CALL US AT 800-952-0521
Close this search box.

Regarding AMSPA Guidelines for Non-Invasive Medical Aesthetic Practices

This page is where the AAFE will post any related updates so esthetic practice and medspa owners can make their own judgements about the AMSPA guidelines and AMSPA advocacy and judge if this is helping or hurting the medical esthetic industry.

MUST LISTEN – Archive of Online Webinar with AAFE and the Texas Med Spa Association

Why The New AMSPA Guidelines Are A Huge Liability For Your Esthetic Practice/Medspa and Why Texas Is The Key To Saving Esthetics  October 21, 2020

Click on this link for the recording

Click below to download the American Med Spa Association recently released guidelines to read these for yourself and make your own determination.  Then see information below.

AMSPA Guidelines




Read member email below this one – this email is a response to an AMSPA member wanting to cancel their membership:

Thank you for reaching out. I will absolutely cancel your membership if that’s what you want, but I would like to at least be allowed to explain our position. I assume you have been in touch with either the AAFE of one of the groups formed Texas. While I do not know exactly what they are saying, I can tell you with 100% certainty that the information being passed from various groups is entirely false. I have received many emails in the past week, several overnight last night, using very similar language, stating that AmSpa is doing things like preventing non-physician ownership, restricting the practice of RNs and other practitioners, and generally trying to shut down the industry. None of this true, or even the least bit accurate. I have no idea where people are getting this information, but it did not come from us and it is not printed anywhere in our new guidelines. It is simply not accurate, and it is clear that someone, or some organization, is intentionally trying to spread this information against us.

For one, the guidelines we put out were not meant to be regulatory – they provide guidance on how to operate if you want to be fully compliant, based upon current law. There is nothing in the guidelines that imposes any new requirements on you or your practice. Anything you have been told to the contrary is incorrect. Further, the guidelines are a draft which we are currently having reviewed by different segments of the industry so that any necessary changes can be made. But I assure you that nowhere in the guidelines, or anything that we’ve ever pursued or will pursue, will restrict the right of anyone to own a med spa, nor will it restrict anything that RNs can currently do.

I am at a loss for how you or any other member of AmSpa received the information that you did, but I caution you that whomever you received it from is either deliberately misleading you or is spreading misinformation. Regardless, virtually nothing of what you have heard is true, and I am willing to show you, in writing, that is the case.

Since you were willing to listen to another organization about our intentions, I hope you will take the time to listen to us also. We will be hosting our own webinar next week where we explain, in detail, the provisions in question, the intent of the guidelines, and address any questions in an open forum. If, after that, you still wish to cancel and receive a refund, I will happily do so. But I would ask that you at least make your decision on the facts, not rumors and deliberate misinformation.

I am also willing to talk to you on the phone, and will be reaching out to any willing attendee of the recent webinars to speak with them also. I am fine with folks not wanting to be a part of AmSpa, but I am not ok with anyone spreading false information about us.

Thank you for listening, and I hope you’ll give due consideration to what I’m offering.

Alex Thiersch

Founder and CEO

American Med Spa Association

Date: Thursday, October 22, 2020 at 7:16 AM
To: Alex Thiersch <>
Subject: Cancellation


Amspa use to be a place I could find guidance and support, especially as a non-md owned medispa operator. Now I see Amspa is looking to destroy the very profession you claim to represent. I can not support the unethical standard I see going on at Amspa and am requesting an immediate termination of my membership as well as a refund for the rest of the year. I would also like to state that this will be fought tooth and nail. It’s a disgrace what you are doing and you should really be as disgusted as I am.



Response from AMSPA to email inviting them to participate in a webinar to explain their guidelines.  No response from AMSPA since this email.

Louis –

Appreciate you reaching out again and for the offer re the webinar. I promise I’m not ignoring you – I’ve had a ton going on and haven’t had a chance to prepare a response to your prior emails. The offer to participate in a webinar is compelling and I’d ask that you give me until Monday to talk it over with my law partners and determine the best course of action. Also, please know that our guidelines are not final and, while we are not going to withdraw them, if you have specific revisions please feel free to send them along and we’ll be happy to consider them.

Thanks again, and I promise we’ll be in touch soon.


Alex Thiersch

Letter sent to AMSPA and Byrd Adatto inviting to participate in an AAFE webinar

From:” <>
Date: Thursday, October 8, 2020 at 5:15 PM

Subject: RE: Regarding AMSPA Guidelines for Non-Invasive Medical Aesthetic Practices

Hi, Alex, hope this email finds you well.

Some of our members suggested inviting you and representatives from Byrd Adatto to a webinar about the AMSPA guidelines in order to give AMSPA a forum to discuss the guidelines and for AAFE members and others to ask questions.

I am happy to extend this invitation to you and I hope you will accept.  Please let me know which evening works for you next week or when it works for your schedule, we are fairly flexible on the date and the time.

Let me know as soon as possible and I will have our team set it up.  Look forward to hearing from you!

Thanks and have a great day!

Dr. Louis Malcmacher


Must Read Linked In Post by Sara Shikhman, Healthcare Attorney specializing in Medical Spas and Esthetic Practices



The AAFE did hear back from AMSPA with a short note on Monday September 28 saying “Thanks for reaching out and I appreciate the feedback. We’ll be in touch soon with additional thoughts. Thanks again”.  Since then, there has been no other correspondence with the AAFE.

Letter sent to the AMSPA President, Mr. Alex Thiersch, on Tuesday, October 6, 2020

Hi, Alex, hope this email finds you well.

Look forward to your comments on the below, haven’t heard back from you.

Many of our AAFE members who are also AMSPA members in addition to a ton of our Texas members (MD, NP, RN) view these guidelines very negatively and I don’t believe it reflects well on AMSPA and ByrdAdatto.

At this point, the argument “if people would just read the guidelines” has passed.  Everyone has read them carefully and the guidelines are regarded more negatively than ever before.  In truth, I haven’t heard from a single person, whether a healthcare professional or anyone in the Medical Spa industry, who has expressed their support for these guidelines.

Look forward to hearing back from you.

Dr. Louis Malcmacher, AAFE President


Letter sent to the AMSPA President, Mr. Alex Thiersch, on Friday September 25, 2020

Hi, Alex, I hope this email finds you well.

On behalf of the AAFE, AAFE members and especially those who are also AMSPA members, I write this letter in the hope that AMSPA will rescind its document titled Guidelines for Non-Invasive Medical Aesthetic Practices released on September 15, 2020.

We have heard from many AAFE members, AMSPA members, and our AAFE faculty,  and I present to you some of the reasons we feel these guidelines are harmful to the future of esthetic practices and medical spas:

  • Many positions taken in these guidelines are more restrictive than many medical, dental, and nursing regulating boards which is unusual for an association that is supposed to be advocating for its members to expand their practices.
  • Implementation of these guidelines will dramatically increase the cost of esthetic services to patients with no increase (and possibly a decrease) in patient safety.  This alone would put many responsible and hard working medical spas out of business.
  • These guidelines may put AMSPA members at legal and regulatory risk (and possibly any esthetic healthcare provider) as we explained recently in a webinar (replay posted on Instagram/Facebook facialesthetics page) and is a document that can be easily weaponized by regulating boards, liability insurances and plaintiff attorneys.
  • Sections of these guidelines are factually wrong – one example is the section related to dentists and their ability to use injectables.  Dentists have been using injectables safely and successfully within their scope of practice since 2007 throughout the US.  The AAFE has worked with nearly all of the dental boards on this issue and presents injectables live patient certification training in the head and neck at the American Dental Association Annual Meeting in addition to 40+ other locations throughout the year for dentists, physicians, nurse practitioners, nurses and physician assistants.  This section is offensive to dental professionals, many of who now legally own medical spas and employ nurses and nurse practitioners within their scope of practice.
  • AMSPA members have expressed to the AAFE that the vast majority of the membership had no input on these guidelines.  I am passing that statement on to you as I do not know the membership mechanism you used to include their input.
  • AMSPA members and AAFE members have expressed their opinion to the AAFE that these guidelines have renewed the “turf war” between physicians, nurse practitioners, nurses, and physician assistants regarding esthetic medicine and who can provide it and who should control it.

This is only some of the feedback we have gotten in the last few days.   It has created quite an uproar in the esthetics healthcare community.  The AAFE will continue to address these guidelines through various outlets at the request of our members.

For these reasons and more not stated here, I hope that you and AMSPA will consider rescinding these guidelines as soon as possible.  In the AAFE’s opinion, they are harmful to the future of esthetic healthcare practices and medical spas.

I am happy to discuss this with you at any time.

Thanks and have a great day!

Dr. Louis Malcmacher