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Compliance · Updated continuously

Medical-Spa Regulation, State by State

The rules that decide whether you're operating legally — who can inject, whether you need a medical director, the good-faith-exam requirement, and the Corporate-Practice-of-Medicine posture — for all 50 states and DC. Free, fast, and in plain English. Tap any state for the full breakdown.

Get the all-50-states cheat-sheet (free, printable) →

Orientation, not legal advice. Aesthetic regulation changes constantly and is interpreted by each state's medical and nursing boards. Use this to know what to ask — then confirm specifics with your state boards or healthcare counsel before you act.
51states + DC tracked
9Strict
36Moderate
6Lenient
46require a medical director
9allow telehealth exams
51 shown

Alabama

Moderate
Who can inject
MD, DO, NP, PA, RN under physician supervision
RNs injecting
Yes, under physician delegation and supervision
Medical director
Required for RN/LPN injectors; physician oversight mandatory
Good-faith exam
Required; in-person exam before treatment
Who can own
Non-physicians via MSO structure with physician medical director

Full Alabama breakdown →

Alaska

Lenient
Who can inject
MD, DO, NP, PA, RN with minimal supervision requirements
RNs injecting
Yes, RNs may inject with general physician oversight; specific delegation requirements are not strictly defined
Medical director
Not explicitly required; physician involvement varies by practice model
Good-faith exam
Required; in-person or telehealth allowed
Who can own
Open; non-physicians may own and operate medical spas

Full Alaska breakdown →

Arizona

Moderate
Who can inject
MD, DO, NP, PA, RN under physician supervision or delegation
RNs injecting
Yes, RNs may inject under physician delegation and standing orders
Medical director
Required; physician medical director must oversee all injection procedures
Good-faith exam
Required; in-person exam before treatment
Who can own
Non-physicians via MSO structure with physician medical director required

Full Arizona breakdown →

Arkansas

Moderate
Who can inject
MD, DO, NP, PA, RN under physician supervision
RNs injecting
Yes, RNs may inject under physician supervision and delegation
Medical director
Required; physician must supervise all injection procedures
Good-faith exam
Required; in-person exam before treatment
Who can own
Non-physicians via MSO structure with physician medical director

Full Arkansas breakdown →

California

Strict
Who can inject
MD, DO, NP, PA, RN under physician supervision and delegation.
RNs injecting
Yes, RNs may inject neurotoxins/fillers under physician supervision and written delegation.
Medical director
Required; physician must supervise and be responsible for all injectable procedures.
Good-faith exam
Required; in-person exam by supervising physician before first treatment.
Who can own
Physician-owned or MSO structure with physician control; non-physicians cannot own.

Full California breakdown →

Colorado

Moderate
Who can inject
MD, DO, NP, PA, RN under physician supervision or delegation.
RNs injecting
Yes, RNs may inject neurotoxins/fillers under physician supervision or written delegation.
Medical director
Required for medical spas; physician must oversee operations and injectable procedures.
Good-faith exam
Required; in-person or telehealth exam by supervising physician before treatment.
Who can own
Non-physicians may own with a supervising physician; physician ownership not required.

Full Colorado breakdown →

Connecticut

Moderate
Who can inject
MD, DO, NP, PA, RN under physician supervision or delegation.
RNs injecting
Yes, RNs may inject neurotoxins/fillers under physician supervision and written delegation.
Medical director
Required; physician must supervise and oversee all injectable procedures.
Good-faith exam
Required; in-person exam by supervising physician before treatment.
Who can own
Non-physicians may own with a supervising physician; physician ownership not required.

Full Connecticut breakdown →

Delaware

Moderate
Who can inject
MD, DO, NP, PA, RN under physician supervision or delegation.
RNs injecting
Yes, RNs may inject neurotoxins/fillers under physician supervision and written delegation.
Medical director
Required; physician must supervise and oversee all injectable procedures.
Good-faith exam
Required; in-person exam by supervising physician before treatment.
Who can own
Non-physicians may own with a supervising physician; physician ownership not required.

Full Delaware breakdown →

District of Columbia

Moderate
Who can inject
MD, DO, NP, PA, RN under physician supervision/delegation
RNs injecting
Yes, under physician delegation and supervision
Medical director
Required for medical spa operations
Good-faith exam
Required; in-person or telehealth permitted
Who can own
Non-physicians may own via MSO/management structure with physician oversight

Full District of Columbia breakdown →

Florida

Lenient
Who can inject
MD, DO, NP, PA, RN, LPN under appropriate supervision/delegation
RNs injecting
Yes, RNs may inject neurotoxins and fillers under physician supervision or NP/PA delegation
Medical director
Not required for all medspas; varies by structure
Good-faith exam
Required; in-person or telehealth permitted
Who can own
Non-physicians may own; physician ownership not required

Full Florida breakdown →

Georgia

Moderate
Who can inject
MD, DO, NP, PA, RN under physician supervision/delegation
RNs injecting
Yes, RNs may inject under physician supervision or NP/PA delegation
Medical director
Required for medical spa operations
Good-faith exam
Required; in-person preferred, telehealth varies by board interpretation
Who can own
Non-physicians may own via MSO/management structure with physician oversight

Full Georgia breakdown →

Hawaii

Strict
Who can inject
MD, DO, NP, PA under physician supervision; RN/LPN injection authority limited or prohibited
RNs injecting
No, or highly restricted; RNs generally cannot inject neurotoxins/fillers independently
Medical director
Required for medical spa operations
Good-faith exam
Required; in-person exam strongly preferred or required
Who can own
Physician-owned or MSO with physician control; non-physician ownership restricted

Full Hawaii breakdown →

Idaho

Moderate
Who can inject
MD/DO, NP/PA under physician supervision, RN under physician delegation.
RNs injecting
Yes, under physician delegation and supervision.
Medical director
Not explicitly required by statute, but physician oversight expected for RN/NP/PA injection.
Good-faith exam
Required; in-person exam generally expected before treatment.
Who can own
Non-physicians may own via MSO or management agreement with supervising physician.

Full Idaho breakdown →

Illinois

Strict
Who can inject
MD/DO only; RN/NP/PA may not inject neurotoxins or fillers.
RNs injecting
No; RNs cannot inject neurotoxins or fillers in Illinois.
Medical director
Required; physician medical director must oversee all aesthetic procedures.
Good-faith exam
Required; in-person exam by physician before any treatment.
Who can own
Physician-only; non-physicians cannot own a medical spa.

Full Illinois breakdown →

Indiana

Moderate
Who can inject
MD/DO, NP/PA under physician supervision, RN under physician delegation.
RNs injecting
Yes, under physician delegation and direct supervision.
Medical director
Not statutorily mandated, but physician oversight required for RN/NP/PA injection.
Good-faith exam
Required; in-person exam by physician or qualified provider before treatment.
Who can own
Non-physicians may own via MSO or management agreement with supervising physician.

Full Indiana breakdown →

Iowa

Moderate
Who can inject
MD/DO, NP/PA under physician supervision, RN under physician delegation.
RNs injecting
Yes, under physician delegation and supervision.
Medical director
Not statutorily required, but physician oversight expected for RN/NP/PA injection.
Good-faith exam
Required; in-person exam by physician or qualified provider before treatment.
Who can own
Non-physicians may own via MSO or management agreement with supervising physician.

Full Iowa breakdown →

Kansas

Moderate
Who can inject
MD, DO, NP, PA, RN under physician supervision/delegation
RNs injecting
Yes, under physician delegation and supervision
Medical director
Required for RN/LPN injectors; physician oversight mandatory
Good-faith exam
Required; in-person or telehealth permitted
Who can own
Non-physicians may own via MSO or management agreement with supervising physician

Full Kansas breakdown →

Kentucky

Moderate
Who can inject
MD, DO, NP, PA, RN under physician supervision
RNs injecting
Yes, under physician supervision and delegation
Medical director
Required; physician must supervise RN/LPN injectors
Good-faith exam
Required; in-person preferred, telehealth varies by board interpretation
Who can own
Non-physicians may own via MSO/management agreement with supervising physician

Full Kentucky breakdown →

Louisiana

Strict
Who can inject
MD, DO, NP, PA under physician supervision; RN only under direct physician supervision in limited settings
RNs injecting
Limited; RN may inject only under direct physician supervision in specific clinical settings; scope varies by board interpretation
Medical director
Required; physician must be actively involved and present or immediately available
Good-faith exam
Required; in-person exam mandatory
Who can own
Physician-owned or MSO with physician as controlling member; non-physician ownership severely restricted

Full Louisiana breakdown →

Maine

Moderate
Who can inject
MD, DO, NP, PA, RN under physician supervision/delegation
RNs injecting
Yes, under physician delegation and supervision
Medical director
Required for RN/LPN injectors; physician oversight mandatory
Good-faith exam
Required; in-person or telehealth permitted under certain conditions
Who can own
Non-physicians may own via MSO or management agreement with supervising physician

Full Maine breakdown →

Maryland

Moderate
Who can inject
MD/DO, NP/PA under physician supervision, RN under physician delegation
RNs injecting
Yes, under physician delegation and supervision
Medical director
Recommended; not universally mandated but common practice
Good-faith exam
Required; in-person or telehealth allowed
Who can own
Non-physicians via MSO/management structure allowed

Full Maryland breakdown →

Massachusetts

Strict
Who can inject
MD/DO only; NP/PA/RN may not inject neurotoxins or fillers
RNs injecting
No; RNs cannot inject neurotoxins or fillers in Massachusetts
Medical director
Required; physician must be on-site or have direct oversight
Good-faith exam
Required; in-person exam mandatory
Who can own
Physician-only or physician-controlled MSO

Full Massachusetts breakdown →

Michigan

Moderate
Who can inject
MD/DO, NP/PA under physician supervision, RN under physician delegation
RNs injecting
Yes, under physician delegation and direct supervision
Medical director
Required; supervising physician must oversee injector activities
Good-faith exam
Required; in-person or telehealth allowed
Who can own
Non-physicians via MSO/management structure allowed

Full Michigan breakdown →

Minnesota

Moderate
Who can inject
MD/DO, NP/PA under physician supervision, RN under physician delegation
RNs injecting
Yes, under physician delegation and supervision
Medical director
Required; supervising physician must oversee operations
Good-faith exam
Required; in-person or telehealth allowed
Who can own
Non-physicians via MSO/management structure allowed

Full Minnesota breakdown →

Mississippi

Moderate
Who can inject
MD/DO, NP/PA under physician supervision, RN under physician delegation
RNs injecting
Yes, under physician delegation and supervision
Medical director
Required for medical spa operations
Good-faith exam
Required; in-person or telehealth allowed
Who can own
Non-physicians via MSO/management structure or physician-owned

Full Mississippi breakdown →

Missouri

Moderate
Who can inject
MD/DO, NP/PA under physician supervision, RN under physician delegation
RNs injecting
Yes, under physician delegation; specific protocols vary by board interpretation
Medical director
Required for medical spa operations
Good-faith exam
Required; in-person preferred, telehealth varies by interpretation
Who can own
Non-physicians via MSO/management structure or physician-owned

Full Missouri breakdown →

Montana

Lenient
Who can inject
MD/DO, NP/PA with physician collaboration, RN under physician delegation
RNs injecting
Yes, under physician delegation; Montana allows broad RN scope
Medical director
Required for medical spa operations
Good-faith exam
Required; in-person or telehealth allowed
Who can own
Non-physicians via MSO/management structure or physician-owned

Full Montana breakdown →

Nebraska

Moderate
Who can inject
MD/DO, NP/PA under physician supervision, RN under physician delegation
RNs injecting
Yes, under physician delegation and supervision
Medical director
Required for medical spa operations
Good-faith exam
Required; in-person preferred
Who can own
Non-physicians via MSO/management structure or physician-owned

Full Nebraska breakdown →

Nevada

Moderate
Who can inject
MD, DO, NP, PA, RN under physician supervision
RNs injecting
Yes, under physician delegation and supervision
Medical director
Required for medical spas; must be on-site or available for consultation
Good-faith exam
Required; in-person exam generally required before treatment
Who can own
Non-physicians may own via MSO structure with physician medical director

Full Nevada breakdown →

New Hampshire

Moderate
Who can inject
MD, DO, NP, PA, RN under physician supervision
RNs injecting
Yes, under physician delegation; scope varies by board interpretation
Medical director
Required for medical spas; physician must oversee aesthetic procedures
Good-faith exam
Required; in-person exam generally required before treatment
Who can own
Non-physicians may own via MSO structure with physician medical director

Full New Hampshire breakdown →

New Jersey

Strict
Who can inject
MD, DO, NP, PA under physician collaboration; RN injection scope limited
RNs injecting
Limited; RNs may not independently inject neurotoxins/fillers; varies by facility protocol and board interpretation
Medical director
Required; physician must be present or immediately available for aesthetic procedures
Good-faith exam
Required; in-person exam by physician required before treatment
Who can own
Physician-owned or MSO with physician as controlling entity; non-physician ownership severely restricted

Full New Jersey breakdown →

New Mexico

Moderate
Who can inject
MD, DO, NP, PA, RN under physician supervision
RNs injecting
Yes, under physician delegation and supervision; scope defined by facility protocol
Medical director
Required for medical spas; physician must oversee aesthetic procedures
Good-faith exam
Required; in-person exam generally required before treatment
Who can own
Non-physicians may own via MSO structure with physician medical director

Full New Mexico breakdown →

New York

Strict
Who can inject
MD/DO, NP/PA under physician supervision, RN under physician delegation.
RNs injecting
Yes, under direct physician delegation and supervision.
Medical director
Required; physician medical director must oversee all injectable procedures.
Good-faith exam
Required; in-person exam mandatory before treatment.
Who can own
Physician-owned or physician-controlled MSO; non-physicians cannot own directly.

Full New York breakdown →

North Carolina

Moderate
Who can inject
MD/DO, NP/PA with physician supervision, RN under physician delegation.
RNs injecting
Yes, under physician delegation; RN must work under direct supervision or standing orders from a physician.
Medical director
Required for facilities offering injectables; physician medical director must oversee protocols.
Good-faith exam
Required; in-person exam generally required before treatment.
Who can own
Non-physicians may own via MSO/management agreement; physician clinical oversight required.

Full North Carolina breakdown →

North Dakota

Lenient
Who can inject
MD/DO, NP/PA with or without physician supervision (varies by setting), RN under physician delegation.
RNs injecting
Yes, under physician delegation; RN may inject under standing orders or direct supervision.
Medical director
Not universally required; physician involvement depends on facility structure and NP/PA practice agreement.
Good-faith exam
Required; in-person exam generally required before treatment.
Who can own
Non-physicians may own; physician collaboration required for clinical oversight.

Full North Dakota breakdown →

Ohio

Moderate
Who can inject
MD/DO, NP/PA under physician supervision, RN under physician delegation.
RNs injecting
Yes, under physician delegation; RN must inject under standing orders or direct supervision from a physician.
Medical director
Required; physician medical director must oversee injectable protocols and delegate authority.
Good-faith exam
Required; in-person exam required before treatment.
Who can own
Non-physicians may own via MSO or management agreement; physician involvement required for clinical governance.

Full Ohio breakdown →

Oklahoma

Moderate
Who can inject
MD, DO, NP, PA, RN under physician supervision/delegation
RNs injecting
Yes, under physician delegation and supervision
Medical director
Required for RN/LPN injectors; physician oversight mandatory
Good-faith exam
Required; in-person exam before treatment
Who can own
Non-physicians may own via MSO structure with supervising physician

Full Oklahoma breakdown →

Oregon

Moderate
Who can inject
MD, DO, NP, PA, RN under physician supervision/delegation
RNs injecting
Yes, under physician delegation; RNs may inject with proper training and oversight
Medical director
Required for RN/LPN injectors; physician oversight mandatory
Good-faith exam
Required; in-person or telehealth allowed under certain conditions
Who can own
Non-physicians may own via MSO structure with supervising physician

Full Oregon breakdown →

Pennsylvania

Strict
Who can inject
MD, DO only; RN/NP/PA injection prohibited or severely restricted
RNs injecting
No; RNs cannot inject neurotoxins or fillers in Pennsylvania
Medical director
Required; physician must be present or immediately available for all procedures
Good-faith exam
Required; in-person exam by physician before treatment
Who can own
Physician-only ownership; non-physicians cannot own a medical spa

Full Pennsylvania breakdown →

Rhode Island

Moderate
Who can inject
MD, DO, NP, PA, RN under physician supervision/delegation
RNs injecting
Yes, under physician delegation and supervision
Medical director
Required for RN/LPN injectors; physician oversight mandatory
Good-faith exam
Required; in-person exam before treatment
Who can own
Non-physicians may own via MSO structure with supervising physician

Full Rhode Island breakdown →

South Carolina

Moderate
Who can inject
MD, DO, NP, PA, RN under physician supervision/delegation
RNs injecting
Yes, under physician delegation and supervision
Medical director
Recommended; not universally mandated but expected for RN/LPN injection programs
Good-faith exam
Required; in-person exam generally expected before treatment
Who can own
Non-physicians may own via MSO or management agreement with supervising physician

Full South Carolina breakdown →

South Dakota

Lenient
Who can inject
MD, DO, NP, PA, RN under delegation; scope varies by board interpretation
RNs injecting
Yes, under physician delegation; specific protocols vary
Medical director
Not universally required; recommended for RN injection programs
Good-faith exam
Required; in-person or telehealth exam acceptable in many cases
Who can own
Non-physicians may own a medical spa; physician oversight recommended but not always mandated

Full South Dakota breakdown →

Tennessee

Moderate
Who can inject
MD, DO, NP, PA, RN under physician supervision/delegation
RNs injecting
Yes, under physician supervision and delegation; specific protocols required
Medical director
Required for facilities offering injection services; physician must be on-site or available
Good-faith exam
Required; in-person exam generally expected before treatment
Who can own
Physician-owned or MSO structure with supervising physician; non-physician sole ownership not permitted for injection services

Full Tennessee breakdown →

Texas

Moderate
Who can inject
MD, DO, NP, PA, RN under physician delegation; scope varies by board interpretation
RNs injecting
Yes, under physician delegation; specific protocols and supervision required
Medical director
Required for medspas offering injection services; physician oversight mandatory
Good-faith exam
Required; in-person exam generally expected before treatment
Who can own
Physician-owned or MSO structure with supervising physician; non-physician sole ownership not permitted for injection services

Full Texas breakdown →

Utah

Moderate
Who can inject
MD, DO, NP, PA, RN under physician supervision/delegation
RNs injecting
Yes, under physician delegation and supervision
Medical director
Required; physician must oversee injector protocols
Good-faith exam
Required; in-person or telehealth allowed for initial visit
Who can own
Non-physicians may own via MSO structure with supervising physician

Full Utah breakdown →

Vermont

Moderate
Who can inject
MD, DO, NP, PA, RN under physician supervision/delegation
RNs injecting
Yes, under physician delegation; scope varies by board interpretation
Medical director
Required; physician oversight of clinical protocols expected
Good-faith exam
Required; in-person exam generally expected
Who can own
Non-physicians may own via MSO structure with supervising physician

Full Vermont breakdown →

Virginia

Strict
Who can inject
MD, DO, NP, PA under physician supervision; RN injection scope limited/unclear
RNs injecting
Limited or not permitted; varies by board interpretation — verify with counsel
Medical director
Required; physician must supervise all clinical protocols and injectors
Good-faith exam
Required; in-person exam generally required
Who can own
Physician-owned or MSO with physician as controlling member; non-physician ownership restricted

Full Virginia breakdown →

Washington

Moderate
Who can inject
MD, DO, NP, PA, RN under physician supervision/delegation
RNs injecting
Yes, under physician delegation; scope defined by board rules
Medical director
Required; physician must oversee clinical protocols and injector delegation
Good-faith exam
Required; in-person or telehealth allowed for initial visit
Who can own
Non-physicians may own via MSO structure with supervising physician

Full Washington breakdown →

West Virginia

Moderate
Who can inject
MD, DO, NP, PA, RN under physician supervision/delegation
RNs injecting
Yes, under physician delegation and supervision
Medical director
Recommended; not universally mandated but common in practice
Good-faith exam
Required; in-person preferred, telehealth varies by board interpretation
Who can own
Non-physicians may own via MSO or management structure with physician involvement

Full West Virginia breakdown →

Wisconsin

Moderate
Who can inject
MD, DO, NP, PA, RN under physician supervision/delegation
RNs injecting
Yes, under physician delegation; scope defined by Wisconsin Nursing Board
Medical director
Required for medical spa operations
Good-faith exam
Required; in-person exam mandated before treatment
Who can own
Non-physicians may own via MSO or management structure with physician involvement

Full Wisconsin breakdown →

Wyoming

Lenient
Who can inject
MD, DO, NP, PA, RN; minimal supervision requirements
RNs injecting
Yes, with minimal or no explicit physician supervision mandated by statute
Medical director
Not required by statute
Good-faith exam
Required; in-person or telehealth permitted
Who can own
Non-physicians may own; physician involvement not mandated

Full Wyoming breakdown →

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