There has been exponential growth in the medical spa industry over the last few years as well as a marked increase in the variety of services and devices offered to patients. However, legal regulations have been much slower to adapt to these changes. As a result, there are still outdated, contradictory, and paradoxical laws that often catch med spa owners by surprise.

Below are some of the most surprising state laws applicable to medical spas.  

  1. Microneedling with or without PRP or Radio Frequency has become a common procedure. Kim Kardashian’s affinity for “Vampire facials” has fueled  the popularity. In New York, microneedling cannot legally be performed by a Registered Nurse or Nurse Practitioner. Surprisingly that procedure can only be legally performed  in New York by a licensed acupuncturist or tattoo artist, a Medical Doctor, or a Physician Assistant.  
  2. Laser hair removal is a very common medical spa procedure. In some states, like New York, virtually anyone can perform laser hair removal. However, in neighboring New Jersey, the use of lasers is technically restricted to physicians.  
  3. In Florida, there are no specific laws prohibiting the corporate practice of medicine. Therefore a regular business person can engage in the practice of medicine, including owning a medical spa. However, Florida has strong prohibitions on the practice of dentistry, meaning only a professional corporation owned by a dentist can practice dentistry.  
  4. Florida also has restrictions on who can be a medical director of a medical spa. If it is the physician’s primary location, any physician may act as the medical director. However, if the physician supervises a nurse practitioner or the physician is not onsite, the physician must be board certified or board eligible in dermatology or plastic surgery. All off-site locations that are not the physician’s primary office must be within 25 miles of the physician’s primary office. 
  5. Over the last two years most states have adopted some type of parity for telemedicine, or at least created waivers that allow for the good faith exam to be done through telemedicine. Pennsylvania has no specific rules related to telehealth other than a statement on the Governor’s website that states “currently, no Pennsylvania law prohibits the practice of telemedicine.”
  6. In Louisiana, the law says a professional medical corporation is organized for the practice of medicine or podiatry. However, the Louisiana Board of Medicine has said that employment of a physician by a corporation shall not violate the Medical Practice Act. The Board will not concern itself with the type of entity so long as the physician’s medical decision making is not interfered with.  
  7. Alabama has one of the clearest laws regulating the use of lasers. In Alabama, physicians must provide supervision, written protocols, educational requirements, quality assurance, equipment safety, registration, and adverse event reporting requirements. Only physicians may use these devices for ablative procedures. Physicians may delegate other laser procedures to nurse practitioners or physician assistants but must perform the initial consultation. The consultation may be done remotely if medically appropriate. Physicians may delegate non-ablative laser procedures to others if properly trained and under direct supervision.
  8. The South Carolina Board of Medical Examiners believes that the revision, destruction, incision, or structural alteration of human tissue is the practice of medicine. Therefore, microneedling must be performed under the direct course of the treatment of the physician and the physician must directly supervise the person performing the procedure. The physician must be on site when the procedure is performed.  
  9. Some states like Vermont do not have any laws regarding microneedling treatments. Surprisingly, the Vermont Office of Professional Regulations has gone on record saying that any licensed cosmetologist or esthetician may use microneedling if appropriately prepared by training, education, and experience.
  10. In Washington, a registered nurse may perform injectables under supervision. The delegating provider must be available on site within 30 minutes. However, for non-FDA approved treatment the provider must be on site.  

This survey of medical spa laws serves only to highlight how different and obfuscated state laws currently are. This article is not intended as legal advice. It is important to consult with an attorney knowledgeable with the laws of your state.