Marketers wishing to advertise cosmetic or plastic surgery should be mindful of not misleading, harming or offending the public, and ensure their ads are socially responsible.
Over the years, the Advertising Standards Authority (ASA) has upheld several complaints against marketers who have exaggerated the qualifications of the surgeons working at their cosmetic surgery clinics. In October 1997, Committee of Advertising Practice (CAP) issued guidance on Cosmetic Surgery claims, relating both to the surgery and the clinic/clinicians who carry out the procedures. The Guidance Note on Cosmetic Interventions, which was revised in 2021, now also includes specific guidance for advertising non-surgical treatments, and includes important sections on the Use of production techniques, Before and After photographs, Responsibility, Targeting, Endorsements and Testimonials, Prescription only medicines (POMs), Botox and Sales Promotions, as well as information about the new rules surrounding placement and scheduling restrictions for under 18s.
Also among the subjects covered by the Guidance Note are:
- ‘qualified’ – surgeons looking to claim they are ‘qualified’, ‘highly qualified’ or ‘fully qualified’ should only do so if they are on the Specialist Register of the General Medical Council (GMC) in respect of a relevant surgical specialty or were practicing cosmetic surgery independently before 1 April 2002, and they should hold a Certificate of Completion of Specialist Training (CCST) in plastic surgery or an equivalent qualification. Surgeons wanting to claim they are ‘qualified’, ‘highly qualified’ or ‘fully qualified’ in a particular area of cosmetic surgery, e.g. ophthalmological procedures, should hold a CCST or equivalent in the relevant surgical speciality;
- ‘experienced’ – the ASA normally expects marketers claiming surgeons are ‘experienced’ or ‘highly experienced’ to be able to show surgeons have practiced their surgical speciality for at least 6 years, the minimum NHS requirement for completion of specialist training;
- ‘specialist’ – ‘specialist’ or ‘specialising in’ is understood to denote a surgeon whose main area of expertise is in a particular discipline, for example, cosmetic or plastic surgery;
- ‘leading’ – marketers looking to prove claims such as ‘leading surgeons’ or ‘foremost surgeons’ would need to show that the surgeons’ achievements and experience put them at or near the top of their speciality;
- ‘consultants’ – ‘consultants’ should have held an NHS Consultant post (not a locum position) or the equivalent in the speciality to which the marketing communication refers and
- clinics – marketers should hold evidence to demonstrate the pre-eminence of their clinic (not just a few of their surgeons) before claiming they are a ‘leading’ clinic and should avoid implying that all their surgeons are of a particular standard if they are not. Clinics should not link themselves with renowned locations such as Harley Street unless they carry out consultations or surgery there.
Marketers must also ensure that they hold robust clinical evidence for the efficacy of their product or service. In 2015, the ASA upheld a complaint about a hair transplant company because they could not prove that “Before and After” imagery they used represented what could generally be achieved by their patients (The Hospital Medical Group Ltd, 19 August 2015).
Similarly, in 2023, the ASA upheld a complaint about a hair transplant clinic in Turkey which stated they had “99% successful results” – a claim the ASA found they could not substantiate. As well as generally misleading customers by exaggerating the effectiveness of the procedure, the ASA considered it also exaggerated the likely success of the operation (GET DHI Hair Clinic, 11 October 2023).
Marketers should also be mindful of more general claims. In July 2014, the ASA considered that the claim “Setting the Gold Standard” without any further qualification was an objective claim that the advertiser had been achieving the highest standard in areas relating to patient care and surgical expertise, and that this had been independently measured. However, the surgical satisfaction surveys the marketer relied on to substantiate the claim did not constitute adequate evidence (Aesthetic and Cosmetic Ltd, 17 July 2014).
Marketers looking for more advice on the kind of evidence they need for cosmetic procedures should see this guidance on the level of Substantiation expected for Health, Beauty and Slimming Claims.
- Harm and Offence
Marketers must ensure that whilst a certain degree of nudity may be acceptable due to the subject matter, gratuitous nudity which could be seen as objectifying or degrading is very unlikely to be acceptable. Furthermore, marketers should be aware of the ASA’s position on gender stereotyping, which prohibits stereotypical portrayals that are likely to cause serious or widespread harm or offence.
Marketers are reminded that new placement and scheduling restrictions were introduced in November 2021 which prohibit cosmetic interventions advertising from being targeted at under-18s. Cosmetic Interventions guidance contains more information about this, and marketers may also find our guidance on Targeting, Children: Targeting and Age-Restricted Ads Online of use.
- Social Responsibility
In line with the Code, marketer should prepare their ads with a sense of responsibility to consumers and society. In particular, they should ensure that the ads are not seen to be particularly aimed at young people, vulnerable groups etc. Any ads that could be seen to exploit the insecurities of certain groups, for instance, offering a “MOMMY MAKEOVER”, are unlikely to be considered acceptable (Grand Clinic, 11 October 2023).
Generally, in ads for cosmetic surgery, the procedure should always be portrayed as something that requires time and thought – marketers looking to advertise surgery should never portray the procedure as “safe”, “easy” or “risk free” because no surgery is without risk – in 2022, the ASA upheld a complaint about a Facebook post which stated “Our breast augmentations are an easy process…” (Linia Cosmetic Surgery, 4 May 2022).
Similarly, in 2014, a poster for the healthcare travel industry in Malaysia was found to breach the Code as it trivialised breast surgery and suggested it could be incorporated into a holiday (Medical Tourism Association, 18 February 2015).
Marketers should take care to ensure that they do not exaggerate the effects of cosmetic surgery nor trivialise the decision to have it – in 2022, the ASA upheld a complaint about an email ad for cosmetic surgery which stated a procedure could improve wellbeing and skin condition, increase energy levels and help customers get more sleep (Transform Hospital Group Ltd, 11 May 2022).
Although the ASA has ruled that it is not necessarily irresponsible to offer surgery as a gift or a prize, marketers should take particular care when executing and administering these types of prize draws or competitions. As competitions/prize draws are often time limited, offering invasive surgery as a prize could be seen to be irresponsible. Furthermore, it could be seen to trivialise the procedure (rather than a risk which requires careful consideration), which in itself could be viewed as a breach of the Code.
In 2022, the ASA investigated a Black Friday deal from Transform. The ad, which was in the form of an Instagram post, stated “If you have been considering breast surgery and haven’t yet booked, there is no better time. We have Black Friday prices on breast surgery starting from just £5990”. The ASA found that the reference to Black Friday implied that there was a very limited window of opportunity to take up the offer, and since the ad created a sense of urgency, it breached the Code (Transform Hospital Group Ltd, 13 April 2022).
Marketers may find the Promotional Marketing guidance useful – however, we recommend that marketers wishing to advertise a sales promotion for cosmetic surgery contact Copy Advice in the first instance. In addition, the Cosmetic Interventions: Social Responsibility guidance contains more on promotions in this sector.
- Services offered abroad
As well as ensuring ads comply to the above, marketers for cosmetic surgery abroad should also bear in mind that linking surgery to a holiday may trivialise the decision to undergo the procedure. (Estheday and Egemed Hastaneleri, 10 May 2023). If advertising a package, marketers should bear in mind that, whilst they can mention other elements of the package, such as any hotels and flights, ads should first and foremost present the service as cosmetic surgery rather than a vacation.
Marketers for cosmetic surgery abroad are reminded of the requirement to include information about the need for a pre-consultation to assess any potential contraindications and general suitability for patients (Clincexpert Hospital, 11 October 2023). Ads should also include all other material information – for instance, ads should not mislead as to the location of any step of the process.
Note: This advice is given by the CAP Executive about non-broadcast advertising. It does not constitute legal advice. It does not bind CAP, CAP advisory panels or the ASA. CAP’s AdviceOnline entries provide guidance on interpreting the UK Code of Non-broadcast Advertising and Direct & Promotional Marketing.
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