Filling the Gaps and Navigating Fine Lines: Regulatory Compliance Framework and Considerations for California Medical Spas

Known for its aesthetics and wellness culture, California continues to be a leading destination for new wellness and medical aesthetics practices (collectively, medical spas). Yet, unlike other states previously discussed in this series, California does not currently have any laws or regulations specifically intended to govern medical spas. Depending upon the level of clinical care provided, medical spas in California may be subject to less-restrictive cosmetology laws and regulations, or the stricter laws and enforcement mechanisms applicable to traditional medical practices, including a robust set of rules regulating ownership, supervision, scope of practice, and advertising. 

Understanding whether a medical spa is subject to medical practice laws is a critical analysis that owners and operators in California should determine prior to providing any services in the state. This post explores the fine line between medical spas subject to purely cosmetology requirements versus medical practice laws, highlighting the legal risks and compliance obligations faced by medical spas operating under the purview of traditional medical provider laws and regulations.

Drawing the Line Between Cosmetology and Practice of Medicine

California does not have a single consolidated law regulating medical spas. Instead, medical spa owners and operators must consult relevant guidance and scope-of-practice laws to determine whether they are subject to the state’s less-rigorous esthetician rules and regulations, governed by the California Board of Barbering and Cosmetology (CBBC), or California’s stricter requirements governing traditional medical practices. Unsurprisingly, we find that most traditional medical spas operating in California are likely to be regulated as medical practices rather than esthetician salons. 

Estheticians, who are licensed by the CBBC, may provide a wide range of non-invasive, purely aesthetic “beautifying” services that include giving facials, tinting and perming eyelashes and brows, tweezing, and waxing. But certain aesthetic procedures, including, among others, body contouring, cryotherapy, any form of injections, intense pulsed light, and all types of laser treatments, have been determined by the CBBC to be outside the scope of an esthetician’s practice and are instead considered medical procedures subject to applicable medical practice rules and regulations. 

The CBBC’s excluded practices—which read like a standard service list for most wellness and medical aesthetics spas operating in the state—indicate that most medical spas operating in California should expect to be governed by the rules and regulations generally applicable to physician practices, ambulatory surgery centers, and the like. California statutes further deem an entity a medical practice if the practice provides “outpatient elective cosmetic medical procedures or treatments” to patients, including offering prescriptive medical devices, prescription drugs, or any other “medical procedures or treatments that are performed to alter or reshape normal structures of the body solely in order to improve appearance.” 

California Medical Practice Laws and Regulations

For medical spas that are deemed to be medical practices, operators should ensure compliance with a patchwork of applicable California laws and regulations, of which we highlight certain critical requirements below. 

Corporate Practice of Medicine (CPOM)

Driven by growing interest from non-medical investors, the medical spa market in California has experienced rapid and dynamic expansion. California’s CPOM doctrine prohibits non‑physician persons or entities (such as corporations, private equity firms, or laypeople) from owning or controlling medical practices. As such, medical spas offering elective cosmetic medical procedures must be owned by licensed physicians (MDs or DOs) who retain majority control of the medical practice, either through sole ownership or via a professional medical corporation in which physicians hold at least 51% of the shares. 

However, as of 2023 and to be implemented in 2026, nurse practitioners (NPs) in California who qualify under the provisions of Assembly Bill 890 (AB-890) are permitted to own and operate medical spas as medical directors. Specifically, those classified as “104 NPs” who meet the criteria for independent practice, such as having six years of experience or holding a Doctor of Nursing Practice degree and having three years of experience as “103 NPs” are allowed to own and operate medical spas in the state without physician supervision. This marks a significant shift in CPOM doctrine, allowing qualifying NPs to bypass the traditional 51% physician ownership requirement.

Licensing Requirements

California law regulates the scope of practice for cosmetic procedures by specifying which licensed healthcare professionals are permitted to perform certain treatments within a medical setting. These laws can impact the structure and business model of medical spas, especially for spas offering a wide array of medical services and procedures from a team of different health professionals. Once a service is considered the practice of medicine, it must be provided by a physician, or a registered nurse or a physician assistant under the supervision of a physician.

Advertising Requirements

California also imposes several advertising and marketing compliance requirements. Medical spas must navigate a complex regulatory landscape to ensure that all promotional content is truthful, transparent, and compliant with both state and federal standards. In California, medical providers are required to include the supervising physician’s name, or fictitious name permit, in all promotional materials. Additionally, providers are prohibited from using misleading tactics such as vague “bait-and-switch” offers or “as low as” pricing schemes. 

Advertisements must accurately reflect the nature of the procedures, the qualifications of the personnel, and the availability of physician supervision. Failure to comply with these requirements may result in disciplinary action, fines, or other legal consequences from the state’s attorney general’s office, medical or nursing boards, or other regulatory authorities.

Conclusion

In California, state legislators have not yet caught up with the rapid expansion of medical spas in the state. Individuals seeking to establish a medical spa are left to determine, based on the patchwork of state laws, which requirements apply and where the risks lie. Before operating a medical spa in California, operators should carefully assess the services offered, the credentials of those delivering services, and the operating entity’s business structure to ensure compliance with state law. Taking the time to structure these businesses correctly and ensure proper clinical oversight will help mitigate legal risks and position your California medical spa practices for long-term success in this evolving landscape. 

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