As the joint owner and practice manager of an aesthetic clinic, part of my daily routine is to be responsible for all of the marketing and advertising requirements to run a successful business. However, even with a strong marketing background of 15 years prior to entering the aesthetic arena, little can prepare anyone for the ethical and moral issues surrounding the advertising of aesthetic procedures to the general public. The dilemma aesthetic practices face is governed largely by the necessity to operate within strict advertising regulations that do not contravene the standards of the Advertising Standards Agency (ASA) and the Committee of Advertising Practice (CAP), while at the same time promoting what are, essentially, medical procedures to the general public.
Here are just a few of the questions we should be considering before committing to any advertising or marketing campaigns: Are we acting ethically as advertisers? Are we using subliminal messages to gain more business from our competitors? And most importantly – are we acting with a sense of responsibility to the consumer when we prepare our marketing material?
A subliminal message that is positive, transparent and reassuring to the patient regarding our services is far more preferable and professional compared to undermining our competition in a negative manner. To begin, it must be decided what the differences between ethics and morals are. One definition describes how, “Ethics and morals relate to ‘right’ and ‘wrong’ conduct. While the terms are sometimes used interchangeably, they are different: Ethics refer
to rules provided by an external source (e.g. codes of conduct in the workplace), while morals refer to an individual’s own principles regarding right and wrong.”
1When considering the best approach to marketing clinical procedures we should not be placing the emphasis on the services we offer, but rather on how these treatments can be offered ethically and responsibly to the consumer.
The CAP offers guidance to help advertisers interpret the UK Code of non-broadcast advertising.2 This guidance covers the marketing of surgical and non-surgical interventions. Non- surgical interventions include treatments such as botulinum toxin injections, dermal fillers, chemical peels and non-ablative laser treatments, amongst others. The CAP Code is explicit in defining what constitutes an advertising statement (i.e. claim). This can be implied or direct, written, spoken or visual – the name of a product can constitute a claim. Therefore, at each stage of the marketing process, every communication we use must be “prepared with a sense of responsibility to consumers and to society.”2So, how do we implement these principles into the daily running of our aesthetic practice? From my own experience as the first point of contact both on the telephone and front of house, a number of issues arise that highlight the need to apply these principles. Members of the public are at their most vulnerable when calling a clinic for the first time. Recent market research from Allergan UK on the timeline from first considering a non-surgical procedure to calling a clinic to book a consultation had a surprising result – it can take a patient up to 10 years to make the decision.3 The manner in which we deal with potential customers in this first instance is key to building trust and confidence prior to the consultation process. At this stage, transparency of service is vital; we should be listening to each individual’s needs and expectations and not focusing on promoting specific treatments – even if this is inevitably part of the process. Patients often ask about the credentials of the practitioner who will be performing their treatment, and, according to the CAP Code (11.9):2
“If we are to include a statement about a practitioner in our marketing material we must be able to provide suitable credentials – for example evidence of relevant professional expertise or qualifications, systems for regular review of skills and competencies, suitable professional indemnity insurance covering all of the services we provide, accreditation by regulatory bodies that has systems for dealing with complaints and taking disciplinary action, and has registration based on minimum standards for training and qualification.” This information should be made readily available to patients when they speak to clinic managers or members of staff when booking consultations.Current indemnity insurance certificates should be on display in all clinics for the patient’s reassurance, as should current membership of regulatory bodies such as Nursing and Midwifery Council (NMC), General Medical Council (GMC) and General Dental Council (GDC).
Professional bodies
Professional associations such as the British Association of Plastic Reconstructive and Aesthetic Surgeons (BAPRAS), the British Association of Dermatologists (BAD), the British Association of Aesthetic Plastic Surgeons (BAAPS), the British College of Aesthetic Medicine (BCAM) and the British Association of Cosmetic Nurses (BACN) together represent the vast majority of medical clinicians within the industry. As members of these associations, practitioners will have access to much of the information they require to run an ethical and professional clinic. Implementing this information and communicating this association clearly in your clinic will assure patients that you practice within the remit of a professional association that is committed to patient safety and wellbeing.
Displaying logos/kite-marks of professional associations both in the clinic and on websites with links attached, as well as on advertising material, gives the general public a point of reference to research when selecting a clinic for treatment.
Promote the ‘consultation’ – not the product
There are some exceptions for websites, principally, those for clinics and pharmacies offering consultations for
the treatment of lines and wrinkles. Such websites may provide information about a prescription only medicine (POM), such as botulinum toxin, in the context of the product being a possible treatment option following a consultation. Marketers offering botulinum toxin may for example, include the claim “a consultation for the treatment of lines and wrinkles.” The CAP says “The offering of a ‘consultation’ in the first instance is paramount because the name of the POM should not be referenced in the initial advert. No reference to a POM should be made on a sponsored ad link, a home page of a website, logos, testimonials or hover text, and any small print at the bottom of a home page should not refer to POMs or directly link consumers to a page where it is referred to. Price lists included on a website should not include product claims or encourage viewers to choose a POM based on the price. Marketers should ensure that the casually browsing consumer does not come across information relating POMs with ease.”4
The ASA recently upheld a complaint about an advert where Botox was the subject of the website, not the consultation itself.5 Promoting the ‘consultation’ and not the product when speaking to customers is very important. The ASA considers that the information on a website “has to be balanced and factual and must be presented in the context of an advertisement for the service i.e. the consultation.”4Another important factor to remember is that, when producing marketing material, botulinum toxin can only be mentioned to treat areas for which the product is licensed. Marketers should not include information in their adverts that suggest botulinum toxin can be used to treat areas other than those areas for which the product is licensed.6 Advertisers should look for information and specific advice on the advertising and promotion of medicines in the UK on the Medicines and Healthcare Products Regulatory Agency (MHRA) website.7
One area of marketing which is often open to abuse is the misleading claims of results post treatment for the average patient. We often see advertisements including visual claims that exaggerate the effect that the cosmetic intervention is capable of achieving. The ASA states that it, “Expects marketers to ensure they retain appropriate material to be able to demonstrate whether any re-touching has been carried out. This might include ‘before’ and ‘after’ images showing the effect of both pre- and post- production techniques as appropriate.”8If we decide to include before and after photographs to demonstrate the possible outcomes of treatment, it is preferable to include photographs of patients that have been treated by the practitioner, rather than generic photos from manufacturers’ websites. These photographs should relate specifically to the treatments that have been performed by the practitioner and, if necessary, the eye area may be blocked out at the request of the patient.
It is important to note that all parties concerned must sign a consent form prior the use of any photographs. From the patient’s point of view, it reinforces the professionalism and transparency of practice of the practitioner who will be performing their treatment. In summary, our ‘ethics’ in advertising and marketing our services to the general public should be based on the guidelines available from organisations such as CAP and ASA, and our ‘morals’ should be self-governing. As an industry, we are obligated to move towards a stance of moral integrity, putting the general public’s safety as our first priority. We should constantly ask the question, “How would you expect to be treated as a patient?” If we don’t sell, but advise on the basis of need, we are fulfilling our moral objective because we are focussing on the patient’s perspective of need and expectancy, and using our medical expertise to analyse the best treatment programme, rather than being influenced purely by the services we offer in the first instance. Often patients come to us expecting a specific treatment which may not necessarily produce the best results based on a full consultation and analysis of a problem area.
All aesthetic practitioners should take these points into consideration. Making claims about our services and products according to the CAP Code should be based on “documentary evidence and adequate substantiation.”8 In a competitive market place and a rapidly growing industry, public awareness of our services is key to successful and on-going business development. Therefore, moral obligation and responsibility to the patient should be pervasive throughout the whole process. 
