Opening a medical spa requires disciplined capital budgeting across six major categories: real estate, equipment, regulatory compliance, staffing, inventory, and marketing. Unlike a traditional spa, a medspa's startup cost is driven by FDA-cleared device acquisition, clinical staff credentialing, and state-specific scope-of-practice compliance. Most independent medspa owners underestimate the gap between equipment purchase price and operational readiness—installation, training, service contracts, and working capital can easily add 30–50% to hard costs. This breakdown walks you through each line item and the variables that move the needle, so you can build a realistic pro forma and avoid the common pitfalls that drain cash before your first patient appointment.