Who can inject
MD, DO only; NP/PA/RN may not inject injectables
Registered nurses (RNs)
No; RNs may not inject neurotoxins or fillers in Hawaii
Nurse practitioners & physician assistants
NP/PA may not independently practice or inject; physician collaboration required but injectables restricted to MDs/DOs
The exam that makes it legal
Required; in-person exam before treatment A valid order or good-faith exam by an authorized provider is what makes an injection lawful — not simply who holds the syringe.
Training expected
No state-mandated injector training beyond licensure.
What to verify in Hawaii
Verify that your medical spa is physician-owned or physician-controlled, and ensure only MDs or DOs perform all injections; do not delegate injectables to RNs, NPs, or PAs.
Primary source: Hawaii Medical Board
General business information for Hawaii medical-spa owners, current as of 2026 — not legal advice. State boards update rules often; confirm specifics with the Hawaii board (and your own counsel) before you act.