To open an aesthetic medicine practice in Spain, before seeing your first patient, you need a health authorisation to operate, granted by the regional health department of your autonomous community, and that authorisation must include care unit U.48, Aesthetic Medicine. With this authorisation, the centre is entered in the regional register of healthcare centres, and you will be issued with a registration number which you must display in your advertising. In addition to this, there are personal requirements you must meet as a doctor: a medical qualification, membership of the medical association and valid professional indemnity insurance.
In this guide, we outline the national framework, the differences between regions, and the practical steps to ensure you don’t start with an incomplete application.
The national framework: prior authorisation and healthcare provision
The basis for this is Article 29(1) of the Law 14/1986, General Health Act: Healthcare centres and facilities, regardless of their level, category or operator, require prior administrative authorisation for their establishment and operation, as well as for any changes to their structure or original operating arrangements. This includes a single-doctor practice.
The development is carried out by the Royal Decree 1277/2003, which lays down the general principles governing authorisation. Article 3 of that regulation grants the autonomous communities the power to authorise the establishment, operation, modification and closure of such facilities. Annex II defines the care units that a centre may have, and it is there that U.48 appears.
What is Unit U.48, Aesthetic Medicine?
Annex II of Royal Decree 1277/2003 defines it as a healthcare unit in which a doctor is responsible for carrying out non-surgical treatments aimed at improving the appearance of the body or face. This has two practical consequences:
- Responsibility for the unit lies with a doctor. It is not enough for the centre simply to have healthcare staff.
- If you also carry out surgical procedures, you’ll be assigned to a different unit – the cosmetic surgery unit – which has its own requirements. Don’t confuse this with Unit 48 when applying for authorisation.
Your practice will normally be classified as a non-inpatient centre, under the category of medical practice (C.2.1), and your range of services will include U.48. The important thing is that what you do is in line with what is authorised: the Royal Decree itself links advertising and activities to the authorised scope of services.
Recent changes you should be aware of
The Royal Decree 239/2026, which came into force on 1 July 2026, has amended Royal Decree 1277/2003. It does not change the definition of U.48, but introduces safeguards that apply to all healthcare facilities, including small practices. The healthcare centre must ensure that care is provided by professionals with the appropriate official qualifications and skills, keep up-to-date records of all its healthcare staff, regardless of their employment status, and brief new staff on patient safety practices. If you share a practice or take on other professionals, bear this in mind from the outset.
In cosmetic surgery, the Ministry of Health In 2024, it approved an order amending Annex II, which was subsequently suspended by the National High Court, and has announced that it is working on other regulatory alternatives. It is worth keeping an eye on this matter, although it does not directly affect U.48.
What varies from one autonomous community to another
State legislation forms the basis, but the procedure, forms and specific technical requirements are set by each autonomous community. Some examples:
- Andalusia approved by Order of 3 April 2024 An Operational Guide for the Aesthetic Medicine Unit. Among other things, it requires the technical director and doctors to hold a specific master’s degree in aesthetic medicine or a specialism with expertise in aesthetics, and sets out requirements for premises, life-support equipment, refrigerated storage of botulinum toxin and traceability records for implants.
- Catalonia regulates authorisation and registration in the Decree 151/2017. It provides for a simplified procedure based on a declaration of responsibility for practices whose activities are limited to taking a patient’s medical history, physical examination, diagnosis and prescribing, involving only one type of healthcare professional and with a usable floor area of up to 100 m². If you carry out cosmetic procedures, your activities go beyond this scope, so you will need to follow the standard authorisation procedure.
- Other regions have their own authorisation decree and, in some cases, specific regulations on cosmetic medicine currently being drawn up. Before taking any action, check the website of the relevant regional health authority.
Personal requirements for doctors
As well as the centre’s requirements, there are requirements specific to you as a professional:
- A Bachelor’s degree in Medicine, and a specialist qualification if required by the regional government or if you wish to advertise yourself as such.
- Membership of the medical association relevant to your practice, in accordance with the regulations governing professional associations.
- Valid third-party liability insurance, a surety or other guarantee. Article 46 of the Law 44/2003 on the regulation of the healthcare professions It requires this of those practising in the private sector.
- If the community requests it, accredited training in aesthetic medicine, as is the case in the Andalusian guidelines.
Practical steps for setting up your practice
- Choose the premises with the regulations to hand. Before signing a tenancy agreement, check with the regional government and the local council to ensure that the property is suitable for residential use. If you are planning to carry out renovation work, some local authorities require authorisation for the installation before work begins.
- Prepare the technical documentation. Floor plan of the premises, activity report detailing the care services provided, list of staff and their qualifications, equipment, protocols and the contract for the collection of clinical waste.
- Apply for an operating licence specifying U.48 in the care provision offer. An inspection will usually take place before a decision is made.
- Receive the registration number and display it in the surgery alongside the sign required by your local authority.
- Check your adverts. Article 6 of Royal Decree 1277/2003 requires the centre’s registration number to be included in its advertising and stipulates that only authorised services may be advertised.
- Please let us know of any changes. New techniques outside U.48, extensions to the premises or a change of owner require authorisation for alterations.
The authorised centres are listed in the REGCESS, the Ministry of Health’s general register, which is compiled from regional registers and is available for public consultation. It is useful for checking how your centre is listed and also for verifying the details of any clinic you intend to work with.
Frequently asked questions
Can I practise aesthetic medicine in a practice that is already authorised?
Yes, provided that U.48 is included in their authorised range of services. If the practice is authorised only for other units, the practice owner would need to request an amendment before you start. Ask to see the authorisation decision.
Is a sworn statement sufficient?
It depends on the community and the type of activity. Generally speaking, where procedures involve injectable products or equipment such as lasers, ensure that the full authorisation procedure is in place and confirm this with the regional health authority.
Do I need separate insurance for the centre and for myself?
Act 44/2003 requires professionals practising in private to hold professional indemnity insurance, and this also applies to organisations providing healthcare services. Check with your insurer that your policy expressly covers the cosmetic medicine procedures you carry out.
How long does it take to get authorisation?
Decision times are set by each regional government and may be extended if documentation needs to be rectified or the premises need to be refurbished. Plan the opening with plenty of time to spare and do not book patients in before you have received the decision.
If you’d rather start out without setting up your own practice
Opening your own centre is a decision that involves both an investment and a time commitment. If you’d like to try out a particular area or timetable first, at Medars, members at Gold level and above have access to Spaces, surgery rooms that you can hire by the hour, day or month. Check the authorisation for any space just as you would for your own practice. If you have a surgery room and wish to make it available to other doctors, you can publish it on Medars. And in The Lounge You can discuss questions like these with other verified doctors.
Related guides
- How much does it cost to open an aesthetic medicine clinic?
- Malpractice insurance for aesthetic medicine: what it should cover
- Advertising in aesthetic medicine: what the regulations permit and what they prohibit
- Software for cosmetic medicine clinics: what it should include
- Working as a self-employed cosmetic doctor in various clinics
Continue exploring Medars
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- Frequently asked questions: verification, access and memberships.