Legal Requirements for Injections at Med Spas

Medical spas, also known as med spas, have become increasingly popular due to rising consumer demand for non-invasive cosmetic treatments. Among the most popular services offered at med spas are injectable treatments, a medication or therapy delivered directly into the body using a needle and syringe. While these procedures are characterized as being “minimally invasive,” this does not mean that anyone, under any conditions, can administer them.

Understanding who can administer med spa injections is crucial for providers to avoid violating state and federal regulations, scope-of-practice laws, and professional liability standards that govern who can administer injectables, how they must be performed, and under what supervision. This is what to consider if operating a med spa that offers injections.

What Sorts of Injections Do Med Spas Offer

Med spas offer a range of injectable treatments designed to enhance appearance, reduce the signs of aging, and improve skin health. These are the most common types of injections:

Botulinum Toxin Injections (Botox, Dysport, Xeomin)

These injections work by relaxing facial muscles that cause dynamic wrinkles and fine lines, smoothing the appearance of the forehead, crow’s feet, and frown lines between the eyebrows. They help prevent further deepening of wrinkles and provide a refreshed, youthful look.

Dermal Fillers

Injectable gels made from hyaluronic acid, calcium hydroxylapatite, or poly-L-lactic acid restore facial volume, smooth wrinkles, and enhance facial contours. They are commonly used in the cheeks, lips, under-eye hollows, nasolabial folds, and jawline. Fillers provide immediate results, improve facial symmetry, and maintain a youthful appearance.

Microneedling with Injectable Serums

This treatment involves making tiny punctures to the skin and infusing serums containing vitamins, growth factors, or hyaluronic acid. It improves skin hydration, elasticity, and overall texture while reducing fine lines and scarring.

Platelet-Rich Plasma (PRP) Injections

PRP injections use the patient’s own blood components to stimulate collagen production and promote tissue regeneration. They are frequently used on the face for skin rejuvenation, on the scalp for hair restoration, or on other areas needing enhanced healing.

Vitamin and Wellness Injections

These nutrient-rich injections, which can include vitamin B12, glutathione, and other supplements, are designed to support energy levels, boost immunity, and promote overall skin and body health.

Risks Involved In Med Spa Injections

Though they are minimally invasive, injections offered at med spas can still have risks. This is why there are limits on who can administer them.

Generally, med spa injections have minimal side effects, or if they occur, they are mild. This could include redness, swelling, bruising, or tenderness at the injection site. Such reactions usually resolve within a few days. More serious risks, although less frequent, can result from pre-existing medical conditions.

However, some adverse effects can occur due to improper technique. Improper technique in med spa injections can lead to a variety of complications. Injecting too shallowly or too deeply can affect results. For fillers, superficial placement may cause visible lumps or bumps, while deeper injections risk vascular occlusion. For Botox, targeting the wrong muscle layer can lead to unwanted weakness or facial asymmetry. Using the wrong injection site can produce uneven results or cosmetic irregularities, and misplacement near sensitive structures, such as the eyes or major arteries, can cause drooping eyelids, vision problems, or tissue damage.

Injecting too much or too little product may result in unnatural swelling, distortion, or asymmetry, which can sometimes necessitate additional treatments, thereby increasing the overall risk. Poor injection technique, including rapid, forceful, or imprecise injections, can cause bruising, pain, or tissue trauma. Contamination may lead to infection or abscesses, while accidental injection into blood vessels or nerves can cause tissue necrosis, scarring, or numbness.

Possible Fallout of Injections Gone Wrong

Complications from cosmetic injections can carry serious legal and financial consequences for med spa owners. If a patient experiences adverse effects due to negligence or improper training, the business may face a lawsuit.

Additionally, regulatory bodies, such as state medical boards or federal health agencies, may impose fines, sanctions, or even revoke licenses if a med spa’s procedures fail to comply with established health and safety regulations. The penalties can be severe, ranging from monetary fines and mandatory corrective actions to suspension of operations, legal investigations, or public reporting of violations.

Who Is Permitted to Inject?

Med spa owners may wonder who, provided they get the right training, can administer certain injections. The answer turns on whether the patient is receiving a medical procedure. All medical procedures must be conducted under the supervision of a licensed physician, even if the physician does not perform them directly. Treatments should be administered by qualified and trained professionals. In many states, this includes registered nurses (RNs), nurse practitioners (NPs), or physician assistants (PAs). Med spa owners should ensure that staff have the requisite medical licensure and credentialing.

According to the Georgia Medical Board, administering Botox and soft tissue fillers, specifically, is classified as the practice of medicine. Botulinum toxin is considered a hazardous drug, and soft tissue fillers are FDA-approved medical device implants. Physicians may delegate injections to physician assistants (PAs) with a Board-approved job description and Additional Duty Request, and to advanced practice registered nurses (APRNs) with a Board-approved protocol agreement and Form C.

Registered nurses (RNs), while lacking prescriptive authority, may perform injections if properly trained and acting under a physician’s written order. Delegation to medical assistants is prohibited and constitutes Unprofessional Conduct under Rule 360-3-.02(21). Injection of botulinum toxin or soft tissue fillers falls outside the scope of practice for estheticians and unlicensed personnel. The supervising physician must examine and prescribe, but is not required to be physically present during the procedure.

Contact an Experienced Med Spa Attorney

Med spa owners should be aware of the legal risks associated with injection procedures and take proactive steps to protect their business. This includes having the right people in roles for which they are qualified and permitted to fill. An experienced healthcare law attorney who understands med spas can help med spa owners get the answers they need regarding injections to safeguard their practice.