What is a medical spa?
How do I know whether a medical spa is safe and compliant?
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 the 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.
- 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.
- 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.
- 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!
What are some common medical spa treatments?
Who should be administering medical spa treatments?
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.
Does a doctor always have to be on-site?
What constitutes a medical treatment?
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 nonmedical 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.
Do I need to see a doctor first before getting a medical spa treatment? For laser treatments? For Botox?
I went to a laser center/medical spa and they told me I didn’t need to see a doctor. Is this correct?
An aesthetician wants to perform my Botox injection. Should I let her?
The medical spa I go to has a nurse practitioner on site, but no doctor. Is this legal? Is this safe?
At the medical spa I go to a nurse, not a doctor, performs Botox and filler injections. Is this legal? Is this safe?
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.
I have been invited to a “Botox party” at someone’s house. Is this legal? Is this safe?
Information provided by the American Med Spa Association Website