The New York Department of State (DOS), working closely with the Department of Health and the Department of Education, has released the results of a major statewide enforcement sweep targeting businesses offering “med spa” services without the proper medical licensure. Inspectors visited 223 appearance enhancement businesses across the state, and 87 were cited for potential violations—including the unlawful practice of medicine. Penalties already imposed in resolved cases range from substantial monetary fines to license suspensions and outright revocations, with many matters still pending administrative hearings.

This initiative serves as a strong reminder: any facility branding itself as a “med spa” or providing medical-grade cosmetic procedures must operate as a licensed medical practice. These services can only be performed by appropriately licensed healthcare professionals—typically physicians, nurse practitioners, or physician assistants—under proper supervision and oversight.

Which Procedures Require Medical Licensure?

New York law treats a wide array of popular med spa treatments as the practice of medicine. These include (but are not limited to):

• Injections of Botox, dermal fillers (such as Restylane), or any other substances—whether delivered by needle or pressure pen

• Intravenous (IV) therapy and vitamin infusions

• CoolSculpting and other body contouring procedures

• Liposuction (lipoplasty)

• Cryotherapy

• Microneedling

• Laser treatments (excluding basic laser hair removal)

• Radiofrequency procedures (for facials or body treatments)

• Plasma treatments

• Ultrasound-based therapies

• Hormone replacement therapy (HRT)

• Administration of GLP-1 weight loss medications (e.g., Ozempic)

• Chemical peels, dermal pen treatments, skin tag removal, and similar invasive skin procedures

Even services often marketed as “non-invasive” fall under medical oversight if they involve penetration of the skin, injection of substances, or use of medical devices. Businesses offering these must be structured as professional entities (such as a PC or PLLC) with appropriate authorization from the New York State Education Department, and they generally cannot include “spa” in the corporate name.

Common Red Flags Uncovered During Inspections

A major focus of the enforcement effort was on appearance enhancement businesses (licensed only for esthetics, cosmetology, etc.) that were improperly crossing into medical territory. Investigators frequently found:

• Sharps containers with used needles

• Unused or new needles and syringes

• Medical-grade injectable substances

• Advanced devices intended for invasive procedures

The mere possession of needles, sharps, or related medical equipment in a non-medical facility is a clear indicator of unauthorized practice. Under New York regulations, estheticians, cosmetologists, and similar licensees are strictly prohibited from performing injections or any needle-based procedures that penetrate the skin for cosmetic or medical purposes.

These discoveries have led to citations for aiding unauthorized practice, unsanitary conditions, and other serious violations—often resulting in emergency suspensions and referrals for further action.

Real-World Consequences: Patient Injuries Highlight the Stakes

State officials pointed to documented cases (separate from or illustrative of the current sweep) where unqualified providers caused significant harm, including:

• A cosmetologist administering multiple injections of unknown substances marketed as Botox, stem cells, and collagen, leading to redness, bleeding, swelling, blistering, scarring, pain, fever, and permanent damage—resulting in license revocation.

• An esthetician performing injections, cryotherapy, and laser services in an unlicensed setting, causing a severe MRSA infection, sepsis, and hospitalization—followed by emergency suspension and revocation.

Additional findings included expired or suspected counterfeit products, controlled substances (such as fentanyl, xylocaine, and propofol), and poor sanitation, all of which amplify the risks to patients.

Essential Compliance Steps for Med Spa Owners and Providers

To avoid regulatory trouble in this heightened enforcement environment:

• Ensure Proper Facility Structure

  Operate as a licensed medical practice with the correct corporate formation and Certificate of Authorization. Avoid non-medical branding that could mislead regulators or patients.

• Verify Delegation & Supervision

  All medical procedures must be performed or properly delegated by licensed professionals within their scope of practice. Non-medical licensees cannot perform or assist with injections or invasive treatments.

• Eliminate Prohibited Items

  Do not store or possess needles, sharps containers, injectables, or medical devices unless your facility holds full medical licensure.

• Conduct Internal Audits

  Regularly review staffing credentials, protocols, inventory, marketing materials, and overall operations to confirm full compliance.

• Stay Vigilant

  The DOS has indicated that inspections of appearance enhancement businesses will continue as part of its ongoing annual program.

Non-compliance carries serious consequences: fines, loss of licenses, business closure, civil liability, and potential criminal referrals in cases involving patient harm.

If your med spa or related practice could benefit from a thorough compliance review—including corporate structure, delegation protocols, inventory controls, or response to any regulatory inquiries—our team is here to assist. Please contact us at (212) 668-0200 or via email to discuss how we can help safeguard your practice and prioritize patient safety in this evolving regulatory landscape.

We remain committed to guiding healthcare professionals and facility owners through New York's complex requirements.