This is the problem with med spas and ghost doctors. This would be completely illegal in California where a good-faith in-person examination by a licensed physician is required before recommending and delegating a treatment using a medical laser, such as Sculpsure. In California, registered nurses can NOT treat a patient legally before the patient is examined by a physician, unless the RN is an RN, Nurse Practitioner or is a California-licensed Physician's Assistant, operating under standard orders. RN's diagnosing and treating a patient with Sculpsure, laser hair removal, filler or Botox injections without a physician exam are operating illegally outside their scope of practice and can be sanctioned by the Board of Registered Nursing. They are practicing medicine without a license. You will have to check Texas law on this matter, as state laws vary and some allow estheticians or electrologists to do laser hair removal. For your own safety, you have to know that the person treating you is under the responsible supervision of a physician, who knows and vouches for the qualifications of the person that has been delegated to treat you. The laws of California try to ensure patient safety in this regard. The California Medical Board and the Nursing Board have been trying to crack down on these kinds of violations in recent years, non-supervising "medical directors" and nurses practicing medicine without a license. It is up to the patient to protect themselves by knowing the qualifications and license status of the person treating them, because these laws are commonly ignored. The weblink below will connect you to the California Board of Nursing. It provides guidance to Registered Nurses in California on their scope of practice. Open the link called: "The Bottom Line: The Business of Medicine - Medical Spas". If what you are describing is illegal in California, I would certainly be concerned in Texas or anywhere else.