Texas med spa & injectable regulations

Physician supervision & delegation

Cosmetic injections, fillers, and cosmetic laser use are medical acts a physician may delegate under supervision. As of Jan 9, 2025 the governing Board rules are in 22 TAC Chapter 169.

• A Texas physician may delegate a medical act — including cosmetic injections, dermal fillers, and cosmetic laser use — to a qualified, properly trained person acting under the physician’s supervision, where a reasonable and prudent physician would find it consistent with sound medical judgment. The delegating physician remains responsible for the delegated act.

  Tex. Occ. Code §157.001

• The Texas Medical Board classifies nonsurgical medical cosmetic procedures — including the injection of medications or substances for cosmetic purposes and the use of a prescription medical device for cosmetic purposes — as the practice of medicine that may be properly delegated and supervised.

  22 TAC §169.25

• The delegating physician must review, approve, or develop a written order for the delegated procedure that identifies the physician, sets patient-screening criteria, describes appropriate care, and provides procedures for handling common complications.

  22 TAC §169.27

Good-faith examination

Texas does not use the phrase “good-faith exam.” The operative requirement is establishing a practitioner-patient relationship before the delegated act.

• Before a delegated cosmetic act, a practitioner-patient relationship must be established by a physician, or by a PA or APRN acting under the physician’s delegation, and an adequate medical record must be maintained. The identity and title of the person who will perform the act must be disclosed to the patient.

  22 TAC §169.26

• A physician, PA, or APRN must be onsite during the procedure or immediately available for emergency consultation, and at least one person trained in basic life support must be present while the patient is onsite.

  22 TAC §169.26

Ownership & corporate practice of medicine

Texas follows the corporate-practice-of-medicine doctrine, derived from the Medical Practice Act’s licensure requirement rather than a single titled statute.

• A person may not practice medicine in Texas unless licensed by the Board. As a result, a general business corporation or an unlicensed individual cannot practice medicine or employ physicians in a way that controls their medical judgment.

  Tex. Occ. Code §155.001

• One recognized structure is a Board-certified nonprofit health organization (a “5.01(a)” corporation) that is organized solely by Board-licensed physicians.

  Tex. Occ. Code §162.001

• Even a certified organization may not interfere with, control, or otherwise direct a physician’s professional judgment.

  Tex. Occ. Code §162.0021

RN / NP scope for injectables

• A registered nurse who is not an APRN (and an LVN) may not perform medical diagnosis or prescribe, but may carry out a delegated medical act — such as administering a cosmetic injection ordered by an appropriately licensed practitioner — when the Board of Nursing’s criteria are met: documented competency/education, written policies and guidelines, an order from an appropriate licensed practitioner, and available medical and nursing support.

  Tex. BON Position Statement 15.11

• For laser therapy performed by RNs or LVNs, the Board of Nursing directs nurses to the Texas Medical Board’s delegation rule for nonsurgical cosmetic procedures and to the Health & Safety Code’s laser provisions.

  Tex. BON Position Statement 15.9

Disciplinary landscape

The enforcement mechanisms below are confirmed from statute. (Specific named med-spa cases were not confirmed from an official source and are omitted.)

• Practicing medicine without a license in Texas is a third-degree felony, and each day of unlicensed practice is a separate offense.

  Tex. Occ. Code §165.152

• The Texas Medical Board may issue a cease-and-desist order against an unlicensed person it believes is practicing medicine.

  Tex. Occ. Code §165.052

• Holding out — through advertising, titles, or stationery — as entitled to practice medicine without a license is a criminal offense, reachable against an individual or a business entity.

  Tex. Occ. Code §165.156