New York medical director requirements for med spas

Physician supervision & delegation in New York

New York reaches cosmetic procedures through the definition of the practice of medicine, plus the physician’s own duties not to delegate to the unqualified and not to permit unlicensed practice. On 7 March 2025 the State Board for Medicine determined that using an energy device which affects the basement membrane or deeper tissue is the practice of medicine — grading devices by depth. The Education Department adopted that determination for every physical condition except laser hair removal, on which it has not acted. Inside it, only a licensed practitioner or a registered professional nurse under a physician’s general supervision may carry out the treatment.

• New York defines the practice of medicine as diagnosing, treating, operating or prescribing for any human disease, pain, injury, deformity or physical condition. Administering a prescription drug such as a neuromodulator or dermal filler, and prescribing it, fall inside that definition.

  N.Y. Educ. Law §6521 · verified Aug 17, 2026

• Delegating professional responsibilities to a person when the licensee knows or has reason to know that the person is not qualified — by training, by experience, or by licensure — to perform them is professional misconduct.

  N.Y. Educ. Law §6530(25) · verified Aug 17, 2026

• Permitting, aiding or abetting an unlicensed person to perform activities requiring a license is itself professional misconduct by the licensee.

  N.Y. Educ. Law §6530(11) · verified Aug 17, 2026

• On March 7, 2025 the New York State Board for Medicine determined that using any energy device, including a laser, which affects the basement membrane or deeper tissue (the dermis or fat) to treat a physical condition is the practice of medicine. The Education Department has adopted that determination for every physical condition EXCEPT laser hair removal, on which — relying on People v. Lehrman — it has not acted. So laser skin rejuvenation, tattoo removal, lesion removal and spider-vein treatment are medical acts in New York, while laser hair removal sits outside the adopted determination.

  N.Y. State Board for Medicine — Use of Energy Devices Including Lasers as the Practice of Medicine (Mar. 7, 2025) · verified Aug 17, 2026

• Treatments the Department has adopted as the practice of medicine must be performed by, or under the order of, a licensed physician, physician assistant, or nurse practitioner. The supervision required is GENERAL supervision: the supervising physician or nurse practitioner need not be physically present, but must be available to give guidance or to intervene within a reasonable period for the treatment being rendered.

  N.Y. State Board for Medicine — Use of Energy Devices Including Lasers as the Practice of Medicine (Mar. 7, 2025) · verified Aug 17, 2026

• Microneedling/Dermalrolling (Collagen Induction Therapy) Cosmetic procedure that involves repeatedly puncturing the skin with tiny, sterile needles to induce collagen and elastin production; penetrates into the deep dermis.

  NY Dept. of State, Appearance Enhancement Licensees — Procedural Service Determinations (Procedure Licensure Chart), row “Microneedling/Dermalrolling”, column “NYS Education Dept. License” · verified Sep 3, 2026

• The Board grades energy devices by how deep they act and who may therefore operate them. Class I (surface only — e.g. handheld LED) is not the practice of medicine and may be performed by trained non-licensed professionals such as aestheticians. Class II (non-ablative devices including IPL and non-ablative hair-removal lasers) and Class IIIa (low-risk devices such as low-level laser therapy) are also not the practice of medicine, but require trained non-licensed personnel to work under supervision. Class IIIb (medium-powered, upper dermis — e.g. Thermage) and Class IV (high-powered, dermis and deeper — e.g. CO2 resurfacing, deep RF, laser lipolysis) ARE the practice of medicine; Class IIIb requires licensed medical professionals or supervised personnel, and Class IV is restricted to licensed medical professionals exclusively.

  N.Y. State Board for Medicine — Use of Energy Devices Including Lasers as the Practice of Medicine (Mar. 7, 2025), Energy Device Classification Table · verified Aug 17, 2026

• Only registered professional nurses, under the general supervision of a licensed physician, physician assistant, or nurse practitioner, may carry out orders for treatment involving energy devices. Registered nurses are also the only professionals other than licensed medical practitioners authorized to perform the patient assessment that the Board requires before, during and after every energy-device treatment.

  N.Y. State Board for Medicine — Use of Energy Devices Including Lasers as the Practice of Medicine (Mar. 7, 2025) · verified Aug 17, 2026

• All treatments with energy devices require an assessment of the patient's condition before, during and after the procedure, and registered professional nurses are the only professionals other than licensed medical practitioners authorized to perform general patient assessments. Under general supervision the supervising physician or nurse practitioner need not be physically present, but must be available to provide guidance or intervene within a reasonable period, depending on the treatment rendered.

  N.Y. State Board for Medicine — Use of Energy Devices Including Lasers as the Practice of Medicine (Practitioner Guidelines — general supervision) · verified Sep 8, 2026

• Microdermabrasion Cosmetic procedure that exfoliates and removes the superficial layer of dry, dead skin cells to help diminish signs of aging.

  NY Dept. of State, Appearance Enhancement Licensees — Procedural Service Determinations (Procedure Licensure Chart), row “Microdermabrasion”, column “NYS Dept. of State License” · verified Sep 3, 2026