Summary of Council decision:

Three issues were investigated, of which one was Upheld and two were Not upheld.

Ad description

A TV and VOD ad, for a cosmetic surgery clinic:

a. The TV ad, which was seen by complainants at various times between 6:45 pm and 10:45 pm on a range of television channels, began with a woman standing in a bathroom. A voice-over stated "If you're unhappy with your appearance ..." as the woman, who had a long nose, scowled at herself in a mirror as she powdered her nose. The voice-over continued "... you could change it", as the woman was shown looking at herself in the mirror again, and seeing that her nose was much smaller. She mouthed "Wow", smiled, and touched her nose. A man was shown giving a business presentation, looking uncomfortable and covering his mouth with his hand as the voice-over stated "If it affects your confidence ...". A close-up showed the man had crooked teeth as the voice-over continued "... you could overcome it". The man was shown glancing to the side and seeing his reflection in a window. In the reflection he was smiling broadly at himself, displaying straight teeth. A woman was shown walking along a street with her arms crossed tightly across her chest. She was wearing a baggy jumper and looked unhappy. The voice-over stated "If it makes you feel self-conscious, you could take control with cosmetic surgery or dentistry from The Hospital Group". The woman glanced at herself in a window, did a double-take and smiled broadly. She was shown in the reflection wearing glamorous make-up and a tight, low-cut red dress which showed off her large breasts. She ran her hands over her figure, smiling. The voice-over stated "So if other self-improvement methods haven't worked, talk to the experts. And just like thousands of others, start seeing the new you". The women and man were shown smiling and admiring their new looks. On-screen text, displayed during the scenario depicting the man, stated "No surgical procedure is entirely without risk. Subject to consultation. Over 18s only".

The TV ad was cleared by Clearcast with no scheduling restriction.

b. The VOD ad, which was viewed on ITV Player, including during Britain's Best Bakery, was the same as the TV ad.


The ASA received 35 complaints.

1. Most of the complainants challenged whether ads (a) and (b) were irresponsible, because they believed they trivialised cosmetic surgery and implied happiness could be achieved through cosmetic surgery.

2. Most of the complainants challenged whether ad (a) was scheduled irresponsibly when children might see it, because they believed it could have a negative impact on young peoples' body image.

3. One complainant challenged whether ad (b) was served irresponsibly when children might see it, because they believed it could have a negative impact on young peoples’ body image.


1. The Hospital Group Healthcare Ltd said the ad showed scenarios that were relevant in everyday life, and they had drawn on patient feedback in creating the ad. Patients told them that a lack of self-confidence was a significant factor in their decision to undergo surgery, and their confidence levels rose with the positive outcome of their surgery. They had attempted to convey that message in the ad by using the smiles of admiration and a change in body language.

The Hospital Group Healthcare said the voice-over used terminology such as "if" and "could" within each scenario and later concluded "if other self-improvement methods haven't worked ...". They felt that clearly implied there were other ways of improving and enhancing the way a person felt about themselves or their appearance. There was no harm or offence intentionally implied; they were just conveying that cosmetic surgery or dentistry was an option for some people. They fully accepted that neither option was suitable for everybody.

The Hospital Group Healthcare said they had reviewed the ad again and saw no evidence of social irresponsibility. They accepted that that was the opinion of the complainants who had contacted the ASA, but it was their view that, given the number of people who had now seen the ad, that was a comparatively small number. They included the on-screen text "No surgical procedure is entirely without risk", "Subject to Consultation" and "Over 18s only" to ensure viewers were made aware of the restrictions and risks associated with surgery. They considered the ad reinforced that there was a process to follow, and there was no speedy resolution. They considered further descriptive comments might be deemed too patronising.

Clearcast considered the ad represented a balanced approach to advertising a legitimate service, and therefore was not irresponsible. Clearcast said each individual case study in the ad was demonstrated in a realistic and matter-of-fact context, representing valid reasons why people might consider cosmetic surgery, with none of the individuals being shown to have made the choice on a whim. The first woman did not like the appearance of her nose and was shown using make-up in an attempt to tone down how it looked, but she did not feel satisfied with this and so opted for cosmetic surgery. The man felt physically uncomfortable with how his teeth looked and felt it was affecting his ability to speak whilst presenting to work colleagues. The second woman would like to be able to wear clothing that would suit a fuller bust.

Clearcast said the voice-over further specified that the advertiser's service could be considered "if other self-improvement methods ha[dn't] worked", which was a clear indication that if people disliked their appearance they should consider other methods before resorting to cosmetic surgery. On-screen text also stated "No surgical procedure is entirely without risk. Subject to consultation. Over 18s only". Clearcast considered all those elements combined conveyed that individuals should give careful consideration to the options available to them before choosing cosmetic surgery.

Clearcast said the voice-over at the end of the ad indicated that people may "start seeing the new you", which cemented the fact that, after surgery, the individuals concerned were able to "see" a new image in the mirror. That was as opposed to "being" a new person. There was no indication that before surgery the individuals were experiencing wide-ranging personal unhappiness and there was no indication that they had any more wide-ranging emotional happiness after surgery. The ad laid out physical elements that the individuals did not like, and after surgery those physical elements had been addressed and the individuals were satisfied with the results.

ITV, responding in relation to the VOD ad only, did not comment on this point.

2. & 3. The Hospital Group Healthcare considered the ad had not been scheduled irresponsibly at any point. They said they only targeted adult-viewing programmes when booking advertising spots, and that their licence was limited to procedures on adults only and there was therefore no financial gain in them targeting those under 18 years of age. They highlighted that Clearcast had considered the ad did not need a scheduling restriction.

Clearcast, responding in relation to the TV ad, said there was no automatic restriction for the product category advertised, and they did not consider that the content of the ad warranted a scheduling restriction. The content was not salacious and the individuals shown were obviously over the age of 18, and were depicted as ordinary adults of a suitable age to make a decision about cosmetic surgery. That message was reinforced in the on-screen text, which carried a strong message about the potential risks of surgery. It was considered highly unlikely that a young person would see the ad, recognise themselves in it and identify with any of the individuals portrayed. Clearcast therefore considered the ad did not contain anything that might cause a young person to recognise the body of a young developing individual being singled out as being in any way at fault. They considered there was therefore nothing in the ad to inspire a young person to feel negatively about their own body. As such they did not consider the ad contained anything that could cause physical, mental, moral or social harm to those under the age of 18. Clearcast said the voice-over indicated that if a viewer identified with the individuals in the ad, they should not consider cosmetic surgery without trying other options first. The on-screen text clearly outlined that there were risks involved with cosmetic surgery and so they believed the ad did not condone or encourage behaviour that prejudiced health or safety.

ITV, responding in relation to the VOD ad, said they had procedures to guard against inappropriate and irresponsible scheduling of VOD ads. They considered the context of the programmes around which ads were served was the key principle to consider, rather than the audiences the programmes might have had on TV. They said they had been mindful of the Keogh Review and had therefore placed the ad responsibly within the ITV on-demand service in suitable and appropriate programming, for example, during Britain’s Best Bakery, Jonathan Ross and Celebrity Juice, and had targeted the London area only. They confirmed the ad was not served during any programmes on VOD which, on TV, had attracted high audiences of children of any age.


1. Not upheld

The ASA acknowledged that many of the complainants had expressed particular concern over the way in which the three character scenarios were represented. We noted the ad depicted instant physical transformations, but considered adult viewers would understand those transformations to be a dramatised representation of ‘before’ and ‘after’ surgery, rather than signifying that surgery was quick and easy or implying that cosmetic surgery was a risk-free way to change physical appearance. We considered that this was emphasised by the on-screen text which included the statement “No surgical procedure is entirely without risk”. We considered adult viewers would understand the scenarios as representations of customers who had felt self-conscious about their physical appearance and who, after surgery, were satisfied with the results. Whilst we acknowledged that some adult viewers might find the ad distasteful, we considered it did not trivialise cosmetic surgery and that adult viewers would not interpret it as implying that life's happiness could be achieved through cosmetic surgery. We concluded the ad was not generally irresponsible.

On this point, we investigated the TV ad under BCAP Code rule  1.2 1.2 Advertisements must be prepared with a sense of responsibility to the audience and to society.  (Responsible advertising), and the VOD ad under CAP Code rule  1.3 1.3 Marketing communications must be prepared with a sense of responsibility to consumers and to society.  (Responsible advertising), but did not find them in breach.

2. Upheld

Notwithstanding the above, we were concerned that children, and in particular young teenagers, were likely to interpret the ad differently to adult viewers. The ad featured three characters who were depicted as unhappy with their appearance. The woman in the final scenario and the man, both of whom attempted to cover up parts of their bodies in public settings, appeared self-conscious and lacking in confidence because they did not like how they looked. The depictions of their sudden physical transformations were accompanied by an instant and dramatic change in their emotional wellbeing. We considered it likely that many young teenagers would identify with such negative feelings about their physical appearance. We considered the ad’s scenarios were likely to reinforce harmful feelings that those who did not have a ‘perfect’ physical appearance were unattractive and should be self-conscious about their looks, should aspire to a particular ideal of beauty, and that they should take action to change their physical appearance in order to meet that ideal. We therefore considered that a scheduling restriction should have been in place to minimise the risk of children, particularly young teenagers, seeing the ad. We concluded the ad should have been given a 9 pm timing restriction.

On this point, the TV ad breached BCAP Code rules  1.2 1.2 Advertisements must be prepared with a sense of responsibility to the audience and to society.  (Responsible advertising),  4.1 4.1 Advertisements must contain nothing that could cause physical, mental, moral or social harm to persons under the age of 18.  (Harm and offence) and  32.3 32.3 Relevant timing restrictions must be applied to advertisements that, through their content, might harm or distress children of particular ages or that are otherwise unsuitable for them.  (Scheduling of Television and Radio Advertisements - Under-16s).

3. Not upheld

As referenced above, we considered the ad was not suitable to be seen by children, and particularly young teenagers. We therefore considered that it should not have been served during programmes on VOD which would be likely to attract high audiences of children, and particularly young teenagers. We noted ITV had taken action to ensure the ad was served only around programmes which, in context, they considered responsible and appropriate. We also noted that the TV audience figures data for Britain’s Best Bakery showed that the programme had very little appeal to children of any age when broadcast on TV.

We considered the programme was unlikely to have much appeal to children and young teenagers on the VOD platform. Because we understood the ad was served in such a way as to minimise the risk of children, including young teenagers, seeing it, we concluded it had not been served irresponsibly.

On this point, we investigated the VOD ad under CAP Code rule  1.3 1.3 Marketing communications must be prepared with a sense of responsibility to consumers and to society.  (Responsible advertising), but did not find it in breach.


Ad (a) must not be broadcast again without the appropriate scheduling restriction. No further action necessary in relation to ad (b).


1.2     4.1     32.3    

CAP Code (Edition 12)


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