FTC Endorsement Guidelines: What US Aesthetic Practices Can and Cannot Say

Every practice owner knows the rules have changed. Very few can tell you what changed, or when.

Here is the short version. Two separate instruments now govern how your practice uses consumer reviews, staff testimonials and influencer partnerships. One is guidance. The other is binding and has been in force since October 2024. Most practices are still operating as though only the first exists.

If your website carries patient testimonials, your front desk asks happy patients to post reviews, or you have ever sent free products or a complimentary treatment to someone with a following, this applies to you.

What are the FTC endorsement guidelines?

The FTC endorsement guidelines are formally the Guides Concerning the Use of Endorsements and Testimonials in Advertising, at 16 CFR Part 255. The Federal Trade Commission announced a revised version on 29 June 2023, updating them to address modern marketing practices that barely existed when the previous version was written.

The core principle is simple. An endorsement must reflect the honest opinions of the endorser, and it cannot be used to make a claim the sponsoring advertiser could not legally make itself. If your practice cannot say a treatment permanently eliminates cellulite, you cannot have a patient say it for you.

The endorsement guides are interpretive. They explain how the Commission reads Section 5 of the FTC Act and carry no civil penalties of their own. That has led plenty of practices to treat them as optional. Conduct inconsistent with the FTC's endorsement guides can still support enforcement, and the Commission assesses endorsements against what ordinary consumers would expect.

What actually counts as an endorsement?

Broader than most people assume. An endorsement is any advertising or promotional message consumers are likely to believe reflects the opinions or experiences of someone other than the advertiser.

That covers verbal statements, demonstrations, and depictions of a name, signature, likeness or other identifying personal characteristics. It covers social media posts, stories and captions. It covers a tag on a photo. If an ad features someone praising your clinic, it is an endorsement whether or not anyone called it one.

Two rules follow. The endorser must be a bona fide user, meaning they cannot claim to use a treatment they have never had. And endorsers must be able to substantiate any product performance claim they make, because a positive statement about results is still an advertising message when it appears in your marketing.

When do you have to disclose material connections?

Whenever the relationship between your practice and the endorser might affect how much weight the audience gives the endorsement. The obligation is to disclose unexpected material connections: if an ordinary consumer would not guess it, it needs disclosing.

Staff, family and insiders

This is where most practices are exposed. An officer or manager who writes a review or testimonial about the business must clearly and conspicuously disclose their material relationship to it. A practice also cannot circulate a testimonial from its own officers, managers, employees or agents without disclosure, where it knew or should have known about the connection.

Officers and managers are separately barred from soliciting reviews from their immediate relatives, or instructing employees to go and get reviews from theirs.

Social media influencers and ambassadors

Free products are compensation. So are early access, a discount, a gift card or a complimentary treatment. Social media influencers who receive any of that must disclose paid endorsements and material connections, and the obligation does not sit with them alone.

Influencers also have to communicate their genuine thoughts and experiences, which means a script your practice wrote is not an endorsement at all. Where you supply approved wording, supply the claims they may make and let them find their own words for the rest.

What makes a disclosure clear and conspicuous?

Clear and conspicuous means easily noticeable and easily understandable by ordinary consumers, and nothing else in the communication may contradict or undercut it.

Where a message has both visual and audio elements, the disclosure should appear in both formats. Someone watching a treatment video with the sound off should still see it.

Which consumer reviews practices are banned outright?

The Rule on the Use of Consumer Reviews and Testimonials, at 16 CFR Part 465, took effect on 21 October 2024. Unlike the guides, it is a binding trade regulation rule, and advertisers can face civil penalties for knowing violations.

It names the prohibited conduct directly:

• Fake reviews, including those written by a reviewer who does not exist, which now expressly covers AI-generated text.
• Reviews from someone who never had the experience described.
• Incentivized reviews where payment is conditioned on sentiment, whether the business wants a positive review or wants someone to post negative reviews about a competitor.

Beyond that, the rule reaches third-party review websites that a business controls while presenting them as independent, the purchase of fake indicators of social media influence, and review suppression.

Can you still use patient testimonials and before and after photos?

Yes, and that is a real advantage over markets with outright testimonial bans. The conditions are tighter than most practices assume.

The testimonial must reflect a genuine patient's honest experience. Where results are atypical, the ad must make clear what ordinary results look like, and that applies to any graph or figure implying a typical outcome. A small disclaimer does not cure a misleading express or implied representation.

Then a second regulator applies. Under the HIPAA Privacy Rule, using protected health information for marketing requires the individual's written authorization, with limited exceptions.

Who carries the potential liability?

Everyone in the chain, which surprises people.

Brands are responsible for monitoring influencer promotions and for instructing their networks on which claims are permitted and exactly how to disclose material connections. Endorsers may be liable for misleading statements they make, and failure to disclose sponsorships can create personal exposure for an influencer. The 2023 revision also addressed intermediaries, so advertising agencies and public relations firms acting on your behalf sit inside the frame.

The standard is not whether everybody was fooled. A practice is deceptive when it is likely to mislead a significant minority of consumers acting reasonably.

Not sure where your practice stands? Talk to our team and we will walk through it with you. You can also see the compliance-first marketing work we do for aesthetic practices.

Frequently asked questions

Do the FTC endorsement guidelines apply to a single location practice?

Yes. They apply to advertisers generally with no carve out for size, and practice owners are responsible for what employees and agencies do on their behalf.

Is a hashtag enough to disclose a paid partnership?

No. A tag or hashtag buried among twenty others does not tell ordinary consumers that anything of value changed hands. A plain statement naming who paid for the post is what the Commission is looking for.

What if a patient posts a glowing review without being asked?

An unsolicited, unincentivized review from a genuine patient is exactly what these rules protect. It becomes a problem only once your practice gives something in return, or republishes it in a way that implies typical results.

Can I ask patients to post reviews at checkout?

Generalized requests to share an experience are permitted and sit outside the insider provisions. What you cannot do is condition anything of value on the review being positive, or route unhappy patients away from public platforms.

Does removing a defamatory review count as suppression?

Reporting a review that genuinely breaches a platform's policies differs from building a system that filters out criticism. Take advice on specific removals rather than applying a blanket approach.

References

• Federal Trade Commission. (n.d.). FTC's endorsement guides: What people are asking. ftc.gov
• Federal Trade Commission. (2024, August 22). Trade regulation rule on the use of consumer reviews and testimonials. Federal Register. federalregister.gov
• Rule on the use of consumer reviews and testimonials, 16 C.F.R. § 465 (2024). ecfr.gov
• U.S. Department of Health and Human Services. (n.d.). Marketing. hhs.gov