Medical Spas Frequently Asked Questions

1. In Texas, can the practice of medicine occur at cosmetology salons?

No cosmetology statute limits a salon to exclusively providing cosmetology services and products. In fact, traditionally, salons have offered many non-cosmetology services, such as tanning and body massage. A growing trend is the “medispa” business. At these facilities, both medical and cosmetology services are offered. The cosmetology statute and rules do not prohibit this practice; however, appropriate licenses must be obtained.

2. Does the Department of Licensing and Regulation (TDLR) have jurisdiction over all services provided inside beauty salons?

No, TDLR does not have jurisdiction over all of the services provided inside cosmetology salons. A person is granted the authority to practice certain acts depending on the type of license the person holds. For example, tanning and permanent makeup are services regulated by the Texas Department of State Health Services, and medical acts are regulated by the Texas Medical Board. A person who offers regulated services or products or practices a regulated profession must comply with the regulations of the applicable regulatory jurisdiction.

3. If an esthetician is in business with a dermatologist, then is the business under TDLR’s jurisdiction or under the Texas Medical Board’s jurisdiction?

Both. The practice of cosmetology is within TDLR’s jurisdiction, and the practice of medicine is within the Texas Medical Board’s jurisdiction. An esthetician is only authorized to perform cosmetology services at a facility licensed by TDLR as a cosmetology salon or facial specialty salon. Therefore, if an esthetician performs acts under an esthetician license at a place of business, then the business must hold a TDLR cosmetology salon or specialty salon license. Please consult with the Texas Medical Board to learn about their jurisdiction in regulating the practice of medicine.

4. If a person with an esthetician license is working in a medical office, shouldn’t the medical office have a salon license?

Yes. Under Occupations Code, Section 1602.251(c), a cosmetologist is only authorized to perform cosmetology services at a facility licensed by TDLR as a cosmetology establishment. Therefore, if a person is performing acts under an esthetician license at a place of business, then that business must hold a TDLR cosmetology salon or specialty salon license.

5. Are there any square feet requirements for an esthetics or medical esthetics practice? What other requirements are there for this space, such as water, restrooms, sanitation, etc.?

Yes, an “esthetics,” “medical esthetics,” or other business by any title that employs or leases space to a licensed cosmetologist or cosmetology specialist must comply with the facility and equipment requirements under Texas Occupations Code, Chapters 1602 and 1603 and Title 16, Texas Administrative Code, Chapter 83. Requirements include, but are not limited to, square feet, water, restroom, and health and safety requirements. You may view these requirements at http://www.tdlr.texas.gov/cosmet/cosmet.htm. Additionally, please contact the Texas Medical Board or the Texas Board of Nurse Examiners to learn the applicable facility requirements for medical and nursing practices, if any.

6. Can an esthetician be either an employee of the medispa or an independent contractor?

Yes, a business may lease space to a cosmetologist as an independent contractor; however, only a business that holds a cosmetology salon or specialty salon license may lease space to a cosmetologist or specialist as an independent contractor. Also, a cosmetologist or specialist who leases space must hold both a cosmetology or specialty license and a booth rental license. Leased space must comply with applicable square feet and equipment requirements. You may view these requirements at http://www.tdlr.texas.gov/cosmet/cosmet.htm.

7. Can a doctor delegate cosmetology procedures in a salon to an esthetician?

No. Regardless of a facility’s name (salon, medical office, medispa, etc.), an esthetician may lawfully practice under the esthetician specialty license in an establishment that holds a cosmetology salon license, without delegation. In fact, a doctor cannot delegate cosmetology procedures. A doctor may delegate only medical procedures in accordance with the laws and rules relating to the medical license. Also, under Occupations Code, Section 1602.403, a salon must, at all times, be under the direct supervision of a cosmetologist.

8. If a cleansing or exfoliation procedure is part of a medical procedure and is within the scope of practice of a dermatologist, can the dermatologist delegate the ability to perform this medical act to another person?

The department does not define or regulate medical procedures. Medical procedures may be delegated pursuant to the laws and rules regulating physicians. Physicians should consult with the Texas Medical Board about what constitutes a medical act and to whom medical acts may be delegated.

9. As an esthetician in a medical spa, may I perform laser hair removal, laser resurfacing, or laser teeth whitening through delegation or supervision by a physician, nurse, or dentist?

No. An esthetician specialty license does not authorize estheticians to use lasers, including lasers for hair removal, skin resurfacing, or teeth whitening. To the extent, if any, that a physician may delegate the use of lasers to a non-medical licensee, please contact the Texas Medical Board at 512-305-7030 or 1-800-248-4062 or at http://www.tmb.state.tx.us. To the extent, if any, that a dentist may delegate the use of lasers to a non-dental licensee, please contact the Texas State Board of Dental Examiners at 512-463-6400 or at http://www.tsbde.state.tx.us. To the extent, if any, that a nurse may delegate the use of lasers to a non-nurse licensee, please contact the Board of Nurse Examiners at 512-305-7400 or at http://www.bne.state.tx.us.

10. If I hold an esthetician license, may I perform additional procedures (procedures not authorized by my esthetician specialty license) because I work with or am supervised by a licensed medical doctor or nurse?

No, an esthetician specialty license does not authorize an esthetician to perform additional procedures or a more advanced or expanded scope of practice depending on the esthetician’s place of employment or title of employer.

11. Do I need an esthetician specialty license before performing facials, masks, general skin care, etc.?

Yes, unless statutorily exempted. A person must obtain a cosmetology license prior to performing a service regulated under the cosmetology statute, including facials, masks, general skin care, etc.; however, certain statutory exemptions apply. Please see Occupations Code, Section 1602.003 for a specific list of exemptions stated in the cosmetology statute.

12. Does TDLR prohibit estheticians from providing certain services?

An esthetician license only authorizes a specific scope of practice, as stated in the cosmetology law and rules. Specifically, under Occupations Code, Sections 1602.002 (a) (6), (7), (8), (9), and (12), a person who holds an esthetician specialty license is authorized to cleanse, stimulate, or massage a person's scalp, face, neck, or arms by hand or by using a device, apparatus, or appliance, and with or without the use of any cosmetic preparation, antiseptic, tonic, lotion, powder, oil, clay, cream, or appliance. An esthetician can also beautify a person's face, neck, or arms using a cosmetic preparation, antiseptic, tonic, lotion, powder, oil, clay, cream, or appliance, administer facial treatments, remove superfluous hair from a person's body using depilatories, preparations, or tweezing techniques. Additionally, an esthetician may apply semi-permanent, thread-like extensions composed of single fibers to a person's eyelashes.

13. Does TDLR prohibit a cosmetologist’s possession of certain equipment, such as lasers?

There is no list of equipment that estheticians are prohibited from possessing because such list could not address every type of equipment that an esthetician is not authorized to use in his or her practice, for instance, haircutting implements, manicuring implements, medical equipment, etc. Further, equipment is continually developed, modified, and repackaged and/or referred to by many product/device names. Instead, a cosmetologist’s scope of practice is determined by the applicable laws and rules. For example, if an esthetician possesses equipment that is outside the scope of an esthetician’s practice, such as a laser hair removal device, then possession of such equipment may be used as evidence to prove an unauthorized practice/unlicensed activity. Unauthorized practices/unlicensed activity will be referred to the appropriate administrative regulatory agency and/or criminal law enforcement agency.

14. What procedures may I perform independently under my esthetician license?

Under Texas Occupations Code, Sections 1602.257, and 1602.002(a) (6), (7), (8), (9), and (12), a person who holds an esthetician specialty license is authorized to cleanse, stimulate, or massage a person's scalp, face, neck, or arms by hand or by using a device, apparatus, or appliance, and with or without the use of any cosmetic preparation, antiseptic, tonic, lotion, powder, oil, clay, cream, or appliance. An esthetician can also beautify a person's face, neck, or arms using a cosmetic preparation, antiseptic, tonic, lotion, powder, oil, clay, cream, or appliance, administer facial treatments, remove superfluous hair from a person's body using depilatories, preparations, or tweezing techniques. Additionally, an esthetician may apply semi-permanent, thread-like extensions composed of single fibers to a person's eyelashes.

15. Does my esthetician specialty license authorize me to perform laser hair removal?

No, an esthetician specialty license does not authorize the use of lasers. Under Occupations Code Section 1602.002(a) (9), an esthetician may remove superfluous hair from a person's body using depilatories, preparations, or tweezing techniques. Laser hair removal is not a temporary hair removal method, and cannot be performed by estheticians.

16. Does my esthetician specialty license authorize me to perform laser skin resurfacing?

No, an esthetician specialty license does not authorize an esthetician to use lasers. Laser skin resurfacing methods affect areas of live tissue below the epidermis. estheticians may remove dead skin cells, but may not affect or treat live tissue. You may learn more information from the Texas Medical Board at 512-305-7030 or 1-800-248-4062 or at http://www.tmb.state.tx.us.

17. Does my esthetician specialty license authorize me to perform laser teeth whitening?

No, an esthetician specialty license does not authorize an esthetician to use lasers. You may learn more information about laser teeth whitening from the Texas State Board of Dental Examiners at 512-463-6400 or at http://www.tsbde.state.tx.us.

18. May I perform microdermabrasion under my esthetician license?

It depends. estheticians may remove the excess accumulations of dead skin cells from a person’s skin by exfoliation. One method of exfoliation is microdermabrasion, commonly performed with a specialized device. To the extent that the microdermabrasion device and technique removes only dead skin cells from a client’s skin, then an esthetician may exfoliate dead skin cells from a client’s skin through microdermabrasion. Deeper microdermabrasion treatments are physician-administered and penetrate the dermis (living tissue).

19. May I perform chemical peels under my esthetician license?

It depends. estheticians may remove the excess accumulations of dead skin cells from a person’s skin. The removal of excess accumulations of dead cells is called many different things, including peeling or exfoliation. estheticians may perform “light peels” or “superficial peels” which are noninvasive and/or nonagressive in nature and enhance or beautify the epidermis by removing dead cells, not the dermis (living tissue). “Medium peels” and “deep peels” are physician-administered and penetrate the dermis (living tissue).

20. As an RN, what esthetic procedures may I perform independently under that license, for example, facials, masks, general skin care, etc.?

Under Occupations Code, Section 1602.003, if a cosmetology service is within the scope of practice of a nurse’s license, then a nurse is not required to have a cosmetology license. Nurses should contact the Texas Board of Nurse Examiners to identify the lawful scope of practice for nurse licensees.

21. As an RN, do I need to take the full 750 hour esthetician course to obtain an esthetician specialty license?

Yes. To obtain an esthetician specialty license, 750 clock hours of facial curriculum are required and must be obtained by attending a licensed beauty culture school. Additionally, an applicant must pass a written and practical exam to obtain an esthetician specialty license. No person may receive credit or hours toward an esthetician specialty license based on another license held, such as an RN license, or course work completed anywhere other than a licensed beauty culture school.

22. What title do I use if I am a registered nurse and have an esthetician license? ie: Esthetic nurse specialist?

Please contact the Texas Board of Nurse Examiners to identify the appropriate titles for nurse licensees.

23. What title may I use if I have an esthetician specialty license issued by the Department of Licensing and Regulation?

For persons who successfully complete the license requirements to obtain an esthetician specialty license, the license issued by the department will state “Esthetician Specialty License,” consistent with the law that authorizes the creation of this license. The cosmetology law and rules do not specifically prohibit a facialist from using other names or titles; however, Occupations Code, Section 1603.401 prohibits knowingly making a false or deceptive statement in advertising.