Who Can Legally Perform Injections at a Texas Med Spa?

In Texas, med spas are regulated by the Texas Medical Board (TMB), which defines strict guidelines regarding who can perform medical procedures, including injections. This is due to the medical nature of many spa treatments, which can pose health risks if not administered properly. This article provides a breakdown of who can legally perform injections at med spas in Texas.

Licensed Physicians:

A licensed physician (MD or DO) is permitted to administer injections. While other health professionals may provide injections, they must do so under the physician's supervision. The physician is responsible for establishing treatment protocols and ensuring compliance with medical standards. Physicians are also the only professionals authorized to independently assess, diagnose, and create a treatment plan for clients.

Mid-Level Practitioners: Nurse Practitioners (NPs) and Physician Assistants (PAs):

Nurse Practitioners and Physician Assistants can perform injections but must have a delegation agreement with a licensed physician. They are also required to work under supervision, though the degree of supervision varies based on experience, setting, and the procedure being performed. The physician does not need to be physically present but must be available for consultation or emergency if needed. PAs and NPs can conduct patient evaluations under physician delegation.

Registered Nurses (RNs):

Registered Nurses are permitted to administer injections (e.g., Botox, fillers) as long as they are under physician supervision and working within their training scope. RNs cannot legally assess, diagnose, or independently prescribe injectables. They must follow the treatment plan established by the physician or an authorized NP/PA. RNs must also adhere to the Texas Board of Nursing guidelines and ensure their practice remains within the scope of their nursing license.

Licensed Vocational Nurses (LVNs):

LVNs may administer injections if they receive direct delegation and supervision from a licensed physician, PA, or RN in line with a physician-developed treatment plan. Their role is generally more limited than that of RNs, and they must avoid procedures that are outside their training and licensure scope.

Medical Assistants:

Medical Assistants are not licensed to perform injections in Texas. They can assist in pre- and post-treatment tasks but cannot legally administer injectables, including Botox, fillers, or other similar procedures. MAs can also perform non-medical tasks, such as preparing clients and managing records, under physician oversight.

Non-Medical Licensed and Unlicensed Personnel:

Tex. Admin. Code §193.17 (d) (3) is clear that, “After a patient has been evaluated and diagnosed, as described in paragraph (2) of this subsection, qualified unlicensed personnel may perform a procedure…”

Aestheticians, cosmetologists, and/or unlicensed persons can perform procedures at a med spa in Texas if they are supervised by a physician or mid-level and are qualified. But consistent with the legal requirements for licensed personnel unlicensed personnel must be properly delegated to and supervised.

Additional Considerations for Administering Injections:

- Telemedicine Limitations: While some med spas may offer telemedicine consultations for convenience, initial in-person evaluations are typically required for injectables.

- Patient Safety and Training Requirements: All individuals administering injections must have adequate training and certification for the specific procedure, and spas are required to uphold safety protocols, including record-keeping, sanitation, and emergency procedures.

- Consent and Disclosure: Providers must inform clients of the risks, benefits, and alternatives to procedures and obtain written informed consent.

Conclusion on Who Can Legally Perform Injections at a Texas Med Spa

A licensed physician must supervise the med spa and oversee medical procedures, but both licensed and unlicensed persons can administer injections when operating under the physician’s delegation and within their scope of practice. In this tightly regulated market, med spas should have a clear delegation agreement and protocols in place to ensure that only those with the appropriate qualifications and training are administering injections.

Feel free to reach out if you need more specific information or further clarification.

Weitz Morgan is a leading law firm in Texas in providing comprehensive advice and guidance to med spas. With a deep understanding of the unique challenges and complexities faced by this rapidly growing industry, our team of experienced attorneys is dedicated to helping med spas navigate the legal landscape successfully.

We recognize that med spas operate at the intersection of healthcare and beauty, which necessitates a multifaceted approach to representation. Our firm offers a range of services, including a flat-fee med spa formation package and an outside general counsel subscription, tailored to meet the specific needs of med spas, ensuring compliance, mitigating risks, protecting licenses, and fostering a legally sound business environment.