By Doctor Nelly Gauthier

After many years of research and experiments, Allergan and Brazilian cosmetic surgeon Dr Mauricio de Maio are presenting doctors from all over the world with a choice way of performing hyaluronic acid injections according to a rational method made up of codes and equations. This codification, when in competent hands, allows doctors to achieve results that are both discreet and natural-looking and respond to our patients’ aesthetic demands.

Can we use numbers, letters and equations to achieve beauty? “Codified beauty” is a language developed in Brazil that has made a splash in the world of hyaluronic acid injections for aesthetic use. DR NELLY GAUTHIER GIVES US AN INSIGHT INTO THIS APPROACH.


What are the MD Codes™?

Basically, they are very precise guidelines to follow when injecting hyaluronic acid from the Allergan™ – Juvederm™ range. It is a protocol that takes into account the face as a whole. Nearly a hundred specific sites are dotted over the whole face. Each anatomical region is characterised by a letter and, within each region, this letter is accompanied by a number that gives the order in which the area should be addressed.

Nothing is left to chance in this protocol and, for each injection site, there is:

  • A minimum quantity of product required
  • A technique for administering the product (needle or cannula, bolus or fan)
  • An injection depth (in relation to the muscles, fat or bone)
  • The name of the product that should be used, chosen from the Juvederm® product range. The large range of Juvederm® hyaluronic acid gels offers different densities of gels designed to respond to the different consistency requirements, in order to restructure the face as naturally as possible.

Les MD Codes Allergan - Juvederm

The protocol is completed with equations that group together certain letters accompanied by a number. These different equations are supposed to respond to the most common emotional requests from patients. According to Dr de Maio, patients tend to have eight main requests. Patients mainly ask to look:

  • “Younger”, to which Dr de Maio associates the following equation: Ck1 + Ck2 + Ck3 + Ck4 + Tt1 + Tt2 + Tt3 + Lp1 + Lp1 + Lp3 + Lp3 + Lp2 + Lp5 + Lp6 + Lp7 + Jw1 + Jw4 + C1 + C2
  • “Less tired-looking”, and the suggested equation is: E1 + E2 + E3 + T1 + T2 + Ck1 + Ck2 + Ck3 + Ck4 + Tt1 + Tt2 + Tt3 + G1 + G2 + O1 + O2 +O3 + SK
  • And so on for the following demands: “More feminine/masculine”, “Slimmer”, “More seductive”, “Less sad-looking”, “Less angry”, “Less stern”

Within this system, a different equation is applied to address each of these eight requests.

The MD CodesTM, their extensions and evolution

The MD Codes™ are changing over the years. They have become a constantly-evolving work and research basis for Dr de Maio, who is continuously refining his approach.

  • The facial dynamics: Our expressions are responsible for our own personal charm and identity. It was therefore vital to include them.

To do this, Dr de Maio added muscular codifications, called the MD DYNACODESTM (dyna for dynamic), to the site-specific MD Codes. Here, every muscle is analysed and treated so as to increase or reduce their action within the facial expressions that are being treated. The experiments and research carried out to produce this system have shown that muscle modulation is possible thanks to the depth of the implantation in relation to the muscle: either above to reduce their contraction, or below to increase their contraction. This is what we call mechanical modulation.

  • A system that prevents aging: In another adaptation, Allergan® and Dr de Maio have invested in research into a strictly preventative system that they have called Next Human™. The aim is to identify the Aging Trigger Points™ and Health Markers™ in young patients. After having identified these in young patients, the idea is to prevent any age-related damage by using hyaluronic acid injections to reinforce the weak area.

A whole programme of protocols!

Is everyone treated in the same way?

Certainly NOT! It is important to avoid applying the codes mindlessly, otherwise you risk creating an “MD Face”.

In order to personalise the treatment, you must take into account the face’s structural differences between sexes, as well as the originality and charm of each individual face.

How can the MD Codes™ be personalised?

Though they benefit from the knowledge provided by the MD Codes, the doctor chosen by the patient to carry out these injections is, ultimately, the person responsible for their results. When applied by the letter, this methodology can somewhat erase the patient’s personality, a kind of cloning that patients dread. When applied thoughtfully by expert hands, the MD Codes™ can help make the face look more beautiful and naturally fresher.

Let us not forget that every face has its own unique charm, and your chosen doctor owes it to you to recognise and respect that.


At the end of the 19th century, the expression “a person skilled in the art” started being used to describe doctors. This phrase, which today covers almost all professions, is applied to anyone who produces top-quality and useful work. Now, more than ever, doctors who specialise in aesthetics have to be worthy of this name.

Soon after, the expression “the rules of the art” was born to encompass all of the technical rules and professional practices that must be respected in order to properly create works in a given profession.It is, in fact, commonly said that a perfect work has been created as per the “rules of art”, which in no way prevents the “person skilled in this art” from using their initiative and creativity, so that they flourish inside the technical rules. Similarly, Doctor Mauricio de Maio has given us the guidelines for performing injections with an aesthetic purpose by drawing up a metrological standard for how to use the hyaluronic acids from the Allergan™-Juvederm™ range. We owe him a lot for this. Thanks to this codification, a new dimension in the use of hyaluronic acid has been created, making it more reproducible and more scientific.

Admittedly, the MD Codes™ are not guaranteed to reveal the magic in a face’s beauty, but they do guarantee that the cosmetic injections will be performed in an anatomically and dynamically safe way. The “magic” of beauty, the preservation and enhancement of a face’s charm, relies on the practitioner’s skill (experience, research, consideration, artistic eye and personal preference) and also the patient’s qualities (intrinsic and extrinsic qualities). It is this combination and the doctor-patient interaction that determine the real success of the desired beautification.

Finally, let us not forget that all hyaluronic acid injections should be carried out by a qualified doctor because they involve certain risks. To minimise the risk of damage to the blood vessels and nerves, it is a good idea to apply other measures, such as the standard precautions for all areas of the face. An example of these precautions is injecting slowly and regularly checking for signs of pain or changes to the skin colour. The more experienced your doctor is, the lower the risk.

Doctor Nelly GauthierDoctor Nelly Gauthier

Graduate of the Institute of Stomatology and Pierre et Marie Curie Paris VI University, in Plastic Surgery and Maxillofacial Surgery. Dr Gauthier graduated in Stomatology, and went on to assist and train with renowned plastic surgeons.


9, rue de Marignan, 75008 Paris – France

Office: +33 (0)1 53 75 04 60

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