Who can do what with cosmetic procedures in Florida? Are the providers qualified? Where are the services being rendered?
Any doctor can do cosmetic services in his/her primary care practice; no specialized background in dermatology or plastic surgery is required. Under Florida law, in a med spa — or an aesthetic center that isn’t the doctor’s primary office — the Nurse Practitioner (ARNP or NP) or Physician Assistant (PA) must be supervised by a board certified dermatologist or plastic surgeon, though they don’t have to be present. This is not descriptive for non-med spa or aesthetic centers or independent practitioners. Laws differ from state to state, but in Florida, anyone with a medical license can practice in any medical field. PA’s and ARNP’s can order and perform injections.
Who is administering Botox®? Botox® can only be prescribed by a doctor, PA or ARNP in the STATE OF FLORIDA. It may not be administered by a Registered Nurse or Medical Assistant. In Florida, injection of Botox and/or fillers is deemed the practice of Medicine and an RN is not allowed to perform these procedures even when a Physician is present. NP’s and PA’s are allowed to perform these procedures under protocols written and reviewed by the supervising Physician, as per Florida Law. It is very disturbing when someone identifies themselves as a “nurse” because all nurses are not educated equally. Unfortunately, until there is a bad outcome, those illegally or unethically providing services may not be reported.
As stated by the Florida Board of Medicine, lasers, laser for hair removal, Botox® injections, collagen injections, and any other noninvasive injections of materials used as procedures to treat patients must be performed by a Physician, a PA under supervision, or an ARNP working under a protocol signed by a Physician (Absolutely not RN’s, MA’s, Tech’s, estheticians, cosmetologists, etc.). Laser Skin Resurfacingis ablative laser therapy and can be done by a doctor, ARNP or PA. Non-ablative fractionated laser treatments use radiofrequency waves that results in fewer side effects and faster recovery but results that do not last as long. These can be performed by any trained person.
FLA. STAT. ANN. § 459.025(2). A PA may, at the supervisory physician’s discretion, utilize light-based or laser hair removal equipment under “indirect supervision.” The provisions of Section 458.348(3) or 459.025(2), Florida Statutes, do not apply to services rendered by a physician assistant who has not been properly trained and qualified to utilize laser and light-based hair removal equipment and delegated the task of providing such service as long as the delegated task is within the scope of the supervising physician’s practice. FLA. STAT. ANN. §.458.348(3), PROTOCOLS REQUIRING DIRECT SUPERVISION All protocols relating to electrolysis or electrology using laser or light-based hair removal or reduction by persons other than osteopathic physicians licensed under this chapter or chapter 458 shall require the person performing such service to be appropriately trained and to work only under the direct supervision and responsibility of an osteopathic physician licensed under this chapter or chapter 458. Physician must be on site. FLA.STAT. Chapter 477 Rule 61G5 of the Florida Administrative Code& Rules and Laws govern the cosmetology profession can be found at The Florida Department of Professional Regulations. Education/Training for the Facial Specialist in the State of Florida consists of obtaining a GED or high school graduate diploma, and successful completion of a program of at least 260 hours offered by a Florida school of cosmetology for a facial specialist. Licensure is issued by the Board of Cosmetology. Facial Specialists do facials including massage of the head, face, scalp, and neck but can also do “facials” on other areas and apply products in a “massage like fashion” otherwise; a person must also be licensed under the Board of Massage Therapy. Medical Estheticians work in doctor’s office, hospitals or medical spas and should be specialty trained in the operation of potent acids, lasers and other equipment. Treatments are more invasive and require more knowledge than a spa facial or basic peel. Patients are advised more therapeutically how to care for their skin for prevention, maintenance and promotion of proper healing.
It is a second degree misdemeanor in Florida if you attempt to practice the trade without a license, or to practice on a suspended or revoked permit. Whether retained for a medical malpractice or personal injury case, knowing the standards and regulations for cosmetic medical practice can lead to successful litigation.
Written by: Medical Esthetician Expert Witness No. 2165
About the Author:
Expert Witness No. 2165 is Pediatric Nurse Practitioner and Licensed Medical Esthetician. She holds numerous certifications in skin care therapies in addition to her extensive experience in pediatrics. She is also a Certified Cardiac Life Support Instructor and Asthma Educator.