This article is part of the Future of Appearance, a collection of articles that investigates what we will look like in 20 years.
What do tweakments and fast fashion have in common? The short answer is: a lot.
Both have rapid trend cycles fuelled by social media algorithms, with little regard for their social or environmental impacts. Both promise quick fixes to manufactured insecurities, feeding on (primarily) young women and trapping them in a cycle of overconsumption. And both are largely unregulated industries with a hidden dark side.
Given the pace of the broader beauty industry, it’s unsurprising that tweakments have evolved in this way, says beauty reporter and critic Jessica DeFino, who regularly debunks beauty culture and the advertising underpinning it through The Review of Beauty newsletter. “All beauty is fast beauty, tweakments included. Even the most luxurious products are supposed to be gone within a couple of months — a year or two tops. Just like fast fashion, most beauty products contain plastics and petrochemicals. And beauty supply chains often have the same issues with workers being paid low wages and having to work in horrible conditions,” she explains. But while the mainstream skincare and beauty industries have faced questions about their sustainability — notably greenwashing, bluewashing and the prominence of single-use plastic — the increasingly popular tweakments space has flown under the radar.
Like fast fashion, tweakments are largely unregulated, which has allowed poor practices to go unnoticed and unchecked. “There is a darker side to the industry,” says Ashton Collins, director of Save Face, a register of trusted clinicians established in 2014 to counter “botched procedures carried out by dodgy practitioners”. This includes opaque, often imported, products delivered by underqualified practitioners without proper waste management systems in place, she explains. Exactly how much waste is generated is unknown, but each procedure requires significant amounts of single-use plastic and metal, from surgical gloves to syringes.
Despite concerns about their impacts, tweakments are growing rapidly, with new innovations continuously coming to market. According to Allergan Aesthetics, one of the leading providers of Botox, the number of non-surgical aesthetic procedures conducted worldwide grew by nearly two million between 2017 and 2020, and is expected to total 23 million dermal filler procedures and 14.6 million body procedures by the end of 2025.
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.
Even if clinicians and consumers were more aware of the environmental impacts of tweakments, there is little evidence to suggest that they would behave differently, says researcher and surgeon Michalis Hadjiandreou. Some clinicians have preferred brands of tweakment products, and preferred clinic settings, which they are not willing to compromise to improve their environmental footprint. Plus, there is a well-documented intention-action gap in sustainable fashion, which would likely apply here, too. “It’s very difficult to argue with people when the products are working for them.”
Beauty culture biases
The more people get tweakments, the more normalised their results become — and the more likely others are to follow suit. Experts say these procedures can also be incredibly addictive, with potentially damaging mental health effects.
When DeFino first began writing about tweakments in 2018, the beauty industry was marketing them as a form of selfcare, smoothing insecurities with almost imperceptible changes. There was an obvious flaw in the pitch, she says. “If a selfcare moment was all you were after, why funnel so much time, money and risk into tweakments, when you could just meditate or do something more fulfilling?” These days, tweakments are positioned as ‘preventative’: do something little and often when you’re younger and you might be able to avoid more major surgeries further down the line. “Today, tweakments are positioned as upkeep — like getting your car serviced,” says DeFino.
These quick but temporary fixes often trap people in a continuous cycle of consumption, says Collins — every two to three months for Botox, and every one or two years for fillers. “They are very repetitive by nature.”
For some, tweakments become addictive, and there is a high risk of over-doing it. When Chloe Saunders was a psychiatric trainee, she worked on a research paper about the potentially addictive nature of lip filler, one of the most popular tweakments, with high rates of what the researchers defined as “overtreatment”, where people’s features became “strikingly distorted”. Twenty-four women with over-filled lips were asked why they got lip filler in the first place and how it changed their self-perception. What struck Saunders was the relationship between tweakments and body dysmorphic disorder (a mental health condition where people spend a lot of time worrying about perceived flaws in their appearance). This was especially true for young women using social media frequently, because the algorithm fed them images of people with enhanced features, and their own photos with larger lips garnered more attention, normalising tweakments and creating a feedback loop whereby filler became compulsive.
The clinicians administering tweakments are not immune to this beauty culture, says DeFino. “Clinicians are just as heavily influenced by beauty culture as the consumer is, and they bring those perceptions and beliefs to their patients.” Then, there’s the profit motive to consider. The more filler clinicians sell, the more they get paid, whether the patient needs it or not. A few years ago, the repercussions on this became clear, when high-profile influencers started to dissolve their filler en masse. “The great filler dissolve” — as DeFino dubs it — revealed the dissatisfaction that can come from working with biased clinicians.
Like fast fashion, tweakments are part of an ever faster trend cycle. A decade ago, fillers and Botox made up the bulk of tweakments, says Collins. Now, there are so-called “skin boosters” like polynucleotides and exosomes, too. “When you look at a treatment menu, any given client will be having two or three treatments at least, and then maybe adding in other things like lasers and body treatments.”
DeFino contextualises these trends — and the associated rise in tweakments — with the instability of our current political climate. “Women’s rights and gender expression are under attack right now, and there is an impulse for people to control what they can, which might be their own body, through beauty,” she explains. “The US is also scrapping diversity, equity and inclusion (DEI) programmes, which includes women, and that makes beauty even more important. When you are in the job market, studies show that people who are considered more attractive get hired more often and make more money. These are all larger political issues where beauty becomes a bargaining chip. A lot of our beauty culture could be changed for the better through political action.”
Is there an antidote?
While there are plenty of parallels with fast fashion, the solutions aren’t necessarily the same. Transparency, for instance, is often touted as the first step towards accountability and progress in fashion supply chains. While it is important for the companies producing and administering tweakments to be transparent about their supply chains and practices, it can easily backfire in the consumer-facing beauty industry.
Some argue that influencers should be required to disclose any tweakments they have had done, especially where those treatments were discounted or gifted, in the same way they disclose other advertisements and partnerships. However, DeFino cautions that this gives people a blueprint for achieving a look rather than exposing it as unattainable. “Transparency should absolutely be the baseline, but it’s not particularly useful for dismantling beauty standards or reducing the pressure to adhere to them,” she adds. “A lot of plastic surgeons have told me they love the cosmetic transparency movement because they get so much business from it.”
A more effective antidote might be to rethink the faces we are exposed to online, and step away from social media, says Saunders. Consumers should ask themselves: “What images are you being exposed to regularly? How might that differ from your neighbours? How is it impacting your consumer choices?”
On the grander scale, there is space for legislation similar to fast fashion, to demand the transparent disclosure and reduction of tweakments’ environmental impacts. But the industry is a long way off, not least because there is so little data available about its current impact and scale. Without this, legislation risks unintended consequences, says Kate Fletcher, professor of sustainability, design and fashion systems at Manchester Metropolitan University.
In the meantime, people want fast results and fast recovery, adds professor Afshin Mosahebi, who leads the Plastic Aesthetic Regenerative Specialists (PARS) research group at University College London, the first multidisciplinary team devoted to education and training in aesthetic medicine. Clinicians are happy to deliver this, because more tweakments means more money. But it’s possible that consumers will return to bigger surgeries when the tweakments novelty wears off, and the long-term results become clearer. As in sustainable fashion, he argues that a simple mantra could be the cure to overconsumption: “Do less but do better.”
*Note on our images:
We created all lead images in this series using OpenAI GPT-4o’s image generation tool. To do that, we leveraged the ongoing partnership between Condé Nast and OpenAI and generated images that best reflect the expert insights and predictions about appearance found in this collection of articles.
We are aware of the debate surrounding the ethics of artificial intelligence in image-making, and we share concerns regarding creative ownership as well as that of our own image. In this series, we are talking about a world that doesn’t yet exist, and as AI is in so many ways the tool of the future, we felt it was appropriate to experiment with it in this way.
We guided the visuals entirely through written prompts. No external images or copyrighted materials were uploaded or referenced — every image was created from scratch based on our team’s original concepts.
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