The medical aesthetics industry is experiencing extraordinary growth, with U.S. health and wellness spa revenues reaching $23.2 billion in 2022 and projected revenues to reach $25.3 billion by 2028. The sector has become a magnet for private equity and institutional investors with multi-location Medi-Spas and aesthetic practices now frequent acquisition targets for private equity. However, beneath this financial momentum lies a web of complex regulatory risks that can derail even the most promising ventures.
At the 2025 Healthcare Leaders Association (“HLA”) New Jersey Annual Conference, Frier Levitt Partners Brandon Zarsky, Esq. and Guillermo Beades, Esq. had the privilege of presenting “MedSpa Missteps: Avoiding Legal and Compliance Pitfalls,” where they addressed the fast-evolving enforcement environment facing aesthetic practices. From federal investigations to aggressive state-level oversight, the message is clear: compliance cannot be an afterthought.
Increased Scrutiny Targeting MedSpas
Recent FDA warning letters have targeted unapproved injectables and supplements commonly used in medical spas, while the New Jersey Attorney General has taken disciplinary action against non-clinicians, such as cosmetologists, performing medical procedures without proper authority. The New Jersey Division of Consumer Affairs and the Board of Medical Examiners (“BME”) have issued multiple alerts regarding unauthorized practices occurring in medical spas, and have stepped up enforcement through inspections, subpoenas, and disciplinary proceedings.
This trend is not isolated to New Jersey as MedSpas across the country are experiencing increased scrutiny from state regulators that are concerned over how aesthetic practices are structured and operated. Many are taking a hard look at scope-of-practice violations, improper corporate ownership, insufficient physician supervision, and telehealth use. There is a common misconception among many MedSpa owners and employees that there is little regulation in the space, however, that is far from true. Not only are there rules and guidelines governing delegation of duties and scope of practice, but there are also specific rules governing how providers can market services, including the use of patient testimonials and “before and after” images. Pharmacy boards are also active, focusing on compounding violations, IV hydration clinics, and the handling of controlled substances.
Weight loss injectables such as semaglutide and tirzepatide are also under the microscope. Now that these medications are no longer on the FDA shortage list, providers must meet full compliance with compounding restrictions and marketing laws. Lawsuits from manufacturers, cease and desist letters, and State Licensing Board warnings have already impacted many practices.
Compliance Pitfalls and Legal Risks
Violations can have serious consequences. Common missteps include improper delegation of procedures like Botox or laser treatments, misleading advertising about outcomes, and failure to document informed consent. Investigations often begin with a patient complaint, a whistleblower, or a referral from another agency, and frequently result in license suspensions, fines, or even practice shutdowns.
To mitigate these risks, it is critical that practices are properly structured with licensed physicians maintaining control over all medical components. Supervision protocols must align with state law and internal compliance audits should be routine. Legal opinions from vendors or consultants must be verified by independent healthcare counsel as well. Simply put, compliance does not scale by default, and relying on informal assurances is a recipe for regulatory trouble.
How Frier Levitt Can Help
At Frier Levitt, we counsel clients across the medical aesthetics landscape, from solo practitioners to multi-state operators and private equity firms. Our goal is to help practices grow with a foundation that is legally sound, fully compliant, and insulated from preventable enforcement actions.
To learn more about compliance and structuring solutions for aesthetic practices, visit www.frierlevitt.com or contact us directly.
