​What do the regulations on botulinum toxin injections set by the Advertising Standard Agency (ASA) mean for Aesthetics Practitioners?

Let's be clear - these regulations are not new. The latest General Dental Council (GDC) letter announced a crackdown on social media advertising regarding Botox and anti-wrinkle injections to tackle unlawful advertising of the treatment and suddenly, its appears, everyone is listening. The GDC letter highlighted that from January 31st the ASA would be taking targeted enforcement action for practitioners who fail or are unwilling to comply consequences of which could result in referral to the Medicines and Healthcare products and Regularity Agency. 

I received multiple screenshots from colleagues and friends, bringing the news to my attention.  I'm unsure whether practitioners have been unaware of the existing regulations by the ASA or now that they are listening because the of GDC guidance.

​So why are there regulations about botulinum toxin specifically, and how do they differ to dermal fillers? The big difference is that whereas dermal fillers are a medical device and in the UK can legally be purchased by anyone and injected by that person into any consenting adult. This differs from botulinum toxin (Botox/Azzalure/Bocoture), which are prescription-only medications (POMs).

 This means that a face to face consultation is required with the client and a prescribing doctor, dentist or nurse to create a prescription for treatment either by that same practitioner or with another practitioner. So what are the implications of this when it comes to advertising? As botulinum toxin injections are POM's this means that their use is prescribed specifically to an individual patient after a full medical consultation has determined that it's application is appropriate and indicated for use. Therefore advertising their use really suggests that they are not infact prescriptive and are available to anyone. Think about as a dentist advertising amoxicillin use - this would suggest that any patient could walk in requesting a course of the antibiotic rather than the dentist assessing them first, making a diagnosis, taking a medical history and prescribing it appropriately. 


From my initial training in botulinum toxin I was aware that using the word Botox or other brand like Bocoture or Azzalure was a big no no. Guidelines state that "any direct reference to products including Botox (or other brands) shouldn't appear on traditional non broadcast media". My training provider educated me on this and when teaching delegates on the Acquisition Aesthetics training courses we are very clear on the rules regarding this. At Paragon Aesthetics, we avoided using the word 'botox' on the website, price lists, business cards and on social media. Instead, we would refer to treatment as anti-wrinkle injections.  After speaking with colleagues and reading the ASA guidelines, at Paragon Aesthetics we sharpened up our approach to botulinum toxin marketing on social and digital media in March 2018.  To be perfectly clear, I am not an expert on the topic, and by following these changes does not ensure complete compliance, but this is now we have interpreted the guidelines. ​

We stopped posting before and after photos of anti-wrinkle treatments. We viewed that even if we referred to the procedure as 'anti-wrinkle' or 'muscle relaxing' injections, the images still portrayed the results created using a prescription-only medication. Regardless of the regulation if I never see another glabella or frontalis botox before and after ever again on social media it'll be too soon. Yes, I completely understand that when starting out the portfolio is a little thin on the ground they're great to 'pad out' the Instagram feed, but frankly, I find images of lined and then smooth foreheads uninspiring and boring, even to someone who could stare at pictures of teeth all day.

​We removed "anti-wrinkle" injections from our bio on instagram. Previously we listed the treatments we delivered names Dermal fillers, anti-wrinkle injections and hyperhidrosis treatment. Although it was clear that any treatment required a consultation prior to performing it we felt that by listing the service on the bio still advertised their use. Instead of leaving only dermal fillers, we replaced the content with our brand message "We create beautifully bespoke medical aesthetics".

​We sharpened up the website. We ensured that the homepage did not refer to any POM's. The guidelines state that information about POM's should not be easily assessable by the casual browser - therefore the homepage contains no links to pages that contain information about anti-wrinkle treatments other than the menu to access other pages. 

Pages about anti-wrinkle injections contain balanced and factual information about the product. The guidelines also state that claims "that the product can be used to treat areas other than those for which the product is licensed for" - therefore the list of areas where botulinum toxin are safely used with informed consent that are 'off license' use were removed.
​Under the prices section of the website, prices for botulinum toxin procedures were removed and replaced with POA. As the guidelines state that botulinum toxin injections "shouldn't include product claims or encourage viewers to choose a POM based on the price" - we felt that this was the easiest way to avoid financially driven treatment chooses for a potential client browsing the website. 

So what are the implications from a business standpoint? How will clients know you offer botulinum toxin treatments if you cannot 

advertise it? Personally, across all our clinics when we made the changes, we saw no reduction in the number of enquiries from new and existing clients about botulinum toxin injections. If anything, their popularity increased. Are we doing things completely right?   We hope so.


​As a patient, have you been deterred by seeing less information about anti-wrinkle injections on digital media? As a practitioner, would you make any other changes? Comment below.