Medical Esthetician Expert Witness No. 2165
FACE IT IN FLORIDA: Pretty Amazing Facts about Cosmetic Procedures
Story Highlights:
 Florida has strict regulations regarding medical cosmetic procedures
 Certain procedures require different levels of physician supervision
 Unlicensed practitioners are subject to criminal penalties
Who can do what with cosmetic procedures in Florida? Are the providers qualified? Where are the
services being rendered?
Any doctor can do cosmetic services in his/her primary care practice; no specialized background in
dermatology or plastic surgery is required. Under Florida law, in a med spa — or an aesthetic
center that isn't the doctor's primary office — the Nurse Practitioner (ARNP or NP) or Physician
Assistant (PA) must be supervised by a board certified dermatologist or plastic surgeon, though they
don't have to be present. This is not descriptive for non-med spa or aesthetic centers or
independent practitioners. Laws differ from state to state, but in Florida, anyone with a medical
license can practice in any medical field. PA’s and ARNP’s can order and perform injections.
Who is administering Botox®? Botox® can only be prescribed by a doctor, PA or ARNP in the
STATE OF FLORIDA. It may not be administered by a Registered Nurse or Medical Assistant. In
Florida, injection of Botox and/or fillers is deemed the practice of Medicine and an RN is not allowed
to perform these procedures even when a Physician is present. NP's and PA's are allowed to
perform these procedures under protocols written and reviewed by the supervising Physician, as per
Florida Law. It is very disturbing when someone identifies themselves as a “nurse” because all
nurses are not educated equally. Unfortunately, until there is a bad outcome, those illegally or
unethically providing services may not be reported.
As stated by the Florida Board of Medicine, lasers, laser for hair removal, Botox® injections, collagen
injections, and any other noninvasive injections of materials used as procedures to treat patients
must be performed by a Physician, a PA under supervision, or an ARNP working under a protocol
signed by a Physician (Absolutely not RN’s, MA’s, Tech’s, estheticians, cosmetologists, etc.). Laser
Skin Resurfacing is ablative laser therapy and can be done by a doctor, ARNP or PA. Non-ablative
fractionated laser treatments use radiofrequency waves that results in fewer side effects and faster
recovery but results that do not last as long. These can be performed by any trained person.
FLA. STAT. ANN. § 459.025(2). A PA may, at the supervisory physician's discretion, utilize light-based
or laser hair removal equipment under "indirect supervision." The provisions of Section 458.348(3)
or 459.025(2), Florida Statutes, do not apply to services rendered by a physician assistant who has
not been properly trained and qualified to utilize laser and light-based hair removal equipment and
delegated the task of providing such service as long as the delegated task is within the scope of the
supervising physician's practice.
FLA. STAT. ANN. §.458.348(3), PROTOCOLS REQUIRING DIRECT SUPERVISION
All protocols relating to electrolysis or electrology using laser or light-based hair removal or
reduction by persons other than osteopathic physicians licensed under this chapter or chapter 458
shall require the person performing such service to be appropriately trained and to work only under
the direct supervision and responsibility of an osteopathic physician licensed under this chapter or
chapter 458. Physician must be on site.
FLA.STAT. Chapter 477 Rule 61G5 of the Florida Administrative Code& Rules and Laws govern the
cosmetology profession can be found at The Florida Department of Professional Regulations.
Education/Training for the Facial Specialist in the State of Florida consists of obtaining a GED or
high school graduate diploma, and successful completion of a program of at least 260 hours offered
by a Florida school of cosmetology for a facial specialist. Licensure is issued by the Board of
Cosmetology. Facial Specialists do facials including massage of the head, face, scalp, and neck but
can also do “facials” on other areas and apply products in a “massage like fashion” otherwise; a
person must also be licensed under the Board of Massage Therapy. Medical Estheticians work in
doctor's office, hospitals or medical spas and should be specialty trained in the operation of potent
acids, lasers and other equipment. Treatments are more invasive and require more knowledge than
a spa facial or basic peel. Patients are advised more therapeutically how to care for their skin for
prevention, maintenance and promotion of proper healing.
It is a second degree misdemeanor in Florida if you attempt to practice the trade without a license,
or to practice on a suspended or revoked permit. Whether retained for a medical malpractice or
personal injury case, knowing the standards and regulations for cosmetic medical practice can lead
to successful litigation.
About the Author:
Expert Witness No. 2165 is Pediatric Nurse Practitioner and Licensed Medical Esthetician. She holds
numerous certifications in skin care therapies in addition to her extensive experience in pediatrics.
She is also a Certified Cardiac Life Support Instructor and Asthma Educator.
Tags: dermatology, plastic surgery, medical esthetics, Botox, laser hair removal, facial specialist,
collagen injections
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Knowing the standards and regulations for cosmetic medical practice can lead to successful
litigation.