Applying the MD Codes™ to Treat Emotional and Social Attributes with HA Fillers: A Retrospective Serial Case Study

BACKGROUND: Aesthetic treatment directed at improving facial emotional messages and social attributes may maximize patient satisfaction with treatment results. The MD Codes™ is an approach to facial aesthetic treatment that accounts for emotional messages and social attributes while minimizing variability in patient assessment, injection technique, injection sites, and treatment outcomes. OBJECTIVE: To assess the impact of the MD Codes systematic treatment approach on emotional and social attributes and natural appearance after facial aesthetic treatment with hyaluronic acid (HA) fillers. METHODS: A retrospective analysis was performed in patients treated with 12 mL of HA fillers (Juvéderm(®) Vycross™ products) per patient using the MD Codes. Study injectors, experienced clinician observers, clinical staff, laypeople, and patients evaluated impact of treatment on emotional and social attributes and natural appearance based on pre- and post-treatment photographs of patients. RESULTS: Twelve patients and 49 external observers, from 12 countries, evaluated the images. More than 90% of patients named “eye bags” as the facial area most in need of aesthetic treatment; >55% of external observers identified “cheeks.” The top 3 facial emotional attributes noted by all evaluators after treatment were, in order, “less tired”, “less saggy”, and “younger.” All patients reported a visible and positive change in emotional attributes except for “less sad.” After 9 months, most patients reported looking “less tired” (n=11/12), “less saggy” (n=8/12), and “less sad” (n=6/12). At months 6 and 9, all patients rated their appearance as natural looking. At least 90% of external observers considered the frontal view results natural for all but 1 patient. Patients reported improved positive social attributes (eg, “looking friendlier”) and improvements in well-being after treatment. No serious side effects were reported. CONCLUSION: Implementing the MD Codes for facial aesthetic treatment may improve facial emotional attributes as well as enhance social attributes and well-being, with natural-looking results.