Few parts of aesthetic marketing carry as many traps as the question of what you are actually allowed to say and show about your treatments. Germany's Heilmittelwerbegesetz, the Act on Advertising in the Healthcare Sector, does not regulate what you offer. It regulates how you talk about it. Clinic owners who internalise that distinction avoid most cease and desist letters before they ever arrive.
When the HWG applies to your clinic
The scope of the Heilmittelwerbegesetz, usually shortened to HWG, sits in section 1. It covers medicinal products and medical devices, and it covers other products, procedures and treatments where the advertising claim relates to detecting, removing or relieving illnesses and pathological complaints. It also expressly covers surgical cosmetic procedures where the claim relates to changing the body without medical necessity.
Here is the point that matters for an aesthetic clinic. Whether the HWG applies depends on your wording, not on your treatment menu. The same injection can fall inside the act in one ad and outside it in the next. "Botulinum toxin for excessive sweating" is a claim about a medical condition. "A fresher complexion after a peel" is not. The moment rosacea, acne, hyperhidrosis or scarring appears in your copy, you have changed the legal status of your own advertisement.
The second layer matters just as much. Even where the HWG does not apply, the Act Against Unfair Competition always does. Misleading is misleading, with or without a medical claim. And if doctors treat in your clinic, the professional code of the relevant state medical chamber applies on top, which permits factual information and prohibits promotional or misleading advertising.
A third layer is frequently overlooked and is one of the sharpest levers in the market. Under section 10 HWG, advertising prescription-only medicines to the general public is prohibited. Botulinum toxin is prescription only. Using the brand name of such a product in Instagram posts, price lists, Google Ads or on a treatment page moves you straight into that territory. Describe the service rather than the product, and have exactly those passages reviewed.
Austria and Switzerland run their own regimes, built on their respective medicines and medical practitioner legislation. If you advertise across borders, you need a review per country rather than one version for all three.
Before and after imagery
Section 11 HWG contains the sentence every aesthetic clinic should know. For surgical cosmetic procedures, you may not advertise the effect by showing a comparison of the body or the appearance before and after the procedure. That is a hard line, not a balancing exercise.
For minimally invasive treatments such as injectables, threads or laser, the position is less settled. Whether they count as surgical procedures for the purposes of that provision is not judged consistently. If you use imagery here, you are carrying a risk that is worth understanding and accepting deliberately rather than ignoring.
Separately, a second provision applies regardless. Images that depict changes to the body in an abusive, repulsive or misleading way are not permitted in advertising aimed at the public. This is where clinics lose cases without meaning to. A before shot under cold overhead light, no makeup, shoulders down, set against an after shot with a ring light, makeup and a lifted chin is misleading even when the clinical result is entirely genuine.
If you use imagery at all, make the capture technically reproducible:
- Same camera, same distance, same focal length, same head position.
- Same lighting, ideally a fixed photo corner with a marked standing position.
- No makeup, no filters and no automatic beauty mode on the phone camera in either shot.
- State the interval, the treatment and the number of sessions.
- Include a clear note that results vary and that no outcome is guaranteed.
Consent sits on top of all of that. For an identifiable person you need written permission, tied to a specific purpose and granted per channel, so separately for website, Instagram, print and events. A single tick box on the intake form will not carry it. Because a before and after image is health data, the stricter GDPR regime applies, and withdrawal has to be workable in practice. That means you must know where every image was published, otherwise you cannot honour a withdrawal at all.
Patient testimonials and reviews
Third party statements, including thank you notes and recommendations, are not banned outright. They become unlawful when they are used in an abusive, repulsive or misleading way. The line is misleading, and it is crossed faster than most clinics expect.
It gets risky when a single case reads like the rule, when a quote implies a medical outcome you could not promise in your own words, or when you publish the five most enthusiastic responses out of fifty and quietly drop the rest. What you may not say yourself, you may not have a patient say for you.
German competition law now adds a concrete disclosure duty. If you make consumer reviews available, you must state whether and how you ensure that those reviews come from people who genuinely used the service. One honest sentence on the reviews page is enough, but it has to be true. Bought or invented reviews, and claiming a verification process you do not actually run, are expressly unlawful.
In practice: ask automatically after every appointment, on the same terms for every patient, with nothing offered in return. The moment you reward a review, it becomes an incentivised review and has to be disclosed. The same logic applies more sharply to creator partnerships. A treatment in exchange for reach is consideration, and the post has to be labelled as advertising.
Discounts, vouchers and packages
Within the scope of the HWG, inducements and promotional gifts are prohibited by section 7, subject to a few exceptions. Items of trivial value are permitted, as are discounts consisting of a specified cash amount or an amount calculable in a specified way.
That gives you a clear ranking for campaign planning:
- Much better protected: "50 euros off this treatment" or "10% off every session on the membership tier". The benefit is quantifiable and tied to a specific service.
- Much riskier: "buy three, get one free", "bring a friend and get treated for nothing", free add-on treatments and referral rewards paid in treatments. Those are payments in kind and inducements, and they sit exactly where the provision is aimed.
There is also a professional conduct argument that often matters more than the statute. A discount must never be the reason for a procedure. As soon as price replaces indication, you have a problem regardless of how the offer is worded.
So if you run memberships or credit balances in your own app, build the benefit as a fixed rule rather than a free treatment. In Zovi, a tier benefit can be configured as a fixed percentage or a fixed euro amount per treatment, which structurally matches a quantifiable cash discount. That is not a legal opinion, but it is the shape your lawyer will find easier to sign off.
Prize draws and competitions
Competitions, draws and other chance-based schemes are prohibited under the HWG where they encourage improper or excessive use of medicinal products. For aesthetics, though, a different problem is usually the bigger one. Raffling a treatment puts the prize before the indication. The winner is decided before anyone has assessed whether that treatment suits that person at all.
The clean approach is to give away something that is not a treatment. A full consultation, a skin analysis, homecare products, or a voucher for a fixed amount that is later credited against a service that is genuinely indicated. The clinical decision stays where it belongs.
Formally you also need complete terms of entry covering the closing date, the prize, how the winner is drawn and how data will be used. And be careful with bundling. Making entry conditional on consenting to marketing is problematic under data protection law.
Pricing your treatments correctly
Price display is the least glamorous and most common trigger of all. You must always show the total price including VAT and every price component.
The VAT trap hits aesthetics specifically. Treatments are only VAT exempt where they are medically indicated. Purely aesthetic services are generally subject to VAT at 19%. If your price list dates from a time when everything was treated as a medical procedure, you now have a tax problem and a competition law problem at the same time.
On price reductions, one distinction is worth knowing. The duty to state the lowest price applied in the previous 30 days when announcing a reduction applies to goods. Your retail skincare shelf and your online shop are covered, your treatments as services are not directly. Even so, a strike-through price that never really existed is still misleading under competition law. Keep a simple dated price history per service and you can evidence any promotion you ever ran.
Mandatory disclosures and consent
A complete legal notice, the Impressum, is the cheapest avoidable mistake there is, and it belongs on your social profiles as well as your website. For doctor-led clinics that includes the professional title and the country that conferred it, the responsible medical chamber, the supervisory authority and the professional code with its source.
Your privacy notice has to reflect what you actually run, which means tracking pixels, booking system, review service and app notifications too. Email marketing needs consent, with a narrow exception for existing customers and similar services, and every message must carry an opt-out notice.
Push notifications are frequently misclassified. The operating system permission the phone asks for on first launch is a technical permission. It does not replace marketing consent. If you run your own channel such as a clinic app, the system should record per patient when consent was given, for what, and when it was withdrawn. Carefully maintained spreadsheet lists fail on exactly this point.
The most common triggers
- Incomplete legal notice, missing chamber and supervisory authority details.
- Brand names of prescription-only products in advertising aimed at the public.
- Before and after images with different lighting, makeup or posture.
- Promises of success. Words like guaranteed, permanent, risk free, painless or instant suggest a certain outcome and no side effects, which is precisely what section 3 HWG prohibits.
- Prices without VAT, without a total, or with unevidenced strike-through comparisons.
- Free add-ons and referral rewards paid in treatments.
- Reviews with no statement on verification, and creator posts with no advertising label.
Letters usually come from competitors or competition associations. The pattern is always the same: a letter with a pre-drafted cease and desist undertaking backed by a contractual penalty, and a very short deadline. Both halves matter. Take the deadline seriously, and never sign the enclosed undertaking unreviewed. It is routinely drafted more broadly than the alleged breach and binds you for good.
A sign-off process for campaigns
Legal safety in marketing is a process problem, not a legal one. These five steps cost very little and prevent most of it:
- A one page advertising policy. An approved list of phrasings and a banned word list, visible to everyone on the team.
- Two sets of eyes before publishing. Stories included, Friday evenings included. Most breaches happen spontaneously.
- An archive. Save every published ad with its date, channel and sign-off. If a letter arrives, you need to reconstruct what ran when.
- Central consent management. Images, email, push, each with date and purpose, withdrawable in one system rather than in folders.
- An annual legal check. Website, price list, social templates and consent forms reviewed once a year by a medical and competition law firm. Measured against a single dispute, it is the cheapest line in the marketing budget.
Conclusion
The HWG is not a ban on advertising. It is an instruction to be precise. Clinics that explain treatments instead of promoting them, that contextualise results instead of promising them, and that quantify benefits instead of giving them away, get remarkably far without ever coming close to a dispute. The rest is craft: a fixed photo setup, clean consent management, a documented price history and a second pair of eyes before every post.