Four issues were investigated, all of which were Upheld.
Four TikTok videos for Erdem Clinic, on Millie Bracewell’s TikTok page, @milliebracewell5:
a. The first video, posted on 9 August 2023, included shots of Millie Bracewell standing outside a hospital, followed by clips of her inside the hospital by herself, together with hospital staff, in the operating room, and again outside the hospital. The clips featured Millie Bracewell and the staff waving at the camera, while an excerpt from the Barbie movie was heard: “Hi Ken! Hi Barbie! Hi Barbie! Hi Barbie! Hi Barbie! Hi Barbie! Hi Barbie!” The Erdem Hospital logo appeared throughout the ad in the top right corner. The caption stated “Click the link in my bio to get 20% off any treatment/surgery using the code millieb [heart hands emoji] #foryou #fyp #erdemhospital #turkeysurgery”.
b. The second video, posted on 9 August 2023, featured different clips of Millie having food at the hospital and walking around Istanbul. The voice-over stated, “So this is two days after surgery. […] It tends to be first thing in the morning when the pain reliever’s worn off from the previous night. […] The day of surgery and the day after I just wanted to sleep. The longer I was walking the more the pain started to hurt but I dealt with it. I think that was my body just saying yeah you need rest now […]””. The caption stated, “If anyone has anyone questions regarding breast surgery feel free to ask [heart hands emoji] #foryou #fyp #erdemhospital #turkeysurgery”.
c. The third video, posted on 9 August 2023, featured Millie outside the hospital waving at the camera. She was then shown in a hospital gown and being taken towards the operating room. A surgeon measured and marked her chest and was then shown operating on her. In a further shot she waved at the camera and said “Thank you Erdem”. The logo “ERDEM ESTHETIC” appeared throughout the ad in the top right corner, and in the final shot. The caption stated, “I had an amazing experience at @Erdem Hospital definitely recommend to anyone wanting surgery! The quailty [sic] of care is phenomenal! Click the link in my bio to get 20% off any surgery/treatment using the code millieb [heart hands emoji] #foryou #fyp #erdemhospital #turkeysurgery”. The song “BLING BLING” was played in the background throughout the ad.
d. The fourth video, posted on 15 August 2023, featured Millie Bracewell getting ready and going to the hospital. The voice-over stated, “This is day 6 post-op […] we went to the hospital, and I met with the surgeon who deals with obesity so I learnt quite a bit about that. Then I went to the main office and met with the team. […] Day 1 and day 2 are the worst, but it does get better I promise. […]”. The caption stated “#foryou #fyp #erdemhospital #turkeysurgery If anyone has any questions regarding breast augmentation feel free to ask me or the hopsital [sic]! I have a code you can use for 20% off any treatment or surgery if you use the code millieb [heart hands emoji] just click the link in my bio or dm them on Instagram [white heart emoji]”.
1. The complainant challenged whether ad (a) was obviously identifiable as a marketing communication.
The ASA challenged whether:
2. ads (b), (c) and (d) were obviously identifiable as marketing communications;
3. ads (a) and (c) were irresponsible because they trivialised the decision to undergo cosmetic surgery; and
4. ads (a), (b), (c) and (d) were directed at those aged under 18 through the selection of media or context in which they appeared.
1., 2., 3., & 4. Erdem Clinic did not respond to the ASA’s enquiries.
Millie Bracewell said that the posts were not ads and that she was simply vlogging her journey. She had not received payment from Erdem Clinic, and her relationship to them was a normal customer relationship.
Ms Bracewell stated that she would never promote that type of content to under 18s and that her audience was primarily adults. She provided her audience age analytics, which showed the ratios of different age-groups that followed her account. There was no available data on the followers below the age of 18. She further stated that going forward she would be more careful and clear when organically showcasing her personal experiences.
TikTok confirmed that the posts under investigation were not marketed, sold or arranged by TikTok. They said that under their Terms of Service and Branded Content Policy, users were required to engage with their branded content disclosure tool, in order to identify the post as a marketing communication. However, the promotion of cosmetic surgery was prohibited under their Branded Content Policy, which was publicly communicated to users on the TikTok Business Help Centre. Therefore, if Millie Bracewell had engaged with the disclosure tool, the post would have been rejected under their Branded Content Policy. Notwithstanding that, at the time the content was posted, users were able to target their organic posts to age groups over the age of 18 by engaging the ‘Audience Controls’ toggle.
The ASA was concerned by Erdem Clinic’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 provide a response to our enquiries and told them to do so in the future.
1.& 2. Upheld
The CAP Code stated that marketing communications must be obviously identifiable as such, and they must make clear their commercial intent if that was not obvious from the context.
The ASA first assessed whether the TikTok videos and Instagram stories were ads. We understood that Ms Bracewell had stated that she had not received payment from Erdem Clinic, and her relationship to them was a normal customer relationship. However, ads (a), (c), and (d) included the discount code “millieb” in the caption. Because ads (a), (c), and (d) included a personalised affiliate code, which would earn Ms Bracewell commission when used, they were marketing communications for the purposes of the CAP Code. Ad (b) did not include the discount code “millieb” in the caption. However, it was posted on the same day as ads (a) and (c), and was thus connected to Ms Bracewell’s affiliate relationship with Erdem Clinic. We therefore concluded that ads (a) to (d) were marketing communications.
We then assessed whether the ads were obviously identifiable as such. Ads (a) and (c) were TikTok videos which featured Ms Bracewell and the Erdem hospital staff waving at the camera at various stages before and after she underwent surgery. Ad (c) included further clips from the operating room, and another shot in which Ms Bracewell waved at the camera and said “Thank you Erdem”. The captions in both ads featured the hashtags #erdemhospital and #turkeysurgery. Ad (c) further included in the caption ““I had an amazing experience at @Erdem Hospital definitely recommend to anyone wanting surgery! The quailty [sic] of care is phenomenal!”. We acknowledged that throughout the videos, the Erdem Hospital and ERDEM ESTHETIC logos respectively appeared in the top right-hand corner. We considered consumers would understand the videos as Ms Bracewell documenting her experience of surgery with Erdem Hospital and ERDEM ESTHETIC in Türkiye. However, in the absence of a clear and prominent identifier, such as “AD”, we considered that ads (a) and (c) did not make their commercial intent clear and were not obviously identifiable as marketing communications.
Ads (b) and (d) were two further TikTok videos which featured Ms Bracewell documenting how she felt following her breast augmentation. Both ads included the hashtag #erdemhospital and #turkeysurgery in the captions. As above, we considered consumers would interpret ads (b) and (d) as accounts of Ms Bracewell’s experience of surgery with Erdem Hospital in Türkiye. However, in the absence of any clear and prominent identifiers in the videos or captions, such as “AD”, we considered that ads (b) and (d) did not make their commercial intent clear and were not obviously identifiable as marketing communications.
On these points, ads (a), (b), (c) and (d) breached CAP Code (Edition 12) rules 2.1 and 2.4 (Recognition of marketing communications).
The CAP Code required marketing communications to be prepared with a sense of responsibility to consumers and to society. The CAP Guidance on the marketing of surgical and non-surgical cosmetic procedures further stated that ads should not trivialise cosmetic interventions or suggest that they be undertaken lightly.
Ad (a) featured a viral soundbite from the movie Barbie, combined with a swiftly changing video sequence of Ms Bracewell, outside the hospital, into the hospital, in the operating room, and again outside the hospital. Ad (c) featured an upbeat pop song, with similar imagery as ad (a), and two additional shots of Ms Bracewell being measured by the surgeon, and then in the operating room, undergoing the surgery. Throughout the ads, Ms Bracewell and the hospital staff are shown smiling and in an upbeat mood.
We considered the rapid succession of the images depicting the various stages oversimplified the process of undergoing a cosmetic intervention, suggesting it was quick and straightforward. Furthermore, because of the overall light-hearted tone of the ads, including the use of a Barbie soundbite and upbeat club-like music, and the cheerful visuals, we considered that the ads were likely to detract from the seriousness of the decision to undertake a cosmetic intervention and the seriousness of the surgery itself. We therefore concluded that the overall presentation of ads (a) and (c) trivialised the decision to undergo cosmetic surgery, and were thus irresponsible.
On that point, ads (a) and (c) breached CAP Code (Edition 12) rule 1.3 (Social responsibility).
The CAP Code required that marketing communications for cosmetic interventions must not be directed at those aged below 18 years through the selection of media or context in which they appeared. ‘Cosmetic interventions’ meant any intervention, procedure or treatment carried out with the primary objective of changing an aspect of a consumer’s physical appearance. That included surgical and non-surgical interventions, both invasive and non-invasive.
Ads (a), (b), (c), and (d) were posted organically by Ms Bracewell. Organic posts on TikTok could be targeted away from under 18s by utilising the ‘Audience controls’ toggle, but Ms Bracewell had not done so. While we did receive analytics of Ms Bracewell’s adult followers on TikTok, we understood that it was not possible to obtain data on audiences under the age of 18. Ms Bracewell therefore could not confirm that under 18s did not form part of the ads’ audience.
We also took into account the mechanics of TikTok and how content was shared with its users. We understood that TikTok’s “For You” page was the first page users saw after opening the app and the main way in which its users engaged with content. We further understood that this page was algorithmically driven, and therefore users would see content from accounts they did not follow but was likely to be of interest to them.
Because of the way organic content was disseminated on TikTok via the “For You” page, ads for cosmetic interventions, such as breast augmentations, should have been appropriately restricted from viewing by under 18s. However, Erdem Clinic and Ms Bracewell had not used the targeting tools available to them to do so. As such, we considered that insufficient care had been taken to ensure that the ad was not directed at people under 18, and therefore breached the Code.
On that point, ads (a), (b), (c), and (d) breached CAP Code (Edition 12) rule 12.25 (Cosmetic interventions).
The ads must not appear again in their current form. We told Erdem Clinic and Millie Bracewell to ensure that their future ads were obviously identifiable as marketing communications, and the commercial intent was made clear, and that identifiers such as “#ad” were clearly and prominently displayed. We also told them to ensure that their ads were socially responsible, did not trivialise the decision to undergo cosmetic surgery, and were appropriately targeted. We referred Erdem Clinic to CAP’s Compliance team.