead has become a booked consultation, our clinic managers have already started interacting with that customer before they walk in through the door. So, say they become- Alex, you come on to our books tomorrow. Our clinic manager in West Omaha will text you and be like, “Hey, Alex, this is Shikhar. I’m the clinic manager at West Omaha. We’re going to be doing these, these, and these things. Let me know if you have any questions. Here’s my direct line. If you have any questions coming in tomorrow, just let me know. I’ll be happy to answer.” You’re more at ease automatically, and then you’ve already sent an email with the- you would get a picture of myself on the email, so you know what I would look like. You can go to the website, you can see what I look like, but we have all of that on email as well, so it’s a very personal email. So when you come in and you see me live, you have already had an interaction with me. You’ve already had some degree of relationship. So you’re not coming in feeling like you’re having this cold experience. So, then you come in. I know you’re coming in. I will be standing in the front as a clinic manager and be like, “Alex, I’m Shikhar. I texted you and I was the one who sent you the email.” And all of a sudden, you’re like, oh yeah, we talked, as opposed to never talking to that person ever and then coming in and having to do that whole introduction stuff. Those little things actually make the customer experience better. So those are things that we’ve iterated on over time. But then after the customer comes in, they have to fill out paperwork, but we make even the paperwork very relaxing. So, it’s on an iPad. Our receptionist, who we call- our receptionist, I’ll just use that word for right now, our receptionist will give an iPad and then say, “Would you like anything to drink? Here’s a really comfortable area to sit. If you have any questions, let me know.” And they’re very much available. Then the clinic manager once again continues this conversation, and we know little things about them already. It’d be like, tell me about yourself. Let’s go ahead and do a tour of the clinic. And we’re really getting to know the questions, really getting to questions, we call them discovery questions, that continue to build this sort of connection with the clinic. Those are very pivotal things that we’re doing that allow the customer to feel much more comfortable and just doing it from the other side. We were consumers of these services and we always look at we do price shopping, we do competitive shopping, and then I go into other businesses, any other business, I’m always like, well, how do I like this? We have iterated on our own business taking examples of what have been successful in our own experience, and we’ve iterated on our business to make a very relaxing atmosphere for the consumer.

Alex Bridgeman: Are there any companies outside of healthcare that you study a lot for consumer experience ideas?

Shikhar Saxena: Yeah, we do. Actually, any business that I am a consumer of I will study. And it’s kind of interesting. Like I’ll study it academically, of course. And I listen to tons of podcasts. I read quite a bit. But I also am just a consumer. My brain doesn’t ever shut off. So, when I’m a consumer of like a restaurant, I’ll actually think about their consumer experience and what they’re doing. I give this example a lot at our state of the union is one that’s really kind of like you wouldn’t even think of, but it’s fast-food restaurants. And the one that I think they do just a tremendous job with the consumer experience is Chick-fil-A. And I think they just do just a tremendous job where how they built out the organization where it is an owner operator, and you go in and they have processes, the place is always pristine, it’s always clean, it’s always a friendly environment, even when the drive through, the lines are really long, operationally, they make it so you’re moving quickly, and the product, the actual product is always consistent. All of those things, we pay a lot of attention to businesses like that. And we try to emulate them in terms of consumer experience that we want that experience to be that strong. So, we get inspiration or we steal ideas, for lack of a better way of saying that, from all sorts of businesses just to continue to make the consumer experience better.

Alex Bridgeman: Yeah, we’ve had a lot of guests mention loving Chick-fil-A. It also just seems like there’s a lot of people back there. There’s always an army of folks running that Chick-fil-A, keeping things moving and quick. So, yeah, it’s no wonder that they’re so fast. There seems to be just so many more people in there per customer coming through.

Shikhar Saxena: Yeah, definitely. That aspect I feel a little bit different about. That one kind of makes me uncomfortable if I’m being honest. I like their operational ability and I like how speedy they are. But sometimes you feel overwhelmed when you have like 20 people there. Our clinics – I’ll just tell you in contrast to what we do – our clinics are very, very personal. And we want to have this sort of one on one interaction with the customer. So usually, our clinic staff is about three to five, and that includes our providers, that includes our providers treating them. Generally, we have one clinic manager, plus minus an assistant clinic manager. So that allows us to have a very close connection with our consumers that we can know, truly know each and every one of them, so they’re getting this sort of premium experience that we want.

Alex Bridgeman: Are there any major changes you’ve noticed in how you run your clinics? Obviously when you’re less than five locations, you could presumably go visit each one and be in person and see everybody. Was there any point, are there any points along the way of Milan’s growth where your role in managing your clinics had to change dramatically?

Shikhar Saxena: Yeah, absolutely. And I think you hit what I think is the challenge with scaling. So, when we had, I’ll even talk about when we had six clinics. Our first six clinics were all in the Midwest. We had a couple in Omaha, one in Lincoln, one in Des Moines, one in Kansas City. Those were our first locations. Myself and Abe could drive to every single one and we could look at them and we could be there and ensure that everything was being followed. When the clinic count started to expand, we had to focus significantly on processes and infrastructure to ensure processes were occurring. What I mean by infrastructure is not just people, but it’s actually systems that allow us to ensure that the clinics are doing well. And it’s things as mundane or seemingly mundane, which I think is insanely important, but seemingly mundane as making sure that we have a checklist for cleaning every single day. Something as basic as that, that has to be operationalized and that has to be absolutely consistent in every single clinic. I know that sounds so crazy that I’m so anal about something so basic, but that’s how anal I want to be in terms of operationalizing things and ensure consistency across our brand. And then the way that we’re able to continuously ensure that the brand stays consistent is we have incredible leaders, the people infrastructure that I mentioned, to ensure that the processes are being followed. And that includes everything that you can imagine from a process standpoint, from a clinic standpoint, from the sales procedures, from the treatments, et cetera. So, we have regional managers from an operational standpoint, but then we also have medical operators who are able to audit our clinics in terms of the treatments to ensure that those processes are being followed. And then we have everything operationalized in terms of automated data. For example, we have our regional managers go in and do checklists to ensure that everything’s being followed in the clinic. Well, that, those PDFs come to us and we’re actually able to see how those clinics are operating, how well they’re doing. In addition to that, we have KPIs in every clinic to ensure that we know that the processes are being followed in terms of you can very clearly see that if a data point is missing here or there. So that was a big change, I would say. And just how the company has scaled over time is really focusing on these things that ensure that consistency is met across the brand because I physically can’t be at obviously 300 locations.

Alex Bridgeman: What are some of the key roles on your executive team that you’ve hired over the last couple of years? Like which ones emerged and kind of at what times?

Shikhar Saxena: So, yeah, over the last couple of years was a little bit different than when we started. The last couple of years, we have, our team is incredibly strong. So I feel that we’ve built out our infrastructure a little bit more a couple of years ago. So, in terms of our executive team, our executive team has generally been there over a couple of years now. So they’ve been strong. Maybe I’ll answer it a different way. When we first started our corporate office, we had about six locations, give or take, we were on that five to six location cusp. And we started out by hiring things that had the highest impact to the business but then also things that we felt weak on or the business needed a lot more support that we could provide. So, for example, the very first hire that we had was a CFO which allowed all the financial stuff that Abe and I were working on to be given to somebody who is constantly monitoring the numbers, constantly budgeting, and focusing on forecasting, things of that nature. And then we hired a Chief Marketing Officer where we were focused on ensuring that the lead generation was incredibly strong. As the company continued to grow, obviously, we needed to hire a COO. We expanded a lot. We hired a Chief Development Officer. We have a Chief Medical Officer, all of those things that our organization needs. So, we’ve really focused on building out infrastructure early to ensure that the company was built on a strong foundation. Over the last couple of years, we’ve been very, very- I’m more than proud of my leadership team. I think they’re the best leadership team on the planet. And I truly mean that. I think they just do an incredible job. I think what we focused on in our organization as it’s grown now is really focused on ensuring that the middle management layer, we’re hiring really strong middle management people, that includes our regional managers, our directors, our VPs, to ensure that the processes continue to get followed as well as continue to develop the organization and people who are interested in even moving up in their own careers. So that’s been really exciting. That’s been kind of the focus over the last few years.

Alex Bridgeman: So with that middle management group, what are some things you look for in hiring and interviewing?

Shikhar Saxena: Yeah, that’s a great question. We really focus on, I know this sounds trite, but we focus on people who align with our mission statement and core values.  Our mission statement is to be or our vision statement is to be the best laser hair removal company in the world. I mean, we’re no ifs, ands, or buts about that. That’s very, very clear what we want to accomplish. But in terms of how we’re going to accomplish that, we are looking for people who, once again, align with our core values, respect diversity, are thinking about consistency, are thinking about the customer experience, are professional individuals who are ethical. We want to ensure that we have a brand that is a five star brand, that is truly a transparent, ethical company, which we’re very excited about. I use that phrase a lot because about 20 years ago, before we started our company, medical spas got this kind of, some a negative connotation because people were trying to sell anything under the sun, even if it wasn’t effective or not, and they weren’t necessarily doing right by the customer. When Abe and I came on the scene, we were both physicians who really focused on not only the customer experience, but a very high efficacious ethical standard. And it was our reputations on the line. So as the company continues to grow, we want to ensure that our customers are coming here, that we are continuing to maintain those very high standards that we set way back when. So those are the types of things that we’re looking for. And then just technically, what I’m also looking for is people who are motivated by improvements, people who are excited about growth, who are- I have these mantras at our company. One of them is never rest on our laurels. It’s always trying to get better as an organization with processes, with things that are scalable, all of those things. Those are the things that we’re looking for. And then the final one is a person who’s positive. That is our last core value, positivity and fun are embraced here. And that’s because I consider myself to be a pretty fun person. And when Abe and I wrote that, we’re like, yeah, we still want to have fun here. This is a fun business to run. And one of the jokes that I always say is I always tell my kids to always be positive. I always go, “Be positive.” And they’re like, “Why do you always say that, Dad?” And I was like, “It’s my blood type.” It’s a very corny dad joke. But I like people that are positive people, like happy to come to work, excited. Those are the types of people that we’re looking for that are obviously hardworking, but they also know how to have fun.

Alex Bridgeman: Is there anything else within people that you’ve thought a lot about or hiring talent and finding the right folks for the right roles?

Shikhar Saxena: Yeah, I would say there’s a couple things. One is ensuring that you have the right people in the positions. That is 100% very, very important. And I think we’ve worked a lot on kind of iterating on how we recruit these individuals. I think that’s incredibly vital. The second one, though, that I think a lot about is kind of this buzzword that’s occurred in corporate America over the last 10 years, which is culture. So, I’m probably not immune to it either. But how I- it’s very hard to define culture. You ask ten different CEOs about what they mean by culture, and they’ll probably give you ten different answers. But in terms of what I’m trying to look for in terms of culture is can this sort of company that started with kind of bootstrapping our way and then became this kind of large organization continue to maintain those core values that the company was founded on. And at headquarters where all of our corporate staff is, it’s very clear that that’s the case. I’m here every single day so I know that’s the case and still people are excited and having fun and great. And our company, across 300 locations, I’m very proud to say, has also maintained that. But it’s a lot more challenging as you have clinics widespread across the United States to ensure that culture, that the foundation that this company was started on, how do you continue to disseminate that sort of feeling across the entire organization? We worked very, very hard on that, to build this sort of Milan community, if you will, that we’re all in it to achieve this vision. We focus a lot on that. Thankfully, we’ve been very successful so far. But we want people who are what we call kind of just out by themselves. So, let’s say we have a location in Fargo, North Dakota. There might not be a location close to them until like Sioux Falls, South Dakota, for example. And we still want them to feel part of the Milan brand. So, we focus on our regional managers, also our clinical specialists who continue and are able to interact with the clinic staff there, but then also having continuous events to feel connected with the brand at large. I think those are the things that I really focus on from the employee experience to ensure that we continue to grow in the right way.

Alex Bridgeman: What are some tools for you personally to continue disseminating the core values and culture across these 300 locations? Do you have town halls? I know some CEOs send a weekly email like Sunday evening talking about the last week. What are some ways that you personally communicate that across the company?

Shikhar Saxena: Yeah. So, I would say personally, I use- I’m going to use synonymously with how the brand itself communicates to all of our employees because nothing’s ever done individually. It’s an amazing team that’s able to be- allowed this company to be successful. But communication, I’m going to go back to something that I believe in very strongly, communication can be process driven and operationalized as well. So, we have very stringent processes on how we disseminate and communicate information. So, for example, every week, we have what’s called Milan Minutes, and it’s every Monday morning at 7 a.m. There’s actually a lot of work that goes on to making sure that the Milan Minutes have all of the information. We actually have a comms committee, a communication committee, to ensure that everything is brought to the comms committee, that we’re creating what needs to be communicated in the most effective but also on brand and beautiful way. So that’s just to give you an example. That happens every single Monday. Then on Wednesdays, we have headquarters meetings that all of headquarters gets all of the, including all of our regional managers, get all the notes about any sort of updates that we have from our executive leadership. So that’s formalized as well. Every month, we have our operations team and our medical team will talk to all the providers, the regional managers, et cetera. We have operationalized meetings every single month that we’re ensuring that we’re disseminating the information. The clinics themselves have morning huddles every single morning. That’s from communication that’s coming from headquarters and things that we should be talking about on a daily basis. And then finally, from a large scale basis, there’s actually quite a bit more, but I’m giving you just highlights, from a large basis, we have routinely every quarter, generally every quarter town halls as well as I’ll do a state of the union to the entire organization. We also have retreats. We’re having a headquarters retreat in just a couple of weeks. We’ll have what we call our Milan Summit next year with all of our clinic managers, along with our headquarters and field leadership coming to Omaha to continue to disseminate the culture and then to build the communication. So, there’s a lot of different processes that we have in place that, like I said, our big focus, our continued focus, I should say, is to continue to have the brand be unified, have consistency across it, as well as to ensure that the culture is disseminated no matter where you are within the Milan community.

Alex Bridgeman: Well, now you have a mic too, if you want to run an internal podcast for the whole company. That could be a fun way to disseminate a lot of communication too.

Shikhar Saxena: This mic is fantastic. I feel like Regis Philbin or something like that, or Larry King. That’s a better example. This mic’s great.

Alex Bridgeman: Yeah, it fits well. You’ve also talked about how the job of being CEO and founder is stressful and often in ways that folks don’t realize or is hard to kind of communicate if someone asked you about it, like me. Can you talk about some of maybe the dimensions of stress and how you deal with each one or how you incorporate them?

Shikhar Saxena: Yeah, that’s a very loaded question. So, I’ll actually first start by saying I absolutely love my job. I get to- I’m very, very lucky, very blessed to be the CEO of this company. It’s truly amazing. But being the CEO of an organization isn’t without stress. And there are different layers to it. So, there’s- actually, let me just talk about kind of the three divisions that I always think of in terms of who my responsibilities lie with. So, I always think of customers, our employees, and then our investors. So those are kind of the three different sort of groups of people I’m continuously thinking about. So when I think about customers, I want to ensure that the decisions that we make continue to improve their lives, improve the service over time. We continue to try to make our protocols better to have the highest degree of efficacy for laser hair removal. Once again, have the greatest experience for them in every aspect of their journey. So, you get very stressed when you think about, am I making a decision that could actually deteriorate or deter the brand in any way, shape, or form? So, I think about those incessantly. When we think about employees, my goal is, once again, improve the lives of our customers, improve the lives of our employees, how do we continue to make our brand work, not only for our customers, but for our employees as well, that we become an employer of choice. We started out with four employees, two of which were the founders. We weren’t thinking about medical insurance back then. We were just trying to survive to the next day. Now our organization is very large, and thankfully we’ve been blessed to be very successful. How do we ensure that we are an attractive place for people to come work in terms of pay, benefits, culture, all of those things, and then also retain our talent as well. How do we continue to do that? So, the decisions we make, I make decisions about that along with our executive team, along with the management team routinely. Every week there’s some sort of whether it be small or big decision about that. And you’re hopeful that all of your decisions are the right ones and that everybody understands it’s with positive intent, but sometimes things don’t go as well as planned or the messaging doesn’t go right or things like that. I get very stressed. And it’s partly because, and it’s probably a little bit self-inflected, I obviously was one of the co-founders of this organization, so I have a very big emotional attachment to it. I also feel a great sense of responsibility and pride and reputational risk in terms of the brand itself. I want to ensure that the brand has the highest reputation from all aspects. And then finally is the investors. So, we have private equity backed- we’re a private equity backed organization. When we take an investment, when I took an investment, I have this just great sense of responsibility that I feel to return, to have a massive return to our investors. And anybody who knows me knows I’m insanely competitive. I want to be the one that gives the biggest return to our investors. I want them to say Milan gave us the biggest return on our money ever, and they’re the greatest company on the planet. I’m being dead serious. That’s actually what I want them to say. And what’s really exciting is over this last couple of years, we’ve been able to give out phantom shares to directors and above in our organization, and we hope to continue to expand that as the years progress. So our investors are not just my private equity company, but our investors are actually people within our organization, tons of people within our organization. So, I have this massive sort of responsibility to ensure that the company is being effective and ensuring that we are being not just fiscally responsible but fiscally taking the appropriate risks to have great returns for everyone involved. And that allows us to have the best life for our employees. That allows us to have the best life for our customers as well. So, I feel like these massive sort of responsibilities, I tell my wife this, and she’s just like this probably might be a little bit too serious, but I think about all of our employees, and we have 1900 employees, I think about when we first started the company, if the company failed, it’s like, okay, whatever, it is what it is, we took a risk, that’s a challenge. That’s not our employees’ responsibility. Our employees are coming because they’re expecting a company to provide a paycheck to them every two weeks so that they can have the pay and benefits to support themselves and their family, send their kids to college, et cetera. I take that responsibility incredibly seriously. So, to have decisions that could jeopardize anything like that is challenging. It’s the nature of the game, and it’s very stressful when those types of thoughts start crossing your mind.

Alex Bridgeman: What changes both to your role and to the business came with private equity ownership? What did you notice start to change over those years once they joined?

Shikhar Saxena: Yeah, a lot of things changed in terms of processes within kind of the organization from a financial standpoint. The actual operations of the businesses themselves didn’t change actually quite at all. Just to talk about that a little bit, we were at about 50 locations when we first had our private equity investment in 2019. A lot of the processes, although we iterated on them, of course, a lot of kind of the operationalization of the organization had been done. Otherwise, we wouldn’t have been able to get to 50 locations. When we had an investment from private equity, they were very clear. They basically said, we are not operators. You guys are the operators. We are supporting you in any way that we need, but we’re financial investors. And I very much appreciated that conversation. And so, it was really good because they’ve been largely hands off in terms of the operations and expecting us to continue to produce. And thankfully we have. But what has really changed is sort of the continued professionalization of this organization from I would call it the financial literacy of our organization, of how we’re able to ensure that we are having strong financials, presenting them in an appropriate way, able to look at data points and to understand when things are not going well and being able to dive into it. We built out an incredibly strong accounting team. We built out a finance team that is incredibly strong. I even started an internal audit team, which is kind of unheard of for private companies to do so. But all of that stuff has allowed us to improve the organization and have areas of focus to continue to improve things along the way. So, I think that’s what’s been most telling. The other thing is also we started having board meetings. Abe and I would have board meetings. We shared an office. Our board meetings would just be on a daily basis. So having the process to formalize board meetings, review things on a quarterly basis, giving sort of the maturity in that sense, those were largely the changes that occurred afterwards.

Alex Bridgeman: Med spas are a very popular industry right now for financial buyers. What’s your view on private equity ownership in med spas?

Shikhar Saxena: I don’t have a strong opinion one way or another. I think it’s just another business that definitely is investable. So private equity is going to invest in businesses that have good sort of financial returns, and they have sort of a good long-term thesis in terms of how they’re going to be successful and give a service offering to consumers. I think med spas 100% do that if they’re run appropriately, so that’s the big if. With any sort of investment that you’re making, you’re backing people that you want to ensure have treatments that are efficacious. You want to make sure that you’re having people who know how to operationalize things and drive processes and have the best customer experience, just like every other business. There are some people who are incredibly good at that, I would put us obviously into that bucket, but there’s some people who may not be focused on that. So I think it’s just like any other retail. So I don’t feel strongly one way or another.

Alex Bridgeman: Does it feel fairly early still in private equity consolidation for med spas? Or do you feel like we’re moving along or maybe halfway through a consolidation period?

Shikhar Saxena: Yeah, I would say we’re about- halfway through is probably about right. There’s probably about four large med spa players, us being the largest in the country. We focus on laser hair removal only. So, we’re a single service offering. There’re other large med spa chains in the traditional sense of the word that can do different other procedures within one unit or one box. So I would say that we’re kind of middle of the ground. It’s still a very fragmented industry. The vast majority of the industry itself is made up of single operators, mom and pop locations that are very successful, that are doing a great job. From the roll up for various other med spas, I would say it’s about kind of halfway. Halfway through seems like the right time for it.

Alex Bridgeman: So why do you focus only on hair removal versus some of these other services as well? What went into that decision?

Shikhar Saxena: That was a very, very big decision when we decided to do that. What we noticed with laser hair removal, we were very strong believers in providing the highest efficacy for a service offering. And what we found is when the consumers are coming in, regardless of where they were getting treated, their race, their ethnicity, you name it, laser hair removal was effective for them, and they were just blown away with the results that they were achieving. Obviously, Abe and I, different ethnicities, but we were both consumers of the service and had insanely great results. So that was great. Various other services in the med spa business have various degrees of results that a consumer will provide. We wanted something, going back to our first core value, that we wanted consumers to be like, wow, this is absolutely incredible what I’m able to get. So that was one decision. The second was what we found is regardless of what people were coming in for from a medical service standpoint, they would always ask about laser hair removal. So even if they were getting like Botox, they’d be like, yeah, so tell me about this laser hair removal. So, we found obviously a huge total addressable market from a laser hair removal standpoint as well. And then third, from an operation standpoint, what allowed us to be very successful and grow was we decided to be the master of one, not the master of none, jack of all trades, so to speak. We decided to be the masters of this one service that we were better at it than anybody else in the world. So all of those things allowed us to operationalize it, to professionalize the industry in terms of laser hair removal, and then to have this premium service offering that Milan is known for.

Alex Bridgeman: So you mentioned every or most customers wanting to learn more about laser hair, whether they’re doing some other service or not. Does that mean that your addressable market for Milan is comparable or similar to what a multi service med spa business would offer?

Shikhar Saxena: Yeah, I believe so. I think if you ask, our consumer base is about 88% female right now, and we’re really excited about the men demographic improving over time. When we started, the company, it was like 4% men. Now we’re up to about 11% men get our services, or 11 % is our consumer base within our business. So, we’re very excited about that. But just generally, when you ask a 25-year-old female, I can give you laser hair removal and it’s a permanent hair reduction procedure, are you interested in that? And they ask a bunch of questions and they’re like, this sounds incredible. Why don’t I know more about this? So I know this sounds- It’s going to sound like I’m embellishing or exaggerating, but I truly believe it’s every single female on the planet would benefit from laser hair removal. And I actually believe that for men too. I obviously am a consumer of the service myself. I just don’t think people know about it. So, I think our total addressable market is- I know that anytime I say that to an investor, they just roll their eyes that I’m saying that it’s every human being on the planet. But I really actually believe that with laser hair removal, that every single person would benefit some way or another from laser hair removal.

Alex Bridgeman: And so, you talked earlier too about having potentially other verticals. Do you think that idea of trying other retail service businesses conflicts with this focus on laser hair?

Shikhar Saxena: No, because how we’re doing those other verticals is they’re their own freestanding business. So, they’re not within our boxes for Milan Laser, they’re going to be completely separate. So, the Milan Laser brand allows it to be completely unique, segregated from our other verticals. And then what we’re doing with these other verticals is we’re doing kind of a similar playbook in terms of focus. So, for example, Athens Hair Restoration is its own unit, own box, and all we do is hair transplantation. We don’t do anything else. We don’t do- We do medications for hair that is obviously things like Rogaine or Finasteride, things like that, but it’s hair transplants. So that is what we’re focused on, and we expect to be the best at that as well. That’s how we’ve looked at these other verticals to ensure that we’re maintaining that consistency.

Alex Bridgeman: What have I not asked you about that you’re excited to talk about or think more about?

Shikhar Saxena: I’m really excited about the future of the company. I’m very, very excited. I feel like I get very passionate and excited about the growth of this organization. We’re at 300 locations in the United States. I fully expect us to get to a thousand locations here in the United States. And that’s exciting. That’s exciting. Being a part of a company that is growing, being a part of company that I still find fun to come into work every single day and seeing the growth of our employees, seeing the growth of our brand, it’s exciting. So, I love talking about the story about my last 12 years or 11 and a half years of being part of Milan, but I’m so excited about what the opportunities are over the next five to ten years. I feel like we’re just getting started, and that’s very, very exciting. And that’s just in the Milan laser brand itself. When I think about the entire group, the Milan group, when we think about other verticals that can be coming to fruition over the next five to ten years, I get very excited about the limitless possibilities that this organization has. So yeah, I get very excited about that.

Alex Bridgeman: And as your company grows, of course, the number of peers that you have running companies that are of similar size is going to be fewer and fewer. So, for yourself and your executive team, where do you go for ideas and ways to keep improving as a team?

Shikhar Saxena: Yeah, that’s a great question. As the company has continued to grow to ensure that we’re having this free flowing of ideas and continued development continues to be an area of focus and continues- obviously, it’s challenges that we have to face. So, what I personally do is I read incessantly. I’m not a big book guy. I’m more of an abstract read, like you read the abstract of a book, and then if you like it, you go into depth of it. So, I’m more of a volume guy. I read tons and tons of blogs. I listen to countless podcasts. So, I continue to do that. I do my own sort of self-development, whether it be conferences. I’m part of YPO and my YPO forum has been incredibly influential for me from developing as a human being, as a person to being the best leader I can. Our executive team does similar things. We have now more national conferences that we attend that could be anything that is multi-unit retail or med spas or even just our private equity has conferences that are just for the operators or just the legal team and just HR. So that’s allowed us to be on the same plane as other incredibly large companies and asking the right questions about how did you think about this or how did you think about this when you were developing the organization? So those are the ways that we’ve done it. Obviously, as the company continues to grow, there’s going to be needing to be the right amount of continued development for all of our leadership team, including myself. And those are things that we’re just going to continuously have to seek out.

Alex Bridgeman: So you mentioned that you’re writing a book, and we’ve had a couple of authors on the podcast to talk about their books and the different lessons and tactics from those books. I’d love to hear what’s the vision for what you’re writing, and what are some of the tactics that are going into it?

Shikhar Saxena: Yeah, I was really excited about writing a book. It’s something I’ve been wanting to do for a while. And kind of the vision was to have a place to write essentially a memoir of the last 11 and a half years of my life. I think it’s kind of a unique story. And truly it was, honestly, it was meant for me. I told my wife I don’t really care if anybody buys the book. I just wanted to write something that I felt very, very proud of. And it would be something for my kids later on when they could read back and be like, oh, this is what dad did in his thirties when he was working hard and help build a company. So, I talk about that a lot. And then I also talk about kind of how I was raised, the core values that I was instilled with, my parents, obviously my wife, and then my best friend, Abe, who I started the business with and kind of the support system that has helped me grow as a human being, the people that I surrounded myself with in terms of close friends, family, all of those things and to kind of being the person I am today. And then also I really wanted to have kind of my thoughts or tidbits about business that I could disseminate with the reader. I gave myself an out actually. So, I have all of these sort of learnings that I think I’ve had over the last 11 and a half years. But one of the comments is your thinking will evolve over time. And it’s just my way of saying that if I think that this book is crazy in five years, it’s like, oh, my thinking evolved, so it’s okay to maybe not have everything ironed out. But it’s obviously beliefs or learnings or lessons that I’ve learned over the last 11 years and how I feel about what I wish somebody would have told me when I first started the organization.

Alex Bridgeman: Yeah. Can we go into a couple for folks who are running smaller businesses but have similar Milan type aspirations?

Shikhar Saxena: Yeah, there’s quite a few of them. Maybe I’ll give just some of the highlights. So, kind of the idea, the first idea is defining your own success. So, I have a very unique story. I’m an MD who is really involved in business and I’m the farthest from a traditional doctor that you can probably imagine. But that’s how I define my success. My success is defined by being the best family man I can possibly be, best husband I can be. But in terms of Milan itself, I would never have done Milan if I was listening to kind of outside voices. So, it’s really important to have defining your own success and building a support team around you that supports you. Being positive and calm under pressure, focusing on data and making decisions based on data. One of the concepts that was really important to me, and I had to learn a lot about myself, was your strengths are your weaknesses. So, I’m very, very strong at being incredibly anal, for example, or very energetic and wanting to move quickly. Well, that can be a strength in certain situations, but it can be a major weakness in others, and it’s how you manifest those traits. Your strengths can be your weaknesses depending on where and how you manifest them. So that was really important. Building out a team, building out infrastructure, building out people to support you within the organization who continue to make the organization better, not hiring or not accepting mediocrity. And then finally, one of the ones that’s kind of near and dear to my heart is the devil’s in the details and that I’m a very strong believer in understanding everything and how it works to be able to manage the people that you’re leading. I think in my job, because I’m a little bit biased, obviously, because I was a founder who is involved in every aspect of this organization starting from square one to now, but I think it’s made me a better leader because I understand how everything works and I have seen- I think all of us have had bosses in the past where you’re like, well, why are you telling me something, you don’t even know what I do. And I never wanted this organization to be like that. I wanted us to be sort of this leadership that understood and empathized with everyone, but then continued to try to make things better. Those are kind of just a few of the concepts that I’ve learned over time. Obviously, I think the organization has been very successful, but those are some of the concepts that have helped make, in my development, help make this organization continue to develop and continue to get better. And I hope I continue to have growth well into the future to continue to grow as a leader.

Alex Bridgeman: If you could send one lesson or one idea back to yourself when you had just the one location, what would it be?

Shikhar Saxena: I think it’s the ones that I mentioned. I think it’s really- Actually, maybe I’ll say it in a different way. It’s to be a very strong leader or to be a leader of this organization requires not just focusing on one aspect of like the financials or this aspect of the business. It requires a holistic look at the organization, having a real honest look of what are the strengths and weaknesses and focusing on both to make the strengths stronger and obviously the weaknesses get better, but then also focusing on yourself to ensure that you’re working on yourself to continue to improve who you are, that you are continuously developing to be the strongest leader that you can be. Leadership or anything that you do in life, in my opinion, takes a great deal of work and effort, and that’s leadership as well. So, if I hadn’t focused on myself, and by no means am I pretending that I don’t have tons of room for improvement in a lot of things, but I just look at myself, what I was 11 years ago to now, and I’ve grown significantly. And I’m proud that I’ve really focused on growth. And I think that’s something I would tell my younger self is to continue to improve yourself, continue to improve, continue to be an avid self-learner, self-developer, continue to focus on your own development. And that ultimately creates a better organization and better environment for everyone.

Alex Bridgeman: Yeah, that’s fantastic. Shikhar, thank you so much for coming on the podcast. I’ve really enjoyed getting to spend more time with you. So thank you for sharing a little bit of time out of your day.

Shikhar Saxena: Thank you, Alex. This was fun. Thanks again.