How to choose an aesthetics clinic marketing agency: find out if it has kept up with the rules

On 6 April 2025 a new banned practice took effect in UK consumer law. Paragraph 13 of Schedule 20 to the Digital Markets, Competition and Consumers Act 2024 bars submitting or commissioning a fake consumer review, or a review that hides the fact it was incentivised, and the CTSI Business Companion guide calls it a new banned commercial practice. For a clinic, the consequence lands on the testimonials page. A testimonial invented in a patient's name is a fake review under that definition. A quote from a patient who got a discounted top-up for writing it falls inside the same paragraph if the page conceals the incentive. So every testimonial an agency publishes for you needs a real patient behind it and a record of anything given in return. A genuine one can still fail for a different reason, covered in question 1. The questions below show whether an agency working for an aesthetics clinic (a med spa in the US) has caught the new rule and still knows the old ones.

1. How do you collect patient reviews, and who answers if one breaks the rules?

The CMA's guidance says marketing companies must not write or arrange fake reviews for clients, and that both the agency and the client risk breaking the law. In the US, the FTC says advertising agencies, public relations firms, review brokers and reputation management companies can be liable under its reviews rule, which has applied since 21 October 2024. That rule does not prohibit incentives unless the review must express a particular sentiment, but the FTC warns that an undisclosed incentive can still breach the FTC Act.

Clinics have a trap of their own. Advice from CAP, the committee behind the UK advertising code, puts testimonials on its list of places where no reference to a prescription-only medicine should be made, so a genuine patient review that names a toxin brand can still put your own site on the wrong side of the UK advertising rules.

Ask the agency to describe its review method in writing, to say whether any reward depends on the rating, and to say whether any followers or reviews are bought. Then ask what it does with a genuine testimonial that names a toxin brand. Listen for a specific answer on all four points, including how that testimonial is handled on your site.

2. Which of my treatments can you name in an ad, and how will you word the ones you cannot?

Under rule 12.12 of the UK advertising code (the CAP Code), no prescription-only medicine or treatment may be promoted to the public. CAP's January 2020 FAQ on Botox says the rule reaches all prescription-only botulinum toxin injectables, naming Botox, Vistabel, Azzalure, Bocouture and Dysport, but not dermal fillers. It also puts posters, leaflets, press ads and your own website inside the rule, with narrow exceptions. A UK clinic's menu therefore splits in two before any creative work starts.

Wording does the damage. The ASA ruled on 18 December 2024 that a clinic's paid Facebook ad offering "cosmetic injections" for three areas from a set price indirectly advertised a prescription-only medicine, and banned the ad in the form it had run. For a clinic that offers both toxin and fillers, CAP's FAQ calls "anti-wrinkle injections" a collective term that might be acceptable, as long as nothing else in the ad points to toxin alone. It advises against wrinkle relaxing injections even then.

None of this is a new rule. Asked in January 2020 whether it had changed the rules, CAP answered that they had been in force for some time, so the social media enforcement it was explaining policed old law, and the 2024 ruling did the same. That month, CAP and the MHRA issued an enforcement notice targeting over 130,000 businesses in the cosmetics services industry, the furthest-reaching notice CAP had issued. The FAQ says a complaint is likely to be referred to the Compliance team, which works with social media platforms to get offending posts removed, and that repeated, deliberate breaches might involve the MHRA or a professional regulator.

Ask the agency to sort your treatment menu into prescription-only and not, to say who checks each headline against that list, and to show how a price-led toxin ad would be rewritten. The answer worth hearing starts from your actual menu, names the rule and offers an ad that promotes the consultation instead.

3. How does a patient get from your ad to a booking without a toxin brand on the page?

Under CAP's advice, a clinic website may mention a prescription-only medicine only in the context of the product being a possible treatment option following a consultation. The same advice keeps any such reference out of a sponsored ad, the homepage, logos, testimonials and hover text, and CAP's FAQ adds that toxin information shouldn't be easy for a potential client to stumble upon. A price list may include Botox, but it should not include product claims or encourage viewers to choose a product based on the price.

Your site has to work alongside the feed. The NHS tells patients to avoid practitioners who only advertise on social media, so a clinic with only a busy Instagram grid gives careful patients a reason to look elsewhere.

Ask to see the whole path on screen: the sponsored ad, the landing page, the homepage and wherever the price list sits. You want to see the consultation promoted at every step, with treatment detail a click deeper and written in balanced, factual terms.

4. How do you handle before-and-after photos, price offers and influencers?

For toxin, photographs of results are best kept out of ads, and the authority here is CAP's advice, which states a likely view rather than a fixed rule. CAP's advice says the ASA would probably treat a before-and-after photograph as an efficacy claim, and such claims are not permitted for a prescription-only medicine. Where a clinic offers fillers as well as toxin, CAP's FAQ allows images of a non-prescription treatment, labelled as such and backed by signed and dated proof that the photos are genuine, and representative of what can be achieved. The FAQ also says a price promotion for toxin, a "20% off" deal for example, is likely to breach the Code.

Influencers add a second layer. In the UK, rule 12.18 of the CAP Code says marketers must not use health professionals or celebrities to endorse medicines, and CAP's toxin advice applies it to Botox. A US influencer given a free or discounted treatment has a material connection to the clinic, and the FTC wants that connection made obvious in the post.

Ask for the photo consent form and labelling method, the rules the agency uses for offers, and the brief it gives influencers. Good practice looks like separate galleries by treatment, signed proof for every image, no toxin price offers and a disclosure in every paid post.

5. How do you keep ads away from under-18s?

CAP rule 12.25 stops a clinic aiming cosmetic-intervention ads at under-18s through the media it picks or the context around the ad. In England, treating anyone under 18 with botulinum toxin or a cosmetic filler injection is also an offence under a 2021 Act. The Act gives a defence to a registered doctor, to a regulated health professional acting in accordance with the directions of a registered medical practitioner, and to anyone who had taken reasonable steps to establish a patient's age and believed, reasonably, that the patient was 18 or over.

So the audience settings are not a technicality. Ask the agency to show the audience and placement settings on a live clinic campaign, and to say where in the booking process a patient's age is checked. Adult-only targeting set at the start, placements away from youth-skewed content and an age question early in the booking, not at the treatment room door, are what to look for.

6. In the US, which physician stands behind each treatment you promote?

Texas is one example. Since 9 January 2025, its medical board rules have listed cosmetic injections among the nonsurgical procedures a physician may delegate and supervise. Each delegation needs a written order that names the physician who made it. Find out who at the agency has read your own state's rules, and when.

Two FDA statements bear on how a US clinic describes its treatments. The FDA classes a filler injection as a medical procedure rather than a cosmetic treatment. It also warned in April 2024 that counterfeit Botox had been injected, and that federal law requires providers to buy prescription drugs only from authorised sources. We did not find an official US source that settles whether a clinic may name Botox in an ad, so ask the agency for its source for whatever it tells you.

Ask whether the supervising physician sees copy before it runs, and how a "genuine product" message is backed by purchase records. Look for a named physician sign-off step and a refusal to promise safety the agency cannot document.

7. What is in the report, and how often will I see it?

Count consultations, not clicks. In the UK, CAP's advice tells toxin advertisers to promote the consultation itself rather than the product, so the booked consultation is the event the agency promotes and the one it should report. Ask for booked consultations, the share that became treatments, split by treatment type, and the cost per booked consultation. Ask also for a log of which ads and posts were checked against which rule, by whom and on what date.

Monthly is often enough, with a named person walking you through it by call or video, and the figures set against your own previous months, because those are the only figures that describe your rooms. The report should let you see a falling number and the reason for it on the same page. One that shows reach and likes, and stops there, tells you nothing about your diary.

8. Can you show work for a clinic like mine?

Proof from a business like yours means the same country, a similar treatment mix and a similar prescriber set-up. Ask the agency to name an aesthetics clinic or med spa it has worked with, to show you live posts and ads from that account and to let you speak to the owner.

Then read that clinic's live ads against questions 2 to 4: the toxin wording, the path to booking and the photographs. Ask about anything that does not fit. Whether an agency is a clinic specialist or a generalist matters less than whether its own clients' ads hold up to that reading.

We have no published case study from an aesthetics clinic, so we cannot pass this check. How we would work is set out on marketing for aesthetics clinics, and that page makes no claim of past results in this trade.

9. Which of this work would you tell me to keep in-house?

Sometimes the better choice is no agency at all. We think a clinic with one or two practitioners may need only a freelancer to place ads, plus a clinician or coordinator who reads every post against sections 2 to 4 before it goes out. CAP's Copy Advice team invites queries on botulinum toxin advertising. Waiting can also beat hiring when your rooms are full and you cannot take more patients.

Some work belongs with your clinical team whoever you hire. Your practitioners should sign off treatment wording, and your own staff should answer consultation enquiries fast. An agency worth hiring tells you which parts to keep. For contract length, ownership of ad accounts and who does the work, see our guide to the questions to put to any agency at a first meeting.

The last question to ask, and how to read the answer

Ask this: "What has changed in the rules since 2024 that changed how you would run a clinic like mine?"

Then sort every date in the reply into one of two piles. Changes go in the first: the April 2025 UK reviews rule and the October 2024 FTC reviews rule both count. Enforcement goes in the second: the December 2024 ASA ruling and the January 2020 enforcement notice applied rules that were already in force. An agency whose answer sits only in the second pile has mixed up the two. One that names nothing beyond following the guidelines, or talks about algorithms, has an empty first pile. If the first pile holds no change and no thing the agency did about it, with who signed off the new version, treat its compliance claims as unproven.

If you run an aesthetics clinic or a med spa and want an agency conversation that starts with these rules, tell us about your business and we will tell you whether we are the right fit.