Office of Health Professionals Regulation

Policy Statement on Office Based Esthetic Procedures

The Department of Health, through its licensing boards of medicine, nursing and cosmetology, has issued the attached statement of policy on office-based esthetic procedures. The topic is timely and very relevant to licensees of these respective boards and therefore we think it appropriate that this policy be widely disseminated. It is also available for viewing at the websites for these member boards including the Board of Medical Licensure and Discipline.

In short, this policy statement defines office-based esthetic procedures including, laser hair removal and BoTox injections, as the practice of medicine. As such these procedures should only be done by physicians or advanced practice clinicians [e.g. nurse practitioners and physician assistants]; or under the supervision of physicians or advanced practice clinicians. It must be emphasized that medical equipment such as medical lasers and prescription pharmaceuticals should only be purchased by and used under the direction of a physician or advanced practice clinician.

This statement specifically requires that, prior to undergoing these procedures, patients have a formal medical assessment conducted by a physician or advanced practice clinician, and that formal medical records be maintained.

It should also be noted that in Rhode Island these esthetic procedures are not considered as part of the scope of practice of a licensed esthetician or cosmetologist.

Failure to meet this standard may constitute practicing medicine without a license and/or unprofessional conduct and will be dealt with accordingly. Penalties for practicing medicine without a medical license include up to three (3) years in prison and/or up to a $1,000 fine. For licensed physicians or advanced practice clinicians, failure to meet this standard may result in a formal Board sanction up to and including license revocation.

If you have any questions or concerns please address them to your member boards.

Policy statement on office based esthetic procedures:

It is the position of the Board of Medical Licensure and Discipline that office based cosmetic or esthetic procedures that require the use of medical lasers, high-frequency radio waves, or injection of sclerosing chemicals or biologically active compounds [e.g. Botulinum toxin A, BoTox] are medical procedures.

Therefore, prior to undergoing such procedures, patients must receive a medical evaluation for appropriateness by a licensed and qualified physician or other practitioner acting within his/her scope of practice. Although these procedures may be performed by an appropriately trained nonphysician working under the supervision and direction of a physician or other practitioner acting within his/her scope of practice, it is the supervising physician's [or other practitioner acting within his/her scope of practice] responsibility to assure that procedures are conducted appropriately; with appropriate assessment, consent and follow-up; and upon appropriate patients; that all patient records are maintained according to standards applicable for medical records; and that patient privacy is protected. The supervising physician or other practitioner acting within his/her scope of practice is responsible for any procedures carried out by nonphysicians under his/her direction.

Physicians [or other practitioner acting within his/her scope of practice] who perform and supervise such procedures must be able to demonstrate appropriate training and experience. Such training and experience may include, but is not limited to, residency or fellowship. The physician or other practitioner acting within his/her scope of practice is responsible to assure and document adequate training for individuals performing such procedures under his/her supervision.

Additionally, other cosmetic procedures such as dermabrasion or the application of potentially scarring chemical treatments [e.g. so-called chemical peels] should also meet this same standard.