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Advertising in Aesthetics – Tightening Regulations

aesthetics advertising

The ASA enforcement notice about use of prescription only medicine terms (i.e. BOTOX®) in aesthetic advertising has triggered a considerable amount of debate. 

We’re here to try and help decipher what you can and can’t say in advertising.

How has the law changed?

The first very important thing to say is that the regulations surrounding advertising of prescription-only medications have not actually changed at all.

The regulations are published in the MHRA Blue Guide Appendix 6, which was published in December 2014 and last updated in July 2019

What has changed is that the ASA have issued a warning about how they are about to start much more strenuous enforcement of those regulations. Armed with new software, they are particularly warning companies about their social media activity, an area which has previously been harder to monitor or enforce.

The relevant enforcement notice was issued 9th January and can be found at:

This followed a previous notice regarding BOTOX® advertising in October 2019:

Social Media Advertising – Key Points

  1. NO direct references to botulinum toxin products on social media as these are POM (prescription only medicine). Banned terms include:
    • BOTOX®
    • Vistabel®
    • Dysport®
    • Bocouture®
    • Azzalure®
    • Xeomin®
    • Not including the ® doesn’t make any difference
    • Botulinum toxin
    • Wrinkle-relaxing injections (as this specifically implies POM)
  2. NO ‘substitute names’ such as ‘beautox’ or ‘beautytox’ ‘bootox’ ‘wrinkle-tox’
  3. NO use of images that incorporate text that refers to POM. This includes logos
  4. NO use of hashtags referring to POM
  5. NO use of the phrase ‘wrinkle relaxing injections’ which is indirect phrase, but specifically refers to POM
  6. NO putting POM prices alongside a reference to ‘anti-wrinkle injections’ – this is viewed as an ad
  7. NO referring to medical treatments which indicate POM usage e.g. hyperhidrosis injections, bruxism injections, sweating injections
  8. NO mentioning ‘anti-wrinkle injections and dermal fillers’ as this juxtaposition specifically implies the former are POMs
  1. CAN promote ‘consultation for the treatment of lines and wrinkles‘ as long as you:
    • Include discussion of various options including non-POM AND
    • State that product will not be sold/administered if the client is unsuitable
    • This only applies for practitioners who do POM alternatives e.g. offer dermal fillers, laser or IPL as well as botulinum toxin. Those who are ONLY offering POM are unable to use this course of communication if the only realistic treatment available is POM
  2. CAN promote ‘anti-ageing treatment options‘ provided that there are POM alternatives available i.e. dermal fillers as well as botulinum toxin
  3. CAN use POM terminology and brand names in direct messaging to individual clients via social media, email and verbal communication (face to face and on the phone), where the client has enquired
  4. CAN promote ‘treatments for excessive sweating’ (not mentioning injections)

Website Content – Key Points

  1. NO use of POM terms on the home page. Banned terms list as above
  2. As with social media, NO ‘substitute names’ such as ‘beautox’ or ‘beautytox’ ‘bootox’ ‘wrinkle-tox’ OR use of images that incorporate text that refers to POM
  3. NO use of hover text (tool tips), small print, hidden text or icons/logos naming a POM on the home page
  4. NO use of POM within website domain name e.g. www.botoxinlondon.co.uk
  5. NO claims without evidence on your website e.g. do not say “…best treatment for”
  1. CAN promote ‘consultation for the treatment of lines and wrinkles‘ as long as you:
    • Include discussion of various options including non-POM AND
    • State that product will not be sold/administered if the client is unsuitable
    • This only applies for practitioners who do POM alternatives e.g. offer dermal fillers, laser or IPL as well as botulinum toxin. Those who are ONLY offering POM are unable to use this course of communication if the only realistic treatment available is POM
  2. CAN promote ‘anti-ageing treatment options‘ provided that there are POM alternatives available i.e. dermal fillers as well as botulinum toxin
  3. CAN use POM terminology and brand names on the website as long as:
    1. Not on the home page
    2. Emphasise the promotion of the consultation
    3. Explain that consultation may not necessarily lead specifically to a POM treatment i.e. a range of treatments may be recommended or treatment may be refused
    4. Avoid promotional terminology, including excessive repetition of brand names which could be deemed promotional
    5. Information should not go beyond balanced and factual information typically found in the patient information leaflet or similar non-promotional information
  4. CAN promote ‘treatments for excessive sweating’ (not mentioning injections)

Advertising, leaflets, posters, email newsletters etc

  1. NO use of POM terms including substitute names and images that incorporate text that refers to POM
  2. NO claims without evidence e.g. do not say “…best treatment for”
  3. NO referring to medical treatments which indicate POM usage e.g. hyperhidrosis injections, bruxism injections, sweating injections
  1. CAN promote ‘consultation for the treatment of lines and wrinkles‘ as long as you:
    • Include discussion of various options including non-POM AND
    • State that product will not be sold/administered if the client is unsuitable
    • This only applies for practitioners who do POM alternatives e.g. offer dermal fillers, laser or IPL as well as botulinum toxin. Those who are ONLY offering POM are unable to use this course of communication if the only realistic treatment available is POM
  2. CAN promote ‘anti-ageing treatment options‘ provided that there are POM alternatives available i.e. dermal fillers as well as botulinum toxin
  3. CAN promote ‘treatments for excessive sweating’ (not mentioning injections)

FAQ

The guidelines and regulations do not specifically rule against use of before and after photos. However, the ASA could rule that such activity constitutes a form of advertising, especially if the results illustrated are only achievable through a specific treatment/product.

We would advise caution in any use of before/after photos, especially on social media.

Yes, the 31st January is the day that stricter enforcement is to be applied, but that doesn’t mean you can post what you like before that date. Remember, the law has not changed. It’s best to remove any social media posts that don’t meet the guidelines.

To be on the safe side, all the way.

It has been suggested that the ASA will only look back 6 months, but that information is not in any of their published advice or guidelines. If you know you have posts that are noncompliant, take them down.

This is a tricky one as realistically, you can’t be responsible for what a patient writes in their review – good or bad. However, the ASA do see reviews as part of promotional activity and will expect you to ensure that patient reviews do not mention prescription only medications such as BOTOX®. You need to ask patients nicely to reword their reviews.

The main consequences of an enforcement notice are published in the MHRA Blue Guide:

  1. The MHRA takes robust enforcement action where a significant risk to public health has been identified from advertising to the public for unlicensed or prescription only medicines.
  2. Failure to comply with the Regulations will result in the Advertising Standards and Outreach Unit requesting that the website is amended or withdrawn.
  3. Cases may also be referred to the Inspection, Enforcement and Standards Division for consideration of legal action or other measures leading to the removal of the website or merchant trader account.
  4. In areas where the ASA has established precedents, we may refer complaints to them. Clinics and individual healthcare professionals may also be referred to their professional regulators if compliance is not achieved in a timely fashion.

In addition, note that names and details of cases will be published on the ASA website.

It is also a lot of stress!

Training schools are not subject to the same regulations, as they are marketing to professionals and not to the general public. They can even use the word ‘BOTOX® on the home page and in social media as their target market is not someone who might have a treatment.

Summing Up…

For those who have previously been frustrated about competitors getting an unfair advantage by using advertising methods that they shouldn’t, this should stop.

For those that have previously been using dubious advertising tactics, this is not the time to ‘see what you can get away with.

The advice outlined above is based on a variety of sources – see links – but ultimately the finer points of guideline application will be subject to interpretation by the ASA/CAP/MHRA. If they deem that activity that would appear to be within guidelines constitutes a form of advertising, then their decision will require you to change your activities.

The advice in this blog is provided in good faith. We accept no responsibility for actions taken or not taken based on the above and advise companies/clinicians to make their own checks.

In case of specific queries, there is a free copy check service https://www.asa.org.uk/advice-and-resources/bespoke-copy-advice/copy-advice-information.html.

For SkinViva Training delegates, there is also plenty of advice and opinion on our closed Facebook group the SkinViva Trainee Network, where delegates are able to share and discuss their experiences and ideas with peers in the industry, raise any queries among fellow practitioners and also give feedback and advice.

BOTOX® and Dermal Filler Training

SkinViva Training Manchester

SkinViva Training is one of the UK’s premier training schools for cosmetic injections. The company only offer training for medical professionals who meet their entry criteria which includes degree-level medical qualifications, working in a clinical role with proficiency in injections/cannula and membership of a regulatory body .

The company offers a range of professional training courses for cosmetic and medical skin treatments. See list of forthcoming training course dates.

SkinViva Training was established in 2013 by Dr Tim Pearce MBChB BSc (Hons) MRCGP. The SkinViva Training team upholds high standards of clinical training providing a combination of fully-supervised practical experience together with essential theory.

For further information, to discuss which course is right for you, to enquire about availability or to book a training course please call 0161 850 2491, or email info@skinvivatraining.com.

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