Regulation explainer · AHPRA s133 + ASPS code
Before-and-after photos in Australian plastic surgery: what the rules actually say
AHPRA s133 and ASPS code on before/after photos in plastic surgery, why we don't display them, and how to read a surgeon's gallery responsibly.
★Key takeaways
- ✓AHPRA s133 restricts use of before/after photos and testimonials that could induce a person to have a cosmetic procedure.
- ✓The ASPS Code requires consent, standardised conditions, no retouching and clear timeframe disclosure for any displayed photos.
- ✓We do not display before/after images on this site - we use AHPRA Specialist Register status and ASPS membership as quality signals instead.
- ✓In-clinic photo viewing remains the most informative form of patient education and is permitted by AHPRA.
The regulation
AHPRA Section 133 in plain English
Section 133 of the Health Practitioner Regulation National Law (uniform across all Australian states and territories) prohibits advertising a regulated health service in a way that:
- Is false, misleading or deceptive (or likely to be)
- Offers gifts, discounts or other inducements without the terms and conditions clearly disclosed
- Uses testimonials about the service
- Creates an unreasonable expectation of beneficial treatment
- Directly or indirectly encourages the indiscriminate or unnecessary use of regulated health services
In practice for plastic surgery, this means: no testimonials in advertising, no idealised or retouched outcome photos, no "perfect" before/after sliders that ignore complication risk, no influencer-style content presenting cosmetic surgery as casual or risk-free. Breaches carry fines up to $60,000 for individuals and $120,000 for companies (2026 levels).
The 2023 Medical Board reforms tightened this further
Following Medical Board of Australia investigations into the "cosmetic surgeon" industry, the September 2023 reforms added:
- Mandatory 7-day cooling-off period between consultation and booking
- Mandatory GP referral for cosmetic procedures
- Restrictions on social media advertising of cosmetic procedures (no influencer testimonials, no time-limited offers)
- Mandatory accreditation of theatres for higher-risk cosmetic procedures
- Restrictions on the use of the title "cosmetic surgeon" by non-FRACS doctors
The ASPS Code of Conduct adds professional-body restrictions
The Australian Society of Plastic Surgeons Code of Conduct (most recent revision 2023) goes further than AHPRA in some areas. ASPS members must:
- Obtain written informed consent for every use of patient photographs
- Photograph patients under standardised conditions (lighting, posture, camera angle)
- Not digitally retouch images in a way that alters apparent surgical outcome
- Display the specific post-op timeframe alongside any "after" image
- Not use before/after images in social media advertising or sponsored posts
ASPS members can be sanctioned by the Society for breaches independent of AHPRA action.
What this means for our directory
We list AHPRA Specialist Register status, ASPS membership, hospital affiliations and self-declared specialisations. These are documentable quality signals. We do not display before/after images, even with consent, because: (a) the photos most patients see online are typically curated to best-case outcomes and create unrealistic expectations, (b) we cannot independently verify the conditions under which any image was taken or whether retouching has occurred, and (c) the regulatory environment is unambiguous that this is not the recommended path for cosmetic surgery patient education.
If you want to see a surgeon’s representative outcomes, the recommended path is: in-person consultation with in-clinic photo viewing. This is permitted by AHPRA, is the most informative form of education (the surgeon explains each case in detail), and matches the reality that responsible surgeons maintain large representative libraries precisely for candidate viewing.
How to read a surgeon’s gallery responsibly
- Consistency across multiple patients. One flawless photo means little. Twenty representative photos showing similar improvement across different body types and ages means a lot.
- Similar body types to yours. A surgeon’s breast augmentation results in a 45kg patient tell you little about results in a 75kg patient. Ask to see cases similar to your anatomy.
- Same camera angle, lighting, posture. Different lighting or posture can fake an outcome. Standardised conditions matter.
- Range of starting points. If every before photo shows an "ideal" candidate (good skin, no asymmetry, moderate concern), the after photos are not telling you what to expect from your harder case.
- Absence of retouching. Compare skin texture, shadows, lighting between before and after. Subtle photoshop is more common than most patients realise.
- Explicit complications and revisions. A surgeon willing to show outcomes that needed revision, or cases where the result was less ideal than hoped, is dramatically more trustworthy than one who only shows perfection. Ask explicitly: "Can I see a case that didn’t go as planned and what you did about it?"
Red flags in any surgeon’s photo gallery
- All photos show identical ideal candidates with no anatomical diversity
- No timeframe disclosed on any "after" photo
- Heavy filtering or visible retouching
- Surgeon uses social media to promote before/after photos (breaches AHPRA s133 in most cases)
- Influencer or paid celebrity testimonials
- No mention of revision cases or complications in any patient education material
Common questions
Before/after photo ethics - common questions
Why don't you show before-and-after photos on this site?
Three reasons. First, AHPRA Section 133 of the Health Practitioner Regulation National Law restricts cosmetic procedure advertising including the use of testimonial photographs that could induce a person to undergo a procedure. Second, the ASPS Code of Conduct (2023) requires that any before/after photo be representative, not idealised, and accompanied by full disclosure of patient outcomes. Third, even photos with consent and disclosures are typically curated from best-case outcomes and create unrealistic expectations. We list AHPRA Specialist Register status and ASPS membership as the meaningful quality signals.
Is it legal for surgeons to have before/after photos on their own website?
Conditionally yes. AHPRA s133 and the ASPS Code allow representative photos with patient consent, but require: identifying information removed, accurate representation (not retouched or idealised), full disclosure of complications and revisions, and a clear statement that "results may vary". Photos cannot be used in social media advertising without these conditions met. A surgeon who shows only flawless retouched outcomes is likely in breach.
How do I read a surgeon's before/after gallery responsibly?
Look for: (1) consistency across multiple patients (one perfect photo means little; 20 representative photos mean a lot), (2) similar body types and skin tones to yours, (3) the same camera angle, lighting, and posture in before vs after, (4) before photos that show a range of starting points (not only "ideal" candidates), (5) absence of obvious photo manipulation, and (6) explicit complication or revision images alongside best-case outcomes. A surgeon willing to show their imperfect outcomes alongside their best ones is more trustworthy.
Why is this regulation tighter than in other countries?
Australia’s 2023 cosmetic surgery reforms followed Medical Board of Australia investigations into "cosmetic surgeon" practices where social media photos of curated outcomes drove patient demand for procedures performed by under-trained operators. The reforms aimed to reduce the role of marketing photos in driving cosmetic surgery decisions, refocusing patient choice on practitioner qualifications and informed-consent processes rather than on visual outcomes alone.
Can I bring photos of results I like to my consultation?
Yes - many surgeons encourage this. A photo of an outcome you like helps the surgeon understand your aesthetic preferences. Bring 5-10 reference photos. However, be open to your surgeon explaining what is and is not anatomically achievable for you - the most common consultation failure is bringing a photo of someone with very different bone structure or skin tone and asking the surgeon to "make me look like this". A skilled surgeon will explain what aspects of the reference photo translate to your anatomy and what does not.
Should I trust influencer or social media testimonials?
No. Influencer and social media testimonials are almost universally either (a) financially compensated, (b) heavily filtered/edited, (c) showing only the immediate post-op result (which is rarely the long-term result), or (d) provided by patients whose follow-up timeline ended before any complications occurred. AHPRA s133 specifically restricts paid testimonials. Trust qualifications (FRACS, AHPRA Specialist Register, ASPS membership, hospital affiliations) over social media content.
What if a surgeon shows me photos at consultation?
In-clinic photo viewing is the most honest form of patient education - the photos cannot be downloaded, shared, or used in advertising, and the surgeon can explain each case in detail. This is encouraged practice and is not restricted by AHPRA. Many surgeons maintain large in-clinic libraries (1,000+ patients) precisely so candidates can see consistent representative outcomes rather than curated marketing images.
What is the ASPS Code on photos specifically?
The ASPS Code requires: written informed consent for photo use including specifics of how each image will be used; photographs taken under standardised lighting, angle and posture; representations be free of digital retouching that alters apparent surgical outcome; and clear statement of follow-up timeframe (e.g. "12 months post-op", not unspecified "after"). Photos in social media or advertising must additionally comply with AHPRA s133 - which most informal social media posts cannot meet.