Last year the National Medical Spa Association told Axios that they estimate up to 90% of medical spas have unlicensed providers. This estimate seems extremely high, in personal experience I would say 35-40% in a highly regulated state such as California. Last time I was at a nail salon I saw a microneedling offered sign (printed on copy paper and stuck to the wall) and I am almost certain they did not have a corporate practice owned by a physician. Some of the most publicized cases of adverse reactions in medspas were done by unlicensed providers, not by unsupervised APRNS (Advanced Practice Registered Nurse).
Contribution By Dr. Chantal Lunderville, L+A Medical Editor
Dr. Chantal Lunderville is a board-certified physician specializing in skin health, aesthetic medicine, and Women’s health. She attended medical school at UCLA School of Medicine, followed by a residency at UCSF Family Medicine, and on graduating opened her own concierge aesthetics practice in the San Francisco Bay Area focusing on hormone health, skincare, and longevity.
Since then Dr. Lunderville has grown her practice to include overseeing nurses and aestheticians as medical director to over 15 practices across California, and through Dr. C’s Academy helps to launch new practices across the US and Canada through consulting and online courses in business, compliance, aesthetic procedures including neurotoxin, fillers, lasers, microneedling, and lasers. Read Full Bio
However, many lawmakers first go to regulating medical providers, as is the case with Texas right now. Currently, Texas has statutes similar to California and is already one of the most regulated states, one that follows the “corporate practice of medicine”. However, in July 2023, a patient named Jenifer Cleveland died after receiving an IV infusion at Luxe Med Spa in Wortham, Texas. The product was administered by an unlicensed woman who was not trained and had no clinical background. She was working under a medical director, however had no actual supervision.
Texas Legislators Responded with Three Proposed Bills
House Bill 3749 (APRNs and PAs in Medical Spas)
- Prohibits APRNs and PAs from conducting good faith exams (GFEs) in medical spas.
- Requires a physician to be on-site during all procedures.
- Critics argue it limits qualified professionals without addressing unlicensed providers.
House Bill 3889 (Physician Oversight in Prescriptions)
- APRNs and PAs can only prescribe medications if a physician has examined the patient.
- Aims to ensure physician involvement in treatment decisions.
- Could reduce APRN autonomy, affecting timely patient care.
House Bill 3890 (Supervision by Specialty)
- Physicians can only supervise APRNs/PAs in their own specialty.
- Exception: Physicians with additional years of experience in a different specialty.
- Designed to improve oversight quality but may restrict collaboration.
March 2025 L+A Report
5 Must Have Modalities In Modern Medical Aesthetics
Aesthetic device technology in the medical + spa skincare industry is evolving rapidly, with cutting-edge technologies transforming how professionals approach skin and body treatments. From LED light therapy and microneedling to microcurrent, laser treatments, and infrared saunas, these advanced modalities are now essential in aesthetic practices.
Comparing APRN Regulations Across States
States with Full Practice Authority
- Alaska, Arizona, Oregon: APRNs can assess, diagnose, treat, and prescribe independently.
- APRNs can own and operate aesthetic practices without physician oversight.
States with Reduced/Restricted Practice
Proposed Bills would impose stricter supervision rules, further limiting APRN independence.
California: APRNs need physician collaboration, and medical spas must be physician-owned.
Texas (Current Regulations): APRNs require a supervisory agreement with a physician.
Dr. Chantal Lunderville, L+A Medical Editor
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Implications of the Proposed Bills
Supporters Say:
- Increases physician oversight for safer aesthetic treatments.
- Prevents unqualified individuals from performing medical procedures.
Critics Say:
- Reduces access to aesthetic treatments and limits APRN autonomy.
- Could worsen provider shortages in aesthetic and wellness services.
Unfortunately, the bills do not address unlicensed people having access to drugs and products that are harmful, as well as “medical directors” who do not actually supervise or visit the practice regularly to see what is going on. It will take educating the public on what to look out for at clinics, as well as funding agencies to enforce these regulations.
If House Bill 3749 passes it could dramatically affect the state’s medical spa industry to be doctor-only-led, and potentially influence other states that have been encountering adverse reactions, unprecedented growth, and criticism from physicians. Meanwhile, in other states such as Utah, there are proposals to expand aesthetician scope to provide specific lasers. One thing is for certain, the tide of scope and supervision is turning and we will be watching closely.