Thanks for your question. In my state (WA), the Department of Health (DOH) specifies what an Esthetician can and cannot do and what level of physician supervision is required. Each state has its own rules, so the best bet is to go to your state's DOH website and see if that is spelled out. In Washington, a "state licensed health care provider (MD, DO, ARNP, or PA) who has training and expertise" in the proper use of the device may "delegate" the treatment to an esthetician, but must be on-site for the initial treatment and must first evaluate the patient's candidacy for the treatment and review the informed consent documentation. Subsequent treatments may be performed by the esthetician alone. We follow the letter of the law in this regard and my esthetician does 98% of all ScupSure treatments with no mishaps. If the company's protocols are followed, then SculpSure is a very low-risk device. Theoretically, it could cause a burn, but that is quite rare and would only result from the protocols not being followed accurately or an improperly functioning device. A doctor will not necessarily do a better job and is just as capable of making an error as an esthetician - the machine does the work, after all. You should take a look at the DOH regulations for NY and if your medspa is not complying with those rules, report them and find another medspa, because if they skirt the rules on one thing, I would suspect that they may on other things too. In my opinion, the states have these rules to protect patients, which is a valid concern. When businesses blatantly disregard these rules, they deserve to have their licenses pulled. They are cutting corners out of greed and disregarding patient safety.