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Botox is considered the practice of medicine in Tennessee, so anyone who conducts the treatment must be a licensed physician or be under the supervision of one. Furthermore, Tennessee's general delegation law is broad in nature, authorizing delegation to PAs, RNs, NPs, LPNs, and pharmacists As a result, a physician can inject Botox for medical spa purposes and delegate the injection of Botox to PAs, RNs, NPs, or LPNs who are under physician supervision, control, and responsibility. Since Tennessee law does not specify the level of supervision required for RNs and LPNs, it should be calculated based on the delegate’s education, training, and relevant experience.

Under the general delegation law, the BME also given additional clarifications for delegating medical duties, such as prescribing Botox or injecting cosmetic fillers, to RNs, LPNs, and pharmacists (collectively, "other supervisees"). The supervising physician has the final say on whether or not to delegate Botox injections to other supervisees.When determining whether Botox administration should be assigned, a supervising physician must consider the quality of care in their culture, the level of supervision that will be given, and the competence—that is, the education, training, and experience—of the staff performing the role. If a physician chooses to assign a medical role to another supervisee, the physician must adhere to the Tennessee BME's clear delegation criteria. At a bare minimum, the supervising physician must: (1) be licensed to practice medicine in Tennessee; (2) supervise on-site or be immediately accessible for contact (3) delegate tasks that are within the physician's customary scope and expertise; (4) delegate tasks to licensees that have demonstrated competency in the procedures through training or education; (5) delegate tasks that are consistent with the standard of care and within the licensee's approved scope; (6) evaluate patient risk and only delegate treatments that do not pose an undue risk and have predictable outcomes. (7) Establish guidelines for any assigned activities, which will be held on-site and updated every two years.