Medical Spa Frequently Asked Questions

The American Med Spa Association defines a medical spa as a hybrid between an aesthetic medical center and a day spa” with four core elements: (1) the provision of non-invasive (i.e. non-surgical) aesthetic medical services; (2) under the general supervision of a licensed physician; (3) performed by trained, experienced and qualified practitioners; (4) with onsite supervision by a licensed healthcare professional.

AmSpa is an organization that was developed in order to keep medical spas and medical aesthetic practices in the United States operating safely and compliantly. Our goal is to help the medical spa industry provide you with the treatments and procedures that you want and need while minimizing any risks you may experience due to unsafe practices. However, AmSpa can’t do all the work … so it is important for you to take your medical spa safety and wellbeing into your own hands. Take the initiative to inform yourself about the medical spa treatments available to you before you make your appointment—check out our Medical Spa Treatment Directory for this info.

As a first step, here are three tips that will help you determine whether your medical spa is complying with the law.

1. Ask if you can see the doctor. The vast majority of treatments you receive at medical spas, such as laser treatments, Botox and fillers, are considered medical treatments. Because of this, prior to treatment, you should see a doctor, nurse practitioner, or physician assistant. Compliant medical spas will schedule you for a consult before you get treated to ensure you are a proper candidate and that a proper treatment plan is in place. If you visit a new medical spa and can be treated without seeing a doctor (or NP or PA), that’s a red flag. Medical spas that don’t have proper physician coverage will make up excuses for why you don’t need to see the doctor, but they are simply untrue … and unsafe.
2. Make sure your practitioner is legally permitted to treat you. As is discussed further here, as a general rule, all medical treatments should be performed by medical professionals under the supervision of a physician. The reality is that most treatments you’ll receive at a medical spa—lasers, fillers, Botox, radiofrequency, ultrasound, microneedling, to name a few—are considered to be medical treatments by the state. This is important because medical treatments require an in-person medical exam by a doctor (either MD or DO) or a mid-level practitioner (nurse practitioner or physician assistant) before the treatment is performed. As a guide, anything with needles or a scalpel should be performed by a practitioner who is, at a minimum, an RN. Laser treatments can usually—but not always—be performed by anyone with sufficient training, but many states are passing laws with specific requirements for firing a laser.
3. Do your research. In this industry, experience matters. Internet searches can be done on everything from the spa itself to the physician, owner and nurse you will be working with. Look beyond the first two pages of results and check and see if this business is currently facing any legislation or issues with the Better Business Bureau. Yelp and RealSelf are amazing resources, but any review site can also be full of questionable reviews. Amazon recently was involved in a lawsuit in order to maintain the integrity of its reviewers … their intent may not be as pure as it should be. Ask around with your friends, at the hair salon, at your gym … anywhere where you know people invest in taking care of themselves. You will probably get more info than you ever wanted to know!

Check out our Medical Spa Treatment Directory for information on the top medical spa treatments available, ranging from botulinum toxin A (Botox/Dysport/Xeomin) to PRP Face Lifts.

Not only should you be making sure the medical spa you are visiting is one of high standing that offers a safe, clean, legally compliant environment for you to have your treatments, but also ensure that the professional performing the procedure is the right person for the job. Did you know that each state has different requirements in regard to what type of licensed professional can do what type of treatment in a medical spa and medical aesthetics environment? For specific treatments, check out the question "Who can safely administer this treatment?” in our Medical Spa Treatment Directory to help guide you on what to expect in regard to the professional administering your procedure.

As a general rule, however, all medical treatments should be performed by medical professionals under the supervision of a physician. This is not always an easy distinction to make, however, as many treatments offered at medical spas are clearly not medical (European facials, for example) and some, at least at first blush, are sort of medical (i.e. microneedling and some laser treatments). As we discuss in the Medical Spa Treatment Directory, legally speaking, most states consider any treatment that "affects” the living tissue to be a medical treatment, although there are exceptions to this rule, depending on which state you are in.

The reality is that most treatments you’ll receive at a medical spa—lasers, fillers, Botox, radiofrequency, ultrasound, microneedling, to name a few—are considered to be medical treatments by the state. This is important because medical treatments require an in-person medical exam by a doctor (either MD or DO) or a mid-level practitioner (nurse practitioner or physician assistant) before the treatment is performed. They should also be performed by trained, experienced, and supervised professionals.

Every treatment is different and every state is different, so determining who can do what is not an easy task. But as a general rule, anything with needles or a scalpel should be performed by a practitioner who is, at a minimum, an RN. Laser treatments can usually—but not always—be performed by anyone with sufficient training, but many states are passing laws with specific requirements for firing a laser.

Bottom line, call your state board of medicine or nursing, a health care lawyer, or AmSpa to get updated information.

Not always. While a doctor doesn’t always have to be on-site for every medical spa procedure; however, you should have a face-to-face consultation with a doctor, physician assistant or nurse practitioner prior to each medical spa treatment. Once that happens, a doctor doesn’t necessarily have to be on-site. However, most states require, and AmSpa recommends, that a medical professional always be on-site to ensure proper treatment and supervision. Note that if you are ever offered a medical treatment without first seeing a doctor, nurse practitioner or physician assistant, that medical spa is likely operating illegally.

This is an important question as medical treatments trigger specific requirements--face-to-face consult with a doctor, nurse practitioner, or physician assistant, to name one--that non-medical treatments do not. A medical treatment is a treatment that impacts or affects the living tissue of the body. For example, most states believe that any treatment that affects anything outside the dead skin cells, i.e. the epidermis, is considered to be a medical treatment. There is some confusion about whether certain treatments constitute medical treatments, such as microneedling and dermaplaning. Most states do believe these are medical treatments and it’s always better to err on the side of caution. It’s never a bad thing when a doctor performs a treatment or is on site.

AmSpa encourages consumers to be aware that oftentimes noncompliant medical spas will indicate that medical spa treatments are not medical treatments, when they are in fact considered medical treatments by the state. Body sculpting and laser treatments are often considered medical treatments, for instance, even though they are often advertised as non-medical treatments. It’s in your hands to do the proper research. There are medical spas out there that aren’t necessarily always honest or even aware about compliance and legalities. The laws are changing and difficult to find, therefore it’s incumbent upon all of us to be aware of the legalities of the industry.

Most medical spa procedures are considered medical in nature. Because of this, most states require, and AmSpa recommends, that prior to your initial treatment, the medical spa should offer you an in-person exam by either a doctor, a nurse practitioner or a physician assistant.

Much confusion exists over who can perform laser hair removal and the laws vary drastically from state to state. A number of states have developed specific laws regarding laser hair removal, so you are strongly encouraged to research your state’s laws relative to this treatment. However, most states have not addressed this issue. 

As a general rule, most states consider all laser treatments, including laser hair removal, to be medical treatments. AmSpa is aware that it is common that estheticians perform this procedure; however, most state boards do not approve of this practice. Because of this, prior to your initial treatment, the medical spa should offer you an in-person exam by either a doctor, a nurse practitioner or a physician assistant. Once the in-person exam is complete, most states (but not all) allow anyone with proper training, experience and supervision by a medical professional to perform laser hair removal.

No. Botox is considered a medical treatment, therefore, prior to your initial treatment, the medical spa should offer you an in-person exam by either a doctor, a nurse practitioner or a physician assistant. While each state treats each procedure differently, AmSpa recommends that only an RN or higher-level practitioner perform Botox or injectables.

It depends on your state, but as a general rule, yes, that’s perfectly fine. 

Nurse Practitioners and Physician Assistants are called "mid-level” providers. This means that they can do many of the same things that a doctor can do provided they are properly trained and experienced. They can see new patients, make diagnoses, develop treatment plans, and even prescribe medication. 

Most states do not require the doctor overseeing the NP or PA to be on site, although there are often distance and documentation requirements. As long as the NP or PA is properly trained and experienced, there should be no problem with the spa being staffed by an NP or PA. 

But don’t be shy! Ask about the NP’s experience, ask about his or her overseeing doctor, and ask to see all supporting documentation if you have questions. All of this should be readily available and, if it’s not, that’s a red flag you need to take into consideration.

It depends on your state, but as a general rule, yes, that’s perfectly fine. Most states allow RNs to inject Botox and fillers, with a few important caveats. One, you should always see a physician (either MD or DO) or a mid-level provider (nurse practitioner or physician assistant) before your first treatment. This is not only true for injectables, but all medical treatments, including laser treatments and microneedling. If you go to a new medical spa and are treated by an RN without ever seeing either an MD, DO, NP or PA, the medical spa is very likely breaking the law and does not have proper medical supervision in place.

Two, the RN must be properly trained, qualified, and experienced. And don’t simply take their word for it—ask for their license number (all nurses are registered with the state), ask to speak to their supervising physician, and ask for references. These should be readily available.

Typically, yes, but you should definitely do some research to make sure the event is safe and compliant. As a general rule, most medical boards don’t exclusively require Botox or fillers to be administered at the doctor’s office. Provided all the proper protocols and safety measures are in place, they often can be performed anywhere, including at a private residence. 

But please know that all the requirements of medical treatments are applicable, even though the treatment is being done offsite. That means that, unless you have already been treated at the medical spa before, you should see a doctor, nurse practitioner, or physician assistant before you receive the treatment. 

If you are invited to Botox party held by a nurse you have never met before (who is not accompanied by a doctor, NP or PA), this is a huge red flag that the party is being held illegally and that proper medical protocols are not in place. Remember, you should see a doctor, NP, or PA first, before you are treated.