Background: The global aesthetic market is experiencing significant growth. Entrepreneurs interested in establishing or expanding aesthetic clinics are inclined to seek favorable locations and market opportunities. Metropolitan areas are attractive due to their high population density and market size. Nevertheless, studies indicate that metropolitan locations have the highest failure rate among new knowledge-intensive and advanced service firms, possibly due to intense competition. Therefore, it is worth assessing entrepreneurial strategies in that context.

Objectives: To explore how and to what extent location and entrepreneurial strategy formulation can help aesthetic clinics overcome their competitive challenges and improve their performance.

Methodology: A qualitative multi-case research design with interviews was used. An exploratory open pre-interview round proceeded with an analysis to discover themes. The literature review found theoretical frameworks to be applied to the themes used to construct a semi-structured interview guide for the explanatory main interview round. A deductive approach, using a template analysis method, was used for the final analysis. 

Results: Immature and small market locations have shown beneficial conditions for high growth performance in aesthetic clinics, in contrast to big and highly competitive market locations. Findings indicate that pivoting strategy can overcome competitive challenges. A common factor among these cases was an adaptive approach to strategic decision making.

Conclusions: A common factor amongst the four clinics is that competition seems to be correlated with the size of the city chosen for their clinics. Thus, the market location choice and a suitable strategy for differentiation is arguably essential for successfully establishing and growing aesthetic clinics. Furthermore, an effective cost leadership strategy can increase a clinic’s profit margins.

Recommendations for future research: This study could be replicated on clinics in other cities, as well as in other countries. Furthermore, other business theories can be applied to the same research field as well as from a technological and innovation perspective to medical technology development in the aesthetic industry. Finally, the theoretical approach of combining location impact with strategy impact can be applied to any industry of interest. Furthermore, this was a qualitative study that explored the various relevant factors for business strategies. Quantitative studies could test different hypotheses relevant to these factors. Last but not least, knowledge-intensive service firms are a focus of interest where management and entrepreneurship theories can be explored more. 

Keywords: Strategic management, aesthetic clinics, location factor, strategy factor, entrepreneurial strategy.