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Who Can Legally Administer Botox in Illinois?

The rise of the medical spa industry has required Illinois lawmakers and other administrative entities to better clarify the scope of a professional aesthetician. This is because many licensed aestheticians, knowingly or not, have blurred the line between medical and non-medical procedures. Part of the confusion may stem from the fact that each state in the United States has different rules about what an aesthetician may and may not do. Another somewhat confusing aspect may be understanding which treatments require direct physician supervision, which varies depending on which kind of professional license is granted. Fortunately, the question of who can legally administer Botox in Illinois can be definitively answered with a close reading of state administrative law.

Day spas have been around since Elizabeth Arden opened her famous Red Door Spa in Manhattan in 1910. But the concept of healing baths and health resorts can be dated back to the ancient Romans, if not before. These types of spas focused on non-invasive treatments of the skin, face, and body, in line with the tenets of a holistic health and wellness approach.

Unlike day spas, which typically offer services including massage, non-invasive facial treatments, and hair removal, in Illinois, a medical spa is considered a medical practice. Although many of the treatments offered at medical spas are similar to those performed at a day spa or other holistic wellness facility, medical spas can also legally provide treatments that affect skin layers below the surface or that affect the body’s soft tissues. Treatments that affect anything below the surface layers of the skin must be performed either by a licensed physician or under a physician’s direct supervision.

What this means is that some services routinely offered at medical spas may be legally performed by a licensed aesthetician, and others may not. In Illinois, according to the Barber, Cosmetology, Esthetics, Hair Braiding, and Nail Technology Act of 1985, an aesthetician is defined as “any person who, with hands or mechanical or electrical apparatus or appliances, engages only in the use of cosmetic preparations, body treatments, body wraps, hydrotherapy, makeups, antiseptics, tonics, lotions, creams or other preparations or in the practice of massaging, cleansing, exfoliating the stratum corneum of the epidermis, stimulating, manipulating, beautifying, grooming, threading, or similar work on the face, neck, arms and hands or body in a superficial mode” (225 ILCS 410/3A-1).

The Act further clarifies aesthetics as services, not including those considered within the purview of a cosmetologist or electrologist, who perform specific procedures under a different license. Aestheticians are also prohibited by law from using all “techniques, products, and practices intended to affect the living layers of the skin” (225 ILCS 410/3A-1).

To ensure patient safety and reduce injury and accident lawsuits, Illinois is one of several states that prohibit licensed aestheticians from performing treatments classified as medical procedures. Among these treatments are Botox injections. Because Botox injections affect the soft tissue layers under the surface of the skin, they are considered a medical procedure. This clearly means that an aesthetician working in a day spa or similar facility may not legally administer Botox injections to his or her clients. But what about an aesthetician working alongside a physician in a medical spa? In the past, some aestheticians have assumed that working in such circumstances automatically qualifies them to give Botox injections. But this is not the case. Each year, the Illinois Department of Financial and Professional Regulation (IDFPR) uncover a number of medical spas in Illinois allowing untrained and unlicensed staff to perform Botox injections and other medical procedures. The problem with such practices is that consumers may be subjected to treatments that are improperly performed, inappropriate, or even unnecessary or dangerous.

Aestheticians who choose to cross the line into performing medical procedures like Botox injections without appropriate physician supervision risk fines, the loss of their license (either temporarily or permanently), and, should a client be injured as a result of their actions, a lawsuit. Yet the burden of making sure spa technicians are properly licensed and trained remains largely with the consumer. In 2010, Donald W. Seasock, Acting Director, Division of Professional Regulation, suggested that consumers must ask the right questions before booking any medical procedures at a spa. “If the treatment involves medical procedures,” he stated, “the client should ask Will qualified medical personnel examine the client prior to the treatment? Who will determine what treatment is appropriate? Who will provide the treatment?” Perhaps by encouraging this kind of consumer screening alongside the Division’s regular compliance examinations, those tempted to perform procedures outside the bounds of his or her professional license will be persuaded not to do so.

If you are at risk of having your license suspended or revoked (or have experienced this in another state), consulting with a lawyer specifically trained in dealing with IDFPR enforcement actions to avoid a future risk to your professional career as a nurse.

The information in this blog post is provided for informational purposes only and is not intended to be legal advice. You should not make a decision whether or not to contact an attorney based upon the information in this blog post. No attorney-client relationship is formed nor should any such relationship be implied. If you require legal advice, please consult with an attorney licensed to practice in your jurisdiction.

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