Question 1

Who can inject Botox and dermal fillers in Virginia?

Accepted Answer

Injecting neuromodulators and dermal fillers is the practice of medicine because it involves administering prescription drugs. It may be performed by a physician (MD/DO), or by a nurse practitioner or physician assistant acting within a practice agreement and scope, and a physician (or NP/PA) may delegate the injection to a registered nurse or other properly trained, supervised person under Va. Code § 54.1-2901, which expressly authorizes nurses and technicians to give injections under the orders of a licensed physician, osteopath, APRN, or PA and permits delegation of nondiscretionary functions. Virginia has no med-spa-specific statute, so this flows from the general Medical Practice Act and the delegation/prescribing statutes.

Question 2

Does Virginia require a good-faith exam before treatment?

Accepted Answer

Before prescribing any prescription drug (including botulinum toxin and fillers), Virginia requires a bona fide practitioner-patient relationship, which includes obtaining the patient's history and performing an appropriate examination physically or by instrumentation/diagnostic equipment. That relationship may be established via telemedicine using face-to-face interactive, two-way real-time or store-and-forward technology when doing so is consistent with the standard of care, so a good-faith exam is required and telehealth is permitted.

Question 3

Does a med spa in Virginia need a medical director?

Accepted Answer

Virginia has no statute or regulation requiring a med spa to designate a 'medical director'; there is no med-spa-specific facility law at all. Instead, any medical procedure delegated to non-physician staff must be performed under the direction and supervision of a licensed practitioner (physician, or NP/PA within their authority) who retains responsibility for the delegated act under Va. Code § 54.1-2901 and the PA/NP supervision statutes, which functionally requires a supervising/delegating physician-level provider even though the term 'medical director' is not used in law.

Question 4

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

Accepted Answer

Virginia has no blanket corporate-practice-of-medicine prohibition, but a professional entity rendering medical services must be owned by individuals (or professional business entities) duly licensed or otherwise legally authorized to provide those services under Va. Code § 13.1-543. That statute groups healing-arts practitioners, advanced practice registered nurses, and related licensees as rendering the 'same professional service,' so ownership is restricted to licensed professionals but is not limited to physicians only (an NP or other authorized licensee may co-own).

Question 5

What supervision does Virginia require for med-spa procedures?

Accepted Answer

Nurse practitioners must maintain collaboration and consultation with a patient care team physician under a written practice agreement, and may practice autonomously without an agreement only after the equivalent of at least three years (roughly full-time) of clinical experience with the required attestation, per Va. Code § 54.1-2957. Physician assistants must work under a practice agreement with a supervising physician who is available at all times to collaborate and consult (with a limit of six PAs per physician), per Va. Code § 54.1-2952, and delegation of medical tasks to RNs or unlicensed staff requires the physician's direction and supervision under § 54.1-2901.

Question 6

What can an esthetician legally do in Virginia?

Accepted Answer

Licensed estheticians and master estheticians are regulated by the Board for Barbers and Cosmetology and are limited to superficial, non-invasive skin care using cosmetic preparations and non-laser devices (cleansing, toning, exfoliation, makeup, mechanical hair removal; master estheticians add lymphatic drainage, chemical exfoliation, and microdermabrasion of the epidermis). Va. Code § 54.1-700 expressly provides that esthetics is not a healing art and excludes anything constituting the practice of medicine, so estheticians may not inject, use lasers, or perform any procedure that penetrates below the epidermis.

Question 7

Who can operate a cosmetic laser in Virginia?

Accepted Answer

By statute, laser hair removal must be performed by a physician (MD/DO), physician assistant, or advanced practice registered nurse, or by a properly trained person under the direction and supervision of one of those licensees, per Va. Code § 54.1-2973.1. The supervising provider need not be physically present but must be readily available and must personally evaluate any patient who develops complications; delegatees must complete training including at least 10 proctored patient cases under 18VAC85-20-91. Other medical lasers (e.g., resurfacing, IPL) are the practice of medicine and are delegated under the same physician/NP/PA supervision framework.

Question 8

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

Accepted Answer

Administering IV fluids and injectable therapies is the practice of medicine requiring a valid order. Va. Code § 54.1-2901(A)(4) expressly permits nurses and technicians to give intravenous infusions and injections when acting under the orders of a licensed physician, osteopath, APRN, or physician assistant, and the ordering practitioner must first establish a bona fide practitioner-patient relationship and appropriate exam under § 54.1-3303. There is no IV-therapy-specific med-spa statute; it is governed by these general delegation and prescribing rules.

Question 9

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

Accepted Answer

Virginia does not license or register 'medical spas' as such — there is no med-spa-specific facility statute, and the Board of Medicine does not issue a medical-spa facility license (secondary sources claiming otherwise are inaccurate). The medical side is regulated solely through practitioner licensure and delegation. A facility offering esthetics/cosmetology services must obtain a 'spa' establishment license from the Board for Barbers and Cosmetology under 18VAC41-70-80 (Va. Code § 54.1-704.1), but that is an occupational cosmetology license covering only the esthetics side, not a healthcare-facility license.

Question 10

What are the penalties for practicing outside scope in Virginia?

Accepted Answer

It is unlawful to practice medicine, osteopathic medicine, or as a physician assistant in Virginia without a valid, unrevoked Board license under Va. Code § 54.1-2902, and unlicensed persons who perform medical procedures such as injections or medical lasers are practicing medicine unlawfully. Under Va. Code § 54.1-111, willful unlicensed practice is a Class 1 misdemeanor, and a third or subsequent conviction within a 36-month period is a Class 6 felony, in addition to civil penalties and restitution; licensees who improperly delegate also face Board disciplinary action.

Virginia Med Spa Regulations