Before-and-after photos: powerful, and a compliance minefield

A real before-and-after is the most persuasive thing you can put on a cosmetic dentistry page — and the fastest way to land in front of the HPCSA if you get the consent or the claim wrong. Both halves are true, which is why most practices either avoid them entirely or use them carelessly. Done properly, they are allowed, and they work.

Start with consent, because this is the part with a clear rule. The HPCSA's Ethical Guidelines on Social Media require written consent from the patient before you publish any case history or photograph in media the public can see — and the guideline is explicit that this holds whether or not you believe the patient can be identified from the image. A cropped photo of just the teeth still needs consent. For a patient under 12, you need the written consent of a parent or guardian and the assent of the child. And because a dental image is health information, it is "special personal information" under POPIA, so how you store and handle the file matters too, not just whether you post it.

The second trap is what the photo implies. Showing a result is fine; implying every patient gets that result is not. Under Rule 3 of the HPCSA's Ethical Rules of Conduct, a guarantee of outcome is canvassing — and a before-and-after with no context quietly promises "this is what you'll get". It isn't, necessarily; every mouth is different. The image needs honest framing around it.

So before-and-afters have a safe way and an exposed way:

Using before-and-afters without crossing a line

• Get written consent, every time — specific to publishing the image publicly, kept on file. For under-12s, a parent's consent and the child's assent.
• Don't imply the result is typical or guaranteed. Frame it honestly: "individual results vary", a note that this was one patient's outcome, not a promise.
• Crop and store carefully. Even an unidentifiable image needs consent, and the file itself is special personal information under POPIA — handle it accordingly.
• Never use an image you don't have consent for — not an old patient's, and not one from a supplier's marketing pack presented as your own work.

Whether they're worth the care, for cosmetic work, is an easy yes — a genuine result does more than any adjective. But the bar is real, and the shortcut is tempting: in audits we still see practices using polished before-and-after images that are plainly stock or supplier-supplied, presented as the practice's own cases. That's two problems at once — no consent, and a quiet untruth about whose work it is.

The honest version takes more effort: your own cases, real consent, careful framing. It is also the only version that persuades without exposing you, because a patient can sense the difference between a real local result and a glossy stock smile.

A compliant before-and-after gallery is part of what we build — but the consent and the framing are yours to get right whatever you build.

General guidance on HPCSA and POPIA, not legal advice; confirm against current HPCSA guidance before publishing patient images.