Med spas can be safe when staffed by properly trained providers, stocked with FDA-approved products, and overseen by a licensed physician. But the industry’s rapid growth has outpaced regulation, and the gap between a well-run med spa and a dangerous one is wide. As of 2025, the FDA has issued 18 warning letters to websites illegally selling counterfeit or unapproved botulinum toxin products, and investigations have linked unsanitary med spa practices to serious bacterial infections. Whether a visit is safe depends almost entirely on the specific facility you choose.
Why Regulation Is Inconsistent
Med spas occupy an awkward middle ground between medicine and beauty. Traditional spas are regulated by state cosmetology boards, and medical clinics answer to state medical boards. Med spas fall under both, and in many states, neither board monitors them closely. Tennessee, for example, requires a medical director who is a licensed medical doctor or osteopathic physician with an active in-state practice. But requirements for who can actually perform procedures, whether the physician must be physically present, and how often the medical director reviews patient care vary dramatically from state to state.
This patchwork system means a med spa in one state might have a physician on-site during every treatment, while another operates with a doctor who signs off remotely and rarely visits. Some states require laser procedures to be performed under direct physician supervision. Others allow nurses or aestheticians to operate lasers with minimal oversight. The result is that “med spa” on a sign tells you very little about what’s happening inside.
The Biggest Risks by Procedure
Dermal Fillers
The most serious filler complication is vascular occlusion, where filler is accidentally injected into or compresses a blood vessel. When this happens, blood flow to surrounding tissue is cut off. Symptoms like purple skin discoloration, swelling, and pain typically develop over two to three days. In severe cases with complete blockage, symptoms can appear within hours and rapidly progress to tissue death, leaving blackened skin and permanent scarring. If filler blocks a vessel supplying the eye, blindness can result, and once it occurs, physical removal of the blockage is nearly impossible.
These complications are rare, but they require immediate treatment with an enzyme called hyaluronidase that dissolves hyaluronic acid fillers. A properly equipped med spa keeps this on hand along with antihistamines, corticosteroids, and antibiotics. If the facility where you’re getting filler doesn’t have an emergency kit ready, that’s a serious problem.
Laser Treatments
Laser devices can cause severe burns, scarring, and permanent skin damage when used incorrectly. The risk increases significantly when the operator lacks proper training. A study published in JAMA Dermatology found that lawsuits involving laser procedures performed by non-physician operators rose from 36 percent of cases in 2008 to 78 percent by 2011, reflecting a trend of underqualified staff performing these treatments as the industry expanded. Burns in sensitive areas like the upper lip and bikini line are particularly common when settings aren’t adjusted for skin type and treatment area.
Weight Loss Injections
Many med spas now offer compounded versions of popular GLP-1 weight loss drugs like semaglutide and tirzepatide. These compounded versions are not FDA-approved, meaning no federal agency has verified their safety, effectiveness, or quality before they reach your body. As of July 2025, the FDA has received 605 adverse event reports tied to compounded semaglutide and 545 tied to compounded tirzepatide.
Some of these problems stem from dosing errors, where patients or even healthcare professionals miscalculated the correct amount. Others involved doses beyond what the FDA-approved versions recommend, either larger single doses or faster dose increases. The FDA has also received complaints about compounded injectables arriving warm or without adequate refrigeration, which can degrade the drug’s quality. Some adverse events were serious enough to require hospitalization, with symptoms including severe nausea, vomiting, diarrhea, and abdominal pain.
Infections From Unsanitary Practices
An NBC News investigation found that a growing number of med spas are employing unlicensed workers to administer injections of unapproved products in unsanitary conditions. One patient, Bea Amma, developed sores at more than 100 injection sites within 24 hours of a 2021 visit. She tested positive for Mycobacterium abscessus, a stubborn bacterial infection that left her with permanent scarring even after treatment.
The FDA has also warned that some facilities are mixing injectable products without proper sterilization. Fat-dissolving injections are a particular concern. Products marketed as Aqualyx and Lipodissolve are not FDA-approved, and the only approved injectable fat reduction product is limited to treating the area under the chin. Patients receiving unapproved fat-dissolving shots at med spas have reported severe infections and skin deformities.
Counterfeit and Unapproved Products
In November 2025, the FDA issued warning letters to 18 websites illegally selling unapproved or misbranded botulinum toxin products. These products may be counterfeit, contaminated, or improperly stored during shipping. The agency has documented adverse events including botulism symptoms linked to these unapproved products. A med spa that sources its Botox, fillers, or other injectables from unauthorized suppliers puts every patient at risk, and you typically have no way of knowing where products came from unless you ask directly.
How to Evaluate a Med Spa Before Booking
The most important questions to ask are straightforward: Who will be performing your treatment, and what are their credentials? Is a licensed medical practitioner on-site during your visit in case something goes wrong? A facility that can’t or won’t answer these questions clearly is one to avoid.
Beyond those basics, look for these specifics:
- A named medical director. This should be a licensed physician (MD or DO) who actively practices in your state. Their name should be easy to find on the med spa’s website or posted in the facility. You can verify their license through your state medical board.
- FDA-approved products. Ask whether the Botox, fillers, or other injectables used are FDA-approved brand-name products, not compounded or imported alternatives. Staff should be able to show you the product vial or packaging.
- A proper consultation before treatment. A safe med spa evaluates your medical history, discusses risks specific to your situation, and explains what to expect. If someone is ready to inject you within minutes of walking in the door, that’s a red flag.
- Emergency preparedness. For injectable treatments, the facility should have hyaluronidase on hand to reverse filler complications, along with basic emergency medications. It’s reasonable to ask about this.
- Transparent pricing. Prices dramatically below market rate often signal unapproved products, diluted formulations, or underqualified staff. A vial of brand-name Botox costs the provider a set amount, and a price that seems too good to be true usually is.
What a Safe Visit Looks Like
At a well-run med spa, your first visit starts with a consultation, not a treatment. A provider reviews your medical history, asks about medications and allergies, and explains both the expected results and the realistic risks. The person performing your procedure should be able to tell you their specific training and credentials without hesitation. For injectables, you should see sealed, brand-name product packaging. For laser treatments, the operator should assess your skin type and explain the device settings being used.
During the procedure, the environment should look and feel clinical: clean treatment rooms, sterile instruments, gloves, and proper disposal of sharps. Afterward, you should receive clear written instructions for aftercare and a direct phone number to call if you experience unexpected symptoms. If a med spa feels more like a retail store running a promotion than a medical facility, trust that instinct.