At a Physician Owned Medi-Spa, is a Registered Nurse Allowed to Administer Botox Without Ever Being Evaluated or Seen by the M.D

I live in CA where "Medi-Spas" are everywhere. I recently had Botox by an RN, leaving me with an inquisitive look on the right side of my face. I have never seen the physician, not even for a consult. At the same time, I had pixel laser done as well. Is this nurse allowed to perform these procedures without direct doctor supervision.....and not ever being consulted by a physician at all?

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12 Doctor Answers | Asked by amy1117

Doctor Answers (12)
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Exam Required for Botox?

Hello. You are correct in assuming that you should be seen or evaluated by the MD first, at least in California. While RNs are allowed to inject Botox in California under the supervision of a physician, they are not allowed to offer a prescription. Because Botox is a prescriptive pharmaceutical, any nurse injecting it prior to a physician exam is breaking the law. The problem is that this law is broken many, many times every day by medi-spas and traditional medical practices every... more

Harold J. Kaplan, MD

4 reviews

Los Angeles Facial Plastic Surgeon

www.celibre.com

Legality and Safety of Nurse and Injector administered Botox in a Medi-Spa

Botox and fillers are a multi-Billion dollars business. Like all such money making opportunities, it attracted a huge number of people who are more concerned with mining as much money from an uneducated and credulent public as is possible. For their part, while the many state Medical Boards and other regulatory bodies would be expected to uphold the public's safety above all considerations, they have not really done so. I'll let you consider for a moment why that... more

Botox by a nurse

Each state is a bit different. A nurse can perform injections but the doctor should be evaluating the patient and discussing the treatment protocol. I inject all patients myself in my practice.

Steven Wallach, MD

12 reviews

Manhattan Plastic Surgeon

Treatment by an RN

In NY, it would be illegal for you to be treated by a nurse wtihout physician evaluation and physical presence in the location at the time of treatment. There are many, many board certified plastic surgeons and dermatologists out there and so I must say that it is buyer beware for anyone who chooses to undergo a procedure at the hands of anyone with lesser credentials. This constitutes the unauthorized practice of medicine in many states.

It depends on the state you receive your treatments

Some states allow to have a nurse practitioner or PA inject the patients with out the doctor supervising. I personally treat all my patients myself. The decision about getting injected by a nurse or PA is up to the patient comfort with being treated by a non physican. Usually the price is lower which is another consideration. What ever you decide make sure the person is experienced and has good reviews about them. Good luck!

Physican owned med spas

Frankly, it depends on the state where this is occurring. Most of the time I will say this: a med spa needs to have a "medical director" who is a physician. This person does not need to be onsite, and in fact, sometimes they can never have even seen the medical spa, but merely collect a check for their "supervision". It's really a crazy way to get around the rules, but it happens more often that I'd like to say. I have a med spa, where I review every patient's... more

Sometimes common sense has to trump state laws where your safety and health is concerned: Botox and nurses at Medispas.

Your question about whether it is legitimate for an RN nurse to inject your Botox at a California medspa without you having been evaluated even once by a physician is a great question. The answer is that state by state, laws may vary over exactly how much "supervision" of a nurse is legally required (sometimes "supervision" means the "medical director" has to have his name on a piece of paper but never be on site). This should in NO WAY determine the final... more

Nurse injections of botulinum toxin

That's depends on the state you live in. In Florida, Botox can only be done by a Physician or a Nurse Practioner / Physician's Assistant. A nurse is not allowed to inject Botox. Unfortuantely, a lot of Med Spas don't adhere to this.

Nurse injections of Botulinum toxin

As you can tell, each state is different. The tightest standards have come from states like NY, NJ, CA and FL, where supply and demand dictate legislation sooner than states like where I practice in Wisconsin. It's embarrassing to even write this, but in WI a nurse can do the injections as long as they are "under supervision", a term that is not defined. And that supervision can take place with a medical director that is within 100 miles of the clinic... more

RN Administering Botox

This is a State dependent question. The best way to look it up in California is to review the CA Board of Nursing website. In Florida, injection of Botox and/or fillers is deemed the practice of Medicine and an RN is not allowed to perform these procedures even when a Physician is present. NP's and PA's are allowed to perform these procedures under protocols written and reviewed by the supervising Physician. Aside from all of this, most consumers/ patients... more