Updated September 2026
Short answer: Who can inject Botox and dermal fillers depends on your state. Where a rule exists, most states let registered nurses inject on a prescriber's order after a physician, NP or PA has examined the patient. The exceptions matter: Alabama's medical board won't allow delegation, Rhode Island says RNs may not inject, Louisiana allows RN Botox but not fillers, and Maryland, Nebraska and Louisiana want the prescriber on the premises. For 20 of 51 jurisdictions, our research found no specific rule as of September 2026.
Who can inject Botox? Three questions every state answers
Botox Cosmetic, Dysport, Xeomin, Jeuveau, Daxxify and Letybo are FDA-licensed prescription biologics. Dermal fillers are Class III devices approved for specific areas. Because both are prescription products, states control who may inject them, and the rules come down to three questions:
- Who may inject. Physicians, PAs and NPs within their own scope; RNs, and sometimes LPNs, under delegation; in a few states, trained unlicensed staff.
- What exam comes first. Most states that address it require a physician, NP or PA to examine the patient before a nurse injects.
- What supervision applies. It ranges from "reachable" (Michigan) to "on the premises" (Louisiana, Maryland, Nebraska).
Can RNs inject Botox? The states that say no, or not fillers
Alabama: no delegation (December 2024)
Alabama's Board of Medical Examiners treats ordering and injecting neuromodulators and fillers as the practice of medicine. In a statement on a petition considered December 12, 2024, it declined to adopt rules letting physicians train and delegate cosmetic injections to RNs, PAs or CRNPs. It said PAs and CRNPs could gain the skill only through future Board-approved protocols. The Board of Nursing had argued RNs could inject on a prescriber's order; the Medical Board rejected that approach.
Rhode Island: RNs and LPNs may not inject (July 2024)
The Rhode Island Department of Health's July 2024 medical spa and IV guidance includes a scope-of-practice chart. For neuromodulators it lists physicians, PAs (in collaboration with a physician), family-practice and adult-gerontology CNPs, dentists, and pharmacists with a valid prescription; for dermal fillers it lists physicians only. RNs, LPNs and estheticians are listed as not permitted for either. A Rhode Island-licensed physician, PA or CNP must assess every patient first.
Louisiana: Botox yes, fillers no
The Louisiana State Board of Nursing's declaratory statement (adopted 2011 and still posted as current) lets a trained RN inject Botox or similar FDA-approved toxins on the order of a physician or collaborating NP, but places all dermal fillers outside RN scope. The physician or NP must take a history, examine and diagnose first, and must be physically on the premises during RN treatment.
Nevada: supervision depends on the facial zone
Nevada's Board of Nursing practice decision (approved January 17, 2025) puts neuromodulators and fillers within RN scope but not LPN scope. Each treatment needs an order from a practitioner who assessed the patient, plus documented training. For neuromodulators and most filler sites the provider must be available for direct supervision. For fillers in the under-eye, nasal, jawline and temporal zones, the grid requires immediate supervision: a provider physically present. Only the practitioner may control access to the drugs.
Maryland: the physician assesses and stays on site
Maryland's Board of Physicians rules count cosmetic injections as cosmetic medical procedures. Under COMAR 10.32.09.05, the physician must personally perform each patient's initial assessment, write a treatment plan and provide on-site supervision whenever a non-physician performs the procedure. Unlicensed staff are not eligible.
Other states with exam or supervision conditions
- Texas: a physician, PA or APRN establishes the patient relationship first and must be on site or immediately available (22 TAC §169.26).
- New York: RNs need a patient-specific order from a prescriber who examined the patient; cosmetic injections are not on the standing-order list.
- South Carolina: RN filler injections need a physician or APRN on site, able to respond within five minutes.
- Washington: the physician examines first and must be reachable within 30 minutes.
- Colorado: the most permissive rule we found. Physicians may delegate cosmetic injections to trained unlicensed staff under Medical Board Rule 1.17, with written agreements and protocols.
Botox delegation rules by state: all 51 jurisdictions
"Yes" means RNs may inject under ordinary delegation rules. "With conditions" means added exam, order or supervision requirements. "No" means RNs may not inject. Summaries are current as of September 2026; the full injectables map has each citation and source date.
| State | Can RNs inject? | Key conditions |
|---|---|---|
| Alabama | No | Medical board declined to allow delegation to RNs, PAs or CRNPs (Dec. 2024). |
| Alaska | Not confirmed — check with the board | — |
| Arizona | Not confirmed — check with the board | A nursing advisory opinion exists; its conditions were not confirmed. |
| Arkansas | Not confirmed — check with the board | — |
| California | With conditions | RNs and PAs under physician supervision after a physician, NP or PA exam; no medical assistants. |
| Colorado | Yes | RNs under the Nurse Practice Act; trained unlicensed staff under Medical Board Rule 1.17. |
| Connecticut | Not confirmed — check with the board | — |
| Delaware | Not confirmed — check with the board | — |
| District of Columbia | Not confirmed — check with the board | — |
| Florida | Yes | No injectables-specific rule; RNs administer as prescribed by a licensed practitioner. |
| Georgia | Not confirmed — check with the board | — |
| Hawaii | Not confirmed — check with the board | — |
| Idaho | Not confirmed — check with the board | — |
| Illinois | Yes | Physicians may delegate to RNs and LPNs, including by standing orders (2026 amendment). |
| Indiana | Not confirmed — check with the board | — |
| Iowa | Not confirmed — check with the board | — |
| Kansas | Not confirmed — check with the board | — |
| Kentucky | With conditions | After a qualified provider's documented assessment, under that provider's supervision. |
| Louisiana | With conditions | RNs: Botox yes, fillers no. Physician or NP examines first and is on the premises. |
| Maine | Not confirmed — check with the board | — |
| Maryland | With conditions | Physician personally assesses each patient, writes the plan and is on site. |
| Massachusetts | Not confirmed — check with the board | Nursing advisory rulings not reviewed; no delegation to unlicensed staff. |
| Michigan | Yes | Delegation to qualified individuals; supervisor reachable, not necessarily on site. |
| Minnesota | Not confirmed — check with the board | — |
| Mississippi | Not confirmed — check with the board | — |
| Missouri | Not confirmed — check with the board | — |
| Montana | Yes | Trained RNs and LPNs may inject as part of a medical treatment plan (2020 FAQ). |
| Nebraska | With conditions | Physician or NP assesses each episode and is physically present in the facility. |
| Nevada | With conditions | RNs only, on individual orders; under-eye, nasal, jawline and temple fillers need on-site supervision. |
| New Hampshire | Not confirmed — check with the board | — |
| New Jersey | Not confirmed — check with the board | RN rule not confirmed; medical assistants inject only with the physician on premises. |
| New Mexico | With conditions | RNs on orders; board expects national certification; no medical assistants. |
| New York | With conditions | Patient-specific order after the prescriber examines the patient; no standing orders. |
| North Carolina | With conditions | Order after a physician, NP or PA evaluation; no on-site prescriber for RNs (LPNs need one). |
| North Dakota | With conditions | Client-specific order after a prescriber history and physical (telehealth allowed). |
| Ohio | With conditions | Physician, PA or APRN evaluates and decides; RNs administer on that order. |
| Oklahoma | With conditions | Individualized order and prescriber history and physical; standing orders do not substitute. |
| Oregon | Yes | RNs carry out a prescriber's order if the Board's scope framework is met. |
| Pennsylvania | Yes | General delegation to trained practitioners such as RNs. |
| Rhode Island | No | RNs and LPNs may not inject Botox or fillers (RIDOH, July 2024). |
| South Carolina | With conditions | Fillers: physician or APRN on site (within five minutes) who assessed the patient first. |
| South Dakota | With conditions | Prescriber assesses each episode (telehealth allowed); LPNs neuromodulators only. |
| Tennessee | With conditions | Med spa registration under a Tennessee-licensed medical director; injector roles not listed. |
| Texas | With conditions | Physician, PA or APRN establishes the relationship; on site or immediately available. |
| Utah | With conditions | Prescriber evaluation and plan first; RN supervisor within 60 minutes or 60 miles. |
| Vermont | With conditions | Valid prescription after the prescriber's own evaluation; no medical-director standing orders. |
| Virginia | Yes | RNs and trained personnel inject on physician, APRN or PA orders. |
| Washington | With conditions | Physician examines first; reachable within 30 minutes (on site for non-FDA-approved products). |
| West Virginia | Not confirmed — check with the board | — |
| Wisconsin | Yes | RNs perform delegated injections under orders and general supervision. |
| Wyoming | With conditions | Provider history and physical first (telehealth allowed); no LPN injectables. |
Med spa injector laws: what to have in place
- A documented exam by a physician, NP or PA before the first treatment, where your state requires one.
- A patient-specific order, not a menu or blanket standing order, in states such as New York, Oklahoma and Vermont.
- Training records for each injector and procedure (Nevada, Maryland and Washington require them).
- A supervision plan that matches your state: reachable, immediately available, or on the premises.
- U.S.-approved product. FDA reported counterfeit Botox in multiple states in 2024 and says fillers should not be bought online.
On MedGrid, vendors clear per-category document diligence before listing, and their licences appear on product pages. You can check FDA status and state rules under neuromodulator rules and dermal filler rules. If you need a physician in the medical director role, MedGrid MSO handles medical directorship matching, and our guide to med spa medical director responsibilities covers delegation and chart review.
Frequently asked questions
Can RNs inject Botox?
In many states, yes, on a prescriber's order and usually after a physician, NP or PA has examined the patient. Alabama's medical board has refused to allow delegation, and Rhode Island's health department says RNs and LPNs may not inject neuromodulators or fillers. Louisiana allows RN Botox but not fillers. Check your state's row and confirm with your board.
Can a nurse inject Botox without a doctor on site?
It depends on the supervision standard. Michigan requires the supervisor to be reachable rather than present, North Carolina RNs need no on-site prescriber, and Oklahoma allows it with an individualized order. Maryland requires the physician on site, and Louisiana and Nebraska require the physician or NP on the premises.
Can LPNs inject Botox or fillers?
Usually not, or only narrowly. Nevada, Wyoming and Rhode Island keep injectables outside LPN scope, Colorado's nursing board says Botox is outside LPN scope, and South Dakota lets LPNs inject neuromodulators only. Montana's nursing board says trained LPNs may inject prescribed medications such as Botox.
Is a good faith exam required before Botox?
In most states that address it, yes. California, New York, Maryland, Oklahoma and North Dakota, among others, require a physician, NP or PA (in Maryland, the physician) to examine or assess the patient first. Oklahoma, North Dakota, South Dakota, Utah and Wyoming allow that exam by telehealth or telemedicine.
Can estheticians or medical assistants inject Botox?
In states with clear rules, generally no. California and New Mexico bar medical assistants from cosmetic injections, Maryland excludes unlicensed staff, and Rhode Island lists estheticians as not permitted. Colorado and Michigan are exceptions: their rules let physicians delegate to qualified unlicensed individuals under conditions.
This article is general information, not legal advice. Scope-of-practice rules change; confirm with your state medical and nursing boards or a healthcare attorney before relying on it.
Check your state, then order with a verified account. Open the sourced injectables delegation map on MedGrid, or verify your NPI and see wholesale pricing. Sign-up is free.
Sources
- Statement on Request to Train and Delegate Injection of Neuromodulators and Dermal Fillers for Cosmetic Purposes, Alabama State Board of Medical Examiners (2024-12-12)
- Guidance Document Regarding the Operation of Medical Spas and Intravenous (IV) Therapy Businesses, Rhode Island Department of Health (2024-07-01)
- Declaratory Statement: Cosmetic and Aesthetic Dermatological Procedures and Treatments Performed by RNs and APRNs, Louisiana State Board of Nursing (2011-03-02)
- Practice Advisory Decision: Scope of Practice Requirements and Limitations for RNs and LPNs Performing Aesthetic/Cosmetologic Procedures, Nevada State Board of Nursing (2025-01-17)
- COMAR 10.32.09.05 – Physician Responsibilities (cosmetic medical procedures), Maryland Division of State Documents (Board of Physicians) (2026-09-23)
- 22 Tex. Admin. Code §169.26 – General Standards, Cornell LII (Texas Medical Board rule text) (2025-01-09)
- Non Patient Specific Orders and Protocols (RNs, LPNs, CNSs & NPs), New York State Education Department, Office of the Professions (2026-09-01)
- Counterfeit Version of Botox Found in Multiple States, FDA (2024-05-02)
- Dermal Fillers (Soft Tissue Fillers), FDA (2023-07-06)
