Many of us crave the appeal of eternal youth, clear skin and sharp jawlines — while also wanting quick results. As the beauty industry grows in scope, so does the popularity of cosmetic face injectables and med spas. In the last 14 years, aesthetic procedures have increased by nearly 40% across the globe.
Though the profit margins of this industry attest to the success of such aesthetic services, there’s also been a rise in botched, illegal and unethical procedures. People are put at risk for life-threatening diseases and oftentimes, disfiguration. For this reason, it’s crucial for anyone interested in aesthetic facial injectables to know exactly what services they’re getting done and who exactly should be re-sculpting their face.
We sat down with Dr. Kate Dee, owner of Seattle’s Glow Medispa and author of Medspa Mayhem to discuss the ins and outs of facial injectables and medical spas (med spas), businesses that blend the pampering of spas with medical aesthetic procedures. As a former breast cancer specialist with 10+ years of experience in medical aesthetics, Dee’s business is rooted in results-driven beauty enhancements, transparency and the integrity of each patient’s health.
So… What Exactly is a Med Spa?
If you’re looking to plump those lips with a side of cucumbers over your eyes, a med spa is the perfect place to be. These businesses offer a buffet of medical and non-medical aesthetic and wellness services. Non-medical services include things like facial peels, exfoliants, manicures, pedicures and massages. Things like laser hair removal, facial injectables and micro needling are typically considered medical aesthetic treatments.
Think of it this way: if the procedure is aimed at correcting skin conditions or changes the anatomy of your skin, it’s medical; if it doesn’t, it’s non-medical.
If you live in the Seattle, Washington area specifically, you’ll be spoiled for choice at Glow Medispa. Dee’s med spa business offers everything from light chemical face peels, laser resurfacing and treatments for melasma and rosacea. Though there is an abundance of cosmetic options to choose from, only certain healthcare professionals have full agency to offer and perform these services independently.
OK, So Who is Allowed To Do What?
The American Med Spa Association is a great resource for answering this question, but here’s a general rule of thumb on the legalities of running a med spa business:
- Doctors: These are the only healthcare professionals that are allowed to own and operate a med spa in all 50 states. They can also perform all medical and non-medical aesthetic procedures conducted in a med spa.
- Nurse Practitioners (NP) and Physician’s Assistants (PA): NPs and PAs can only own and operate med spas in certain states. In states where they cannot own their own med spa, they must perform medical aesthetic procedures under the guidance and employment of a doctor.
- Registered Nurses (RN): In some states, RNs can own up to 49% of a med spa business, though many still own them illegally. They too must perform medical aesthetic procedures under a doctor.
- Estheticians and Cosmetologists: Because these specializations are non-healthcare related, they cannot, under any circumstances, own or operate a med spa and perform medical aesthetic procedures. They can, however, offer and perform non-medical services like light chemical peels and exfoliants.
For a more in-depth guide at your specific state’s laws, take a look at this comprehensive article from the med spa Moxie.
How Do I Spot an Illegally Operated Medical Aesthetic Business?
If you’re looking to get facial injectables specifically, the business or med spa you’re interested in should be owned and run by a licensed doctor (unless your state allows NPs to do so too). Some people prefer to err on the side of caution and consult with doctor-owned businesses only.
Second, if an RN offers you facial injectables independently, run. This is not only illegal, but extremely risky for your health because most RNs do not have the adequate expertise and experience to run their own medical aesthetic business/spa.
“The typical thing that happens is that an RN is working in a dermatology clinic, or for a plastic surgeon or med spa,” Dee says. “They get trained on how to inject Botox and fillers and they get really good at it… they think, ‘I just want to go out on my own! I can do this,’ so they go out and do that in various forms, but that’s not legal.”
Third, ask yourself, “Who is conducting my ‘good faith’ exam?” What is a good faith exam, you ask? Great question.
“It means that when you go to a new place… someone who knows medicine is going to assess you and prescribe whatever it is you need or make a plan for you,” says Dee. “RNs can’t do that. Nurse practitioners can do it independently and PAs can if they’re working under a doctor, in some states.”
It may be tempting to let an RN administer facial injectables, especially if they’re easy to access and offer discounted prices. But, remember that RNs are not only illegally operating their business, but likely illegally obtaining their own facial injectables too.
“There are many doctors and nurse practitioners in states where nurse practitioners can have independent practices that are willing to lend their license to a nurse [RN] so they can buy their own Botox,” Dee says. “I’ve heard they’re paying doctors as low as $500 a month to borrow their license.”
These illegal medicine practices are considered felonies and could result in jail time from one to eight years.
My Med Spa/Medical Aesthetician Legally Operates Their Business. I’m All Set Then, Right?
You might think you’ve conducted all your research, but you’re not done yet. Say you’re sure your med spa is run by a licensed doctor or NP. Licensed professionals perform your procedures and good faith exam. Your med spa looks like a luxury dream with high-tech furniture and free mimosas. Everything looks legal on the outside until you get botched Botox injections that make your nose feel weird, turn red and after some time, break in half completely.
While this sounds absolutely far-fetched, it’s not. Aside from her new book, Dee hosts her own podcast, also called Medspa Mayhem. She often interviews victims of injectable scams; one guest, Krysta Carson, also known as “Disfigured Beauty,” lost half of her nose due to botched Botox injections.
In fall of 2023, The Daily Mail UK and New York Post released now-viral articles detailing Carson’s account of fillers that left half of her nose “melting” with necrosis. The injection, administered in 2020, happened to hit a blood vessel in her nose, blocking the flow and decaying the skin so badly she now wears a prosthetic over the other half of her nose.
“We have this concept called ‘informed consent,’” says Dee. “If you’re consenting to a procedure, the doctor has to have told you all about the procedure, what it’s supposed to do, what the possible risks are, what the alternatives are.”
Along with knowledge of potential health risks, people should know what liquids/gels are going into their face. Fake fillers and injectables are more common in the market than some people might think.
In April of this year, the Center for Disease Control (CDC) reported nearly 20 cases of hospitalizations or sicknesses due to fake injectables across the U.S. Such cases have been on the rise even before then, with one Californian man arrested for setting up a fake Botox business with counterfeit injectables and no medical license in February of this year. Back in 2021, another Californian, this time a woman, was caught trying to sell fake injectables to undercover officers.
Like Carson, Bea Amma, another one of Dee’s podcasts guests, suffered harmful reactions to botched injections. Amma, a fitness influencer who runs the YouTube channel “Beyond Skin Deep,” suffered from a debilitating mycobacterium all over her body after B12 shots went wrong.
Back in April of 2021, Amma was offered the shots, which boost energy and alleviate anemia, by a Californian med spa via Instagram. Instead of receiving actual B12 shots, she was injected with fake Kybella from Alibaba. Real Kybella is used to dissolve face fat and can pose similar functions to B12 shots. Fake Kybella, in this case, led to one of the most horrifying skin diseases ever.
“It [the fake Kybella] was contaminated with… a flesh-eating bacterium that could kill you,” says Dee. “She was injected with this stuff… over a hundred sites all over her body… she was in the hospital for over three months.”
What Steps Can I Take to Avoid Botched Injections?
Research, research, research. Based on what Dr. Dee discussed, here’s a roundup of the most pressing information you need before getting injections.
- Establish if your state allows NPs to own med spas
- Make sure your NP or doctor is licensed to practice medicine.
- Ask to see the vials/boxes of injectables. Make sure they aren’t fake.
- Ask your NP or doctor to explain all possible risks and side effects of injectables. Do your own research too.
- Avoid online offers for injectables whether it’s on social media or websites like Amazon and Alibaba.
- If the cost of the injectable service looks too good to be true, it probably is.
- When in doubt, Dr. Dee is always available for educational advice!
Even if you aren’t in the Seattle area, you can access Dee’s expert knowledge through her book, podcast and website. It’s one of the things she encourages people to do.
Part of her values as a medical aesthetician is to provide services like injectables with intention and mindfulness. She says genuine and ethical doctors won’t perform certain procedures if they don’t think you need it because profit does not come before clients.
“The number one thing for me is to help people and never harm them,” she says. “Our entire being and career is to help people be healthy, live better lives and cure diseases. That aligns with the entire essence of me.”
Hopefully you feel more comfortable and educated about pursuing injectables after this guide. A big thanks to Dr. Dee again for speaking with the N Crew too. Remember to stay informed and stay safe!
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