Background
Summary of Council decision:
Two issues were investigated, both of which were Upheld.
Ad description
A post on The Lipstick Gangster’s Facebook page, on 5 September 2022, included a before and after photo comparison that depicted a female torso that appeared noticeably more sculpted in the second photo. The caption stated “Another example of the magical results created by @bodyworks_ldn [heart emoji]. Brazilian Body Contouring, Lymphatic Drainage Massage & fat dissolving is available Mondays at The Lipstick Gangster [heart emoji].”
Issue
1. The ASA challenged whether the ad breached the Code because it promoted an unlicensed medicinal product.
2. The complainant challenged whether the ad, including the before and after photos and the impression given regarding the results that could be achieved, was misleading and could be substantiated.
Response
1. Lipstick Gangster Ltd said the treatments and services were provided by Bodyworks LDN Ltd. Lipstick Gangster did not have expertise in this area, but they were confident that all products used by Bodyworks LDN were licensed.
Bodyworks LDN said the fat dissolving injection they used was Lipo Lab PPC, which included the active substance phosphatidylcholine. They said they had never promoted Lipo Lab PPC by name. Based on its availability to purchase from UK aesthetic pharmacies, opportunities to receive training on its use, and the ability to insure its use, they had understood that it was appropriately licensed. It was never their intent to use an unregulated medication and they would not use it in future.
2. Lipstick Gangster said that the ASA’s investigation had highlighted to them the need to ensure that all advertising across all platforms was responsibly shared with a focus on transparency. They apologised if the ad had not met those standards and would ensure that this did not happen again. However, they were confident that the results of the techniques used by Bodyworks LDN were proven.
Bodyworks LDN explained that they worked out of Lipstick Gangster’s clinic once a week. They had not asked Lipstick Gangster to post about their services and had not had any input into the content of the ad. The ad did not reflect the content of their own advertising. They believed the ad did not provide sufficient context about the full process of treatment for each client and should not have referred to “magical results”. However, they considered the outcome of the treatment, as shown in the photos in the ad, was substantiated by evidence.
They said that the client featured in the ad had not received cosmetic surgery and was put on a strict diet and had to wear a compression garment for seven days. They stated that the client held more water retention rather than fat, which was why the change observed was significant. The photos had not been digitally altered and differences in the client’s pose between the before and after photos were because it was not feasible to arrange a client in identical positioning each time; there were many changing variables such as different clinic sites or internal clinic room layouts. The pictured client had contacted the ASA to confirm she was happy with the results of the treatment. A further client had also emailed providing a video showing a transition between before and after photos of the results of her treatment and explaining that in the before photo she was suffering from swelling as a result of liposuction, which had been helped by Bodyworks LDN’s treatment.
The advertisers jointly explained the processes of each treatment used for the client: manual lymphatic massage, Brazilian body contouring and lipolysis (the Lipo Lab PPC fat dissolving injections). In addition to the client testimonials emailed to the ASA, they provided a 2015 journal article on local adiposity reduction relating to the use of a product called Aqualyx, and said the website for that product included additional clinical evidence. Bodyworks LDN acknowledged Aqaulyx did not have the same active ingredient as Lipo Lab PPC but highlighted that Aqualyx was a single action solution, whereas Lipo Lab PPC was triple-acting, containing phosphatidylcholine, sodium deoxycholate and l-carnitine. They said l-carnitine’s use for weight loss was well-documented in clinical trials.
The advertisers also provided a letter from a plastic surgery clinic which stated that their patients who had received High-def Vaser liposuction, Brazilian ’butt lifts’ and tummy tuck operations were referred to Bodyworks LDN for lymphatic drainage massages as a form of post-operative care. Bodyworks LDN further provided a 2014 study on the efficacy of manual lymphatic drainage in plastic surgery post-operative care, a link to a 2023 article in a magazine for beauty professionals about manual lymphatic drainage, and their practitioner’s professional certifications.
Assessment
1. Upheld
The CAP Code stated that medicines must have a licence from the MHRA (Medicines and Healthcare products Regulatory Agency), VMD or under the auspices of the EMA before they were marketed.
The ASA noted that unlicensed medicines had not been tested for efficacy, quality or safety.
The MHRA confirmed that Lipo Lab PPC was an unlicenced medicinal product and therefore it was not allowed to be used for cosmetic purposes such as fat dissolving. The only basis on which it could be used in the UK would be if it was imported to meet the clinical medical need of a specific patient (known as a ‘special’). It could not be imported into the UK for a non-medicinal purpose. They said that the advertising of unlicensed medicines was not permitted, and considered that the ad was advertising an unlicensed medicine.
The ad included a before and after photo with a caption that stated “[…] fat dissolving is available Mondays […]” and we considered that consumers would understand from the ad that the results achieved were at least in part due to a fat dissolving treatment. We understood that treatment was injections of Lipo Lab PPC, which was an unlicensed medicine. We therefore concluded that the ad breached the Code because it promoted an unlicensed medicine.
On that point, the ad breached CAP Code (Edition 12) rule 12.11 (Medicines, medical devices, health-related products and beauty products).
2. Upheld
Notwithstanding that the ad attributed the results shown in the images in part to the effects of an unlicensed medicine, in breach of Code rule 12.11, we also assessed whether the efficacy claims in the ad could be substantiated.
We understood that Bodyworks LDN, who offered the treatment from Lipstick Gangster’s clinic, had no input into the creation or content of the ad. However, we considered they had joint responsibility to ensure that ads which promoted their services complied with the Code.
The images in the ad depicted a client’s torso from behind, and in the after image they appeared to have a significantly slimmer waist. We considered that the before and after images, combined with the claim “Another example of the magical results created by @bodyworks_ldn [heart emoji]. Brazilian Body Contouring, Lymphatic Drainage Massage & fat dissolving is available Mondays at The Lipstick Gangster [heart emoji]” would be understood by consumers to mean that those results could be achieved by a combination of lymphatic drainage massage, Brazilian body contouring and fat dissolving injections.
We understood that the client featured in the ad had received four lymphatic massages with Brazilian body contouring and two sessions of fat dissolving injections. Bodyworks LDN had said that the client had not received any form of surgery to achieve the results featured in the ad. We therefore assessed the evidence submitted by Lipstick Gangster and Bodyworks LDN on the basis that the results could be achieved without surgical intervention.
The 2015 study on local adiposity reduction was conducted on 186 patients between October 2009 and November 2013. Over that time, each subject received six sessions of injections of 40 ml of Aqualyx, a deoxycholic acid-based solution. The trial did not have a control group, and it was therefore not clear that the conclusions of the study could be attributed solely to the effects of the injection. Furthermore, the subjects had six sessions of injections, which was three times the number of injections administered to the advertisers’ client. Additionally, Lipo Lab PPC contained phosphatidylcholine, sodium deoxycholate and l-carnitine rather than deoxycholic acid. While Lipo Lab PPC might have more ‘active’ ingredients than Aqualyx we considered that in itself did not demonstrate that it would have the same effects as Aqualyx. Therefore, we concluded that even if Lipo Lab PPC had been licensed for cosmetic use, the study provided (and further clinical evidence relating to Aqualyx) would not be relevant substantiation for Lipo Lab PPC’s efficacy.
The 2023 magazine article described the popularity of manual lymphatic drainage and different methods that could be used. It was not adequate evidence to support claims of efficacy for the treatment. We also reviewed the 2014 study provided by Bodyworks LDN on the efficacy of manual lymphatic drainage in post-operative care for liposuction and lipoabdominoplasty. This study did not have a control group and so did not compare the effects of manual lymphatic drainage to the body’s natural response following cosmetic surgery. In any event, we understood that the client featured in the ad had not undergone cosmetic surgery. Because the study only concerned post-operative cases, we concluded that the results were not relevant substantiation for the challenged claim.
Furthermore, the advertisers’ response heavily emphasised the treatments as being post-operative. We excluded any evidence associated with such references from our assessment as they were not relevant to the claims made in the ad. The advertisers had said that outside their main, post-operative function, lymphatic drainage massage and Brazilian body contouring were used to promote circulation, reduce the appearance of cellulite, flush toxins and reduce stress. However, they did not provide any relevant clinical evidence substantiating those effects.
Additionally, we understood that the process of manual lymphatic drainage with Brazilian body contouring required the client to follow a strict diet that excluded meat, dairy and alcohol, and the use of a compression garment for seven days after each session. We considered these factors could have contributed to the change in the client’s body shape seen in the photos, particularly if the photo was taken immediately after a compression garment was removed. The ad made no reference to significant changes in diet being necessary to achieve the results depicted, which we considered was misleading.
We noted the emails we had received from two Bodyworks LDN clients, but testimonials were not adequate to substantiate claims about the efficacy of treatments. While we accepted that minor variations in the poses were to be expected across different sessions, we also considered that the difference in the positioning of the body in the ad’s photos contributed to the implied effectiveness of the treatments. Given the dramatic difference in the body shape, in the absence of evidence that substantiated this was the result of the treatments, we were also concerned that we had not been provided with the original photos of the clients’ results.
Because we had not received robust evidence to support the efficacy claims in the ad for manual lymphatic drainage with Brazilian body contouring and Lipo Lab PPC injections, we concluded that they had not been substantiated and were in breach of the Code.
On that point the ad breached CAP Code (Edition 12) rules 3.1 (Misleading Advertising), 3.7 (Substantiation), 3.47 (Endorsements and testimonials), 12.1 (Medicines, medical devices, health-related products and beauty products), and 13.9 (Weight control and slimming).
Action
The ad must not appear again in its current from. We told Lipstick Gangster Ltd and Bodyworks LDN Ltd not to advertise unlicensed medicines to the public. We also told them not to make efficacy claims for manual lymphatic drainage and Brazilian body contouring unless they held robust scientific evidence to substantiate them.
