Navigating the State-by-State Legal Landscape of Medical Spas

Alyssa Vazquez
Alyssa Vazquez

General Manager for MAP Meeting

Medical spas have grown in popularity recently, spurred by rising demand for minimally invasive cosmetic procedures and easily accessible alternatives to traditional dermatology and plastic surgery practices. With this surge comes an increase in medical spa openings nationwide. In 2021, the medical spa market was valued at $14.4 billion by Data Bridge Market Research; the firm forecasts rocketing growth up to $41.37 billion by 2029 at a compounded annual growth rate of 14.10% between 2022 and 2029.

While the market boom is exciting for the industry, fast-paced and widespread growth in medical spa prevalence may become problematic without a comprehensive understanding of the laws and regulations surrounding their operation.

State-Specific Laws and Regulations

In the United States, medical spas are regulated on a state-by-state basis, which can result in significant differences from one state to the next. This can make it difficult for owners and operators to keep up with the ever-changing legal landscape, but it’s essential that they do so to ensure they are operating within the law.

Here are some of the states with the highest numbers of health and wellness spa businesses, the category medical spas fall under, and the laws they currently have in place.


California currently boasts the largest market share of medical spas, with nearly 2,900 businesses. In accordance with Californian law, medical spas must be owned by physicians who bear the ultimate responsibility of patient care. In case of mishaps or complications, medical spas and physicians must have a written emergency plan in place and a protocol for administering all treatments and procedures.

In California, Botox and similar cosmetic procedures offered as medical spa treatments are considered prescriptions. As a result, physicians, physician assistants, or advanced nurse practitioners must legally conduct a good-faith examination of a patient before the procedure can take place.

New York

Second on the list of states with the most med spas is New York, with nearly 2,500 businesses. Similarly to California, medical spas must be owned solely by physicians, and all individuals performing procedures must have an active state license and have completed training from a higher education institution.

New York is particularly stringent regarding regulating physician advertising and naming professional entities. The state requires the registrant of an entity to provide proof of their professional designation (MD, NP, etc.) and restricts the naming of the professional entity by requiring it to describe the profession and services being offered appropriately. For medical spas, this typically means using the words “medical” and “medicine” unless they decide to advertise a specialty area, for which an entirely different set of rules apply. More details about New York state’s regulations on naming can be found here.


With over 2,200 businesses licensed in Florida, the state ranks third on the list of most popular med spa destinations. Currently, there are no state statutes explicitly regulating medical spas and no restrictions on who can own and operate a medical spa. However, the law states that non-physicians cannot receive compensation or profits from the use of equipment or services performed by a physician. Although, practice owners may create contracts that permit non-physicians to have a share of the practice’s revenue.

Additionally, under Florida Law, nurse practitioners and physician assistants must be supervised by a board-certified dermatologist or plastic surgeon within a med spa, although they do not have to be physically present. They may perform injection and laser procedures under protocols written and reviewed by the supervising physician. On the other hand, registered nurses and medical assistants cannot inject wrinkle relaxers and/or fillers or perform laser treatments even with a physician present.


Texas has the fourth highest number of medical spas in the United States and similar laws to the aforementioned states. Although, several state-specific regulations are crucial to note. The Texas Medical Board requires medical spas to be owned by physicians, yet licensed laser technicians and estheticians may own med spas provided they only perform laser hair removal services. Furthermore, all laser hair removal devices require a physician’s order or prescription and must be registered.

The Board also has a cosmetology statute, which prohibits med spas that solely provide cosmetology services from providing medical care outside of aesthetics. While the Texas Medical Board has jurisdiction over medical procedures performed by non-physicians working with physicians, the Texas Department of Licensing and Regulation regulates cosmetology services.

The Importance of Legal Compliance

Not adhering to state laws when owning and operating a medical spa can result in severe consequences. Failure to comply with regulations can result in hefty fines, legal penalties, and even the revocation of your business and medical license. Individuals who perform treatments without proper licensing or training may sometimes face criminal charges. These consequences can be financially devastating for owners, as well as damaging to their reputations.

Moreover, failing to follow regulations can put clients at risk of serious health complications, infection, and lasting injury resulting in potential lawsuits. If a medical spa does not adhere to strict sanitation protocols or the latest procedural best practices, clients may receive less effective treatments and experience long-term, worsened outcomes.

Operating Within the Legal Landscape

The laws and regulations surrounding the medical spa industry vary significantly from state to state, and the responsibility is on med spa owners to ensure their business operates safely and responsibly in accordance with state-specific laws.

From owning and operating regulations to licensing requirements, it is crucial to stay informed of the ever-changing legal landscape in the industry. This can be done by attending industry educational events, workshops, or courses and following the latest news in the field.

By doing so, owners and operators can ensure they are operating within the law and providing their clients with the safest, most effective treatments and procedures.

To further protect their business, a med spa owner may consult with a lawyer knowledgeable in the medical aesthetics industry to help ensure they comply with all relevant state laws and regulations.

By staying current on the legal landscape in their state, medical spa owners can ensure their business is operating within the law and they can provide high-quality services and the best possible care.

Alyssa Vazquez
Alyssa Vazquez

General Manager for MAP Meeting

Stay ahead in MedSpa with exclusive resources in your inbox.