06/22/2026
It is a 20 billion dollar industry, about as big as the NFL, and the person injecting your face might have trained for a single weekend. No medical license. No malpractice insurance. Nothing to lose if it goes wrong.
Kate Dee, MD is a board certified breast radiologist who runs a med spa in the Seattle area and wrote Med Spa Mayhem about what she has watched happen to her own industry.
Here is the part nobody tells you. Aesthetics exploded so fast that the rules never caught up. There are weekend courses all over the country that will teach an unlicensed person how to inject Botox, then promise to find them a medical director on paper so they can order product. The "director" might be an anesthesiologist who works in a hospital a hundred miles away and has never set foot in the building. The person is now practicing medicine on your face, completely on their own, and it is illegal in every state.
And almost nothing happens to them. Last year people in 11 different states ended up in the hospital from fake Botox ordered off the internet. When a patient does get hurt, the answer she keeps hearing from prosecutors is that you walked in there of your own free will, so what did you expect. There is no malpractice case to bring, because there is no license and no insurance and no money.
To be clear, a legitimate physician run med spa is a genuinely good thing. Most physicians will not risk a license they spent a decade earning. The danger is the operators nobody is policing.
So before anyone injects anything into you, ask three questions. Who exactly is treating me, and what is their license, and look it up. Who is the medical director, and can I actually get an appointment with them. And did a qualified person do a real exam before reaching for a needle.
Kate put it this way:
"If you don't have a license, you don't have one to lose."
Listen to the full conversation on The Podcast by KevinMD. Link in the comments.