Written by Korosh Borhani, D.O., board-certified emergency physician and Medical Director of Skin Bio. Clinically reviewed September 10, 2026. This article is educational and is not a substitute for a consultation.
I grew up around here. Calabasas High, the Valley, the 101 at rush hour, all of it. I still work shifts in emergency departments around Los Angeles, and the rest of my week I’m at Skin Bio, the practice my wife Cristina and I opened in Calabasas in 2018. I mention the ER because it shaped how we run the place. When you spend enough nights taking care of people on the worst day of their year, you stop thinking of any medical procedure as a small thing. Even the elective ones. Especially the elective ones.
So this is the checklist I’d give a neighbor who asked me where to go for Botox, filler, a laser, or an IV. Some of it is California law. Some of it is just what I’ve learned doing this work. None of it is complicated, and all of it is stuff I wish more people asked before they sat down in a chair.
The short version
“Med spa” doesn’t mean anything legally, which is exactly why the phrase gets thrown around so loosely. What does mean something is the practice of medicine. The Medical Board of California treats neurotoxin injections (Botox and its cousins), dermal fillers, laser and light treatments, and IV therapy as medical procedures. Once you know that, the rest of this falls into place.
Who can treat you: a physician, or a nurse practitioner, physician assistant, or registered nurse working under a supervising physician. Estheticians and cosmetologists are licensed for the surface of the skin. They can’t inject anything and they can’t run a medical laser, no matter how good they are at facials and no matter how many weekend “certifications” are framed on the wall.
Who has to evaluate you first: before your first treatment, a physician, NP, or PA has to do what the Board calls a good faith exam. That’s a real look at you and your history, not a signature on a tablet. It’s where someone who can actually prescribe decides that the treatment makes sense for you and writes the order. A registered nurse can carry out that order under standardized procedures, but the nurse can’t be the one who decides you’re a candidate.
Who can own the place: California doesn’t let non-physicians own a medical practice and hire a doctor as a name on the door. Nurses, NPs and other licensed professionals can hold a minority share of a professional medical corporation, but the practice has to be physician-owned and physician-run. The setup where a doctor’s name is on the wall and the doctor has never met a patient there has a nickname in this business. People call it renting a license. It’s behind most of the bad stories you’ve heard.
If you remember one thing from this article, make it this: when a practice gets vague about who holds which license, the vagueness is your answer.
You want a plain answer: a physician (MD or DO), an NP, a PA, or an RN. Then check it. The Department of Consumer Affairs runs a free license lookup at search.dca.ca.gov that covers doctors, nurses, and PAs in California. It takes about a minute. I’ve never once been bothered by a patient looking me up. I’d think less of you if you didn’t.
The right answer is a physician, NP, or PA, before your first treatment, in person or through a proper telehealth visit. The wrong answers are “the injector handles that,” “it’s part of the intake form,” or a blank look.
Not “on call.” Not “available by text.” Ask how often the physician is in the building, whether they see patients, and whether you can meet them. I’ll give you my own honest answer so you can hear what one sounds like: I’m not at Skin Bio every hour the doors are open, because I still work in the hospital. But I see patients in-person on my schedule weekly, I do the physician evaluations, I set the protocols, and Cristina and I make the clinical decisions together. A practice should be able to explain its doctor’s role in one plain sentence. If it takes a paragraph of hedging, keep walking.
This is the ER guy’s question, and it’s the one that tells me the most. Every injectable practice needs a written plan for the rare emergencies: filler that gets into a blood vessel, a real allergic reaction, a faint that turns into something more. Ask whether they keep hyaluronidase on hand, the enzyme that dissolves hyaluronic acid filler, and whether the staff has actually practiced using it. Ask what’s in their emergency kit. Ask when they last walked through the plan. How they answer matters as much as what they say.
You’re allowed to know the brand, that it came from a legitimate distributor, and that it hasn’t expired. A good practice is happy to show you. Counterfeit and gray-market neurotoxin has made it into the United States more than once, and a price that looks too good is sometimes the only warning you get.
Volume isn’t everything, but it isn’t nothing. Somebody who treats dozens of faces a week and has seen a hundred versions of your anatomy is a different proposition from somebody who does a few a month in between other services. Ask about the specific treatment you want, not the practice in general.
The clinicians I respect most in this field say no all the time. No, you don’t need more filler, that’s a skin problem. No, that laser is wrong for your skin type in August. No, let’s get labs before we talk about hormones. If a practice runs on sales quotas, you’ll feel it in how they answer this one.
Want the physician-led version of a consultation? Every new patient at Skin Bio is evaluated by a physician or nurse practitioner before treatment. That isn’t a slogan; it’s how a medical practice is supposed to work.
I’ve seen “medical grade” and “physician-led” used as decoration too many times, so let me be concrete about ours.
Skin Bio is owned by physicians and run by clinicians. I’m the Medical Director. I’m board certified in emergency medicine, I completed an advanced fellowship in regenerative medicine, and I still practice in Los Angeles-area emergency departments. Cristina Borhani, MSN, NP, my wife and co-founder, is a nurse practitioner who treats patients every day and runs this blog. Nobody without a medical license injects at our practice. Every new patient gets a good faith evaluation before treatment. Our treatment rooms are set up for the emergencies we hope never to see, because my other job taught me that “it never happens” is not a plan.
We also say no. Some of the best visits we have end with a patient going home with a skincare plan instead of a syringe. It costs us money that day. It’s also the reason people in this town send their friends and their mothers to us, and I’d take that trade every time.
I’m not going to put a price list in an article, because prices change and because “how much per unit” is the wrong question. The right question is “how many units, and why.” Neurotoxin should be priced and written down by the unit, filler by the syringe, and you should leave with a record of exactly what went into you. If a practice can’t tell you the unit count afterward, they either didn’t track it or would rather you didn’t know.
No. Estheticians aren’t licensed to inject or to use medical lasers. In California, neurotoxins and fillers can be given only by a physician, or by an NP, PA, or RN under physician supervision.
It’s the medical evaluation a physician, NP, or PA does before your first cosmetic treatment to confirm you’re a good candidate and to authorize the plan. It has to happen before a nurse can treat you.
Use the Department of Consumer Affairs license search at search.dca.ca.gov. It covers the Medical Board of California, the Board of Registered Nursing, and the Physician Assistant Board. Search the name and confirm the license is current with no discipline.
Not necessarily, and either one can be excellent. What matters is the structure: physician ownership, a licensed clinician doing the treatment, a medical evaluation before treatment, and an emergency plan. A dermatology office that hands injectables to unlicensed staff is a worse choice than a med spa that follows the rules.
Because the things I care about most in the ER, a careful assessment, straight talk, and being ready for the rare bad outcome, are exactly the things aesthetic medicine tends to skip. Cristina and I built Skin Bio on a simple idea: treat elective medicine with the same seriousness as urgent medicine, and treat our neighbors the way we’d want our own family treated.
Sources and further reading
This article provides general information about aesthetic medicine and California regulations as of its publication date. It is not legal advice or medical advice for any individual, and it does not create a physician-patient relationship. Regulations change; verify current rules with the Medical Board of California.
Consultations at Skin Bio are with a physician or nurse practitioner — not a salesperson. We’re in Calabasas and see patients from across the greater Los Angeles area.
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