Medical spas in New York

Physicians may inject. A physician assistant (PA) may perform medical services under a physician's supervision that is continuous but does not require the physician to be present, and only within the supervising physician's scope. A physician may not employ or supervise more than six PAs in private practice at one time.⁷

A nurse practitioner may diagnose and prescribe in collaboration with a physician under a written practice agreement and protocols. The section says a nurse practitioner with more than 3,600 hours of practice need not comply with the agreement and protocol requirements until 1 July 2030, and a later version asks that nurse practitioner to keep a form attesting to collaborative relationships.⁸ Registered nurses (RNs) execute medical regimens prescribed by an authorised provider.⁸⁹ We found no Education Department or Board of Nursing text on RNs or licensed practical nurses (LPNs) giving neurotoxin or fillers.

New York does not license medical assistants, and we found no rule setting what an unlicensed assistant may do. Injections by unlicensed people are unauthorised practice.⁴⁶

The Education Department's practice alert on dentists, as reproduced by the state dental association, says dentists may use Botox or fillers in the oral and maxillofacial area if related to restoring and maintaining dental health. It says doing so as a stand-alone cosmetic procedure is not within scope.¹¹

Ask who will inject you, what their licence is, and which physician is responsible for them.

The Board for Medicine considered in March 2025 that using any energy device, including a laser, that affects the basement membrane or deeper tissue to treat a physical condition is the practice of medicine. The examples are laser skin rejuvenation, tattoo removal, lesion removal and spider vein removal. Treatment must be done by or under the order of a physician, PA or nurse practitioner. The Board says only RNs, under general supervision, may carry out those orders. The Education Department adopted the Board's determination except for laser hair removal, on which it has not acted.¹⁰

The Board's table puts Class II and IIIa devices, including IPL and non-ablative hair removal lasers, with trained non-licensed personnel under supervision. It puts Class IV devices with licensed medical professionals only.¹⁰

On laser hair removal the state's sources differ. The Board for Medicine excludes it.¹⁰ The Department of State's chart lists laser hair removal as a cosmetology or esthetics service, and says IPL used for hair removal is not medical treatment.² The chart lists other IPL as medical.² Two bills in committee, A1916A and S6231A, would license laser hair removal technicians.²³

We found no state licence for non-physician laser operators. The Department of Labor requires laser installations to register, with an exception for approved low-intensity lasers. Whether a med spa's hair removal laser must register is not settled by the sources we read.²⁵

Esthetics is services to enhance the appearance of the face, neck, arms, legs and shoulders by compounds or procedures such as makeup, lashes, depilatories, tonics, waxes, sanding and tweezing.¹⁷ The Department of State's rules say appearance enhancement licensees may not diagnose or treat disease, including diseases of the skin, hair and nails, which is within the practice of medicine, and that an owner may not permit the practice of medicine at the business.¹⁸

The sources disagree on microneedling. The Department's release lists it among medical procedures, while its chart assigns microneedling, microchanneling and nano-needling to the Education Department's Acupuncture licence.¹² A bill, A3084A, would let estheticians and cosmetologists practise microneedling.²⁴

The chart and the Department's release list IV therapy and vitamin infusions as medical services.¹² RNs execute regimens ordered by an authorised provider, and nurse practitioners may prescribe under a practice agreement.⁸ A physician or nurse practitioner may give an RN a non-patient-specific regimen only for the conditions listed in the law, and wellness hydration is not among them.⁹ We found no Board of Nursing or Board for Medicine statement on IV hydration or drip bars. Ask who will examine you before the drip, who ordered it, and who will place the IV.

The chart lists GLP-1 weight-loss drugs, including tirzepatide and semaglutide, as medical, and the Department's release lists compound or brand-name weight-loss drugs of that class as medical.¹² Only a licensed prescriber may prescribe. We found no New York statement on compounded semaglutide or tirzepatide. Ask whether your medicine is FDA-approved or compounded, and which pharmacy prepares it.

A centre that does surgical or invasive procedures needing general anesthesia, moderate or deep sedation, or any liposuction, outside a hospital, must be accredited under the office-based surgery law, with adverse events reported within three business days.¹⁹

New York has no statute defining a medical director for a med spa. The Department of State's pages disagree on who may be one. Its release says practices employ licensed physicians or nurse practitioners as medical directors. Its Business Resources page says they must be licensed physicians.¹³ The Department's consumer tips say the medical director's name and credentials should be easy to find on the business's website.¹

The Office of the Professions' 1998 report to the Regents says professional services can be offered only by a licensed person or an organisation authorised by law, that business corporations cannot hire a licensee to provide professional services, and that licensees may not split fees.¹³ Every member of a medical professional LLC must be a New York physician. A professional service corporation may issue shares only to individuals authorised to practise its profession.¹⁴¹⁵ The Department says a PC or PLLC offering med spa services needs a certificate from the Education Department, and that such an entity may not have "spa" in its name.¹³¹⁶ The sources we read do not settle whether a nurse practitioner may own a medical PC or PLLC.

The practice of medicine is diagnosing, treating, operating or prescribing for any human disease, pain, injury, deformity or physical condition.⁵ Practising medicine without a licence is a class E felony, and so is knowingly aiding three or more unlicensed people.⁴ For physicians, permitting an unlicensed person to do work that needs a licence, and delegating to a person not qualified by training, experience or licence, are professional misconduct.⁶

The Department of State's chart lists neurotoxin injections, dermal fillers, PRP, weight-loss drugs of the GLP-1 class, hormone replacement, and IV and vitamin infusions as medical. It lists dermal or deeper peels, radiofrequency facials, ultrasound treatments, plasma and "pen" treatments and PDO threads as medical too. Esthetics and cosmetology services include superficial peels limited to the epidermis, dermaplaning, microdermabrasion, LED therapy and waxing.² The chart says it might not be all inclusive. The Department's release says injections of any drug, including Botox, or any filler, by needle or pressure pen, are medical procedures.¹

The Department also tells consumers they must be seen by a medical professional before receiving any services.¹ We found no statute or rule that requires an in-person examination before a cosmetic injection.

The appearance enhancement licence does not cover permanent makeup, micropigmentation or tattooing.¹⁸ A state law requires permits for tattoo and body piercing operators and artists, but the Department of Health says its regulations are still being developed, and local rules apply meanwhile.²⁰