“General Manager Thinking” Is Destroying Small Medical-Aesthetics Companies

Many medical-aesthetics companies start with a single product or a single business line. Facing an unfamiliar category and a complex market, a lot of founders choose to run product development, registration and manufacturing themselves, and hire one “general manager” to own everything commercial — sales, marketing, brand, social, medical affairs and the rest.

From where I sit, this “general manager thinking” is becoming the trap small medical-aesthetics companies fall into most easily.

Why?

The ideal is full; reality is bony.

Anyone genuinely able to command sales, marketing, medical affairs and strategy at once has usually already gone and started their own company rather than working for someone else’s. So what actually happens is that the general manager most small companies hire comes out of a sales management role.

Which is not to say such a manager is bad. It is that they can hardly cover sales, marketing, medical affairs and strategy simultaneously, and they are not the right person to carry all of the founder’s responsibility alone while the business is still immature.

Medical aesthetics is a composite business layering sales, marketing, medicine and compliance. No single perspective can sustain its long-term development.

A sales-oriented general manager’s short-term playbook genuinely can grow the number. But over the medium and long run, this organisational model hollows out the durable, stable, predictable commercial impact that strategy produces. It is becoming the single biggest obstacle to companies becoming professional — and it is dragging the whole industry into low-grade competition.

Deeper down, what this reflects is a founder in a hurry to monetise, and an underestimation of the industry.

Part.

Many founders did not come from medical aesthetics. They may come from investment, from cosmetics, from traditional pharma or devices, or from somewhere else entirely.

Once development or registration is complete, their greatest anxiety is how fast revenue can appear.

The first reaction is:

“I’ve got the certificate. You just sell it.”

And so the most natural choice is to hand the business to whoever can produce an immediate result.

That logic tends to overlook how complex this industry is.

What has to be understood is that the commercial reality here requires someone who understands sales and can lead a team, who also understands marketing, can set strategy, read trends and run promotion, who can talk to physicians about clinical questions — and who can keep the books straight as well.

Professional managers who can genuinely combine strategy with execution and manage across functions do exist. But the fact is they rarely appear at a small company.

• Opportunity and risk cost: people with that capability do not leave an established company for a start-up lightly. And given the current state of this industry, where acquiring a product is not especially hard, they generally start their own venture or join as a founding partner rather than keep working for someone small.
• A limited stage: a small company has limited resources and platform, so the appeal is not there.
• Cultural mismatch: a well-rounded manager who grew up in a mature organisation often fails to acclimatise in a start-up, caught between cultural friction and insufficient resources.

So most founders end up promoting someone with a sales background into the general manager role, in order to secure channel resources as fast as possible.

A manager who came up through sales usually arrives with existing customers, relationships and a sales team in the territory they used to run. They can readily:

• use bonus and target policies to attract a group move, standing up a team or a distributor network;
• expand territory scope or upgrade job titles to attract sales talent quickly;
• use established customer relationships to get the product tried and open up sales.

In a company’s early days this genuinely produces short-term momentum. But it also breeds an organisational habit of over-reliance on sales and of being held hostage by short-term performance.

Part.

While sales are going well, the founder and the general manager get on and the team is a happy place. But the moment there is pressure on the number, the friction appears fast:

the founder starts doubting the general manager’s ability;

the general manager, protecting the position, focuses harder on short-term metrics, using tactical diligence to paper over a strategic vacuum;

strategy swings back and forth, execution follows every swing, and the organisation becomes unstable and directionless.

In some cases you get outright two-headed decision-making: the founder will not delegate and the general manager wants to demonstrate control, leaving the team exhausted and lost. (This came through in our last workplace survey; I hope to share more results next week.)

A sales-oriented general manager’s core lens is always shipment volume. Which leads to:

Marketing reduced to an appendage of sales. Nobody cares about positioning or brand strategy, and nobody is capable of working an STP or an FAB. The day goes on posters and small gifts, plus events and meetings wherever sales happen to be good.

Medical affairs with no strategic pull. Promotion degenerates into certifying clinics and physicians territory by territory. No evidence framework gets built, no thought goes into how different types of evidence combine, and no genuine evidence-based clinical communication tool is created.

Every resource is allocated around sales output, and marketing and medical affairs are appraised by sales.

Sales culture prizes short-term speed and market impact; brand, marketing and medical affairs prize professionalism and steady long-term accumulation. That difference in values requires a leader capable of coordinating and co-creating.

Management by treating the headache where the head hurts leaves marketing and medical affairs roles with no long-term value to build, no professional progression and certainly no growth path.

The deeper problem is that a sales-oriented manager’s own capability profile tends to determine their view of talent. They rely on their own people, and they recruit those willing to comply and execute rather than people who could challenge and complement them professionally.

Over time the company’s talent structure sets at a relatively low level, with no professional depth and no room to progress. Senior professionals cannot get in or cannot stay, and the organisation’s overall ceiling stays where it is.

A start-up’s systems are still incomplete and ill-fitted. If the founder will not get their own hands dirty, does not understand the market well enough and has no independent judgement, and simply relies on a general manager to represent the market and tell them what to do, then having one person control the entire business means the organisation’s judgement and decision rights are one-sided.

Over-rely on that and sales decisions can hold the organisation hostage, pulling strategy and execution off course, generating internal friction, and becoming almost impossible to cure. There is too much choice in this market; for a small brand or a small company, a second chance is very hard to come by.

Part.

To break out of this, founders of small medical-aesthetics companies have to recognise that this is a complex, composite business. It cannot rest on a single-function manager. It needs a staged organisational model and institutionalised checks and balances.

A staged organisational model

Early stage: the founder owns strategy and marketing personally; a sales lead owns channel development; medical affairs and marketing can be supplemented through outsourcing or part-time advisers.

Growth stage: build a small matrix team (sales + marketing + medical affairs), with clear division of labour and collaboration, managed directly by the founder.

Long term: once the business is stable, consider bringing in a professional manager, with careful cross-design between functional allocation, checks and balances, equity incentives, and contributions to both performance and strategy.

Avoiding internal friction

Pick the right person: look beyond sales resources and industry experience to the candidate’s professional conduct, ability to collaborate and depth of expertise.

Do the right things: short-term volume is not the same as actually winning. Only long-term brand and scientific accumulation form a company’s moat.

Build a culture: encourage simple, candid communication; avoid letting sales thinking hold everything hostage; let marketing, medical affairs and sales complement rather than cannibalise one another.

Be clear about strategic positioning

The founder has to decide: is this company a business built for short-term monetisation, or a brand built for long-term value?

That is not an either/or. It is a question of how resources get weighted against the objective.

Different positions demand different sales strategies, different marketing investment and different team building.

The founder has to be in it

The single most important point: the founder cannot be an absentee. Even with a general manager in place,

the founder must own strategy and direction personally — particularly decisions about brand building and market strategy. That cannot be handed over entirely. Resources and budget must follow the strategy rather than following sales. And in strategic decisions the founder should stay open, listening to the market and to the professionals.

The founder also has to manage the general manager’s attitude toward talent: content with their own people, or willing to invest resources in attracting and keeping professionals stronger than themselves?

A company built to last does not rely on one all-purpose role. It relies on clear strategy, a sensible organisation, a team that works together, and a founder who is genuinely engaged with the industry.

Only when the founder is willing to be in it — to understand customers and market first-hand, to build a real division of labour and real checks and balances, and to let sales, marketing and medical affairs grow complementarily in a professional environment — does the company have a chance to break the short-term performance cycle and move toward genuine professionalism and quality growth.

For investors, this deserves attention too. Capital investing in this industry today tends to focus on product materials and technology patents.

But what actually determines whether a company can survive the cycle is the growth capacity and speed of the founder and the team. In an era of open policy and crowded registration certificates, that determines a company’s ceiling far more than any single product.