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 in Texas? 2026 Delegation Rules →

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), 22 TAC §169.26 — the successor rule requires establishing a practitioner-patient relationship and maintaining a Chapter 163 medical record; the express history/examination/diagnosis/written-treatment-plan language of the repealed 22 TAC §193.17 does not appear in it (TMB rule text via Cornell LII), Tex.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), Tex. Occ. Code §155.001 — a person may not practice medicine in Texas without a license; this is the statutory basis for the corporate-practice-of-medicine doctrine requiring physician ownership/control of the medical practice (22 TAC §177.17, which formerly stated the doctrine, was repealed effective January 9, 2025)

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: Tex. Occ. Code §155.001 — a person may not practice medicine in Texas without a license; with §§155.003, 157.001 and 164.052(a)(17) (a physician who aids or abets practice of medicine by an unlicensed person or corporation commits a prohibited practice) this is the statutory basis of the corporate-practice-of-medicine doctrine that generally prohibits corporations, entities and non-physicians from practicing medicine or employing physicians to do so, Tex. Occ. Code §162.001 — the principal statutory exception: the Board certifies a non-profit health organization that may employ licensed physicians. TMB certification now sits in 22 TAC Chapter 174 (Business Organizations), Subchapter A; the former 22 TAC §177.17 'Exceptions to Corporate Practice of Medicine Doctrine' was repealed effective January 9, 2025 and no successor rule carries that title

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, Tex. Occ. Code §155.001 — practicing medicine in Texas requires a license, the statutory basis for requiring the medical practice to be physician-owned/controlled (the former 22 TAC §177.17 was repealed effective January 9, 2025)

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, Tex. Occ. Code §164.052(a)(17) — a physician who directly or indirectly aids or abets the practice of medicine by a person, partnership, association or corporation not licensed by the Board commits a prohibited practice and is subject to TMB discipline; (a)(13) separately covers permitting another to use one's license (the former 22 TAC §177.17 collected these statutory bases and was repealed effective January 9, 2025)