# COMAR Title 10 — Maryland Department of Health

## Subtitle 27 — Board of Nursing

### Chapter 25 — Cosmetic Procedures

**Authority:** Health-General Article, §4-403; Health Occupations Article, §8-205(a)(1) and (2); Annotated Code of Maryland

**Administrative History:** Effective date: May 30, 2011 (38:11 Md. R. 671)

**Administrative History:** Regulation .05E adopted effective October 13, 2025 (52:20 Md. R. 1002)

#### Regulation .01 Exclusion from Regulations.

*COMAR 10.27.25.01*

A. This chapter is not applicable to, and does not restrict or limit, other health care practitioners who are authorized to perform these duties under their respective practice acts.

B. This chapter does not restrict or limit a Maryland Certified Registered Nurse Practitioner from possessing, prescribing, evaluating, or performing the procedures under this chapter.

#### Regulation .02 Definitions.

*COMAR 10.27.25.02*

A. The following terms have the meanings indicated.

B. Terms Defined.

  (1) “Body treatment” means cellulite lymphatic drainage and cellulite vacuum massage.

  (2) “Cellulite lymphatic drainage”  means a therapy in which the practitioner uses a range of specialized and gentle rhythmic pumping techniques to move the skin in the direction of the lymph flow.

  (3) “Cellulite vacuum massage” means:

    (a) The massage of peripheral blood, lymph, and inter-tissue liquid with the goal of reducing stagnation of these fluids and increasing the skin’s elasticity; and

    (b) The external use of a vacuum component directly on the area to be massaged followed by a straight line, circular, or zigzag movement to massage the area.

  (4) “Chemical peels” also called deep skin peels, means the removal of the top layers of skin using chemicals applied directly to the skin.

  (5) “Clinical preceptor” means a licensed or certified individual who is:

    (a) Proficient in the procedure for which they are precepting; and

    (b) Permitted by the appropriate health occupation licensing board to provide care and treatment for cosmetic services.

  (6) “Cryotherapy” means the application of:

    (a) Extreme cold to destroy abnormal or diseased tissue, warts, moles, skin tags, and solar keratoses; and

    (b) Liquid nitrogen to freeze tissues at the cellular level.

  (7) “Dermal fillers” means various types of natural or man-made materials which are injected intradermally to correct imperfections in the skin and subcutaneous tissue.

  (8) “Direct supervision” means on site, physically present, accessible in the immediate patient care area and available to intervene if necessary.

  (9) “Injectable treatments” means the use of FDA approved medication and includes the following:

    (a) Dermal fillers;

    (b) Micropigmentation, also known as cosmetic tattoo or permanent make-up; and

    (c) Neuromuscular agents.

  (10) “Laser treatment” means a technique in which exposure to low-level laser light or light emitting diodes are used to stimulate or inhibit cellular function possibly leading to beneficial clinical effects.

  (11) Light Treatment.

    (a) “Light treatment” also known as phototherapy, means the use of non-ionizing electro-magnetic radiation for therapeutic benefit.

    (b) “Light treatment” does not mean laser treatment.

  (12) “Lipodissolve” means a procedure that uses subcutaneous micro-injections of drugs with the sole purpose of dissolving fat for body contouring.

  (13) Magenta Light.

    (a) “Magenta light” means a non-invasive technique that combines infrared and magenta light with subdermal tissue massage to produce a penetrating light that affects the epidermis, alters cellulite formation,  and controls cellulite formation at the cellular level.

    (b) “Magenta light” does not mean laser or intensive pulse light.

  (14) “Mesotherapy” also known as intradermotherapy, means a non-invasive cosmetic treatment which employs multiple intra or subcutaneous injections of pharmaceutical and homeopathic medications, plant extracts, vitamins, and other ingredients for the treatment of fat or cellulite.

  (15) “Micro current treatment” means passing radio frequency electricity through the skin to:

    (a) Heat up tissue;

    (b) Cause the tissue to contract; and

    (c) Stimulate collagen production.

  (16) “Neuromuscular agents” means injectable drugs that cause muscle weakness for the purpose of cosmetic softening of wrinkles and includes, but is not limited to, Botox and Dysport.

  (17) “Nurse” means a registered nurse (RN) or a licensed practical nurse (LPN).

  (18) “Peels” or “Topicals” means:

    (a) Chemicals peels;

    (b) Cryotherapy; or

    (c) Microdermabrasion.

  (19) “Photochemotherapy” means the use of a photodynamic light source to destroy dystrophic cells.

  (20) “Photodynamic (PDT)” means the use of a light source, combined with a light-sensitive drug to destroy dystrophic cells.

  (21) “Photosensitizing agent” means a drug used with a photodynamic light source to produce a therapeutic photosensitivity.

  (22) “Precepted clinical practice” means after theoretical learning and until competency is achieved:

    (a) Working directly with patients;

    (b) Performing cosmetic or dermatologic procedures on patients; and

    (c) Working under the direct supervision of a clinical preceptor who has the knowledge and ability to perform the procedure independently.

  (23) Radio Frequency and Current.

    (a) “Radio frequency and current” means:

      (i) Magenta light;

      (ii) Microcurrent treatment;

      (iii) Photochemotherapy;

      (iv) Photodynamic;

      (v) Thermage; and

      (vi) Ultrasound (therapeutic only).

    (b) “Radio frequency and current” does not mean laser.

  (24) Theory.

    (a) “Theory” means the body of knowledge regarding the principles underlying the safe execution of a cosmetic procedure and is obtained through didactic instruction provided by a licensed health care provider who has the knowledge and skill to perform the procedure.

    (b) “Theory” includes didactic instruction by the licensed health care provider which may be augmented by a manufacturer’s representative.

  (25) “Thermage” means the use of radio frequency technology to:

    (a) Target collagen in the dermis layer of the skin around the eyes and forehead; and

    (b) Cause the dermis and underlying tissue to tighten.

  (26) Ultrasound.

    (a) “Ultrasound” means the therapeutic use of inaudible sound in the frequency range of approximately 20,000 to 10,000,000,000 cycles per second for therapeutic use at low intensity producing a heating effect to stimulate collagen production.

    (b) “Ultrasound” does not mean the use of ultrasound for diagnostic purposes.

#### Regulation .03 Procedural Categories.

*COMAR 10.27.25.03*

A. Procedures designated as Category A shall include body treatments with:

  (1) Cellulite lymphatic drainage; and

  (2) Cellulite vacuum massage.

B. Procedures designated as Category B shall include light treatments with:

  (1) Infrared light;

  (2) Magenta light;

  (3) Photochemotherapy;

  (4) Photodynamic;

  (5) Photosensitizing agents;

  (6) UVA light; and

  (7) UVB light.

C. Procedures designated as Category C shall include laser treatments administered by a selective laser.

D. Procedures designated as Category D shall include injectable treatments with:

  (1) Dermal fillers;

  (2) Micropigmentation with topical anesthetics only; and

  (3) Neuromuscular agents.

E. Procedures designated as Category E shall include radio frequency and current treatments with:

  (1) Micro current;

  (2) Thermage; and

  (3) Ultrasound.

F. Procedures designated as Category F shall include peels or topicals with:

  (1) Chemical peels;

  (2) Cryotherapy;

  (3) Microdermabrasion; and

  (4) Power peel.

#### Regulation .04 Education.

*COMAR 10.27.25.04*

To administer medication or to perform cosmetic and dermatologic treatments, a nurse shall:

A. Complete a program of study that includes theory appropriate to the medication to be administered and the procedure to be performed that includes, but is not limited to:

  (1) Anatomy, physiology, and pathophysiology related to the integumentary system as well as systems specific to the procedure being performed;

  (2) Appropriate technique for each cosmetic procedure;

  (3) Nursing assessment, cosmetic indications, and contraindications for treatment;

  (4) Pharmacology intervention specific to the cosmetic procedure including, but not limited to:

    (a) Assessment and monitoring of the receiving the medication;

    (b) Effects and potential side effects of the medication;

    (c) Contraindications to the administration of the medication;

    (d) The ability to anticipate and recognize potential complications of the medication;

    (e) The ability to recognize emergency situations and institute appropriate interventions;

    (f) Preparation, storing, and handling of the medication; and

    (g) Proficiency in administering the medication by the required route;

  (5) Selection, maintenance, and utilization of equipment;

  (6) Identification of realistic and expected outcomes of the procedure;

  (7) Identification of complications or adverse reactions;

  (8) Nursing care required and appropriate nursing interventions in the event of complications or untoward outcomes;

  (9) Infection control procedures;

  (10) Safety precautions appropriate to each procedure;

  (11) Documentation appropriate to the type of the procedure being performed; and

  (12) Precepted clinical practice by a clinical preceptor that includes documented initial and annual competency of the nurse in each cosmetic procedure the nurse is to perform;

B. Document evidence of clinical and psychomotor proficiency competency before independently performing each cosmetic procedure;

C. Perform the procedures on a frequent routine predictable basis in order to retain practice proficiency;

D. Be evaluated for continued clinical competency at periodic intervals; and

E. Obtain additional education when the population changes or new procedures are introduced into the practice.

#### Regulation .05 Cosmetic Procedures in General.

*COMAR 10.27.25.05*

A. The nurse shall comply with the employment settings written cosmetic policies and procedures that comply with this chapter.

B. The nurse shall be guided by and comply with the written policies and procedures in keeping with recognized standards of care that include, but are not limited to:

  (1) Care and maintenance of appropriate equipment and safe operation;

  (2) Description of how the procedure is to be performed;

  (3) Education;

  (4) Assessment;

  (5) Emergency procedures;

  (6) Monitoring guidelines;

  (7) Operator and safety when utilizing equipment;

  (8) A continuous quality improvement process which includes, but is not limited to:

    (a) Unexpected outcomes;

    (b) Side effects; and

    (c) Complications;

  (9) Obtaining or ensuring that the client’s informed consent has been obtained that documents the patient’s awareness that it is the licensed nurse who will perform the cosmetic procedure; and

  (10) Documenting the performance of the cosmetic procedure including, but not limited to:

    (a) Patient response;

    (b) Patient education; and

    (c) Safety precautions taken on behalf of the patient.

C. The nurse may perform the identified cosmetic procedure when there is a completed prescriptive order from an authorized prescriber that includes, but is not limited to:

  (1) The procedure to be performed;

  (2) Identification of the specific treatment area;

  (3) Identification of medication, dosage, route, and time interval for administration of the medication for the specific cosmetic procedure;

  (4) Identification of the light source and the radio frequency, current dosage, intensity, and time period it is to be applied; and

  (5) The use of any topical anesthetic.

D. Before a nurse performs any of these cosmetic procedures, the authorized prescriber shall:

  (1) Complete an initial assessment and evaluation of the patient before the procedure is performed;

  (2) Develop a treatment plan for the specific patient;

  (3) Be physically present in the setting; and

  (4) Be immediately available:

    (a) At the time the procedure is performed; and

    (b) Post-treatment to evaluate the patient.

E. The nurse shall maintain medical records in accordance with Health-General Article, Title 4, Subtitle 4, Annotated Code of Maryland.

#### Regulation .06 Cosmetic Procedures — Licensed Practical Nurse.

*COMAR 10.27.25.06*

Except for Category C, the LPN may perform the cosmetic procedures identified in Regulation .03 of this chapter.

#### Regulation .07 Cosmetic Procedures — RN.

*COMAR 10.27.25.07*

The RN may perform all of the procedures identified in Regulation .03 of this chapter.

#### Regulation .08 Exceptions.

*COMAR 10.27.25.08*

Except for cryotherapy, the nurse may perform the cosmetic procedures identified in Regulation .03 Category F independent of the requirements stated in Regulation .05D of this chapter.

#### Regulation .09 Prohibited Acts.

*COMAR 10.27.25.09*

A. The licensed nurse may not:

  (1) Perform cosmetic procedures on a standing order or protocol;

  (2) Perform the pre-procedure medical assessment or evaluation;

  (3) Perform medical diagnosis or prescribe cosmetic procedures;

  (4) Develop the client treatment plan;

  (5) Prescribe medications for cosmetic or dermatological procedures;

  (6) Perform the post-procedure medical evaluation of the client; and

  (7) Administer injections for the purpose of:

    (a) Mesotherapy; and

    (b) Lipodissolve.

B. The nurse may not perform:

  (1) Liposuction;

  (2) Hair transplants;

  (3) Invasive radiofrequency procedures;

  (4) Phenopeels;

  (5) Sculptra injections; and

  (6) Lipostabil or phosphatidycholine for the purpose of lipodissolve.