Before-and-after photos in aesthetic medicine – what is permitted?

Key takeaways

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• Before-and-after photos are generally prohibited in public advertising for non-medically necessary aesthetic treatments – following the BGH ruling of July 31, 2025, this also applies to minimally invasive procedures such as hyaluronic acid and Botox injections.
• The ban cannot be circumventedby publishing before and after images separately in terms of time or location on your website, Instagram posts, stories, or videos.
• Legally compliant alternatives include factual educational content, patient interviews without visual comparisons, behind-the-scenes insights into daily practice, and showing results during individual consultations with documented consent.

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A patient has consented to the publication of their photos, the treatment result is impressive, and your new Instagram post seems like the perfect way to showcase the quality of your work. A few weeks later, your practice receives a formal warning – not because of a lack of consent, but because the public display constitutes an impermissible before-and-after comparison. Such situations often arise because data protection, patient consent, and advertising laws for medical products are confused with one another. Just because something is medically documented and approved by the patient does not automatically make it permissible as advertising.

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Disclaimer: This article is for general information purposes only and does not constitute legal advice. For specific questions regarding your own marketing communications, we recommend consulting a lawyer specializing in medical law.

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The legal basis: Section 11 of the HWG

The central legal basis for before-and-after images in aesthetic medicine is Section 11, Paragraph 1, Sentence 3, No. 1 of the German Therapeutic Products Advertising Act (HWG). According to this, advertising using comparative depictions for medically unnecessary plastic surgery procedures is prohibited outside of professional circles.

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The protective purpose of the regulation is clear: the legislature aims to prevent potential patients from being persuaded by suggestive and misleading advertising to undergo medically non-indicated procedures that may involve significant health risks. The freedom of choice of the individuals concerned is to be protected.

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Crucial to the practical scope of the prohibition is the term "operative plastic surgery procedure" in Section 1, Paragraph 1, No. 2, Letter c of the HWG. This term was long disputed until the Federal Court of Justice provided a final clarification in July 2025.

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The Federal Court of Justice ruling of July 31, 2025 (Case No. I ZR 170/24)

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On July 31, 2025, the Federal Court of Justice handed down a Landmark ruling, which has significantly changed the legal landscape for all aesthetic medicine in Germany. The First Civil Senate of the Federal Court of Justice (BGH), which is responsible for claims under the Injunctions Act, among other things, ruled that for treatments involving injections of hyaluronic acid or hyaluronidase to alter the shape or appearance of the nose or chin, advertising with before-and-after images is prohibited.

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The background: A consumer protection agency had filed a lawsuit against two doctors in the field of aesthetic medicine who had been heavily promoting their treatments, particularly on social media platforms. The defendant doctors argued that these procedures—in which filler is injected under the skin—did not constitute a surgical intervention in the medical sense.

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The BGH did not accept this argument. Even non-surgical treatments such as Botox or hyaluronic acid injections fall under the term "surgical plastic surgery procedures" as defined by the German Therapeutic Products Advertising Act (HWG). This means that advertising with before-and-after images is also prohibited for these procedures if they serve a purely promotional purpose rather than exclusively providing information. The BGH emphasizes that such images have a suggestive effect on the public and are not medically representative.

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Case law of the Higher Regional Courts

Even before the Federal Court of Justice ruling, several Higher Regional Courts had consistently expanded the scope of the ban – specifically capturing creative attempts to circumvent it on social media.

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The Higher Regional Court of Frankfurt explicitly addressed the argument that new social media formats justify different standards: the boundaries are clear. What the market finds strategically appealing quickly collides with the protection of patient autonomy and the legal order. The regulation must also be applied to new forms of advertising such as social media stories , as these have a particularly high suggestive effect and are especially likely to create false expectations regarding unnecessary procedures.

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The Higher Regional Court of Cologne confirmed the same stance for hyaluronic acid treatments and emphasized the protective purpose of the HWG: The HWG is intended to prevent incentives for medically unnecessary and health-endangering procedures. Against this background, its application to even minimally invasive procedures is easily justifiable.

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What exactly is prohibited

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Based on the current case law reveals a clear picture of prohibited practices:

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• ‍Classic before-and-after photos
  Direct comparison images are prohibited for medically unnecessary aesthetic treatments – even for minimally invasive procedures.
• Separate presentations
  The ban also applies if before and after images are spread across different posts or stories. The overall impression is what matters.
• Paid advertising
  In Meta and Google ads, such content violates both the German Therapeutic Products Advertising Act (HWG) and platform policies.
• Videos and Reels
  Videos showing the state before and after a treatment are also subject to the ban.
• Minimally invasive treatments
  Since the Federal Court of Justice ruling in July 2025, the ban explicitly applies to Botox, hyaluronic acid, fillers, and other injections.

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What is permitted and under what conditions

The ban on before-and-after advertising does not mean that aesthetic practices must completely forgo visual social proof. The context and function of the presentation are decisive. The following is possible:

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• Medical consultation
  During a personal consultation, result images may be shown objectively, provided they are not misleading.
• Individual result images
  A "post-treatment" image without a direct or indirect before-and-after comparison is legally less problematic.
• Educational content
  Factual information regarding treatment, effects, and potential outcomes is permissible as long as it does not contain promises of specific results.
• Patient interviews
  Testimonials without a visual before-and-after comparison generally do not fall under the prohibition.
• Patient consent
  Written, specific, and revocable consent is required for every publication. A general treatment consent form is not sufficient.

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How aesthetic practices can communicate in a legally compliant way today

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The most common mistake is the belief that one must completely refrain from showing results. This is not the case – visual social proof remains a key tool, but it must be used correctly.

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The following approach has proven effective in practice: Result images are used during personal consultations – within an objective framework, a clear educational context, and with documented consent. No comparison images are used in paid advertising – instead, we use testimonials and patient videos without visual comparisons and educational content. On social media, the focus is on communicating expertise, providing insights into daily practice life, and sharing patient stories without a suggestive comparative nature.

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Conclusion

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The legal situation has been clear since the Federal Court of Justice ruling on July 31, 2025: Before-and-after photos are generally prohibited in public advertising for aesthetic treatments – including Botox and hyaluronic acid –. No channel, format, or creative workaround changes this. Anyone still using such content on Instagram, their own website, or in advertising campaigns today is acting at their own risk.

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The good news: Legally compliant communication and compelling marketing are not mutually exclusive. Practices that communicate their expertise, treatment quality, and patient trust in a legally sound way build a more sustainable brand than those relying on short-term, yet legally risky, image comparisons.

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Curia Consulting supports aesthetic practices in developing legally compliant marketing strategies – from HWG-compliant campaign design to structured consent documentation for result images.