Botox (botulinum toxin) is a popular injection for both cosmetic and medical procedures. Because Botox temporarily weakens or paralyzes muscles or blocks certain nerves, it can smooth facial wrinkles, help with chronic migraines, and fix severer underarm sweating, among other uses. Its usage is controversial, but when used by trained professionals, it can treat various health issues and make a difference in people’s lives.
Many laws vary from state to state regarding who can administer Botox injections and what are allowable injection sites. For example, Botox is an FDA-approved method of injection that serves different purposes. While it has been romanticized and idealized by the media as a cosmetic approach to fuller features, such as dimples and chin, Botox injections can also medically help some patients with their quality of life.
Laws regarding Botox on a federal level limit who can administer them so that only medical professionals can conduct this procedure. This means that licensed aestheticians usually cannot perform Botox injections, even if the purpose is purely cosmetic.
At a state level, Botox is usually regulated for such issues as dermal fillers. Each state has a different approach from its dental board regarding injecting dental botox. Arkansas, Alabama, and Maryland have the most guidance on the laws regarding Botox injections.
A prescription is required to obtain Botox and fillers because significant complications can occur with their injections. The performance of aesthetic procedures is within the scope of practice of a trained advanced practice registered nurse (APRN) or registered nurse (RN) as part of a medically prescribed plan of care for the treatment of various dermatological conditions or as a part of a health maintenance and health promotion regime.
The Alabama Board of Medical Examiners issued an opinion stating that procedures involving Botox, Restylane, Collagen, and Mesotherapy are be the practice of medicine and, as such, each procedure must be performed by a licensed physician.
Many cosmetic procedures, including Botox filler, are now recognized as a practice of medicine and can only be performed, in most cases, by a trained physician. That training must be approved by the American Medical Association. In addition, only licensed doctors and physicians can prescribe botulinum toxin.
State | Certifications Required | Notes |
|---|---|---|
| Alabama | Licensed Physicians | the Alabama Board of Medical Examiners issued an opinion stating that procedures involving Botox, Restylane, Collagen, and Mesotherapy are be the practice of medicine and, as such, each procedure must be performed by a licensed physician. |
| Alaska | Aesthetic nurses or nurse injectors | Aesthetic nurses, or nurse injectors, administer BOTOX and cosmetic filler injections to their patients, however, there must be oversight by a medical director for consultation or in the event of an emergency. |
| Arizona | Registered nurses may perform botox with the supervision of a doctor. | Registered Nurse may inject Botox as long as they have a medical director. As a Registered Nurse does not have authority to prescribe, they need a Nurse Practitioner or Doctor to prescribe the medication and oversee their treatment plan. Estheticians may not inject Botox. |
| Arkansas | Advanced Practiced Registered Nurse and Registered Nurses | A prescription is required to obtain Botox and fillers and significant complications can occur with their injections. The performance of aesthetic procedures is within the scope of practice of a trained advanced practice registered nurse (APRN) or registered nurse (RN) as part of a medically prescribed plan of care for treatment of various dermatological conditions or as a part of a health maintenance and health promotion regime. |
| California | Oral Surgeons | California-licensed general dentists are not permitted to offer Botox and dermal filler injections to patients for purely cosmetic purposes. Only oral surgeons who hold an elective facial cosmetic surgery permit can provide these products for stand-alone cosmetic services |
| Colorado | Mediacal Aestheticians and Registered nurses with the supervision of a Licensed Physician or Nurse Practitioner Medical Director | This varies by state but in Colorado, a Medical Aesthetician or RN can inject under the direct supervision of a Physician or Nurse Practitioner Medical Director. |
| Connecticut | Licensed health care provider within his/her scope of practice | By law, cosmetic procedures, including botox administration, must be performed (1) in a medical spa or licensed health care facility and (2) by a Connecticut-licensed health care provider within his or her scope of practice. |
| Delaware | Registered Nurses and Licensed Practical Nurses | It is within scope of practice for licensed nurses (RN and LPN) to perform cosmetic/aesthetic dermatological procedures as prescribed/ordered by a licensed physician, nurse practitioner, physician assistant, or other licensed health care practitioner with prescriptive authority acting within her/his legal scope of practice, provided all criteria required in this statement are met. |
| Florida | Unregulated | According to the Florida Board of Medicine there are no laws or rules that directly address who may or may not inject Botox |
| Georgia | General Dentists | The American Academy of Facial Esthetics (AAFE) Level I course is the first board approved courses in injectable pharmacologics that will allow general dentists to perform Botulinum Toxin and dermal filler procedures in Georgia |
| Hawaii | Licensed Physicians, physician assistants | According to the Hawaii Board of Medical Examiners, both physicians and physician assistants can perform laser hair removal, intense pulse light treatments, Botox injections, chemical peels, and filler injections. |
| Idaho | Licensed Physicians | Under Idaho law any doctor can do cosmetic services in his/her primary care practice; no specialized background in dermatology or plastic surgery is required. A PA can order and perform injections as long as it is in their practice agreement with a licensed physician. |
| Illinois | Registered Nurses | RNs may administer Botox in Illinois as long as certain regulatory requirements are met. Any use of botox must be provided in accordance with Board of Medicine and Board of Nursing requirements. Because these are considered medical treatments, they require an initial good-faith medical exam by either an MD or an APRN with full practice authority. |
| Indiana | Any Licensed Physician or Nurse Practitioner | Any physician or nurse practitioner (NP) can provide Botox and filler injection treatments, regardless of their medical specialty, expertise, and training. |
| Iowa | Licensed Physicians | In Iowa, medical aesthetic services are generally provided in medical spas, overseen by medical directors. In this setting, medical directors may delegate provision of these services to non-physicians, under certain circumstances as detailed below. |
| Kansas | Only medical practitioners who hold an MD, DO, DDS, DMD, NP, and nurses under the supervision of a Licensed Physicians | |
| Kentucky | Licensed estheticians with the supervision of a Licensed Physician | Licensed estheticians may only administer BOTOX under a physician's "immediate supervision." Therefore, it is nonsensical that a physician may allow an unlicensed person to administer BOTOX, with little or no supervision |
| Louisiana | Licensed practical nurses | Perform "head to toe" physical assessments. The administration of botox, for cosmetic purposes only, is within the scope of practice of licensed practical nurses in the state of Louisiana when certain conditions are met. |
| Maine | Licensed physicians, physician assistants, and nurses | Licensed physicians, physician assistants and nurses are able to administer Botox and fillers injections for facial rejuvenation. |
| Maryland | Trained Licensed Physicians | Many cosmetic procedures, including Botox filler, are now recognized as a practice of medicine and can only be performed, in most cases, by a trained physician. That training must be approved by the American Medical Association. In addition, only licensed doctors and physicians can prescribe botulinum toxin |
| Massachusetts | Licensed medical professionals, such as RN, PA, LPN, MD, and NP | |
| Michigan | Licensed Physicians | Currently, the administration of Botox and dermal filler must be either: (1) performed by a physician; or (2) delegated by a physician to someone under his or her supervision who is qualified by education, training, and experience to perform such injection service |
| Minnesota | Licensed Physicians | Botox is not an over-the-counter medication. It can only be ordered by a physician with a DEA license. |
| Mississippi | PAs, RNs, NPs, or electrologists with the supervision of a Licensed Physician | The state is also not restrictive in terms of the requirements needed to perform procedures. As long as they have been delegated or supervised by a licensed physician, any PA, RN, NP, or electrologist can provide the specific treatment. |
| Missouri | Medical practitioners who hold an MD, DO, DDS, DMD, NP, and nurses under the supervision of a physician | |
| Montana | Licensed Physicians | The state also doesn’t have any strict rules regarding the requirements to perform the treatments as long as the physician has the skill, extensive training, and experience to practice medical aesthetics. However, the law provides that any establishment that violates the corporate practice of medicine may be subject to penalties and possible imprisonment. |
| Nebraska | Licensed Physicians | According to their law, any doctor can perform Botox and soft tissue fillers without any specialized training. |
| Nevada | Licensed Physicians, PAs, properly trained dentists, RNs, ARNPs, and podiatric physicians | Under NRS 454 and 629.086, the state only allows Botox and filler injections to be done by licensed physicians, PAs, properly trained dentists, RNs, ARNPs, and podiatric physicians. |
| New Hampshire | PAs, RNs, and NPs | |
| New Jersey | Licensed Physicians | The state clearly provides that aestheticians aren’t allowed to perform these procedures and should only be administered by licensed physicians with special training from higher education. |
| New Mexico | Unregulated | |
| New York | All procedure performers must have a valid state license and higher education training | It’s a must that all individuals performing the procedures should have an active state license and have completed training from a higher education institution. |
| North Carolina | Licensed Physicians, PAs, NPs, and Nurses | Physicians, PAs, NPs, and Nurses are legally able to inject in North Carolina |
| North Dakota | Licensed Physicians | Cosmetic procedures like Botox, dermal fillers, and lasers should also only be done by a licensed physician. There are exemptions for injectables where a PA, NP, and RN can perform the treatment under physician supervision. |
| Ohio | PAs, RNs, and NPs | The law also states that injectables can be given by PAs, RNs, and NPs |
| Oklahoma | Licensed Physicians | A licensed physician is the only one allowed to perform the medical services. |
| Oregon | There’s no specialized background required for performing injectables | |
| Pennsylvania | All procedure performers must have a valid state license and higher education training | The state also requires that all individuals performing procedures should have training from a higher education institution and have an active license. |
| Rhode Island | RNs, PAs, LPNs, and Dentists. | RN's and Physician Assistants are legally allowed to administer Botox injections as well as LPN's and Dentists |
| South Carolina | Licensed Physicians | A licensed physician can perform procedures that are within the scope of their education and training. They can attend specialized training courses and have continuing education to demonstrate competency in the treatment. They can also supervise no more than 3 non-physicians in the practice. |
| South Dakota | PA, NP, and RN with Licensed Physician's supervision | |
| Tennessee | Qualified medical professional in sanitary conditions | Tennessee law does not specifically address Botox parties so the law does not prohibit Botox parties or injections in the home. However, the injections must be performed by a qualified medical professional or allied health professional in sanitary conditions |
| Texas | Licensed medical professionals | Texas Botox Certification Requirements state that, you must be a licensed medical professional to inject |
| Utah | Licensed Physicians | The Utah state law clearly defines medical treatments as any procedure involving Botox, light and heat devices, collagen injections, and dermal fillers. Any doctor can provide cosmetic injectables without advanced training required. |
| Vermont | Licensed medical professionals | Anyone can form and own a medical spa practice in Vermont, however, not any practitioner can perform certain cosmetic treatments. A special license is required for some procedures |
| Virginia | Licensed Physicians and practitioners | Any doctor or practitioner can perform cosmetic injectables, however RNs and medical assistants can’t provide such procedures even with a supervising physician. Additionally, under the Virginia HB 2119, only licensed physicians, PAs, or properly trained PAs with supervision can perform laser treatments. |
| Washington | Licensed Physicians | A physician must be fully and appropriately trained in a nonsurgical medical cosmetic procedure prior to performing the procedure or delegating the procedure. |
| West Virginia | Licensed Physicians | The right to perform procedures is given to any licensed doctor with an appropriate background in aesthetic medicine but the law doesn’t require any advanced training. |
| Wisconsin | Any Licensed Physicians and nurse practitioners | Common procedures such as Botox and cosmetic fillers can be performed by any doctor or PAs and NPs. |
| Wyoming | Any Licensed Physicians and nurse practitioners | The state doesn’t restrict the corporate practice of medicine so doctors can be employed to provide medical care and cosmetic services in non-physician owned businesses. Most procedures can be performed by any licensed physician and practitioner without needing specialized background or training. |