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 Advertising Standards Authority.
Marketers wishing to advertise cosmetic or plastic surgery should be mindful of not misleading, harming or offending the public.
Over the years, the ASA has upheld several complaints against marketers who have exaggerated the qualifications of the surgeons working at their cosmetic surgery clinics. In October 1997, 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 2013, 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.
Among the subjects covered by the Guidance Note are:
1. '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 (Rule 12.3);
2. ‘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;
3. ‘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;
4. ‘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;
5. ‘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
6. 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).
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)
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 (rule 4.9).
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 target young people, vulnerable groups etc.
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 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).
For more detailed guidance, see Cosmetic Interventions: Social Responsibility.
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.
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.