Alabama

Moderate

Who can inject: Physicians (MD/DO) and, under physician supervision/delegation, RNs and other licensed staff acting under medical orders; neurotoxin and filler administration is treated as the practice of medicine.
RNs injecting: RNs may inject only under a valid physician order and supervision/delegation by a physician; they cannot independently prescribe or diagnose. Scope is interpreted by the Board of Medical Examiners and Board of Nursing together, so verify the specific delegation documentation.
Medical director: Practically required: a supervising/collaborating physician must be in place for delegated injectables and NP/PA work; formal medical director structure is expected by many operators and boards.
Good-faith exam: A good-faith exam by a licensed prescriber is required before treating; in-person examination is the conservative standard.
Who can own: Physician-owned or physician-controlled; non-physician ownership generally requires a structure where the clinical practice is physician-owned (MSO-style arrangement) — verify with counsel.

Full Alabama breakdown →

Alaska

Moderate

Who can inject: Physicians and physician assistants and nurse practitioners within their scope; RNs and other licensed staff may inject under physician or prescriber orders. Interpretation varies by board.
RNs injecting: RNs may inject under a valid prescriber order or delegation; independent RN practice of prescription injectables is not clearly authorized. Verify scope with the Alaska Board of Nursing.
Medical director: Medical director or supervising physician is commonly expected; confirm specific requirements with the Alaska Board of Medical Examiners.
Good-faith exam: A good-faith exam by a licensed prescriber is required before treatment; in-person examination is the conservative standard.
Who can own: Physician-owned or physician-controlled clinical entity is the conservative approach; non-physician ownership usually requires an MSO-style management structure.

Full Alaska breakdown →

Arizona

Moderate

Who can inject: Physicians, NPs, and PAs with appropriate scope; RNs may administer injectables under a prescriber order or delegation.
RNs injecting: RNs may administer neurotoxins and fillers under a valid prescriber order and within delegation rules; they cannot prescribe independently. Verify scope with the Arizona State Board of Nursing.
Medical director: Medical director is commonly expected for operations; not always strictly mandated for all settings — verify with the Arizona Medical Board.
Good-faith exam: A good-faith exam by a licensed prescriber is required before treatment; in-person examination is the conservative standard, with telehealth permitted only under specific conditions.
Who can own: Physician-owned or physician-controlled with MSO-style management structures; non-physician ownership of the clinical practice is restricted.

Full Arizona breakdown →

Arkansas

Strict

Who can inject: Physicians and, under physician supervision/delegation, RNs, NPs, and PAs; neurotoxin and filler administration is treated as the practice of medicine.
RNs injecting: RNs may inject only under a physician order and supervision; no independent prescribing authority. Verify delegation scope with the Arkansas State Board of Nursing.
Medical director: Physician supervision and a medical director are expected; formal arrangements are commonly required for delegated services.
Good-faith exam: A good-faith exam by a licensed prescriber is required before treatment; in-person examination is the conservative standard.
Who can own: Physician-owned or physician-controlled; non-physician ownership requires MSO-style structure with clinical control retained by physicians.

Full Arkansas breakdown →

California

Strict

Who can inject: Physicians (MD/DO) directly; RNs, NPs, PAs, and LVNs/MAs under delegation or supervision of a licensed physician, with scope varying by license type and delegation rules
RNs injecting: RNs may inject neurotoxins and fillers only under physician delegation/standing order or supervision; BRN and Medical Board interpretations on scope of delegation are nuanced, so verify with counsel
Medical director: Physician supervision/delegation required; a supervising physician must be identified and oversee injectable protocols, with formal medical director role expected in most multi-provider settings
Good-faith exam: Required before treatment; in-person or telehealth GFE allowed under state telehealth rules with appropriate establishment of a physician-patient relationship, but details vary by board interpretation
Who can own: Physician-owned or MSO-based structure; non-physicians may not directly own the clinical practice

Full California breakdown →

Colorado

Moderate

Who can inject: Physicians and licensed providers acting within scope; RNs, NPs, and PAs may inject under the state's delegation and supervision framework, with physician oversight expected for many procedures
RNs injecting: RNs may inject under delegation and supervision principles of Colorado nursing law; scope interpretations vary, so verify with counsel
Medical director: Medical director or supervising physician arrangement is commonly expected; specific requirements vary by board interpretation
Good-faith exam: Required before treatment; in-person exam preferred, telehealth GFE permitted under Colorado telehealth rules within clinical limits; verify current requirements
Who can own: Physician-owned preferred; non-physician ownership may be possible through management structures with appropriate compliance review

Full Colorado breakdown →

Connecticut

Moderate

Who can inject: Physicians directly; APRNs and PAs under their respective scope and supervision rules; RNs and LPNs under delegation or supervision
RNs injecting: RNs may inject under delegation or supervision of a physician or APRN with prescriptive authority; verify specific protocols with counsel
Medical director: Medical director or supervising physician commonly expected for medspa operations; specifics vary by facility and board interpretation
Good-faith exam: Required before treatment; in-person or telehealth exam allowed within state telehealth rules, with appropriate clinical justification; verify current requirements
Who can own: Physician-owned preferred; non-physician ownership requires careful structuring and counsel review

Full Connecticut breakdown →

Delaware

Moderate

Who can inject: Physicians directly; NPs, PAs, and RNs under delegation or supervision within their scope
RNs injecting: RNs may inject under physician delegation or supervision; verify scope specifics with counsel
Medical director: Medical director or supervising physician commonly expected; verify facility-specific requirements
Good-faith exam: Required before treatment; in-person or telehealth GFE allowed within Delaware telehealth rules; verify current requirements
Who can own: Physician-owned preferred; non-physician ownership requires structuring and counsel review

Full Delaware breakdown →

District of Columbia

Moderate

Who can inject: Physicians (MD/DO) and, under physician delegation/supervision, licensed RNs and PAs; NPs under the DC NP scope framework with physician collaboration as applicable. Verify exact delegation terms with the Board.
RNs injecting: Generally yes, under physician order/delegation for neurotoxins and fillers; RN injection scope is tied to physician orders and facility policy. Verify specifics with the Board of Nursing.
Medical director: Practically required: a licensed physician is needed to supervise injectables, prescribe, and sign orders. Exact title and documentation requirements vary, verify with the Board.
Good-faith exam: A good-faith examination by a prescriber is required before administering prescription injectables; in-person exam is the expected standard.
Who can own: Physician-owned or physician-controlled; non-physician ownership generally requires an MSO/management structure with physician control of clinical decisions. Verify structure with counsel.

Full District of Columbia breakdown →

Florida

Strict

Who can inject: Physicians (MD/DO) may inject directly. Licensed RNs may administer neurotoxins and fillers under a delegated order from a supervising physician; APRNs may practice under collaborative protocols with a supervising physician. LPNs and estheticians are restricted from independent injection.
RNs injecting: Yes, but only under a physician delegation or protocol, and typically with a physician responsible for supervision and prescribing. Verify delegation terms with the Board of Nursing.
Medical director: Required in practice: a physician must supervise and delegate injectable procedures, and clinics often must name a medical director. Details vary by license type and facility, verify.
Good-faith exam: A good-faith exam by a licensed prescriber is required before prescribing or administering injectables; in-person examination is the expected standard.
Who can own: Physician-owned; non-physicians generally cannot own a clinic providing medical services, requiring a physician-controlled entity and management services arrangement.

Full Florida breakdown →

Georgia

Strict

Who can inject: Physicians may inject directly. RNs may administer injectables under a physician's order or protocol; APRNs under physician collaboration; PAs under a supervision agreement. Estheticians and unlicensed staff may not inject.
RNs injecting: Yes, under physician order or protocol; verify the delegation documentation required by the Georgia Board of Nursing and Medical Board.
Medical director: Practically required: a supervising physician is needed for injectables and delegation. Specific title and record requirements should be verified.
Good-faith exam: A good-faith exam by a prescriber is required before injectable treatment; in-person exam is the expected standard.
Who can own: Physician-owned or physician-controlled clinical entity; non-physicians typically participate via a management services arrangement. Verify structure with counsel.

Full Georgia breakdown →

Hawaii

Moderate

Who can inject: Physicians may inject directly. RNs may administer injectables under a physician's order or delegation; APRNs and PAs practice under collaboration or supervision with a physician. Verify specific delegation terms.
RNs injecting: Generally yes, under physician order or delegation; verify the scope and documentation expectations with the Hawaii Board of Nursing.
Medical director: Practically required: a supervising physician is needed for injectables and delegation. Verify title and documentation requirements.
Good-faith exam: A good-faith exam by a prescriber is required before injectable treatment; in-person exam is the expected standard.
Who can own: Physician-owned or physician-controlled clinical entity; non-physicians generally participate via management arrangements. Verify structure with counsel.

Full Hawaii breakdown →

Idaho

Moderate

Who can inject: Physicians, NPs, and PAs with delegation; RNs may inject under physician or NP/PA order and delegation, with scope limited by Idaho Nurse Practice Act and Board of Medicine rules
RNs injecting: Conditional: RNs may administer neurotoxins and fillers only under valid physician or APRN/PA order and delegation; independent RN practice is not permitted
Medical director: Not universally mandated by statute; supervising physician oversight is expected for injectables — practice-specific requirements vary by board interpretation
Good-faith exam: Required in-person or by appropriate evaluation before prescribing or delegating treatment; telehealth GFE is conditionally allowed under Idaho telehealth rules — verify specifics
Who can own: Generally physician-owned or management-services structure; non-physician ownership of clinical practice is restricted — verify with counsel

Full Idaho breakdown →

Illinois

Strict

Who can inject: Physicians and licensed prescribers (APRNs/PAs) under supervision; RNs and LPNs may administer under physician delegation and written protocol with Illinois Nurse Practice Act limits
RNs injecting: Conditional: RNs may administer under a physician's written order/protocol and delegation; RNs cannot independently assess, diagnose, or prescribe
Medical director: Physician collaboration/supervision is required; a medical director is expected and documented practice arrangements must be in place
Good-faith exam: Required before treatment; in-person evaluation expected — telehealth GFE is not clearly permitted for the initial visit without verification
Who can own: Physician-owned or MSO structure required; non-physician ownership of clinical medical practice is restricted

Full Illinois breakdown →

Indiana

Strict

Who can inject: Physicians and supervised clinicians; RNs and NPs may administer under physician supervision/delegation and written protocols; PAs under supervision agreement
RNs injecting: Conditional: RNs may administer under physician order and delegation; independent RN assessment and prescribing are not permitted
Medical director: Physician supervision and collaborative arrangements are required; a medical director or supervising physician must be documented
Good-faith exam: Required before treatment; in-person evaluation generally expected — telehealth GFE is not clearly permitted for initial visit without verification
Who can own: Physician-owned or physician-controlled structure required for clinical practice; non-physician ownership restricted

Full Indiana breakdown →

Iowa

Moderate

Who can inject: Physicians, APRNs, and PAs with appropriate prescriptive authority; RNs may administer under a prescriber's order/delegation with Iowa Nurse Practice Act limits
RNs injecting: Conditional: RNs may administer under a valid prescriber order and delegation; independent RN assessment and prescribing not permitted
Medical director: Collaborative/supervising physician arrangements are expected for APRN and PA practice; a dedicated medical director is not uniformly mandated for all medspas — verify with the board
Good-faith exam: Required before treatment; in-person evaluation expected for initial visit under typical interpretation — telehealth GFE status should be verified
Who can own: Physician-owned or management-services structure typically required; non-physician ownership of clinical practice is restricted — verify with counsel

Full Iowa breakdown →

Kansas

Moderate

Who can inject: Physicians and PAs under delegation; NPs with prescriptive/delegated authority; RNs may administer under physician delegation/protocol. Verify current scope with the Board of Nursing.
RNs injecting: RNs may administer neurotoxins and fillers only under a physician order or protocol; independent RN prescribing/diagnosis is not permitted. Exact delegation documentation expectations vary by board interpretation — verify with counsel.
Medical director: Practice-level medical director or supervising physician arrangement is expected; exact formal requirements vary by board interpretation.
Good-faith exam: A good-faith exam by a licensed prescriber is expected before treatment; in-person requirement is the conservative reading. Verify specifics with the Board.
Who can own: Physician-owned or physician-controlled structures are the safest path; non-physician ownership through a management/MSO arrangement requires careful structuring.

Full Kansas breakdown →

Kentucky

Moderate

Who can inject: Physicians and PAs under supervision/delegation; APRNs with prescriptive authority and collaborative agreements; RNs may administer under physician order or protocol. Verify current scope with the Board.
RNs injecting: RNs may administer under a valid physician order or protocol; independent RN assessment and prescribing for injectables is not permitted. Details vary by board interpretation.
Medical director: A supervising or medical director physician is expected for clinical oversight; exact requirements vary by board interpretation.
Good-faith exam: A good-faith exam by an appropriate prescriber is expected before treatment; in-person is the conservative reading. Confirm with the Board.
Who can own: Physician-owned or physician-controlled clinical structure is the safest path; non-physician ownership requires careful MSO-style structuring.

Full Kentucky breakdown →

Louisiana

Strict

Who can inject: Physicians directly; PAs and APRNs under supervision/collaboration; RNs and LPNs may administer only under a physician order and supervision. Verify exact scope with the Board.
RNs injecting: RNs may administer neurotoxins and fillers only under physician order and supervision; independent RN injection is not permitted. Details vary by board interpretation.
Medical director: A supervising physician is expected; formal medical director requirements vary by board interpretation.
Good-faith exam: A good-faith exam by a licensed prescriber is expected before treatment; in-person is the conservative reading. Confirm with the Board.
Who can own: Physician-owned or physician-controlled clinical structure is required in practice; non-physician ownership needs careful structuring and counsel review.

Full Louisiana breakdown →

Maine

Moderate

Who can inject: Physicians directly; PAs and NPs under supervision/collaboration; RNs may administer under physician order or protocol. Verify current scope with the Board.
RNs injecting: RNs may administer under physician order or protocol; independent RN prescribing and assessment for injectables is not permitted. Details vary by board interpretation.
Medical director: A supervising or medical director physician is expected; exact requirements vary by board interpretation.
Good-faith exam: A good-faith exam by a licensed prescriber is expected before treatment; in-person is the conservative reading. Confirm with the Board.
Who can own: Physician-owned or physician-controlled structure is the safest path; non-physician ownership requires careful MSO-style structuring.

Full Maine breakdown →

Maryland

Moderate

Who can inject: Physicians (MD/DO) and, under delegation, RNs and LPNs may administer neurotoxins and fillers under physician supervision; NPs may inject within their scope under collaborative agreement with a supervising physician.
RNs injecting: Yes, RNs may inject under physician delegation and an established protocol; the RN is not independently authorized to determine candidacy or prescribe the product, so a physician must order and oversee.
Medical director: A supervising/collaborating physician is needed for delegated and NP/PA practice; a formal medical director designation is advisable and often expected by boards and insurers, verify exact requirements with counsel.
Good-faith exam: A good-faith exam by a licensed prescriber is required before administering prescription drugs such as neurotoxins; in-person examination is the expected standard.
Who can own: Physician-owned or management-services structure typically required; non-physicians generally cannot directly own clinical practice.

Full Maryland breakdown →

Massachusetts

Strict

Who can inject: Physicians and, under physician supervision, NPs and PAs may inject; RNs and LPNs may administer under physician-delegated protocols, with board and facility requirements applying.
RNs injecting: Conditional, RNs may administer injectables under a physician order and delegation, not independently determine treatment.
Medical director: Physician oversight is required; a medical director or supervising physician is needed for delegated services and must be physically accessible per board expectations, verify details with counsel.
Good-faith exam: A good-faith examination by an appropriately licensed prescriber is required before treatment with prescription neurotoxins or fillers; in-person exam is the expected standard.
Who can own: Physician-owned or physician-controlled; non-physicians cannot own the clinical practice outright and must work through a compliant structure, verify with counsel.

Full Massachusetts breakdown →

Michigan

Moderate

Who can inject: Physicians, and under delegation and supervision, NPs, PAs, and RNs may administer neurotoxins and fillers; Michigan's rules allow delegation with physician oversight.
RNs injecting: Yes, RNs may inject under physician delegation and an established protocol, with the physician responsible for oversight.
Medical director: A supervising physician or medical director is generally required for delegated injectable services; verify the scope of required oversight with counsel.
Good-faith exam: A good-faith exam by a licensed prescriber is required before administering prescription neurotoxins or fillers; in-person examination is the expected standard.
Who can own: Physician-owned clinical practice generally required; non-physician ownership through a compliant MSO structure, verify with counsel.

Full Michigan breakdown →

Minnesota

Strict

Who can inject: Physicians and, under delegation and supervision, NPs, PAs, and RNs may administer neurotoxins and fillers; Minnesota requires physician oversight for these services.
RNs injecting: Conditional, RNs may inject under physician delegation and an established protocol with oversight; independent RN injection is not permitted.
Medical director: Physician oversight and a medical director or supervising physician are expected for delegated and NP/PA injectable services; verify exact requirements with counsel.
Good-faith exam: A good-faith exam by a licensed prescriber is required before treatment with prescription neurotoxins or fillers; in-person examination is the expected standard.
Who can own: Physician-owned clinical practice generally required; non-physician ownership must be structured through a compliant arrangement, verify with counsel.

Full Minnesota breakdown →

Mississippi

Moderate

Who can inject: Physicians and NPs with appropriate authority inject; RNs and LPNs may administer under physician order/delegation. Scope varies by board interpretation of 'medical treatment'.
RNs injecting: Generally not independently; RNs may administer neurotoxins/fillers under a physician's delegation and order. Verify with Board of Nursing and Board of Medical Licensure.
Medical director: Physician supervision/oversight is expected; a medical director is commonly required by boards in practice, specifics vary.
Good-faith exam: In-person good-faith exam by the treating prescriber is expected before treatment; exact requirements vary by board interpretation.
Who can own: Physician-controlled ownership is the safe path; non-physician ownership typically requires an MSO/management structure with physician ownership of the clinical entity.

Full Mississippi breakdown →

Missouri

Moderate

Who can inject: Physicians inject directly; NPs and PAs may inject under their scope and collaborative/supervision agreements; RNs may administer under a physician's order and protocol.
RNs injecting: RNs may administer injectables under physician orders/protocols; independent RN prescribing or independent evaluation for neurotoxins is not permitted. Verify specifics with the Missouri State Board of Nursing.
Medical director: Physician collaboration/supervision is required; a medical director is commonly used to satisfy oversight expectations.
Good-faith exam: A good-faith exam by a qualified prescriber is expected before treatment; specifics depend on board rules and the scope of the provider.
Who can own: Physician-controlled ownership of clinical operations; non-physician investors typically participate through a management services arrangement.

Full Missouri breakdown →

Montana

Lenient

Who can inject: Physicians, NPs, and PAs with appropriate authority inject; RNs may administer under a physician or provider order. Scope depends on the practitioner's license and board rules.
RNs injecting: RNs may administer under a physician or provider order; independent evaluation and prescribing of neurotoxins is not generally within RN scope. Verify with the Montana Board of Nursing.
Medical director: Not uniformly required by statute; a supervising or collaborating provider is needed for certain practitioners, so verify by license type.
Good-faith exam: A good-faith exam by the treating prescriber is expected before treatment; specific requirements vary by license type.
Who can own: Open to a broader range of ownership structures than many states, but clinical services must still be performed by licensed providers; confirm the structure with counsel.

Full Montana breakdown →

Nebraska

Moderate

Who can inject: Physicians and NPs with appropriate authority inject; PAs under supervision; RNs may administer under physician or provider order and delegation.
RNs injecting: RNs may administer under a physician or provider order; independent prescribing or evaluation for neurotoxins is not within RN scope. Verify with the Nebraska Board of Nursing.
Medical director: Physician collaboration or supervision is expected; a medical director is commonly used, with specifics depending on provider type.
Good-faith exam: A good-faith exam by the treating prescriber is expected before treatment; details depend on the prescriber's license and board rules.
Who can own: Physician-controlled ownership of clinical operations; non-physician business participation typically via management services arrangements.

Full Nebraska breakdown →

Nevada

Moderate

Who can inject: Physicians (MD/DO), and NPs/PAs/RNs under delegation or supervision; RNs may administer neurotoxins and fillers only under a physician's delegation/protocol, and the scope is set by the Nevada State Board of Nursing and Board of Medical Examiners.
RNs injecting: Conditional: RNs may inject under a physician's delegation/supervision and written protocol; they cannot independently prescribe or select treatment for medspa use. Verify exact scope with the boards.
Medical director: Practical requirement: a supervising/collaborating physician is needed for injectables and many medspa services; formal medical director designation depends on structure and board interpretation.
Good-faith exam: A good-faith exam (in-person or telehealth) is generally needed before prescribing or delegating treatment; specifics vary by board interpretation.
Who can own: Physician-owned or MSO/management services structure is typically required for non-physician investors; verify with counsel.

Full Nevada breakdown →

New Hampshire

Moderate

Who can inject: Physicians and licensed providers acting within scope; RNs and APRNs may administer neurotoxins and fillers under physician delegation or collaboration, with scope set by the NH Board of Nursing and Board of Medicine.
RNs injecting: Conditional: RNs may inject under physician delegation or collaborative practice agreements; independent RN prescribing or selection is generally not permitted. Verify the specific delegation rules.
Medical director: Physician oversight or collaboration is practically required for injectables; formal medical director designation is advisable and depends on structure.
Good-faith exam: A good-faith exam is generally required before prescribing or delegating injectables; the exam may be in-person or telehealth depending on the provider and board rules.
Who can own: Physician-owned or MSO/management services structure is typically advisable; verify with counsel.

Full New Hampshire breakdown →

New Jersey

Strict

Who can inject: Physicians and, under physician supervision, APNs/NPs and PAs; RNs may administer injectables only under physician order and supervision. Scope is set by the NJ Board of Medical Examiners and Board of Nursing.
RNs injecting: Conditional: RNs may administer injectables under a physician's order and supervision; independent RN injection or selection is not permitted.
Medical director: Physician supervision is required; a medical director or supervising physician is practically mandatory for injectable services.
Good-faith exam: A good-faith exam is generally required before prescribing or delegating; in-person vs. telehealth scope should be verified with the boards.
Who can own: Physician-owned; non-physician ownership of clinical medspas is generally restricted, with MSO structures used cautiously.

Full New Jersey breakdown →

New Mexico

Moderate

Who can inject: Physicians, and APRNs/PAs with appropriate authority; RNs may inject under physician delegation or collaborative practice. Scope set by the NM Medical Board and Board of Nursing.
RNs injecting: Conditional: RNs may inject under physician delegation or a collaborative practice agreement; independent RN selection and prescribing is not permitted.
Medical director: Physician oversight is required for injectables; a supervising physician or medical director is practically necessary.
Good-faith exam: A good-faith exam is generally required before prescribing or delegating; telehealth rules should be verified.
Who can own: Physician-owned or MSO structure is typically advisable; verify with counsel.

Full New Mexico breakdown →

New York

Strict

Who can inject: Physicians (MD/DO) and, under physician supervision/delegation, RNs and PAs; NPs may inject within their certified scope with physician collaboration per Education Law rules; aesthetic injections are treated as medical acts.
RNs injecting: Yes, RNs may administer neurotoxins and fillers only under a physician's order and supervision (delegation of medical acts); RNs cannot independently assess or prescribe.
Medical director: Effectively required in practice: a supervising/collaborating physician must oversee medical procedures, and facilities should have a licensed physician responsible for protocols; verify exact structure with counsel.
Good-faith exam: Required: a physician or qualified prescriber must perform an in-person evaluation (good-faith exam) before treatment; interpretation of exam requirements varies by board guidance.
Who can own: Physician-owned or MSO/management-services structure required; non-physicians may own the business side via an MSO but not the medical practice.

Full New York breakdown →

North Carolina

Moderate

Who can inject: Physicians and, under delegation/supervision, NPs and PAs; RNs may administer under a physician's order or delegation. Injections are considered medical acts requiring a licensed prescriber's oversight.
RNs injecting: Conditional: RNs may administer injectables under a physician's order or delegation, but cannot independently assess or prescribe; NC Board of Nursing guidance governs.
Medical director: Medical oversight by a physician is expected; a formal medical director requirement varies by facility type and board interpretation, so verify.
Good-faith exam: Required: a physician, NP, or PA must conduct an in-person evaluation before prescribing or delegating injectables; telehealth allowances are narrow and interpretation varies.
Who can own: Physician-owned or MSO/management-services structure; non-physicians may own the business via an MSO but not the medical practice.

Full North Carolina breakdown →

North Dakota

Moderate

Who can inject: Physicians and, under delegation/collaboration, NPs and PAs; RNs may administer under a physician's order or delegation. Specific aesthetic-injection rules are not widely detailed and should be verified.
RNs injecting: Conditional: RNs may administer injectables only under a physician's order or delegation; independent assessment and prescribing are not permitted.
Medical director: Physician oversight expected; a formal medical director requirement varies by facility type and board interpretation.
Good-faith exam: Required: an in-person evaluation by a physician or qualified prescriber is expected before treatment; telehealth allowances vary and should be confirmed.
Who can own: Physician-owned or MSO/management-services structure is the common approach; non-physician ownership of the medical practice is generally restricted.

Full North Dakota breakdown →

Ohio

Moderate

Who can inject: Physicians and, under delegation/collaboration, NPs and PAs; RNs may administer under a physician's order or delegation, with Ohio's Board of Nursing guidance governing.
RNs injecting: Conditional: RNs may administer injectables under a physician's order or delegation; independent assessment and prescribing are not permitted.
Medical director: Physician oversight required for medical procedures; a formal medical director requirement depends on facility and board interpretation.
Good-faith exam: Required: an in-person evaluation by a qualified prescriber is expected before treatment; telehealth allowances are limited and should be verified.
Who can own: Physician-owned or MSO/management-services structure; non-physicians may own the business side but not the medical practice.

Full Ohio breakdown →

Oklahoma

Moderate

Who can inject: Physicians (MD/DO) directly; RNs, LPNs, NPs, and PAs may inject under physician delegation/supervision per their scope and protocols
RNs injecting: Yes, RNs may administer neurotoxins and fillers only under a delegating physician's order/protocol; RN independent ownership or independent prescribing of injectables is not permitted
Medical director: Practical requirement in practice: a supervising/collaborating physician is needed for delegated injectable services; verify exact delegation documentation with the board
Good-faith exam: Required before treatment (in-person evaluation by the prescriber); verify current scope of acceptable telehealth evaluation with the board
Who can own: Physician-owned or management-services structure (MSO-type) typically required; non-physician direct ownership of the clinical practice is generally not permitted

Full Oklahoma breakdown →

Oregon

Strict

Who can inject: Physicians and licensed providers acting within scope; RNs and NPs may inject under scope and protocols; LPNs and unlicensed staff require direct supervision and are limited
RNs injecting: Yes, RNs may inject within scope, but the medical oversight and protocol requirements are strict and should be verified with the Board of Nursing
Medical director: Medical oversight is expected for injectable services; the exact requirement depends on the service and provider type, so verify with the board
Good-faith exam: Required before treatment; the in-person versus telehealth standard should be verified with the board because interpretations vary
Who can own: Physician-owned or structured through a compliant management arrangement; non-physician direct ownership of the clinical practice is generally not permitted

Full Oregon breakdown →

Pennsylvania

Strict

Who can inject: Physicians directly; RNs, NPs, and PAs may inject under physician delegation or collaborative agreement within scope; unlicensed staff are restricted
RNs injecting: Yes, RNs may inject under physician delegation/protocol; independent RN injectable practice without physician order is not permitted
Medical director: A supervising or collaborating physician is required for delegated injectable services; verify the specific documentation requirements
Good-faith exam: Required before treatment; the in-person versus telehealth standard should be verified with the board
Who can own: Physician-owned or structured through a management services arrangement; non-physician direct ownership of clinical practice is generally not permitted

Full Pennsylvania breakdown →

Rhode Island

Moderate

Who can inject: Physicians directly; NPs and RNs may inject within scope under physician collaboration or protocol; unlicensed staff are restricted
RNs injecting: Yes, RNs may inject under physician protocol or collaboration; independent RN injectable practice without a physician framework is not permitted
Medical director: A supervising or collaborating physician is expected for injectable services; verify documentation requirements with the board
Good-faith exam: Required before treatment; the in-person versus telehealth standard should be verified with the board
Who can own: Physician-owned or structured through a management services arrangement; non-physician direct ownership of clinical practice is generally not permitted

Full Rhode Island breakdown →

South Carolina

Moderate

Who can inject: RNs and NPs may inject neurotoxins and fillers under physician supervision or delegation; LPNs and estheticians generally may not inject prescription neurotoxins; physician oversight required for the medical component.
RNs injecting: Yes, RNs may administer neurotoxins and fillers under a physician's order/protocol and supervision; RN independence is limited, so verify the specific delegation documentation with counsel.
Medical director: Physician supervision or a collaborating/supervising physician is required for medical aesthetic procedures; formal medical director expectations vary by facility and board interpretation.
Good-faith exam: A good-faith exam by an appropriately licensed prescriber is required before prescribing or delegating injectable treatments; in-person vs telehealth should be verified with the Board.
Who can own: Physician-owned or physician-controlled structure generally required; non-physician ownership via management structure requires counsel review.

Full South Carolina breakdown →

South Dakota

Moderate

Who can inject: RNs, NPs, and PAs may inject under physician or prescriber authority; estheticians may not inject prescription products; LPN scope is limited and requires supervision.
RNs injecting: Yes, RNs may inject under a prescriber's order or protocol; independence depends on delegation documentation.
Medical director: Medical director or supervising physician arrangement is expected for medical aesthetic services; specifics vary by board interpretation.
Good-faith exam: A good-faith exam by a licensed prescriber is required before treatment; in-person vs telehealth should be verified with the Board.
Who can own: Physician-owned structure generally expected; non-physician owners typically use a management structure requiring counsel review.

Full South Dakota breakdown →

Tennessee

Strict

Who can inject: Physicians, NPs, and PAs may inject; RNs may inject neurotoxins and fillers only under a physician's delegation/order; LPNs and estheticians may not inject prescription products.
RNs injecting: Yes, but only under a physician's delegated order or protocol; RNs cannot independently prescribe or own the medical component.
Medical director: Medical director/supervising physician required; Tennessee has been active on physician supervision of medspas.
Good-faith exam: A good-faith exam is required before prescribing or treating; telehealth GFE is restricted and verification with the Board is essential.
Who can own: Physician-owned required for the medical practice; non-physician owners generally cannot own the medical component.

Full Tennessee breakdown →

Texas

Strict

Who can inject: Physicians may inject; RNs and LVNs may inject neurotoxins/fillers only under physician delegation (delegated medical acts); estheticians may not inject prescription products; NPs and PAs may inject under delegation/prescriptive authority.
RNs injecting: Yes, but only under physician delegation through a delegation order and supervision; RNs cannot independently prescribe injectables.
Medical director: Physician supervision and delegation documentation required; Texas enforces delegation rules for injectables.
Good-faith exam: A good-faith exam by an appropriately licensed prescriber is required before prescribing or delegating; telehealth GFE is restricted and verification with the Texas Medical Board is essential.
Who can own: Physician-owned medical practice required; non-physician owners typically operate through an MSO/management structure with counsel review.

Full Texas breakdown →

Utah

Moderate

Who can inject: Physicians, PAs, and NPs (with prescriptive authority) may inject; RNs and LPNs may inject only under delegation/supervision of a physician or APRN per Utah scope rules
RNs injecting: Conditional: RNs may administer neurotoxins and fillers under delegation and supervision of a licensed prescriber; verify current delegation specifics with the Utah Division of Professional Licensing
Medical director: Not uniformly mandated by statute for all medspas; a supervising/collaborating physician or prescriber relationship is generally needed for injectables and prescribing — varies by license type, verify with counsel
Good-faith exam: Physician or prescriber must establish a patient relationship and evaluate the patient before prescribing or delegating Rx-only treatments; in-person requirement details vary by board interpretation
Who can own: Non-physicians may generally own through management structures (MSO-style) with physician oversight of clinical services; verify structure with counsel

Full Utah breakdown →

Vermont

Moderate

Who can inject: Physicians, PAs, and APRNs may inject; RNs may inject under delegation from a licensed prescriber; LPNs only under direct supervision of a prescriber
RNs injecting: Conditional: RNs may perform injections under a licensed prescriber's delegation and orders; verify whether the specific delegation documentation requirements apply to your facility
Medical director: Not uniformly mandated for all medspas; a supervising or collaborating prescriber is generally needed for injectables and Rx-only treatments — verify scope with the Board
Good-faith exam: Prescriber must evaluate the patient before prescribing or delegating Rx-only treatments; in-person requirement specifics vary by board interpretation
Who can own: Physician-owned or management-structured; non-physician ownership is possible in some structures but verify with counsel given fee-splitting and CPOM-adjacent rules

Full Vermont breakdown →

Virginia

Strict

Who can inject: Physicians, and NPs/PAs under supervision or collaboration per Virginia scope rules; RNs may inject only under a licensed prescriber's order and delegation; LPNs under supervision
RNs injecting: Conditional: RNs may administer injections under a prescriber's order and delegation, but independent RN injection of neurotoxins/fillers is not clearly permitted; verify with the Board of Nursing
Medical director: Generally required in practice: a supervising physician or collaborating prescriber is needed for injectables and Rx-only treatments
Good-faith exam: Prescriber must establish a valid patient relationship and evaluate the patient before prescribing or delegating Rx-only treatments; in-person requirement varies by board interpretation
Who can own: Physician-only or MSO/management structure with clinical control by licensed physicians; non-physician direct ownership of clinical practice is generally not permitted

Full Virginia breakdown →

Washington

Moderate

Who can inject: Physicians, APRNs, and PAs may inject with appropriate authority; RNs may inject under delegation/order from a licensed prescriber, with LPNs under RN supervision and delegation
RNs injecting: Conditional: RNs may administer neurotoxins and fillers under a prescriber's order and under Washington nursing delegation rules; verify facility-specific documentation requirements
Medical director: Not uniformly mandated by statute for all medspas; a prescriber must be responsible for Rx-only treatments, and a medical director arrangement is commonly used — verify with counsel
Good-faith exam: Prescriber must evaluate the patient before prescribing or delegating Rx-only treatments; in-person requirement details vary by board interpretation
Who can own: Licensed-professional ownership through professional service corporations is typical; non-licensed ownership of clinical services is restricted — verify structure with counsel

Full Washington breakdown →

West Virginia

Moderate

Who can inject: Physicians, PAs and NPs with prescriptive authority and delegation; RNs and LPNs may administer under delegation/supervision of a physician or licensed prescriber.
RNs injecting: RNs may administer neurotoxins and fillers only under a physician's or qualified prescriber's order and delegation; they cannot independently assess and prescribe. Verify scope specifics with the West Virginia Board of Nursing.
Medical director: Physician oversight or medical direction is expected for injectable services; formal medical director designation details vary by board interpretation — verify with counsel.
Good-faith exam: A good-faith exam (in-person evaluation by the prescriber before treatment) is expected for prescription neurotoxins and fillers; the exact GFE standard is interpreted by the Board of Medicine.
Who can own: Physician-owned or MSO/management-services structure; non-physicians generally cannot own the clinical practice outright.

Full West Virginia breakdown →

Wisconsin

Strict

Who can inject: Physicians, and PAs/NPs under their scope and collaboration/prescribing rules; RNs may administer injectables under a physician's order or delegation, and LPNs under RN or physician direction.
RNs injecting: RNs may administer neurotoxins and fillers under a valid prescriber's order; independent prescribing or assessment authority is limited, so the physician or prescriber must have examined the patient and ordered the treatment.
Medical director: A physician (or qualified prescriber) must supervise and order treatments; a formal medical director arrangement is strongly recommended and often expected in practice — verify specifics with the Medical Examining Board.
Good-faith exam: A good-faith exam (in-person evaluation by the prescriber before treatment) is required before administering prescription neurotoxins and fillers; the specific standard is interpreted by the Medical Examining Board.
Who can own: Physician-owned or MSO/management-services structure; non-physicians cannot own the clinical practice.

Full Wisconsin breakdown →

Wyoming

Moderate

Who can inject: Physicians, and NPs and PAs under their prescriptive authority and collaboration/supervision; RNs and LPNs may administer under a physician's or prescriber's order or delegation.
RNs injecting: RNs may administer neurotoxins and fillers under a valid order from a physician or qualified prescriber; RNs cannot independently assess and prescribe these treatments.
Medical director: A supervising physician or qualified prescriber is required for injectable services; formal medical director details vary by board interpretation — verify with counsel.
Good-faith exam: A good-faith exam (in-person evaluation by the prescriber before treatment) is expected before prescription neurotoxins and fillers; the specific standard is interpreted by the Board of Medicine.
Who can own: Physician-owned or MSO/management-services structure; non-physicians generally cannot own the clinical practice.

Full Wyoming breakdown →

Medical-Spa Regulation, State by State

When your state's rules change, know the same day.

By the time it's news, it's too late.