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TQ-021 · v4.2EN / ES01 / 12

Master technique guide · clinician

BiViDerma
technique guide.

A clinician-facing reference for injecting BiViDerma I, III, and V — covering product rheology, patient consultation, anatomical mapping, injection protocols by zone, post-treatment care, and adverse-event management.

Audience

Certified injectors

Last revision

March 2026

Revision cycle

Quarterly

02	Product family — rheology & positioning
03	Patient consultation framework
04	Pre-injection preparation
05	Anaesthesia options
06	Upper face — temple, glabella, brow
07	Peri-orbital — tear trough
08	Mid-face — cheek, NLF
09	Lower face — chin, jawline, marionette
10	Lips — vermillion, body, cupid's bow
11	Post-injection assessment & aftercare
12	Adverse-event decision tree

Koretreat Market SAS · ARCSA-2023-3.3-0000041For clinical use only

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TQ-021 · Technique guide02 / 12

Product family

Three densities. One scientific principle.

BiViDerma uses Multi-Layered Crosslinking (MLC) — three sequential cross-linking passes that capture a denser lattice inside a softer outer matrix. The result: hydration that stays where it's placed, with predictable rheology.

Variant	HA	G′	Cohesivity	Lift	Longevity	Indication
BiViDerma I Light · 30G TW	24 mg/ml	180 Pa	26 %	Low	9 mo	Lips, fine lines, tear trough, hydration
BiViDerma III Medium · 27G TW · 25G cannula	24 mg/ml	320 Pa	62 %	Medium	14 mo	Mid-face, NLF, marionette, chin contour
BiViDerma V High · 27G TW · 22G cannula	24 mg/ml	540 Pa	88 %	High	18 mo	Cheekbone, jawline, chin tip, deep volume

Storage

5–23 °C, ambient. No refrigeration required. Protect from direct sunlight. 24-month shelf life.

Lidocaine

All variants contain 0.3% lidocaine HCl for patient comfort. Verify allergy history before injection.

BDDE

Residual cross-linker < 2 ppm across all variants — within international safety thresholds.

Clinical · BiViDermav4.2 · 2026

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TQ-021 · Technique guide03 / 12

Step 01 · Consultation

Listen first. Inject last.

A structured 15-minute consultation prevents 80% of post-treatment disappointment. Photograph, document, and align expectations before opening a single syringe.

History. Allergies (lidocaine, BDDE-class agents), prior filler exposure, current medications including anti-coagulants and aspirin, pregnancy or breastfeeding status, active skin infection, autoimmune disease, dental work pending in next 4 weeks.
Expectations. Ask the patient to describe — not point at — what they want changed. Open-ended question: "If we did one thing today, what would have the biggest impact for you?" Listen for unrealistic goals (e.g. "I want to look like X").
Photograph. Standardised lighting, neutral background, 0°/45°/90° angles, rested expression and animated expression. Without this you have no medico-legal baseline.
Assess. Skin quality (Glogau scale), bone-loss pattern, fat-pad descent, asymmetry. Document on a face diagram — show the patient.
Plan. Volume estimate per zone, product per zone, total syringes, indicative price. Schedule a touch-up review at week 2.
Consent. Signed informed consent listing common risks (bruising, swelling) and rare risks (vascular occlusion, blindness). Patient initials each line.

Decline if

— Active herpes simplex or skin infection in the treatment area. — Patient under 18 (without specific legal context). — Body dysmorphic indicators or unrealistic expectations. — Pregnancy or breastfeeding. — Recent (< 2 weeks) dental work, vaccination, or another filler product in the same plane.

Clinical · BiViDermav4.2 · 2026

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Step 02 · Preparation

Mark, cleanse, anaesthetise.

Marking — patient upright

— Map gravity-dependent fat-pad descent.
— Mark vascular danger points: facial artery, infraorbital foramen, mental foramen, supratrochlear notch.
— Outline injection vectors with surgical pen.
— Show the patient in the mirror. Confirm.

Cleansing

— Remove makeup with micellar water.
— Cleanse with chlorhexidine 0.5% in 70% ethanol. Two passes.
— Avoid iodine-based preparations in the mid-face (staining, sensitivity).
— Allow 60 seconds to dry. Inject through a cleansed field only.

Tray setup checklist

BiViDerma syringe(s) — verify lot, expiry, integrity of packaging.
Cannulas in correct gauge(s) for the plan.
Needles 23G (entry pre-dilation), 27G, 30G.
Topical anaesthetic and remover.

Hyaluronidase 1500 U vial. Reconstitution solvent. Verify expiry.
Sterile gauze, cotton-tipped applicators.
Cold packs (clean, dry).
Camera ready. Consent form signed and visible.

Clinical · BiViDermav4.2 · 2026

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Step 03 · Anaesthesia

Comfort without compromise.

BiViDerma contains 0.3% lidocaine intrinsically. Topical and regional anaesthesia stack on top of this for sensitive zones — especially lips and tear trough.

Technique	Agent	Onset	Best for	Notes
Topical	Lidocaine 4% / prilocaine 2.5%	20 min	Lips, tear trough, fine lines	Apply under occlusion. Remove fully before injection — residue compromises adhesion of dressings.
Ice	Clean dry pack	30 s	Cheek, NLF, marionette	Hold against vector for 30 s immediately before puncture. Patient-titrated.
Infraorbital block	Lidocaine 2% + epi (intra-oral)	3 min	Tear trough, NLF, upper lip	Trans-mucosal at canine fossa. 0.5–1.0 ml per side. Risk: vascular event, transient ptosis.
Mental block	Lidocaine 2% (intra-oral)	3 min	Chin, lower lip, marionette	Trans-mucosal at second-premolar root. 0.5 ml per side.
Vibration / distraction	—	Immediate	All zones	Gate-theory based. Cheap, effective, no drug burden.

Anaesthetic limit

Maximum lidocaine dose 4.5 mg/kg (without epinephrine), 7 mg/kg (with). A standard mid-face plan (intrinsic + topical + block) is well within this limit, but track carefully for combined-zone work or low-weight patients.

Clinical · BiViDermav4.2 · 2026

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Zone 01 · Upper face

Temple. Glabella. Brow.

Temporal hollows

Product

BiViDerma V

Tool

22G × 70 mm cannula

Entry

1 cm inferior to the zygomatic arch, lateral canthus vertical

Plane

Supraperiosteal (deep) or sub-galeal (superficial)

Volume

0.5–1.0 ml per side, divided into 2–3 fan vectors

Avoid

Middle temporal artery (runs ~1 cm anterior to tragus, deep)

Glabella — fine lines

Product

BiViDerma I (consider neuromodulator first)

Tool

30G × 13 mm needle, intradermal threading

Entry

Lateral end of each glabellar line

Plane

Mid dermis

Volume

0.05–0.15 ml total. Never bolus.

Avoid

Supratrochlear / supraorbital — retinal anastomosis. Stay superficial, retrograde only, < 0.05 ml per pass.

The glabella is a high-stakes zone

Most reported blindness events from filler injection involve the glabella or nasal dorsum. If the patient's primary concern is dynamic glabellar lines, neuromodulator is the safer first intervention. Reserve filler for static residual lines only, intradermal, threading retrograde with minimal volume.

Clinical · BiViDermav4.2 · 2026

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Zone 02 · Peri-orbital

Tear trough.

The tear trough rewards conservatism — over-correction is more disfiguring than under-correction. Use only the lightest product, pre-periosteal, in 0.05-ml aliquots.

Product

BiViDerma I — the only variant for this zone.

Tool

25G × 38 mm cannula. Sharp needle is acceptable only for experienced injectors using pre-periosteal serial puncture.

Entry

2 cm inferior to the lid margin, mid-pupil vertical. Pre-dilate with 23G needle.

Plane

Pre-periosteal — directly on bone. Anything above this risks Tyndall, lymphatic congestion, or visible product.

Vector

From entry point, advance cannula medial along the inferior orbital rim. Inject on retraction only, 0.05 ml every 5 mm.

Volume

0.2–0.5 ml per side total. Stop earlier than feels right.

Avoid

Infraorbital foramen (1 cm below the rim, mid-pupil). Stay deep to the orbicularis. Never inject superficial in this zone.

Patient selection

— Tear-trough deformity in the absence of lower lid bag.
— Adequate skin thickness (pinch test > 2 mm).
— No history of malar oedema.

Decline if

Festoon or lower-lid bag present.
Thin skin, prone to Tyndall.
Previous unsatisfactory tear-trough work elsewhere — dissolve first, treat later.

Clinical · BiViDermav4.2 · 2026

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Zone 03 · Mid-face

Cheekbone. Anterior cheek. NLF.

Zygomatic / malar projection

Product

BiViDerma V (structural) ± III (anterior blending)

Tool

25G × 50 mm cannula. 27G needle acceptable for periosteal bolus on the zygomatic apex.

Entry

Pre-jowl sulcus or anterior to the zygomatic arch

Plane

Supraperiosteal — directly on bone, deep to SMAS

Volume

0.8–1.5 ml per side. Bolus 0.2–0.3 ml on bone, then fan anteriorly with III in deep fat compartment.

Avoid

Transverse facial artery (parallel to zygomatic arch, 1 cm inferior). Stay on bone.

Nasolabial fold (NLF)

Product

BiViDerma III

Tool

25G × 50 mm cannula. Cannula strongly preferred — facial artery runs at the medial cheek base.

Entry

Cephalic to the fold apex, lateral to nasal ala

Plane

Deep dermis blending into SMAS

Volume

0.4–0.8 ml per side. Linear threading, retrograde.

Pearl

Soften the fold; do not erase it. Over-correction produces an unnatural lateral shelf.

NLF + glabella + nose = highest published occlusion sites

If the patient has had a prior occlusion in any of these zones, do not inject the same territory. Refer to a senior colleague.

Clinical · BiViDermav4.2 · 2026

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Zone 04 · Lower face

Chin. Jawline. Marionette.

Chin — projection & contour

Product

BiViDerma V

Tool

27G × 25 mm needle (mid-line periosteal bolus); 22G × 50 mm cannula for lateral blending

Plane

Supraperiosteal

Volume

0.5–1.5 ml total. 0.3–0.5 ml mid-line bolus + lateral blending.

Avoid

Mental foramen (vertical line below second premolar). Stay medial of foramen for the bolus.

Jawline

Product

BiViDerma V

Tool

22G × 70 mm cannula

Entry

Pre-jowl notch and gonial angle (two entry points per side)

Plane

Supraperiosteal

Volume

1.0–2.0 ml per side. Linear retrograde threading along the inferior mandibular border.

Pearl

Stop 1.5 cm posterior to the mental foramen on each side. Re-enter from the gonial angle for the posterior jaw — do not push a single thread across.

Marionette

Product

BiViDerma III

Tool

25G × 50 mm cannula

Entry

Lateral commissure

Plane

Deep dermis

Volume

0.3–0.6 ml per side

Clinical · BiViDermav4.2 · 2026

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Zone 05 · Lips

Vermillion. Body. Cupid's bow.

Lips show every error. Plan vectors before opening the syringe; never improvise on the table.

Vermillion border

Product

BiViDerma I

Tool

30G × 13 mm needle

Technique

Linear retrograde threading along the white roll

Plane

Submucosal, just deep to vermillion

Volume

0.1–0.3 ml per lip

Lip body (hydration / volume)

Product

BiViDerma I

Tool

30G × 13 mm needle, or 27G × 38 mm cannula for experienced injectors

Technique

Serial micro-puncture (0.02 ml per puncture) along the wet/dry junction

Plane

Submucosal

Volume

0.2–0.5 ml per lip

Cupid's bow

Tool

30G × 13 mm needle

Technique

Two precise punctate boluses, 0.02 ml each, at the philtral column tubercles

Plane

Submucosal

Volume

0.04–0.08 ml total

Lip ratios

Aim for an upper:lower lip ratio of 1:1.6 (golden) for European morphology. Asian and African lip morphology may target 1:1 to 1:1.3. Match the patient's facial proportions, not a single universal target.

Clinical · BiViDermav4.2 · 2026

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Step 04 · Post-injection

Assess, instruct, schedule.

Immediate assessment (5 minutes on the table)

Patient upright. Reassess in natural light. Photograph mirror-image of pre-treatment angles.
Animate. Smile, frown, purse. Identify any dynamic asymmetry.
Gentle massage for even distribution — only where intended, never where contraindicated (tear trough, lip body).
Capillary refill test in any zone of concern. > 2 seconds → reassess for occlusion.
Cold compress 5 minutes before the patient leaves.

Patient instructions

Hand the patient the relevant aftercare PDF (AC-001 for lips, AC-002 if mid-face was treated). Walk through it before they leave. Confirm:

They understand 24/7 hotline access at +593 988 089 010.
They have your direct email or messaging contact.
Review appointment is booked at 2 weeks.
They know red flags: severe pain, blanching, vision changes, fever.

Documentation

In the patient record: lot numbers per syringe used, volume per zone, technique (cannula vs needle, gauge), anaesthesia used, immediate adverse events, post-procedure photographs, instructions provided, follow-up scheduled.

Clinical · BiViDermav4.2 · 2026

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Step 05 · Adverse events

Decision tree.

Event	Timing	First action	Escalation
Bruising	0–7 d	Pressure, ice, arnica topical	Pulsed-dye laser if persistent > 7 d
Swelling	0–3 d	Cold compress, head elevation	Antihistamine if > 3 d; steroid only if severe
Lumps / nodules	2–14 d (early), 4 wk+ (late)	Massage if early; reassure	Late nodule → hyaluronidase + steroid; biopsy if persistent
Vascular occlusion	Immediate	STOP. Hyaluronidase 200–450 U. Warm compress. Aspirin 325 mg.	Hospital if > 4 h or any visual symptom
Visual symptoms	Immediate	STOP. Call 24/7 hotline. Patient flat. Hospital transfer.	Ophthalmology emergency
Infection	3 d+	Culture, oral antibiotics	IV antibiotics + hyaluronidase if abscess
Granuloma	Weeks–months	Document, photograph	Intralesional steroid + hyaluronidase + 5-FU
Tyndall (bluish)	Days–weeks	Hyaluronidase to dissolve	Re-treat in correct plane after 2 wk

Support contacts

+593 988 089 010

24/7 clinical hotline

farmacovigilancia@
koretreat.com

Reporting

— Within 48 h of any adverse event.
— ARCSA notification filed by Koretreat on your behalf.
— Maintain your local patient record per Ecuadorian regulations.

Disclaimer. This guide is a reference, not a replacement for certified training. BiViDerma practitioner certification is conducted quarterly by Koretreat — contact training@koretreat.com. Local regulation (Ecuador: ARCSA) may impose additional requirements. Practitioners are responsible for adherence to their jurisdiction's rules and their own clinical judgement.

Koretreat Market SAS · ARCSA-2023-3.3-0000041TQ-021 · v4.2 · 2026

BiViDermatechnique guide.

Contents

Three densities. One scientific principle.

Storage

Lidocaine

BDDE

Listen first. Inject last.

Decline if

Mark, cleanse, anaesthetise.

Marking — patient upright

Cleansing

Tray setup checklist

Comfort without compromise.

Anaesthetic limit

Temple. Glabella. Brow.

Temporal hollows

Glabella — fine lines

The glabella is a high-stakes zone

Tear trough.

Patient selection

Decline if

Cheekbone. Anterior cheek. NLF.

Zygomatic / malar projection

Nasolabial fold (NLF)

NLF + glabella + nose = highest published occlusion sites

Chin. Jawline. Marionette.

Chin — projection & contour

Jawline

Marionette

Vermillion. Body. Cupid's bow.

Vermillion border

Lip body (hydration / volume)

Cupid's bow

Lip ratios

Assess, instruct, schedule.

Immediate assessment (5 minutes on the table)

Patient instructions

Documentation

Decision tree.

Support contacts

Reporting

BiViDerma
technique guide.