Does a med spa in Oklahoma need a medical director?

Short answer
The cited rules do not settle this — none mentions a medical director. What they do require is a supervising physician for any physician assistant, responsible for all orders and protocols, regular review of services and charts, and available for consultation.

Oklahoma writes the supervision duty as a list the supervising physician must satisfy, and it is unusually concrete about orders. In all patient care settings that physician must provide appropriate methods of supervising the physician assistant’s services, and § 519.6 names them: being responsible for the formulation or approval of all orders and protocols — standing, direct or otherwise — and periodically reviewing them; regularly reviewing the services provided and any problems or complications; being available physically or by telemedicine or direct telecommunication for consultation, emergencies or referral; and reviewing a sample of outpatient medical records. The Cosmetology and Barbering Board’s scope rule then draws the esthetician’s line by DEPTH: cosmetology expressly does not include services that puncture the skin or that fall within the healing arts, and “puncturing the skin” is defined to include microneedling — a multi-needled device creating microchannels at a depth greater than 0.25 mm — as well as laser, ultrasound and HIFU, plasma pen, injections including needle-free devices, FDA Class 3 devices and dermabrasion.