Hair Transplant Clinics Confront Their Environmental Footprint
In the U.S., one of the defining conversations surrounding hair transplant surgery for the past several decades has been one of technology. Gone are the days of painful plugs and linear scars, and replaced instead with minimally-invasive follicular unit extraction (FUE), robotic assistance, and ever improving natural-looking results. For both patients and doctors alike, the singular consideration when it comes to hair transplants has been focused on the aesthetic result. That conversation, while still of primary importance, now has a critical partner: the environmental impact of the procedure.
The problem, the solution, and the march towards a greener, more sustainable hair transplant are rooted in a single, simple, and unavoidable truth. Hair transplant surgery, when it is done in the traditional way, creates an enormous amount of medical waste. This waste, which goes into tall, blue biohazard bags for every surgery and accumulates by the truckload at every clinic, is immediately destined for the incinerator or the landfill. There is almost nothing in the “take-make-dispose” cycle that comes with these medical supply kits that can be recycled, composted, or repurposed. This means that every surgery is 100% new, 100% waste at the end of the procedure.
This is the unfortunate reality of modern medicine. The legacy of medical device sterilization has been decades of single-use plastics and disposables, sterilized and sealed for convenience, ready to be used in a clinical setting. While this allows for an incredible standard of sterility and efficiency, it is also massively wasteful. This challenge is what many clinics are waking up to.
We can begin to understand this by looking at the products and disposables used in a typical hair transplant surgery. They range from the complex and specialized (single-use plastic handles for punch devices, sterile packaging for surgical drapes and gowns) to the seemingly mundane (plastic suture kits, single use specimen cups to hold harvested grafts). The sterile plastic wrap that envelops every single glove, syringe, and gauze pad is also part of the problem. In a single-day, a busy clinic may create tens of thousands of these small “moments of waste” and a large part of the movement towards a greener procedure involves reducing that waste.
The leadership on this issue has come from two different, but symbiotic sources. The first is from the patients. In the U.S., a new generation of environmentally conscious patients are coming to the clinic, asking questions. They are the people who recycle, drive electric cars, and follow a plant-based diet. They want the best possible hair transplant, but are also mindful of the waste produced as part of the procedure and want to know that it is being addressed. They are demanding more from the clinics that they choose for their procedures.
The second source of momentum is the clinicians themselves. These are doctors, nurses and surgical staff who love the outdoors, play in rock-climbing gyms, have young families and drive Priuses. They too, feel a sense of cognitive dissonance in performing an elective procedure that provides individual healing but in large quantities contributes to the public health crisis of pollution and climate change. This has sparked significant bottom-up innovation as surgeons become motivated to solve the problem on their own turf.
The largest lever in this movement has been with single-use plastics and the effort to reduce their impact. There are good and compelling arguments for single-use devices in the medical industry. Patient safety is the primary one, followed closely by infection control and sheer speed. Reprocessing equipment can be laborious, requiring a huge input of energy, water, and space to sterilize thousands of instruments, with a small but real risk of cross contamination. This applies more stringently to items that come in direct contact with a patient’s blood. However, the argument for single-use should not extend to every single item that comes in a surgical kit and an increasing number of clinics are asking an important question item-by-item: what can be reused?
The answer to that question is often high-tech and simple. The most impactful intervention many clinics have made is the move to reusable, medical-grade stainless steel handles for FUE punch systems. While the punch tip is often single-use to retain the sharpest edge, the handle comprises a large fraction of the plastic waste in each case. A clinic can purchase a set of these stainless steel handles and autoclave (steam sterilize) them between cases, keeping them in rotation for hundreds of patients. Clinics are also investing in reusable gowns and surgical drapes rather than disposables, serviced by medical laundry companies that can meet the strictest standards for hygienic reprocessing. While the individual tools that come into contact with a patient’s scalp and grafts will remain mostly disposables, the more general clinical consumables are being transitioned to reuse.
Beyond the core surgical tools, the low-hanging fruit is being picked quickly. Clinics are replacing single-use plastic specimen cups with autoclavable glass or stainless-steel ones. Plastic backed gauze and single-use plastic trays have given way to reusable stainless-steel bowls and trays. Patient pre-operative areas are being stripped of their single-use plastic water bottles and cups and replaced with filtered water stations and compostable cups. The net effect for the clinic is significant. What used to be several large blue biohazard bags of medical waste per case, only 1/3 of which is actually hazardous, now has a much larger fraction of the waste that is recyclable or compostable.
The key piece of the transition to reusables is of course sterilization. The move to reusables is a hard stop on the automatic take-make-dispose cycle and instead requires an investment in autoclaves and staff to run them. This transition is also a change of culture, a return to a rigor of cleaning and sterilization that had previously been delegated to the company that sold the disposable kits. Clinics are finding that this cost, while significant, is both worth the environmental impact and offset over time by the recurring investment in buying and throwing away thousands of disposables each year. The sticker shock on a new autoclave and set of stainless-steel handles is real, but most clinics see the ROI in terms of equipment lifetime value and recurring expense quickly.
A clinic’s sustainability work does not end with the surgical tools in the operating room. Energy use is another major area that progressive clinics are looking at. Many are actively seeking ways to power their operations with renewable energy, whether through utility providers that have a portfolio from renewables, through solar installations on clinic roofs, or through renewable energy credits. Design of new clinics are factoring in energy-efficient HVAC and lighting systems, sustainable building materials, and water-saving fixtures.
The patient journey is also being retooled. The enormous paper trail that surrounds a patient, from consent forms, pre-op instructions, pre-operative testing, post-operative care instructions and even marketing brochures are all being digitized. Every patient has a secure portal and a tablet on the day of surgery for instructions. Marketing departments are moving away from printed brochures and targeting digital platforms, a much more sustainable and effective way to connect with patients in a digital-first world. Even the post-op care kits that patients are sent home with, once containing a plastic container full of post-operative shampoo and antibiotics are being retooled. Plastic is being replaced with recycled cardboard, and single-use plastic bottles are giving way to recommendations for sustainable, bottled in glass alternatives that can be purchased.
The movement is, of course, not without its challenges and the single largest is regulation. The FDA has tight regulations around medical devices, and reprocessing or moving to a reusable alternative for a device that was pre-approved as a single-use requires validation and re-certification that the device is not compromising patient safety. The process can be long and expensive, and the risk of delay and liability are a significant hurdle for clinics to overcome. This cost barrier means that larger, chain-owned clinics have moved faster, but the grassroots nature of the movement means that the individual doctor who wants to make this transition is looking for a solution as well.
There are also other supply chain issues at play here. In particular, the capital investment required to purchase autoclaves and sets of reusable surgical instruments is a significant barrier for small, independent clinics who are motivated to make the transition, but lack the resources of a corporate-owned practice.
The movement towards a more sustainable and green hair transplant procedure is gaining significant momentum. We are being led by a group of high profile surgeons and clinic chains that are speaking up, writing about their work, and talking at international conferences. They are transparently publishing data about their waste, showing their ROI, and creating a new marketing message. This message is powerful, particularly to the millennial and zoomer market that clinics are seeking: Look good, feel good, and do good.
The goal is clear: a carbon neutral, zero waste surgical procedure. We are still far from that goal, and in the meantime we need to continue to develop new biomaterials to design compostable medical supplies, work more collaboratively with our device manufacturers to design for circularity, and support each other in more transparently reporting our impact. In the U.S., the number of hair transplant procedures is at an all-time high and the per patient impact can be enormous. There is, quite literally, a mountain of single-use plastics and plastic waste to tackle and the movement that is in place today will ensure that when those numbers begin to recede, they do so leaving a smaller footprint behind.
