The Last Word: Before and After Images

By Natalie Haswell / 18 Sep 2020

Nurse prescriber Natalie Haswell explains why she no longer uses before and after photos for marketing

The Advertising Standards Authority (ASA) and the Committee of Advertising Practice (CAP) has always reminded practitioners that it is prohibited to use before and after images for prescription-only medicines (POMs) like botulinum toxin or ‘Botox’ in marketing.

In fact, as we know, it’s prohibited in the UK to market POMs to the public at all, including vitamin and hay fever injections for example, unlike in the US.1 In January, this was reinforced after the CAP and the Medicines and Healthcare products Regulatory Agency (MHRA) issued an Enforcement Notice to the beauty and cosmetic service industry due to minimal compliance from injectors.2,3

This reminder prompted me to revise my own marketing efforts, not just for toxin, but every message I was sending my patients. What I realised was that some of my own social media posts (notably the before and after images) did not actually give the right or appropriate messages that I believe in: safe, bespoke treatments. So, I decided to delete all my previous before and after posts on my social media and website and not use ANY (including for filler and skin treatments) in future.

This article will discuss the relevance, reliability and significance of before and after images in marketing for not only the consumer, but other injectors and the aesthetics industry as a whole.

Using before and after images in marketing

Personally, I have great concerns for the younger and vulnerable generation with regards to what message before and after photos are actually giving. Often, pictures are promoting certain products and specific individual results, which is not educational for the consumer. Importantly, the same results cannot be achieved for every patient; 1ml of product, three chemical peels or medical-grade skincare will not give the same results to everyone, and not every patient is suitable for every treatment. So how are one person’s before and after photos of these treatments beneficial to anyone but the patient in question?

Mentioning certain products when sharing good before and after photos can also influence consumers to ask for them specifically, when they might not actually be suitable for them. This could be filler, skincare or skin treatments – in fact I once had a patient that said they wouldn’t come to me unless I used a certain product! In my experience, often the only thing patients can tell me about the product/ treatment they think they want is the name, not actually what they need to know for their own health and safety and if it’s actually of benefit to them.

This is concerning, and as medical professionals I feel it is our duty of care to educate the public that not one treatment, amount, product or procedure fits all. Ensuring patients are aware that it’s not just about price, photos and results – but that their safety comes first – is paramount.

It has been reported by Save Face that the public predominantly choose practitioners based on social media following and pictures of aesthetic treatments.4 The same report also suggests that the majority of the complaints received by Save Face came from patients who sought an aesthetician or injector on social media for their images and predominantly nothing else. So, actually, how reliable and safe is this kind of marketing?

It’s my opinion that as medical professionals we should focus on educating the public to source well trained, educated and experienced professionals with appropriate knowledge, qualifications and word-of-mouth reputation, not just simply posting a before and after photo. Encourage patients to find someone who can assess and consult them according to their holistic needs/ desires, not to simply administer the treatment they demand.

The possible concerns I have with the marketing of before and after photos are outlined in Table 1, as are the potential positives/benefits. I do feel that there are some positives of before and after imagery, however I feel they are dependent on the honesty of the practitioner. I also believe that the benefits are more valuable to the market and the injector, not really the patient. In my practice, the way I use before and after images is through the consultation to show potential patients some of my treatment results (with consent as per GDPR of course).

The solution

We know that patients like seeing before and after images. However, I believe practitioners should be actively promoting the consultation, assessment and the knowledge and expertise of the practitioner; not the drug, amount, brand, product or treatment. This, I believe, is more beneficial for the patient.

I am not saying we should stop taking before and after images or ban them; they do absolutely have their place for tracking a patient’s unique treatment journey, for insurance and legal purposes and for the further education of colleagues. But I do think we need to be more responsible in how we use them in marketing for the mental health of our current and future patients.

Official guidance focuses specifically on POMs and advertising, and I believe a universal framework or guidelines on all aesthetic marketing would be useful for all to follow to ensure patient safety and continuity. Alternatively, looking at other ways to show aesthetic results digitally would be beneficial for patients and aesthetic injectors.

Patients should be encouraged to research a practitioner for their skill, visible real-life results from friends and family, reputation, word of mouth, ethics, legal responsibility and accountability, safety and qualifications, not just their before and after images.

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