Verification Is Not Six Checkboxes. My Op-Ed on Why Injection Safety Is One System

Australia's Therapeutic Goods Administration recently reissued its cosmetic-injection checklist: verify the prescriber, the injector, the product registration, the complication discussion, the written aftercare, and the follow-up plan. Every item on that list is reasonable. My concern is with the list format itself. A checklist invites a patient to verify each item independently and consider the job done once every box is checked. That is not how safety actually works in a treatment room, and I think presenting it as six separate items understates how much they depend on each other.

Why I think of it as one system, not six checkboxes

A verified prescriber who uses an unverified product has not actually reduced risk very much. A verified product administered by an untrained injector has not either. Written aftercare means little without a credible emergency pathway behind it if something goes wrong at 9 p.m. on a Saturday. Each item on the checklist is a necessary condition. None of them, alone, is a sufficient one. What actually protects a patient is the integrity of the whole chain — prescriber, injector, product, device, consent, aftercare, and emergency plan — functioning as a single connected system where a failure anywhere weakens everything downstream of it.

What this looks like at my practice in Alpharetta

When a patient asks me why a treatment costs what it costs, the honest answer is that the price reflects the whole system, not just the syringe. It reflects sourcing product through an authorized distributor rather than the cheapest available channel, maintaining the training required to recognize a complication early, and having a real emergency protocol rather than a phone number that goes to voicemail after hours. I would rather a prospective patient in Alpharetta, Johns Creek, or anywhere in North Fulton ask about the system than ask about any single item on the checklist in isolation, because a practice can pass every individual box and still have a weak link between them.

The question I'd add to the checklist

If I could add a seventh item to the TGA's list, it would not be about any single safeguard. It would be: ask the practice to describe what happens, step by step, if something goes wrong — not what they hope will happen, but who calls whom, in what order, within what time frame. A practice that can answer that question fluently, without pausing to invent an answer on the spot, is telling you their system has actually been tested, not just assembled from a checklist.

— Dr. Iryna Lazuk, MD, Lazuk Esthetics, Alpharetta, Georgia