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Contents
Introducing the MD Codes™. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
What are the MD Codes™?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Why use the MD Codes™?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
The MD Codes™ and the VYCROSS® Collection. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Treatment considerations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
General aseptic precautions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Gender difference. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Injection device. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Injection delivery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Targeted structures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Injection technique. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Alert areas. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
The MD Codes™ have been developed by Dr Mauricio de Maio
and all recommendations presented in this guide are based Using the MD Codes™ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
on his clinical experience. The injector is responsible for The 8-point lift. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
customising the MD Codes™ for each individual patient. The 3-point forehead reshape. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Please refer to Instructions for Use before injecting. The 2-point temple reshape . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
The 3-point eyebrow reshape. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
The 3-point lateral periorbital reshape . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
The 3-point tear trough reshape. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
The 5-point cheek reshape. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
The 3-point nasolabial reshape. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
The 8-point lip reshape . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64
The 3-point marionette lines reshape. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74
The 6-point chin reshape . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
The 5-point jawline reshape. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86

Danger and alert zones . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92

References and mandatories. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96

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What are the MD Codes™?

Practical injection strategies

The MD Codes™ are a series of precise sites (or subunits) within each unit that are designed to guide injection. They are based
on the principle that facial units have to be rebuilt, or treated, in an architectural mode.
Each injection site is represented by a combination of letters and numbers. The letters represent the anatomical unit and the
numbers indicate the sequence in which the injections may potentially be delivered.
The most important injection site in a particular anatomical unit is represented by the number 1 and this should usually be the
starting point. Injection site number 3 is typically an alert zone, and care should be taken in these areas. Every patient will have
a specific sequence and may not need all of the MD Codes™ in the anatomical unit – each patient should be assessed and
treated individually.

Each code is depicted with a combination of the following:

Introducing the MD Codes™ Letters The anatomical unit (e.g. Ck=cheeks)

Numbers The subunits of the anatomical unit (e.g. Ck1=zygomatic arch; Ck2=zygomatic eminence)

The side of the face (e.g. Ck1r is the zygomatic arch on the right hand side; Ck1l is the
Number location
zygomatic arch on the left hand side)
Superscript (Xn) refers to upper areas (e.g. Lp1=vermilion body of the upper lip)
Number position
Subscript (X n) refers to lower areas (e.g. Lp1=vermilion body of the lower lip)

Colours Alert areas denoted in red

Shapes Technical delivery of the product

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Why use the MD Codes™? The MD Codes™ and the VYCROSS® Collection
A landmark in facial aesthetics Product selection

The MD Codes™ are a useful tool to help patients understand their treatment motivation. The VYCROSS® Collection, manufactured by Allergan, comprises of hyaluronic acid fillers designed to meet the specific anatomical
needs of different facial regions.
By presenting the MD Codes™ to the patient, they will point out the areas of concern so that the injector may discuss the
appropriate codes for their individual treatment plan. The MD Codes™ can help the patient to understand why the improvement The VYCROSS® Collection of hyaluronic acid fillers includes:
of a target area may be achieved by treating a neighbouring or distal area.
JUVÉDERM® VOLUMA® Intended to restore volume of the face, for example, in temples, midface region,
The MD Codes™ are treatment patterns that guide the spotting of injection points on the patient’s face, according to their
with Lidocaine chin and jaw (≤2 ml per treatment area per session)1
individual treatment needs. They represent not only specific sequences of injection points but also act as a tool to facilitate the
communication between patient and doctor.
Treatment of deep skin depressions, face contouring and volume restoration to
JUVÉDERM® VOLIFT®
In addition, the MD Codes™ can be used to aid financial planning and patient follow up. correct facial structural defects such as asymmetry, contour deformities, volume loss
with Lidocaine
in the lips, cheeks, chin, lower face…etc.2

Treatment of any fine lines and medium-sized skin depressions. Enhancement

JUVÉDERM® VOLBELLA®
and pouting of the lips to correct structural defects such as asymmetry, contour
with Lidocaine
The MD Codes™ are a landmark in facial aesthetics, it’s a FACT deformities, volume loss…etc.3

Finance Patients come with a specific budget

Unique crosslinking technology
Assessment Accurate diagnosis must be made

VYCROSS® technology is a proprietary4 mix of low and high molecular weight hyaluronic acid, combined with a crosslinking
Communication Clarify “Patient wants vs. Patient needs” process, which results in an efficiently and tightly crosslinked gel.5–9
This tight hyaluronic acid network results in:
Technique Precise and safe injection can help achieve desired outcomes • Greater resistance to degradation, delivering long-lasting duration.5,7–9
• Minimal gel expansion due to low water uptake coupled with low hyaluronic acid concentration.5,9
This patented technology4 allows the customisation of gel hardness (G’) and cohesivity, resulting in products with optimised lift
and mouldability.5–7,9

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General aseptic precautions

The presence of active bacterial or viral infection should postpone treatment.1–3

Maintaining an appropriate aseptic environment will help reduce the risk of infection. Ensure the patient has removed any
makeup and prepare the skin with antibacterial soap or alcohol.10
Wash your hands, wear appropriate clothing and use sterile or disposable gloves and equipment. Ensure you have everything you
need before you start injecting.

Gender differences

Gender differences should be taken into account when individualising treatment.

Treatment considerations
Recommended for men Injection point for a more masculine outcome

Recommended for women Injection point for a more feminine outcome

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Injection device Injection delivery

The choice of injection device should be based on individual experience and preference.

Micro-aliquot Very small droplet of filler (0.01–0.05 ml per point)

• May minimise risk of intravascular injury and bruising
Cannula
• Recommended for use in alert zone areas

Aliquot Static injection of a small amount of filler (0.1 or 0.2 ml)

• May be preferred for fine, controlled injections
Needle
• Ideal for bolus at the supraperiosteal level

Small bolus Static injection of filler (<0.3 ml)

• Injection of JUVÉDERM® VOLUMA® with Lidocaine with the supplied 27G 1/2” sterile needle is recommended.1 Use of a cannula
where mentioned is the recommendation of Dr de Maio.*
Linear Antegrade or retrograde
• Injection of JUVÉDERM® VOLBELLA® with Lidocaine with the supplied 30G 1/2” sterile needle is recommended. It is possible to
use a 30G sterile cannula.2
• 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 cannula.3
Fanning Multiple linear injections via a single entry site creating a fan-like pattern

*Use of cannula with JUVÉDERM® VOLUMA® with Lidocaine has not been validated by Allergan.

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Targeted structures Alert areas

1. To minimise the risk of injury to blood vessels and nerves, standard precautionary measures should be taken in all areas
Dermal Mucosa of the face. These include injecting slowly and frequently checking for signs of pain and skin colour changes.
2. Alert areas are highlighted with a caution sign, where needle aspiration is highly recommended or the use of cannulas
should be considered.
3. Standard injection technique should include reflux/aspiration of the syringe plunger to check if blood is drawn into
the chamber. If blood is detected, withdraw the needle, compress and choose a different site. It is important to prime
Subcutaneous / fat pads Supraperiosteal before injecting.

• High-risk areas where additional caution must be taken if injecting at or

near these sites
Injection technique Alert area
• A
 lert areas may be highly vascular, highly innervated or adjacent to critical
structures or organs
1. Aspiration is highly recommended during deep injections close to the bone.
2. Avoid scratching the periosteum during injection, it can lead to pain and bleeding. The technique and depth of the injection
vary depending on the area to be treated. Do not inject • Areas to avoid injecting with dermal fillers
3. Massage gently following injection to ensure tissue integration and even distribution of the product. A more robust massage
may be needed in deeper planes with a higher volume.
4. When creating structure, remember that indirect changes may happen in neighbouring or distal areas.
5. Younger patients with mild-to-moderate deficiencies may require smaller volumes than older or more complex patients.
6. Do not inject more than 2 ml of JUVÉDERM® VOLUMA® with Lidocaine per treatment area in a single session.

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Using the MD Codes™

The treatment codes provided in this book include guidance on product, choice of injection device, technique
and a suggested volume range. These recommendations are based on the clinical experience of Dr de Maio
and may be adapted based on the experience of the injector and the patient’s facial features.

The MD Codes™

L The 8-point lift Ck The 5-point cheek reshape

F The 3-point forehead reshape NL The 3-point nasolabial reshape

Using the MD Codes™

T The 2-point temple reshape Lp The 8-point lip reshape

E The 2-point eyebrow reshape M The 3-point marionette lines reshape

C The 6-point chin reshape O The 3-point lateral periorbital reshape

Jw The 5-point jawline reshape Tt The 3-point tear trough reshape

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The 8-point lift: The 8-point lift:

Surface anatomy Injection areas and effects

Code Injection area Effect of injection Structures affected

L1 Lifts the cheek Bone structure and

Zygomatic arch
(Ck1) Gives support to eyebrow and lower eyelid lateral SOOF

L2 Provides projection of the cheek and Bone structure and

Zygomatic eminence
(Ck2) shortening of palpebral-malar sulcus lateral SOOF

L3 Improves the medial lid-cheek junction and Bone structure; deep malar
Anteromedial cheek
(Ck3) softens the tear trough fat pad; medial SOOF

L1
L4 Reduces the prominence of the Subdermal support
Nasolabial fold
L2 (NL) nasolabial folds to nasolabial fold

L3 Strengthens and lifts the mucosa of the

L5 Subdermal support
Marionette line oral commissure and improves the
(M) to marionette lines
appearance of marionette lines
L4
L8
L6 Reduces the prominence of the Bone structure and/or
Prejowl sulcus
(C6, Jw4) prejowl sulcus subcutaneous

Bone structure;
L5 L7 L7 Mandible angle Reshapes and lifts the jawline
subcutaneous

Addresses the sunken area and improves

L8
Parotid and submalar area submalar and preauricular volume loss; Subcutaneous
L6 (Ck4, Ck5)
and lifts the jawline

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The 8-point lift: The 8-point lift:

Topographical anatomy for deep injection Topographical anatomy for superficial injection

Be wary of the
angular and
facial arteries

L1
L2
L3
L8 L4
Deep injection
with needles at
the infraorbital
L7
L1
foramen is
prohibited
L5
L2 L6
L3

L3 alert: Be wary of the infraorbital artery

L8 alert: B
 e wary of the parotid gland, buccal nerve, L4 alert: Be wary of the facial artery
facial vein and artery

L7

L6
L2
L3

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The 8-point lift: Notes

Product and volume recommendations

Volume Injection Injection Targeted

Code Product Notes
range (ml) technique device structure

L1
0.1– 0.3
(Ck1) JUVÉDERM®
VOLUMA® with
L2 Lidocaine
0.2– 0.4* Zygomatico-
(Ck2)
facial artery†
JUVÉDERM®
VOLUMA® with
Lidocaine Infraorbital artery†
L3
0.1– 0.3 or or
(Ck3)
JUVÉDERM® VOLIFT®
with Lidocaine

L4
0.1– 0.5
(NL)
JUVÉDERM® VOLIFT® Facial artery;
or inject slightly medial
with Lidocaine
L5 to the nasolabial
0.1– 0.5 crease
(M)

L6
0.1–0.5* or or or
(C6, Jw4) JUVÉDERM®
VOLUMA® with
Lidocaine
L7 0.1–0.5* or

JUVÉDERM® VOLUMA®
L8 with Lidocaine
0.2–1.0 or Parotid gland; buccal
(Ck4, Ck5) JUVÉDERM® VOLIFT® nerve; facial vein and
with Lidocaine artery†

* The total volume should be delivered in small boluses (<0.3 ml) † Aspiration is highly recommended
These recommendations are provided by Dr Mauricio de Maio and are based on his clinical experience. Some of these recommendations (e.g. volume, injection device, targeted structure) may not be
aligned with the Instructions for Use and other products from the VYCROSS® Collection may be used to treat this area. Please consult the Instructions for Use document for each product.

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The 3-point forehead reshape: The 3-point forehead reshape:

Surface anatomy Injection areas and effects

Code Injection area Effect of injection Structures affected

F1 Medial forehead

Reshapes the forehead

and improves the appearance
F2 Lateral forehead Deep support
F2 F1 F3 of forehead lines

F3 Central forehead

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The 3-point forehead reshape: The 3-point forehead reshape:

Topographical anatomy Product and volume recommendations

Volume Injection Injection Targeted

Code Product Notes
range (ml) technique device structure

F1 0.1– 0.3 Supraorbital

artery

F2 F1 F3 F2 F1 F3
JUVÉDERM® VOLIFT®
F2 0.2– 0.5* or or
with Lidocaine
2 cm

F3 0.1–0.2 Supratrochlear
artery

* The total volume should be delivered in small boluses (<0.3 ml)

When direct approach to the lines is needed, use JUVÉDERM® VOLBELLA® with Lidocaine

Volume Injection Injection Targeted

Code Product Notes
range (ml) technique device structure
F1 alert: Be wary of the supraorbital artery
F3 alert: Be wary of the supratrochlear artery

F1 0.1–0.3 Supraorbital
Injection should be avoided in the 2 cm region above the orbit artery

JUVÉDERM® VOLBELLA®
F2 0.1–0.3
with Lidocaine

F3 0.1–0.3 Supratrochlear
artery

These recommendations are provided by Dr Mauricio de Maio and are based on his clinical experience.
Some of these recommendations (e.g. volume, injection device, targeted structure) may not be aligned
with the Instructions for Use, please consult these documents before using these products.

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Notes Notes

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The 2-point temple reshape: The 2-point temple reshape:

Surface anatomy Injection areas and effects

Code Injection area Effect of injection Structures affected

T1 Anterior temple
Reshapes the temple Deep support
T2 Posterior temple

T2
T1

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The 2-point temple reshape: The 2-point temple reshape:

Topographical anatomy Product and volume recommendations

Volume Injection Injection Targeted

Code Product Notes
range (ml) technique device structure

T1 0.2– 0.5* Aspiration

is highly
JUVÉDERM® VOLUMA® recommended
with Lidocaine
Avoid deep
T2 0.3– 0.5* temporal arteries

* The total volume should be delivered in small boluses (<0.3 ml)

T2 The volume range may vary according to the degree of severity:

• Mild deficiencies up to 0.5 ml per side per session.
T1 • Moderate deficiencies up to 1 ml per side per session.
• Severe deficiencies up to 2 ml per side per session. A total of 2– 4 boluses may be required.

These recommendations are provided by Dr Mauricio de Maio and are based on his clinical
experience. Other products from the VYCROSS® Collection may be used to treat this area,
please consult the Instructions for Use document for each product.

T2
T1

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Notes Notes

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The 3-point eyebrow reshape: The 3-point eyebrow reshape:

Surface anatomy Injection areas and effect

Code Injection area Effect of injection Structures affected

E1 Eyebrow tail

E2 Eyebrow centre Lifts and projects the eyebrow Fat pads (ROOF)

E3 Eyebrow head

ROOF=Retro-orbicularis oculi fat

E3 E2
E1

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The 3-point eyebrow reshape: The 3-point eyebrow reshape:

Topographical anatomy Product and volume recommendations

Volume Injection Injection Targeted

Code Product Notes
range (ml) technique device structure

E2
E3
E1 E1
E2 alert: Inject lateral E1 0.1– 0.2 or or
to the supraorbital
foramen Inject slowly
E3 alert: Inject lateral JUVÉDERM® VOLIFT® and protect
to the supratrochlear with Lidocaine the upper eyelid
foramen
with your finger
E2 0.1– 0.2

or
E3 0.1– 0.2

These recommendations are provided by Dr Mauricio de Maio and are based on his clinical experience.
Some of these recommendations (e.g. volume, injection device, targeted structure) may not be aligned
with the Instructions for Use; please consult these documents before using these products.
NOTE: JUVÉDERM® VOLBELLA® with Lidocaine can also be used to treat fine lines in this area.

E3 E2
E1 E1

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 38 39

Notes Notes

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 40 41

The 3-point lateral periorbital reshape: The 3-point lateral periorbital reshape:
Surface anatomy Injection areas and effects

Code Injection area Effect of injection Structures affected

O1 Central periorbital

Improves the appearance

O2 Lower periorbital of static lines and volume loss Subdermal
in the lateral periorbital area

O3 Upper periorbital

O3

O1

O2

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 42 43

The 3-point lateral periorbital reshape: The 3-point lateral periorbital reshape:
Topographical anatomy Product and volume recommendations

Volume Injection Injection Targeted

Code Product Notes
range (ml) technique device structure

O1

JUVÉDERM® VOLBELLA®
O2 0.2– 0.5
with Lidocaine

O3
Upper eyelid

These recommendations are provided by Dr Mauricio de Maio and are based on his clinical experience.

O3

O1

O2

O3 alert: Avoid injecting into the upper eyelid

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 44 45

Notes Notes

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 46 47

The 3-point tear trough reshape: The 3-point tear trough reshape:
Surface anatomy Injection areas and effects

Code Injection area Effect of injection Structures affected

Tt1 Central infraorbital

Lid-cheek junction;
Tt2 Lateral infraorbital Improves infraorbital area palpebral-malar sulcus;
nasojugal sulcus

Tt3 Medial infraorbital

Tt3 Tt2
Tt1

This treatment is reserved for specialists specifically trained

in this technique and having a sound knowledge of the
anatomy and physiology in this particular area.

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 48 49

The 3-point tear trough reshape: The 3-point tear trough reshape:
Topographical anatomy Product and volume recommendations

Volume Injection Injection Targeted

Code Product Notes
range (ml) technique device structure

Tt1 0.1– 0.3

The tear
trough
Infraorbital
should be
JUVÉDERM® foramen
treated by
Tt3 Tt2 VOLBELLA® 0.1–0.3 or specialists
Tt3 Tt2 with Lidocaine
Tt2 specifically
Tt1 trained in this
Tt1 technique

Tt3 0.1–0.3 Infraorbital

foramen; angular
artery

These recommendations are provided by Dr Mauricio de Maio and are based on his clinical experience.

Tt1 alert: Be wary of the infraorbital artery branches

Tt3 alert: Be wary of the angular artery and vein

Injection with needles at the infraorbital foramen should be avoided

This treatment is reserved for specialists specifically trained

in this technique and having a sound knowledge of the
anatomy and physiology in this particular area.

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 50 51

Notes Notes

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 52 53

The 5-point cheek reshape: The 5-point cheek reshape:

Surface anatomy Injection areas and effects

Code Injection area Effect of injection Structures affected

Lifts the cheek

Ck1
Zygomatic arch Gives support to eyebrow Bone structure and lateral SOOF
(L1)
and lower eyelid

Provides projection of the

Ck2
Zygomatic eminence cheek and shortening of Bone structure and lateral SOOF
(L2)
palpebral-malar sulcus
Ck1 Ck1
Improves the medial
Ck2 Ck2 Ck3 Bone structure; deep malar fat
Anteromedial cheek lid-cheek junction and softens
(L3) pad; medial SOOF
the tear trough
Ck3 Ck3
Ck4
Addresses the sunken area
Lateral lower cheek / at the parotid level and
Ck5 Ck5 Ck4 Subcutaneous
parotid area preauricular volume loss;
lifts the jawline

Addresses the sunken area

Ck5 Submalar and improves volume loss in the Subcutaneous
submalar area

SOOF=suborbicularis oculi fat

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 54 55

The 5-point cheek reshape: The 5-point cheek reshape:

Topographical anatomy Product and volume recommendations

Volume Injection Injection Targeted

Code Product Notes
range (ml) technique device structure

Ck1 Aspiration is highly

0.1– 0.3
(L1) recommended
JUVÉDERM® VOLUMA®
with Lidocaine
Ck2 Zygomaticofacial
Ck1 Ck1 (L2)
0.2– 0.4*
artery
Ck2 Ck2
Ck3 Ck3
JUVÉDERM® VOLUMA®
with Lidocaine Infraorbital artery
Ck4
Ck5 Ck3
(L3)
0.1– 0.3   or 

JUVÉDERM® VOLIFT®
with Lidocaine

or
JUVÉDERM® VOLUMA® In large areas
with Lidocaine prefer cannula†
Ck4 0.2–1.0
Ck2 JUVÉDERM® VOLIFT®
with Lidocaine Parotid gland
Ck3
JUVÉDERM® VOLUMA®
with Lidocaine
Buccal nerve;
Ck5 0.2– 0.5*   or   
facial vein
JUVÉDERM® VOLIFT®
Ck3 alert: and artery
Be wary of the with Lidocaine
infraorbital foramen

Ck5 alert:
Be wary of the
* The total volume should be delivered in small boluses (<0.3 ml) †Use of cannula with
facial artery JUVÉDERM® VOLUMA® with Lidocaine has not been validated by Allergan
These recommendations are provided by Dr Mauricio de Maio and are based on his clinical experience. Some of these recommendations (e.g. volume, injection device, targeted
structure) may not be aligned with the Instructions for Use; please consult these documents before using these products.

NOTE: JUVÉDERM® VOLBELLA® with Lidocaine can also be used to treat fine lines in this area.

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 56 57

Notes Notes

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 58 59

The 3-point nasolabial reshape: The 3-point nasolabial reshape:

Surface anatomy Injection areas and effects

Code Injection area Effect of injection Structures affected

NL1 Upper nasolabial fold

Reduces prominence Subdermal support to

NL2 Central nasolabial fold
of the nasolabial folds nasolabial fold

NL3 Lower nasolabial fold

NL
1
NL
Consider treating the cheek first.

2
NL
3

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 60 61

The 3-point nasolabial reshape: The 3-point nasolabial reshape:

Topographical anatomy Product and volume recommendations

Volume Injection Injection Targeted

Code Product Notes
range (ml) technique device structure

NL1 0.1– 0.4 Facial artery

JUVÉDERM® VOLIFT®
NL2 0.2– 0.4 or
with Lidocaine Inject slightly

NL
medial to the

1
nasolabial crease
NL1 alert: Be wary NL3 0.1– 0.2
of the facial artery

NL
and the branches

2
to the nasal flare.
In Asian patients the These recommendations are provided by Dr Mauricio de Maio and are based on his clinical experience. Other products from the VYCROSS® Collection may be used to treat
facial artery may lie

NL
this area; please consult the Instructions for Use document for each product.
in the nasolabial fold

3
NL
1

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 62 63

Notes Notes

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 64 65

The 8-point lip reshape: The 8-point lip reshape:

Surface anatomy Injection areas and effects

Lp1, Lp2 and Lp3

Code Injection area Effect of injection

Lp1 Vermilion body Promotes lip augmentation

Lp2 Cupid’s bow Gives structure to cupid’s bow area

Gives structure to the white line / lip border.

Lp3 Lip border
Indirectly decreases perioral lines

Lp
3
2
Lp
Lp1 Lp1

Lp1 Lp1

Lp
3

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 66 67

The 8-point lip reshape: The 8-point lip reshape:

Surface anatomy Injection areas and effects

Lp1, Lp2, Lp3, Lp4 and Lp5

Code Injection area Effect of injection

Lp1 Vermilion body Promotes lip augmentation

Lp2 Cupid’s bow Gives structure to cupid’s bow area

Gives structure to the white line / lip border.

Lp3 Lip border
Indirectly decreases perioral lines

Lp4 Medial tubercle Provides projection or fullness of the medial tubercle of the upper lip
Lp
3
2
Lp
Lp5 Lateral tubercles Provides projection or fullness of the lateral tubercles of the lower lip
Lp1 Lp4 Lp1

Lp1 Lp5 Lp5 Lp1

Lp
3

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 68 69

The 8-point lip reshape: The 8-point lip reshape:

Surface anatomy Injection areas and effects

All codes
Code Injection area Effect of injection

Lp1 Vermilion body Promotes lip augmentation

Lp2 Cupid’s bow Gives structure to cupid’s bow area

Gives structure to the white line / lip border.

Lp3 Lip border
Indirectly decreases perioral lines

Lp7
Lp8 Lp4 Medial tubercle Provides projection or fullness of the medial tubercle of the upper lip
Lp
3
2
Lp
Lp5 Lateral tubercles Provides projection or fullness of the lateral tubercles of the lower lip
Lp1 Lp4 Lp1
Lp6
Lp1 Lp5 Lp5 Lp1 Lp6 Oral commissure Lifts and corrects the downturn of the corner of the mouth

Lp
3 Lp7 Philtrum column Gives structure and defines philtrum columns

Lp8 Perioral lines Corrects the perioral lines

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 70 71

The 8-point lip reshape: The 8-point lip reshape:

Topographical anatomy Product and volume recommendations

All codes
Volume Injection Injection
Code Product Structure
range (ml) technique device

Lp1 0.05– 0.1   or

Lp2 0.05– 0.1

Juvéderm® VOLBELLA®
Lp3 with Lidocaine 0.05– 0.1
or

Lp7
Lp8 JUVÉDERM® VOLIFT®
Juvéderm® VOLIFT®
Lp with Lidocaine
3
2 Lp4 or 0.05– 0.1
Lp JUVÉDERM ULTRA® XC
or
Lp1 Lp4 Lp1 or
Lp5 JUVÉDERM ULTRA 0.05– 0.1
Lp6
PLUS® XC
Lp1 Lp5 Lp5 Lp1
Lp6 0.05– 0.1 or 
Lp
3

Lp7 0.05– 0.1

Lp8 0.1– 0.2

These recommendations are provided by Dr Mauricio de Maio and are based on his clinical experience.
  Inject at the level of the mucosa

  Inject at the intradermal layer

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 72 73

Notes Notes

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 74 75

The 3-point marionette lines reshape: The 3-point marionette lines reshape:
Surface anatomy Injection areas and effects

Code Injection area Effect of injection Structures affected

M1 Upper marionette line

Improves the appearance Subdermal and subcutaneous

M2 Central marionette line
of the marionette lines support to marionette lines

M3 Lower marionette line

M1
M2
M3

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 76 77

The 3-point marionette lines reshape: The 3-point marionette lines reshape:
Topographical anatomy Product and volume recommendations

Volume Injection Injection Targeted

Code Product Notes
range (ml) technique device structure

M1 0.1– 0.2
M1
Inject medially to
JUVÉDERM® VOLIFT®
M2 0.2– 0.4 or the labial-mental
with Lidocaine
M2

crease

M3 0.2– 0.4
M3

These recommendations are provided by Dr Mauricio de Maio and are based on his clinical experience.
Some of these recommendations (e.g. volume, injection device, targeted structure) may not be aligned
with the Instructions for Use and other products from the VYCROSS® Collection may be used to treat this
area. Please consult the Instructions for Use document for each product.

M1
M2
M3

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 78 79

Notes Notes

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 80 81

The 6-point chin reshape: The 6-point chin reshape:

Surface anatomy Surface anatomy

C1 C1
C6
C6
C3 C3 C3

C5 C5
C2
C2
C4 C5 C6
C4

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 82 83

The 6-point chin reshape: The 6-point chin reshape:

Injection areas and effects Topographical anatomy

Code Injection area Effect of injection Structures affected

Reduces the protrusion of

Mental crease / the lower lip, gives support to
C1 Subcutaneous; muscle
Labial-mental angle the oral commissure and
elongates the chin

C2 Improves vertical dimension /

Chin apex Bone structure
(Jw5) chin height C1
C6 C6
C3 C3

C6

C6
Anterior chin / Improves anterior projection C5 C5
C3 Bone structure; subcutaneous C2
Soft tissue pogonion of the chin

Enhancer of C2 and C3 – further

Submental / improves vertical dimension
C4 Subcutaneous; muscle
Soft tissue menton and anterior projection. It also
rotates the chin upwards

Widens the chin and gives lateral

C5 Lateral lower chin support, producing a more Bone structure
square chin. Ideal for men

C6 Reduces the prominence Bone structure and / or

Prejowl sulcus
(L6, Jw4) of the prejowl sulcus subcutaneous
C3
C2
C4 C2
C4

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 84 85

The 6-point chin reshape: Notes

Product and volume recommendations

Volume Injection Injection Targeted

Code Product Notes
range (ml) technique device structure
JUVÉDERM® VOLUMA®
with Lidocaine
C1 0.5–1.0 or  or
JUVÉDERM® VOLIFT®
with Lidocaine

C2
0.2– 0.4*
(Jw5)

C3 0.2– 0.4* or Don’t go too lateral

due to mental artery

C4 0.2–0.4*

JUVÉDERM® VOLUMA®
with Lidocaine

C5 0.2– 0.4*
Recommended for men

C6
0.1– 0.5* or  or or
(L6, Jw4)

* The total volume should be delivered in small boluses (<0.3 ml)

These recommendations are provided by Dr Mauricio de Maio and are based on his clinical experience. Some of these recommendations (e.g. volume, injection device, targeted structure) may not be
aligned with the Instructions for Use; please consult these documents before using these products.
NOTE: JUVÉDERM® VOLBELLA® with Lidocaine can also be used to treat fine lines in this area.

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 86 87

The 5-point jawline reshape: The 5-point jawline reshape:

Surface anatomy Injection areas and effects

Code Injection area Effect of injection Structures affected

Widens the face

Bone structure
(for masculine-looking results)
Jw1 Mandible angle
Lifts and defines the
Subcutaneous
mandible angle

Lifts the skin and reduces

Jw2 Pre-auricular area Subcutaneous
jawline sagginess

Improves definition
Jw3 Mandible body Subcutaneous
of the jawline
Jw2
Jw4 Reduces the prominence of the Bone structure and / or
Prejowl sulcus
(L6, C6) prejowl sulcus subcutaneous

Jw5 Improves vertical dimension /

Chin apex Bone structure
(C2) chin height
Jw1

3
Jw

Jw4
Jw5

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 88 89

The 5-point jawline reshape: The 5-point jawline reshape:

Topographical anatomy Product and volume recommendations

Volume Injection Injection Targeted

Code Product Notes
range (ml) technique device structure

Jw2
0.2– 0.5*
Recommended
JUVÉDERM® VOLUMA® for men
Jw1
with Lidocaine
Jw1
Jw1 0.2
Recommended
for women
3
Jw JUVÉDERM® VOLUMA®
with Lidocaine
Jw2 0.5–1.0 or Be wary of
JUVÉDERM® VOLIFT®
Jw5 Jw4 with Lidocaine
parotid gland

Jw3 0.2– 0.5 or Be wary of

facial artery

Jw3 alert: Don’t touch the bone with the needle. Jw4 JUVÉDERM® VOLUMA®
Be wary of the facial artery 0.1– 0.5* or or or
(L6, C6) with Lidocaine

Jw5
0.2– 0.5*
(C2)

Jw5
* The total volume should be delivered in small boluses (<0.3 ml)
These recommendations are provided by Dr Mauricio de Maio and are based on his clinical experience. Some of these recommendations (e.g. volume, injection device, targeted
structure) may not be aligned with the Instructions for Use; please consult these documents before using these products.
NOTE: JUVÉDERM® VOLBELLA® with Lidocaine can also be used to treat fine lines in this area.

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 90 91

Notes Notes

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 92 93

G2 E3

G1
Tt3

Danger and alert zones

Whenever injecting into a danger or alert zone, knowledge
of topographic anatomy is essential. For safety reasons, L3 Tt1 Ck3
some of these areas should be treated using a blunt cannula.
When injecting close to the bone or in an alert zone with
needles, aspiration is highly recommended.

NL1
Jw3
L8 Ck5

Be careful when injecting

close to the highlighted areas

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 94 95

Notes Notes

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 96 97

JUVÉDERM® VOLIFT® is a sterile, pyrogen-free gel implant presented in a graduated, pre-filled, disposable syringe, containing 17.5 mg/mL cross-linked hyaluronic acid with lidocaine 3 mg/mL.
PBS Information: JUVÉDERM range of products are not listed on the PBS JUVÉDERM® VOLBELLA® is a sterile, pyrogen-free gel implant presented in a graduated, pre-filled, disposable syringe, containing 15 mg/mL cross-linked hyaluronic acid with lidocaine 3 mg/mL.
Indications: JUVÉDERM® VOLIFT® with lidocaine is intended for the treatment of deep skin depressions, face contouring and volume restoration via deep dermis or lip mucosa injection. JUVÉDERM®
VOLBELLA® with lidocaine is intended for the treatment of any fine lines and medium sized skin depressions as well as for enhancement and pouting of lips via superficial, mid-dermis or lip mucosa
injection. The presence of lidocaine is meant to reduce the patient’s pain during the treatment. Contraindications: Common to both: Injection into the blood vessels (intravascular); overcorrection;
patients with untreated epilepsy, those who tend to develop hypertrophic scarring or suffer from porphyria; hypersensitivity to hyaluronic acid, lidocaine, amide-type local anaesthetics and/or gram-
BEFORE PRESCRIBING, PLEASE REVIEW APPROVED INSTRUCTIONS FOR USE (IFU’S) AVAILABLE ON positive bacterial proteins; in areas with inflammation or infection; children; pregnant or breast-feeding women; simultaneous administration with laser therapy, chemical peeling or dermabrasion.
JUVÉDERM® VOLIFT® should not be injected in the periorbital area (eyelids, bags under the eyes, crow’s feet) and glabellar region. JUVÉDERM® VOLBELLA® should not be injected in the eyelids.
REQUEST FROM ALLERGAN BY PHONING 1800 252 224 OR FROM www.allergan.com.au/products Precautions/Warnings: Standard precautions associated with injectable materials should be followed. Caution for use with another non-Allergan dermal filler; patients with autoimmune disease,
history of severe and/or multiple allergies, streptococcal disease or anaphylactic shock, on anti-coagulation medication or using substances that can prolong bleeding including herbal supplements;
Minimum Instructions for Use areas with inflammation or infection; Avoid makeup for 12 hours and avoid prolonged exposure to sunlight/UV light/extreme temperatures for at least 2 weeks post-treatment. Incompatible with
JUVÉDERM ULTRA® XC and ULTRA PLUS® XC are sterile pyrogen-free gel implants presented in a graduated prefilled, disposable syringe, containing 24 mg/mL cross-linked hyaluronic acid with quaternary ammonium salts, e.g. benzalkonium chloride, and therefore filler must not be placed in contact with objects treated with these substances. Due to presence of lidocaine, caution is to be
lidocaine 3 mg/mL. Indications: JUVÉDERM ULTRA® XC is for filling medium-sized depressions of the skin via mid-dermis injection, as well as for lip definition and pouting of lips. JUVÉDERM used when filler is used in combination with drugs that reduce or inhibit hepatic metabolism and in patients with symptoms of cardiac conduction disorders. It is recommended not to inject into a site
ULTRA PLUS® XC is for filling mid and/or deep depressions of the skin via mid and/or deep dermis injection, as well as for lip definition and enhancement. The presence of lidocaine is meant to which has been treated with a permanent implant. Not intended for use in breast augmentation/reconstruction. Adverse Reactions: Injection site inflammatory reactions (redness, oedema, erythema)
reduce the patient’s pain during treatment. Contraindications: Common to both: Injection into the blood vessels (intravascular); overcorrection; patients with untreated epilepsy, those who tend to which may be associated with itching and/or pain on pressure and/or paraesthesia; haematomas; induration or nodules; discolouration; weak filling effect; abscesses; granuloma and hypersensitivity.
develop hypertrophic scarring or suffer from porphyria; hypersensitivity to hyaluronic acid, lidocaine, amidetype local anaesthetics and/or gram-positive bacterial proteins; in areas with inflammation Rare but serious adverse events associated with intravascular injection of dermal fillers in the face and tissue compression have been reported and include temporary or permanent vision impairment,
or infection; children; pregnant or breast-feeding women; simultaneous administration with laser therapy, chemical peeling or dermabrasion. JUVÉDERM ULTRA® XC should not be injected into blindness, cerebral ischaemia or cerebral haemorrhage, leading to stroke, skin necrosis and damage to underlying structures. Dose/Administration: Injected into dermis or the mucous membrane of
eyelids. JUVÉDERM ULTRA PLUS® XC should not be used in the crow’s feet or glabellar region. Precautions/Warnings: Standard precautions associated with injectable materials should be the lips by a medical practitioner trained in injection technique for filling. Inject slowly. After needle insertion and before injection, it is recommended to withdraw slightly the plunger to aspirate and verify
followed. Caution for use with another non-Allergan dermal filler; patients with autoimmune disease, history of severe and/or multiple allergies, streptococcal disease or anaphylactic shock, on anti- the needle is not intravascular. The quantity injected will depend on the areas to be corrected. Massage the areas treated after the injection for uniform distribution. If immediate blanching occurs at any
coagulation medication or using substances that can prolong bleeding including herbal supplements; areas with inflammation or infection; Avoid makeup for 12 hours and avoid prolonged exposure time during the injection, the injection should be stopped and appropriate action taken such as massaging the area until its return to a normal colour. (24Nov2016)
to sunlight/UV light/extreme temperatures for at least 2 weeks post-treatment. Incompatible with quaternary ammonium salts, e.g. benzalkonium chloride, and therefore filler must not be placed in References: 1. JUVÉDERM® VOLUMA® with Lidocaine IFU. 2. JUVÉDERM® VOLIFT® with Lidocaine IFU. 3. JUVÉDERM® VOLBELLA® with Lidocaine IFU. 4. WO2004/092222A2 patent. 5. Callan P
contact with objects treated with these substances. Due to presence of lidocaine, caution is to be used when filler is used in combination with drugs that reduce or inhibit hepatic metabolism and in et al. Clin Cosmet Investig Dermatol. 2013;6:81–89. 6. Borrell M et al. J Cosmet Laser Ther. 2011;13:21–7. 7. Muhn C et al. Clin Cosmet Investig Dermatol. 2012;5:147–158. 8. Raspaldo H. J Cosmet
patients with symptoms of cardiac conduction disorders. It is recommended not to inject into a site which has been treated with a permanent implant. Not intended for use in breast augmentation/ Laser Ther. 2008;10:134–142. 9. Eccleston D, Murphy DK. Clin Cosmet Investig Dermatol. 2012;5:167–172. 10. Sherman, R. Clinics in Dermatology. 2009;27:S23–S32. ™® Trademark(s) and
reconstruction. Adverse Reactions: Injection site inflammatory reactions (redness, oedema, erythema) which may be associated with itching and/or pain on pressure and/or paraesthesia; Registered trademark(s) of Allergan, Inc. Allergan Australia Pty Ltd. 810 Pacific Highway, Gordon NSW 2072. ABN 85 000 612 831. Allergan New Zealand Limited, Auckland. © 2017 Allergan. All
haematomas; induration or nodules; discolouration; weak filling effect; abscesses; granuloma and hypersensitivity. Rare but serious adverse events associated with intravascular injection of dermal rights reserved. ANZ/0153/2016. DA1731CB. ALMD12507W. Date of preparation: June 2017. Ward6.
fillers in the face and tissue compression have been reported and include temporary or permanent vision impairment, blindness, cerebral ischaemia or cerebral haemorrhage, leading to stroke, skin
necrosis and damage to underlying structures. Dose/Administration: Injected into dermis or the mucous membrane of the lips by a medical practitioner trained in injection technique for filling.
Inject slowly. After needle insertion and before injection, it is recommended to withdraw slightly the plunger to aspirate and verify the needle is not intravascular. The quantity injected will depend on
the areas to be corrected. Massage the areas treated after the injection for uniform distribution. If immediate blanching occurs at any time during the injection, the injection should be stopped and
appropriate action taken such as massaging the area until its return to a normal colour.

JUVÉDERM® VOLUMA® with Lidocaine is a sterile, pyrogen-free gel implant containing 20 mg/mL cross-linked hyaluronic acid with lidocaine 3 mg/mL. Indications: JUVÉDERM® VOLUMA®
with Lidocaine is intended to restore volume of the face. The presence of lidocaine is meant to reduce the patient’s pain during the treatment. Contraindications: Injection in the periorbital area
(eyelids, bags under the eyes, crow’s feet), glabellar region or in the lips; injection into the blood vessels (intravascular); overcorrection; patients with untreated epilepsy, those who tend to develop
hypertrophic scarring or suffer from porphyria; hypersensitivity to hyaluronic acid, lidocaine, amide-type local anaesthetics and/or gram-positive bacterial proteins; in areas with inflammation or
infection; children; pregnant or breast-feeding women; simultaneous administration with laser therapy, chemical peeling or dermabrasion. Precautions/Warnings: JUVÉDERM® VOLUMA® with
Lidocaine is not indicated for injections other than subcutaneous, upper-periostea, or into the deep dermis. Standard precautions associated with injectable materials should be followed. Caution
for use with another non-Allergan dermal filler; patients with autoimmune disease, history of severe and/or multiple allergies, streptococcal disease or anaphylactic shock, on anti-coagulation
medication or using substances that can prolong bleeding including herbal supplements; areas with inflammation or infection; Avoid makeup for 12 hours and avoid prolonged exposure to sunlight/
UV light/extreme temperatures for at least 2 weeks post-treatment. Incompatible with quaternary ammonium salts, e.g. benzalkonium chloride, and therefore filler must not be placed in contact with
objects treated with these substances. Due to presence of lidocaine, caution is to be used when filler is used in combination with drugs that reduce or inhibit hepatic metabolism and in patients with
symptoms of cardiac conduction disorders. It is recommended not to inject into a site which has been treated with a permanent implant. Not intended for use in breast augmentation/reconstruction.
JUVÉDERM® VOLUMA® with lidocaine is not recommended for intramuscular injections. There is no available clinical data regarding the efficiency and tolerance of JUVÉDERM® VOLUMA® with
Lidocaine injection into the non-midline areas of the nose, nasal tip and the post-surgical/traumatic nose. Medical practitioner should be aware of the increased risk of vascular compromise/injury
in the nasal tip due to the limited space available to accommodate injected product and in the post-surgical/traumatic nose due to scar and/or anatomic disruption. Adverse Reactions: Injection
site inflammatory reactions (redness, oedema, erythema) which may be associated with itching and/or pain on pressure and/or paraesthesia; haematomas; induration or nodules; discolouration;
weak filling effect; abscesses; granuloma and hypersensitivity. Rare but serious adverse events associated with intravascular injection of dermal fillers in the face and tissue compression have been
reported and include temporary or permanent vision impairment, blindness, cerebral ischaemia or cerebral haemorrhage, leading to stroke, skin necrosis and damage to underlying structures. Dose/
Administration: Injected into deep dermis, subcutaneously or in the upper periostea by a medical practitioner trained in injection technique for filling. Inject slowly. After needle insertion and before
injection, it is recommended to withdraw slightly the plunger to aspirate and verify the needle is not intravascular. The quantity injected will depend on the areas to be corrected. Massage the areas
treated after the injection for uniform distribution. If immediate blanching occurs at any time during the injection, the injection should be stopped and appropriate action taken such as massaging the
area until its return to a normal colour.

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