No Before-and-After Advertising for Hyaluronic Acid Injections: German Federal Court of Justice Upholds Ban Under the Therapeutic Products Advertising Act

What Does the Therapeutic Products Advertising Act Say About Before-and-After Advertising?

The German Therapeutic Products Advertising Act (HWG) contains specific provisions governing advertising in the healthcare sector. Its primary purpose is to protect consumers from misleading, inappropriate or unduly influential advertising.

A key provision is Section 11(1), sentence 3, no. 1 HWG. It prohibits advertising certain operative plastic surgery procedures using comparative depictions of a person’s physical condition or appearance before and after treatment. This applies where the procedure is intended to alter the human body without medical necessity within the meaning of Section 1(1), no. 2(c) HWG.

The advertising ban particularly affects cosmetic procedures performed solely for aesthetic reasons. Whether the treatment result shown was actually achieved or whether the person depicted consented to publication is not decisive. What matters is whether the advertising falls within the scope of the statutory prohibition.

For businesses and doctors, this means that even an accurate before-and-after comparison can violate the Therapeutic Products Advertising Act.

The relevant provisions can be found in Section 11 of the German Therapeutic Products Advertising Act.

BGH Ruling: Hyaluronic Acid Injections Qualify as Operative Plastic Surgery

In its ruling of 31 July 2025 (Case No. I ZR 170/24, “Hyaluronic Acid Nose Correction”), the German Federal Court of Justice clarified an important question concerning advertising for medical treatments.

The case concerned advertising for aesthetic treatments using hyaluronic acid.

The Facts: Advertising Cosmetic Treatments on Instagram

A provider of aesthetic facial treatments advertised procedures that were not medically necessary on Instagram, using images intended to show patients before and after hyaluronic acid injections. The services offered included nose correction, lip enhancement and chin augmentation using injections.

The North Rhine-Westphalia Consumer Advice Centre considered the before-and-after images a violation of the Therapeutic Products Advertising Act and took legal action against the advertising. The Higher Regional Court of Hamm upheld the claim in its judgment of 29 August 2024 (Case No. 4 UKl 2/24).

The provider appealed. In its ruling of 31 July 2025, the Federal Court of Justice dismissed the appeal and upheld the ban on the advertising in question.

Why Are Hyaluronic Acid Injections Covered by the Advertising Ban?

The key legal question was whether treatment with hyaluronic acid can qualify as operative plastic surgery within the meaning of the Therapeutic Products Advertising Act. Unlike conventional cosmetic surgery, hyaluronic acid injections generally do not involve the use of a scalpel. Instead, the appearance is altered by introducing the substance using a cannula.

However, the BGH clarified that operative plastic surgery does not necessarily require an incision with a scalpel. The insertion of an instrument into the body to deliberately alter its shape or form may be sufficient.

The fact that hyaluronic acid is gradually broken down by the body, meaning that the treatment result may not be permanent, does not change this classification. Consequently, the aesthetic hyaluronic acid injections considered in the judgment, particularly those used to correct the nose or chin, fall under the statutory advertising ban.

The significance of the ruling therefore extends beyond conventional cosmetic surgery and also affects minimally invasive aesthetic treatments.

Why Is Before-and-After Advertising Prohibited?

Before-and-after images are among the most effective forms of advertising in aesthetic medicine. Comparing an allegedly undesirable initial appearance with an improved treatment result can create a strong incentive to purchase or undergo treatment. With cosmetic procedures in particular, this creates a risk that potential patients may make decisions without adequately considering the medical risks involved.

The Therapeutic Products Advertising Act is intended to counteract such inappropriate influences. It makes no decisive difference whether a procedure is advertised as particularly gentle, minimally invasive or low-risk. Hyaluronic acid injections can also involve health risks and side effects.

The statutory advertising ban is therefore intended, in particular, to protect the freedom of choice of potential patients and prevent medically unnecessary procedures from being presented as less significant or less risky than they actually are.

Which Hyaluronic Acid Advertising Is Specifically Affected?

The Federal Court of Justice’s ruling is particularly relevant to the digital marketing of aesthetic treatments. Many doctors, cosmetic clinics and providers of hyaluronic acid treatments use social networks to showcase treatment results and attract new patients.

This is an area where significant risks under competition law can arise.

Before-and-After Advertising on Instagram, Facebook and TikTok

Social media platforms make it particularly easy to present aesthetic treatment results visually. Examples of potentially prohibited advertising include Instagram posts comparing a patient’s face before and after a hyaluronic acid treatment.

The same applies to videos or Reels that first show a person’s appearance before treatment and then present the purported result.

The advertising ban cannot be circumvented by publishing before-and-after comparisons in different image formats or showing them sequentially over time.

The decisive factor is whether the content is perceived by its intended audience as a comparison of the treatment’s effects.

Before-and-After Images on Practice Websites

Social media posts are not the only content affected. Websites belonging to aesthetic practices and cosmetic clinics also frequently feature image galleries showcasing treatment results.

So-called success stories, patient testimonials and image sequences may violate the Therapeutic Products Advertising Act if they promote the effects of a medically unnecessary operative plastic surgery procedure through a before-and-after comparison.

Consent from the patients depicted does not eliminate this advertising prohibition.

Advertising by Manufacturers and Providers of Hyaluronic Acid Products

Manufacturers, retailers and distributors should also take this case law into account. When hyaluronic acid fillers or other products for aesthetic treatments are marketed, legal issues may arise, particularly where the advertising presents specific treatment results.

Examples include product marketing campaigns, promotional materials for treatment partners and advertising concepts developed jointly with doctors.

Whether the prohibition applies in a particular case depends, among other things, on the treatment being advertised, the target audience and the message conveyed by the presentation. For the legal assessment, it may also be relevant whether the communication is directed exclusively at medical professionals or at the general public.

Manufacturers and distributors should therefore review not only their own advertising activities but also the legal requirements governing the subsequent use of marketing materials they provide.

Is All Advertising for Hyaluronic Acid Treatments Now Prohibited?

No. The Federal Court of Justice’s ruling does not establish a general ban on advertising hyaluronic acid treatments.

What is prohibited is advertising using comparative before-and-after images where the statutory ban applies.

Doctors and providers of aesthetic treatments may generally continue to advertise their services, provided they comply with the applicable requirements of the Therapeutic Products Advertising Act, competition law and professional regulations.

Which Advertising Activities May Still Be Permitted?

In principle, permissible advertising may include factual information about the treatments offered, how they are performed, their areas of application and their potential risks and side effects. Presenting a practice, its medical qualifications or its technical equipment is not prohibited merely because of the BGH ruling.

However, advertising must not contain impermissible claims about treatment effects or misleading statements. Particular care is required when advertising specific treatment results.

The use of individual patient images is not automatically unproblematic either. The decisive factors are the specific advertising context and the message conveyed by the images.

The legal challenge is to promote aesthetic services effectively without crossing the boundaries set by the Therapeutic Products Advertising Act.

Violations of the Therapeutic Products Advertising Act: What Are the Consequences?

A violation of the Therapeutic Products Advertising Act can have significant legal and financial consequences for doctors, clinics and businesses.

Cease-and-Desist Letters Under Competition Law

Unlawful advertising can lead to cease-and-desist letters under competition law. Eligible competitors, qualified consumer protection organisations and competition associations may take action against unlawful advertising.

A cease-and-desist letter frequently demands that the advertising be discontinued and that the recipient submit a cease-and-desist undertaking backed by a contractual penalty. Such undertakings should not be signed without careful review, particularly where advertising activities are repeatedly published on social media platforms.

Injunctions and Court Proceedings

If an out-of-court settlement cannot be reached, court proceedings seeking an injunction may follow. These proceedings can result in additional legal fees and court costs. The BGH case demonstrates that even the use of individual advertising images can lead to litigation.

Fines Under the Therapeutic Products Advertising Act

In addition to civil law claims, regulatory offences may also have consequences. Under Section 15 HWG, certain violations of the advertising prohibitions contained in the Therapeutic Products Advertising Act may be punishable by fines.

For the offences covered by Section 15(1) HWG, the statutory maximum fine is €50,000. Whether a fine is imposed and, if so, in what amount depends on the individual circumstances.

Further information is available in Section 15 of the Therapeutic Products Advertising Act.

What Should Doctors, Practices and Manufacturers Do Now?

The Federal Court of Justice’s ruling highlights the importance of proactively reviewing advertising activities in aesthetic medicine. In particular, operators of medical practices, cosmetic clinics and businesses in the medical device sector should review their existing advertising.

Legally Assess Existing Advertising

The first step is to check whether the practice’s website or social media accounts contain comparative before-and-after images promoting medically unnecessary aesthetic procedures.

Older posts, image galleries that remain accessible and previously published videos should also be taken into account.

Ensure New Marketing Campaigns Comply with the Law

An early legal review can prevent advertising campaigns that have already been developed from having to be amended or withdrawn entirely at a later stage.

For extensive online marketing activities in particular, it is advisable to clarify the legal permissibility of advertising images, videos, copy and claims about treatment effects before publication.

Consider Other Aesthetic Treatments as Well

The ruling specifically concerns the insertion of hyaluronic acid using a cannula to alter the body’s shape or form. Other aesthetic treatments, including certain applications involving botulinum toxin, microneedling or laser treatments, require a separate legal assessment. Not every cosmetic treatment automatically falls under the same prohibition.

However, the broad interpretation adopted by the Federal Court of Justice of the term “operative plastic surgery” demonstrates that other minimally invasive procedures should also be assessed carefully from a legal perspective.

Lawyer for Healthcare Advertising and Competition Law: How SCHNELLER LEGAL Can Help

The legal requirements governing advertising for medical devices, aesthetic treatments and health-related services are complex. Legal issues frequently arise, particularly at the intersection of the Therapeutic Products Advertising Act, competition law and digital marketing.

As a specialist lawyer for intellectual property and competition law, I advise doctors, medical institutions, manufacturers and businesses on the legal assessment of their advertising activities and help them reduce risks under competition law.

My services include reviewing existing and planned advertising, assessing social media campaigns and advertising claims, and advising on cease-and-desist letters and disputes under competition law.

The focus is not solely on potential legal violations. The aim is to develop legally sound solutions that allow products and services to continue to be marketed successfully.

Further information is available on my service page covering healthcare advertising law.

Avoid Legal Risks in Your Advertising Now

Do you operate an aesthetic practice, a cosmetic clinic or a business in the medical device sector?

Have your advertising reviewed in good time before a marketing campaign turns into a dispute under competition law. I can help you assess the legal implications of your advertising and develop compliant advertising concepts.