In Texas (per Texas Medical Board Rule §193.17), a patient who is seeking a non-surgical medical cosmetic procedure, including the injection of medicines (such as Botox or dermal fillers) or the use of an FDA approved device (such as Fraxel, photofacial, or CoolSculpting) must first be evaluated in person by a physician or other provider with prescriptive authority (i.e., Certified Physician Assistant or Nurse Practitioner) before being treated by a registered nurse, aesthetician or other service provider.  Regardless of who the physician delegates to perform the procedure, the physician is ultimately responsible for the safety of the patient and all aspects of the procedures offered.  [Note that laser hair removal treatments are specifically excluded from this rule.]

In Texas, it is not permitted for patients to be treated with Botox, fillers, or any medical device (excluding laser hair removal) without first meeting with a physician, Certified Physician Assistant, or Nurse Practitioner.  Patients are encouraged to report any med-spas performing these treatments without proper supervision to the Texas Medical Board.