Texas Med Spa Regulations

Who can inject Botox and dermal fillers in Texas?

Injecting cosmetic products such as botulinum toxin and dermal fillers is the practice of medicine in Texas. A physician (MD/DO) may perform the injection or delegate it; physician assistants and APRNs (nurse practitioners) may inject under a physician's delegation and prescriptive authority, and an RN (or other qualified, properly trained person) may administer the injection under physician delegation and written protocol. The provider who performs the good-faith exam and orders the treatment must be a physician, PA, or APRN — not an RN or esthetician.

Full guide: Who Can Inject Botox and Fillers in Texas? RN, NP, PA Delegation Rules 2026 →

Source: 22 TAC §169.25 — injection of medication/substances for cosmetic purposes is the practice of medicine (TMB rule text via Cornell LII), 22 TAC §169.26 — physician, or PA/APRN acting under physician delegation, must act before the delegated act (TMB rule text via Cornell LII), Tex. Occ. Code §157.001 — physician may delegate a medical act to a qualified and properly trained person under supervision

Does Texas require a good-faith exam before treatment?

Before any nonsurgical cosmetic procedure a practitioner-patient relationship must be established and documented — a good-faith exam (history, appropriate examination, diagnosis, and written treatment plan) — by a physician, PA, or APRN. Texas permits that relationship to be established via telemedicine, including synchronous audiovisual interaction, without a prior in-person visit.

Source: 22 TAC §169.26 — must establish a practitioner-patient relationship and maintain the medical record before a delegated cosmetic procedure (TMB rule text via Cornell LII), Former 22 TAC §193.17 (predecessor rule; framework preserved in §§169.25–169.29) — physician must take history, perform exam, make diagnosis, develop written treatment plan before authorizing a procedure, Tex. Occ. Code §111.005 — practitioner-patient relationship for telemedicine may be established via synchronous audiovisual interaction (no prior in-person exam required)

Does a med spa in Texas need a medical director?

Texas does not use a statutory 'medical director' title for med spas, but a delegating/supervising physician is mandatory in substance: that physician is legally responsible for the delegated medical acts, must review or develop the written orders/protocols, and — under the corporate-practice-of-medicine doctrine — must own the medical entity. So physician oversight is required even though 'medical director' is not a defined statutory role.

Full guide: Texas Med Spa Medical Director Requirements 2026: TMB Rules & Who Qualifies →

Source: Tex. Occ. Code §157.001 — delegating physician remains responsible for the medical acts of the person performing them, 22 TAC §169.27 — delegating physician must review/approve or develop the written orders identifying the responsible physician (TMB rule text via Cornell LII), 22 TAC §177.17 — corporate-practice-of-medicine doctrine requires physician ownership/control of the medical practice

Can a non-physician own a med spa in Texas?

Texas enforces the corporate practice of medicine doctrine: corporations, entities, and non-physicians generally may not practice medicine, own/control a medical practice, or employ physicians to practice medicine. A med spa offering medical services must therefore be owned through a physician professional entity (PA/PLLC), commonly paired with a management-services organization; only narrow statutory exceptions (e.g., certain hospitals) apply.

Source: 22 TAC §177.17 — 'The corporate practice of medicine doctrine ... generally prohibits corporations, entities or non-physicians from practicing medicine'; statutory basis Occ. Code §§155.001, 155.003, 157.001, 164.052(a)(8),(13), 165.156; lists limited exceptions

What supervision does Texas require for med-spa procedures?

A delegating physician must either be onsite during the procedure or immediately available for emergency consultation and able to see the patient, must approve or develop written protocols/standing orders, and must ensure at least one person trained in basic life support is present while the patient is onsite. PAs and APRNs act under a written prescriptive authority agreement that requires quality-assurance chart review and meetings between the physician and the PA/APRN at least monthly.

Source: 22 TAC §169.26 — physician/PA/APRN must be onsite or immediately available for emergency, able to conduct an emergency appointment, and ensure a BLS-trained person is present (TMB rule text via Cornell LII), 22 TAC §169.27 — physician must review/approve or develop written orders with screening criteria, care description, and emergency procedures (TMB rule text via Cornell LII), Texas Medical Board — Prescribing and Supervision: PA/APRN prescriptive authority agreement requires chart review and at least monthly meetings; supervising physician need not be physically present at all times

What can an esthetician legally do in Texas?

TDLR-licensed estheticians/cosmetologists may treat only the epidermis — superficial/light chemical peels and microdermabrasion that remove dead skin cells without piercing the dermis. They may not use hypodermic needles to inject (e.g., botulinum toxin), may not use lasers/IPL for hair removal or resurfacing, and may not perform medium/deep peels or any service that penetrates or removes living tissue below the epidermis; those are medical acts a physician must perform or delegate.

Full guide: Texas Esthetician & Advanced Skin Scope 2026: Peels, Microneedling & Med Spa Rules →

Source: TDLR — Medical Spas (Barbering & Cosmetology): esthetician license does not authorize injections, lasers, or peels/procedures penetrating the dermis; deeper/medical acts must be delegated by a physician

Who can operate a cosmetic laser in Texas?

Laser hair removal is regulated by TDLR under Health & Safety Code Ch. 401, Subchapter M and 16 TAC Ch. 118: an individual must hold a laser hair removal certificate (technician/senior/professional tiers), and each facility must hold a facility certificate and maintain a written contract with a consulting physician. Cosmetic laser/IPL procedures beyond hair removal (e.g., resurfacing, tattoo removal) are the practice of medicine and must be performed or delegated by a physician to a PA/APRN/RN or other trained personnel under protocol; DSHS separately requires registration of Class 3B/4 laser devices.

Full guide: Texas Laser Safety Regulations for Med Spas 2026: Training, DSHS Rules & Who Can Operate Lasers →

Source: TDLR — Laser Hair Removal Laws & Rules: governed by Tex. Health & Safety Code Ch. 401 Subch. M and 16 TAC Ch. 118; TDLR certifies individuals and facilities, TDLR — Laser Hair Removal FAQ: each facility must obtain a written contract with a consulting physician and designate a laser hair removal professional; certified individuals perform procedures; physician delegation authority preserved, Texas DSHS — Laser and Laser Device Services Registration: businesses using Class 3B/4 lasers for human/medical use must register with the Radiation Control Program, 22 TAC §169.25 — use of a prescription medical device for cosmetic purposes is the practice of medicine that may be delegated/supervised (TMB rule text via Cornell LII)

What are the rules for IV therapy and vitamin drips in Texas?

Texas has no IV-therapy-specific rule, but IV vitamin/hydration therapy falls squarely within the Medical Board's definition of nonsurgical cosmetic/medical practice — 'injection of medication or substances' — so it is the practice of medicine. It requires a physician's order and delegation and a good-faith exam by a physician, PA, or APRN before treatment; an RN (or other qualified, properly trained person) may administer the infusion under physician delegation and protocol.

Source: 22 TAC §169.25 — 'injection of medication or substances' and colonic irrigations are the practice of medicine that may be delegated/supervised (TMB rule text via Cornell LII), 22 TAC §169.26 — practitioner-patient relationship (good-faith exam) required before the delegated act (TMB rule text via Cornell LII), Tex. Occ. Code §157.001 — physician may delegate to a qualified, properly trained person under supervision and remains responsible

Does a med spa have to register or hold a license in Texas?

Texas has no med-spa-specific license or registration. A med spa is regulated by whichever agencies its services touch: the Texas Medical Board (physician delegation and corporate-practice-of-medicine compliance for medical acts), TDLR (cosmetology/esthetician licenses and laser hair removal individual + facility certificates), the Texas Board of Nursing (nurses), and DSHS (Class 3B/4 laser device registration). The medical component must be organized as a physician-owned professional entity.

Source: TDLR — Medical Spas: med spas are not licensed as a single entity; services are regulated across agencies and medical acts must be delegated by a physician, 22 TAC §177.17 — corporate-practice-of-medicine doctrine requires the medical practice to be physician-owned/controlled

What are the penalties for practicing outside scope in Texas?

Practicing medicine without a Texas license is a third-degree felony, and each day the violation continues is a separate offense. A physician who aids or abets unlicensed practice — for example, through improper delegation or allowing a non-physician to control the practice — is subject to Medical Board discipline, and the Board or Attorney General may also seek injunctions and civil penalties.

Source: Tex. Occ. Code §165.152 — an offense (unlicensed practice under §165.151) is a felony of the third degree; each day is a separate offense, 22 TAC §177.17 — statutory basis cites Occ. Code §164.052(a)(8),(13) (aiding unlicensed practice = ground for discipline) and §165.156 (injunctions)