Before and after images are the most persuasive marketing device this sector has, which is exactly why they are the most constrained. The rules are not obscure and they are not new. They are just widely ignored, because enforcement is complaint driven and most patients do not know they can complain.
The underlying rule
UK non broadcast advertising is governed by the CAP Code, enforced by the Advertising Standards Authority. The foundational requirement is that marketing communications must not materially mislead or be likely to do so. Every specific rule about before and after imagery flows from that.
A before and after pair is a claim. It claims that this outcome followed from this treatment. If any part of the visual difference is attributable to something other than the treatment, the claim is being inflated by that amount.
The variables that do the work
Look for these before you look at the face.
Lighting. The single most powerful variable. Flat frontal light fills lines; overhead or side light carves them. A before shot lit from above and an after shot lit from the front will show a dramatic improvement in nasolabial shadowing with no treatment at all.
Angle and camera height. A camera below eye level heavies the jaw and shortens the neck. Raise it slightly and the same person appears to have had a jawline treatment.
Expression. A neutral before and a slight smile after changes the mid face entirely. Watch the eyes and the corners of the mouth.
Head position. A small chin tuck in the before and a small chin lift in the after produces a visible submental change.
Make up, hair and grooming. Frequently different, occasionally dramatically so.
Post processing. Skin smoothing, colour grading, contrast, and the beauty filters built into phone cameras by default. A filter applied to one image and not the other is not a marginal issue.
Time of day and swelling. Immediately after filler, swelling contributes volume that is not the final result. An after image taken at fifteen minutes is showing you something that will change.
What you are entitled to at this stage
- Marketing that does not materially mislead, under the CAP Code.
- Not to be shown atypical results presented as typical.
- To complain to the ASA about any marketing you have seen, free, whether or not you are a customer.
- To control the use of your own images: consent to treatment is not consent to publication.
- To withdraw consent for the use of your images and to be told how to do so.
Prescription only medicines may not be advertised to the public, which includes naming them alongside results imagery.
What the codes require specifically
Beyond the general prohibition on misleading advertising, several rules bear directly on this material. Marketing must not exaggerate the effect a product or treatment can achieve. Results that are not typical must not be presented as though they were. Marketing communications must be obviously identifiable as such, which reaches influencer and affiliate content. And prescription only medicines must not be advertised to the public, which means before and after content for a toxin treatment must not name the product.
Professional guidance runs alongside the codes. The GMC's guidance for doctors offering cosmetic interventions addresses the use of imagery and promotional practice, and expects doctors to be open and not to mislead.
A results gallery with no dates, no interval stated, no mention of how many treatments were involved, and no indication of what else the patient had done. Without those, the images are not evidence of anything, including of the treatment being advertised.
The questions that make a gallery useful
If a clinic uses before and after images, the following turn them from persuasion into information. Ask them, because a practice with good documentation will answer easily.
- How long after treatment was the after image taken?
- How many sessions, and how much product, produced this?
- Was anything else done at the same time or in the preceding months?
- Were the images taken in the same place, with the same camera, lighting and settings?
- Has any filter, retouching or smoothing been applied to either image?
- Is this a typical result, and if not, what is?
The last question is the important one. A gallery is by definition a selection of the best outcomes. Asking what a middling result looks like is entirely fair, and the willingness to show one is a strong signal.
The patients in the photographs
There is a second issue that the marketing conversation usually skips. Those are identifiable patients, and their images are personal data being used for a commercial purpose. Consent for treatment is not consent for publication, and consent for publication in a clinic album is not consent for use in paid advertising or on social media.
If you are asked to allow your images to be used, you are entitled to know where they will appear, for how long, whether they will be used in paid advertising, and how to withdraw permission. A discount offered in exchange for image rights is a commercial transaction and should be described as one.
Complaining about a misleading gallery
The ASA takes complaints from anyone who has seen a marketing communication. You do not need to have been a patient, and it costs nothing. Rulings are published, which makes them effective within the industry.
Screenshot the material with the date before complaining, because it may be removed. The route is set out in how to complain and to whom.
What a good gallery looks like
Standardised photography: same position, same distance, same lighting, same background, neutral expression, no make up in either image, no filter, stated interval and stated number of sessions. Some clinics do this properly. When you see it, it tells you something about the practice well beyond the photographs, because standardised clinical photography takes effort that a business optimising for persuasion would not spend.