Meta's Advantage+ creative enhancements (auto crop, brightness and filter tweaks, text changes) are on by default in a lot of accounts now, and my worry is that they change the ad you actually tested. Say a dental clinic approves a clean before-and-after frame, and Meta quietly re-crops it to 4:5 and adds a filter. The hook that won in testing might not be the one running anymore.
So I'd switch the enhancements off for any ad that's already performing, and only let them touch new test ads, where you don't know yet what works. Some people argue the auto-tweaks lift delivery enough to be worth giving up control. Honestly, it depends how much you care about knowing which variant really won.