By: Alex R. Thiersch, JD, Founder/Director of the American Med Spa Association (AmSpa)

Microneedling is a trending procedure in med spas, but many owners and practitioners are not clear if aestheticians can legally perform the treatment. The answer to that question, like many regulatory issues in the medical spa industry, can vary depending on what state you practice in. For the much of the United States, however, the answer is likely no.

Also known as collagen induction therapy, microneedling is a minimally invasive treatment to rejuvenate the skin. A device with fine needles creates tiny punctures in the top layer of the skin, which triggers the body to create new collagen and elastin.

Sign up for AmSpa's webinar on the Trends, Science and Economics of Microneedling for more information on the procedure.

The Practice of Medicine

An aesthetician's license does not permit them to perform medical treatments, but rather aestheticians may only perform procedures for the purpose of beautification. Many med spas look at this standard and assume that aestheticians can perform microneedling, however many state regulatory boards are specifically classifying microneedling as medical treatment, no matter whether the needles penetrate the outer layer of the skin.

Illinois and California, for example, specifically listed microneedling as medical treatment in 2016 because they classify the device as medical equipment. At an American Med Spa Association Medical Spa Boot Camp in San Jose Kristy Underwood, executive director of the California Board of Barbering and Cosmetology, gave additional details as part of a 30-minute Q&A.

"This isn't new – aestheticians cannot penetrate the skin," said Underwood. "They also can't use any metal needles, period. [California] aestheticians are prohibited from using metal needles." She added that they cannot use anything that might be disapproved by the FDA, cautioning people against the Dermatude device until more information came out from the federal government related to its use.

For more business and legal med spa best-practices attend an AmSpa Medical Spa & Aesthetic Boot Camp near you.

Physician Supervision and Delegation

In some states, however, there are ways in which individuals holding aesthetician licenses can perform certain medical procedures. As noted in this video update, for example, the state differentiates between an aesthetician and a person who is performing medical procedures under the supervision and delegation of a physician.

This means that if the patient is examined by a physician or a mid-level practitioner (like a nurse practitioner or a physician assistant) then an individual working in a medical spa may perform microneedling. It is very important to note for aestheticians that if you are going to do this procedure under this caveat you cannot represent yourself as an aesthetician while doing so. This means flipping over your aesthetician name tag and taking down any certification you might have hanging on the wall.

The state may allow you as a person to perform this procedure under proper medical supervision, however your regulatory board does not cover this under your license.

Supervision Requirements

This sounds onerous, and it is certainly involves more of a pain point than a facial or another aesthetician service, but depending on your state this does not have to be a deal-breaker for offering microneedling services in your medical spa. The supervising physician doesn't have to be in the room watching the aesthetician perform the procedure, and in many states does not have to see the patient before every treatment – just the first one.

Know the Law

Regulations can vary greatly depending on where your business operates so it's very important to know the laws specific to your business. When in doubt consult an attorney in your state familiar with aesthetics.

AmSpa members have access to legal summaries of the laws regulating medical spas in their state, as well as an annual complimentary compliance consultation with the law firm of ByrdAdatto.

See AmSpa's Treatment Directory for more information on microneedling.