Every before-and-after I post is an advertisement. So is yours. The question is what else it is.
I've come round to a fairly unpopular view, which is that the format itself is the problem — not the honesty of any particular pair of images. A before-and-after shows a result. It does not show selection. It cannot show the patients who were turned away, the cases where the same technique produced less, the revisions, or the one that took eight months to settle. An audience seeing a hundred of these forms a completely reasonable and completely false impression of the distribution.
That's before you reach the ordinary manipulations: lighting, angle, expression, makeup, the fact that people smile in the after and not the before.
Consent obtained at the wrong moment
A patient consenting to have their face used in marketing is consenting to something they cannot fully picture. They are usually happy, usually recently operated on, and usually in the least critical frame of mind they will be in for the next two years. Consent obtained at that moment, for indefinite use, across platforms that didn't exist when the form was written, is thin.
I think it should be time-limited and revocable by default, and I think most clinics would resist that fiercely, which tells you something.
The audience nobody accounts for
UK advertising rules already prohibit targeting cosmetic interventions at under-18s and restrict where such ads can appear. That's necessary and insufficient. Nothing in a code governs an adult audience of fifteen-year-olds who found the account organically, and pretending the rules solve it is comfortable rather than true.
What I try to do, imperfectly
Show process rather than outcome where possible, talk about who a procedure doesn't suit, and post the cases that taught me something rather than the ones that flatter me. It performs worse. That's the trade, and anyone claiming otherwise hasn't looked at their own analytics.
The uncomfortable conclusion is that a surgeon with a large following has an interest in patient anxiety. Every account in this field, mine included, is monetising a feeling it also helps create. I don't think there's a clean resolution to that. I think the minimum is to say it out loud rather than pretend the content is purely educational.