Can RNs Perform Botox and Dermal Filler Injections in North Carolina?
March 01, 2024Can registered nurses inject Botox and dermal fillers in North Carolina?
For registered nurses interested in aesthetic medicine, the answer in North Carolina is yes, but with important limitations.
The North Carolina Board of Nursing has issued guidance stating that cosmetic and aesthetic dermatological procedures may fall within the scope of practice for licensed nurses, including RNs and LPNs, when the procedures are properly prescribed or ordered by an authorized healthcare provider and all required criteria are met.
That distinction is important.
An RN’s ability to participate in Botox, botulinum toxin, and dermal filler procedures does not come from a training course alone. A course can help document education and build hands-on skill, but it does not create independent legal authority to diagnose, prescribe, order products, determine a treatment plan, or perform procedures outside the nurse’s scope of practice.
In North Carolina, RNs should understand the full compliance picture before performing aesthetic injectable procedures.
What does the North Carolina Board of Nursing say?
The North Carolina Board of Nursing’s Cosmetic/Aesthetic Dermatological Procedures Position Statement applies to RN and LPN practice.
The Board identifies cosmetic and aesthetic dermatological procedures as a broad category that may include procedures such as chemical peels, microdermabrasion, sclerotherapy, laser aesthetic procedures, light treatments, and neuromodulator and dermal filler injections, including products such as Botox and fillers.
According to the Board’s position statement, it is within the scope of practice for licensed nurses, including RNs and LPNs, to perform cosmetic or aesthetic dermatological procedures when those procedures are prescribed or ordered by one of the following:
- A licensed physician
- A nurse practitioner
- A physician assistant
- Another licensed healthcare practitioner with prescriptive authority acting within their legal scope of practice
The Board also states that all required criteria in the position statement must be met.
What requirements apply before an RN injects?
For a North Carolina RN, injectable practice should include more than technical injection skill.
Before an RN performs Botox or dermal filler injections, the following should be in place:
- A proper client evaluation or assessment
A licensed physician, nurse practitioner, physician assistant, or other authorized prescriber must complete the client evaluation or assessment for procedure appropriateness. - A prescription or order
The authorized healthcare provider must issue a prescription or order for the procedure to be implemented by the licensed nurse. - Documented knowledge, skill, and competency
The RN must have the documented knowledge, skill, and competency necessary to carry out the cosmetic or aesthetic procedure safely. - Facility policies and emergency procedures
The employing agency should have cosmetic/aesthetic dermatological policies and emergency procedures available in the facility. - Practice within scope
The RN remains responsible for practicing within North Carolina nursing scope, applicable board guidance, employer policy, and the nurse’s own education and competency.
This means that an RN should not treat Botox or dermal filler injections as independent services simply because they have completed a weekend course or received a certificate of training.
Does a physician, NP, or PA need to be on site?
For RNs, the North Carolina Board of Nursing position statement says the RN role does not require the on-site presence of a physician, nurse practitioner, physician assistant, or other licensed healthcare practitioner to perform prescribed or ordered cosmetic/aesthetic dermatological procedures.
However, that does not mean an RN is practicing independently.
The RN still needs a proper provider evaluation or assessment, a prescription or order, documented competency, appropriate policies and procedures, and a clinical environment prepared to manage complications.
For LPNs, the rule is different. The Board’s position statement says that an LPN must have on-site presence and supervision by an RN, physician, nurse practitioner, physician assistant, or other licensed healthcare practitioner acting within their scope in order to perform prescribed or ordered cosmetic/aesthetic dermatological procedures.
Where do physicians, NPs, and PAs fit into North Carolina RN injectable practice?
Botox and dermal filler procedures are medical aesthetic treatments. They involve assessment, treatment planning, product selection, prescribing or ordering, dosing decisions, informed consent, documentation, risk management, and complication response.
For that reason, the RN’s role should be connected to an appropriate medical structure.
In North Carolina, the Board of Nursing position statement requires that a licensed physician, nurse practitioner, physician assistant, or other licensed healthcare practitioner with prescriptive authority complete the client evaluation or assessment for procedure appropriateness and issue a prescription or order for implementation by the licensed nurse.
Physicians, nurse practitioners, physician assistants, and other prescribers should also follow the rules and guidance of their own licensing boards. For example, the North Carolina Medical Board states that before prescribing a drug, a licensee should make an informed medical judgment based on the circumstances, training, and experience. Ordinarily, this includes an appropriate history and physical examination, a working diagnosis, a therapeutic plan, and documentation.
This is why a simple “medical director agreement” or generic standing order should not be treated as a substitute for appropriate patient evaluation, prescribing, documentation, and oversight.
Can an RN open an aesthetic practice in North Carolina?
North Carolina RNs may explore entrepreneurial opportunities through a professional nursing business structure, such as a Professional Corporation or Professional Limited Liability Company, but this is an area where legal review is strongly recommended.
The North Carolina Board of Nursing states that RNs exploring entrepreneurial opportunities are encouraged to seek legal advice when establishing a professional corporation or professional limited liability company for nursing and related services. The Board also states that nursing professional corporations and PLLCs must meet applicable North Carolina laws and rules.
An RN-owned business does not remove the need for the required provider evaluation, prescription or order, documented competency, and applicable policies and procedures for cosmetic/aesthetic dermatological procedures.
LPNs should be especially cautious. The North Carolina Board of Nursing states that LPNs are not authorized to establish professional corporations or professional limited liability companies under the applicable nursing regulations.
What about clients who present directly for cosmetic treatment?
The North Carolina Board of Nursing position statement includes a note about settings where clients independently present for cosmetic or aesthetic dermatological treatment and the treatment has not been prescribed or ordered by a licensed healthcare provider based on an evaluation or assessment.
In that situation, the Board states that the licensed nurse can perform cosmetic/aesthetic dermatological procedures only if also licensed in compliance with, and performing activities authorized and regulated by, the North Carolina Electrolysis Practice Act or North Carolina Cosmetic Art Act.
This section should be read carefully.
It should not be interpreted as permission for an RN to independently prescribe, order, diagnose, select, or inject prescription products such as botulinum toxin or dermal fillers without the required healthcare provider evaluation and order. RNs should consult the North Carolina Board of Nursing, the applicable licensing board, employer policy, and qualified legal counsel if they are unsure how this applies to their practice model.
Does North Carolina require a Botox “certification”?
Many nurses search online for “Botox certification” or “filler certification,” but the term can be misleading.
A training program may provide continuing education and a certificate documenting completion of training. That certificate can be valuable because it helps document education and hands-on training. However, a course certificate is not the same thing as a state-issued license or independent authorization to inject.
In North Carolina, an RN’s ability to participate in injectable procedures depends on licensure, scope of practice, a proper provider evaluation, a prescription or order, documented competency, facility policies, emergency procedures, and compliance with all applicable board guidance.
A better way to describe this is:
RNs can complete aesthetic injectable training and receive a certificate of training, but they must still practice within North Carolina scope-of-practice requirements and under the required provider evaluation and order structure.
Why hands-on injectable training still matters
Even when an RN has an appropriate order and is practicing within scope, training is essential.
Botox and dermal filler procedures require a strong understanding of:
- Facial anatomy
- Patient assessment
- Treatment planning
- Indications and contraindications
- Product handling
- Injection technique
- Dosing concepts
Risk reduction
- Vascular anatomy
- Infection control
- Adverse event recognition
- Emergency protocols
- Documentation
- Post-treatment care
A responsible North Carolina RN should view training as one part of a broader compliance and competency pathway. The goal is not just to learn where to inject. The goal is to practice safely, legally, and professionally.
How MedAesthetics Training supports North Carolina RNs
MedAesthetics Training’s Botox, Botulinum Toxin & Dermal Filler Training | Level I course is designed for licensed healthcare professionals who are beginning or expanding their education in aesthetic injectables.
The course combines didactic education with supervised hands-on training focused on facial anatomy, patient assessment, treatment planning, injection technique, and safety considerations for botulinum toxin and dermal filler procedures.
Attendees receive a Certificate of Training upon successful completion. The course is currently approved for up to 9.75 CME/CE credits, and continuing dental education is offered by MedAesthetics Training, LLC as an AGD PACE-recognized provider.
North Carolina RNs should confirm that aesthetic injectable procedures are within their own scope of practice and that their practice setting has the proper provider evaluation, prescription/order process, competency documentation, policies, and emergency procedures in place.
Bottom line for North Carolina RNs
North Carolina RNs may be able to perform Botox and dermal filler injections when the procedure is within nursing scope and all required safeguards are met.
A responsible pathway includes:
- Completing appropriate aesthetic injectable training
- Maintaining documentation of knowledge, skill, and competency
- Ensuring an authorized provider has completed the client evaluation or assessment
- Working from a valid prescription or order
- Following facility policies and emergency procedures
- Practicing within North Carolina nursing scope and employer policy
- Understanding that a course certificate does not create independent legal authority to inject
Botox and dermal filler injections should be treated as regulated medical aesthetic procedures, not simply as cosmetic services.
For RNs who are ready to build a strong clinical foundation, MedAesthetics Training offers small-group, hands-on education in botulinum toxin and dermal filler techniques.
Disclaimer
This article is for general educational purposes only and is not legal advice. Scope-of-practice rules, supervision requirements, prescribing requirements, facility requirements, ownership rules, and board guidance can change. Registered nurses and other healthcare professionals should consult the North Carolina Board of Nursing, applicable licensing boards, their employer, supervising or ordering provider, and qualified legal counsel before performing Botox, dermal filler, or other aesthetic injectable procedures.
Sources Reviewed
This article was prepared using publicly available North Carolina regulatory resources, including:
- North Carolina Board of Nursing — Cosmetic/Aesthetic Dermatological Procedures Position Statement for RN and LPN Practice
- North Carolina Board of Nursing — Position Statements and Decision Trees
- North Carolina Board of Nursing — RN/LPN Laws and Rules
- North Carolina Board of Nursing — Nursing Practice Act
- North Carolina Board of Nursing — Professional Corporations and Professional Limited Liability Companies
- North Carolina Medical Board — Contact With Patients Before Prescribing
- North Carolina Medical Board — Physician Supervision of Other Licensed Health Care Professionals
- North Carolina Medical Board — Office-Based Procedures
- MedAesthetics Training — Botox, Botulinum Toxin & Dermal Filler Training | Level I
Last reviewed: July 2026