[Before-and-After Pictures in Aesthetic Plastic Surgery: European Legal Perspectives and an Approach for Germany].

Abstract

Background: In plastic and aesthetic surgery, before-and-after photographs play a central role in patient education and decision-making. The recent court decision of the German Federal Court of Justice (Bundesgerichtshof, BGH) on the use of before-and-after images in minimally invasive treatments (e. g., hyaluronic acid injections, case no. I ZR 170/24, issued July 31, 2025) highlights an ongoing conflict: according to recent case law in Germany, the publication of before-and-after photographs - particularly for advertising purposes and in procedures "without medical necessity" - is prohibited under the German Drug Advertising Act (Heilmittelwerbegesetz, HWG) §11, the Medical Professional Code ((Muster-)Berufsordnung für die in Deutschland tätigen Ärztinnen und Ärzte, MBO), and the Unfair Competition Act (Gesetz gegen den unlauteren Wettbewerb, UWG). Nevertheless, such images can still be found online, as they are legally hosted on foreign servers.

Methods: As part of a doctoral dissertation project, the German legal framework was analyzed in international comparison, and a quantitative survey of patients and plastic surgeons was conducted. The survey addressed topics such as sources of information, willingness to consent to the publication of personal images, and the influence of social media. Data were analyzed descriptively and tested for statistical significance.

Conclusion: The findings demonstrate a clear demand for before-and-after images among both patients and physicians. Controlled legalization of such photographs could enhance transparency, promote realistic expectations, and increase patient safety. The introduction of a standardized seal or disclaimer is recommended to ensure authenticity and ethical acceptability. Legislative adjustments should safeguard against misleading representations while upholding ethical standards.