Compliance surrounding advertising guidelines within the aesthetics industry could be better. This is partially due to a lack of awareness of the rules. Clinicians have an ethical and moral responsibility to safeguard the public concerning advertising in the industry and provide an honest yet educational narrative.
Advertising via social platforms is crucial for clinics’ success. An ever-growing quantity of new users, teamed with the continual growth of social media, has led to a significant increase in digital advertising.1 However, extreme care should be taken by clinicians, as advertising can easily influence vulnerable viewers. Pondering cosmetic intervention material on social media platforms, spending large amounts of time viewing such media and having negative self-views are all associated with an increased likelihood of undergoing cosmetic procedures in the future.2
Engaging with existing or prospective patients is critical to any clinic’s success. Advertising in aesthetics, especially on social media, provides an opportunity to highlight work and results, develop trust with prospective patients, build brand awareness and share success stories. But while digital marketing and highlighting services may seem clear-cut, it is easy to breach advertising regulations put in place by the Advertising Standards Authority (ASA) and Committees of Advertising Practice (CAP).2
When clinicians disseminate factual and evidence-based information, however, they can help counteract some of the misinformation available on such platforms. Clinicians are responsible for promoting the best interests of their patients, and making the online social community safer.
Reaching existing and prospective patients
As practitioners, I’m sure most of us can see that social media is currently the primary source of advertising in the aesthetics specialty. This form of communication allows clinics to reach patients in real-time and at a more significant rate and wider reach than traditional forms of advertising.
Conventional forms of advertising, including television, radio and print, should still be engaged with if this is within your scope as a practice, but social media is the ideal avenue if your clinic has limited budget for advertising, as you can get your name out there at no expense to yourself.
Ethical considerations for social media advertising
A study has shown that individuals with body dysmorphia disorder (BDD) commonly use and spend vast amounts of time on social media.6 According to a 2022 literature review published in Clinics in Dermatology, 76% of BDD individuals undertake cosmetic treatments to fix perceived defects.7 Patients with this disorder are vulnerable to the pressures of social media and our increasingly digital world. Viewing such content can negatively affect their self-esteem, psychosocial wellbeing and mental health, and it is pivotal that clinicians are aware of and safeguard the public, especially in a specialty like aesthetics which has an increased likelihood of attracting vulnerable patients.8
In fact, the CAP Code states that cosmetic practitioners have a ‘social responsibility’ to handle body image sensitively, hence not implying that one body type or appearance is preferable to another, as this may exploit insecurities.9
In my view, there are basic ethical principles clinicians should consider to ensure treatments are responsibly promoted to uphold the best interests of patients:
- Autonomy: are patients fully informed of the risks, benefits, outcomes and alternatives? As clinicians, we face the challenge of ensuring that patient expectations are realistic.
- Non-maleficence: as a clinician, we are under a moral obligation to do no harm and to abide by our duty of care, as well as not putting financial gain before risk to our patients – we must keep potentially vulnerable viewers in mind.
- Beneficence: as a clinician, anything we do must be in the patients' best interests – we should ensure the advertising material we release is factually accurate and not misleading.
These principles are reflected in the CAP’s various areas of regulation around social media advertising – adhering to these is imperative to protect yourself and your patients.13
It is crucial to acknowledge that an infringement of the CAP code can lead to a referral to the Medicines & Healthcare products Regulatory Agency (MHRA) or professional regulatory bodies such as the Nursing and Midwifery Council (NMC), General Medical Council (GMC) and General Dentistry Council (GDC). Such infringement may result in a fitness to practise investigation and potential further repercussions; therefore, compliance as clinicians is paramount.9
Advertising regulation
Under-18s
Following a public consultation in May 2022, new guidance from the CAP and Broadcast Committee of Advertising Practice (BCAP) has implemented restrictions forbidding cosmetic intervention adverts directed at under-18s.10 The restrictions also state that such ads must not be promoted when the audience is more than 25% under-18s.10 The consultation determined that young people and children can be particularly susceptible to developing negative body image.10
Because of this, social media advertising can have a big impact on their self-esteem.10 When it was published, director of communications at CAP Shahriar Coupal commented, “The new rules will ensure ads for cosmetic interventions can’t be targeted at under-18s and, where children and young people do see them, our strict content rules mean the ads can’t be misleading or exploit the vulnerabilities of their audience.”10
Ensuring under-18s are not influenced by social media content can be difficult to navigate as most business accounts are public, open profiles that any user can browse. Using built-in analytics to check audience demographics regularly is a great way of knowing who is actually following you. My clinic’s social strategy includes in-house regulations of not posting any cosmetic injectable results from patients under the age of 25. Our users are more likely to be influenced by the results of patients of a similar age/appearance, so limiting this narrative helps.
Time-limited offers
Time-limited promotions like sales, discounts or competitions publicised on social media must be approached with caution. The CAP Code states that cosmetic interventions should not be trivialised, and that pressurising a prospective patient to decide to engage in treatment may do just that.9,11 The ASA states that patients should have ample time to consider treatment, and should have a cooling-off period before being obliged to commit to a procedure.11
In 2022, the ASA ruled against a cosmetic surgery clinic after they posted a Black Friday promotion on Instagram offering a discount on breast surgery for a set period of time.12 The ASA found that this time limit may prompt patients to make a decision hastily due to fear of missing out.12
Moreover, in 2013, a claim was upheld against a non-surgical aesthetic clinic when it posted an advert saying, ‘But hurry, offer must end midnight this Friday the 23rd of November’, which the ASA deemed to be trivialising cosmetic procedures.11 Patients should have ample time to decide whether or not to opt for a cosmetic procedure without any element of pressure.11
Influencers
Utilising influencer marketing can be an effective way of promoting your clinic, but certain rules must be followed. In the eyes of the CAP and the ASA, an influencer is anyone with an active social media account on any platform – there is no requisite number of followers needed to qualify.13
The main thing to be mindful of is that any free or discounted treatment provided to an influencer for promotional purposes must be clearly identifiable.13 In 2019, the ASA conducted research which showed that social media users struggled to differentiate between promotional and non-promotional social media content,14 so this year, the boundaries were made clearer.
Influencers must now disclose that promotional material is an ad at the beginning – ideally at the start of a caption or video.13 An advertising disclaimer should not be buried in a long list of hashtags, or hidden at the corner of an image/video.13 The ASA finds the following disclaimers to be acceptable: ‘advertisement feature’, ‘ad’, ‘advert’, ‘advertising’ or ‘ad feature’.13 This is because they are explicit enough for a viewer to understand, avoiding any potentially ambiguous industry jargon.13 Just tagging the clinic or practitioner who administered the treatment is not sufficient.13
A recent ASA ruling found an aesthetic clinic to be in breach of these rules after influencer Carl Woods posted on his Instagram story about botulinum toxin treatments he received and did not explicitly disclose that they were ads.15 The ASA concluded that a clear ad disclaimer must appear in any future material, rather than just tagging the clinic as he did.15 The product appearing in the ad also posed a regulatory issue as it was about a prescription-only medicine (POM), as outlined below.
Another consideration for using influencers to promote products, treatments or services is editing or filtering to enhance images. The use of filters in ads is allowed, but becomes problematic if a filter exaggerates the efficacy of the advertised product and misleads the consumer about what the product can achieve.20 If this is the case, the responsibility ultimately lies with the advertiser.20 When entering commercial agreements with influencers, brands may wish to clarify their responsibilities when marketing cosmetic products on social media and advise them against using beauty filters if they are likely to exaggerate the efficacy of the product.20
Prescription-only medications
A key consideration when advertising anywhere is that POMs cannot be advertised to the public.16,17 In aesthetics, this frequently applies to public advertisements for botulinum toxin. Social media has been specifically identified by the Joint Council for Cosmetic Practitioners (JCCP) as an area of concern where many breaches of this rule have been identified.18
On social media, botulinum toxin and other POMs must not be promoted in any way as patients can only access them following consultation and prescription from an appropriately trained registered practitioner.16,17 Using the aforementioned ASA case as an example, the clinic in question stated that because they referred to the toxin as ‘anti-wrinkle injections’ rather than explicitly saying toxin or Botox, they believed they would not be in breach of ASA rules.15 However, any phrase which implies the use of botulinum toxin is prohibited; this also applies to imagery and hashtags.16,17
A full explanation of these regulations is beyond the scope of this article, but they were explored in Aesthetics in June 2023, and can be found online.19
A positive influence
Social media holds the most significant influence and is the primary source of advertising in the aesthetics industry. Social advertising allows prospective patients to get to know a clinic before considering an appointment. Young vulnerable people are, more than ever, exposed to this form of advertising due to a surge in internet users and social media prevalence.
As such, clinicians play a pivotal role in safeguarding the public by ensuring their advertising is morally, ethically and lawfully compliant, which will also protect their professional body registration.
