Before-and-after photos: allowed or prohibited?
Are “before-and-after” photos allowed for cosmetic injections? Here’s what the German Law on the Advertising of Medicines and the Federal Court of Justice ruling mean for your advertising.
Before-and-after photos are prohibited in advertisements for certain cosmetic procedures. This also applies to the hyaluronic acid injections for nose and chin correction that were reviewed by the Federal Court of Justice (BGH). The patient’s consent does not override the advertising ban. The decisive factors are the treatment itself and the intended use of the images.
Before-and-After Pictures: What Does the Law on Advertising of Medicines Regulate?
In the world of aesthetic medicine, before-and-after photos play an important role in showing potential patients the results of aesthetic injections. In this blog post, we’ll address the legal aspects and examine whether before-and-after photos of aesthetic injections are legally permitted in Germany.
The German Law on the Advertising of Medicines (HWG) regulates the advertising of drugs, medical devices, and certain treatments. For non-medically necessary plastic surgery procedures, Section 11(1), Sentence 3, No. 1 of the HWG prohibits advertising outside professional circles that includes comparative “before and after” images of the procedure. Further sources: Section 1 HWG and Section 11 HWG.
An authentic photo and the disclaimer “individual results” do not make a before-and-after advertisement subject to the ban permissible. In addition, misleading advertising remains prohibited: Images must not create false impressions about the effects of a treatment. Further reference: § 3 HWG.
Federal Court of Justice: “Before-and-After” Advertising for Hyaluronic Acid Injections
On July 31, 2025, the Federal Court of Justice (BGH) ruled that “before-and-after” advertising for the hyaluronic acid treatments on the nose and chin that were the subject of the investigation is prohibited. The ruling bears the case number I ZR 170/24. The injection of hyaluronic acid via a cannula to alter body contours constitutes a plastic surgery procedure within the meaning of the German Health Promotion Act (HWG).
A scalpel is not required for this. Nor does the fact that hyaluronic acid can be broken down change the legal classification. The earlier reference to a gray area that had not been clarified by the highest court therefore no longer applies to these treatments. Additional source: Federal Court of Justice (BGH), Judgment of July 31, 2025 – I ZR 170/24, in particular paras. 12–19 (full text of the judgment) .
You can find additional guidelines for your public image in the guide “Advertising Aesthetic Treatments.”
Consent and Privacy Rights Regarding Patient Images
When using “before-and-after” images, it is important to respect the personal rights of the individuals depicted. As a general rule, the consent of patients is required before publishing images in which they are recognizable. The specific purpose and the intended channels of publication should be explicitly documented. Further reading: Section 22 of the German Art Copyright Act (KunstUrhG).
Pixellation does not automatically prevent recognition. Even a cropped image of a face can be linked to a specific person based on other identifying characteristics. Above all, image rights and advertising law must be assessed separately: Consent or anonymization does not override the prohibition on certain “before-and-after” advertisements. Data protection and medical confidentiality must also be observed.
The Role of the Code of Medical Ethics
The Code of Medical Ethics establishes rules for the practice of medicine. It is important to observe the specific regulations of the respective state medical association. Section 27 of the Model Code of Medical Ethics distinguishes between factual, profession-related information and advertising that is contrary to professional ethics. The respective state code of professional conduct is binding; the HWG applies in addition. Further source: German Medical Association: § 27 MBO-Ä, as of May 2026.
Education and Transparency: Putting Pictures into Context
Regardless of the legal aspects, it is very important to provide patients with comprehensive information and to be transparent. Before-and-after photos are no guarantee of specific results. Professionals should explain to patients that individual differences and other factors can influence the final outcome.
Medical documentation of a treatment should be distinguished from publication for advertising purposes. A photo taken for a patient’s medical record is not automatically authorized for use on a website or on Instagram. Factual information about the treatment process, qualifications, and treatment options provides other starting points for your communication with patients.
Frequently Asked Questions About Before-and-After Photos
Are before-and-after photos allowed on Instagram?
The HWG also applies to Instagram. When advertising the procedures covered by the law, it makes no difference whether the comparison appears on a website or in a social media post. A disclaimer such as “results not guaranteed” does not override the advertising ban. Further reference: § 11 HWG.
Does the Federal Court of Justice ruling also apply to Botox photos?
The ruling I ZR 170/24 specifically addresses changes in facial contours caused by hyaluronic acid or hyaluronidase. It should therefore not be presented as a blanket decision regarding all Botox treatments. Section 10 of the German Advertising of Medicines Act (HWG) also applies to advertising for prescription drugs. A “before-and-after” advertisement for Botox is therefore not permitted simply because the ruling addresses a different active ingredient. Further sources: BGH I ZR 170/24 and § 10 HWG.
Is consent sufficient for before-and-after advertising?
No. The consent pertains to the rights to the image. It does not replace the assessment of whether the specific advertisement is permissible under the Law on the Advertising of Medicinal Products. Even an anonymized comparison may fall under the advertising ban.
Are all “before-and-after” photos banned in the cosmetics industry?
No, the ban on certain aesthetic procedures does not imply a blanket ban on all cosmetic image comparisons. The decisive factors are the treatment, the advertising message, and the scope of application of the HWG. Dermal fillers cannot be exempted from the advertising ban solely by being labeled “cosmetic.” Further sources: § 1 HWG and § 11 HWG.
Conclusion: Before-and-after photos in aesthetic medicine
In the case of “before-and-after” advertising, the specific treatment and legal requirements are decisive. The previous assessment—which characterized hyaluronic acid injections as a “gray area”—as determined by the Federal Court of Justice (BGH) is now outdated. It is important to take into account the German Law on the Advertising of Medicinal Products, the medical code of ethics, and personal rights collectively.
Would you like to deepen your knowledge of aesthetic injections? Find out where you can learn about aesthetic injections, or check out our introductory course on hyaluronic acid. The guide “Who Is Allowed to Administer Hyaluronic Acid and Botox?” explains the requirements for these treatments.
This article does not constitute legal advice and is not a substitute for such advice. The article does not claim to be up-to-date, complete or correct. We accept no liability for damage caused by incorrect information. If in doubt, seek legal advice.