Surgery or just a minor injection? – The Federal Court of Justice draws a fine line

What do lips, chins and noses have in common? Nowadays, they can be altered without a scalpel – a small cannula, a little hyaluronic acid, and the new contour is ready. This is rarely medically necessary. However, anyone who thinks that these ‘light cosmetic corrections’ are also treated lightly from a legal perspective is greatly mistaken. The Federal Court of Justice has now made a clear statement (judgment of 31 July 2025 – I ZR 170/24): Injections are also ‘surgical’ – at least in the sense of the German Medicines Advertising Act (Heilmittelwerbegesetz, HWG).

At the heart of the case: an aesthetically ambitious Instagram presence of a practice for non-invasive cosmetic procedures. The practice advertised using the usual before-and-after pictures – noses that were somewhat distinctive before, but delicate and smooth afterwards. The problem: Section 11 (1) sentence 3 no. 1 HWG prohibits advertising for medically unnecessary plastic surgery procedures using such image comparisons. And now the Federal Court of Justice has clarified that even ‘gentle’ corrections using hyaluronic acid injections fall under this prohibition.

This is quite remarkable. Until now, the term ‘surgical’ was usually reserved for classic surgical instruments – scalpels, clamps, anaesthesia. Now, even a cannula is sufficient if it interferes with physical integrity and changes the external appearance. Whether the result is reversible is irrelevant. In short: it is not the depth of the incision that matters, but the depth of legal understanding.

Anyone who now cries out ‘freedom of occupation!’ or ‘censorship!’ is referred by the Senate to good old health protection. Advertising with before-and-after pictures is particularly suggestive and could tempt people to expose themselves to risks without real necessity. Pain, swelling and, in the worst case, embolisms cannot be ruled out, even with injections.

The ruling shows that the legal assessment is not based on cosmetic advertising aesthetics, but on tangible legal considerations. And this consideration is clear: the protection of decision-making sovereignty – especially in the case of offers that are primarily marketed on the basis of their external image.

What does this mean for doctors with a affinity for aesthetic transformations on the internet? Be careful with before-and-after posts. Those who want to showcase their successes should either limit themselves to professional target groups – or find more creative ways to illustrate the effect of an injection. Perhaps with metaphors, sketches or poetic descriptions? This is certainly more legally secure.

In any case, the Federal Court of Justice makes it clear: even if cosmetic medicine is becoming gentler, advertising law remains strict.