Unlocking the code

to facial revitalisation:
A step-by-step approach to using
injectables with the MD Codes™

Marketing authorization number and date:

Juvederm VOLBELLA with Lidocaine 515-02-00101-21-003 dated 14.4.2021
Juvederm VOLITE 515-02-02741-20-003 dated 30.7.2020
Juvederm VOLUMA with Lidocaine 515-02-02742-21-003 dated 31.8.2021
Juvéderm VOLUX 515-02-05669-21-003 dated 24.2.2022
Juvederm VOLIFT with Lidocaine 515-02-02493-21-003 dated 04.10.2021
Local representative: AbbVie d.o.o. Beograd, Bulevar Mihaila Pupina 115 E,
6th floor, 11070 Belgrade (New Belgrade)

Adverse events should be reported to your local

regulatory authority and AbbVie d.o.o. Beograd.

Produced and funded by Allergan Aesthetics, an AbbVie company.

RS-ABBVD-220001 | Date of preparation: July 2022
For training purposes only

FOR HEALTH CARE PROFESSIONALS ONLY

 Unlocking the code
to facial revitalisation:
A step-by-step approach to using
injectables with the MD Codes™

Brought to you by the Allergan Medical Institute®

in partnership with Dr Maurício de Maio

2 3
Preface and Heading
acknowledgements

It has been almost 10 years since I launched the 8-point Lift™ at an international congress.
In that time, medical aesthetics has undergone an incredible transformation, and I am thrilled
that the MD Codes™ continue to be at the forefront of this evolution. While we all share a goal
to best address patients’ needs, previously injection technique was based only on the intuition
of the injector, which may not lead to predictable and reproducible results. With the MD
Codes™, I wanted to disrupt this way of thinking.

The MD Codes™ are a series of anatomical injection points designed to help injectors aim
to achieve specific outcomes. Each point – or code – is identified by a unique combination
of letters and numbers, and is accompanied by detailed guidance on injection technique.
This innovative and universal aesthetic language has helped to facilitate a better treatment
planning process between injectors and their patients all over the world. In 2020, I reached an
important personal milestone with the publication of the MD Codes™ methodology, including
the technical recommendation for each code and their associated active numbers.*

The response has been truly inspiring. Thank you to everyone who has found a place for the
MD Codes™ in their clinical practice. Together, we are aiming to raise the standard of medical
education in facial aesthetics and improve safety for our patients.

Over the years, I have expanded the MD Codes™ methodology and this edition contains
additional clinical tools you may be familiar with from the MD Codes™ Curriculum: Foundation-
Contour-Refinement and the active numbers. There is also further emphasis on anatomy using
cadavers and technique using flash cards for each code, plus the introduction of MD Codes™ Dr Maurício de Maio
strategies: the 7-point ∑hape™ , the 9-point ∑hape™, the MD Codes™ Look and the MD Codes™ Lip. Plastic Surgeon
October 2021
I would like to extend my deepest gratitude to a number of people who have helped me along
this journey, making this book possible and my dream a reality: Mark Chaplin, Claudia Ledda,
Viviana De Angelis, Holly Lemmon and Raphael Chu from the Allergan Medical Institute®
and the Syneos Health® and Materia Prima teams, whose support and encouragement in
developing these ideas has been invaluable.

I hope you find the MD Codes™ insightful, practical, and useful.

The MD Codes™ have been developed by Dr Maurício de Maio (CRM/SP 69331 RQE 14478), and all recommendations presented in this guide
are based on his extensive clinical and personal experience. *Active numbers represent the minimum volume to be injected in an area represented
by a code to deliver a demonstrable result. Actual injection volumes should be determined by the clinician for each patient. The active number is
based on the author’s experience with more than 10,000 syringes over a 4-year period.1

4 5
Contents

Disclaimers 9 REFINEMENT OF THE PERIORBITAL AREA: The 3-point tear trough 95

Introducing the MD Codes™ 13 REFINEMENT OF THE PERIORAL AREA: The 3-point nasolabial fold 103

An innovative language in facial aesthetics 14 REFINEMENT OF THE PERIORAL AREA: The 3-point marionette lines 123

Why use the MD Codes™? 14 REFINEMENT OF THE PERIORAL AREA: The 8-point lip 131

An injection methodology designed for the JUVÉDERM® COMPLEX AREAS: The 3-point forehead 157
range of hyaluronic acid injectables 15 COMPLEX AREAS: The 3-point eyebrow 173
The MD Codes™: A clinical tool with wide-ranging applications 17 COMPLEX AREAS: The 2-point glabella 185
The language of the MD Codes™ 19 The MD Codes™ strategies 193
The principles of the MD Codes™ 22 The 8-point Lift™ 193
The MD Codes™ and the Allergan Aesthetics portfolio 23 The 7-point ∑hape™ 201
The MD Codes™ architecture: A structural approach 24 The 9-point ∑hape™ 207
The MD Codes™ strategies 25 The MD Codes™ Look 213
Injection device symbols 26 The MD Codes™ Lip 219
Injection delivery symbols and target layer symbols 27 References 225
Alert areas and MD Codes™ flash card 28

General precautions to observe when injecting 29

General injection technique guidelines 30

Minimising the risk of complications 33

The injection technique of the MD Codes™ 39

FOUNDATION MIDFACE: The 5-point cheek 39

CONTOUR THE UPPER FACE: The 2-point temple 55

CONTOUR THE LOWER FACE: The 6-point chin 63

CONTOUR THE LOWER FACE: The 5-point jawline 75

REFINEMENT OF THE PERIORBITAL AREA: The 3-point lateral orbital 87

6 7
Disclaimers

9
Disclaimers

Disclaimers Active numbers

• The MD Codes™ have been developed by Dr Maurício de Maio (CRM/SP 69331 RQE • The active numbers represent the minimum volume to be injected in an area, represented
14478), and all recommendations presented in this guide are based on over 25 years of by a code, to deliver a demonstrable result. Actual injection volumes should be determined
extensive clinical and personal experience1 by the clinician for each patient. The active number is based on Dr Maurício de Maio’s

• Allergan Aesthetics and Dr de Maio provide no warranty for subsequent undertakings of experience with more than 10,000 syringes over a 4-year period.1

this training by healthcare professionals (HCPs) in their clinical practice Images

• The responsibility of treatment decisions remains with the treating HCP. Treatment • All anatomy images are provided by Dr KM Kapoor and Allergan Aesthetics, an AbbVie
requirements should always be based on clinician assessment of individual patient needs company, for illustrative and educational purposes only

• Graphical representation of the MD Codes™ is for illustrative purposes only

Selecting the appropriate product

• The following information refers to the MD Codes™, an injection methodology designed for
HCPs using the JUVÉDERM® range of hyaluronic acid facial fillers. Please refer to your local
Directions for Use for each product. Licence terms may vary by country and responses to
treatment may vary between individuals

• Do not inject more than 2 mL of Juvéderm® VOLUX™ or Juvéderm® VOLUMA® with

lidocaine per treatment area in a single session2,3

• Use of cannula where mentioned is the recommendation of Dr Maurício de Maio. Use of

cannula with Juvéderm® VOLUMA® has been reported in the literature;4–6 it is not included
in the Juvéderm® VOLUMA® with lidocaine Directions for Use3

• There is no data available regarding the safety of injecting greater than 20 mL volumes of
JUVÉDERM® dermal fillers per 60 kg (130 lbs) body mass per year2,3,7–9

10 11
Introducing the
MD Codes™

13
Introducing the
MD Codes™

An innovative language in facial aesthetics An injection methodology designed for the JUVÉDERM® range
Aesthetic medicine is constantly evolving, with the development of cutting-edge products and of hyaluronic acid injectables
innovative ways to use them. With almost endless treatment possibilities, it is essential that we Why use hyaluronic acid injectables?
understand how to aim to achieve the best results for our patients. This book introduces a
Volume loss is a fundamental component of facial aging.4 Contributing factors include fat
series of practical injection strategies – or treatment codes – resulting from over 25 years of
redistribution, skeletal remodelling and other changes in tissue composition.4,10 Hyaluronic
clinical experience.
acid injectables are an established means of addressing volume loss and contouring.10
Using the MD Codes™, the injectors can aim to optimise patient outcomes in an effective way1
Hyaluronic acid is a natural polysaccharide present in the human dermis.11,12 Due to its
with the wide range of options offered by Allergan Aesthetics’ hyaluronic acid injectables – the
chemical structure, it is highly water soluble and will readily dissolve in water to form a viscous,
JUVEDERM® range.
clear liquid.11 The hydrophilic nature of hyaluronic acid means it plays an essential role in the
regulation and maintenance of hydration within tissues.12
Why use the MD Codes™? The synthetic form of hyaluronic acid created for use in injectables can be stabilised by crosslinking
The MD Codes™ are designed to raise awareness of how each aesthetic facial unit (e.g. to increase longevity, as uncrosslinked hyaluronic acid will remain in the skin for a few days
cheek, nasolabial folds, lips, etc.) comprises subunits that must be respected during injection. before being degraded.13 Structurally, the hyaluronic acid present in hyaluronic acid injectables
These subunits – the MD Codes™ – are the structural sites that aim to create or recreate the is similar to the hyaluronic acid present in native tissue, providing biocompatibility and good
desirable facial architecture for our patients.1 tissue integration.13 Specific physicochemical properties vary by product, determining its
clinical performance and suitability for particular applications.10,14
By introducing specific terminology and patterns into the MD Codes™, injectors are able to
systematise treatment plans and better understand the complexity of the human face.1

This practical guide was developed specifically for the JUVÉDERM® range to assist injectors
to aim to achieve optimal results through personalised facial aesthetic treatment plans.

14 15
Why use the JUVÉDERM® range? The MD Codes™: A clinical tool with wide-ranging applications
Allergan Aesthetics’ comprehensive collection of fillers2,3,7–9,15–19 are designed and tailored for The MD Codes™ are a useful tool for clinicians to help their patients understand the components
the most treated areas of the face.20* The JUVÉDERM® range of facial fillers feature thorough of their individual treatment plan, allowing patients to have well-informed expectations for
tissue integration, 14,21–24†
which may contribute to the natural look and feel assessed as a result treatment outcomes.1
of treatment14,25–27 that patients can be satisfied with.4,12,25,27–30 There are two filler technologies
Patients are typically unaware of the precise injection sites for their areas of concern. The
to choose from: VYCROSS® and HYLACROSS®.
face is a mechanical structure with firm and soft tissues that may, at times, need support. For
The MD Codes™ presented in this book are for use with the collection of hyaluronic acid instance, the treatment of the cheekbone area with facial fillers to add volume may improve
injectables that use Juvéderm® VYCROSS® technology: Juvéderm® VOLUX™,2 Juvéderm® the appearance of the nasolabial fold and shorten the lid–cheek junction.35
VOLUMA® with lidocaine,3 Juvéderm® VOLIFT® with lidocaine,7 Juvéderm® VOLBELLA® with
The MD Codes™ can be considered to establish a treatment pattern comprising specific
lidocaine8 and Juvéderm® VOLITE™.9
injection points on the patient’s face, created according to their individual treatment needs.
The VYCROSS® filler technology: Our patients expect much more from us than they usually communicate, and we need a tool to
help us bridge that gap.

• Different balances of cohesivity The MD Codes™ are more than just a treatment planning tool; they may help to explain the
and elasticity5,31,32 four key aspects of aesthetics practice: Finance, Assessment, Communication and Technique.
• Tailored mouldability,5,33,34 lift
capacity10,33 and enhanced
spreadability vs HYLACROSS®23,33‡ The MD Codes™ are a landmark in facial aesthetics, it’s a FACT
<1 MDa5 >1 MDa5 • Smooth consistency and low
extrusion force5,33 Finance Patients may come with a specific budget
For illustrative purposes only

Assessment Accurate diagnosis must be made

Communication Clarify ‘Patient wants vs Patient needs’

Technique Precise safety considerations can help achieve desired outcomes

*Based on market research involving >1000 healthcare professionals from 15 international markets.20 †Tissue integration was demonstrated by The MD Codes™ have been developed by Dr Maurício de Maio, and all recommendations presented in this guide are based on his clinical
Juvéderm® ULTRA XC, Juvéderm® ULTRA PLUS XC, Juvéderm® VOLBELLA® with lidocaine, Juvéderm® VOLIFT® with lidocaine, Juvéderm® experience and personal opinion. The injector is responsible for customising the MD Codes™ for each individual patient. The Directions for Use
VOLUMA® with lidocaine, Juvéderm® VOLUX™ and Juvéderm® VOLITE™ at 4 weeks in animal in vivo studies.14,21–23 Tissue integration was also for each product should be respected and product indications needed.
demonstrated by Juvéderm® VOLUX™ at 30 days after treatment in human subjects.24 ‡Juvéderm® VOLITE™ spreadability based on in vitro testing.23

16 17
The language of
the MD Codes™

19
The language of the
MD Codes™1,36

F2 F1 F3 F3 F1 F2

T2
E2 T1
G1 G1 E3 E1
G2
O3

O1
Ck1
Tt3 Tt2
O2
Tt1
Ck2 Jw2
Ck3
Ck4

NL1
Lp7
Lp2 Lp8 NL2 Ck5
Lp3
Lp
1
Lp1 NL3
Lp6 Lp4
Lp1 Lp1 Jw1
Lp5 Lp5
Lp3 Lp8 M1

C6 C1 M2
Jw3
C3 M3
C4
C2 C5 Jw4
Jw5

20 21
The principles of The MD Codes™ and the
the MD Codes™ Allergan Aesthetics portfolio

The face can be split into separate anatomical units (e.g. eyebrows, cheeks, lips, etc). The The MD Codes™ presented in this book were designed for use with the Juvéderm® VYCROSS®
MD Codes™ are a series of precise anatomical sites (or subunits) within each unit that Collection of facial fillers, which comprises five hyaluronic acid injectables designed and
are designed to guide injection. They are based on the principle that facial units can be tailored for the most treated areas of the face: Juvéderm® VOLUX™,2 Juvéderm® VOLUMA®
addressed, or treated, in an architectural mode. Each injection site is represented by a with lidocaine,3 Juvéderm® VOLIFT® with lidocaine,7 Juvéderm® VOLBELLA® with lidocaine8
combination of letters and numbers. The letter represents the anatomical unit and the number and Juvéderm® VOLITE™.9
indicates the subunit.1 The treatment codes provided in this book include guidance on product, choice of injection
Besides letters and numbers, the injection sites are also coloured and represented by different device, technique and the active number. These recommendations are based on the clinical
shapes. The colour red represents an ‘alert zone’, indicating that the injector should be aware experience of Dr Maurício de Maio and may be adapted based on the experience of the
of and avoid important anatomical structures in the area, such as neurovascular bundles. injector and the patient’s facial features.
Shape symbols are used to indicate technical delivery: for example, a circle to indicate a bolus, From here onwards, each product will be referred to using its two-letter abbreviation stated below.
a line to indicate linear injection, and a triangle to indicate fanning.1
Product Abbreviation Indication

Juvéderm® VOLUMA®
VM Intended to restore volume of the face3
with lidocaine
Summary

Juvéderm® VOLUX™ VX Intended to restore and create volume of the face2

Each code is depicted with a combination of the following:1
Intended for the treatment of any deep skin
Letters The anatomical area (e.g. Ck=cheeks) depressions due to conditions such as premature
Juvéderm® VOLIFT® aging. Can also be used for face contouring and
VL
with lidocaine volume restoration to correct facial structural defects
The subunit of the anatomical unit (e.g. Ck1=zygomatic arch;
Numbers such as asymmetry, contour deformities, volume loss
Ck2=zygomatic eminence)
in the lips, cheeks, chin and lower face7
The side of the face (e.g. Ck1R is the zygomatic arch on the right-hand
Number location Used for the treatment of any fine lines and medium-
side; Ck1L is the zygomatic arch on the left-hand side)
sized skin depressions due to conditions such as
Superscript (Xn) refers to upper areas (e.g. Lp1=vermillion body of the premature aging. Can also be used for enhancement
upper lip) and pouting of the lips to correct structural defects
Number position Juvéderm® VOLBELLA®
Subscript (Xn) refers to lower areas (e.g. Lp1=vermillion body of the VB such as asymmetry, contour deformities and volume
with lidocaine
lower lip) loss. Can also be used for treatment of the infraorbital
skin depressions (also known as tear trough area)8
MD Codes™ in red denote alert areas, where there are sensitive
Colours
structures, such as neurovascular bundles in facial danger zones
Technical delivery of the product (e.g. circle for bolus, triangle
Shapes Used for the treatment, by filling, of superficial
for fanning, etc.)
cutaneous depressions such as fine lines and for
Juvéderm® VOLITE™ VT
additional improvement of skin quality attributes
such as hydration and elasticity9

Indications may vary by product and by country. Please refer to your local Directions for Use for each product.2,3,7–9

22 23
The MD Codes™ architecture: The MD Codes™ strategies
A structural approach

MD Codes™ for the three architectural stages of facial revitalisation.1,36 Specific combinations of MD Codes™ designed to achieve a specific aesthetic outcome.

FOUNDATION in the midface Full facial lifting

Ck The 5-point cheek 8L The 8-point Lift™

CONTOUR in the upper face CONTOUR in the lower face

Mid- and lower facial shaping
The The
T The 2-point temple C 6-point Jw 5-point
chin jawline 7∑ The 7-point ∑hape™ 9∑ The 9-point ∑hape™

Periorbital REFINEMENT
Tear trough and orbital codes are reserved for specialists specifically trained in this technique
and those who have a sound knowledge of the anatomy and physiology for this particular area8,36 Periorbital and perioral approaches

The 3-point The 3-point

O Tt
lateral orbital tear trough
Look The MD Codes™ Look Lip The MD Codes™ Lip

Perioral REFINEMENT

The 3-point The 3-point

NL Lp The 8-point lip M
nasolabial fold marionette lines

MD Codes™ advanced indications

COMPLEX AREAS
Do not attempt unless you are extensively trained in injectable fillers and facial anatomy

The 3-point The 3-point The 2-point

F E G
forehead eyebrow glabella

24 25
Injection device symbols Injection delivery symbols
and target layer symbols1,39–41

The choice of injection device should be based on individual experience, product guidance Injection delivery symbols1
and preference.

• May minimise risk of intravascular injury and bruising37, 38 Micro-aliquot Very small droplet of injectable (0.01–0.05 mL per point)
• Recommended for use in alert zone areas 1
Cannula
• Preferable for large areas in the subcutaneous and fat pad
layers, using fanning technique1
Static injection of a small amount of injectable (0.1–0.2 mL
Aliquot
per point)
• May be preferred for fine, controlled injections1
Needle
• Ideal for bolus at the supraperiosteal level1

Bolus Static injection of injectable (0.3 mL)

• Injection of Juvéderm® VOLUX™ with supplied 27G 1/2” sterile needle is recommended. It
is possible to use a 25G x 38 mm cannula2
• Injection of Juvéderm® VOLUMA® with lidocaine with the supplied 27G 1/2” sterile needle
Linear Anterograde or retrograde (0.5 mL)
is recommended3
• Use of cannula where mentioned is the recommendation of Dr Maurício de Maio
• Use of cannula with Juvéderm® VOLUMA® with lidocaine has been reported in the Multiple linear injections via a single entry site creating a
Fanning
literature;4–6 it is not included in the Juvéderm® VOLUMA® with lidocaine Directions for Use3 fan-like pattern with needles or cannulas (0.5 mL)

• Injection of Juvéderm® VOLIFT® with lidocaine with the supplied 30G 1/2” sterile needle is

recommended. It is possible to use a 25G, 27G or 30G sterile cannula7
• Injection of Juvéderm® VOLBELLA® with lidocaine with the supplied 32G 1/2” sterile needle Target layer symbols1,39–41

is recommended.8 It is possible to use a 30G 1/2” sterile needle and 30G sterile cannula.8
The indications for the use of Juvéderm® VOLBELLA® with lidocaine may vary by country. Retro-orbicularis
Please consult your local Directions for Use before using this product8 oculi fat (ROOF)
Lip mucosa Dermis
• Injection of Juvéderm® VOLITE™ with the supplied 32G 1/2” sterile needle is Suborbicularis
recommended. It is possible to use a 32G 3/16’’ TSK needle9 oculi fat (SOOF)

Subcutaneous Deep Supraperiosteal/

fat fat pads Periosteal

Indications may vary by product and by country. Please refer to your local prescribing information and the Directions for Use for each product.2,3,7–9

26 27
Alert areas and General precautions to
MD Codes™ flash card observe when injecting42

Alert areas1
• High-risk areas where additional caution must be taken if injecting at or near these sites
1. The presence of an active bacterial or viral infection
• Alert areas may be highly vascular, highly innervated or adjacent to critical structures or or cutaneous inflammatory process should postpone
organs, such as the eye treatment
• Needle aspiration is highly recommended or the use of cannulas should be considered

2. Maintaining an appropriate aseptic environment and

MD Codes™ flash card example1,3,36 technique are required to help reduce the risk of infection.
Ensure the patient has removed any make-up and prepare
the skin with antibacterial soap or alcohol

Layer = bone VM Product

3. Wash your hands, wear appropriate clothing, and use
disposable gloves and equipment

Device = needle Ck2 MD Codes™

4. Ensure you have everything you need before you

start injecting

Delivery = bolus 0.2 mL Active number

5. Please refer to the individual Directions for Use for each

product2,3,7–9

28 29
General injection
technique guidelines

1. To minimise the risk of injury to blood vessels and nerves, standard precautionary measures
should be taken in all areas of the face. These include injecting slowly, and frequently
checking for signs of pain and skin colour changes. If immediate blanching occurs at any
time during the injection, the injection should be stopped and the area massaged until
normal colour returns2,3,7–9,15–19

2. Standard injection techniques should include reflux/aspiration of the syringe plunger to

check if blood is drawn into the chamber2,3,7–9,15–19

3. Ensure proper assembly of the syringe to minimise risk of leakage or needle

disengagement2,3,7–9,15–19

4. Massage gently following injection to ensure even distribution of the product2,3,7–9,15–19

5. Do not overcorrect as injection of an excessive volume may lead to side effects such as
tissue necrosis and oedema2,3,7–9,15–19

6. A touch up may be required to achieve optimal correction, and/or a repeat treatment may
be required to maintain this2,3,7–9,15–19

7. The degree and duration of the correction depends on the character of the defect treated,
the tissue stress at the implant site, the depth of the implant in the tissue and the injection
technique. The amount injected will depend on the areas which are to be corrected based
on the experience of the medical practitioner2,3,7–9,15–19

8. Do not inject more than 2 mL of Juvéderm® VOLUMA® with lidocaine or Juvéderm® VOLUX™
per treatment area in a single session2,3

9. There is no data available regarding the safety of injecting greater than 20 mL volumes of
JUVÉDERM® dermal fillers per 60 kg (130 lbs) body mass per year2,3,7–9

30 31
Minimising the risk
of complications

33
Minimising the risk
of complications

Clean: Practice aseptic technique before injection

• Take a thorough medical history and assess patients
Screen 1. Avoid injection areas that have irritated, inflamed, or infected skin42,44
before treatment to determine any risk factors42–44
2. Have patient wash face and hands thoroughly with soap and water43

• Practice aseptic technique before and during treatment44,45 3. Disinfect patient’s entire face with antiseptic or alcohol; you may want to do this
Clean
• Counsel patients on proper aftercare to avoid contamination42 multiple times42,43

4. Have patient use chlorhexidine mouthwash before lip treatments42

• Inject slowly and apply the least amount of pressure 5. Avoid unnecessary contact with skin or hair43,46
Strategies
necessary3,45
6. Do not touch the needle or cannula; change the needle or cannula after possible
contamination42

7. Use your non-injecting hand to gently mould or manipulate the skin47

Screen: Assess patients before treatment
8. Limit contact with the mucosal area when injecting lips/perioral region. Do not touch any
Appropriate patient selection may help minimise the risk of complications. 42
other area of the face after touching the mucosa43
Take a thorough medical history and assess patients to determine any risk factors. After 9. Inject lips and perioral region last43
considering underlying health issues, you may want to avoid treating patients who may be
10. Clean and re-clean each injection site during the treatment48
easily triggered. This may include patients with:42–44

• Skin infections

• Inflammatory conditions

• Allergies

• Autoimmune conditions

• Immunosuppression

• Pigmentation disorders

• Coagulation disorders

Remember:
Always read the contraindications in the Directions for Use.42

34 35
Minimising the risk
of complications

Clean: Counsel patients on aftercare Observe: Inject slowly and carefully

What patients do after their treatment may be just as important as the treatment itself.42,43
Post-procedure care can help minimise complications.42,43 Inject slowly and apply the least amount of pressure necessary
to minimise trauma to vascular structures3,45

To help prevent the introduction of bacteria into the treatment area,

• Select a small bolus size45
advise patients to:
• Use incremental injections45

• Avoid touching the treated area and keep hair (and phone) away from the treated
area for several hours42

• Avoid make-up for 12 hours after treatment, especially lipstick or lip gloss after lip Inject in the correct plane3
treatment42,49
– When resuming make-up, use new/clean brushes, sponges, etc.42 • Injecting too superficially may result in visible lumps and/or discolouration – injection
depth will vary between products. Please refer to the Directions for Use for each
• Avoid using skincare products for 24 hours after treatment43
product guidance2,3,7–9
– When resuming skincare, use new containers of products 42

• Avoid intravascular injection

• Postpone dental procedures for at least 2 weeks after treatment. Please refer to the
Directions for Use for each product guidance2,3,7–9

• Please be aware that the syringe itself is not completely sterile and frequent changes
of needle and cannula is advised.45 Do not leave uncapped needle or cannula when
not in use43

36 37
The injection technique
of the MD Codes™

FOUNDATION MIDFACE:
The 5-point cheek36

39
Ck1

Ck2

Ck3
Ck4

Lifting codes:* Ck1 + Ck2 + Ck4

Ck5

Volumetric codes:* Ck3 + Ck5

*Lifting codes and volumetric codes.50

40 41
Bridging the MD Codes™ The 5-point cheek:
with anatomy1,36,39,40 Anatomical locations
and aims of effects36,50

Anatomical location36 Placement36 Aims50

• A lifting code: Lifts and defines the cheek

• Gives support to the eyebrow and lower eyelid,
and opens the eye
• Improves sagginess of the cheek and jawline
Ck1
Zygomatic arch Supraperiosteal • Indirectly improves hollowness in the infraorbital
Ck1 Ck1* anchor
Ck2 area and tear trough
Ck3 Ck3
• Indirectly improves prominent nasolabial folds,
oral commissures and marionette lines; may aid
in creating a slimming and more contoured effect

• A
 lifting code: Aims to create structure and
Ck1* Zygomatic arch Sub-SMAS
definition along the zygomatic arch

Supraperiosteal Sub-SMAS & deep malar fat pads

• A lifting code: Lifts and provides projection to
the cheek
Zygomatic • Shortens the palpebral-malar sulcus and gives
Ck2 eminence
Supraperiosteal support to the lateral canthal area
• Improves eye shape
• Indirectly improves nasolabial folds

• A volumetric code: Creates volume, projection

• Supraperiosteal and improves the medial lid–cheek junction by
Anteromedial • Deep malar advancing the mid-cheek
Ck3 cheek fat pad • Lifts the cheek
• SOOF • Indirectly softens the tear trough and
nasolabial fold
Ck3
Ck4 • A lifting code: Lifts the lower cheek and jawline
Lateral lower
Ck5 • Addresses the sunken area at the parotid level
Ck4 cheek/parotid- Subcutaneous
masseteric area • May aid in creating a slimming and more
contoured effect

• A volumetric code: Improves volume loss in the

• Subcutaneous submalar/buccal area
Submalar/
Ck5 buccal area
• Deep dermis/
subdermal • Corrects collapse of the buccal area and
SOOF Subcutaneous improves cheek lines

Ck1*: Ck1 curve; SMAS: superficial muscular aponeurotic system; SOOF: suborbicularis oculi fat. Ck1*: Ck1 curve; SMAS: superficial muscular aponeurotic system; SOOF: suborbicularis oculi fat.

42 43
Ck1 anchor and curve - Ck1 anchor and curve -
Zygomatic arch1,36 Zygomatic arch1,36
(continued)

Ck1 anchor Ck1 anchor

Active
Target Injection
Code 36
Product 3
Delivery 36
number per Notes36
layer36 device36
side (mL)36
VM
Aspiration is highly
recommended
Ck1 when injecting
VM 0.1 + 0.1 + 0.1*
anchor with a needle
at the level of Ck1
Ck1
the bone†

Ck1 curve 3 x 0.1 mL

Active
Target Injection
Code36 Product3 Delivery36 number per Notes36
layer36 device6,36
side (mL)36
Ck1 curve
Target the
Ck1
VM 0.5 sub-SMAS
curve area

VM

Ck1*
Ck1*

0.5 mL
*Consider Ck1 as the starting point for treatment with the MD Codes™. Injections in Ck1 are done supraperiosteally and serve as anchors to
promote SMAS lifting.36 †Do not inject into the bone, but rather at the level of the bone.36
Do not inject more than 2 mL of Juvéderm® VOLUMA® with lidocaine per treatment area in a single session.3
SMAS: superficial muscular aponeurotic system. Ck1*: Ck1 curve.

44 45
Ck2 - Zygomatic eminence1,36 Ck3 - Anteromedial cheek1,36

Active Active
Target Injection Target Injection
Code36 Product3 Delivery36 number per Notes36 Code36 Product Delivery36 number per Notes36
layer36 device36 layer36 device6,36
side (mL)36 side (mL)36

Be wary of the
0.3 infraorbital artery
Be wary of the and foramen*
Ck2 VM 0.2 zygomaticofacial
artery*
VM3 Target the deep
malar fat pad
0.5 Be wary of the
Ck3
infraorbital artery
and foramen

Target the SOOF

Be wary of the
VM VL7 0.5
infraorbital artery
and foramen

Ck2 Ck2 Consider the product selection below:

VM with needle VM with cannula VL with cannula
Bone retrusion/deficiency Deep malar fat pad deficiency SOOF deficiency
and volume loss
0.2 mL

*Aspiration is highly recommended when injecting with a needle at the level of the bone. Do not inject into the bone, but rather at the level of
the bone.36
Do not inject more than 2 mL of Juvéderm® VOLUMA® with lidocaine per treatment area in a single session.3
Juvéderm® VOLIFT® with lidocaine is intended for intradermal use and there is currently no clinical data in terms of performance and safety
available on the injection of Juvéderm® VOLIFT® at the subcutaneous or supraperiosteal depth. Please consult the Directions for Use before using
*Aspiration is highly recommended when injecting with a needle at the level of the bone. Do not inject into the bone, but rather at the level of the bone.36 this product.7
Do not inject more than 2 mL of Juvéderm® VOLUMA® with lidocaine per treatment area in a single session.3 SOOF: suborbicularis oculi fat.

46 47
Ck3 - Anteromedial cheek1,36
(continued)

VM VL

Ck3
Ck3 Ck3
Ck3

0.3 mL 0.5 mL

VM

Ck3
Ck3

0.5 mL

48 49
Ck4 - Lateral lower cheek/ Ck5 - Submalar/buccal area1,36
parotid-masseteric area1,36

Active Active
Target Injection Target Injection
Code36 Product3 Delivery36 number per Notes36 Code36 Product Delivery36 number per Notes
layer36 device6,36 layer36 device6,36
side (mL)36 side (mL)36

VM3
Be wary of the
Be wary of the
Ck4 VM 0.5
parotid gland 0.5
buccal nerve,
facial vein
and artery36
Ck5 VL7

Intradermal
VT 9
0.5 Avoid injecting
too superficially51

VM
Consider the product selection below:
VM VL VT
Deep fat pad support and Subcutaneous support with Skin hydration
Ck4 severe volume loss mild/moderate volume loss
Ck4

0.5 mL

Do not inject more than 2 mL of Juvéderm® VOLUMA® with lidocaine per treatment area in a single session.3
Juvéderm® VOLIFT® is intended for intradermal use and there is currently no clinical data in terms of performance and safety available on the
Do not inject more than 2 mL of Juvéderm® VOLUMA® with lidocaine per treatment area in a single session.3 injection of Juvéderm® VOLIFT® at the subcutaneous or supraperiosteal depth. Please consult the Directions for Use before using this product.7

50 51
Ck5 - Submalar/buccal area1,36
(continued)

VM VT

Ck5 Ck5

Ck5 Ck5

0.5 mL 0.5 mL

VL

Ck5

Ck5

0.5 mL

52 53
The injection
technique of
the MD Codes™

CONTOUR
THE UPPER FACE:
The 2-point temple36

55
 Bridging the MD Codes™
with anatomy1,36

T2
T2
T1 T1

T2 T1

Supraperiosteal

Temporal fascia

56 57
The 2-point temple: T1 - Anterior temple1,36
Anatomical locations
and aim of effects36,50

Anatomical location36 Placement36 Aims50 Active

Target Injection
Code36 Product3 Delivery36 number per Notes36
layer36 device36
side (mL)36
Anterior
T1 temple
• Reshapes the temple
Be wary of the
Supraperiosteal* • Reduces the concavity at this level superficial
Posterior
• May indirectly lift the eyebrow T1 VM 0.5 temporal artery
T2 temple
and the deep
temporal arteries*

Anterior and
• Additional reshaping for the temple for those
T1/T2 posterior Temporal fascia
with a skeletonised appearance
temple

VM
T1

T1

0.5 mL

*Aspiration is highly recommended when injecting with a needle at the level of the bone. Do not inject into the bone, but rather at the level of
the bone.36
*Do not inject into the bone, but rather at the level of the bone.36 Do not inject more than 2 mL of Juvéderm® VOLUMA® with lidocaine per treatment area in a single session.3

58 59
T2 - Posterior temple1,36 T1/T2 - Anterior and
posterior temple1,36*

Active Active
Target Injection Target Injection
Code36 Product3 Delivery36 number per Notes36 Code36 Product3 Delivery36 number per Notes36
layer36 device36 layer36 device6,36
side (mL)36 side (mL)36

Product should be
Be wary of the placed just below
superficial the temporal fascia
T2 VM 0.5 temporal artery Be wary of the
and the deep temporal branch
temporal arteries* T1/T2 VM 0.5
of the facial
nerve, superficial
temporal artery
and the deep
temporal arteries

*Additional approach for severe volume loss and for those with a skeletonised appearance.

VM
T2

VM
T2 T2 T1

T1/T2
0.5 mL

0.5 mL

*Aspiration is highly recommended when injecting with a needle at the level of the bone. Do not inject into the bone, but rather at the level of
the bone.36
Do not inject more than 2 mL of Juvéderm® VOLUMA® with lidocaine per treatment area in a single session.3 Do not inject more than 2 mL of Juvéderm® VOLUMA® with lidocaine per treatment area in a single session.3

60 61
The injection
technique of
the MD Codes™

CONTOUR
THE LOWER FACE:
The 6-point chin36

63
 Bridging the MD Codes™
with anatomy1,36

C3
C5
C2

Supraperiosteal

C6 C1
C1 C6 C4
C2
C3
C4

C5 C2 C2
Subcutaneous

64 65
The 6-point chin: C1 - Labiomental angle1,36
Anatomical locations
and aim of effects36,50

Anatomical location36 Placement36 Aims50 Active

Target Injection
Code36 Product2 Delivery36 number per Notes36
layer36 device36
side (mL)36
• Opens the labial-mental angle
• Reduces the mental crease
Labiomental
C1 angle
Subcutaneous • Elongates the chin
• Reduces the protrusion of the lower lip Be wary of the
C1 VX 0.5*
sublabial artery
• Gives support to the oral commissure

• Improves vertical dimension

• Subcutaneous
C2 Chin apex
• Supraperiosteal
• Improves chin height
• Makes the chin triangular

C3 Anterior chin Supraperiosteal • Improves anterior projection of the chin

VX
• Creates the labial-mental sulcus
Anterior chin/ • Rotates the chin upwards
C4* soft tissue Subcutaneous • Shortens chin height
pogonion •
•
Enhances C2 and C3
Opposite effect of C1
C1

• Gives lateral support

C5
Lateral lower
chin
Supraperiosteal
•
•
Widens the chin
Makes the chin square
C1 0.5 mL
• Ideal for masculine look

• Improves lateral chin depression

C6 Lateral chin Subcutaneous • Reduces the prominence of the prejowl sulcus
• Gives support to the marionette line area

*Although the active number for C1 is 0.5 mL, when treatment of C1 is combined with C2, the active number for C1 becomes 0.7 mL, so that the
total volume for C1 + C2 = 1.0 mL (1 syringe).36
*The injection entry point is in the inferior chin into the soft menton. However, the product should be delivered in the midline, between C3R
and C3L. Do not inject more than 2 mL of Juvéderm® VOLUX™ per treatment area in a single session.2

66 67
C2 - Chin apex C2 - Chin apex
treatment options1,36 treatment options1,36
(continued)

Active
Target Injection
Code36 Product2 Delivery36 number per Notes36
layer36 device36
side (mL)36
VX

0.3
C2
C2 VX

0.3
Be wary of the
submental 0.3 mL
(only midline)
artery* C2

VX

C2

0.3 mL
(only midline)
C2

*Aspiration is highly recommended when injecting with a needle at the level of the bone. Do not inject into the bone, but rather at the level of
the bone.36
Do not inject more than 2 mL of Juvéderm® VOLUX™ per treatment area in a single session.2

68 69
C3 - Anterior chin1,36 C4 - Anterior chin/soft
tissue pogonion1,36

Active Active
Target Injection Target Injection
Code36 Product2 Delivery36 number per Notes36 Code36 Product2 Delivery36 number per Notes36
layer36 device36 layer36 device36
side (mL)36 side (mL)36
Be wary of the
mental artery
and foramen* Be wary of the
0.3 submental
C3 VX 0.3 Do not inject C4 VX
(only midline) artery at entry
lateral due to point*
mental artery
and foramen

VX VX

C3 C4

0.3 mL
0.3 mL
C3 C4 (only midline)

*Aspiration is highly recommended when injecting with a needle at the level of the bone. Do not inject into the bone, but rather at the level of
the bone.36 *Entry point is in the inferior chin into the soft menton; delivery of product should be in the subcutaneous layer in midline between C3R and C3L.
Do not inject more than 2 mL of Juvéderm® VOLUX™ per treatment area in a single session. 2
Do not inject more than 2 mL of Juvéderm® VOLUX™ per treatment area in a single session.2

70 71
C5 - Lateral lower chin1,36 C6 - Lateral chin1,36

Active Active
Target Injection Target Injection
Code36 Product2 Delivery36 number per Notes36 Code36 Product2 Delivery36 number per Notes36
layer36 device36 layer36 device36
side (mL)36 side (mL)36

Be wary of the Be wary of the

C5 VX 0.3 submental C6 VX 0.5 mental artery
artery* and foramen

VX VX

C5 C6

0.3 mL C6
0.5 mL
C5

*Aspiration is highly recommended when injecting with a needle at the level of the bone. Do not inject into the bone, but rather at the level of
the bone.36
Do not inject more than 2 mL of Juvéderm® VOLUX™ per treatment area in a single session.2 Do not inject more than 2 mL of Juvéderm® VOLUX™ per treatment area in a single session.2

72 73
The injection
technique of
the MD Codes™

CONTOUR
THE LOWER FACE:
The 5-point jawline36

75
 Bridging the MD Codes™
with anatomy1,36

Jw1

Jw2
Jw4

Supraperiosteal

Jw2

Jw1

Jw1

Jw3 Jw3
Jw4 Jw5

Jw4
Jw5
Subcutaneous

76 77
The 5-point jawline: Jw1 - Mandible angle
Anatomical locations and treatment options1,36
aim of effects36,50

Anatomical location36 Placement36 Aims50 Active

Target Injection
Code36 Product2 Delivery36 number per Notes36
layer36 device36
side (mL)36
• Defines the mandible angle
• Supraperiosteal
Jw1 Mandible angle
• Subcutaneous
• Improves mandible projection
• Widens the face for masculine-looking results
0.5

• Lifts the lateral cheek Be wary of the

Pre-auricular Jw1 VX
parotid gland*
Jw2 area
Subcutaneous • Reduces jawline sagginess
• Reduces pre-auricular lines
0.5

Jw3 Mandible body Subcutaneous • Improves definition of the jawline

• Corrects prejowl sulcus

• Subcutaneous
Jw4 Lower prejowl
• Supraperiosteal
• Lifts the jawline
• Improves submental skin excess

• Reshapes and projects the chin

Lower anterior
Jw5 chin
Subcutaneous • Lifts the jawline
• Improves submental skin excess

*Aspiration is highly recommended when injecting with a needle at the level of the bone. Do not inject into the bone, but rather at the level of
the bone.36
Do not inject more than 2 mL Juvéderm® VOLUX™ per treatment area in a single session.2

78 79
Jw1 - Mandible angle Jw2 - Pre-auricular area1,36
treatment options1,36
(continued)

Active
Target Injection
Code36 Product2 Delivery36 number per Notes36
layer36 device36
side (mL)36
VX
Be wary of the
superficial
Jw2 VX 0.5 temporal artery
and the parotid
Jw1 gland

Jw1
0.5 mL

VX

Jw2
VX Jw2

0.5 mL
Jw1

Jw1

0.5 mL

Do not inject more than 2 mL of Juvéderm® VOLUX™ per treatment area in a single session.2

80 81
Jw3 - Mandible body1,36 Jw4 - Lower prejowl
treatment options1,36

Active Active
Target Injection Target Injection
Code36 Product2 Delivery36 number per Notes36 Code36 Product2 Delivery36 number per Notes36
layer36 device36 layer36 device36
side (mL)36 side (mL)36

0.5
Be wary of the
Jw3 VX 1.0
facial artery Be wary of the
Jw4 VX submental
artery*

0.3

VX

Jw3

Jw3 1.0 mL

*Aspiration is highly recommended when injecting with a needle at the level of the bone. Do not inject into the bone, but rather at the level of
the bone.36
Do not inject more than 2 mL of Juvéderm® VOLUX™ per treatment area in a single session.2 Do not inject more than 2 mL of Juvéderm® VOLUX™ per treatment area in a single session.2

82 83
Jw4 - Lower prejowl Jw5 - Lower anterior chin1,36
treatment options1,36
(continued)

Active
Target Injection
Code36 Product2 Delivery36 number per Notes36
layer36 device36
side (mL)36
VX
Be wary of the
Jw5 VX 0.5 submental
artery
Jw4

0.5 mL
Jw4

VX

Jw5
VX

0.5 mL
Jw4 Jw5

0.3 mL
Jw4

Do not inject more than 2 mL of Juvéderm® VOLUX™ per treatment area in a single session.2

84 85
The injection
technique of
the MD Codes™

REFINEMENT OF THE
PERIORBITAL AREA:
The 3-point lateral
orbital36

This treatment is reserved for specialist injectors extensively trained in this

technique, with a sound knowledge of this area’s anatomy and physiology.8,36

87
 Bridging the MD Codes™
with anatomy1,36

O3

O1 O3

O1
O2 O2

Supraperiosteal

88 89
The 3-point lateral orbital: O1 - Central lateral orbital1,36
Anatomical locations
and aim of effects36,50

Anatomical location36 Placement36 Aims50 Active

Target Injection
Code36 Product8 Delivery36 number per Notes36
layer36 device36
side (mL)36
Central lateral
O1 orbital
Avoid injecting into
• Improves the appearance of static lines and the lower eyelid
Lower lateral volume loss in the lateral periorbital area O1 VB 0.2
O2 orbital
Supraperiosteal
• Helps to reposition lateral canthus Be wary of the
lacrimal artery*

Upper lateral
O3 orbital

VB

O1

O1

0.2 mL

*Do not inject into the bone, but rather at the level of the bone.36
The indications for the use of Juvéderm® VOLBELLA® with lidocaine may vary by country. Please consult your local Directions for Use before using
this product.8

90 91
O2 - Lower lateral orbital1,36 O3 - Upper lateral orbital1,36

Active Active
Target Injection Target Injection
Code36 Product8 Delivery36 number per Notes36 Code36 Product8 Delivery36 number per Notes36
layer36 device36 layer36 device36
side (mL)36 side (mL)36

Avoid injecting into Avoid injecting into

the lower eyelid the upper eyelid
O2 VB 0.2 O3 VB 0.1
Be wary of the Be wary of the
lacrimal artery* lacrimal artery*

VB VB
O3

O2 O3
O2

0.2 mL 0.1 mL

*Do not inject into the bone, but rather at the level of the bone.36 *Do not inject into the bone, but rather at the level of the bone.36
The indications for the use of Juvéderm® VOLBELLA® with lidocaine may vary by country. Please consult your local Directions for Use before using The indications for the use of Juvéderm® VOLBELLA® with lidocaine may vary by country. Please consult your local Directions for Use before using
this product.8 this product.8

92 93
The injection
technique of
the MD Codes™

REFINEMENT OF THE
PERIORBITAL AREA:
The 3-point
tear trough36

This treatment is reserved for specialist injectors extensively trained in this

technique, with a sound knowledge of this area’s anatomy and physiology.8,36

95
 Bridging the MD Codes™
with anatomy1,36

Tt2
Tt3
Tt1
Tt2
Tt3
Tt1

Supraperiosteal

96 97
The 3-point tear trough: Tt1 - Central infraorbital1,36
Anatomical locations and
aim of effects36,50

Anatomical location36 Placement36 Aims50 Active

Target Injection
Code36 Product8 Delivery36 number per Notes36
layer36 device36
side (mL)36
Central
Tt1 infraorbital

Be wary of the
Lateral Tt1 VB 0.2 infraorbital artery
Tt2 infraorbital
Supraperiosteal • Improves infraorbital area via the direct approach
branches*

Medial
Tt3 infraorbital

VB

Tt1 Tt1

0.2 mL

*Do not inject into the bone, but rather at the level of the bone.36
The indications for the use of Juvéderm® VOLBELLA® with lidocaine may vary by country. Please consult your local Directions for Use before using
this product.8 Tear trough is reserved for specialists specifically trained in this technique and those who have a sound knowledge of the anatomy
and physiology for this particular area.8,36

98 99
Tt2 - Lateral infraorbital1,36 Tt3 - Medial infraorbital1,36

Active Active
Target Injection Target Injection
Code36 Product8 Delivery36 number per Notes36 Code36 Product8 Delivery36 number per Notes36
layer36 device36 layer36 device36
side (mL)36 side (mL)36

Be wary of the
Be wary of the
Tt2 VB 0.2
lacrimal artery*
Tt3 VB 0.1 angular artery
and vein*

VB VB

Tt2 Tt3
Tt2
Tt3

0.2 mL 0.1 mL

*Do not inject into the bone, but rather at the level of the bone.36 *Do not inject into the bone, but rather at the level of the bone.36
The indications for the use of Juvéderm® VOLBELLA® with lidocaine may vary by country. Please consult your local Directions for Use before using The indications for the use of Juvéderm® VOLBELLA® with lidocaine may vary by country. Please consult your local Directions for Use before using
this product.8 Tear trough is reserved for specialists specifically trained in this technique and those who have a sound knowledge of the anatomy this product.8 Tear trough is reserved for specialists specifically trained in this technique and those who have a sound knowledge of the anatomy
and physiology for this particular area.8,36 and physiology for this particular area.8,36

100 101
The injection
technique of
the MD Codes™

REFINEMENT OF
THE PERIORAL AREA:
The 3-point
nasolabial fold36

Treatment of the nasolabial folds should start with assessment and treatment
of the cheek (Ck codes), which may indirectly improve their appearance.
Should this be insufficient, proceed to direct treatment using the NL codes.50

103
 Bridging the MD Codes™
with anatomy1,36

NL1 NL1
NL2
NL3

Supraperiosteal Subcutaneous

NL1

NL2

NL3

NL1
NL2
NL3

Deep dermis/subdermal

104 105
The 3-point nasolabial fold:
Anatomical locations and
aim of effects36,50

Anatomical location36 Placement36 Aims50 Bone deficiency36

Bone deficiency36

Upper
NL1 nasolabial fold
Supraperiosteal*

Mild/moderate36†

Upper
NL1 nasolabial fold
• Subcutaneous
• Deep dermis/subdermal
Central
NL2 nasolabial fold • Reduces prominence of the nasolabial
folds via the direct approach
Severe36†

Upper
NL1 nasolabial fold

Central • Subcutaneous
NL2 nasolabial fold • Deep dermis/subdermal

Lower
NL3 nasolabial fold

*This treatment approach is designed to correct bone structural deficiencies. Do not inject into the bone, but rather at the level of the bone.36
†
Based on the Modified Fitzpatrick Wrinkle Scale.52

106 107
NL1 - Upper nasolabial fold1,36

Code36 Product3
Target
layer36
Injection
device36
Delivery36
Active
number per
side (mL)36
Notes36 Mild/moderate36*
Inject slightly
medial to the
nasolabial
crease
NL1 VM 0.3
Be wary of the
facial artery and
the branches to
the nasal flare*

VM

NL1
NL1

0.3 mL

*Aspiration is highly recommended when injecting with a needle at the level of the bone. Do not inject into the bone, but rather at the level of
the bone.36
Do not inject more than 2 mL Juvéderm® VOLUMA® with lidocaine per treatment area in a single session.3
This treatment approach is designed to correct bone structural deficiencies.36 *Based on the Modified Fitzpatrick Wrinkle Scale.52

108 109
NL1 - Upper nasolabial fold1,36 NL1 - Upper nasolabial fold1,36
(continued)

Active
Target Injection
Code36 Product7 Delivery36 number per Notes36
layer36 device36
side (mL)36
VL
Inject slightly
0.3 medial to the
nasolabial
crease
NL1 VL NL1
Be wary of the
NL1
facial artery and
0.3 the branches to
the nasal flare
0.3 mL

VL

NL1
NL1

0.3 mL

Juvéderm® VOLIFT® is intended for intradermal use and there is currently no clinical data in terms of performance and safety available on the
injection of Juvéderm® VOLIFT® with lidocaine at the subcutaneous or supraperiosteal depth. Please consult the Directions for Use before using
this product.7

110 111
NL2 - Central nasolabial fold1,36 NL2 - Central nasolabial fold1,36
(continued)

Active
Target Injection
Code36 Product7 Delivery36 number per Notes36
layer36 device36
side (mL)36
VL
0.2 Inject slightly
medial to the
nasolabial
NL2 VL crease NL2
Be wary of the NL2
0.2 facial artery

0.2 mL

VL

NL2
NL2

0.2 mL

Juvéderm® VOLIFT® is intended for intradermal use and there is currently no clinical data in terms of performance and safety available on the
injection of Juvéderm® VOLIFT® with lidocaine at the subcutaneous or supraperiosteal depth. Please consult the Directions for Use before using
this product.7

112 113
 Severe36*

*Based on the Modified Fitzpatrick Wrinkle Scale.52

114 115
NL1 - Upper nasolabial fold1,36 NL1 - Upper nasolabial fold1,36
(continued)

Active
Target Injection
Code36 Product7 Delivery36 number per Notes36
layer36 device36
side (mL)36
VL
Inject slightly
0.5 medial to the
nasolabial
crease
NL1 VL NL1
Be wary of the
NL1
facial artery and
0.5 the branches to
the nasal flare
0.5 mL

VL

NL1
NL1

0.5 mL

Juvéderm® VOLIFT® is intended for intradermal use and there is currently no clinical data in terms of performance and safety available on the
injection of Juvéderm® VOLIFT® with lidocaine at the subcutaneous or supraperiosteal depth. Please consult the Directions for Use before using
this product.7

116 117
NL2 - Central nasolabial fold1,36 NL2 - Central nasolabial fold1,36
(continued)

Active
Target Injection
Code36 Product7 Delivery36 number per Notes36
layer36 device36
side (mL)36
VL
0.3 Inject slightly
medial to the
nasolabial
NL2 VL crease NL2
Be wary of the NL2
0.3 facial artery

0.3 mL

VL

NL2
NL2

0.3 mL

Juvéderm® VOLIFT® is intended for intradermal use and there is currently no clinical data in terms of performance and safety available on the
injection of Juvéderm® VOLIFT® with lidocaine at the subcutaneous or supraperiosteal depth. Please consult the Directions for Use before using
this product.7

118 119
NL3 - Lower nasolabial fold1,36 NL3 - Lower nasolabial fold1,36
(continued)

Active
Target Injection
Code36 Product7 Delivery36 number per Notes36
layer36 device36
side (mL)36
VL
0.2 Inject slightly
medial to the
nasolabial
NL3 VL crease NL3
Be wary of the
0.2 facial artery NL3

0.2 mL

VL

NL3

NL3

0.2 mL

Juvéderm® VOLIFT® is intended for intradermal use and there is currently no clinical data in terms of performance and safety available on the
injection of Juvéderm® VOLIFT® with lidocaine at the subcutaneous or supraperiosteal depth. Please consult the Directions for Use before using
this product.7

120 121
The injection
technique of
the MD Codes™

REFINEMENT OF
THE PERIORAL AREA:
The 3-point
marionette lines36

123
 Bridging the MD Codes™
with anatomy1,36

M1
M2
M3

Deep dermis/subdermal

M1

M2

M3

124 125
The 3-point marionette lines: M1 - Upper marionette line1,36
Anatomical locations and
aims of effects36,50

Anatomical location36 Placement36 Aims50 Active

Target Injection
Code36 Product7 Delivery36 number per Notes36
layer36 device36
side (mL)36
Upper
M1 marionette line

Inject medially to
Central Deep dermis/ M1 VL 0.2 the labial-mental
M2 marionette line subdermal
• Improves the appearance of marionette lines crease

Lower
M3 marionette line

VL

M1

M1
0.2 mL

126 127
M2 - Central marionette line1,36 M3 - Lower marionette line1,36

Active Active
Target Injection Target Injection
Code36 Product7 Delivery36 number per Notes36 Code36 Product7 Delivery36 number per Notes36
layer36 device36 layer36 device36
side (mL)36 side (mL)36

Inject medially to Inject medially to

M2 VL 0.2 the labial-mental M3 VL 0.1 the labial-mental
crease crease

VL VL

M2 M3

M2 0.2 mL 0.1 mL
M3

128 129
The injection
technique of
the MD Codes™

REFINEMENT OF
THE PERIORAL AREA:
The 8-point lip36

131
 The 8-point lip:
Anatomical locations
and aims of effects36,50

Anatomical location36 Placement36 Aims50

Vermillion
body Submucosa/ • Promotes lip augmentation
Lp1 + Lp1 (upper lip + mucosa • Promotes lip projection and eversion
lower lip)

Cupid’s
Lp2 bow
Mucosa • Gives structure to Cupid’s bow area

Lip border • Gives structure to the white line/border

Lp3 + Lp3 (upper lip + Mucosa
lower lip) • Indirectly decreases perioral lines

Medial • Provides projection or fullness of the medial

Lp4 tubercle
Mucosa
tubercle of the upper lip

Lp7
Lateral • Provides projection or fullness of the lateral
Lp2 Lp8 Lp5 tubercles
Mucosa
tubercles of the lower lip
Lp3
Lp1 Lp4 Lp1
Lp6 Oral • Lifts and corrects the downturn of the corner
Lp6 commissure
Mucosa
of the mouth
Lp1 Lp1
Lp5 Lp5
Lp3 Philtrum Deep dermis/
Lp7 • Gives structure and defines philtrum columns
Lp8 column subdermal

Perioral lines
• Subcutaneous • Corrects the perioral lines
(upper perioral
Lp8 + Lp8 lines + lower
• Deep dermis/
subdermal • Reshapes the cutaneous part of the lip
perioral lines)

132 133
Lp1 - Vermillion body Lp1 - Vermillion body
(upper lip)1,36 (lower lip)1,36

Active Active
Target Injection Target Injection
Code36 Product7 Delivery36 number per Notes36 Code36 Product7 Delivery36 number per Notes36
layer36 device36 layer36 device36
side (mL)36 side (mL)36

Be wary of the Be wary of the

Lp1 VL 0.2 superior labial Lp1 VL 0.2 inferior labial
artery artery

VL VL

Lp1
Lp1 Lp1
Lp1

0.2 mL 0.2 mL

134 135
Lp2 - Cupid’s bow1,36 Lp2 - Cupid’s bow1,36
(continued)

Active
Target Injection
Code36 Product Delivery36 number per Notes
layer36 device36
side (mL)36
VL
VL7

Lp2

Lp2 0.05 Lp2

VB8

0.05 mL

Consider the product selection below:

VL VB
For distinct definition For subtle definition

VB

Lp2
Lp2

0.05 mL

136 137
Lp3 - Lip border Lp3 - Lip border
(upper lip)1,36 (upper lip)1,36
(continued)

Active
Target Injection
Code36 Product Delivery36 number per Notes
layer36 device36
side (mL)36
VL
VL7

Lp3

Lp3 0.15 Lp3

VB8

0.15 mL

Consider the product selection below:

VL VB
For distinct definition For subtle definition

VB

Lp3
Lp3

0.15 mL

138 139
Lp3 - Lip border Lp3 - Lip border
(lower lip)1,36 (lower lip)1,36
(continued)

Active
Target Injection
Code36 Product Delivery36 number per Notes
layer36 device36
side (mL)36
VL
VL7

Lp3 0.15 Lp3

Lp3

VB8

0.15 mL

Consider the product selection below:

VL VB
For distinct definition For subtle definition

VB

Lp3
Lp3

0.15 mL

140 141
Lp4 - Medial tubercle1,36 Lp4 - Medial tubercle1,36
(continued)

Active
Target Injection
Code36 Product Delivery36 number per Notes36
layer36 device36
side (mL)36
VL
0.1
VL7
(only midline)
Be wary of
Lp4
Lp4
Lp4 the superior
labial artery
0.1
VB8
(only midline)
0.1 mL
(only midline)

Consider the product selection below:

VL VB
For distinct projection For subtle projection

VB

Lp4
Lp4

0.1 mL
(only midline)

142 143
Lp5 - Lateral tubercles1,36 Lp5 - Lateral tubercles1,36
(continued)

Active
Target Injection
Code36 Product Delivery36 number per Notes36
layer36 device36
side (mL)36
VL
VL7 0.05

Be wary of the
Lp5 inferior labial Lp5
Lp5
artery

VB8 0.05

0.05 mL

Consider the product selection below:

VL VB
For distinct projection For subtle projection

VB

Lp5
Lp5

0.05 mL

144 145
Lp6 - Oral commissure1,36 Lp6 - Oral commissure1,36
(continued)

Active
Target Injection
Code36 Product Delivery36 number per Notes
layer36 device36
side (mL)36
VL
0.1

VL7
Lp6 Lp6
Lp6 0.1

0.1 mL
VB8 0.1

Consider the product selection below:

VL VB
For distinct lifting For subtle support
VB

Lp6 Lp6
VL

0.1 mL
Lp6 Lp6

0.1 mL

146 147
Lp7 - Philtrum column1,36 Lp7 - Philtrum column1,36
(continued)

Active
Target Injection
Code36 Product Delivery36 number per Notes
layer36 device36
side (mL)36
VL
VL7 Lp7

Lp7 0.05 Lp7

VB8

0.05 mL

Consider the product selection below:

VL VB
For distinct definition For subtle definition

VB
Lp7

Lp7

0.05 mL

148 149
Lp8 - Perioral lines Lp8 - Perioral lines
(upper perioral lines)1,36 (upper perioral lines)1,36
(continued)

Active
Target Injection
Code36 Product Delivery36 number per Notes8,9,51
layer36 device36
side (mL)36
VL
VL7
Lp8

Lp8
VB 8

Lp8 0.25

VB8 0.25 mL
Intradermal
Avoid injecting
too superficially
VT9

Consider the product selection below: VB

VL VB with cannula VB with needle VT
For distinct support For subtle support For perioral lines For skin hydration
Lp8

Lp8

0.25 mL

Juvéderm® VOLIFT® is intended for intradermal use and there is currently no clinical data in terms of performance and safety available on the
injection of Juvéderm® VOLIFT® with lidocaine at the subcutaneous or supraperiosteal depth. Please consult the Directions for Use before using
this product.7 Juvederm® VOLBELLA® with lidocaine is intended for intradermal, mucous membrane of the lips and submuscular/pre-periosteal
injection in the infraorbital area. There is currently no clinical efficacy or safety data available on this product injected at the subcutaneous depth.
The indications for the use of Juvederm® VOLBELLA® with lidocaine may vary by country. Please consult your local Directions for Use before using
this product.8

150 151
Lp8 - Perioral lines Lp8 - Perioral lines
(upper perioral lines)1,36 (lower perioral lines)1,36
(continued)

Active
Target Injection
Code36 Product Delivery36 number per Notes8,9,51
layer36 device36
side (mL)36
VB
VL7

Lp8

Lp8
VB8

Lp8 0.25

0.25 mL VB8
Intradermal
Avoid injecting
too superficially
VT9

VT Consider the product selection below:

VL VB with cannula VB with needle VT

For distinct support For subtle support For perioral lines For skin hydration
Lp8

Lp8

0.25 mL

Juvéderm® VOLIFT® is intended for intradermal use and there is currently no clinical data in terms of performance and safety available on the
injection of Juvéderm® VOLIFT® with lidocaine at the subcutaneous or supraperiosteal depth. Please consult the Directions for Use before using
this product.7 Juvederm® VOLBELLA® with lidocaine is intended for intradermal, mucous membrane of the lips and submuscular/pre-periosteal
injection in the infraorbital area. There is currently no clinical efficacy or safety data available on this product injected at the subcutaneous depth.
The indications for the use of Juvederm® VOLBELLA® with lidocaine may vary by country. Please consult your local Directions for Use before using
this product.8

152 153
Lp8 - Perioral lines Lp8 - Perioral lines
(lower perioral lines)1,36 (lower perioral lines)1,36
(continued) (continued)

VL VB

Lp8 Lp8
Lp8
Lp8

0.25 mL 0.25 mL

VB VT

Lp8 Lp8
Lp8
Lp8

0.25 mL 0.25 mL

154 155
The injection
technique of
the MD Codes™

COMPLEX AREAS:
The 3-point
forehead36

Treatment of the forehead is very advanced and should only be delivered by

highly trained experts with extensive injection experience and knowledge on
the management of severe complications.36

157
 Bridging the MD Codes™
with anatomy36
F2 F1 F3 F3 F1 F2

F2 F1 F3

F2 F1 F3

Supraperiosteal

Deep dermis/subdermal

158 159
The 3-point forehead:
Anatomical locations and
aims of effects36,50

Anatomical location36 Placement36 Aims50 Forehead reshape36

Forehead reshape: This approach is for restoring
forehead volume loss, forehead advancement,
and forehead reshape36 This approach is for restoring forehead volume loss,
forehead advancement, and forehead reshape36
Medial
F1 forehead
• Reshapes the forehead
• Improves forehead concavity
Lateral
F2 forehead
Supraperiosteal • Indirectly improves the appearance
of forehead lines
Central • Indirectly lifts the brow
F3 forehead

Forehead lines: This approach is for treating fine lines36

Medial
F1 forehead

Lateral
F2 forehead
Deep dermis/subdermal

Central
F3 forehead

160 161
F1 - Medial forehead36 F2 - Lateral forehead36

Active Active
Target Injection Target Injection
Code36 Product7 Delivery36 number per Notes36 Code36 Product7 Delivery36 number per Notes36
layer36 device36 layer36 device36
side (mL)36 side (mL)36

Be wary of
Be wary of the
the superficial
F1 VL 0.5 supraorbital F2 VL 0.5
temporal
artery*
artery*

F1
VL VL
F2

F1 F2

0.5 mL 0.5 mL

*Do not inject into the bone, but rather at the level of the bone.36 Injection should be avoided in the 2-cm region above the orbit.36 *Do not inject into the bone, but rather at the level of the bone.36 Injection should be avoided in the 2-cm region above the orbit.36
Juvéderm® VOLIFT® with lidocaine is intended for intradermal use and there is currently no clinical data in terms of performance and safety Juvéderm® VOLIFT® with lidocaine is intended for intradermal use and there is currently no clinical data in terms of performance and safety
available on the injection of Juvéderm® VOLIFT® with lidocaine at the subcutaneous or supraperiosteal depth. Please consult the Directions for available on the injection of Juvéderm® VOLIFT® with lidocaine at the subcutaneous or supraperiosteal depth. Please consult the Directions for
Use before using this product.7 Use before using this product.7

162 163
F3 - Central forehead36

Code36 Product7
Target
layer36
Injection
device36
Delivery36
Active
number per
side (mL)36
Notes36 Forehead lines36
This approach is for treating fine lines36
Be wary of the
F3 VL 0.5 supratrochlear
artery*

F3
VL

F3

0.5 mL

*Do not inject into the bone, but rather at the level of the bone. Injection should be avoided in the 2-cm region above the orbit.36
Juvéderm® VOLIFT® with lidocaine is intended for intradermal use and there is currently no clinical data in terms of performance and safety
available on the injection of Juvéderm® VOLIFT® with lidocaine at the subcutaneous or supraperiosteal depth. Please consult the Directions for
Use before using this product.7

164 165
F1 - Medial forehead36 F1 - Medial forehead36
(continued)

Active
Target Injection
Code36 Product Delivery36 number per Notes36
layer36 device36
side (mL)36
F1 VB
VB8

Be wary of the
F1 0.5 supraorbital F1
artery

VT9

0.5 mL

Consider the product selection below:

VB VT
For forehead lines For skin hydration

F1 VT

F1

0.5 mL

166 167
F2 - Lateral forehead36 F2 - Lateral forehead36
(continued)

Active
Target Injection
Code36 Product Delivery36 number per Notes36
layer36 device36
side (mL)36
F2 VB
VB8

Be wary of the
F2 0.5 superficial F2
temporal artery

VT9

0.5 mL

Consider the product selection below:

VB VT
For forehead lines For skin hydration

F2 VT

F2

0.5 mL

168 169
F3 - Central forehead36 F3 - Central forehead36
(continued)

Active
Target Injection
Code36 Product Delivery36 number per Notes36
layer36 device36
side (mL)36
F3 VB
VB8

Be wary of the
F3 0.5 supratrochlear F3
artery

VT9

0.5 mL

Consider the product selection below:

VB VT
For forehead lines For skin hydration

F3 VT

F3

0.5 mL

170 171
The injection
technique of
the MD Codes™

COMPLEX AREAS:
The 3-point
eyebrow36

Treatment of the eyebrow is very advanced and should only be delivered by

highly trained experts with extensive injection experience and knowledge on
the management of severe complications.36

173
 Bridging the MD Codes™
with anatomy1,36

E2
E1 E3
E2
E1 E3

ROOF

ROOF: retro-orbicularis oculi fat.

174 175
The 3-point eyebrow: E1 - Eyebrow tail1,36
Anatomical locations and
aims of effects36,50

Anatomical location36 Placement36 Aims50 Active

Target Injection
Code36 Product Delivery36 number per Notes36
layer36 device36
side (mL)36
E1 Eyebrow tail

VL7
• Lifts and projects the eyebrow
E2 Eyebrow centre ROOF • Indirectly improves the hollow eye appearance Be wary of the
of the upper eyelid E1 0.2
lacrimal gland

VB8
E3 Eyebrow head

Consider the product selection below:

VL VB
For distinct support and projection For subtle support

Juvéderm® VOLIFT® with lidocaine is intended for intradermal use and there is currently no clinical efficacy or safety data available on this product
injected at the subcutaneous or supraperiosteal depth. Please consult the Directions for Use before using this product.7 Juvéderm® VOLBELLA®
with lidocaine is intended for intradermal, mucous membrane of the lips and submuscular/pre-periosteal injection in the infraorbital area and
there is currently no clinical efficacy or safety data available on these products injected at the subcutaneous depth. The indications for the use of
Juvéderm® VOLBELLA® with lidocaine may vary by country. Please consult your local Directions for Use before using this product.8
ROOF: retro-orbicularis oculi fat.

176 177
E1 - Eyebrow tail1,36 E2 - Eyebrow centre1,36
(continued)

Active
Target Injection
Code36 Product Delivery36 number per Notes36
layer36 device36
side (mL)36
VL
E1
VL7
Inject lateral to
the supraorbital
E1 E2 0.2
foramen

Be wary of the
supraorbital artery
VB8

0.2 mL

Consider the product selection below:

VL VB
For distinct support and projection For subtle support

VB
E1

E1

0.2 mL

Juvéderm® VOLIFT® with lidocaine is intended for intradermal use and there is currently no clinical efficacy or safety data available on this product
injected at the subcutaneous or supraperiosteal depth. Please consult the Directions for Use before using this product.7 Juvéderm® VOLBELLA®
with lidocaine is intended for intradermal, mucous membrane of the lips and submuscular/pre-periosteal injection in the infraorbital area and
there is currently no clinical efficacy or safety data available on these products injected at the subcutaneous depth. The indications for the use of
Juvéderm® VOLBELLA® with lidocaine may vary by country. Please consult your local Directions for Use before using this product.8

178 179
E2 - Eyebrow centre1,36 E3 - Eyebrow head1,36
(continued)

Active
Target Injection
Code36 Product Delivery36 number per Notes36
layer36 device36
side (mL)36
VL
E2
VL7 Inject lateral to
the supratrochlear
foramen
E2 E3 0.1
Be wary of the
supratrochlear
VB8 artery

0.2 mL

Consider the product selection below:

VL VB
For distinct support and projection For subtle support

VB
E2

E2

0.2 mL

Juvéderm® VOLIFT® with lidocaine is intended for intradermal use and there is currently no clinical efficacy or safety data available on this product
injected at the subcutaneous or supraperiosteal depth. Please consult the Directions for Use before using this product.7 Juvéderm® VOLBELLA®
with lidocaine is intended for intradermal, mucous membrane of the lips and submuscular/pre-periosteal injection in the infraorbital area and
there is currently no clinical efficacy or safety data available on these products injected at the subcutaneous depth. The indications for the use of
Juvéderm® VOLBELLA® with lidocaine may vary by country. Please consult your local Directions for Use before using this product.8

180 181
E3 - Eyebrow head1,36
(continued)

VL
E3

E3

0.1 mL

VB
E3

E3

0.1 mL

182 183
The injection
technique of
the MD Codes™

COMPLEX AREAS:
The 2-point glabella36

Treatment of the glabella is very advanced and should only be delivered by

highly trained experts with extensive injection experience and knowledge on
the management of severe complications.36

185
 Bridging the MD Codes™
with anatomy1,36

G1 G1
G2

G1
G2

Supraperiosteal

186 187
The 2-point glabella: G1 - Lateral glabella1,36
Anatomical locations and
aims of effects36,50

Anatomical location36 Placement36 Aims50 Active

Target Injection
Code36 Product8 Delivery36 number per Notes36
layer36 device36
side (mL)36
• Improves the appearance of static
G1 Lateral glabella
glabellar lines

Supraperiosteal Be wary of the

• Improves the appearance of cutaneous G1 VB 0.1 supratrochlear
G2 Central glabella
depressions
artery and vein*

VB
G1

G1

0.1 mL

*Do not inject into the bone, but rather at the level of the bone.36
The indications for the use of Juvéderm® VOLBELLA® with lidocaine may vary by country. Please consult your local Directions for Use before using
this product.8

188 189
G2 - Central glabella1,36

Active
Target Injection
Code36 Product8 Delivery36 number per Notes36
layer36 device36
side (mL)36

Be wary of the
0.3
G2 VB
(only midline)
supratrochlear
artery and vein*

VB
G2

G2

0.3 mL
(only midline)

*Do not inject into the bone, but rather at the level of the bone.36
The indications for the use of Juvéderm® VOLBELLA® with lidocaine may vary by country. Please consult your local Directions for Use before using
this product.8

190 191
The MD Codes™
strategies

The 8-point Lift™

193
 The 8-point Lift™:
Anatomical locations and
aims of effects36,50
Anatomical location36 Placement36 Aims50
• A lifting code: Lifts and defines the cheek
• Gives support to the eyebrow and lower eyelid,
and opens the eye
L1
• Improves sagginess of the cheek and jawline
(Ck1 Zygomatic
Supraperiosteal • Indirectly improves hollowness in the infraorbital area
anchor) arch
and tear trough
• Indirectly improves prominent nasolabial folds, oral
commissures and marionette lines; may aid in creating
a slimming and more contoured effect

L1 Zygomatic • A lifting code: Aims to create structure and definition

(Ck1 arch
Sub-SMAS level
along the zygomatic arch
curve)
• A lifting code: Lifts and provides projection to the cheek
• Shortens the palpebral-malar sulcus and gives support
L2 Zygomatic
Supraperiosteal to the lateral canthal area
L1 (Ck2) eminence
• Improves eye shape
• Indirectly improves the nasolabial folds
L2 • A volumetric code: Creates volume, projection and
• Supraperiosteal
improves the medial lid–cheek junction by advancing
L3 Anteromedial • Deep malar fat
the mid-cheek
L3 (Ck3) cheek pad
• Lifts the cheek
• SOOF
• Indirectly softens the tear trough and nasolabial fold

L8 Upper, central • Subcutaneous

L4 and lower • Deep dermis/
• Reduces the prominence of the nasolabial fold via the
(NL1-3) nasolabial fold Subdermal
direct approach

L4 Upper, central
L5 and lower
Deep dermis/
• Improves the appearance of marionette lines
(M1-3) marionette line
Subdermal

L7 • Corrects prejowl sulcus

L6 Lower prejowl
• Subcutaneous
• Lifts the jawline
(Jw4) • Supraperiosteal
• Improves submental skin excess

• Defines the mandible angle

L7 Mandible • Supraperiosteal
• Improves mandible projection
(Jw1) angle • Subcutaneous
• Widens the face for masculine-looking results
L5
Lateral lower • Lifts the lower cheek and jawline
cheek/parotid- • Addresses the sunken area at the parotid level
L8 masseteric • May aid in creating a slimming and more contoured effect
(Ck4, area Subcutaneous
• Improves volume loss in the submalar/buccal area
Ck5) • Corrects collapse of the buccal area and improves
L6 Submalar/
buccal area cheek lines

SMAS: superficial muscular aponeurotic system; SOOF: suborbicularis oculi fat.

194 195
The 8-point Lift™: The 8-point Lift™:
Product and volume Product and volume
recommendations36 recommendations36 (continued)

Active Active
Target Injection Target Injection
Code36 Product3 Delivery36 number per Notes36 Code36 Product Delivery36 number per Notes36
layer36 device6,36 layer36 device6,36
side (mL)36 side (mL)36

L1 Be wary of the
Aspiration is highly 0.3
(Ck1 VM 0.1 + 0.1 + 0.1*
recommended†
infraorbital artery*
anchor)
VM3
Target the deep
L3 malar fat pad
L1 0.5
Target the (Ck3) Be wary of the
(Ck1 VM 0.5
sub-SMAS area infraorbital artery
curve)
Target the SOOF
VL 7
0.5 Be wary of the
Be wary the infraorbital artery
L2
VM 0.2 zygomaticofacial
(Ck2) artery†

Be wary of the
L4 facial artery and
VL 7
0.5/1.0 †
(NL1-3) the branches to
the nasal flare

Consider the product selection below for Ck3:

VM with needle VM with cannula VL
Bone retrusion/deficiency Malar fat pad deficiency SOOF deficiency
and projection and volume loss

*Aspiration is highly recommended when injecting with a needle at the level of the bone. Do not inject into the bone, but rather at the level of the bone.36
†
For mild/moderate nasolabial fold, the total active number for NL1 and NL2 is 0.5 mL per side, while for severe nasolabial fold, the total active
number for NL1, NL2 and NL3 is 1.0 mL per side.
*Consider Ck1 as the starting point for treatment with the MD Codes™. Injections in Ck1 are done supraperiosteally and serve as anchors to
promote SMAS lifting.36 *Aspiration is highly recommended when injecting with a needle at the level of the bone. Do not inject into the bone, but rather Do not inject more than 2 mL of Juvéderm® VOLUMA® with lidocaine per treatment area in a single session.3
at the level of the bone.36
Juvéderm® VOLIFT® with lidocaine is intended for intradermal use and there is currently no clinical data in terms of performance and safety available
Do not inject more than 2 mL of Juvéderm® VOLUMA® with lidocaine per treatment area in a single session.3 on the injection of Juvéderm® VOLIFT® at the subcutaneous or supraperiosteal depth. Please consult the Directions for Use before using this product.7
SMAS: superficial muscular aponeurotic system. SOOF: suborbicularis oculi fat.

196 197
The 8-point Lift™: The 8-point Lift™:
Product and volume Product and volume
recommendations36 (continued) recommendations36 (continued)

Active Active
Target Injection Target Injection
Code36 Product Delivery36 number per Notes36 Code36 Product Delivery36 number per Notes36
layer36 device36 layer36 device6,36
side (mL)36 side (mL)36

0.5

L5 L7 Be wary of
VL7 0.5 VX2
(M1–3) (Jw1) the parotid gland*

0.5

VM3
0.5
L8 Be wary of
(Ck4 the parotid gland,
1.0
L6 Be wary of the and buccal nerve, facial
VX2
(Jw4) submental artery* Ck5) vein and artery
VL7
0.3

Consider the product selection below for Ck5:

VM VL
Deep fat pad support and Subcutaneous support with
severe volume loss mild/moderate volume loss

*Aspiration is highly recommended when injecting with a needle at the level of the bone. Do not inject into the bone, but rather at the level of the bone.36
Do not inject more than 2 mL of Juvéderm® VOLUMA® with lidocaine or Juvéderm® VOLUX™ per treatment area in a single session.2,3

*Aspiration is highly recommended when injecting with a needle at the level of the bone. Do not inject into the bone, but rather at the level of the bone.36 Juvéderm® VOLIFT® with lidocaine is intended for intradermal use and there is currently no clinical data in terms of performance and safety
available on the injection of Juvéderm® VOLIFT® with lidocaine at the subcutaneous or supraperiosteal depth. Please consult the Directions for
Do not inject more than 2 mL of Juvéderm® VOLUX™ per treatment area in a single session.2 Use before using this product.7

198 199
The MD Codes™
strategies

The 7-point ∑hape™

201
 Anatomical
locations and
aims of effects36,50

Anatomical location36 Placement36 Aims50

• A lifting code: Lifts and defines the cheek

• Gives support to the eyebrow and lower eyelid,
and opens the eye
• Improves sagginess of the cheek and jawline
Ck1 Zygomatic arch Supraperiosteal • Indirectly improves hollowness in the infraorbital
anchor area and tear trough
• Indirectly improves prominent nasolabial folds, oral
commissures and marionette lines; may aid in creating
a slimming and more contoured effect

Ck1 Zygomatic arch Sub-SMAS level

• A lifting code: Aims to create structure and definition
curve along the zygomatic arch
Ck1
Lateral lower
• A lifting code: Lifts the lower cheek and jawline
cheek/parotid-
Ck4 masseteric
Subcutaneous • Addresses the sunken area at the parotid level
• May aid in creating a slimming and more contoured effect
area

• Opens the labial-mental angle

Ck4 • Reduces the mental crease
Labiomental
C1 angle
Subcutaneous • Elongates the chin
• Reduces the protrusion of the lower lip
• Gives support to the oral commissure

• Improves vertical dimension

• Subcutaneous
C2 Chin apex
• Supraperiosteal
• Improves chin height
Jw1 • Makes the chin triangular

• Defines the mandible angle

• Supraperiosteal
Jw1 Mandible angle
• Subcutaneous
• Improves mandible projection
• Widens the face for masculine-looking results

• Corrects prejowl sulcus

• Subcutaneous
Jw4 Lower prejowl
• Supraperiosteal
• Lifts the jawline
• Improves submental skin excess
C1
• Reshapes and projects the chin
Lower anterior
Jw4 Jw5 chin
Subcutaneous • Lifts the jawline
• Improves submental skin excess
Jw5 C2

SMAS: superficial muscular aponeurotic system.

202 203
The 7-point ∑hape™: The 7-point ∑hape™:
Product and volume Product and volume
recommendations36 recommendations36 (continued)

Active Active
Target Injection Target Injection
Code36 Product3 Delivery36 number per Notes36 Code36 Product2 Delivery36 number per Notes36
layer36 device6,36 layer36 device36
side (mL)36 side (mL)36
Aspiration is highly
recommended Be wary of the
Ck1 when injecting C1 VX 0.5*
sublabial artery
VM 0.1 + 0.1 + 0.1*
anchor with a needle at
the level of the
bone†

C2 VX 0.3*
Ck1 Target the
VM 0.5‡
curve sub-SMAS area

0.5

Be wary of
Be wary of the Jw1 VX
the parotid gland†
Ck4 VM 0.5‡
parotid gland
0.5

Jw4 VX 0.5

Be wary of the
submental artery

Jw5 VX 0.5

For the aim of making the chin more triangular, consider C2 midline:
C236‡/VX2/supraperiosteal36†/needle36†/bolus36/0.3 mL (only midline)36
Additional consideration for Jw4:
Jw436‡/VX2/supraperiosteal36†/needle36†/bolus36/0.3 mL36

*Consider Ck1 as the starting point for treatment with the MD Codes™. Injections in Ck1 are done supraperiosteally and serve as anchors to These recommendations are provided by Dr Maurício de Maio (CRM/SP 69331 RQE 14478) and are based on his extensive clinical and personal
promote SMAS lifting.36 †Do not inject into the bone, but rather at the level of the bone.36 ‡When Ck1 anchor and Ck4 or Ck1 curve are combined experience. *Although the active number for C1 is 0.5 mL, when treatment of C1 is combined with C2, the active number for C1 becomes 0.7 mL,
in the same session, either the active number of Ck4 or Ck1 curve becomes 0.7 mL.36 so that the total volume for C1 + C2 = 1.0 mL (1 syringe).36 †Aspiration is highly recommended when injecting with a needle at the level of the bone.
Do not inject into the bone, but rather at the level of the bone.36 ‡C2 and Jw4: Be wary of the submental artery.36
Do not inject more than 2 mL of Juvederm® VOLUMA® with lidocaine per treatment area in a single session.3
Do not inject more than 2 mL of Juvéderm VOLUX™ per treatment area in a single session.2
SMAS: superficial muscular aponeurotic system.

204 205
The MD Codes™
strategies

The 9-point ∑hape™

207
 Anatomical
locations and
aims of effects36,50
Anatomical location36 Placement36 Aims50

• A lifting code: Lifts and defines the cheek

• Gives support to the eyebrow and lower eyelid,
and opens the eye
• Improves sagginess of the cheek and jawline
Ck1 Zygomatic arch Supraperiosteal • Indirectly improves hollowness in the infraorbital
anchor area and tear trough
• Indirectly improves prominent nasolabial folds,
oral commissures and marionette lines; may aid in
Ck1 creating a slimming and more contoured effect
Jw2 Ck1 • A lifting code: Aims to create structure and definition along
Zygomatic arch Sub-SMAS level
define the zygomatic arch

Lateral lower • A lifting code: Lifts the lower cheek and jawline
Ck4 Ck4 cheek/parotid- Subcutaneous • Addresses the sunken area at the parotid level
masseteric area • May aid in creating a slimming and more contoured effect

• Opens the labial-mental angle

• Reduces the mental crease
Labiomental
C1 angle
Subcutaneous • Elongates the chin
• Reduces the protrusion of the lower lip
• Gives support to the oral commissure
Jw1
• Improves vertical dimension
C2 Chin apex Subcutaneous
• Improves chin height

• Gives lateral support

Lateral lower • Widens the chin
C5 chin
Supraperiosteal
• Makes the chin square
• Ideal for masculine look

• Defines the mandible angle

• Supraperiosteal
C1 Jw1 Mandible angle
• Subcutaneous
• Improves mandible projection
• Widens the face for masculine-looking results
Jw4 • Lifts the lateral cheek
Pre-auricular
Jw2 area
Subcutaneous • Reduces jawline sagginess
• Reduces pre-auricular lines
Jw5 C2 C5
• Corrects prejowl sulcus
• Subcutaneous
Jw4 Lower prejowl
• Supraperiosteal
• Lifts the jawline
• Improves submental skin excess

• Reshapes and projects the chin

Lower anterior
Jw5 chin
Subcutaneous • Lifts the jawline
• Improves submental skin excess

SMAS: superficial muscular aponeurotic system.

208 209
The 9-point ∑hape™: The 9-point ∑hape™:
Product and volume Product and volume
recommendations36 (continued) recommendations36 (continued)

Active Active
Target Injection Target Injection
Code36 Product Delivery36 number per Notes36 Code36 Product2 Delivery36 number per Notes36
layer36 device6,36 layer36 device36
side (mL)36 side (mL)36

Ck1 Aspiration is highly Be wary of the

VM3 0.1 + 0.1 + 0.1* C5 VX 0.3
submental artery*
anchor recommended†

0.5
Ck1 Target the
VM3 0.5‡
define sub-SMAS area
Be wary of
Jw1 VX
the parotid gland*

0.5
Be wary of the
Ck4 VM3 0.5‡
parotid gland
Be wary of the
superficial
Jw2 VX 0.5 temporal artery
and the parotid
Be wary of the gland
C1 VX2 0.5§
sublabial artery

Jw4 VX 0.5

Be wary of the
C2 VX2 0.3§ submental artery

Jw5 VX 0.5

Additional consideration for Jw4:

Jw436†/VX2/supraperiosteal36*/needle36*/bolus36/0.3 mL36
*Consider Ck1 as the starting point for treatment with the MD Codes™. Injections in Ck1 are done supraperiosteally and serve as anchors to promote
SMAS lifting.36 †Aspiration is highly recommended when injecting with a needle at the level of the bone. Do not inject into the bone, but rather at the
level of the bone.36 ‡When Ck1 anchor and Ck4 or Ck1 define are combined in the same session, either the active number of Ck4 or Ck1 define becomes
0.7 mL.36 §Although the active number for C1 is 0.5 mL, when treatment of C1 is combined with C2, the active number for C1 becomes 0.7 mL, so that
the total volume for C1 + C2 = 1.0 mL (1 syringe).36
*Aspiration is highly recommended when injecting with a needle at the level of the bone. Do not inject into the bone, but rather at the level of the bone.36
Do not inject more than 2 mL of Juvéderm® VOLUMA® with lidocaine or Juvéderm VOLUX™ per treatment area in a single session.2,3 †
Jw4: Be wary of the submental artery.36
SMAS: superficial muscular aponeurotic system. Do not inject more than 2 mL of Juvéderm® VOLUX™ per treatment area in a single session.2

210 211
The MD Codes™
strategies

The MD Codes™ Look

213
 Anatomical
locations and
aims of effects36,50
T1

Anatomical location36 Placement36 Aims50

Ck1 Zygomatic arch Sub-SMAS level

• A lifting code: Aims to create structure and definition
curve along the zygomatic arch

• Reshapes the temple

T1 Anterior temple Supraperiosteal* • Reduces the concavity at this level
• May indirectly lift the eyebrow
Ck1*
Tt2 • A volumetric code: Creates volume, projection and
• Supraperiosteal*
improves the medial lid–cheek junction by advancing
Anteromedial • Deep malar
Ck3 cheek fat pad
the mid-cheek
• Lifts the cheek
Tt1 Tt3 • SOOF
• Indirectly softens the tear trough and nasolabial fold

Central
Tt1 infraorbital

Ck3 Tt2
Lateral
Supraperiosteal* • Improves infraorbital area via the direct approach
infraorbital
Medial
Tt3 infraorbital

*Do not inject into the bone, but rather at the level of the bone.36
Ck1*: Ck1 curve. SMAS: superficial muscular aponeurotic system; SOOF: suborbicularis oculi fat.

214 215
The MD Codes™ Look: The MD Codes™ Look:
Product and volume Product and volume
recommendations36 recommendations36 (continued)

Active Active
Target Injection Target Injection
Code36 Product Delivery36 number per Notes36 Code36 Product8 Delivery36 number per Notes36
layer36 device6,36 layer36 device36
side (mL)36 side (mL)36

Be wary of
Target the
Ck1 the infraorbital
VM 3
0.5 sub-SMAS Tt1 VB 0.2
curve area
artery
branches*†

Be wary of the
superficial Be wary of
T1 VM 3
0.5
temporal Tt2 VB 0.2 the lacrimal
artery and the artery*†
deep temporal
arteries*
Target the deep Be wary of the
malar fat pad Tt3 VB 0.1 angular artery
and vein*†
VM3 0.5 Be wary of
the infraorbital
artery and
Ck3 foramen
Target the
SOOF
VL7 0.5 Be wary of
the infraorbital
artery

Consider the product selection below for Ck3:

VM with cannula VL
Malar fat pad deficiency and volume loss SOOF deficiency

Additional consideration for Ck3:

Ck336†/VM3/supraperiosteal36*/needle36*/bolus36/0.3 mL36

*Aspiration is highly recommended when injecting with a needle at the level of the bone. Do not inject into the bone, but rather at the level
of the bone.36 †Ck3: Be wary of the infraorbital artery and foramen.36
Do not inject more than 2 mL of Juvéderm® VOLUMA® with lidocaine per treatment area in a single session.3
Juvéderm® VOLIFT® with lidocaine is intended for intradermal use and there is currently no clinical data in terms of performance and safety
available on the injection of Juvéderm® VOLIFT® at the subcutaneous or supraperiosteal depth. Please consult the Directions for Use before using
this product.7
*Do not inject into the bone, but rather at the level of the bone.36 †Tear trough is reserved for specialists specifically trained in this technique and
SMAS: superficial muscular aponeurotic system; SOOF: suborbicularis oculi fat. those who have a sound knowledge of the anatomy and physiology for this particular area.8,36

216 217
The MD Codes™
strategies

The MD Codes™ Lip

219
 Anatomical
locations and
aims of effects36,50
Anatomical location36 Placement36 Aims50

Upper
NL1* nasolabial fold
• Subcutaneous
Central • Reduces prominence of the nasolabial folds via the
NL2* nasolabial fold
• Deep dermis/
direct approach
subdermal
Lower
NL3* nasolabial fold

Vermillion body
Submucosa/ • Promotes lip augmentation
Lp1 + Lp1 (upper lip +
mucosa • Promotes lip projection and eversion
lower lip)

Lp2 Cupid’s bow Mucosa • Gives structure to Cupid’s bow area

Lip border
• Gives structure to the white line/border
Lp3 + Lp3 (upper lip + Mucosa
• Indirectly decreases perioral lines
lower lip)

NL1 Lp6
Oral
Mucosa
• Lifts and corrects the downturn of the corner of
commissure the mouth
NL2 Lp7 Philtrum Deep dermis/
Lp7 • Gives structure and defines philtrum columns
Lp column subdermal
NL3 2
3
Lp
Lp1
Lp6
Lp1
Lp3

*The guidance presented is for severe nasolabial folds; guidance and volume recommendations will differ for patients with mild/moderate
nasolabial folds. Please refer to the 3-point NLF section for other NLF recommendations.

220 221
The MD Codes™ Lip: The MD Codes™ Lip:
Product and volume Product and volume
recommendations36 recommendations36 (continued)

Active Active
Target Injection Target Injection
Code36 Product7 Delivery36 number per Notes36 Code36 Product Delivery36 number per Notes
layer36 device36 layer36 device36
side (mL)36 side (mL)36

Be wary
0.5 of the Lp6 VL7 0.1
facial artery
NL1* and the
branches to
0.5 the nasal Lp2 VL7 VB8 0.05
flare

0.3 Lp3 VL7 VB8 0.15

NL2* VL

0.3 Lp3 VL7 VB8 0.15

Be wary of
the facial
artery
0.2 Lp6 VL7 VB8 0.1

NL3*

0.2 Lp7 VL7 VB8 0.05

Be wary of
Lp1 VL 0.2 the superior
labial artery Consider the product selection
Consider the product selection for Lp6:
for Lp2, Lp3 and Lp7:
Be wary of VL VB VL VB
Lp1 VL 0.2 the inferior For distinct definition For subtle definition For distinct lifting For subtle support
labial artery

*The guidance presented is for severe nasolabial folds; guidance and volume recommendations will differ for patients with mild/moderate
nasolabial folds. Please refer to the 3-point NLF section for other NLF recommendations.
Juvéderm® VOLIFT® with lidocaine is intended for intradermal use and there is currently no clinical data in terms of performance and safety
available on the injection of Juvéderm® VOLIFT® at the subcutaneous or supraperiosteal depth. Please consult the Directions for Use before
using this product.7

222 223
References

225
References

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2. Juvéderm® VOLUX™ Directions for Use. 73651JT10. Revision 2019-09-09. 32. Allergan. Unpublished Data. JUVÉDERM® (gel elasticity G’) data. INT/0141/2019. March 2019.
3. Juvéderm® VOLUMA® with lidocaine Directions for Use. 73650JT10. Revision 2019-09-09. 33. Bernardin A, et al. Poster presentation at the Fall Clinical Dermatology Conference, Las Vegas, NV, USA, Oct 20–23, 2016.
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doi: 10.1186/1471-5945-9-9.
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10. Borrell M, et al. J Cosmet Laser Ther 2011;13:21–7. doi: 10.3109/14764172.2011.552609. Berlin, Heidelberg, 2013;p.29–45 ISBN: 978-3-642-21836-1. doi: 10.1007/978-3-642-21837-8_2.
11. Tezel A, Frederickson GH. J Cosmet Laser Ther 2008;10:35–42. doi: 10.1080/14764170701774901. 41. Fitzgerald R, Rubin AG. Dermatol Clin 2014;32:37–50. doi: 10.1016/j.det.2013.09.007.
12. Callan P, et al. Clin Cosmet Investig Dermatol 2013;6:81–9. doi:10.2147/CCID.S40581. 42. De Boulle K, Heydenrych I. Clin Cosmet Investig Dermatol 2015;8:205–14. doi: 10.2147/CCID.S80446.
13. De Boulle K, et al. Dermatol Surg 2013;39:1758–66. doi: 10.1111/dsu.12301. 43. Urdiales-Gálvez F, et al. Aesthetic Plast Surg 2017;41:667–77. doi: 10.1007/s00266-017-0798-y.
14. Hee CK, et al. Dermatol Surg 2015;41:S373–S381. doi: 10.1097/DSS.0000000000000536. 44. Wagner RD, et al. Semin Plast Surg 2016;30:83–6. doi: 10.1055/s-0036-1580734.
15. Juvéderm® ULTRA 2 Directions for Use. 73661JT10. Revision 2019-09-09. 45. Heydenrych I, et al. Clin Cosmet Investig Dermatol 2018;11:603–11. doi: 10.2147/CCID.S180904.
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49. Collier H. J Aesthetic Nurs 2014;3:476–81. doi: 10.12968/joan.2014.3.10.476.
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22. Allergan. Data on File. Juvéderm® VOLUX™ host tissue integration response. INT-NON-2150475. October 2021.
51. Ogilvie P, et al. Clin Cosmet Investig Dermatol 2020;13:267–74. doi: 10.2147/CCID.S239667.
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52. Shoshani D, et al. Dermatol Surg 2008;34:S85–S91. doi: 10.1111/j.1524-4725.2008.34248.x.
integration, spreadability. INT-VOT-2050006. May 2020.
24. Urdiales-Gálvez F, et al. J Cosmet Dermatol 2020. doi: 10.1111/jocd.13632.
25. Eccleston D, Murphy DK. Clin Cosmet Investig Dermatol 2012;5:167–72. doi:10.2147/CCID.S35800.
26. Baumann LS, et al. Dermatol Surg 2007;33(Suppl 2):S128–35. doi: 10.1111/j.1524-4725.2007.33352.x.
27. Philipp-Dormston WG, et al. J Cosmet Dermatol 2014;13:125–34. doi: 10.1111/jocd.12085.
28. Jones D, Murphy DK. Dermatol Surg 2013;39:1602–12. doi: 10.1111/dsu.12343.
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226 227
Adverse events should be reported to your local
regulatory authority and AbbVie d.o.o. Beograd

Produced and funded by Allergan Aesthetics, an AbbVie company.

RS-ABBVD-220001 | Date of preparation: July 2022