By Madilyn Moeller, Editorial Assistant, American Med Spa Association

Neuromodulators, such as Botox, Dysport and Xeomin, have become increasingly popular since the COVID-19 pandemic began. With the uptick in the market for neurotoxins, many medical aesthetics practices are looking to expand these treatments. But how can you determine who at your practice can inject these products? Here's a quick guide.

The injection of botulinum toxin type A injectables fall under the practice of medicine because a U.S. Food and Drug Administration (FDA) legend drug is being used to affect a person's living tissue. This means that these injections must be performed by a licensed physician, independent practice nurse practitioner or another licensed medical professional acting within their scope of practice. These rules vary by state, and understanding which providers can perform these treatments is key to maintaining your compliance with the medical and nursing boards in your state.

Why Are There Restrictions for Who Can Provide Neurotoxin Treatments?

These botulinum toxin type A (BoNT-A) neurotoxin injections are among the most commonly performed non-invasive aesthetic procedures in the U.S. Each of the injectables mentioned has been approved by the FDA for cosmetic use and is commonly used as an anti-aging fix to temporarily reduce the appearance of wrinkles in the face and jawline.

The medical and nursing boards in your state restrict the delegation of these treatments because they are considered medical procedures. These neurotoxin treatments come with risks, complications and contraindications, which is why they must be performed by medical professionals with documented training and appropriate supervision.

Who Can Perform Neurotoxin Injections?

A person's ability to legally inject neurotoxins comes down to the regulations imposed by the licensing board in your state. In many states, nurse practitioners (NPs), physician assistants (PAs) and registered nurses (RNs) can perform the treatment with sufficient training and supervision from a physician. Several states allow trained dentists to provide neurotoxin injections for therapeutic treatments as well as cosmetic treatments, if they are related to the dental scope of practice. Physicians are able to practice these procedures and order the products, provided they also have sought out appropriate training.

In AmSpa's home state of Illinois, for example:

• NPs can perform treatments with injectable toxins and dermal fillers with documented training and if the procedure is within their scope of practice, pursuant to a written collaborative agreement or with full practice authority;
• PAs can perform these treatments with documented training in the procedure and pursuant to written guidelines with a supervising physician; and
• RNs, licensed vocational nurses/licensed practical nurses (LVNs/LPNs) and medical assistants can perform treatment with injectable toxins and dermal fillers, with documented training in the procedure and pursuant to a patient examination and treatment order from a physician who provides onsite supervision or is able to promptly respond by telephone or other means.

Who Cannot Perform Neurotoxin Injections?

As injections fall under the practice of medicine in all states, persons who do not have prescriptive authority or the licensed scope of practice are not able to inject on their own. As such, while a trained medical assistant may be able to inject when ordered and supervised by a physician, they cannot perform this treatment on their own. Injecting or performing exams without a license is considered the unlicensed practice of medicine.

Limiting the injection of toxins such as Botox, Dysport and Xeomin to only those providers approved to perform these treatments by your state medical board is the best way to protect your medical aesthetic practice and the license of the supervising physician and injector. If a patient suffers a bad outcome and raises a case with the state medical board, the offending practice could suffer severe financial penalties, and the physician's license could be in jeopardy.

Consult an experienced health care attorney to follow the state guidelines down to their finer details. AmSpa partners with medical aesthetic law firm ByrdAdatto, and AmSpa Members receive an annual complimentary legal consultation.

Join AmSpa to find state-by-state medical spa laws. AmSpa Plus Members receive access to AmSpa's state legal summary for their state; each summary answers more than 100 questions related to medical spas, including the question of who can inject neurotoxins in your state.