Medical Spas

About Medical Spas

A medspa typically offers esthetic and non-surgical medical treatments that are designed to enhance the look and feel of their client’s skin and body. Services could include traditional esthetic services like facials, applying eyelash extensions, and using wax or tweezers to temporarily remove unwanted hair, which can be performed by licensed estheticians or cosmetology operators.

Massage therapy is another service that might be offered at a medspa and those services must be provided by a licensed massage therapist. Other services provided at medspas, such as botox and filler injections, body cavitation and contouring, laser-assisted skin treatments, and medical-grade facial treatments, fall under medical treatments that must be provided under the order and delegation of a licensed physician.

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Anyone offering services at a medspa must have the appropriate license and training for the services they are providing, or be under the delegation of a licensed physician, when providing medical treatments. Anyone offering a regulated service must be in compliance with the licensing and regulation requirements that apply to those services, unless an exception is allowed by the specific statutes or rules that govern that treatment or procedure.

Who Regulates Medspas?

It depends. Although TDLR regulates cosmetology, massage therapy and laser hair removal, the agency does not have jurisdiction over all the services provided at a medspa.

A person who offers regulated services or products, or practices a regulated profession, must comply with the regulations of the appropriate regulatory jurisdiction. For example, tanning and permanent makeup are services regulated by the Texas Department of State Health Services, and medical acts are regulated by the Texas Medical Board.

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Estheticians may only perform esthetic services at an establishment licensed by TDLR. If an esthetician works in a medical office providing esthetic services, the medical office should have an establishment license from TDLR.

It may not always be clear whether the service provided is a cosmetology service, medical, or something else. If you have any questions about the service being provided, you should ask the practitioner or contact an appropriate state agency.

What Services Can Estheticians and Cosmetology Operators Provide?

Regardless of a facility’s name (salon, medical office, medspa, medispa, etc.), an esthetician and cosmetology operator may lawfully provide any services allowed under the scope of their license if the facility holds an appropriate TDLR establishment license. No physician or other medical provider needs to be present or delegate to the esthetician or cosmetology operator in those circumstances.

Someone who holds an esthetician license can:

• cleanse, stimulate, or massage a person’s scalp, face, neck, or arms by hand or by using a device, apparatus, or appliance, and with or without the use of any cosmetic preparation, antiseptic, tonic, lotion, powder, oil, clay, cream, or appliance;
• beautify a person’s face, neck, or arms using a cosmetic preparation, antiseptic, tonic, lotion, powder, oil, clay, cream, or appliance;
• administer facial treatments, (please note that these treatments do NOT include injectables, fillers and other types of medical-type procedures that require the use of needles);
• remove superfluous hair from a person’s body using depilatories, preparations, or tweezing techniques; and
• apply semi-permanent, thread-like extensions composed of single fibers to a person’s eyelashes.

View the scope of an esthetician’s license.

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Someone who holds a cosmetology operator license can:

• arrange, color, shape, or cut a person’s hair
• treat a person’s moustache or beard by coloring, styling, trimming, or shaving with a safety razor
• cleanse, stimulate, or massage a person’s scalp, face, neck, shoulders, or arms
• administer facial treatments, (please note that these treatments do NOT include injectables, fillers and other types of medical-type procedures that require the use of needles)
• massage, cleanse, treat, or beautify a person’s hands or feet
• treat a person’s fingernails or toenails
• weave a person’s hair
• remove superfluous hair from a person’s body using depilatories, preparations, chemicals, tweezers, or other devices or appliances of any kind or description
• apply semi-permanent, thread-like extensions composed of single fibers to a person’s eyelashes

View the scope of a cosmetology operator’s license.

Can an esthetician or cosmetology operator perform microdermabrasion?

It depends. Estheticians and cosmetology operators can remove excess accumulations of dead skin cells from a person’s skin by exfoliation. One method of exfoliation is microdermabrasion, commonly performed with a specialized device. To the extent that the microdermabrasion device and technique removes only dead skin cells from the outermost layer (epidermis) of a client’s skin, and does not pierce the dermal layer of skin, then an esthetician or cosmetology operator may perform microdermabrasion. Deeper microdermabrasion treatments that contact or penetrate the dermis (living tissue) do not fall within the scope of an esthetician or cosmetology operator license and must be administered or delegated by a physician.

Can an esthetician or cosmetology operator perform chemical peels?

It depends. Estheticians and cosmetology operators can remove excess accumulations of dead skin cells from a person’s skin, including peeling or exfoliation. Estheticians and cosmetology operators may perform “light peels” or “superficial peels” that are non- invasive and/or non-aggressive in nature and enhance or beautify the epidermis by removing dead cells, but do not pierce the dermis (living tissue). “Medium peels” and “deep peels” penetrate the dermis (living tissue) and are considered medical procedures regulated by the Texas Medical Board.

What is Not in the Esthetician’s or Cosmetology Operator’s Scope of Practice?

• An esthetician or cosmetology operator license does not authorize the esthetician or cosmetology operator to use lasers for hair removal, skin resurfacing or teeth
• An esthetician or cosmetology operator license does not authorize the esthetician or cosmetology operator to use hypodermic needles to inject botulinum toxic (for example, Botox) or other substances, even for cosmetic
• A physician cannot delegate cosmetology A doctor may delegate only medical procedures in accordance with the laws and rules relating to their medical license.
• Physicians should consult with the Texas Medical Board about what constitutes a medical act and to whom medical acts may be delegated, including cleansing or exfoliation procedures that are procedure.

Facility Requirements

• An “esthetics,” “medical esthetics,” or other business by any title that employs or leases space to a licensed cosmetologist or esthetician must comply with the facility and equipment requirements under Chapter 1603, Texas Occupations Code, and Title 16, Texas Administrative Code, Chapter 83. Requirements include running water, restroom, and health and safety requirements. You may view these requirements at 16 TAC Chapter 83.
• A business may lease space to a cosmetologist as an independent contractor only if the business is licensed by TDLR as an establishment under Chapter 1603, Texas Occupations Code. The person who leases space must also hold the required practitioner license to provide regulated services.

Services and Regulations

TDLR has created the following resources to assist establishment owners in offering a wide range of services:

• Who Regulates What? – A comprehensive list of services and information on who regulates them.
• Scope of Practice Guides – A list of TDLR license types and the services that each can provide.

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