The Last Word: Cosmetic Surgery Adverts

By Mr Nigel Mercer / 14 Nov 2018

Consultant plastic surgeon Mr Nigel Mercer argues for the ban of cosmetic surgery adverts

The concern

We are all familiar with the pressure many people feel to look ‘perfect’. With the growth in social media and the rise of ‘influencers’ portraying their filtered lifestyle through their Instagram feed, the public are increasingly exposed to pressures to look and act a certain way.

It seems that this pressure is frequently being fuelled by plastic surgery companies that target a very specific demographic via television adverts, in magazines and through social media’s clever algorithms. They are able to directly reach a young and impressionable audience of women, which I find are generally aged between 18-30, who follow celebrities and social influencers, and are reality TV viewers. This, in my opinion, is completely irresponsible when research has shown a significant proportion of the patients who go on to seek treatment have significant psychological issues with their appearance.1

Essentially, an advert is a sales pitch. It does not offer balanced, personalised and in-depth information on the risks or side effects of what it is promoting, and it certainly doesn’t discuss more suitable alternatives.

Upon viewing a cosmetic surgery advert, many women will opt for a procedure with the impression that it is straightforward and completely safe – they treat it as a commodity. And as we know, both surgical and non-surgical treatments are not commodities; they are medical procedures and should be treated as so.

In accordance with the Montgomery ruling,2 we should take time to educate our patients on the risks, as well as the benefits, of undergoing any procedure in order for them to make an informed decision. We should be confident that our patients have taken time to carefully consider their options and are undergoing treatment for the right reasons. We certainly shouldn’t be rushing to carry out a boob job because the patient has seen an advert with the latest reality TV star shouting about how quick, simple and pain-free it was.

The solution

A ban on the advertising of cosmetic surgery was previously called for following the Poly Implant Prothese (PIP) scandal in 2010,3 however this was not approved by the Advertising Standards Authority (ASA) which stated that, instead, adverts relating to cosmetic surgery could continue to run as long as they were legal, honest, truthful and socially responsible.4

It is my belief, however, that adverts are frequently crossing the line of being ‘socially responsible’. The Committee of Advertising Practice (CAP) states that ‘socially responsible’ is classed as those that do not put customers under an undue pressure to purchase because of a time limited deal and suggest that a procedure should be undertaken light-heartedly.4 The ASA also states that it will likely look more favourably to those marketers that state an in-depth consultation is required and if the patient is a prize winner, for example, they will only undergo treatment after a detailed consultation.4 The authority also advises companies to schedule the adverts responsibility to minimise the risk of children seeing it.4

I would recommend that the ASA looks at the evidence from countries such as France where advertising for cosmetic surgery is banned.3 If we followed this lead, companies would save their marketing revenue stream and we could be more confident that patients are not unduly pressured into undergoing a procedure that they have little understanding of and are not fully prepared for.

I think we could also learn a lot from the advertising changes that took place in 2017 which made it illegal to sell branded cigarette packets and instead had to include numerous health warnings.8 Now you can’t sell a packet without saying there is a cancer risk associated and we know that there’s a risk of cancer associated with breast implants, for example.7

The opposing view

I appreciate that it could be argued that practitioners’ websites advertise cosmetic surgery. And yes, I agree, that this is a form of advertising; however, if someone logs onto your website, they are actively looking for you and a website allows for more detailed information to be outlined. This allows users to take time to absorb the information and make an informed decision.

Companies will also say, ‘But we need to advertise our brand within the market’. But my argument is, why? Their market share is stable and if you’re that good then you don’t need adverts to maintain it. Happy patients will do that for you.

Advertisers may also believe that if they include disclosures such as ‘the procedure is subject to a consultation’, at the end of the advertisement, or in small print throughout, then that is ethical and that the viewer is making an informed decision. However, I don’t believe many viewers actually take notice of these and they are often so small that they go unnoticed.

This summer we saw blatant targeted advertising towards young women with ads for cosmetic surgery appearing in the breaks between Love Island on ITV. Largely, the response was negative, with social media and national news sites awash with criticism of the decision.3 The Mental Health Foundation wrote to ITV’S CEO warning that the strategically placed adverts ‘painted a false picture of perfection’ and ‘exacerbated young people’s insecurities’,9 while the head of NHS England, Simon Stevens, commented, “The time has come to think long and hard about whether we should be exposing people to those kinds of pressures.”10

The British Association of Aesthetic Plastic Surgeons (BAAPS) called for a full ban on advertising plastic surgery, which is something I very much support. BAAPS stated in a press release, ‘By advertising cosmetic surgery alongside this type of programming – and in some instances, even using the stars of the show – unscrupulous clinics are targeting young people in a way that commodifies surgery as a quick fix and endangers patients’.6

Following the broadcast of the adverts seen during Love Island, UK TV and radio communications regulator Ofcom received more than 650 complaints. They investigated and ITV advised that there were no more adverts of this nature scheduled and accepted that they had made a mistake in broadcasting them, stating they ‘take its responsibility to viewers very seriously’.10 As a result of this, on October 17, the ASA upheld the complaints about the advert deeming it ‘irresponsible and harmful’ and said it should not be shown again in its current form.11

Moving forward

Very few cosmetic surgeons and aesthetic practitioners will have the money to advertise on the same scale as some of the larger companies. Traditionally, the advertising that a plastic surgeon or aesthetic practitioner would do mostly be word of mouth. And, to me, this is how it should be. If you provide a good service and a safe service, then your practice will grow.

As practitioners, we should report any unethical advertising to the ASA if we have concerns that it could put patients at risk. And most importantly, we should continue to deliver in-depth consultations with our patients, ensuring that they are making an informed decision in regards to any type of treatment they choose to undergo.    

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