Before and after imagery and the advertising codes
Before and after images are the most persuasive material a clinic has and the most frequently criticised. The difference is entirely in how they are made.
PrerequisitesModule 05 · The rulesModule 13 · Risks and aftercare
Before and after images must be genuine, must be of the same patient under materially identical conditions, must not be edited in ways that exaggerate the result, and must carry the consent of the patient. The practical requirement is a written photographic standard covering lighting, distance, angle, expression and background, applied to every image, so that any pair could be defended on request.
What you will be able to do
By the end of this module you will be able to:
- Write a photographic standard for your clinic covering the six variables that must be held constant.
- State the consent requirements and record them properly.
- Recognise the edits and presentations that turn a genuine result into a misleading one.
- Decide whether to publish images at all, which is a legitimate answer.
The same regulatory stack
Before and after imagery sits under exactly the layers introduced in Module 05, The rules that constrain everything you publish, and it is worth re-reading that figure with images in mind: the advertising codes govern whether the image misleads, professional guidance governs the consent and the conduct, and medicines law governs whether the image is promoting a prescription-only medicine.
The single most useful reframing is that an image is a claim. Everything you know about substantiating written claims applies unchanged. A pair of photographs asserts that this result followed this treatment in this patient, and that assertion must be true and must not be exaggerated by the way the photographs were made.
Six variables to hold constant
Almost every misleading before and after pair is misleading because of a variable that changed between the two photographs. Six matter.
| Variable | What goes wrong | The standard |
|---|---|---|
| Lighting | Flat overhead light before, soft directional light after | One fixed lighting setup, same position, same source, no window light. |
| Distance and lens | Wider lens before, longer after, which changes facial proportion | Fixed camera position, fixed focal length, marked floor position for the patient. |
| Angle | Chin down before, chin level after | A fixed head position, ideally with a headrest or a marked eye-line. |
| Expression | Neutral before, slight smile after | Same instruction, every time, recorded in the standard. |
| Preparation | No makeup before, makeup after | Same state, every time. Usually no makeup, hair back, no jewellery. |
| Background | Cluttered before, clean after | One background, one colour, always. |
Written down, this is a page. Applied consistently, it removes the entire category of complaint that says the difference is in the photography rather than the treatment. It also improves the images, because consistent photography makes real changes easier to see.
Consent, and what it must cover
Consent for treatment and consent for publication are different things and must be obtained separately. Publication consent needs to cover where the images may appear, for how long, whether they may be used in paid advertising, and how the patient withdraws consent.
Withdrawal matters more than clinics expect. A patient who consented three years ago may change their mind, and a clinic without a record of which images belong to whom cannot act on that request. Keep a register: patient, date, images, scope of consent, and where each image has been published.
Edits that make an image misleading
Colour correction applied equally to both images is normal. Anything applied to one and not the other is a problem. Anything that alters the subject is a serious problem.
The specific practices to avoid: smoothing, sharpening or brightening the after image only; cropping the two images differently; applying any filter or beauty mode, including the ones a phone applies by default; and selecting the single best result from a series while presenting it as typical. The last is the subtlest and the most common.
Presentation and context
An image needs the context that makes it interpretable: how long after treatment it was taken, what was done, and how many sessions. A pair with no interval stated implies an immediate result, which for many treatments is not what happened.
Avoid presenting images in a way that implies a typical outcome unless it is typical. Where results vary substantially, say so beside the images rather than in a disclaimer at the foot of the page, which readers do not read and which does not correct a misleading impression created above.
The option of not publishing them
This is a legitimate and sometimes correct decision. Some treatments do not photograph meaningfully. Some patient groups will not consent. A clinic without a controlled photographic setup will produce inconsistent images, and inconsistent images are worse than none because they invite exactly the criticism the standard is designed to prevent.
If you do not publish images, say why on the page. "We do not publish before and after photographs because we cannot control the conditions well enough for them to be a fair comparison" is a sentence that builds more confidence than a poorly controlled gallery, and it is the sort of specific, verifiable difference Module 06, Writing the clinic's proposition asks you to look for.
Write the photographic standard
An hour, with whoever takes the photographs. Produce a one-page document you can hand to a new member of staff.
- Write the standard for each of the six variables: lighting, distance and lens, angle, expression, preparation, background.
- Mark the floor position and the camera position physically, in the room. Photograph the setup so it can be reproduced.
- Write the publication consent form covering placement, duration, paid use and withdrawal.
- Build the consent register: patient, date, images, scope, where published.
- Audit every image currently published on your site against the standard. Remove any pair where a variable changed.
- If the audit removes most of your gallery, consider whether to rebuild it under the standard or to publish none and say why.
The audit is the uncomfortable step and it is the one that matters. An image that cannot be defended is a liability sitting on your most visited page.
Questions readers ask about this module
Can I use images supplied by a manufacturer?
They are not your results and presenting them as illustrative of your work would be misleading. Where a manufacturer image is genuinely illustrative of a mechanism rather than a result, label it as such. In most cases the better answer is a diagram.
Do I need to show the same patient?
Yes. A before image of one person and an after image of another is not a before and after; it is two photographs, and presenting them as a pair is misleading regardless of intent.
Are video and social media clips treated differently?
The same principles apply, and the practical risk is higher because platform filters and automatic enhancement are applied without the clinic noticing. Turn them off, and check the output rather than assuming.
What if a patient consents but later appears in a complaint?
This is why the register and the withdrawal process exist. Being able to demonstrate what was consented to, when, and by whom, and to remove images promptly on request, is the difference between an administrative task and a serious problem.
Sources and primary references
Disclosure. This module contains no commercial links of any kind. This course is independently published, is free to read, and is funded by the workbook pack and by clearly labelled series sponsorship. We do not rank, review or recommend agencies or clinics.
Module 18 of 32