Cosmetic Surgery Advertising Ban, Don’t Shoot the Messenger

The British Association of Aesthetic Plastic Surgeons (BAAPS) has lobbied for strict controls on advertising for cosmetic surgery. Their recommendations are:

"1. Prohibit all advertising aimed at the under 18s for example the use of young spokespeople such as celebrities that appeal to this age group
2. Prohibit advertising in public places where children can see these ads, such as posters, billboards, sides of buses and television
3. Prohibit all forms of discounted offers and financial inducements to encourage people having cosmetic surgery including seasonal incentives such as 'New Year, new body!', 'Summer body' surgical makeovers', Christmas gift vouchers for surgery
4. Prohibit time limited offers e.g., 'book by Friday!'
5. Prohibit targeting vulnerable specific groups such as divorced people, brides to be, women after pregnancy e.g.,'Divorce feel-good' and 'Mummy makeovers' discount packages
6. Ban the principle of loyalty cards as inducement to have multiple or repeat procedures
7. Prohibit advertising for combined procedures as inducement such as two-for-ones and BOGOFs
8. Prohibit recruitment of patients for cosmetic surgery by agent, either in the UK or abroad, whether through publications or websites
9. Prohibit the use of pictures of models or 'real life' patients that raise unrealistic expectations from cosmetic surgery such as through the use of Photoshop
10. Prohibit advertising of money-off and discount vouchers such as Groupon as inducement for booking for surgery
11. Prohibit giving cosmetic surgery as prize in any shape or form
12. Prohibit encouragement of refer-a-friend schemes in return for discount on surgery."

The reason BAAPS feels the need to make these recommendations is that the practices of a profit driven industry often clash with the professional standards of those working within the industry. There is a tension between the desire to increase sales and the need to give balanced advice to patients ("customers") seeking surgery. A surgeon's professional duty to advise a patient of the risks, benefits, and complications of the surgery, and of the non-surgical alternatives does not sit easily with the clinic using sales techniques to induce the patient to part with their money.

BAAPS has consistently stood up for high standards and its recommendations should be seen in the context of a general campaign to improve services to cosmetic surgery patients. However, some of the recommendations are probably unnecessary, some would be difficult to implement and others are directed to the message about cosmetic surgery services when arguably it is the services themselves which require attention.

Unnecessary

Some of the practices which the recommendations are intended to prohibit are already treated as unacceptable under advertising codes. The Advertising Standards Authority has previously made adjudications against cosmetic surgery advertisements which referred to breast surgery as "safe", which used "misleading" before and after photographs, which were in an untargeted medium which might be seen by children, and which claimed that the advertised clinics were "leaders in cosmetic surgery here in the UK" when that claim could not be substantiated.

So cosmetic surgery advertising which is targeted at children or uses altered images or misleading claims is already covered. Is there a need to go further?

Difficult to Implement

It is difficult to regulate the offering of discounts and time-limited offers etc. Sometimes it will be cheaper to do two procedures in one operation. Sometimes patients ought to be told that prices are going up in September, for example. In an industry offering a product which is beneficial to customers (which BAAPS members surely believe) the use of price competition is not only legitimate, it is of benefit to consumers since it leads to lower prices.

In any event, if such practices are unacceptable then arguably surgeons should not allow the clinics in which they work to deploy such offers, rather than relying on an advertising ban.

Shooting the Messenger

There is a danger in over-regulating the advertising of a product or service which is not in itself harmful, like cigarettes, but which carries risks of harm and should be purchased only by patients for whom it is suitable and who have full knowledge of what they are consenting to undergo.

Adults are entitled to make decisions for themselves about cosmetic surgery but surgeons and clinics are obliged to ensure that their patients are suitable (physically and mentally) for the surgery they seek and that they are giving their informed consent to the procedures, whatever inducements brought the patient into the clinic in the first place.

Is BAAPS being over-protective?

Take recommendation 5. Are "brides to be" a vulnerable group? (A cable TV show called Bridalplasty offered a prize of cosmetic surgery to the winning bride-to-be. Her betrothed would see the "new bride" post-surgery for the first time on the big day!) It may be said that recent divorcees are a "vulnerable group" (I understand that a significant proportion of patients seeking cosmetic surgery are recently divorced), but surely the point of cosmetic surgery is to make the patient feel better about themselves. They may seek that benefit at times when their self-esteem is low.

Is it unethical for clinics to advertise a service directly to that group?

In my view the greater need for strengthened regulation is in relation to the services to patients once they arrive at a clinic: the engagement of suitably qualified and experienced surgeons, the proper assessment of patients, advice to them about procedures and risks, adequate consultation time and "cooling off" periods before commitments to surgery are made. It is also necessary to ensure that contractual arrangements between surgeons, clinics and patients are transparent and that full professional indemnity insurance is in place.