It’s hard to scroll through social media today without seeing someone getting Botox, lip filler, or laser resurfacing,m often in what looks more like a boutique than a clinic. Med spas are booming, blending medicine and beauty in ways that attract millions. But behind the aesthetics lies a troubling reality: inconsistent oversight, unclear qualifications, and patients assuming a level of safety that doesn’t always exist.
The global medical aesthetics market was valued at over $18 billion in 2023 and is expected to keep growing. In the U.S. alone, med spas are popping up at record pace, with influencers and non-physician providers entering the field in droves. Many offer injections, lasers, microneedling, and even IV infusions (procedures that can have real medical consequences if performed incorrectly).
And yet, oversight of this industry is murky at best. While some states require physician supervision for injectables, others allow nurses, physician assistants, or even aestheticians to perform them with minimal oversight. There’s no federal standard governing who can own or operate a med spa. In many cases, the doctor whose license is being used to legitimize the business is never even on-site.
This lack of regulation has real consequences. A 2024 investigative report from NBC News described cases of patients developing Mycobacterium abscessus infections after visiting a med spa that failed basic sanitation standards. A study published in the Journal of Dermatologic Surgery in 2024 found that in Nevada, 73% of injectable procedures in med spas were performed by non-physicians, and only 38% had a physician physically present.
Even John Oliver tackled the issue in an episode of Last Week Tonight, dubbing med spas “the Wild West of medicine,” pointing to TikTok trends where injectors show off treatments while dancing or advertising deeply discounted Botox on Groupon. Take a look:
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The appeal of med spas is understandable. They’re often more accessible than dermatology or plastic surgery clinics, with a focus on convenience and cash-pay models that avoid the red tape of insurance. For some physicians, aesthetics offers a way out of clinical burnout, offering flexible hours and better revenue. But the loose regulation of the space creates a two-tier system: some med spas are operated by board-certified physicians with extensive training; others are essentially beauty parlors with syringes.
Tragically, it often takes a patient injury—or death—for lawmakers to act. In Texas, “Jenifer’s Law” was introduced after a woman died from complications following an unregulated IV vitamin infusion. The law aims to require physician oversight of all med spa IV procedures, but it’s still making its way through the legislative process and we found an article on an attorney website that claims that “what began as a bill that could have shuttered many IV hydration clinics has transformed into legislation that may actually reduce regulatory restrictions on the industry.”
The confusion isn’t just dangerous. It’s exhausting for patients trying to make safe choices. Some articles, including this one from the American Med Spa Association, (which, of note, has advice compiled from a mix of MD’s, PA’s, and nurses), warn consumers to ask for credentials, know the state’s laws (why are they different for every state, anyway?), verify licenses, and undergo proper standard operating procedures (SOPs) that “should be upheld and that are supported by evidence-based medicine”. But in an industry driven by aesthetics and marketing, regulation often lags far behind influence.
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So where do we go from here?
For starters, clearer legislation is essential. States need uniform standards that define who can perform what procedures, and under what supervision. There should also be a national framework that ensures a basic level of medical oversight for any facility offering invasive procedures. The American Med Spa Association (AmSpa) has begun pushing for this, providing state-by-state breakdowns of the laws, but enforcement remains a challenge.
Physicians also have a role to play. Those entering the aesthetics space must uphold the same standards they would in any clinical setting. That means providing proper training, supervision, and informed consent. It also means speaking out when they see unsafe practices, because silence protects bad actors.
Finally, patients deserve transparency. It should be clear who is performing a procedure, what their qualifications are, and what the risks involve. A culture of informed choice, not just visual results, will protect both patients and practitioners in the long run.
Med spas are not inherently dangerous. Many offer high-quality care in safe, serene environments. But without consistent rules and proper medical oversight, we risk letting a booming industry become a breeding ground for harm.
Beauty may be skin-deep, but oversight shouldn’t be.
Oversight of the medspa industry is murky at best.
