Summary of Council decision:
Five issues were investigated, all of which were Upheld.
In June 2023 the United Nations confirmed that, following a request from their government, that the Republic of Turkey would henceforth be identified as the Republic of Türkiye. Although the change has been implemented we have used the former here because it is currently more commonly understood by consumers and reflects the language used in the advertising content considered in this case.
A paid-for Facebook ad for Egemed Hospitals, promoting cosmetic surgery in Turkey, was seen on 30 November 2022.
The ad stated “Health and vacation together in the Turkish holiday centre Kusadasi [heart eyes emoji] Professional hospital, professional doctors…” and “[sun emoji] Summer sale [parasol emoji] [present emoji] 3-zone facial botox [...] Transactions included in the Mommy Makeover package . tummy tuck. breast surgery. Liposuction [pin emoji] The all-inclusive package includes; preoperative tests, operations, Medication and care after surgery, 24/7 interpreter support, luxury hotel, VIP transfer, and lifetime online support”.
Large text next to an image of a smiling woman holding a young child stated “TIME TO REFRESH YOURSELF! MOMMY MAKEOVER”. Underneath it stated, “ALL INCLUSIVE / NO HIDDEN COST”. Text underneath detailed what was included in the package. Further text stated “£4200 No waiting list, A World-Class Hospital, Perfect Service” and underneath appeared a graphic of a gift box with text stating “3 Zone Facial BOTOX” next to it.
The Joint Council for Cosmetic Practitioners (JCCP) challenged whether:
1. the ad, which encouraged consumers to travel abroad for cosmetic surgery and to treat it as a “vacation”, was irresponsible because it trivialised the decision to have cosmetic surgery;
2. the reference to a “Summer sale” pressured consumers into purchasing surgery and was therefore irresponsible; and
3. the ad breached the Code because it advertised Botox, a prescription only medicine.
The ASA challenged whether:
4. the ad misleadingly omitted information regarding the need for a pre-consultation to assess the patient’s potential contraindications and suitability for the procedures, including where such a pre-consultation would take place; and
5. the claim “TIME TO REFRESH YOURSELF! MOMMY MAKEOVER” was irresponsible because it exploited new mothers’ insecurities around body image.
Egemed Hastaneleri t/a Egemed Hospitals (Egemed) did not respond to the ASA’s enquiries.
Facebook had no comments in relation to the ASA’s investigation.
The ASA was concerned by Egemed’s lack of response and apparent disregard for the Code, which was a breach of CAP Code (Edition 12) rule 1.7 (Unreasonable delay). We reminded them of their responsibility to respond promptly to our enquiries and told them to do so in future.
The CAP Code required marketing communications be prepared with a sense of responsibility to consumers and to society.
The ad made reference to a “vacation” and featured a series of relevant emojis. The ad also gave emphasis to items of the cosmetic surgery package which people would closely associate with holidays such as: “luxury hotel”, “VIP transfer” and “all-inclusive package”. We considered that the ad was not likely to be interpreted as promoting a holiday; rather, its purpose was clear that it was for cosmetic surgery abroad. However, because the overall emphasis of the ad, the wording and visuals, focused on the travel and the cosmetic intervention, it was likely to detract from the seriousness of the surgery offered. It was also relevant that the surgery would take place abroad which raised the potential for additional risks such as: whether the doctors and treatment providers would have the same standards of care and safety as in the UK and how any arrangements for follow-up care and dealing with any complications which arose would be managed. We considered that the ad could be interpreted as suggesting that surgery was a decision that could be undertaken lightly as part of a holiday, without serious consideration of the nature of the intervention. We therefore concluded that the overall presentation of the ad was likely to be seen as trivialising cosmetic surgery.
On that point the ad breached CAP Code (Edition 12) rule 1.3 (Social responsibility).
We considered that although it would not necessarily be irresponsible to offer promotions for surgical procedures, marketers would need to take particular care when executing and administering them.
The ad referred to a “Summer Sale” accompanied by holiday themed emojis. We considered that consumers would, in the absence of a specific time frame in the ad, interpret the reference to “Summer Sale” to mean that there was a time-limited opportunity to take up the offer.
We considered that cosmetic surgery should be portrayed as something that required time and thought from consumers, because of the seriousness of a decision to undertake an invasive medical procedure. By advertising the “Summer Sale”, a promotion which offered “3 zone facial BOTOX” as a free gift, with no indication of a specific time frame, consumers could be rushed into making an important decision without having sufficient time to consider the consequences. Because it created a sense of undue urgency to respond quickly, we considered that the ad had not been prepared in a socially responsible manner, and therefore concluded that it breached the Code.
On that point the ad breached CAP Code (Edition 12) rule 1.3 (Social responsibility).
The CAP Code stated that prescription-only medicines (POM) must not be advertised to the public.
We understood that Botox was a POM. The ad featured two separate references to a free gift of “3 zone facial BOTOX” as a part of Egemed’s “Summer Sale” promotion. We therefore considered that the ad promoted a POM to the general public in the UK and concluded that it breached the code.
On that point the ad breached CAP Code (Edition 12) rule 12.12 (Medicines).
The CAP Guidance on Cosmetic interventions stated that marketers should not imply that invasive surgery was a “minor procedure” or similar if that claim was likely to mislead as to the complexity or duration of the operation, the pain experienced either during or after the operation, the length of the recovery time or the potential side-effects. Ads should not mislead as to the likely commitment required for pre-consultation, surgery, recovery and post-operative assessments.
The ad omitted information regarding the need for a pre-consultation to assess the patient’s potential contraindications and suitability for the three procedures advertised, including where such a pre-consultation would take place. We understood that a pre-consultation would be necessary in order to discuss the patient’s concerns and suitability for the procedures, outline the complexity or duration of the operations, the pain during or after the operation, the length of recovery time and the potential risks and side effects. While we had not received a response from the advertiser, we understood it was likely that those pre-consultations might sometimes need to take place in person rather than remotely. In this case, three significant medical interventions were included in the package: “tummy tuck”, “breast surgery” and “Liposuction”, each with their own risks and recovery times. We considered that in the context of an ad for cosmetic surgery abroad, information regarding the necessity for pre-consultations and where those would take place was material information necessary for consumers to make a considered decision and should have been included in the ad. Because that material information was not included we considered that the ad was misleading.
On that point the ad breached CAP Code (Edition 12) rule 3.1 and rule 3.3 (Misleading advertising).
The CAP code required that marketing communications must not include gender stereotypes that were likely to cause harm, or serious or widespread offence.
We considered that women may already be body conscious because of pre-existing societal pressures and that any concerns and anxieties about their weight and shape were likely to have been heightened after giving birth.
We considered that the image of a new mother with her young child with the claim “TIME TO REFRESH YOURSELF! MOMMY MAKEOVER”, in the context of an ad for a package of cosmetic interventions which included a tummy tuck, breast surgery, liposuction and Botox, exploited the insecurities of mothers about their body image and perpetuated pressure for them to conform to body image stereotypes.
We concluded that the ad presented a gender stereotype regarding body image in a way that was likely to cause harm and therefore breached the Code.
On that point the ad breached CAP Code (Edition 12) rule 4.9 (Harm and offence).
The ad must not appear again in the form complained about. We told Egemed Hastaneleri t/a Egemed Hospitals to ensure that their ads were socially responsible and did not present the decision to have cosmetic surgery as a trivial one, nor a decision that should be rushed in order to meet the deadline for a promotional offer. We told Egemed not to advertise prescription-only medicines to the public. We told Egemed not to mislead consumers by omitting material information regarding cosmetic surgery procedures abroad and the need for a pre-consultation, including where it would take place. We also told them not to present gender stereotypes regarding body image in a way that was likely to cause harm.
We referred the matter to CAP’s Compliance team.