By Cassandra Debenham, AGACNP-BC · Last updated May 30, 2026
MD Codes is a clinical framework developed by Brazilian plastic surgeon Mauricio de Maio that maps the face into anatomical zones, each with a published depth, tool, technique, and minimum volume for a natural, reproducible result. At Nervana Medical, an integrative medical clinic in Sandy, UT, it is one of the assessment method behind every consult for dermal fillers in Sandy, UT. The goal is restoration that fits your face, sequenced over visits rather than crowded into one.
Table of Contents
- Where MD Codes came from
- How MD Codes structure facial balancing
- What an MD Codes consult feels like
- What MD Codes is not
- Why Nervana uses MD Codes for dermal fillers in Sandy, UT
- Frequently Asked Questions
- Book a Consultation in Sandy, UT
If you have ever wondered why one person’s filler looks effortless and another’s looks done, the difference usually traces back to one thing. It is whether the face was actually assessed before it was injected. MD Codes is the framework that makes that assessment systematic, and at our integrative medical clinic in Sandy, UT it is the method behind every consult for dermal fillers we run.
Where MD Codes came from
MD Codes was developed by Brazilian plastic surgeon Dr. Mauricio de Maio to give injectors a shared anatomical language. The system divides the face into named zones, assigns each a short alphanumeric code, and publishes the exact volume, depth, and technique that produces a natural, reproducible result.
Before MD Codes, injectors were getting wildly different outcomes with the same products, because there was no shared map. de Maio built one. He carved the face into anatomical subunits (cheek, temple, chin, jaw, nasolabial, marionette, tear trough, lips, nose) and gave each subunit a code: Ck1, T1, C1, Jw1, NL1, M1, Tt1, Lp1, and so on.
For every code he published the depth, the tool (needle versus cannula), the safe injection technique, the danger structures to avoid, and the minimum volume needed to produce a visible, reproducible result. That last piece, the “active number,” is the part that quietly changed the field. It turned a freehand craft into a method that could be taught, audited, and reproduced. MD Codes is now one of the most widely adopted facial assessment frameworks in aesthetic medicine.
How MD Codes structure facial balancing
Three ideas hold the system together: treat architecture (not the wrinkle), sequence treatment as Foundation then Contour then Refinement, and use the published dose and technique for each zone. Together they produce facial balancing that lifts rather than fills.
Treat the architecture, not the wrinkle. Most lines on the face (the nasolabial fold, marionette lines, jowling, the shadow under the eye) are not standalone problems. They are downstream of something deeper: bone resorption, fat pad descent, loss of ligament support. MD Codes asks why a feature appears before asking what to inject there. This is anatomy-first thinking, and it is the difference between filler that lifts a face and filler that adds weight to one.
Sequence matters. Every plan is ordered the same way: Foundation, then Contour, then Refinement. Foundation is the structural midface, the cheek vectors (Ck1, Ck4) that support everything above and below. Contour is the upper face (temples) and lower face (chin, jawline). Refinement is the periorbital and perioral detail work, including the tear trough, lips, and fine lines. With MD Codes, refinement is the last step, not the first.
Every code has a published dose and technique. A single 0.3 mL bolus of filler at the cheekbone behaves differently than three 0.1 mL anchoring boluses at the same site. The first can bulge; the second produces a natural lift. The framework specifies the exact technique for each zone, which is what makes results reproducible from session to session, and from one injector to another inside the same clinic.
This sequenced approach is what most patients are describing when they ask about facial balancing. It is the same idea: treat the whole face as a related system, in sequence, with restraint.
What an MD Codes consult feels like
An MD Codes consult starts with the emotional word you use to describe your face (tired, sad, heavy, angry, aged), then traces that word back to the specific anatomy producing it. You leave with a phased plan, not a single-session quote.
A real MD Codes consult does not start with “what would you like done.” It starts with a more useful question: what bothers you when you look in the mirror? Patients almost never describe their face in anatomical terms. They describe an emotional read. I look tired even when I am rested. I look sad when I am not. My face looks heavier than I feel.
Those phrases are the diagnosis. de Maio formalized eight emotional attributes (tired, sad, angry, saggy, plus their positive counterparts: younger, attractive, contoured, feminine or masculine) and eight social attributes (trustworthy, confident, friendly, resilient, and so on) that the consult is structured around. The work of the assessment is translating the emotional word into the specific anatomy that is producing it, then choosing the smallest set of codes that resolves it.
A Nervana consult layers a few things on top of the standard MD Codes flow:
- Standardized photography at five angles, both at rest and during animation (smile, kiss, pout, frown). In our experience, most aesthetic issues only show themselves on movement.
- Validated severity scoring (Merz Aesthetic Scales, Allergan Mid-Face Volume Deficit, Hirmand Tear Trough, Carruthers Marionette, MJAS Jawline) for each region, so progress is measured against an objective baseline.
- Ultrasound-guided assessment in selected cases, for vascular structures or collagen assessment.
- A phased plan. Most full-face restorations are sequenced across two or four sessions rather than crowded into one. The published cadence is roughly 4 mL per session, layered over time (de Maio et al., 2023).
This is a map, not a sales pitch. We can tell you the codes we are planning, the volumes, the sequence, and what you can realistically expect after each phase.
What MD Codes is not
MD Codes is not a brand of filler, not a fixed template plan, and not a method that simply “fills the line.”
MD Codes is not a product.
MD Codes is not the assessment.
MD Codes is the map.
Assessment determines:
- What is deficient?
- Why is it deficient?
- What is aging first?
- What should be treated first?
MD Codes then answers:
- Where do I inject?
- In what sequence?
- With what goal?
Assessment → Diagnosis → MD Codes Mapping → Treatment Plan
It is not a template plan. Two patients with the same age and the same complaint can land on entirely different code lists, because the anatomy underneath the complaint is what dictates the plan.
It is not “fill the line.” A patient whose deep nasolabial fold improves when they look up is telling you, anatomically, that their fold is a midface volume problem. The right answer is to lift the cheek first, not to inject the fold. That distinction is exactly the kind of decision MD Codes structures.
Nervana is an integrative medical clinic in Sandy, UT, which means we treat the face the way we treat the rest of the body: assess the structure first, treat the cause rather than the symptom, sequence interventions rather than stack them. MD Codes is the aesthetic expression of that philosophy.
Nervana Medical is an integrative medical clinic in Sandy, UT, combining aesthetics, wellness, hormone therapy, and mental health under one roof. The thing those services have in common is that none of them work well when treated in isolation. Filler is no exception. It is the same logic we bring to BHRT, peptide therapy, and medical weight loss, applied to the face.
It also means we say no to things. We will tell you when a tear trough does not need filler and a snap test is the reason. We will tell you when “I want bigger lips” is actually a chin projection question. The framework gives us a structured way to make those calls, and to explain them in a way that makes sense.
Frequently Asked Questions
Is MD Codes a brand of filler?
No. MD Codes is an assessment and injection methodology developed by Dr. Mauricio de Maio, used with standard hyaluronic acid fillers. The framework specifies where, how deep, what tool, and how much.
Do I have to use MD Codes for every filler treatment?
Not strictly. Some injectors prefer the MD Codes style assessment and some have their own niche. The codes are shorthand for a real conversation about your anatomy, your goals, and what is producing the look you do not love.
How many sessions does an MD Codes plan usually take?
Most full-face plans are phased across two or four sessions, spaced four to twelve weeks apart, with roughly 4 mL of filler per visit. Lighter plans (a younger patient with one or two specific concerns) can be done in a single session. We tell you the realistic count at the consult.
Will my MD Codes plan look like everyone else’s?
No. The codes are universal, but the combination is individual. Two thirty-eight-year-old women can land on entirely different plans depending on cheek projection, vector, retaining ligament behavior, dynamic muscle pattern, and what they want their face to communicate. The framework’s job is to make sure nothing important gets missed.
Is MD Codes safe?
The methodology was designed with safety as a primary aim. Every code specifies the depth, tool, and technique that minimizes contact with the vascular and neural structures in that zone. All dermal filler carries risk, and the most important safety variable is the experience and judgment of the injector. We use ultrasound guidance in selected zones for that reason.
Book a Consultation in Sandy, UT
If you have been curious about filler but wary of the over-treated results that get the most social media attention, an MD Codes consult is the conversation to start with. We will look at your whole face, listen to the words you use to describe it, and build a plan you can say yes to without hesitation. Book a consultation at Nervana Medical and we will map it out together, anatomy first.
Medically reviewed by Cassandra Debenham, AGACNP-BC · Last updated May 30, 2026
Individual results vary. The information in this post is educational and is not a substitute for a personal consultation with a qualified medical provider. Please consult our team to discuss whether a treatment is right for you.
Sources
- de Maio M. MD Codes™: A Methodological Approach to Facial Aesthetic Treatment with Injectable Hyaluronic Acid Fillers. Aesthetic Plastic Surgery. 2021;45(2):690-709. https://pubmed.ncbi.nlm.nih.gov/33438047/
- de Maio M, et al. Treatment of the Whole Face With Hyaluronic Acid Fillers Using the MD Codes Method: An Investigator-Initiated Single-Center Prospective Cohort Study. Clinical, Cosmetic and Investigational Dermatology. 2023;16:3441-3453. https://www.dovepress.com/treatment-of-the-whole-face-with-hyaluronic-acid-fillers-using-the-md–peer-reviewed-fulltext-article-CCID
- Kefalas N, Eshetu T, Solish N, et al. Validation of a 5-Point Photonumeric Scale for the Assessment of Marionette Lines. Dermatologic Surgery. 2024;50(2):172-177. https://pubmed.ncbi.nlm.nih.gov/38051665/