I got my first Botox injections at a plastic surgeon’s office. As with any visit to a doctor, I never even considered tipping. Years later, I tried Botox at a local medical spa, and when I went to pay for my service, I was prompted to add a 15%, 20% or 25% tip.

I was thrown off. I had been paying for Botox for years without tipping, and suddenly I was asked if I’d like to add over $100 in gratuity on an already expensive procedure. I had no idea what the etiquette was. In the rules of tipping culture, you’d never add gratuity for a medical procedure, but you would for a spa service. So what happens at a med spa, which offers both medical and spa treatments?

After a fruitless Google deep dive proved that the internet is divided on the issue, I asked three med spa professionals from across the country about whether tipping for Botox is expected, and if they could clear up some common misconceptions around med spa etiquette.

If you’re concerned that an added gratuity could impact an already expensive procedure, there’s good news: The med spa professionals I interviewed were in agreement that tipping is not necessary for Botox — or any other injectable procedure — at a med spa.

“It is not industry standard to tip for injectables,” said Michelle Paty, a double board-certified nurse practitioner who is the founder and lead injector at Preva Aesthetics in Encinitas, California. “Since the procedures are performed by licensed medical professionals ... tipping is not something that is expected or that is generally practiced.”

“You should be paying for the service only, without a tip on top,” said registered nurse Selika Gutierrez-Borst, who works as an injection specialist at Impressions Face + Body in Chicago. Since cosmetic injectables “are considered medical treatments,” tipping for them “could potentially blur the lines of the patient-provider relationship,” she said.

However, “people should tip for nonmedical procedures at med spas,” including lash and brow treatments, facials, and waxing, said Tracy Beluscak, an advanced registered nurse practitioner and advanced aesthetic injector at Elase Medical Spas in St. Augustine, Florida. “The pay scale for nonmedical personnel would fall into a category of employees who often depend on tipping as part of their overall compensation package. This rate should follow typical tipping patterns of 15-22%.”

Still, Gutierrez-Borst suggested that tipping for nonmedical procedures at a med spa “can be a bit nuanced.”

“If the med spa is owned by a physician, tipping might be seen as fee splitting, which can be tricky,” Gutierrez-Borst noted. “However, if the med spa is not physician-owned and the service is nonmedical — such as a brow wax or facial — then, sure, tipping is totally acceptable. As for how much? The amount should be whatever the client feels comfortable with; I don’t feel there’s any rule book. Just tip what feels right.”

Tipping aside, med spa customers receiving cosmetic injectable treatments should be mindful of potentially rude behaviors.

“Wearing makeup to your appointment is not preferred,” Beluscak said. “Ensure your skin is clean prior to a procedure to minimize any risk of infection or adverse events. It is a matter of safety.”

“It’s best to arrive with a clean face,” Gutierrez-Borst added. “If that’s not possible, be prepared to remove all makeup to maintain a sanitary environment.”

“I don’t mind when another adult comes to the appointment with my clients,” Paty said. “Many clients like to have a support person, especially if they aren’t comfortable with needles.”

However, you should make sure your plus-one is “not expecting a free consultation,” Gutierrez-Borst noted.

“Having food or drinks with you is fine. Just try not [to] actively eat or drink during your visit,” Gutierrez-Borst recommended. “Be mindful of where you place these items, especially in the clinic rooms where treatments happen.”

Some people tend to feel dizzy or lightheaded around needles. In such cases, “we welcome clients to bring their own food, and we also provide light snacks,” Paty noted.

Texting is appropriate in the lobby, but making phone calls is not. And “devices should be silenced during the appointment or consultation to avoid distractions and get the most out of your time with the provider,” Beluscak said.

“Most providers really want to make sure their patients are pleased with their outcomes,” Gutierrez-Borst said. “If you’re not happy with your results, be sure to talk to your provider about it. This gives them a chance to understand your concerns and find a solution that works for you.”

“The worst thing to do is to seek out Dr. Google, friends or even other providers who don’t have [the] context of what treatments were done,” Paty added. “If, for whatever reason, a client feels like their provider isn’t taking their concerns seriously, I recommend getting a second opinion. But the first step should always be working with your current provider and making them aware of your concerns.”