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.
This Ruling forms part of a wider piece of work on cosmetic surgery abroad.
Summary of Council decision:
Two issues were investigated, both of which were Upheld.
A paid-for Google search ad for Care in Turkey, seen on 6 September 2023, stated “Ultimate Rhinoplasty Solution – Get Your Dream Nose in Turkey”. Further text below stated “Enhance your facial appearance with safe and natural-looking rhinoplasty in Turke [sic]. Get the best rhinoplasty experience in Turkey with safe and affordable services. World-Class Doctors”.
The ASA challenged whether the claims:
1. “World-Class Doctors” was misleading and could be substantiated; and
2. “safe […] rhinoplasty” and “safe […] services” were misleading and irresponsible.
1. & 2. Pasifik Health Services Inc t/a Care in Turkey said that they were a health services organisation that provided services in the fields of aesthetic treatments, surgeries and general health. They had gathered 1,500 “solution partners” with expertise such as health, travel, accommodation and transportation to their international patients.
They considered that Istanbul was home to some of the most advanced medical facilities in Europe. Because of this, it received international recognition and patients from all over the world. Care in Turkey and their partners strove to reach high standards in innovation, professionalism, research and development. They worked with eminent professionals to ensure that patients had a great medical experience at affordable prices.
They named some of the professionals and hospitals they worked with and attached some of their professional accreditations. They said they worked with hospitals, laboratories and health centres that had various accreditations on quality achievement, patient care and safety. They had not faced any issue, lawsuit, complaint or dispute with customers regarding the ad in question.
The ads were served via Google Ads. Care in Turkey understood Google Ads checked whether their ads complied with Google’s advertising policies. They provided an excerpt from a Google Advertising Policies ‘Help’ page which stated that they used a combination of Google AI and human evaluation to ensure that ads complied, and that they took action against ads and accounts that violated them. On that basis, Care in Turkey believed Google Ads would have imposed sanctions on them if their ads included misleading statements.
Google UK said that following the investigation, Google Ireland confirmed that the ad was served through Google Ads, a self-administered system. Under the terms agreed by the advertisers, it was the advertiser’s responsibility to abide by the applicable laws and regulations, which included the CAP Code. The ad in question was found to be in breach of Google’s policies and was disapproved.
The CAP Guidance on the Marketing of Surgical and Non-Surgical Cosmetic Procedures stated that marketers should be able to prove claims such as “leading surgeons”, “best surgeons”, “foremost surgeons” and “surgeons of the highest calibre”. They would need to show that the surgeons’ achievements and experience put them near the top of the profession in their surgical speciality nationally or internationally, depending on the context. Showing that the surgeons had held high administrative posts in the medical profession was unlikely, on its own, to be enough.
The ASA considered consumers would understand the claim “World-Class Doctors”, in the same way as the above claims referenced in the CAP Guidance, to mean that the plastic surgeons who performed rhinoplasties through Care in Turkey were near the top of their profession. Because of the wider connotations of the term “World-Class”, we considered that the context for the claim was international, and therefore that the doctors were amongst the best in the world.
Care in Turkey provided us with professional certifications relating to four of their doctors, of whom only two were Plastic, Reconstructive and Aesthetic surgeons. The certificates included: one membership to the American Society of Plastic Surgeons (2023), one membership to the International Society of Aesthetic Plastic Surgery, two Fellowships from the European Board of Plastic Reconstructive and Aesthetic Surgery (2004, 2012), and a certificate of professorship for the Bezmiâlem Foundation University.
We did not receive any evidence that contextualised those certifications within the overall standards of plastic surgery practitioners globally. Because of this, we were not satisfied that Care in Turkey had demonstrated that its doctors’ achievements and experience put them near the top of their profession worldwide. In addition, they had only provided evidence in relation to four doctors and had not confirmed that these were the only surgeons who provided services to their patients. We understood that they worked with a number of different hospitals and it was therefore likely that other surgeons also operated on their customers.
We concluded that the claim “World-Class Doctors” had not been substantiated and was therefore misleading.
On that point the ad breached CAP Code (Edition 12) rules 3.1 (Misleading Advertising) and 3.7 (Substantiation).
The ad featured the claims “safe […] rhinoplasty” and “safe […] services”. We considered that consumers would understand those claims to mean that undergoing a rhinoplasty or any other service at Care in Turkey did not carry any risks and could not result in any detriment to the patient.
We acknowledged that the credentials and certifications the advertiser had referenced related to the quality of care and conditions at the hospitals and laboratories with which they worked. However, we understood that all cosmetic surgery procedures, including rhinoplasty, carried some level of risk to the patient, including when carried out at appropriately certified institutions.
We therefore concluded that the claims “safe […] rhinoplasty”, and “safe […] services” were misleading and were also irresponsible.
On that point the ad breached CAP Code (Edition 12) rules 1.3 (Social Responsibility) and 3.1 (Misleading Advertising).
The ad must not appear again in the form investigated. We told Pasifik Health Services Inc t/a Care in Turkey not to mislead consumers by making claims such as “World-class” in the absence of adequate substantiation. We further told them not to claim that a cosmetic intervention, including rhinoplasty, was safe.