Reviews for Med Spas and Plastic Surgery Practices

By the Expert Reputation team · Updated October 26, 2026

Aesthetic patients research harder than almost anyone else, and they read reviews looking for results. That raises the stakes for med spas and plastic surgery practices: a review platform built around outcomes (RealSelf), photos that need consent, testimonial rules from ASPS and the FTC, and complaints about results you can't discuss in public. This guide covers each one.

Where aesthetic patients read reviews

• Google is where most local searches start, for "Botox near me" as much as for a surgeon's name. See our Google reviews guide.
• RealSelf is built for cosmetic treatments. Reviews there tell a patient's story, often with photos, and carry a "Worth It" vote.
• Yelp matters for med spas in many cities, but it tells businesses not to ask for reviews. See our Yelp guide.
• Healthgrades lists surgeons and physicians and lets them reply. See our Healthgrades guide.

How RealSelf reviews and verification work

RealSelf's help center explains its system in more detail than most platforms.

Who can post, and how reviews are checked

• Verified contact details. RealSelf requires every reviewer to register with a valid email address. When a review names a doctor or other provider, RealSelf also requires a phone number and texts a code the reviewer must enter.
• Moderation before publishing. RealSelf says it moderates "all reviews using a multi-step process that leverages both technology and human analysis." Its moderators check that the reviewer gave enough detail, including the treatment received, has no conflict of interest with the practice, and "wasn't compensated for their review." Reviews are published within one business week, and RealSelf says it re-moderates reviews periodically after that.
• What gets declined. Reviews with excessive cursing or name-calling, hearsay about other people's experiences, threats, and reviews from "anyone with a relationship to the doctor or practice." RealSelf also says "freebies, discounts and other benefits can't be offered by the practice in exchange for a review."

When RealSelf removes a review

RealSelf removes a published review only if it breaks the Terms of Service, if the reviewer turns out to have connections to a brand, practice, or provider, or if the reviewer asks. It says it will not remove reviews "if a provider asks us to, regardless of whether they advertise on RealSelf," or "because the review is negative." Its advertising policy adds that advertisers "can't alter or remove content (including reviews)." Anyone offering to get a RealSelf review taken down for a fee is selling something RealSelf says can't be bought. See review removal scams.

Worth It Ratings and the Verified badge

• Worth It Rating is the share of reviews for a treatment that say it was "Worth It." It is a ratio of positive to negative reviews, and "Not Sure" votes are left out.
• RealSelf Verified doctors must keep a patient satisfaction rating of at least 4 out of 5 stars. RealSelf verifies their medical license every 3 months. They also commit to showing "unedited before and after photos," listing active board certifications, and answering consultation requests within 2 business days.

Responding on RealSelf

RealSelf's own advice for negative reviews is to wait before replying. If you post a public response, keep it focused on service, ask the patient to contact you directly, and "never react in anger or get defensive." If a review breaks the Terms of Service, you can dispute it through RealSelf. RealSelf also encourages practices to ask "all patients to share their story online," and that fits with not asking selectively.

Before-and-after photos: consent and HIPAA authorization

Before-and-after photos are your most persuasive marketing and your biggest privacy risk. Treat a photo as patient information, because it is.

If your practice is a HIPAA covered entity (any practice that sends insurance claims or eligibility checks electronically, directly or through a billing service, is one; see the covered-entity test in our chiropractic and wellness guide):

• Using a patient's photos to promote your services is marketing. Under 45 CFR 164.508(a)(3), that requires a signed authorization.
• "Full face photographic images and any comparable images" are on HIPAA's list of identifiers (45 CFR 164.514(b)(2)). Cropping out the face doesn't always make a photo anonymous. A tattoo, a birthmark, or a caption can identify someone.
• A patient can revoke an authorization in writing at any time (164.508(b)(5)). Have a process to pull the photo from your website, social accounts, and RealSelf gallery.
• You can't make treatment conditional on the patient signing a marketing authorization (164.508(b)(4)).

If your med spa doesn't bill insurance and never sends claims or eligibility checks electronically, HIPAA may not apply to you. Written consent is still the minimum. State privacy laws, your medical director's licensing board, and basic trust all point the same way.

Keep the clinical photo consent separate from the marketing release. Say exactly where photos may appear: your website, social media, RealSelf, ads. Note whether the face will show, and keep the signed form with the patient record.

Making the photos honest

• The ASPS Code of Ethics (Section 2, Article I(G)) bars before-and-after photos that "use different light, poses, or photographic techniques to misrepresent the results." It also bars showing patients whose results "are not typical of the results obtained by the average patient, without clearly and noticeably disclosing that fact."
• RealSelf's photo tips ask for factual captions: techniques, devices, areas treated, time elapsed. Don't caption with "conjecture about patient satisfaction." Borders and text aren't allowed in RealSelf galleries.
• If the person in a photo is a model who didn't have the treatment, ASPS requires a clear statement saying so (Article II(D)).

What the ASPS Code of Ethics says about testimonials and advertising

The ASPS Code of Ethics (updated January 2025) binds ASPS members. Its advertising rules are among the most specific in medicine. Under Section 2, Article I(G), a member may not use a communication that:

• contains a testimonial about the quality of care "if the experience of the endorser does not represent the typical experience of other patients" (G(6));
• contains a testimonial from someone who "has not actually received services from the Member" (G(7));
• is "likely to create false or unjustified expectations of favorable results" (G(8)), or guarantees "satisfaction or a cure" (G(12)).

Article II adds three rules:

• Paid testimonials are allowed only if the compensation "is clearly and conspicuously disclosed." The Code's glossary counts "gratis or discounted services" as compensation.
• Members must approve every ad before it runs and keep a copy for one year.
• Members are personally responsible for violations by a marketing firm or paid endorser they use.

The Code's glossary also says that on social media, "tags, likes, pins" and similar actions count as endorsements.

Med spas aren't ASPS members, but the physicians who supervise them may belong to ASPS or another society with similar rules. State medical boards also regulate advertising.

FTC rules on testimonials and "results not typical"

The FTC's Endorsement Guides (16 CFR Part 255, revised in 2023) apply to every practice that advertises, ASPS member or not:

• Testimonials are read as typical. Under 255.2(b), a testimonial about a key result "will likely be interpreted as representing that the endorser's experience is representative of what consumers will generally achieve." If you can't substantiate that, "clearly and conspicuously disclose the generally expected performance."
• "Results not typical" doesn't fix it. The Guides' own example (255.2(e)) says the FTC tested "Results not typical" and a stronger version, and "neither disclosure adequately reduced the communication that the experiences depicted are generally representative." So a tiny disclaimer under a dramatic transformation photo doesn't do much.
• Disclose connections. Free or discounted treatment for a testimonial is a material connection that must be disclosed (255.5). That covers influencer and "model" programs.
• Don't distort your reviews. When publishing or editing reviews, businesses should not take actions that distort "what consumers think" (255.2(d)).

The separate Consumer Reviews and Testimonials Rule (16 CFR Part 465) bans fake reviews, incentives tied to a review's sentiment, and review suppression through unfounded legal threats or intimidation. See our guide to incentives and FTC compliance.

Replying to results-based complaints without discussing outcomes

"My lips are uneven." "I paid thousands and look the same." These complaints are hard because the honest answer involves the patient's anatomy, their healing, and what they agreed to. That's exactly what you can't post. Don't mention the procedure, the result, swelling or healing time, photos, consent forms, or an offer of a touch-up. Each one confirms the person is a patient and discloses care details.

Thank you for sharing this. We take every concern seriously, and patient privacy rules mean we can't discuss anyone's treatment online. Dr. [Name] would welcome the chance to talk with you directly. Please call [Name], our practice manager, at [Phone]. — [Practice Name]

For a review that seems to be from someone you can't identify:

We're concerned to read this and want to understand what happened. Privacy rules keep us from discussing care online, so please reach out to [Name] at [Phone] or [Email] and we'll follow up personally. — [Practice Name]

Then handle the clinical conversation privately, by phone or at a follow-up visit. If you offer a revision or refund, don't make it conditional on deleting the review. RealSelf and Google both treat benefits tied to reviews as a problem. For more wording, see our HIPAA-safe reply templates and HIPAA and online reviews.

Asking aesthetic patients for reviews

The best time to ask is when the patient can see the result: after the final follow-up for surgery, or at the touch-up or repeat visit for injectables and lasers. Ask every patient the same way. Google forbids businesses to "selectively solicit positive reviews from customers," and RealSelf encourages asking all patients. Our guide on how to get patient reviews covers wording and timing. To automate the request for every patient, see Review IQ.