Does a med spa in Alabama need a medical director?

Short answer
The cited rules do not settle this — none names a "medical director"; they establish that a physician who delegates non-ablative treatments to a Level 1 or 2 Delegate must have 30 hours of training and must supervise the work under a written protocol.

Alabama has a chapter for this and it tiers the delegate. 540-x-11 governs lasers and light/energy-based devices — any energy source, chemical or modality affecting living tissue below the stratum corneum, for surgical, therapeutic or cosmetic purposes — and says outright that using them is the practice of medicine. A physician may delegate only NON-ABLATIVE treatments, only through written protocols, and only to a properly trained LEVEL 1 OR LEVEL 2 DELEGATE — and Alabama counts the training in hours: THIRTY for a physician, FORTY for a delegate, before either may use a device. The written protocol is a physician’s order kept ON SITE and producible to the Board on request. The delegating physician must formulate or approve the protocol, review and authorize it at least ANNUALLY, and provide on-site or locally remote supervision.