A 27-year-old woman’s death following an intravenous therapy session at a Bronx medical spa has drawn attention to the largely unregulated nature of the growing med spa industry in New York and beyond. Elizabeth Baron received an NAD+ IV injection at the Bereshit Lifestyle Center on July 20 before suffering cardiac arrest. She was transported to a hospital but was pronounced dead shortly after arrival.

NAD+ therapy, touted for its purported anti-aging benefits and endorsed by celebrities, remains legal but is not approved by the U.S. Food and Drug Administration. The Bronx clinic where Baron was treated was operated by Luis Rojas Cabrera, who held a medical license in the Dominican Republic but was not licensed to practice medicine in New York, according to reports following the incident.

Baron’s death sheds light on challenges in oversight of medical spas, which offer a range of cosmetic and wellness treatments—from injectable fillers to body-contouring and vitamin drips—and have proliferated rapidly in recent years. The number of med spas nationwide has increased sixfold since 2010, with the market projected to reach $47 billion over the next five years. In New York alone, retail space occupied by such facilities expanded from 20,641 square feet in 2008 to 83,370 square feet in 2024.

Regulatory oversight is fragmented and complex, involving multiple state agencies. Under New York law, medical services businesses are required to register as physician-owned limited liability companies (LLCs) or professional limited liability companies (PLLCs). However, industry experts say many operators circumvent these requirements by employing licensed doctors purely in nominal medical director roles or structuring ownership through management companies, leading to ambiguous lines of accountability. Direct medical supervision is mandated for nurse-administered treatments, but enforcement and verification remain difficult.

This regulatory gray area has led to numerous documented incidents of substandard care and dangerous practices. In April 2026, a Queens man posing as a surgeon was sentenced to up to 15 years in prison after a patient died from a lidocaine overdose during a body-contouring procedure at an unlicensed clinic. Another recent case involved a Hell’s Kitchen med spa where clients were allegedly injected with counterfeit Botox, causing serious side effects. In Los Angeles, aesthetician Sonia Dakar lost her license following allegations of severe burns and scarring from a chemical peel.

Patients also publicly share their negative experiences through online support groups, recounting botched procedures, lasting disfigurement, and emotional distress. Some report facial nerve damage, persistent pain, and complications from improperly administered injectables. For others, what appeared to be routine cosmetic treatments resulted in lasting physical and psychological harm.

Industry insiders describe the med spa business model as low-cost and high-volume, relying on hiring nurses and low-fee medical directors to minimize expenses while maximizing patient throughput. Licensed medical professionals may be absent during treatments, and some staff perform procedures beyond their formal scope of practice. One aesthetician reported working without a valid license and no on-site physician oversight.

A notable example is the Cleavage Clinic in Manhattan, which opened in 2023 offering “non-surgical” breast enhancement with injectable fillers and radiofrequency microneedling—treatments legally considered medical procedures in New York. The clinic advertises services online and operates with registered nurses performing the treatments under a Florida-based medical director who is not physically present.

Doctors and legal experts emphasize that while nurses can perform certain cosmetic procedures under physician supervision, direct oversight is required for patient evaluation and treatment planning. However, many operations exploit loopholes allowing nominal medical director roles without effective supervision, creating significant risks for consumer safety.

Elizabeth Baron’s death has intensified calls for tighter regulation and enforcement in the expanding med spa sector, underscoring the urgent need to ensure patient protections amid a booming but loosely regulated industry.