Heads Up, Cosmetologists, Estheticians, and Medical Spa Service Providers: Are you conducting medical procedures without the required licenses?  

There has been an increasing number of new businesses in New York offering various cosmetology services, including Botox, fillers, and other cosmetic injectable services. These businesses are informally referred to within the cosmetics industry as “medical spas” or more formally referred to by the New York Department of State (“NYDOS”) as “appearance enhancement businesses.” Coincidentally, consumers have also filed numerous complaints regarding these businesses to various government agencies over the past few years. This led to government-initiated inspections of over 200 “appearance enhancement businesses” last year. In January 2026, the NYDOS’s Division of Licensing and Consumer Protection (“Division of Licensing”) issued a Warning to notify consumers about the investigation results and the potential harms related to these types of businesses. This Warning also has important implications for the healthcare industry and healthcare professionals, as summarized below.

NYDOS Consumer Warning

The NYDOS requires businesses offering esthetics and cosmetology services, such as facials and other skin-enhancing treatments, to obtain appearance enhancement licenses. The NYDOS’s Division of Licensing partnered with the New York City Office of Oversight and Investigations, the New York State Department of Education, and the New York State Department of Health to inspect over 200 of these appearance enhancement businesses.

The inspections revealed that, among other things, many businesses with appearance enhancement licenses are performing unlicensed or improper services that have resulted in serious injuries. The NYDOS, therefore, is warning consumers to be cautious about obtaining medical spa services from these types of businesses.

To illustrate, NYS provided a few case examples. In one example, a New York City Complainant alleged that a cosmetologist affiliated with “Princess Beauty, LLC” in Flushing, Queens (the “Respondent”) delivered “128-140” neck injections of unknown substances, that were purportedly Botox, stem cells, or collagen treatments that resulted in “redness, bleeding, swelling and substantial pain” (Complaint No.:2025-17028).

At the hearing, the Chief Investigator from the Division of Licensing testified that a cosmetologist is not permitted to administer any injections of Botox, stem cell, collagen, or other substances that other licensed professionals, like a nurse or physician, could administer. Ultimately, the administrative law judge determined that, among other things, the Respondent violated Section 160.27 of the General Business Law. That Section expressly prohibits appearance enhancement businesses or licensees such as cosmetologists from diagnosing or treating any “diseases of the hair, skin, and nails” since those activities constitute “the practice of medicine.” The Respondent’s cosmetology license was also revoked as a result of the determination.

The Queens County District Attorney also filed a criminal complaint alleging that the Respondent committed various criminal offenses, including the Unauthorized Practice of Medicine, which is a Class E Felony. The criminal charges are still pending.

Healthcare Industry Implications

New York State does not issue “medical spa” licenses, nor is there a single State agency that licenses providers of medical spa services. Many cosmetologists and appearance enhancement businesses providing spa services deliver both non-medical and medical procedures. When these individuals or businesses offer medical procedures, these procedures can only be provided by certain licensed healthcare professionals. For example, only a licensed physician or other authorized healthcare professional can provide injectable services for the “diagnosis or treatment of disease” unless such services are performed by an individual supervised by a physician or authorized healthcare professional. These licensed individuals typically provide services through professional entities (such as PLLCs or PCs) or business entities that have obtained a license issued by the New York State Department of Health (such as a clinic license).

The NYDOS notes that in general, the more invasive the spa procedure, the more likely it is to be considered a medical procedure required to be performed by licensed healthcare professionals. However, certain non-invasive procedures could also be medical procedures requiring a professional healthcare license.  

Common medical spa services considered non-medical procedures include:

• Facials
• Waxing
• Laser hair removal

Medical spa services considered medical procedures requiring a healthcare license include:

• Injections of any drugs (including Botox) or any fillers (including Restylane), whether by needle or pressure pain
• Liposuction (lipoplasty)
• Microneedling
• Laser procedures (except for laser hair removal)
• Vitamin infusions
• Plasma treatments

The NYDOS WARNING can be found here.

Contact Us. If you have any questions about medical spas, licensure standards, or related business formation issues, please contact Roopa Chakkappan (716.848.1258) or David Stark (716.848.1369). 

Disclaimer:

This client alert is a form of attorney advertising. Hodgson Russ LLP provides this information as a service to its clients and other readers for educational purposes only. Nothing in this client alert should be construed as, or relied upon, as legal advice or as creating a lawyer-client relationship.