Before and after images for aesthetic treatments such as hyaluronic acid or hyaluronidase injections are not permitted outside specialist circles. With much attention Judgment of July 31, 2025 (Ref. I ZR 170/24) the Federal Court of Justice (BGH) has made a groundbreaking decision for the aesthetics and beauty industry.

The trick: minimally invasive injection treatments without a scalpel are also considered "surgical plastic surgery procedures" within the meaning of the Therapeutic Products Advertising Act (HWG). They are therefore subject to the strict advertising restrictions of Section 11 HWG. The ruling affects not only doctors, but also alternative practitioners, beauticians and anyone who publicly advertises aesthetic filler or Botox offers.

What was it about?

The defendant runs a practice for aesthetic facial treatments. The services offered include Lip shaping, Nose correction ("liquid rhinoplasty") and chin augmentation by means of Hyaluronic fillers. Treatments with Hyaluronidase (to break down hyaluronic acid) and botulinum toxin (Botox) are offered. The practice's Instagram account has published several series of images showing patients "before" and "to" of the treatment. These comparisons were intended to emphasize the visual improvement.

The plaintiff, a qualified consumer association pursuant to Section 4 UKlaG, saw this as a clear violation of Section 11 (1) sentence 3 no. 1 HWG. It issued a warning letter to the practice and demanded an injunction and reimbursement of the warning costs. As the practice refused, the association took the matter to court.

Special feature: In actions under the German Injunctions Act (UKlaG), the court of first instance is not the Regional Court, but the Higher Regional Court. The OLG Hamm upheld the action in its entirety and prohibited the practice from using such before-and-after images. It also ordered the defendant to pay the warning costs plus interest. The appeal allowed by the OLG was unsuccessful before the BGH.

The legal considerations of the BGH in detail

1. procedural starting position

Pursuant to Section 6 (2) UKlaG, an appeal on points of law against judgments of the higher regional courts of first instance is admissible if - as here - claims under the UKlaG are at issue. Consumer protection laws within the meaning of Section 2 (2) No. 6 UKlaG also include the provisions of the German Drug Advertising Act (Sections 3-13 HWG). The plaintiff's claim for injunctive relief was therefore based directly on Section 2 (1) UKlaG in conjunction with Section 11 HWG.

2. advertising ban of § 11 para. 1 sentence 3 no. 1 HWG

According to this provision, for surgical plastic surgery procedures within the meaning of Section 1 para. 1 no. 2 c HWG outside the professional circles with the effect of such a treatment by comparing the condition of the body before and after the procedure be advertised.

So the decisive factor is:

  • Is it a "surgical plastic surgery procedure"?
  • Is the advertising outside the professional circles?
  • Is the effect illustrated by a before and after comparison?

Prohibited before-and-after advertising for hyaluronic acid treatment

3. term "surgical plastic surgery procedure"

The BGH also affirms this in the case of minimally invasive hyaluronic acid injections. The term "surgical" is not limited to treatments with a scalpel, sutures or general anesthesia. Rather, the decisive factor is that by means of instruments (here: cannula) is inserted into the body and Shape or form changed will.

The Reversibility of the change - for example through natural degradation of the filler or the use of hyaluronidase - does not change the qualification as a surgical procedure. Nor does it matter whether the treatment is performed under local anesthesia or without anesthesia.

4. protective purpose and legislative intent

The regulation aims to prevent suggestive and emotionally charged advertising for not medically necessary aesthetic interventions. Before-and-after images have a particularly strong impact on consumers' decisions and can push the risks and limitations of the treatment into the background. The legislator therefore expressly banned this form of advertising back in 2012 - particularly with regard to cosmetic surgery and similar procedures.

5. application to the specific case

The practice's Instagram posts were clearly aimed at the general public and therefore "outside specialist circles". The picture series presented a direct comparison of the condition "before" and "after" the treatment and suggested a clear improvement. This meant that the requirements of Section 11 para. 1 sentence 3 no. 1 HWG were fully met.

6. balancing of fundamental rights

Although the defendant's freedom to exercise a profession (Art. 12 (1) GG) and freedom of opinion (Art. 5 (1) GG) are restricted by the advertising ban, the interference is constitutionally justified. The ban serves a legitimate purpose (health protection, protection against improper influence), is appropriate and necessary, and the burden is reasonable because not all advertising is prohibited - but only this particularly suggestive form.

7. no obstacles under EU law

The BGH clarifies that neither the Unfair Commercial Practices Directive (UCP Directive) nor the Services Directive or the Human Medicines Code preclude the application of Section 11 HWG.

8 Legal consequences

The defendant must refrain from the objectionable advertising and reimburse the warning costs plus interest (Section 5 UKlaG in conjunction with Section 13 (3) UWG, Sections 291, 288 (1) sentence 2 BGB).

Consequences for practice

The judgment leaves no doubt:

  • Forbidden are all before and after pictures of aesthetic injections (hyaluron, Botox, hyaluronidase, etc.) in lay advertising, regardless of the medium (social media, website, print, outdoor advertising).
  • Inadmissible are also indirect before-and-after formats such as image collages or "swipe" comparisons in Instagram stories.
  • Allowed remain factual information about treatments, procedures, risks - without pictorial before-and-after comparisons.
  • High risk of warnings exists with influencer cooperations if before-and-after images are distributed via external profiles - these are attributed to the practice owner.

Recommendation for action

Practices and providers of aesthetic treatments should immediately review all their public relations work and Consistently remove before and after formats. Existing social media cooperations should also be legally reviewed and contractually structured in such a way that HWG violations are excluded. An up-to-date content and marketing check is strongly recommended in order to avoid expensive warnings and legal proceedings.

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