An e-mail on 27 May 2011, offering discounted cosmetic surgery procedures stated "Today's deal in Manchester. Today's deal: £1,999 Instead of £5,000 for Cosmetic Surgery Such as Breast Augmentation and Rhinoplasty at Birkdale Clinic. View now. For £1,999. This deal is available until May 27, 2011 11:59 PM". Underneath, in a list of bullet points, it stated "Highlights: Choice of procedures include breast augmentation and rhinoplasty, General Medical Council-registered consultant plastic surgeon, Consultation included, Private hospitals located 20 minutes from Liverpool city centre, Dr. Adegoba has been with the clinic for over 7 years and is a member of the International Society of Aesthetic Plastic Surgeons (ISAPS), Before and after pictures always included, CQC registered clinic".
When clicking on 'view now', consumers were redirected to the Groupon website which featured the same headline and highlights as the e-mail and included the following 'Fine Print' which stated "Expires 28 November ... Must be 18 or over. All treatments subject to initial consultation. If unsuitable for treatment a full refund will be provided ... 7 day cancellation policy. Call 0151 xxx xxxx for booking and enquiries".
Further down the same page, the web page stated "Altering the physique needs a lot of careful consideration, a substantial amount of initial information and is better performed by someone who nose [sic] best. Build a bridge over the River Seineus with today's Groupon: for £1,999 get a £5,000 voucher towards cosmetic surgery at Birkdale Clinic ... Groupon grippers are offered £5,000 towards a procedure of their choice for £1,999. Those over the age of 18 can take their carefully considered bodily modifications, including breast augmentation, along to an initial consultation at Birkdale Clinic. During this in depth professional consultation, which includes browsing before and after photos, discussing suitability, and finding out whether you can realistically achieve your desired look, doctors and patients come to informed decisions over suitable procedures ...".
The Independent Healthcare Advisory Services and a member of the public challenged whether the offer was irresponsible because it encouraged recipients to hurry into a decision to purchase cosmetic surgery.
MyCityDeal (Groupon) did not believe that the promotion, and therefore, the e-mail encouraged a frivolous or rushed decision to purchase the voucher.
Groupon said the offer was available to buy for 24 hours only and the decision for that timeframe was made in collaboration with Birkdale Clinic, who provided the surgery. Groupon and Birkdale Clinic agreed on a maximum number of vouchers available to buy and they said it was possible that the offer could run again if the maximum number had not been met or if Birkdale Clinic decided to increase that number. Groupon believed that 24 hours would be an adequate amount of time to sell the agreed number of vouchers. They said this time limit was an indicator of their business model and was not indicative of pressure purchase tactics.
Groupon said that when recipients of the e-mail clicked on the 'view now', consumers saw further information about the offer. That information stated that the offer was only available for those aged over 18 years, all treatments were subject to a consultation, that you would be offered a refund if following that consultation you were unsuitable, that they offered a seven-day cancellation policy and provided a contact number for the clinic where consumers could make queries and make a booking.
Groupon explained that the day after the offer expired, consumers had the opportunity to speak with health professionals at Birkdale Clinic on the telephone or in person. Those who wanted to continue then had a further period of time in which to book their procedure. They said that those consumers were also encouraged to seek independent medical advice before fully committing themselves to a procedure.
Groupon sent a follow-up e-mail to all consumers who had purchased the voucher which explained they had established a unique multi-stage booking process for the offer. The e-mail provided contact details for the clinic, gave consumers the opportunity to attend the clinic and meet with the staff, invited consumers to arrange a consultation with a co-ordinator to receive advice about procedures and to arrange a consultation with a surgeon and it explained that consumers were given a "cooling off" period in which to reconsider their decision to have a procedure. The e-mail also provided details of the surgeons available at the clinic and a link to check their registration with the General Medical Council. It further stated that consumers were entitled to a full refund at any point. Groupon said that as of the end of September, 48 out of 186 consumers had cancelled their vouchers – eight of whom had cancelled within seven days of buying the voucher.
Groupon believed that the tone of the information in the e-mail and on the website presented the offer in a factual and honest way and was not irresponsible.
The ASA noted that Groupon had taken reasonable steps to ensure that once the voucher had been purchased, those consumers had the opportunity to contact the clinic for advice and they were also encouraged to seek independent medical advice about their intended procedure. We understood that the British Association for Aesthetic Plastic Surgeons (BAAPS) Marketing and Advertising Code of Ethics prohibited ads that offered discounts linked to a deadline date for booking appointments or other date-linked incentives. We also understood ads offering such discounts also went against the General Medical Council's good practice guide.
We noted that once the voucher had been purchased, consumers had a period of six months in which to redeem the voucher and had time and further opportunities to consider their decision before confirming their appointment with the clinic. However, we noted that those opportunities were not available without buying the voucher first.
Whilst the ad made clear that the offer was available only to over 18s, we understood that it may have been sent to those who had not previously considered having cosmetic surgery. We considered the decision to undergo physically invasive procedures was one that required substantial consideration. We understood from BAAPS that multiple consultations were required before proceeding with a cosmetic surgery procedure, and that in some cases, candidates could be referred to a clinical psychologist to help assess their suitability for surgery. We understood that once the surgeon and candidate were satisfied that they were suitable for surgery, candidates were advised to wait a minimum of two further weeks before booking and going ahead with the procedure.
We noted consumers only had 24 hours in which to buy the voucher and because of that, we considered that consumers buying the voucher would have already financially and mentally committed themselves to going ahead with a procedure. We considered the very limited time in which consumers had to buy the voucher pressured consumers into making a decision to (to all intents and purposes) purchase cosmetic surgery. We therefore concluded the ad was irresponsible.
The ad breached CAP Code (Edition 12) rules 1.3 1.3 Marketing communications must be prepared with a sense of responsibility to consumers and to society. (Social responsibility). We also investigated the ad under CAP Code rule 12.3 12.3 Marketers offering individual treatments, especially those that are physically invasive, may be asked by the media and the ASA to provide full details together with information about those who supervise and administer them. Practitioners must have relevant and recognised qualifications. Marketers should encourage consumers to take independent medical advice before committing themselves to significant treatments, including those that are physically invasive. (Medicines, medical devices, health related products and beauty products) but did not find it in breach.
The ad must not appear again in its current form.