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MD CODES: A genuine revolution in facial treatment

Today, MD Codes combined with new-generation hyaluronic acids can restore facial support and contours. This concept makes it possible to achieve harmonisation with natural results and “gentle” after-effects.

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More than 15 years ago I went to the United States to attend a Fellowship in Plastic and Aesthetic Surgery with Pr. Michael Yaremchuk (Harvard Medical School – Boston).
I was impressed by the quality of his results in rejuvenating and beautifying the face.
He was one of the first to understand the need to restore facial support. Today, hyaluronic acid and MD Codes are joining this approach with treatments that have lighter after-effects for our patients.

During his facelifts, Pr. Michael Yaremchuk combined small implants in the cheekbone, lower orbital rim and chin.

Ageing is a multifactorial mechanism. The facelift is a very powerful tool that will allow the muscles and skin to be repositioned upwards and backwards where they were before.
But over the years we also lose bone and deep fat, which leads to a loss of support for the skin, which accumulates “down and forward”.

This creates the nasolabial fold, the bitterness fold and the jowls.

A facelift alone could treat the sagging but would risk giving the appearance of a drawn and flattened face.

Implants therefore provided a real synergy with the facelift by restoring facial support.

These small prostheses were gradually replaced by autologous fat transfers, also known as lipofilling, which achieve comparable results but with simpler after-effects.

However, the fat used is more fluid than the fat and bone we lose over the years, and so does not offer the same support.

I still use lipofilling in the majority of my facelifts, but in smaller quantities.

This is because it provides valuable stem cells and growth factors that improve skin quality.

But now, before facelifts, I restore the facial support with hyaluronic acid.

New hyaluronic acid gels make it possible to obtain results that last for several years, requiring only “maintenance” injections in increasingly smaller quantities.

These will be carried out approximately every 2 years.

The different gel densities enable us to best restore the loss of support that occurs with bone or fat resorption.

The injections are extremely precise because they are carried out with the patient awake in a sitting position.

The doctor works like a sculptor, according to a precise treatment plan drawn up after a personalised study that respects each patient’s wishes and needs.

On the other hand, it is important to avoid carrying out hyaluronic acid injections on the “consequences” of sagging during the first sessions. These treatments in the superficial planes of the lower face, such as the nasolabial folds or the bitterness folds, could erase wrinkles but would make facial features heavier and block expressions.

The first step in rejuvenating or beautifying a face is to restore its support system. The causes must therefore be treated first, not the consequences.

Hyaluronic acid injections will therefore be performed first on the upper two-thirds of the face to restore a beautiful, youthful oval or inverted cone.

The face is made up of several anatomical units. MD Codes are specific sites within each of these units. The facial units are treated using an architectural method that restores facial support by lightening the face. This revolutionary technique delivers remarkably effective, natural and harmonious results. The principle is not to inject to create volume, but to inject to restore facial support.

MD Codes

The injection sites are represented by a combination of letters and numbers.

The letters represent the anatomical area and the numbers the injection sequence. This coding makes it possible to optimise the development of the treatment plan and also to give the patient a better understanding of the proposed strategy.

The MD Codes also make it easier to teach our colleagues at conferences and training sessions on injection techniques. This is a truly groundbreaking tool that has no equivalent in our therapeutic arsenal.

MD Codes also offer the possibility of restoring facial muscle dynamics. A face is a vector of emotions, which can be positive or negative. To express them, we use elevator and depressor muscles (agonist/antagonist).

Over the years the elevator muscles (for rather positive emotions) tend to function less well due to the loss of bone and fat in the area around them.

Small, precise deposits of hyaluronic acid gel in these areas enable the achievement of positive muscle modulation.

The injected product will restore the mechanical lever effect and the positive muscle (such as the zygomatic elevators) will function as it did before.

Conversely, small deposits of gel on the surface of lowering muscles such as the Depressor Anguli Oris (DAO) at the angle of the mouth reduce the expression of negative emotions (inverted smiley face).

The hyaluronic acids used in this way no longer act as fillers but instead restore facial support and muscular dynamics.

The creator of the MD Codes, Dr Mauricio DE MAIO, a Brazilian plastic surgeon, brought a new dimension to the use of hyaluronic acid with this codification.


A face is a vector of emotions, which can be positive or negative.

In just a few years, our approach to analysing and treating the face has evolved considerably. Our regular exchanges with Dr Mauricio DE MAIO enable us to refine the use of MD Codes even further.


Every face is different and all our patients have their own wishes for rejuvenation or beautification. Some will want to look less tired, less slack or even less sad or severe.

Others may wish to have a more feminine, masculine or lighter face. Analysis and strategy are always the first steps in a consultation in order to create a treatment plan.

The precise, codified use of hyaluronic acid gels will usually enable the objectives set to be achieved. However, there may be significant sagging of the face or eyelids, which will require surgery or tensor threads at a later stage.

The restoration of deep support with MD Codes will enable to achieve an optimised result by using a genuine synergy between injection treatments and surgery. This global medical-surgical approach also makes it possible to postpone the time for surgery. Surgical interventions will then be gentler than if they had been used to treat all the consequences of ageing.

After the surgery, injections will also be carried out, but more spaced out and in smaller quantities in order to maintain the results as well as possible. This global and progressive approach also has a real preventive virtue, which allows us to get through the years serenely.