Shifting U.S. state regulations are redrawing professional lines, steadily narrowing what licensed aestheticians can do and pushing many popular services into the realm of ‘medical practice’.
A wave of state legislation across the United States is steadily narrowing what popular treatments aestheticians can perform, including those using lasers, microneedling, dermablading, radiofrequency-based devices, chemical peels and even microdermabrasion.
In a developing trend, several states have enacted or proposed legislation that reclassifies these procedures as medical in nature, effectively restricting aestheticians from performing them unless directly supervised by physicians (medical doctors) or advanced practitioners (registered nurses and nurse practitioners).
The shift, driven by safety concerns and growing legal scrutiny, is redrawing the boundaries between many ‘beauty’ services and medical procedures.
‘THE SHIFT, DRIVEN BY SAFETY CONCERNS AND GROWING LEGAL SCRUTINY, IS REDRAWING THE BOUNDARIES BETWEEN MANY ‘BEAUTY’ SERVICES AND MEDICAL PROCEDURES.’
Regulatory reset across US states
Until recently, aestheticians in many US states operated in a regulatory grey area when it came to advanced modalities. Treatments like microneedling, IPL and Class 3 and 4 laser therapies were often performed under vague supervision guidelines or not supervised at all.
In 2024 and early 2025, states including Texas, Illinois and Florida moved decisively to define these services as medical acts. In practice, this means:
- Microneedling is now regulated as a medical procedure in many jurisdictions due to its penetration into the dermis.
- Laser and IPL treatments, including hair removal, are being limited to licensed medical professionals or certain professionals (registered nurses, nurse practitioners and physician assistants) working under direct doctor supervision.
The Texas Legislature is currently considering multiple bills that could have a major impact on how medical spas and wellness clinics operate statewide. Key among these is a bill which mandates that medical spas be overseen by a physician with aesthetics as part of their primary medical specialty (backgrounds in family medicine, emergency medicine or internal medicine would therefore be disqualified) and imposes strict supervision requirements.
A second bill explicitly prohibits aestheticians from using medical devices such as microneedling pens or lasers. Although such services should already be supervised, this bill would bar aestheticians from providing these services entirely, even working under practitioner supervision.
Interestingly, another bill proposes restrictions on delegation and practice radius. In essence, it would limit multi-location medspa models and also limit delegation of tasks to physicians who are dermatologists or cosmetic specialists.
The state of Illinois issued a December 2024 memo clarifying that any technique ‘intended to affect the living layers of the skin’ is outside an aesthetician’s scope. According to the memo, aestheticians are prohibited from procedures including microneedling, chemical peels, laser treatments, LED light therapy, IPL therapy, deeper microdermabrasion, dermaplaning, microneedling, radiofrequency-based treatments and Hydrafacial treatments, unless they are delegated by a licensed physician within a bona fide physician-patient relationship. The memo also states that medspas must be owned and operated by physicians.
In California, laser hair removal, among other laser-based procedures, and any other treatments that penetrate the skin beyond the dermis have long been outside the scope of practice for aestheticians.
The California Code of Regulations states that the use of laser or IPL devices is to be performed by physician assistants and other licensed medical professionals. Aestheticians are not recognised as medical professionals in many states (including California), so physician supervision does not extend their legal scope of practice.
Florida, meanwhile, considers microblading and microneedling as forms of tattooing and requires licensure as a tattoo artist.
Legal and safety drivers
Behind the scenes, a convergence of legal and clinical factors is driving the clampdown. Laws in many states prohibit non-physicians from owning medical practices or employing doctors, requiring medspas to be physician-owned.
This structure places increased legal responsibility on supervising doctors, especially when aestheticians operate in grey zones of scope and delegation, leaving physicians exposed to liability for actions taken under their oversight.
Patient safety concerns also drive the shift: state boards cite burns, scarring and pigment injuries from Class III and IV lasers used without adequate medical oversight.
While aesthetician advocacy groups continue to push for broader access based on skill and certification, the legal direction appears to be reframing the role of the aesthetician from autonomous practitioner to delegated technician in many medspa settings in the US.
Susanne Schmaling, president and founder of the Esthetics Council in the US, told MedEsthetics: ‘The statement that all medical spas are medical practices changes how these businesses operate, especially when looking at corporate practice of medicine laws… The over- medicalisation of beauty is putting many aestheticians out of business.’
Australia’s patchwork of laser regulations For the use of lasers in cosmetic practice, it is tempting to view Australia as more cohesive, given the overarching guidance from the Australian Radiation Protection and Nuclear Safety Agency (ARPANSA) and the involvement of Ahpra and the TGA. In reality, Australia faces its own patchwork of laser rules. Laser and IPL use for cosmetic procedures is regulated on a state-by-state basis, meaning national uniformity is still lacking.
Queensland, Tasmania and Western Australia require practitioners to hold specific laser licences and adhere to radiation safety standards. Queensland and Western Australia, in particular, have some of the strictest requirements, with mandates for supervised hours and logbooks.
Voluntary or minimal requirements exist in New South Wales, Victoria, South Australia, the ACT and the Northern Territory. There are currently no specific licensing requirements; however, even in states and territories without licensing, obtaining a Laser Safety Certificate is generally recommended to meet minimum safety standards and for insurance purposes.
The use of IPLs for cosmetic purposes is currently only regulated in Tasmania. There is no regulatory oversight for the use of LED phototherapy in Australia.
Monash University and ARPANSA are currently supervising a noteworthy new study investigating adverse effects of energy-based cosmetic treatments in Australia.
‘MONASH UNIVERSITY AND ARPANSA ARE SUPERVISING A NEW STUDY INVESTIGATING ADVERSE EFFECTS OF ENERGY- BASED COSMETIC TREATMENTS IN AUSTRALIA. THE FINDINGS ARE EXPECTED TO INFORM FUTURE REGULATORY DECISIONS AND HIGHLIGHT THE NEED FOR NATIONAL STANDARDS.’
The findings of this study are expected to inform future regulatory decisions and highlight the need for national standards.
PhD student and lead researcher Zoe Thomas says the use of energy-based cosmetic devices is increasing rapidly, with Australians now spending over $1 billion annually on non-invasive treatments.
‘Despite this growing popularity, there is limited research on the risks and adverse effects associated with these procedures,’ says Thomas. ‘We are surveying users of these products and procedures to better understand the safety of energy-based cosmetic treatments in Australia.’
The research is being co- supervised by ARPANSA’s Health Impact Assessment Assistant Director, Associate Professor Ken Karipidis. ‘While some Australian states regulate select cosmetic treatments, these regulations are limited and inconsistent across jurisdictions,’ he says. ‘This PhD will inform us if greater regulation is required for consumer protection given the increasing and widespread use of these products and services.’
As aesthetic procedures become more ubiquitous and medical- grade technologies become more accessible, the line between beauty and medicine continues to blur. The regulatory response in the US is one to watch as it will shape not only who should perform these procedures but also how governments could define the future of non-surgical aesthetic treatments. AMP
Who can own a medspa in the US?
In the United States, over 30 states enforce Corporate Practice of Medicine (CPOM) laws, which prohibit non-physicians from owning or controlling medical practices, including medspas.
States with strict CPOM laws include:
- California: Medspas must be owned by licensed physicians or professional medical corporations where physicians hold the majority ownership.
- New York: Ownership of medspas is restricted to licensed physicians.
- Illinois: Medspas must be owned by state-licensed physicians or nurse practitioners.
- Georgia: Requires medspa owners to be state-licensed physicians.
- Colorado: Medspa ownership is limited to state-licensed physicians.
- Rhode Island: Only state- licensed physicians can own medspas.
In these states, while non- physicians cannot own medspas, they may participate in the business side through Management Services Organizations (MSOs). MSOs handle non-clinical operations such as marketing, staffing and administrative tasks, but they must not interfere with medical decisions or patient care.
Conversely, some states allow non-physician ownership of medspas, provided that a licensed medical professional oversees all medical procedures. For instance, in Florida, non- physicians can own medspas but must employ licensed medical professionals to perform medical services. And in Texas, the law allows for a co-ownership model where a physician and a physician assistant can co-own a medical spa. However, the PA must hold a minority stake, and the physician must retain control over the medical services offered.
