Unlocking the code to periorbital revitilisation: A surgeons non-surgical approach Maurício de Maio, MD, ScM, PhD Plastic Surgeon, São Paulo, Brazil The periorbital area is the aesthetic centre of the face – it is where we look to estimate age and to judge a person’s emotional state. This masterclass will focus on treatment of the periorbital area with hyaluronic acid dermal fillers and botulinum toxin type A*. This workshop is going to introduce a new language to facial aesthetics using treatment codes resulting from over 20 years of clinical experience. Why use treatment codes? By introducing common terminology and treatment patterns – codes – we are able to identify the right injection points. The codes provide a more practical guide for injectors to achieve optimal results through personalised facial aesthetic treatment plans. Topographic anatomy can also be challenging for many injectors. Use of the codes will also enable faster communication in a globalised world where different languages may be a barrier in medical aesthetics. The 8-point lift was the first facial code introduced. How do the treatment codes work? Every patient has a specific sequence that can be used to facilitate patient communication, treatment and financial planning, technical strategy and to avoid complications. Guidance is also provided on the recommended products and volume. Case Study 1: Young female patient complaining about tired look and eye-bags. The proposed treatment was the injection of L3 Tt1 Tt2 Tt3 with 1 ml of Juvéderm VOLBELLA® with Lidocaine. 1 Treatment strategy and patient record: Volume injected per side with Juvéderm VOLBELLA® with Lidocaine: ⦁ L3: 0,5 ml; Tt1: 0,2 ml; Tt2: 0,2 ml; Tt3: 0,1 ml ⦁ Codes tool: 27G cannula Results Case Study 2: Business man complaining about lateral eye-bag and tired eyes. He was open to surgery but could not have any downtime at that time. 2 A nonsurgical solution was proposed with the periorbital codes. He was offered a single or two sessions to achieve the expected result as follows: The patient opted for a single session and the treatment was delivered in the following sequence: Juvéderm VOLUMA® with Lidocaine (per side) ⦁ L1: 0,1 ml; 27 G needle supraperiosteal bolus ⦁ L2: 0,2 ml; 27G needle supraperiosteal bolus ⦁ L3: 0,2 ml; 25G blunt cannula medial deep malar fat pad Juvéderm VOLBELLA® with Lidocaine (per side) ⦁ Tt1: 0,3 ml; 27G blunt cannula ⦁ Tt3: 0,2 ml; 27G blunt cannula Results The result obtained was similar to surgery and the patient was impressed with the outcome. No anaesthesia was used and it was an office-based procedure. There was no downtime and the patient went back to professional activities on the same day. 3 Language of the code Each treatment code is numbered in a sequence in which the injections may be given. Usually, code number 1 is the most important in the respective area and code number 3 is the alert zone. The more codes an area has, the more sophisticated the treatment must be. The codes have been designed to provide a template injection pattern for the different areas of the face. Each area is represented by a letter which, when combined with a number, provides a unique injection pattern or treatment code. Below some other codes for the periorbital area F = Forehead T = Temples 4 These treatment codes are for guidance only and are to be individualised by the injector following a thorough assessment of the patient’s facial features. A sound knowledge of underlying anatomy is also necessary to avoid the risk of complications. They may be used to facilitate communication between the patient and injector. The codes have also shown to be helpful in the patient’s medical records and documentation. Financial and follow up planning are also part of this new concept that tends to be incorporated in clinical practice. 5