HA fillers treatment:
20 MCQs — MD Codes™ and HA Filler Treatment
1. What is the principal purpose of the MD Codes™ system?
A. To standardize the rheological properties of HA fillers
B. To provide standardized anatomical injection guidance and reduce technical variability
C. To determine the ideal facial proportions for every patient
D. To replace individualized aesthetic assessment
Answer: B
The MD Codes specify anatomical location, injection layer, delivery tool/technique, and recommended minimum volume. The broader objective is to reduce variability while shifting treatment from isolated lines and folds toward facial attributes.
2. In MD Codes nomenclature, Ck1 corresponds to which anatomical region?
A. Zygomatic eminence
B. Anteromedial cheek
C. Zygomatic arch
D. Submalar region
Answer: C
Ck1 represents the zygomatic arch. Ck2 is the zygomatic eminence, Ck3 the anteromedial cheek/midcheek, Ck4 the lateral lower cheek/parotid region, and Ck5 the submalar region.
3. Which statement regarding the numerical component of an MD Code is correct?
A. It represents the order in which injections must be performed
B. It represents the recommended filler volume
C. It identifies an anatomical subunit
D. It indicates the depth of injection
Answer: C
The letters designate the anatomical unit and the numbers designate its subunits. Importantly, the numbers do not indicate injection sequence.
4. Which cheek MD Codes represent the lateral lifting vectors that should generally be addressed first when establishing midface foundation?
A. Ck1 + Ck2
B. Ck1 + Ck4
C. Ck2 + Ck3
D. Ck3 + Ck5
Answer: B
The methodology recommends beginning cheek treatment with the lateral lifting vectors represented by Ck1 and Ck4, before proceeding toward anterior and medial cheek treatment when indicated.
5. What is the recommended overall treatment sequence in the MD Codes methodology?
A. Refinement → contour → foundation
B. Contour → refinement → foundation
C. Foundation → contour → refinement
D. Foundation → refinement → contour
Answer: C
The methodology uses the analogy of constructing a house: establish the foundation, create contour, and perform refinement last.
6. A patient complains primarily of prominent tear troughs but also has midface volume loss and cheek sagginess. According to the MD Codes approach, what should generally be addressed first?
A. Tear troughs directly
B. Nasolabial folds
C. Midface foundation
D. Lip volume
Answer: C
The paper emphasizes that isolated treatment of the tear trough is usually not ideal. In most patients with tear-trough concerns, associated cheek sagginess/volume loss should first be addressed by establishing midface foundation.
7. Which equation represents direct treatment of the tear trough?
A. T1 + T2 + T3
B. Tt1 + Tt2 + Tt3
C. Ck1 + Ck2 + Ck3
D. Tt1 + Ck2 + Tt3
Answer: B
The tear-trough equation comprises Tt1 (central infraorbital), Tt2 (lateral infraorbital), and Tt3 (medial infraorbital).
8. A young patient has a conspicuous tear trough but no appreciable cheek sagginess or volume loss. Which strategy may be appropriate according to the algorithm?
A. Mandatory treatment of all five cheek codes first
B. Direct treatment of Tt1 + Tt2 + Tt3
C. Treatment of the temples before the tear trough regardless of deficiency
D. Treatment of the nasolabial folds first
Answer: B
Direct tear-trough treatment may be appropriate in a young patient without associated volume loss or sagginess, although the author notes that this situation is relatively uncommon clinically.
9. In the MD Codes methodology, treatment of the temples belongs primarily to which stage?
A. Foundation
B. Upper-face contour
C. Periorbital refinement
D. Perioral refinement
Answer: B
After establishing midface foundation, the upper-face contour stage can include treatment of temporal volume deficiency.
10. Which combination correctly matches the temple codes with their anatomical regions?
A. T1 = posterior temple; T2 = anterior temple
B. T1 = anterior temple; T2 = posterior temple
C. T1 = central temple; T2 = infraorbital region
D. T1 = temporal crest; T2 = zygomatic arch
Answer: B
Within the system, T1 represents the anterior temple and T2 the posterior temple.
11. What does an “active number” associated with an MD Code represent?
A. Maximum safe filler volume for that region
B. Number of injection points required
C. Minimum recommended volume intended to produce a visible, reproducible result
D. Number of treatment sessions required
Answer: C
Active numbers are intended as minimum volume recommendations for visible and reproducible effects; they do not replace clinician judgment regarding the actual volume appropriate for an individual patient.
12. According to the methodology, which is the preferred instrument when a precise bolus must be delivered at bone level?
A. Cannula
B. Needle
C. Either must always be used interchangeably
D. Blunt dissector
Answer: B
The paper describes needles as preferable for precise bolus injections at bone level, whereas cannulas are generally preferred for subcutaneous/fat-pad delivery and situations in which proximity to vascular bundles is a concern.
13. What does a red MD Code signify?
A. An area requiring a high-volume bolus
B. An area that should always be injected with a needle
C. An alert area containing sensitive structures or associated with facial danger zones
D. A region contraindicated for all HA fillers
Answer: C
Red codes designate alert areas. They signal the need for particular caution because of important neurovascular anatomy; they do not imply that treatment is risk-free when the prescribed approach is followed.
14. Who should treat MD Codes designated as alert areas according to the article?
A. Any clinician after basic filler training
B. Novice injectors provided they use cannulas
C. Highly trained clinicians with extensive injection experience and detailed anatomical knowledge
D. Only surgeons, regardless of filler experience
Answer: C
The author explicitly cautions against using alert codes to guide novice injectors. Hazardous areas require substantial injection experience, anatomical/physiological knowledge, and the ability to manage serious complications.
15. Which statement best describes the general recommendation for bolus volume within the same compartment?
A. It should not exceed 0.1 mL
B. It should not exceed 0.3 mL
C. It should not exceed 0.5 mL
D. It should always be exactly 1 mL
Answer: B
The article proposes a general rule that bolus injections should not exceed a total of 0.3 mL within the same compartment, with specified exceptions in the methodology.
16. When fanning an area using a cannula, what minimum volume does the article recommend?
A. 0.1 mL
B. 0.2 mL
C. 0.3 mL
D. 0.5 mL
Answer: D
The paper states that when performing fanning with a cannula, at least 0.5 mL should be used in the specified area.
17. Two patients have the same type of facial deficiency, but one has substantially greater severity. How does the MD Codes approach principally accommodate the increased severity?
A. By injecting a much larger bolus at every code
B. By increasing the number of appropriate MD Codes used
C. By switching from HA to permanent filler
D. By treating refinement areas first
Answer: B
A key concept is that greater severity may require more appropriate anatomical codes, rather than simply increasing the volume delivered at each individual code. Excessive volume per code may contribute to unnatural results or complications.
18. Which sequence best represents treatment of a “tired look” in a patient with saggy cheeks, temporal hollowing and tear troughs?
A. Tear trough → temple → cheek
B. Temple → tear trough → cheek
C. Cheek → temple → tear trough
D. Tear trough → cheek → temple
Answer: C
This follows the central foundation → contour → refinement principle: cheek/midface foundation first, temporal contouring second, and direct tear-trough refinement last.
19. Which of the following is NOT one of the four unfavorable facial attributes specifically emphasized in the MD Codes treatment algorithms described in the paper?
A. Tired
B. Sad
C. Saggy
D. Asymmetric
Answer: D
The four unfavorable attributes described are tired, sad, saggy, and angry. The corresponding favorable attributes include attractive, younger, more contoured, and feminine/soft or masculine appearance.
20. Which statement most accurately captures the conceptual shift proposed by the MD Codes methodology?
A. Treat every visible wrinkle individually until it disappears
B. Standardize every face toward identical anthropometric proportions
C. Treat underlying structural deficiencies in the context of the facial messages and attributes they produce
D. Base filler treatment primarily on chronological age
Answer: C
Rather than treating a patient’s complaint as an isolated line, fold, or hollow, the methodology attempts to identify the broader structural deficiencies contributing to unfavorable facial attributes and then treats them in a planned sequence.
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