By Alex R. Thiersch, JD, CEO of the American Med Spa Association (AmSpa)

Microneedling is a popular procedure in med spas, but many owners and practitioners do not know if aestheticians can legally perform the treatment. As is the case with many regulatory issues in the medical spa industry, the answer can vary depending on what state you practice in. In much of the United States, however, the answer likely is no.

Also known as collagen induction therapy, microneedling is a minimally invasive treatment that is designed 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.

Is It Medicine?

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

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

"This isn't new—aestheticians cannot penetrate the skin," Underwood said. "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.

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

Supervision & Delegation

In some states, however, people holding aesthetician licenses can perform certain medical procedures. These states differentiate 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 first examined by a physician or a mid-level practitioner—a nurse practitioner or a physician assistant—an individual working in a medical spa may perform microneedling. However, it is very important to note that if aestheticians are going to perform this procedure under this caveat, they cannot represent themselves as aestheticians while doing so. This means aestheticians must flip over their aesthetician name tags and take down any certification they might have hanging on the wall.

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

This sounds onerous, and it is certainly involves more effort than a facial or another aesthetician service, but this does not have to be a deal-breaker for offering microneedling services in your medical spa. The supervising physician does not need to be in the room watching the aesthetician perform the procedure and, in many states, does not need to see the patient before each treatment—just the first one.

The More You Know

Regulations can vary greatly depending on where a business operates, so it is very important to know the laws that govern medical aesthetic businesses in your state. When in doubt, consult an attorney in your state who is 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.

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