Who can perform advanced esthetic/medical procedures?

It is no surprise to most that many medical offices are now offering esthetic cosmetic procedure and services in addition to traditional medical care.   On January 1, 2022, Senate Bill (SB) 291, which was passed during the 2021 Legislative Session, went into effect creating new definitions of ablative esthetic medical procedures, esthetic medical procedures and advanced esthetic procedures and who can now perform these procedures.   The new statutes have been codified in NRS Chapter 644A.  Practitioners who offer these procedures/services in their practice should be fully aware of the impact these new laws may have on their practices and their own professional licenses.

SB 291 created a new Advanced Esthetician License which is now being issued by the Nevada State Board of Cosmetology.  While some esthetic procedures also defined as advanced esthetic procedures may still be performed by licensed estheticians under the scope of their practice, only an advanced esthetician will be able to perform advanced esthetic procedures outside of the scope of a licensed esthetician and those considered esthetic medical procedures.  

In the past, some of the procedures newly defined as esthetic medical procedures, including nonablative esthetic medical procedures, were delegated to registered nurses, medical assistants and others by health care provider.  Under the current changes, these individuals will no longer be legally able to perform any procedure considered an advanced esthetic procedure or an esthetic medical procedure.  The Board of Cosmetology has been allowing individuals currently holding active esthetician or cosmetology licenses to become advanced estheticians through a form of “grandfathering” if the individual can show certain training or practical experience to avoid having to engage in complete retraining, however this option will only be available for a limited time.  More information on that process can be found on the Board’s website at nvcosmo.com.

Additionally, procedures that are considered nonablative esthetic medical procedures, may only be performed by an advanced esthetician under the supervision of a health care professional.  The new laws use the definition of health care professional found at NRS 453C.030 which includes only Nevada licensed physicians (both MDs and DOs), physician assistants and advanced practice registered nurses.  While the new laws do not require the health care professional to be on site at the time the nonablative esthetic medical procedure is performed, they must be readily available for consultation by phone or other immediate means, and must be within sixty miles or sixty minutes of the location where the procedure is being performed. 

Advanced estheticians are prohibited from performing any ablative esthetic medical procedure.   Based on the description of ablative esthetic medical procedures as “esthetic” arguably these will not be able to be delegated to any non-health care professional. 

Currently no regulations have been promulgated by the Board of Cosmetology regarding advanced estheticians and their scope of practice, but it is anticipated that regulations will be forthcoming.  The Nevada State Medical Board has recently initiated the process of promulgating regulations regarding the supervision of advanced estheticians by physicians and physician assistants.   

Health care providers should proceed cautiously if they intend to continue to offer esthetic services within their practice or if they are acting as a medical director for any type of medical spa.  Continuing to delegate or otherwise allow individuals who do not hold the appropriate credentials to perform any type of esthetic procedure can potentially subject them to disciplinary action by their own licensing board.

Newly defined procedures

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• Ablative esthetic medical procedures

An ablative esthetic medical procedure is newly defined at NRS 644A.150 as “an esthetic medical procedure that is expected to excise, vaporize, disintegrate or remove living tissue”.    A nonablative esthetic medical procedure is also newly defined at NRS 644A.127 simply as an esthetic medical procedure not expected to do any of the above.

 

• Esthetic medical procedures

An esthetic medical procedure is a “procedure performed using an esthetic medical device” for “care of the skin, beautification, anti-aging, permanent hair reduction, skin tightening, skin rejuvenation, noninvasive body contouring, noninvasive lipolysis or other similar esthetic purposes.”  This in essence encompasses a large number of esthetic procedures offered in medical offices and medi-spas (a topic outside the scope of this article).  An esthetic medical device is currently defined at NRS 644A.063 in part as a device used to perform an esthetic medical procedure and includes lasers, cryotherapy devices, intense pulse light devices, among others.  These devices are commonly used to perform widely available esthetic medical procedures such as laser hair removal, IPL facial treatments, and cryolipolysis (fat freezing) treatments to mention only a few. 

 

• Advanced esthetic procedures

The last category of procedures newly defined in statute at NRS 644A.012 is an advanced esthetic procedure which includes familiar treatments such as exfoliation, microdermabrasion, microneedling, dermaplaning, extraction, hydrotherapy as well as nonablative esthetic medical procedures.These procedures have now been provided legal definitions contained within NRS Chapter 644A.