The short answer
Cosmetic treatment of a minor is off-label: BOTOX Cosmetic is FDA-approved for adults, and most hyaluronic acid fillers such as Juvéderm and Restylane are indicated for patients over 21. Off-label use is lawful but requires prescriber judgment, parental or guardian consent under state law, and documentation of the medical or psychosocial indication.
What does the FDA labeling actually say?
BOTOX Cosmetic is approved for the temporary improvement of moderate to severe glabellar lines, lateral canthal lines and forehead lines in adults. The pivotal cosmetic trials enrolled adults, and the labeling is written for that population. Botulinum toxin does have approved pediatric indications — pediatric spasticity and pediatric detrusor overactivity, for example — but those are therapeutic, not cosmetic.
Dermal fillers are more explicit still. The FDA-approved hyaluronic acid fillers in the Juvéderm and Restylane families are indicated for patients over 21 for their respective facial locations. Injecting a 17-year-old with a filler labeled for patients over 21 is off-label device use, and the FDA has published consumer guidance warning against fillers in people under 22.
Off-label use is not illegal. A licensed prescriber may lawfully use an approved product outside its labeled indication when clinical judgment supports it. But off-label status changes three things at once: the disclosure obligation rises, the standard of care question sharpens, and the insurer's appetite for defending you drops.
Who can consent for a minor?
| Situation | Who signs |
|---|---|
| Minor under 18, routine case | Parent or legal guardian, with proof of relationship |
| Divorced or separated parents | Depends on custody order; get the custodial parent, and verify |
| Legal guardian or foster placement | Court documentation of guardianship authority |
| Emancipated minor | The minor, with documentation of emancipation |
| Minor who has reached majority | Themselves; majority is 18 in most states, 19 in Alabama and Nebraska |
Every state has minor-consent statutes, but they generally cover categories such as reproductive health, mental health, substance use and emergency care — not elective cosmetic procedures. Assume you need a parent or guardian unless your state's law clearly says otherwise, and verify identity and authority rather than accepting a claim at the front desk.
Note also that a minor's assent matters independently of the parent's consent. A parent cannot compel a competent adolescent into an elective cosmetic injection, and proceeding over an unwilling minor's objection is both an ethics problem and a battery risk.
What about therapeutic uses in adolescents?
Different analysis. Hyperhidrosis, sialorrhea, bruxism-related masseter hypertrophy and migraine are therapeutic contexts where a treating physician may reasonably use botulinum toxin in a younger patient, subject to labeling and evidence. These belong in a physician-directed care plan with documented diagnosis, failed conservative measures and follow-up — not in an aesthetic walk-in appointment.
The practical line most well-run practices draw is a policy floor: no cosmetic neuromodulator or filler under 18, and often under 21 for filler to match the device labeling, with therapeutic exceptions requiring medical director approval and a documented diagnosis.
What this means for your paperwork
If your practice treats anyone under 18 or 21, the file needs to show more than a signature. Document identity and age verification with a copy of a government ID. Document the consenting adult's legal authority, including custody documentation where relevant. Record the prescriber's good faith exam, the clinical or psychosocial indication, and an explicit note that the use is off-label with that fact disclosed to both the minor and the guardian. Capture the minor's assent separately.
The consent form itself should carry an off-label acknowledgment naming the product and the labeled age range it departs from, a statement of alternatives including deferring treatment until adulthood, and a signature block for parent or guardian plus the minor.
Then write the policy down. A one-line age floor in your procedures manual, with a named approver for exceptions, prevents the far more common failure: an injector making the call alone, at the chair, with a persuasive parent in the room.
Related questions
This answer is educational and is not legal or medical advice. Requirements vary by state and change over time — verify with your own legal and clinical advisors before applying anything here in practice.