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Top five reasons medical spas are investigated

Due to the rapid growth of medical spas in physician practices, regulatory investigations into these services have increased. According to the American Med Spa Association, here are the top five reasons medical spas are investigated. 1

  1. Improper intake procedures
    The primary reason medical spas are investigated is due to improper patient intake procedures. Because most procedures performed at medical spas are considered medical, many states require that a physician, advanced practice registered nurse (APRN), or physician assistant (PA) perform a face-to-face exam before treating each patient.

    Some nurses have performed medical procedures without an intake exam because they believe their background and experience eliminates the requirement for an exam.

    Although certain licensed practitioners can perform intake exams, such as an APRN or PA, physicians are ultimately in charge of managing and/or supervising all medical procedures.
  2. Improper or lack of physician oversight of employees
    In some states, a licensed professional must always be on-site to oversee all medical procedures. Some medical spa procedures that have not traditionally been considered medical, such as microneedling and dermaplaning, have recently been recognized as medical procedures. Check your state regulations and with your health care attorney for information about the rules relevant to your practice.

    Sometimes physicians serve as the medical director for several medical spas simultaneously, which may indicate the physician is being stretched too thin and may not be able to pay close attention to what is happening at each of the medical spas. This may create a risk for improper oversight of employees.
  3. Improper marketing
    Medical spa owners should not exaggerate the scope of their services.  Since medical advertising regulations are strict, practices must be honest about the skills and accomplishments of their medical spa practitioners.

    Make sure you are not violating HIPAA patient privacy laws or state medical board regulations. Unless you obtain a patient’s consent in advance, any social media post that identifies a patient violates federal law.
  4. Non-approved drugs and equipment
    Any drugs or equipment purchased from other countries runs the risk of not being approved by the FDA. Only legal purchases made in the United States can be positively cleared by the FDA.

    “Parallel importation” is a practice in which products sold for a lower price in other countries are re-sold in the U.S. at a much lower price. This practice is It is illegal, and the FDA will prosecute.
  5. Failure to file with the state board of cosmetology
    Practices offering aesthetic services should make sure they are compliant with their state board of cosmetology. Most state boards require practices to apply for a cosmetology “establishment license,” which will confirm that aesthetic services are being performed.



1. Thiersch AR. The Top 5 Reasons Your Medical Spa Is Going to Get Investigated. Modern Aesthetics. November/December 2018. Available at Accessed August 22, 2019.