Is the industry ready for a reckoning?

Hidden environmental costs

Much of the academic research around tweakments — and healthcare more generally — focuses on product safety and efficacy. Until now, environmental impacts have barely even been an afterthought, says Colby Hyland, a resident at Harvard Plastic Surgery and Mass General Brigham, the largest hospital-based research enterprise in the US. “The conversation is slowly changing and different things are being prioritised. More and more, people are asking how healthcare impacts financial and environmental costs.”

One of the challenges is the lack of transparency in tweakment supply chains, which makes it hard to carry out robust life cycle assessments. “While we don’t know all the specifics of how treatments are made, delivered and disposed of, looking at the manufacturing cycle and the supply chain is probably a reasonable place to start,” says Hyland. “The problem is, you can only build awareness of these impacts with solid data, which we don’t currently have.”

Experts agree that the potential environmental impacts of tweakments can be broken down into various buckets: the extraction of raw materials, the purification and manufacturing processes (including energy, water use and pollutants), the product packaging (which is often single-use), the transport (which might involve refrigeration), the storage, and the administration (which would also involve several single-use components as well as energy-intensive machinery). Then, the physical waste (including syringes, gloves, masks and other PPE) and the push for continued consumption through regular top-ups and supplementary procedures.

Single-use plastic, packaging and clinical instruments are among the biggest concerns, which many see as unavoidable. “From the product perspective, there is very little we or the clinics can do, because they’re all single-use products and — when they are injectibles — they have to be disposed of in a safe and sterile way, which doesn’t really lend itself to sustainability or even recycling,” says Collins. Still, there have been some efforts to curb impact. Last year, the Royal College of Surgeons published a Green Theatre Checklist for surgeons across the healthcare space. Its recommendations include prioritising reusable equipment (including PPE and textiles), reducing the use of unnecessary equipment, recycling waste where possible, and limiting energy consumption.

With regulation sparse, some manufacturers are taking matters into their own hands. Allergan Aesthetics says it introduced a minimum-order quantity for its Botox and Juvéderm fillers in April 2022, incentivised with free shipping. It claims this has reduced packaging materials, dry ice, water and carbon waste by maximising the space within shipping boxes and the overall volume of packages passed on to ground and air carriers. In July 2024, it also stopped offering Monday delivery slots, because cold shipments sent over weekends require more packaging and dry ice. This year, the company plans to remove dry ice (which it says will also remove the need for gloves or special precautions when handling packages) and streamline packaging, which it predicts will reduce its greenhouse gas emissions by six million kilograms per year. Without robust data on the overall carbon footprint of the tweakments industry, it is difficult to contextualise these savings.