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Injecting Botox As A 'Medical Esthetician'

It seems that there are medical spas that are having non-medical staff performing medical treatments... In this case, Botox injections.

Here's a comment that someone posted on the comment thread from the post: Medical Assistants Can Not Inject Botox.

As a medical aesthetician I have injected under a physician's supervision for nearly eight years. That is the concept of a med spa? Medical Aesthetic procedures delivered under a physician's supervision. I have more often seen patients injured by laser treatments. In fact, in a decade of working in spas that offered Botox, I've never seen serious side effect. I've seen one temporarily droopy brow, once, injected by a "diamond" injector physician.

@Aesthetic Injector
You may have been doing this. Your supervising physician may know that you're doing this... but this is not legal in the US (or Canada or Euroope as far as I know).

First: There is no such licensee as a 'Medical Aesthetician'. If you're an esthetician working in a medical spa, you're an esthetician working in a medical spa. You have no expanded scope of practice or licensure about what medical treatments you can perform. Your esthetican license allows you to perform certain treatments... none of which allow you to break the dermis. You have no licensure that allows you  to perform injections. In this case there is no difference between an esthetician and the front desk staff (or anyone off the street).

Second; you equate what you're doing directly with a physician. In this you're correct. You are indeed performing medicine.

However, your supervising physician can not extend his or her license to allow you to perform Botox injections. It does not matter if the physician knows about it. It does not matter if the physician trained you to do it. It does not matter if the physician tells you to do it. The fact that it's relatively easy and that you've been doing it (even successfully) is irrelevent. Your physician can not 'expand' the treatments that you're licensed to perform. Injecting Botox is not one of them. There is no legal difference between what you're doing inside of this 'medical spa' and what you would be doing if you were injecting Botox in a motel room somewhere, other than the physician that's allowing you to do this is on the chopping block too.

Third; If you have any issue at all, you are not going to be covered by any malpractice carrier. You (and your supervising physician) are performing entirely without any net or recourse. Your supervising physician is probably in deeper water since his or her medical license is also at risk.

You mention that you've seen 'diamond' injectors who's Botox treatments have resulted in drooping around the eye. This is a known potential complication with Botox. So, if a diamond level physician who's squirting Botox day and night can have a complication, what are the odd that you could run into any sort of complication?

If you ever perform a treatment with a negative outcome that results in any investigation, you'll be found to be performing medicine without a license, without malpractice coverage, and without a chance of any good outcome.

So, what's going to happen?

Truthfully, I don't know, but here's a probable outcome based on experience.

Something is going to go wrong; you're going to have a complication, a patient is going to be unhappy, a staff member is going to be fired but has a grudge... something will happen. It always does at some point. It may even be unrelated.

Someone is going to point out that this clinic is operating outside of both legal and ethical guidelines, and then it's going to get ugly. If it involves a patient or civil suit it's going to be even uglier. These things have a way of cascading out of control.

If you disagree, I'd truly love to hear your arguments.

Anyone else want to weigh in on this?

Reader Comments (21)

@Aesthetic Injector,
I'd be interested to know what state your medical spa is in. This certainly wouldn't be legal in mine.

10.24 | Unregistered CommenterDermgal

I'd also love to hear some defense of having an esthetician injecting Botox. I'm at a loss to understand how any physician in the US would permit this, let alone condone it.

10.25 | Unregistered CommenterCutter MD

Actually guys in my state of Texas a non-Physician or any non-medical person can administer Botox injections as long as they are "supervised" by a Physician. So I'm guessing @Aesthetic injector is working in the Lone Star State. Of course, supervision is a very loose term here. This could mean an off-site doc. or a doctor who works as a "consultant" or "medical director" of a med. spa. Physicians are responsible for the actions of any employee doing anything in the office, so the threat of malpractice is always around. However, I believe the issue really is that it is not yet socially accepted for someone other than a Physician, NP. or PA to be performing Botox on patients.

10.29 | Unregistered Commenterwendyh

@wendyh or Aesthetic Injector,
Please provide some resource from any state that says a non-medical person can inject Botox. I'm afraid that an anonymous post that claims to disclose what medical law is in a specific state is not credible.

Is there anyone who can post a link that says this is permissible in ANY state?

As far as I'm aware, this is illegal in every state in the US. Please provide a link to some state's statute that says differently.

10.30 | Unregistered CommenterBotox MD

Nurses can't in my state. It is cosidered the practice of medicine and they can lose their license.

10.30 | Unregistered CommenterLH

If an aesthetician medical or otherwise is injecting Botox, it is outside their scope of practice. Injections under the supervision of an MD need to be administered by a Medical Professional, RN/NP/PA/MD. A Physician can only delegate to an appropriate professional. If Texas law doesn't differentiate who can inject under the supervision of a MD malpractice insurance certainly will. It is up to the practitioner to know what is legal and acceptable for their profession. If a MD can delegate injections of Botox to an aethetician it is no different than delegating to a plumber or the cleaning lady, it is not LEGAL or acceptable and inappropriate. It may seem like it is "easy" to learn to inject, but it's not simple to deal with the complications.

10.31 | Unregistered CommenterBotox RN

@wendyh, to comment that it is not socially acceptable makes the whole idea sound as though that is the big issue. This is no different than an aesthetician being disturbed by the fact that non-licensed individuals can purchase various machines and/or products (that are deemed for prof. use only) and practice aesthetics in there living room. No different than a cosmetologist teaching Aesthetics in her living room and handing out certificates when she is not a licensed instructor of anything AND her living room is not a learning facility. We have boundaries and a scope of practice set forth for a reason. To have individuals in the world who go beyond the scope of practice or law only degrades the profession, both medical and beauty.

@jennifer s.- well put

I believe that a doctor can deligate anyone to do anything in their practice. The responsibility falls upon the doctor. While it may not be a wise decision, it is up to the doctor. If a doctor wants to hire someone who works at Burger King to assist in surgery, he can. The difference is that someone who works at Burger King doesnt have a license to lose so they are better off! I once had a conversation from someone who works at the Dept of Professional Regulation in my state and they simply said that when a doctor deligates someone to do Botox or whatever else that goes beyond their license, they are working as an assistant to the doctor. I understand that this may enrage people who go to school and get licenses but unfortunately, things like this happen in ALL licensed industries. There is always someone less qualified that is given the opportunity to undercut you. Its not their fault, its the doctors....

11.21 | Unregistered Commentercat

I live in Texas and what cat says seems to be very true around here.

03.20 | Unregistered CommenterTexasgirl

I think what cat is saying is true with some exceptions of the person he/she is choosing and/or training that they do not have some type of licensure and governing state board. If they are licensed in some capacity they have a consensual agreement to follow their guidelines and rules set by their governing organizations. IMO it would be best to hire and train someone without "any" license or any kind if going this route...but then again why go this route when their are many qualified-train people who can do these procedures and truly understand them overall.

03.21 | Unregistered Commenterrkn

Cat is wrong. According to cats theory a physician can "delegate" the TV repairman to do open heart surgery. She is wrong. If I were to "delegate" an aesthetician to do Botox I would run the risk of being fined and possibly lose my license.

03.23 | Unregistered CommenterLH

LH is correct as always. A physician can not 'delegate' anything outside the scope of practice. Not only would he lose his license, his malpractice insurance would certainly not cover him (or anyone else).

I live in MN and am working in this very situation. I am an esthitician and would never inject. But no one is regulating medi spas in this state. My concern with that is this- is the md able to "extend" her license to a non medical staff member and delegate to whom ever? I thought there was a code of ethics for physicians about aiding and abetting someone to practice medicine who does not have a medical license ie RN/PA etc. Some say it all has to deal with liability insurance. Any thoughts

03.16 | Registered Commentersarah

I came across this post and found that no one bothered to back up the Texas claims with actual law! I would like to do so as i have done much research on this. I was told my business would greatly increase if i were to offer Botox, however I chose not to as I do not want to put anyone at risk myself!

New rules adopted by the Texas Medical Board (§193.17) effective November 7, 2013 regarding the delegation of nonsurgical cosmetic procedures for all medical practices in Texas.

Patients will now require an aesthetic pre-op exam by a physician or physician assistant (PA) prior to receiving a treatment by the nurse or aesthetician. The rule applies to patients scheduled with a RN or aesthetician for procedures including Botox, injectables, and FDA approved laser devices (other than laser hair removal).

So basically, oversight by a physician in Texas BUT the aesthetician CAN perform Botox injections. It appears, at least here in Austin, that the supervision by physician is very loose. There are aestheticians performing Botox parties around here all the time and although they have a physician as an over seer, you never see that physician.

The injection of medication is clearly the practice of medicine.
It is not even close to the legal scope of practice for any aesthetician including the " medical " aesthetician who remarkably has not credible medical knowledge or education.
These phantom doctors, " overseeing" doctors , figure head doctors what ever people call them are risking tremendous legal action if they allow non medical persons to inject.

I can see this entire cosmetic arena becoming an hot bed for law suits resulting in the inevitable decision that only physicians can perform any laser procedures as seen in NJ. Then and only then will this insanity cease.

01.19 | Unregistered Commenternymd

I agree @nymd, I was just quoting what the law says. I'm finding here in Texas in my research that the laser manufactures have it so that when you purchase from them you are "partnering" with them and "overseen" by the Drs on their staff. That to me is just nonsense!

The post from wendyh is completely false. In order to practice medicine you must have medical training. How would you like your surgeon to supervise a butcher to remove you appendix .

A physician CAN NOT authorize anyone to practice medicine without the license to do so as sanctioned and administered by the state medical board.

I can not believe some of the statements I read in this site.

01.21 | Unregistered Commentergm


06.12 | Unregistered CommenterWendy NM

I can't figure out a date as to when this post originated or when follow-up comments were posted, so it may be very old. I am posting on June 14, 2017. I live in Texas, and I am interested in doing injectables, and found this information helpful from the Texas Medical Board. For those of you who want to see a legal website with information that states that a non-physician can do injectables, I believe this is it.$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=&p_ploc=&pg=1&p_tac=&ti=22&pt=9&ch=193&rl=17

I hope that works. It is Title 22, Part 9, Chapter 193, Rule 193.17.

Esthetician in TX here.... Working with/under DO. I don't inject botox, only assist Dr. BUT, only because our medspa feels it's more credible that ONLY the Dr. injects. He has trained and released me to perform phlebotomy within our facility though. Personally, I'm curious about the "medical" esthetician title. Irks me to hear folks call themselves one. Where did they obtain this title exactly? I am a certified laser tech and licensed esthetician and still don't feel comfortable calling myself that.

06.18 | Unregistered Commentermrsb

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