Before and After Photos in Ontario: What You May Publish

Before-and-After Photos in Ontario: What a Clinic Can Publish, and Where

The before-and-after image is the most persuasive asset in aesthetics marketing and the most heavily conditioned one in Ontario. Half the clinics we look at either refuse to use them at all or use them everywhere, and both positions cost money.

The rules do not ban the image. They draw a line in a place most clinics have never located: not between what the photo shows, but between a patient who went looking for it and a person who did not.

A before-and-after photo on a clinic's own website is treated differently from the same photo inside a paid social post, even when the consent form is identical and the image is unaltered. Get the placement wrong and the image fails no matter how good the paperwork is.

What follows is what the regulators in this province actually require, quoted where the wording matters, and where the two colleges part company for a clinic whose services are provided by a physician versus a dentist. This is marketing guidance, not legal advice, and nothing here replaces a review by your own compliance professional.

The short answer

• Physician-led clinics (most med spas). CPSO permits before-and-after photos and videos in advertising, subject to conditions. The two that decide most cases are express consent to that specific use, and a placement rule: they must not appear where members of the public are likely to see them unsolicited.
• A compliant before-and-after image is not a testimonial. CPSO's policy states that an image meeting its requirements will not be considered a testimonial, which matters because testimonials are prohibited in physician advertising in Ontario.
• Dental practices. RCDSO treats a patient's image as personal health information, requiring the same consent and confidentiality safeguards as the rest of the record — and consent is required even when the image does not identify the patient.
• Where a prescription drug is being promoted, Health Canada names before-and-after imagery among the creative that causes difficulty, alongside procedure videos and testimonials about therapeutic benefit. That sits on top of everything above.

What the CPSO policy requires of the image itself

For a physician-led clinic, the image has to carry its own conditions before consent is even discussed. Read the list and then look at your gallery, because most clinic galleries fail on the third item alone:

1. Educational purpose. The image is there to inform, not to sell.
2. A result that can reasonably and typically be expected — not the best result the clinic has ever produced.
3. The physician's own patient, who received that service at that practice. A stock image, a supplier's marketing photo or a colleague's case does not qualify.
4. No manipulation that misrepresents the result. CPSO is explicit that cropping or resizing is acceptable provided consistent techniques are applied, so the controlled comparison is the point: same lighting, same pose, same technique, same setting.
5. De-identification, unless the patient has specifically consented to being identified.
6. A statement alongside the image that the outcome or results depicted are not guaranteed and may vary between patients.

That is a demanding standard, and it is the reason a compliant gallery looks plainer than a US one. It is also the reason a compliant gallery is worth having: it shows the consultation, the assessment and the follow-up rather than borrowing credibility from an exceptional case.

Where an image may be shown: seek out versus unsolicited

This is the part that decides most campaigns, and the wording is not ambiguous. CPSO states that physicians must not display before and after photos or videos in advertisements where members of the public are likely to see them unsolicited.

The College's companion advice explains what that means in practice, in both directions.

Available: a practice's own website, even when the practice pays to host it; and the practice's own social media pages used generally, with no targeting and no promotion of the posts — "formats where prospective patients may seek them out".

Not available: print advertisements in magazines or newspapers, television advertisements, and paid sponsored or promoted social posts that appear in the feeds of people who do not follow the practice.

The strategic consequence is uncomfortable but simple: the channel that usually performs best for a clinic is the one where this imagery may not be used. Paid social is where the reach is, and paid social is where the image is not allowed. That does not leave you with nothing — it means the paid creative has to sell the appointment instead of the result, and the imagery has to work on the pages and the organic feed where a prospective patient is already looking.

The consent is more specific than most clinics assume

CPSO treats photo consent as something separate from consent to treatment, and it sequences it deliberately. For physician-led clinics, the policy requires that the physician:

• wait until after the medical service is provided to discuss and obtain consent — not at the consultation, not at booking;
• obtain express consent to the specific use of the photos or videos in advertising;
• show the patient the final images before they are used;
• explain that consent can be withdrawn, and what publication actually means;
• talk it through with the patient rather than relying on a form, even when a form is used;
• consider how the power imbalance in the physician-patient relationship could make a patient feel pressured to agree, and take reasonable steps to reduce that;
• and not offer incentives — a discount, a free treatment, a credit — in exchange for consent.

Two of those are routinely broken. Consent is collected at the front desk as part of intake, and someone offers an incentive because it seems harmless. Under this policy both are defects, and the second one is named explicitly in the policy as a prohibition, not a caution.

Consent survives the platform, not just the photograph

Ontario's dental guidance goes further on one point that every clinic — medical or dental — should read, because it is where consent quietly expires without anyone noticing.

RCDSO's advice on patient images begins from a single premise: a patient's image is personal health information and requires the same consent and confidentiality safeguards as the rest of the record. Consent is required even when the images do not identify the patient, which is the part most clinics have backwards. De-identification reduces a privacy risk; it does not remove the obligation.

The same guidance sets out what a workable process looks like: discuss how the images will be used and describe all possible uses, especially in electronic publications that reach a wider audience than print; obtain consent in advance and re-confirm it in writing once the patient has seen and approved the final images; document that consent in the record with the date and the patient's signature; and avoid personal devices such as cell phones when taking patient images. The patient also has to understand two limits honestly stated: that an image which enters the public domain likely cannot be removed later, and that images downloaded from a website can pass beyond the practice's control.

Where consent quietly expires is scope. RCDSO's social media guidance gives the example of a dentist who shared a patient's photos online after the patient had consented to their use on the dentist's website. The College's own summary is blunt: while the patient did consent to the use of their photos, they did not consent to other aspects of their treatment being divulged or to the photos being shared on a platform other than the dentist's website. The takeaway it states is that all aspects of the consent process regarding the scope and context of image usage must be fully understood by the patient.

For a clinic, that means a consent that says "marketing" is not enough. The consent has to name the places: this website, these social profiles, this newsletter — and nothing else without asking again. Posting the same image on a new channel next year is a new use.

What happens when consent is withdrawn

RCDSO is direct here too: consent may be withdrawn at any time, and when it is, the images must be removed from any of their uses. The patient must also be reassured that refusing or withdrawing consent will not affect their care — a reassurance that only means something if the treating team can see that the consent was optional in the first place.

The practical problem is that "remove the image" is impossible to do reliably if nobody knows where it went. Images get saved to a phone, posted to two profiles, emailed to a designer, added to a print brochure and picked up by a directory. A withdrawal request then turns into a scavenger hunt, and whatever is missed stays public. The fix is a register, not a memory.

The dental advertising rules add two filters

Dental practices work under advertising guidelines that reach the same conclusions by a different route. RCDSO's advertising guidelines prohibit, among other things, statements that suggest or create an expectation of favourable results, and testimonials or any statement that can only be verified by a person's feelings or views, alongside incentives such as giveaways, contests and free products or services.

Applied to before-and-after promotion, those two filters do real work. A gallery entry that reads like a promise of the same outcome is a favourable-results statement. A caption built from patient praise is a testimonial. Neither is fixed by adding "results may vary" at the bottom, because the guidance is about the impression the advertisement creates, not the disclaimer attached to it.

What this means for the marketing, not just the gallery

The image is the asset everyone argues about, and it is not where the growth is. The legitimate surface is larger than most clinics use:

• the consultation: what happens, in what order, with whom;
• the assessment: who decides whether a treatment is appropriate, and on what basis;
• the practitioner: credentials, registration, and what those mean;
• the process: pricing structure, follow-up, what aftercare involves;
• the clinic itself: environment, access, accessibility, privacy practice;
• and the questions a prospective patient should ask any clinic, including yours.

That content can run anywhere, including in paid placements, and it is what a person comparing two clinics actually reads. Organising a site and a treatment-page set around those questions rather than around claims is the substance of med spa marketing in Ottawa, and it is the difference between marketing that keeps its reach and marketing that has to be pulled down.

Images then do their work where they are allowed: on the site and in the organic feed. That makes the content calendar a compliance decision as much as an editorial one — which posts may carry an image, which may not, and what the organic schedule looks like when the promotional reach is unavailable. That is what social media marketing for a clinic has to solve, and it is solvable: process, credentials and patient questions are inexhaustible subjects.

A workflow that holds up

1. One consent that names the places. Not "marketing", not "social media" — the specific website and the specific profiles, with a line for anything added later.
2. Consent collected after the service, with the final images shown first, and a copy in the record. If the consent was signed at intake, it is the wrong consent.
3. An image register. Every published image, its patient, the date, the consent, and every place it appears. This is the document that makes withdrawal possible.
4. A placement rule in the calendar. Paid and promoted placements carry no before-and-after imagery. Whoever schedules the posts should not have to make that judgement per post.
5. A named approver. One person, a regulated professional with the authority to refuse, who reads the caption as well as the image. Advertising written by an agency is still the clinic's advertising, and CPSO's policy states plainly that advertising prepared on a physician's behalf must comply with it.
6. A quarterly review, because platform policy, college guidance and provincial rules all move, and a register that was correct in the spring may be wrong by the autumn.

Questions clinics ask

Can an Ontario clinic use before-and-after photos?

In a physician-led clinic, yes, but only under the conditions in CPSO's Advertising policy. The images must be used for educational purposes, show a result that can reasonably and typically be expected, come from that physician's own patient, avoid manipulation of the result, use consistent lighting, pose, technique and setting, and appear alongside a statement that the outcome is not guaranteed and may vary between patients. If the patient is identifiable, they must have specifically consented to being identified. In a dental practice the starting point is different again: a patient's image is personal health information and carries the same safeguards as the rest of the record. This is marketing guidance, not legal advice.

Where can before-and-after photos be shown?

Only where a prospective patient can reasonably seek them out. CPSO's policy states that physicians must not display before-and-after photos or videos in advertisements where members of the public are likely to see them unsolicited, and the College's companion advice names the acceptable formats: a practice's own website, including a site the practice pays to host, and its own social media pages used generally with no targeting and no promotion of the posts. It names the unacceptable ones just as clearly: print advertisements in magazines or newspapers, television advertisements, and paid sponsored or promoted social posts that appear in the feeds of users who do not follow the practice.

What consent is required before using a patient's photo?

Express consent to that specific use, obtained after the service is provided rather than before. CPSO's policy requires the physician to wait until after the medical service to discuss and obtain consent, to show the patient the final photos or videos before they are used, to explain that consent can be withdrawn and what publication means, to engage in a dialogue with the patient about the use, to consider the power imbalance in the physician-patient relationship and take reasonable steps to reduce pressure to agree, and not to offer incentives in exchange for consent. A dental practice's guidance adds that consent should be re-confirmed in writing once the patient has seen and approved the final images, and documented in the record with the date and the patient's signature.

Can a clinic post patient photos on Instagram?

On the clinic's own unpromoted page, it is closer to the line than most clinics assume, and it is not a free pass. CPSO's advice distinguishes a clinic's own social media page from a paid sponsored or promoted post, because a promoted post appears in the feeds of people who do not follow the practice and therefore did not seek the image out. The image conditions and the consent requirements still apply on the organic page. RCDSO supplies the mirror example: a patient who agreed to photos on a dentist's website had not agreed to them being shared on another platform, or to other details of their treatment being disclosed.

Can a clinic use patient photos as testimonials?

No, and the distinction is worth understanding. Testimonials are prohibited in physician advertising in Ontario, and CPSO's policy states that a before-and-after photo or video that complies with its requirements will not be considered a testimonial. That is an important carve-out, because it explains why the conditions matter so much: the compliant version of the image is educational documentation, and the version that praises the clinic is a testimonial, and they are treated as different things. RCDSO's advertising guidelines take the same line on the dental side, prohibiting testimonials or any statement that can only be verified by a person's feelings or views, along with statements that suggest or create an expectation of favourable results.

What happens if a patient withdraws consent?

The images have to come down from every use. RCDSO's advice on patient images says consent may be withdrawn at any time, in which case the images must be removed from any of their uses, and the patient must be reassured that refusing or withdrawing consent will not affect their dental care. CPSO's policy requires that the patient be told consent can be withdrawn before they give it. That is why the useful internal control is a register listing every place an image was published, rather than relying on whoever is asked to remember: withdrawal is only as good as the list, and an image that stays up after consent is withdrawn is the version of this that ends up in front of a regulator.

Sources

• CPSO — Advertising policy, including the conditions on before-and-after photos and videos, the prohibition on displaying them where the public may see them unsolicited, the express-consent requirements and the definition of a testimonial
• CPSO — Advice to the Profession: Advertising, which names the formats where prospective patients may seek images out and the paid formats where they may not
• RCDSO — Advice on the Use of Patient Images, which states that a patient's image is personal health information and sets out the consent steps
• RCDSO — Use of social media, including the case where a patient consented to photos on a website and not to another platform
• RCDSO — Advertising Guidelines, which prohibit statements creating an expectation of favourable results, testimonials and incentives
• Health Canada — Illegal marketing of prescription drugs, which names before-and-after imagery among the creative that causes difficulty where a prescription drug is being promoted
• Office of the Privacy Commissioner of Canada — Interpretation bulletin: personal information, on why a photograph of a person is personal information

Checked 16 October 2026. College guidance changes, and a policy summary is not the policy. The colleges' current documents are the governing ones, and any specific campaign should be confirmed by the practice's own advisor.