1.

Product preparation & pre/post-treatment advice

2. Fibrosis
3. Scars
4. Cellulite
5. Lifting & anti-aging therapy
6. Stretch marks
7. Double chin & Facial remodelling
8. Localized fat (body)
9. Lipoma (?)
10. Flaccidity
11. Eye bags
12. Hand rejuvenation
HIGH

MEDIUM

LOW
PREPARATION INSTRUCTIONS

1. Reconstitute the lyophilized powder of the enzymatic

reagent with the 1.5mL of HA

+
Once it is totally solved, collect the content with the
1,5 mL syringe.

2. Mix the reconstituted product with the Reconstitution

buffer (the final volume may vary) and shake gently
until homogeneous mix.

Collect the final content (enzymes + HA + buffer) into

the syringe

··Optional use of SIMPLE LIDOCAINE

··If the amount of liquid is too high for the treatment,

remove some saline solution from the big vial before mixing
it with the reconstituted powder.
Number of sessions

From the very first session, visible improvement will be appreciated. Then, depending on the case, the
characteristics of the patient and other factors, the total number of sessions may vary.

On average, the number of applications required to get the final result may vary from 1 to 3. However,
there are pathologies which might require some more sessions (e.g. severe fibrosis and scars with many
years of evolution).

Post-treatment advice
· Rest 24 a 48 h (no intense exercise)

· Avoid swimming pool or sauna

· Drink water and reduce carbohydrate intake (Medium)

· +50SPF

Precautions
· Autoimmune disease, including psoriasis
· Atopia
· Unsolved allergic reactions / Cutaneous hypersensitivity (sun, metals, etc.)

· Hepatic disorder/ Renal disorder

· Vascular/Coagulation problems

· Uncontrolled diabetes

· Pregnancy or breast-feeding

· Infection (special care of S. aureus)

· Vaccines (wait 15 days)

 CASE DETAILS PRODUCT CHOICE APPLICATION LEVEL

Can be applied after surgery (e.g.

liposuction) as a preventive
treatment.
FIBROSIS HIGH Fibrotic tissue
Only product in the market able to
definitely remove existant fibrosis in a
tissue.

Any type of scar, even atrophic ones.

SCARS Older scars will require more sessions HIGH Intralesional
than more recent ones.

Prioritise treatment of bigger nodules

CELLULITE HIGH Inside nodules
in case the area is too big.

LIFTING Loose skin with wrinkles and flaccidity HIGH / LOW Superficial (papule)

Better result in red ones, specially

STRETCH MARKS those associated to flaccidity. HIGH Intralesional (superficial)
White ones also improve.

DOUBLE CHIN & Excess fat deposits in cheeks, neck,

FACIAL double chin. MEDIUM / LOW Adipose panicle (subdermal)
REMODELLING Redefinition of jawline.

Removal of localized fat

LOCALIZED FAT accumulations in specific areas. MEDIUM Adipose panicle (subdermal)
(Not for global weight loss)

If encapsulated or too vascularized,

LIPOMA MEDIUM Inside lipoma
do not use PBSerum Medical.

FLACCIDITY Loose skin, accordion-like folds of skin. HIGH / LOW Superficial (papule)

Eye bags with excess oedema and/or

EYE BAGS LOW Inside eye bag
fa
FIBROSIS AFTER SURGERY
HIGH

1. Clean the area with an antiseptic solution (e.g. chlorhexidine) before the injection.

2. It is recommended to use a pencil to delimit the priority sections and make a division between the
places where there is more fibrotic tissue and those with less fibrosis. This will help to choose the main
areas to be treated in case the amount of product is limited.
• In a general basis, the final total volume of 19.5 mL is to be used in a 20x20cm area (for
intense fibrosis) or a wider one in milder cases (where the product can be distributed more
extensively).
3. Start infiltrating the reconstituted preparation directly inside the fibrotic tissue performing retro-
injections (see fig.1).
• Suggested needle: 30Gx1/2 (13mm) or 30Gx1 (25mm) for very deep fibrosis
• Use between 0,2 ml and 0,4 mL of product and apply it every 1,5cm in retro-injection.
4. Continue the multipuncture with retro-injection in different points and different angles all along the
area affected with fibrosis. Alternatively, the fan technique can also be performed (fig.2).

5. Additional superficial injections can be performed in the areas with depressions or adhesions, if there
are any.

0,2
mL

0,2
mL

0,2 mL

Fig. 1 Fig. 2
SCARS (HYPERTROPHIC, KELOID)
HIGH
1. Clean the area with an antiseptic solution (e.g. chlorhexidine) before the injection.

2. Consider applying some topical anaesthesia in painful scars, as well as adding some lidocaine
(without epinephrine) to the vial, in order to minimize discomfort during application.

3. Start infiltrating the reconstituted preparation directly inside the scar performing a retro-injection
(see fig.1).
• Suggested needle: 30Gx1/2 (13mm)

4. Continue the multipuncture with retro-injection in different points and different angles all along the
scar. (usually leaving a distance of approximately 1-2 cm between each puncture).

5. Finish with superficial injections using blanching technique (see fig.2).

The idea is filling the scar in deep, medium and superficial level with the maximum quantity of product in
order to work intensively on the degradation of excessive and amorphous collagen fibres and to stimulate
the tissue’s regeneration.

The final volume of reconstituted product needed here will vary depending on the size of the scar. (e.g., a
post-cesarean scar normally requires up to 9-10 mL, while a small area with acne scars can be covered
with 4 mL).

0,2
mL Fill the
0,2
scar
mL

0,2 mL

Fig. 1 Fig. 2
SCARS (ATROPHIC, ACNE MARKS)
HIGH
1. Clean the area with an antiseptic solution (e.g. chlorhexidine) before the injection.

2. Consider applying some topical anaesthesia in painful scars, as well as adding some lidocaine
(without epinephrine) to the vial, in order to minimize discomfort during application.

3. Start infiltrating the product directly inside the scar performing superficial injections with blanching
technique (see fig.1). Apply as much volume of product as needed to form a papule that covers
the whole scar.
• Suggested needle: 30Gx1/2 (13mm)
• Optionally, in areas with acne scar, a cannula can be used. (see video)

4. Finally, do some deep infiltrations leaving 1-2 cm distance in between and applying about 0.2-0.3
cc per puncture

5. Additionally, subcision movements can be performed right under the surface of the scar to
mechanically break down the collagen fibres that are responsible of the tension creating the
depression (specially in acne scars) (see fig.2).

The idea is filling the scar with a papule in order to work intensively on the degradation of excessive
and amorphous collagen fibres and to stimulate the tissue’s regeneration.
The final volume of reconstituted product needed here will vary depending on the size of the scar.
(e.g., a post-cesarean scar normally requires up to 9-10 mL, while a small area with acne scars can be
covered with 4 mL).

0,1-0,3 cc

Fig. 2
Fig. 1
ORANGE PEEL SKIN
HIGH
1. Firstly, localize the fibrotic nodules and the depressions. Draw lines and circles around them to use
as a guide during the injections (the orange peel may look smoother when the patient is lying on
the stretcher).

• If the area to treat is extense, consider using 1 box of HIGH on each side (one for left thigh,
one for right one): total of 2 boxes of HIGH.
• If this is not possible, prioritise the treatment of deeper nodules and leave the rest for next
sessions (it is preferrable to obtain good result in a few nodules than trying to cover a very
big area with a limited amount of product)

2. Clean the area with an antiseptic solution (e.g. chlorhexidine) before the injection.
3. Start infiltrating the product directly inside the nodule performing superficial injections with
blanching technique (see fig.1). Apply approximately 0.1-0.3cc per puncture or as much as needed
to form a papule that fills the whole depression.
• Suggested needle size: 30Gx1/2 (13mm)

4. Additionally, subcision movements can be performed superficially inside the depression in order to
mechanically break down the collagen fibres that are responsible of the tension creating the
nodule (see fig.2).
5. Finally, in bigger nodules, perform some deep infiltrations (retro injection), depositing 0.2-0.3 cc per
puncture (to reach deep fibrotic areas)

Add some sessions with Medium (1 – 2 boxes) if it is required to reduce volume due to excess fat
accumulation in localized areas. (see “Localized fat” protocol)

0,1-0,3 cc

Fig. 1
Fig. 2
Protocol for global cellulite treatment

HIGH
(fibrotic nodules)

MEDIUM MEDIUM
(localized fat) (localized fat)

HIGH
(fibrotic nodules)

HIGH MEDIUM
FACE AND NECK LIFTING (intensive)
HIGH
1. Clean the area with an antiseptic solution (e.g. chlorhexidine) before the injection.

2. Reconstitute the product obtaining an appropriate amount of final volume depending on the
extension of the area to treat.
• (e.g., using the whole 19.5 mL we can cover both neck and décolleté; if the case requires
focusing on a small region of the face/neck, it is possible to concentrate the product and
use less amount of reconstitution buffer to obtain a smaller final volume).

3. Perform superficial injections (dermis) all over the area with loose skin and accordion-like skin folds
(see picture 1), leaving a small papule and approx 1-2 cm distance between each puncture
(mesotherapy-like technique).

4. When there is also sagging tissue in jowls, cheeks and neck (see picture 2), infiltrate the product
with a 13mm (30-32G) needle directly in retroinjection, leaving 0,2-0,1-0,1mL of product at deep-
medium-superficial layers. We may previously pinch the skin to improve penetration.

The High is used instead of the Low to treat flaccidity and accordion-like skin folds in a more intense
way (both in face and body).

0,1-0,3 cc

Fig. 1

Picture 1 Picture 2
STRETCH MARKS
HIGH

1. Clean the area with an antiseptic solution (e.g. chlorhexidine) before the injection.

2. Start infiltrating the product directly inside the stretch mark performing superficial injections with
blanching technique (see fig.1), creating a papule and covering the whole stretch mark.

• Suggested needle: 30Gx1/2 (13mm)

The final volume of reconstituted product needed here will vary depending on the size of the area or
on the amount of stretch marks.

The best results will be obtained at an early stage of development of the stretch mark (red ones are
the easiest ones to treat), although visible improvement will be observed in both white and red stretch
marks.
Flaccidity that comes with stretch marks (specially after weight loss or pregnancy) will be also improved
with this treatment.

0,1-0,3 cc

Fig. 1
FACIAL REMODELLING & DOUBLE CHIN
(intensive localized fat removal)
MEDIUM
1. Remove the makeup and clean the area with an antiseptic solution (e.g. chlorhexidine) before the
injection.

2. APPLICATION WITH 13 mm NEEDLE:

a) Draw a mesh in the area of treatment (1,5 x 1,5 squares)

b) Use between 0,2 ml and 0,4 mL of product previously mixed in the syringe, apply it every
1,5cm performing retro-injection.

3. APPLICATION WITH CANNULA:

Define the area of treatment and decide the place/s of cannula introduction performing the FAN
TECHNQUE to infiltrate the product uniformly in all the area.

4. When treating excess fat accumulation in jowls, we will inject the product with a 13mm or 25mm 30-
32G needle directly in the adipose panicle (we may pinch the skin to improve penetration) and
perform retroinjection, leaving 0,2-0,1-0,1mL of product at deep-medium-superficial layers.

In any case, it is reminded that the final volume of 19,5 mL of PBSerum HA1.5 + MEDIUM can cover an
approximate area of 20cmx20cm. For smaller areas, please consider using an inferior amount of
reconstitution buffer to obtain a smaller final volume of product (e.g. 10 mL).
FACIAL REMODELLING & DOUBLE CHIN
(less severe cases, smaller areas, fat & flaccidity)
LOW
1. Remove the makeup and clean the area with an antiseptic solution (e.g. chlorhexidine).
2. Draw a mesh (leaving 1-2 cm between the lines) on the area to treat, delimiting the more
problematic zones (giving priority to them in case there is a limited amount of product)
3. For the treatment of flaccidity, perform superficial injections all along the lines of the mesh.
4. To work on fat accumulation, perform deep injections with a 13 mm needle (30 or 32G) in the
center of the squares delimited by the lines of the mesh. Ideally, retro injections will be performed in
this case (depositing 0.2-0.1-0.1cc of the product from a deep to a medium/superficial level).
5. If there is localized fat in the jowls (or in the cheeks), we can perform a fan technique with a
cannula depositing the product uniformly in retro injection and changing the injection angle to
cover a 360º area.
6. Alternatively, we can use a13mm or a 25mm (30-32G) needle directly in the adipose panicle of the
jowl or the cheek (we may pinch the skin to improve penetration) and perform retroinjection, leaving
0,2-0,1-0,1mL of product at deep-medium-superficial layers..

The choice between Low or Medium will depend on the amount of fat that is present in the area: If
there is a high accumulation of fat, a Medium will be more adequate (see protocol for intense double chin
treatment). Otherwise, Low will be the product of choice.

In case of extreme flaccidity, the use of High in superficial infiltration with papules or following the lines
of a mesh can be considered as an alternative (see protocol facial rejuvenating)

mesh Fan technique

LOCALIZED FAT ACCUMULATION
MEDIUM

1. Clean the area with an antiseptic solution (e.g. chlorhexidine) before the injection.

2. Delimit the priority sections with a pencil and make a division between the places where there is
more fat tissue and those with less. This will help to choose the main areas to be treated in case the
amount of product is limited.
• In a general basis, the final total volume of 19.5 mL is to be used in a 20x20cm area

3. Start infiltrating the reconstituted preparation directly inside the fat tissue performing retro-injections
(see fig.1).
• Suggested needle: 30Gx1/2 (13mm) or 30Gx1 (25mm) for very deep fat accumulation

4. Continue the multipuncture with retro-injection all along the area affected with excess fat
accumulation, depositing 0.3-0.4 mL per puncture and leaving a distance of approximately 2 cm
between each injection point.

5. Also, a cannula could be a good option to infiltrate the product in the area, performing fan
technique (fig. 2) and depositing the product uniformly all over the area.

0,2 mL

0,2 mL

0,2 mL

Fig. 1 Fig. 2
LIPOMA
MEDIUM

1. Clean the area with an antiseptic solution (e.g. chlorhexidine) before the injection.

2. Inject directly inside the lipoma performing retro injection and filling it in all tissue layers. Do this from
different angles to ensure the complete filling of the lipoma with enough amount of product.

• Suggested needle: 13mm 30G (or 35G).

It will not be necessary to use the whole content of the reconstitution buffer vial present in the box, as the
final volume of product needed to treat one lipoma usually is small (4-6 mL of final volume would be
enough for small-medium lipomas; we can increase the volume for bigger lipomas or cases with more than
one lipoma).

IMPORTANT!

It is crucial to do get a right diagnose of the case before choosing this treatment. First of all, the doctor
should make sure the lump is indeed a lipoma and not something else (by using detection techniques such
as MRI scan or others, besides physical examination).
Then, this protocol applies to simple lipomas, not too vascularized and easy to access. If the lipoma is too
encapsulated or has too much vascularization, the doctor may consider another option to remove it.

0,2 mL

0,2 mL

0,2 mL

Fig. 1 Fig. 2
FLACCIDITY
LOW

1. Clean the area with an antiseptic solution (e.g. chlorhexidine) before the injection.

2. Draw a mesh on the affected area.

(In wider areas, if the amount of product is limited, draw vertical lines instead, e.g. thighs)

3. Perform superficial injections all along the lines.

• In case of excess fat accumulation too, additional deep injections will be performed
in this case (depositing 0.2-0.3 cc of the product from a deep to a
medium/superficial level).

4. Another option consists in performing superficial injections (dermis) all over the area, leaving a small
papule and approx 1-2 cm distance between each puncture.

If there is severe flaccidity, loose skin or accordion-like skin folds, consider using PBSerum HIGH instead
of LOW (as per seen in the rejuvenating protocol for face).

Superficial

Deep
EYE BAGS
LOW
1. Remove the makeup and clean the area with an antiseptic solution (e.g. chlorhexidine) before the
injection.

2. Use a cannula to avoid bruises due to excessive puncture and to deposit the product uniformly all along
the eye bag (see video, next slide). The maximum amount of liquid to be infiltrated per eye bag is 2mL
(take this into account when preparing the dilution, using only the required amount of reconstitution
buffer).
• So, in this case, the usual final volume of reconstituted product would be 4 mL (1.5 mL HA +
2.5 mL reconstitution buffer)

3. If preferred, the use of a small 4mm needle can also be suitable, performing several punctures inside the
eye bag.

Remember the LOW is to be applied in eye bags caused by excess oedema and/or fat. If the problem is only
loose skin or wrinkles (usually coming along with a depression in the area), then please consider choosing
another treatment.

LOW can also be applied on upper eye lid if there is also oedema and/or fat there (see video next slide)

Cannula Needle 4 mm
HAND REJUVENATION
LOW

1. Clean the area with an antiseptic solution (e.g. chlorhexidine) before the injection.
2. Draw longitudinal lines along the hand, a guideline for injection (see fig.1.). Reconstitute the
product in 5ml of total volume (1,5mL HA + 3,5mL Buffer Solution, or 3mL of Buffer Solution
and 0,5mL of Simple Lidocaine).
3. Start infiltrating the product along the drawn lines, performing superficial injections with
blanching technique (see fig.2) separated 01cm approximately, leaving about 0,1mL per
puncture, leaving a papule. Make additional injections in most problematic areas (i.e.
knuckles).
• Suggested needle size: 30Gx1/2 (4mm)

4. For better access to the tissue, we recommend to pinch the skin a little, like you may see in
the video in the next slide.

In less evident flaccidity cases, we may substitute HIGH product by LOW, following the same protocol.

0,1-0,3 cc

Fig. 2

Fig. 1