Beauty and wellness appear synonymous in American culture, as if one could not exist without the other. As consumers continue to strongly pursue health and beauty, the field of medical aesthetics has exploded and continues to grow. In fact, the Medical Spa (MedSpa) market size alone reached $18 billion in 2023, with a projected Compound Annual Growth Rate (CAGR) of 18.7% through 2032. California leads the nation with the highest concentration of MedSpa businesses.¹ As the industry grows, opening a MedSpa or serving as the Medical Director of a MedSpa would appear to be a lucrative endeavor for a physician and an easy way to enhance income, especially as the challenges of traditional healthcare models continue to increase.
The following scenario is based on a compilation of facts from various cases, and demonstrates the risks involved in running a MedSpa and why you should heed the old saying, “If it sounds too good to be true, it probably is.”
■ Dr. “R”
Shortly after completing medical school and residency, Dr. R opened a MedSpa specializing in non-invasive cosmetic and laser procedures in a large metropolitan area. Dr. R spent a significant amount on social media marketing and built a large following in a highly competitive market. Part of Dr. R’s goal was to be at the forefront of offering the latest treatments to patients. As Dr. R’s practice rapidly grew, Dr. R delegated more and more tasks to staff, including providing laser treatments to meet the increasing demand.
Dr. R struggled to manage the practice, and patient follow-up and documentation suffered. Several years after opening the MedSpa, Dr. R came under investigation by the state’s medical board after multiple patient complaints were filed for alleged violations, including lack of informed consent, improper delegation of medical procedures to unlicensed personnel, patient harm, and false advertising. Ultimately, the medical board placed Dr. R on probation with several terms and conditions imposed on their medical license.
■ The MedSpa
As the owner and provider of the MedSpa, Dr. R assumed ultimate responsibility for all patients treated there. MedSpas are medical clinics that combine spa services with medical treatment, offering services ranging from facials and injectables to laser treatments, non-surgical fat reduction, and beyond.² Although MedSpas may look like a day spa, they remain medical facilities and are subject to the rules and regulations of a physician’s office.
In California, MedSpas must be owned and operated by licensed medical professionals, and only licensed physicians can hold majority ownership. MedSpas must also have a Medical Director—a licensed physician who oversees all medical procedures and manages the quality of the care provided to the patients served.³ MedSpa Medical Directors are responsible for patient safety, ensuring proper protocols are in place, overseeing care plans, and complying with applicable laws and regulations, including HIPAA and the Federal Trade Commission Act.1,4
■ Delegation of Laser Treatments
The Medical Board of California and the California Board of Registered Nursing have ruled that only licensed practitioners can operate lasers, as they are considered medical devices that can have a harmful impact, such as burns, scarring, and/or permanent discoloration. Unlicensed medical assistants, licensed vocational nurses, cosmetologists, or aestheticians may not legally perform these treatments under any circumstances.5 Furthermore, registered nurses or physician assistants who operate these treatments must do so only under a physician’s supervision.
Dr. R’s delegation of laser treatments to unlicensed staff, such as medical assistants, was improper and in violation of state regulations. Even when delegating this treatment to licensed staff, physicians must provide meaningful supervision and oversight—and not in name only. Doctors serving as a Medical Director of a MedSpa without regular review and supervision of the staff and treatments provided are “putting their medical licenses at great risk,” and may be charged with illegally operating a medical practice.4
To avoid improper delegation, treatments should be properly classified, with protocols for each treatment clearly defined. Each treatment should specify which roles may perform the treatment and what qualifications are required. Each role in a MedSpa should define and outline the appropriate scope of practice, and the Medical Director should validate that every staff person and provider in the practice understands their roles.6 It would be wise to invest in comprehensive and continuous training for your staff and providers, with a system for documenting their completion and your supervision of their work.
■ Inadequate Informed Consent and Documentation
As MedSpas are subject to the regulations of a physician office, it is imperative that proper informed consent is obtained. Although procedures typically performed in a MedSpa are not considered “invasive,” risk is involved, with potential to harm the patient. Failing to take informed consent seriously can leave doctors vulnerable to liability.
Complaints surrounding Dr. R included patients alleging they were not thoroughly informed of the risks and potential complications of their procedures, and that they were unaware that a non-physician would be performing their treatment. To avoid these risks, consistent and thorough informed consent procedures must be applied across the board, regardless of how “minor” or “non-invasive” the treatment may seem. This includes clear communication with patients about the details of the procedure, risks and benefits, alternative treatments, and the qualifications of the provider who will be performing the treatment. Documentation of these discussions and the patient’s reported understanding are essential.6
Consider protocols for taking photos of patients before and after their procedure, including progress photos with ongoing treatments. These photographs should complement your written documentation.
■ Advertising and Representation
Dr. R’s success was in part due to marketing, which highlighted that the practice attracted patients from across the globe and implied Dr. R was a specialist in areas outside of their formal training. Advertisements featured only Dr. R and never referenced the practice’s team or other providers, misleading some patients to believe that Dr. R would personally perform all treatments.
Whenever publicizing a MedSpa practice, be mindful of the relevant California Business and Professions Code requirements. Some common issues are related to misleading or unsubstantiated claims regarding you or the treatments you offer. Any medical information shared should be supported by scientific evidence, and relevant material facts to procedures advertised should be disclosed. When using patient images, ensure you have their explicit written consent, and do not alter the images to enhance the advertised results. The photos must be “accompanied by easily readable text explaining what procedures were performed and disclaiming that ‘results may not occur for all patients.’”7
Opening a MedSpa in California may appear to be an exciting and lucrative venture, where you may use your skills to enhance your patients’ lives without the stress that often accompanies working in a hospital or running a private primary care office. Yet MedSpas are subject to the same strict regulations and risks—with an arguably more challenging patient population with unrealistic expectations. To achieve their desired results of establishing and maintaining a successful MedSpa, physicians must establish ethical business practices at the outset, ensure legal compliance, and prioritize patient safety.
Yvette Ervin, JD, is a Senior Risk & Patient Safety Specialist. Questions or comments related to this article should be directed to YErvin@CAPphysicians.com.
¹AmbWealth, “Medspa Market Overview,” (Feb. 2024), ambwealth.com, https://ambwealth.com/medspa-industry-primer/#:~:text=The%20MedSpa%20Ma…; (April 29, 2025)
²Burr & Forman, “Getting into the Medical Spa Game: A Primer on Legal Considerations,” (Feb. 21, 2024), burr.com, https://www.burr.com/newsroom/articles/getting-into-the-medical-spa-game (April 29, 2025)
³Moxie, “How to Open a MedSpa in California: A Complete Guide,” (Jul. 17, 2024), joinmoxie.com, https://www.joinmoxie.com/post/how-to-open-a-med-spa-in-california (April 29, 2025)
4Renee E. Coover, JD, “Want to be a Medical Director at a Medical Spa? Beware,” (March/April 2014), modernaesthetics.com, https://modernaesthetics.com/articles/2014-mar-apr/want-to-be-a-medical… (April 29, 2025)
5Medical Board of California, “Cosmetic Treatments,” Frequently Asked Questions, https://www.mbc.ca.gov/FAQs/?cat=Licensees&topic=Cosmetic%20Treatments (April 29, 2025)
6David Holt, “The California Med Spa Owner’s Guide to Staying Compliant: Avoiding Costly Mistakes,” djholtlaw.com, https://djholtlaw.com/the-california-med-spa-owners-guide-to-staying-co… (April 29, 2025)
7Cal. Business and Professions Code § 651 (2018)