An investigation released last month by the New York City Council into improperly licensed medical spas (med spas) in New York City revealed what the Council is calling “systemic and overlapping issues” ranging from improper medical procedures to safety and hygiene violations that pose risks to consumer health and safety and highlight the need for stronger oversight.

Med spa storefront clinics, according to the investigators, are blurring the line between the day spa and the dermatologist’s office, according to the Council.

According to data from Brenton Way, the med spa market is forecasted to reach $49.4 billion by 2030, growing at a CAGR of 15.13%.

Appearance Enhancement or Medical Service?

New York State law draws a distinction between what is an appearance enhancement service (waxing, manicures or facials) and a medical service, such as fillers or Botox injections. Esthetic, cosmetology and nail businesses require an Appearance Enhancement Business (AEB) license issued by the New York State Department of State. Medical procedures fall under a different framework, and by law can only be performed by licensed medical professionals, and only within medical practices organized under specific corporate rules.

The Council and stakeholders like the American Academy of Dermatology Association (AADA), a sister organization of the American Academy of Dermatology, are calling for New York State lawmakers to pass legislation requiring medical spas and other appearance-enhancement businesses, including cosmetology and nail establishments, to clearly disclose to consumers that they are not licensed to perform medical procedures.

According to AADA, medicine and surgery practiced in a med spa do not have clear regulations or oversight from federal or state agencies. AADA asserts that cosmetic medical procedures, including laser treatments, are safest when performed in a dermatologist’s office or under the direct, on-site supervision of a physician. While lasers used for hair removal are safe and effective when operated by properly trained medical professionals, improper use can result in painful burns, permanent scarring and long-term complications, according to AADA.

AADA contends consumers may be confused about the seriousness of the cosmetic procedures offered in a med spa and trust the personnel performing them has the appropriate medical and cosmetic training and state license.

In a statement, AADA noted: “While cosmetic treatments may appear simple, performing them safely requires an in-depth understanding of the structure and function of the skin. Board-certified dermatologists undergo rigorous medical education and specialized training in facial anatomy, including nerves and muscles. This advanced expertise allows them to minimize risks and effectively manage any complications that may arise.”

AADA and the New York State Society of Dermatology and Dermatologic Surgery support the New York City Council in calling on lawmakers to “enact legislation requiring medical spas to meet essential standards for patient safety and transparency.”

The med spa facilities, according to AADA, should be required to publicly post and educate consumers about the specific procedures they are legally prohibited from performing as non-physicians.

New York City Investigation Findings

Coordinated inspections of 15 med spas across all five New York City boroughs were conducted between June and September 2024. Investigators documented a wide range of violations at every location.

Specifically, every business was found to be offering medical procedures, such as injectables or IV treatments, without the required licensure and oversight.

According to the report, 93% failed to properly display licenses, 86% were missing required safety records, and 73% operated without any medical professional present to oversee medical procedures.

Sanitation and hygiene failures were observed in 53% of businesses. Issues ranged from overflowing sharps containers to dirty implements potentially being reused between clients. Labeling issues were documented in 46% of businesses, including medications housed in unmarked or handwritten bottles.

According to the report, 26% relied on unlicensed practitioners or practitioners whose licenses had expired.

Additionally, 63% had chemical or fire safety violations.

Following the inspections, disciplinary proceedings were commenced against all 15 businesses. Four cases have been adjudicated, resulting in license revocations through consent orders. In each case, businesses and individuals lost their legal authority to operate, according to the Council’s report.

The Council is recommending New York State lawmakers require AEBs to post clear notices informing consumers of the services they cannot legally provide. It is also calling for stronger oversight by regulatory agencies, such as institutionalized coordinated inspections to ensure compliance with licensing, sanitation, and medical standards. Lastly, the Council wants state agencies to launch a multilingual public education campaign helping consumers to recognize unlicensed facilities, understand the dangers and be aware of their rights.