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Nicole Irmer | Posted in Licensing Defense on September 15, 2025
A new evolution in Medicine has emerged- the Medical Spa. Medical Spas have become a booming and profitable industry providing Botox, Collagen, and Restylane. These spas are now heavily regulated by licensing agencies. This new industry is redefining traditional medical treatment, and in doing so has created confusion for many medical professionals, with many thinking that such services are “just” cosmetic, similar to a facial or pedicure.
However, contrary to the assumption of some, these injectable procedures involve prescriptive medical devices and “dangerous drugs,” and as such are considered a medical procedure that requires a trained and licensed healthcare provider to evaluate patient suitability via a “good faith examination,” and proper administration of the medication. Additionally, the management of a medical spa requires the same supervision and administration of medical care as a medical office. Anyone who violates these rules could be subject to criminal charges and/or disciplinary action.
At the Law Offices of Nicole Irmer, we offer skilled, compassionate legal representation to doctors, nurses, and other healthcare professionals in disciplinary and licensing matters. If you are facing criminal charges and/or a disciplinary investigation into the unlicensed practice of medicine related to Botox and other injectables, we can help. Reach out today to schedule a confidential consultation with a California healthcare license defense attorney.
With the rise of plastic surgery and cosmetic procedures, it isn’t surprising that an industry has sprouted up to fulfill the demand. On TikTok, Instagram, and other social media platforms, it isn’t hard to find a photo or video touting the benefits of Botox, fillers, and more. Unfortunately, this business opportunity can bring with it some dangers, particularly when it comes to performing medical procedures.
The State of California views injections of Botox, collagen, Restylane, and other “injectables” as medical procedures. As such, these procedures must be performed by a licensed physician or by a registered nurse or physician assistant under the supervision of a physician. No unlicensed persons, including but not limited to medical assistants and estheticians, can inject Botox or other dangerous drugs.
The Department of Consumer Affairs, The Medical Board of California, the Board of Registered Nursing, The Food and Drug Administration (FDA), the United States Attorney’s Office, and District Attorney’s Office are cracking down on medical doctors, physician assistants, nurse practitioners, registered nurses, and unlicensed individuals who are not adhering to the laws and regulations. These regulatory bodies are prosecuting healthcare professionals for such violations as the unlicensed practice of medicine (Business and Professions Code 2052), corporate practice prohibitions (Business and Professions code 2400), fee-splitting and payment for referrals (Business and Professions Code 650), and the aiding and abetting in the unlicensed practice of medicine (Business and Professions Code 2264). As such, regulatory agencies are bringing both criminal charges in addition to license discipline. The MBC and BRN have articles on point.
The rules for cosmetic treatments also include the following restrictions:
These restrictions are designed to protect patients from potential harm. While these types of cosmetic treatments are incredibly common, they do carry risks like infection, allergic reactions, tissue damage, burns, and granulomas. That is why the state of California, through various licensing and law enforcement agencies, requires that these treatments be performed by or under the direct supervision of licensed physicians.
Additionally, there have been reports of practitioners, either unwittingly or unknowingly, in the effort to reduce overhead cost, injecting toxic counterfeit drugs from overseas that have made patients critically ill, caused disfigurement, and even death. The only legal and permitted drugs must be purchased in the United States, not in overseas markets, to ensure their legitimacy. Federal regulators and prosecutors are warning healthcare professionals about purchasing products for reduced costs in Canadian and European markets to circumvent the cost of FDA compliance (21 U.S. Code § 331).
The use of prescriptive medical devices and injections for cosmetic reasons is the practice of medicine. The laws that govern the practice of medicine are the same laws that govern these “med spa” procedures. Physicians (and other healthcare professionals) will be held accountable for the same standard of care as they are for their routine medical practice. This means that the standards of informed consent, good-faith exam, delegation to an allied health care professional, patient–physician confidentiality, maintaining medical records, as well as responsibility and liability of supervision.
There are potential disciplinary and criminal sanctions for any person who violates the laws and regulations related to medical spas. This article briefly touches upon the potential liability facing a healthcare provider in an illegal medical spa arrangement. The exact consequence will depend on the facts of the case.
Generally.for physicians, physician assistants, and registered nurses, their respective Boards could pursue disciplinary action for unlicensed practice of medicine and/or aiding and abetting in the unlicensed practice of medicine. This could result in consequences such as a formal reprimand, probation, suspension, or even license revocation. Per the Medical Board of California’s disciplinary guidelines, aiding and abetting in the unauthorized practice of medicine carries a minimum penalty of a stayed revocation with 5 years of probation and a maximum penalty of revocation.
As a licensed physician, it is critical to understand that allowing anyone on your staff to perform these injections without the necessary qualifications and without your direct supervision could jeopardize your own medical license. While it might be tempting to keep up with demand for these treatments by having non-physicians administer them, the possibility of losing your license should outweigh any benefit of doing so.
Engaging in the unauthorized practice of medicine is also a criminal offense in California. Even if no one is harmed, prosecutors can still bring misdemeanor or felony charges. Under this law, it is a crime to:
Under this law, no bodily harm or illness is required to bring charges. It is enough that a person is engaged in the unauthorized practice of medicine, such as by performing injections at a medical spa despite not being a licensed physician.
Prosecutors can charge this offense as a misdemeanor, punishable by up to 1 year in county jail and/or a fine of up to $1,000. In more serious cases, unauthorized practice of medicine might be charged as a felony. As a felony, it is punishable by up to 3 years in state prison and/or a fine of up to $10,000.
Cosmetic procedures like collagen, Botox, and fillers have become both incredibly popular and common. However, they are not without risk, which is why California law requires that these injections and certain other cosmetic treatments be performed by or under the supervision of a licensed physician. If you plan to offer or get involved with these treatments in any way, it is incredibly important to understand the rules and limits surrounding medical spas in California.
It can be tempting to jump into the medical spa business, particularly given how lucrative the practice can be. Any doctor who decides to offer these services must understand the limitations on injecting Botox, Restylane, and collagen to avoid running afoul of these laws. This includes closely supervising staff to ensure that no one is engaged in the unauthorized practice of medicine.
At the Law Office of Nicole Irmer, we have represented healthcare professionals, including doctors, physician assistants, and registered nurses, who are facing criminal and/or disciplinary charges in this emerging area of prosecution. If you have been contacted by an investigator, please contact our office at 619-237-6130 or fill out our online contact form to discuss the matter further.