What the FTC, State Boards, and ADA Actually Require for Procedure Photos and Patient Testimonials

Before-and-after photos sit at the intersection of three distinct regulatory frameworks, each with different enforcement mechanisms and penalties. Understanding which rules apply—and where they overlap—prevents the compliance gaps that lead to enforcement actions.

Federal Trade Commission (FTC)

The FTC's Endorsement Guides (16 CFR Part 255) and Health Products Compliance Guidance govern how you can present patient outcomes. Key requirements include disclosing when depicted results aren't typical, avoiding manipulated images that misrepresent outcomes, and ensuring testimonials reflect honest opinions with material connection disclosures.

State Medical Boards

Your state medical board likely has advertising rules specific to cosmetic procedures. These vary significantly—some states prohibit any photo enhancement including lighting correction, while others allow reasonable adjustments with disclosure. Board violations can result in license discipline, making these rules higher-stakes than federal guidance for most practices.

[ADA website accessibility](/resources/attorney/attorney-website-compliance) applies to image galleries under WCAG 2.1 AA standards

Under the Americans with Disabilities Act as interpreted through WCAG 2.1 AA standards, your procedure galleries must be accessible to users with visual impairments. This means descriptive alt text for images, keyboard-navigable galleries, and sufficient color contrast in comparison sliders. Accessibility lawsuits against medical practice websites have increased substantially in recent years.

This overview is educational guidance, not legal advice. Consult healthcare marketing counsel and verify current rules with your state medical board.

The FTC's updated Endorsement Guides create specific obligations for cosmetic surgery marketing that many practices misunderstand or under-implement.

The "Typical Results" Standard

If your before-and-after photos show results that aren't typical for most patients undergoing that procedure, you must clearly and conspicuously disclose what results consumers can generally expect. The old approach of adding "results may vary" in small print no longer satisfies FTC expectations.

Effective disclosure means: stating what the typical patient experiences (not just that results vary), placing the disclosure where consumers will actually see it before making decisions, and using language that's understandable to the average person.

Material Connection Disclosure

When patients provide testimonials—written reviews, video testimonials, or social media posts—any material connection must be disclosed. This includes:

• Discounts on procedures in exchange for testimonials
• Free touch-up treatments or products
• Referral credits or gift cards
• Entry into prize drawings for reviews

The disclosure must be clear and prominent. Burying it in terms and conditions or using ambiguous language like "patient ambassador" doesn't satisfy FTC standards.

Enforcement Reality

The FTC has increased enforcement actions against health-related advertising claims. While they typically pursue the most egregious cases, enforcement often starts with competitor complaints or patient reports. Proactive compliance is substantially less expensive than responding to an FTC inquiry.

State medical board advertising rules vary dramatically, and many cosmetic surgeons unknowingly violate their own state's specific requirements while following general industry practices.

Photo Manipulation Restrictions

States take different positions on what constitutes acceptable photo preparation:

• Strict states prohibit any digital enhancement, including color correction, lighting adjustment, or removal of temporary marks
• Moderate states allow technical corrections but require disclosure of any modifications
• Permissive states allow reasonable adjustments that don't misrepresent actual outcomes

Check your specific state medical board's advertising regulations—many have been updated in the past three years as photo technology has advanced.

Consent Documentation Requirements

Most states require written patient consent for marketing use of photos, but the specific requirements vary. Some require:

• Separate consent for digital versus print use
• Specification of which platforms photos may appear on
• Time limitations on consent validity
• Patient ability to revoke consent and have images removed

Multi-State Practice Considerations

If you practice in multiple states or market to patients across state lines (common in cosmetic surgery), you must comply with each relevant jurisdiction's rules. The safest approach: default to the most restrictive state's requirements across all marketing.

State regulations change frequently. Verify current rules with your state medical board and healthcare attorney before implementing or updating gallery policies.

Accessibility lawsuits against healthcare websites have become increasingly common. Before-and-after galleries present specific accessibility challenges that require deliberate design choices.

Alt Text Requirements

Every image in your gallery needs descriptive alt text that conveys the meaningful content to users who can't see the image. For before-and-after photos, this means describing the procedure area and general outcome—not just labeling images as "before" and "after."

Example: Instead of alt="before rhinoplasty", use alt="Patient's nose from front view before rhinoplasty procedure showing dorsal hump" and corresponding descriptive alt text for the after image.

Comparison Slider Accessibility

Interactive before-and-after sliders must be keyboard-navigable and work with screen readers. Many popular slider plugins fail accessibility testing. Requirements include:

• Full keyboard control without requiring mouse interaction
• Screen reader announcements when slider position changes
• Sufficient color contrast for slider controls
• Alternative static comparison available for users who can't interact with the slider

Gallery Navigation

Patients browsing multiple procedure examples need accessible navigation between images. This includes logical tab order, clear focus indicators, and properly labeled navigation controls.

Compliance Testing

Automated accessibility scanners catch some issues but miss many context-dependent problems in image galleries. Manual testing with actual screen readers and keyboard-only navigation reveals the real user experience.

Implementing a gallery that satisfies all three regulatory layers while still showcasing your work effectively requires systematic planning.

Photo Capture Protocol

Establish consistent photography standards that prevent compliance issues before they start:

• Standardized lighting and positioning eliminates the need for post-processing corrections that might violate state rules
• Neutral backgrounds reduce the temptation to edit out distracting elements
• Consistent camera settings ensure before and after images are technically comparable
• Same-day consent documentation captures patient permission while context is fresh

Disclosure Placement Strategy

Rather than hiding disclosures in footers, integrate them into the gallery experience:

• Display typical results information before patients browse individual photos
• Include relevant procedure-specific context with each gallery category
• Make testimonial material connections visible alongside the testimonial, not in separate disclosure pages

Technical Implementation Checklist

1. Audit current gallery for accessibility using both automated tools and manual screen reader testing
2. Implement descriptive alt text for all existing and future images
3. Test slider components for keyboard accessibility
4. Verify mobile gallery experience meets same accessibility standards
5. Document your compliance measures for potential regulatory inquiries

For practices seeking SEO-optimized and compliant plastic surgery galleries, the technical implementation must satisfy search visibility requirements alongside regulatory compliance—these goals align when properly executed.

[Patient testimonials](/resources/plastic-surgeon/plastic-surgeon-online-reputation-management) require clear disclosure of any compensation or incentive provided drive cosmetic surgery conversions, but the compliance requirements extend beyond your website to every platform where patient opinions appear.

Website Testimonials

For testimonials you directly publish:

• Obtain written consent specifying where the testimonial will appear
• Document any compensation or incentive provided
• Display material connection disclosures immediately adjacent to the testimonial
• Verify the testimonial reflects the patient's honest experience (don't edit to change meaning)

Third-Party Review Platforms

Google reviews, RealSelf, and similar platforms have their own terms of service prohibiting incentivized reviews. When encouraging patients to leave reviews:

• Never offer compensation contingent on leaving a review
• Don't suggest what rating or content the review should contain
• If offering any incentive, it must be available regardless of whether a review is left or what it says
• Remember that many platforms prohibit even disclosure-compliant incentivized reviews

Video Testimonials and Social Media

Video testimonials require the same disclosures as written testimonials, plus additional considerations for HIPAA-compliant consent documentation. When patients post about their experience on social media, any incentive or compensation you've provided makes that post a sponsored endorsement requiring disclosure by the patient.

Documentation for Regulatory Defense

Maintain records of:

• Original consent forms with date and scope
• Any compensation or incentives provided
• Where and when testimonials were published
• Evidence that disclosures were properly displayed

This documentation becomes critical if facing an FTC inquiry or state board complaint.