Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_813_Библиотеки_им_академика_М_И_Перельмана.pdf
468 Part IX&Body Contouring
Answers
PREOPERATIVE CONSIDERATIONS
1. Which of the following bariatric surgery techniques is considered both a restrictive and malabsorptive procedure?
D. Roux-en-Y gastric bypass.
The answer is D, Roux-en-Y gastric bypass, which is the most common bariatric surgery procedure performed, which contains both malabsorptive and restrictive components. Body contouring procedures must
be performed with caution in this patient population as vitamin, mineral, and nutritional deficiencies can be
seen in up to 40% of patients. All other answer choices are considered restrictive procedures only.
REFERENCES
1. Aly AS. Body Contouring After Massive Weight Loss. New York: Thieme Publishers; 2006
2. Rubin JP, Nguyen V, Schwentker A. Perioperative management of the post-gastric-bypass patient presenting for
body contouring surgery. Clin Plast Surg 2004;31:601
3. Hamad GG. The state of the ar t in bariatric surgery for weight loss in the morbidly obese patient. Clin Plast Surg
2004;31:591
4. Gilbert EW, Wolfe BM. Bariatric surgery for the management of obesity: state of the field. Plast Reconstr Surg
2012;130:948
PREOPERATIVE CONSIDERATIONS
2. After gastric bypass surgery, when should body contouring be performed?
E. After weight stabilization for at least 6 months.
The answer is E, after weight stabilization for at least 6 months. This usually occurs when patients’ BMI is
between 30 and 35, which usually occurs 12 to 18 months after surgery making answers A, B, and C incorrect.
Active weight fluctuation is a contraindication to performing body contouring as rapid weight loss can interfere with wound healing and overall body contour.
1,2,3,4
1,2,3,4
REFERENCES
1. Aly AS. Body Contouring After Massive Weight Loss. New York: Thieme Publishers; 2006
2. Rubin JP, Nguyen V, Schwentker A. Perioperative management of the post-gastric-bypass patient presenting for
body contouring surgery. Clin Plast Surg 2004;31:601
3. Hamad GG. The state of the ar t in bariatric surgery for weight loss in the morbidly obese patient. Clin Plast Surg
2004;31:591
4. Gilbert EW, Wolfe BM. Bariatric surgery for the management of obesity: state of the field. Plast Reconstr Surg
2012;130:948
PREOPERATIVE CONSIDERATIONS
3. What is the most common nutritional deficiency after bariatric surgery?
A. Iron deficiency anemia.
The answer is A, iron deficiency anemia, which is especially common after malabsorptive procedures. Rickets is
caused by extreme and prolonged vitamin D deficiency which may lead to osteomalacia. Scurvy is caused by a
severe lack of vitamin C (ascorbic acid) which may lead to weakness, anemia, gum disease, poor wound healing,
and skin hemorrhages. Pellagra is caused by low levels of niacin (vitamin B-3) which may lead to dementia, diarrhea, and dermatitis, also known as “the three Ds.” If left untreated, pellagra can be fatal. Beriberi is secondary to
thiamine deficiency (vitamin B-1) which may lead to weakness, neuropathies, and pain in the limbs. All other
answers may occur after weight loss surgery but are not as common as iron deficiency anemia.
1,2
REFERENCES
1. Kenkel J. The physiological impact of bariatric surgery on the massive weight loss patient. Plast Reconstr Surg
2006;117(1 Suppl):14S; discussion 82S
2. Kenkel J. Safety considerations and avoiding complications in the massive weight loss patient. Plast Reconstr
Surg 2006;117(1 Suppl):74S; discussion 82S
Chapter 62&Body Contouring in Massive-Weight-Loss Patients 469
OPERATIVE SELECTION
4. In a patient with both horizontal and vertical abdominal excess, addition of which of the following surgical
techniques will improve body contour?
B. Vertical resection (fleur-de-lis).
The answer is B, vertical resection resulting in a fleur-de-lis or corset abdominoplasty. Although progressive
tension sutures, mons lift, and circumferential body lift may improve body contour, only addition of vertical
resection will treat both vertical and horizontal excess.
abdominoplasty. Redundant vertical tissue above the umbilicus is removed as a triangle connected to the
redundant skin in the lower abdomen, which is marked as a standard abdominoplasty. Points A and B
will join as an inverted-T closure in the midline at the pubic symphysis (point C). In patients with significant mons ptosis, point Ć is marked 4 to 6 cm below to resect additional inferior redundancy and to elevate the mons.
1,2
Fig. 62.1 shows markings for a fleur-de-lis
Fig. 62.1 Markings for a fleur-de-lis abdominoplasty. Redundant vertical tissue above the umbilicus is removed
as a triangle connected to the redundant skin in the lower abdomen, which is marked as a standard abdominoplasty. Points A and B will join as an inverted-T closure in the midline at the pubic symphysis (point C). In
patients with significant mons ptosis, point C′ is marked 4 to 6 cm below to resect additional inferior redundancy and to elevate the mons.
Aesthetic Surgery. 1st Edition. New York: Thieme; 2018.)
(Source: Surgical approach to the trunk/abdomen. In: Janis J, ed. Essentials of
REFERENCES
1. Kenkel J. Marking and operative techniques. Plast Reconstr Surg 2006;117(1 Suppl):45S; discussion 82S
2. Aly AS, Cram AE, Heddens C. Truncal body contouring surgery in the massive weight loss patient. Clin Plast Surg
2004;31:611
470 Part IX&Body Contouring
SURGICAL ANATOMY
5. In a standard brachioplasty, which structure is most at risk for damage?
C. Medial antebrachial cutaneous nerve.
The answer is C, medial antebrachial cutaneous nerve, which arises from the medial cord of the brachial
plexus, which is the most common neurovascular structure damaged during brachioplasty. Liposuction
prior to resection preserves neurovascular structures and facilitates easy resection of subcutaneous tissues.
All the structures in the other answer choices are much deeper and should not be encountered during a
brachioplasty.
1,2
REFERENCES
1. Cannistra C, Valero R, Benelli C, et al. Brachioplasty after massive weight loss: a simple algorithm for surgical
plane. Aesthetic Plast Surg 2007;31:6
2. Knoetgen J III, Morgan SL. Long-term outcomes and complications associated with brachioplasty: as retrospective review and cadaveric study. Plast Reconstr Surg 2006;117:2219
PATHOPHYSIOLOGY OF FACIAL AGING
6. What is the cause of premature facial aging in the massive weight loss patient?
C. Skin redundancy.
The answer is C, skin redundancy. Relaxation of the facial retaining ligaments can lead to tear trough deformities and jowls while superficial musculoaponeurotic system (SMAS) laxity is a common cause of facial
aging in non-massive weight loss patients. Skin redundancy is the most common etiology of facial aging
in the massive weight loss patient.
1
REFERENCE
1. Sclafani AP. Restoration of the jawline and the neck after bariatric surgery. Facial Plast Surg 2005;21:28
POSTSURGICAL COMPLICATIONS
7. Early seroma after body contouring procedures is best treated first with which of the following modalities?
B. Aspiration.
The answer is B, aspiration, which is considered the first-line treatment for early seromas. Compression is
usually ineffective as the sole modality, and sclerosing/seroma cavity resection is useful for late seromas
refractory to aspiration and closed suction drain placement.
1,2
REFERENCES
1. Kenkel J. The physiological impact of bariatric surgery on the massive weight loss patient. Plast Reconstr Surg
2006;117(1 Suppl):14S; discussion 82S
2. Kenkel J. Safety considerations and avoiding complications in the massive weight loss patient. Plast Reconstr
Surg 2006;117(1 Suppl):74S; discussion 82S
POSTSURGICAL COMPLICATIONS
8. Which of the following body contouring procedures is associated with the highest venous thromboembolism
risk?
C. Abdominoplasty.
The answer is C, abdominoplasty, which is associated with increased intraabdominal pressure leading to
decreased venous return from the extremities. Although all the other options have a lower risk of venous
thromboembolism (VTE), the Caprini score should be used for every patient undergoing body contouring
procedures to evaluate risk and determine the best modality of prophylaxis.
1,2,3
REFERENCES
1. Rubin JP, Nguyen V, Schwentker A. Perioperative management of the post-gastric-bypass patient presenting for
body contouring surgery. Clin Plast Surg 2004;31:601
Chapter 62&Body Contouring in Massive-Weight-Loss Patients 471
2. Kenkel J. Safety considerations and avoiding complications in the massive weight loss patient. Plast Reconstr
Surg 2006;117(1 Suppl):74S; discussion 82S
3. Moran MC. Benefits of epidural anesthesia over general anesthesia in the prevention of deep vein thrombosis
following total hip arthroplasty. J Arthroplasty 1995;10:405
SURGICAL ANATOMY
9. Suturing of Scarpa's fascia of the thigh to which of the following structures increases longevity of the result
and decreases the risk of hypertrophic scarring?
C. Colles fascia.
The answer is C, Colles fascia, also known as the superficial perineal fascia. Securing the superficial fascial
system of the thigh to Colles fascia prevents scar migration and widening. Dartos fascia is present in the penis
and therefore incorrect. Camper's fascia is ill-defined, superficial, and would not provide a lasting result.
Suturing the superficial fascial system to the inguinal ligament would not provide the correct vector of pull
and place neurovascular structures at unnecessary risk.
1,2
REFERENCES
1. Kenkel J. Marking and operative techniques. Plast Reconstr Surg 2006;117(1 Suppl):45S; discussion 82S
2. Aly AS, Cram AE, Heddens C. Truncal body contouring surgery in the massive weight loss patient. Clin Plast Surg
2004;31:611
PATIENT SELECTION
10. At what body mass index (BMI) is body contouring after massive weight loss considered ideal?
B. 25–30.
The answer is B, 25 to 30, as the risk of surgical complications dramatically decreases as patients approach
their ideal body weight. A body mass index (BMI) of <18 after weight loss surgery may suggest malnutrition
while obese patients (BMI >30) may still be losing weight and are at higher risk of postoperative complications and dissatisfaction.
1,2,3,4
REFERENCES
1. Aly AS. Body Contouring After Massive Weight Loss. New York: Thieme Publishers; 2006
2. Rubin JP, Nguyen V, Schwentker A. Perioperative management of the post-gastric-bypass patient presenting for
body contouring surgery. Clin Plast Surg 2004;31:601
3. Hamad GG. The state of the ar t in bariatric surgery for weight loss in the morbidly obese patient. Clin Plast Surg
2004;31:591
4. Gilbert EW, Wolfe BM. Bariatric surgery for the management of obesity: state of the field. Plast Reconstr Surg
2012;130:948
63. Female Aesthetic Genital Surgery
Sammy Sinno, Jeremie Oliver Piña
See Essentials of Aesthetic Surger y, pp. 887–926
VULVOVAGINAL AESTHETIC SURGERY
1. Which of the following vulvovaginal plastic surgery procedures is the most commonly requested?
A. Clitoral hood reduction.
B. Perineoplasty.
C. Vaginal tightening.
D. Labiaplasty.
E. Labia majora reduction.
VULVOVAGINAL AESTHETIC SURGERY
2. What is the most widely accepted upper limit of normal length of labia minora, measured from the labial
base to the labial edge?
A. 2 cm.
B. 3 cm.
C. 5 cm.
D. 7 cm.
E. Has not been defined.
VULVOVAGINAL AESTHETIC SURGERY
3. What is the most common reason for patients to request revision vulvovaginal plastic surgery?
A. Reduced sensation.
B. Vaginal laxity.
C. Clitoral hood redundancy.
D. Irritation with form-fitting clothes.
E. Perforated labia minora skin.
VULVOVAGINAL AESTHETIC SURGERY
4. What is the most appropriate treatment method for a patient presenting with enlarged mons fat?
A. Nutrition consult.
B. Encouraging 6 to 12 months of diet and exercise.
C. Cryotherapy.
D. Liposuction.
E. Surgical resection.
VULVOVAGINAL AESTHETIC SURGERY
5. Addressing which of the following structures will most effectively correct ptosis of the anterior vaginal
commissure?
A. Clitoral hood.
B. Clitoral body.
C. Introitus.
D. Labia majora.
E. Mons pubis.
Chapter 63&Female Aesthetic Genital Surgery 473
VULVOVAGINAL AESTHETIC SURGERY
6. Which of the following preoperative assessment approaches can help in preventing postoperative vaginal
splaying?
A. Adduction/abduction of patient's legs.
B. Use of mirror while pointing out areas of concern.
C. Examination in both standing and lithotomy positions.
D. Hip flexion/extension.
E. Ultrasound imaging.
VULVOVAGINAL AESTHETIC SURGERY
7. All labiaplasty procedures are performed with the patient in which position?
A. Prone.
B. Reverse Trendelenburg.
C. Supine.
D. Lithotomy.
E. Left-side fetal.
VULVOVAGINAL AESTHETIC SURGERY
8. When combining clitoral hood and labiaplasty procedures, what is the proper order in which to address these
multiple concerns?
A. Clitoral hood first.
B. Labiaplasty first.
C. Both simultaneously.
D. Refer to gynecologist for recommendation.
E. Defer treatment if multiple concerns.
VULVOVAGINAL AESTHETIC SURGERY
9. In which vulvovaginal procedure should a plastic surgeon most strongly consider the involvement of a
urologist?
A. Labiaplasty.
B. Perineoplasty.
C. Monspexy.
D. Clitoropexy.
E. Labia majora direct excision.
VULVOVAGINAL AESTHETIC SURGERY
10. What is a potential result of labia majora direct excision/reduction?
A. Decreased sensation to clitoris.
B. Pelvic organ prolapse.
C. Perceived decreased prominence of the clitoral hood or labia minora.
D. Friction discomfort on ambulation with clothing.
E. Decreased contrast of skin color and hair pattern.
474 Part IX&Body Contouring
Answers
VULVOVAGINAL AESTHETIC SURGERY
1. Which of the following vulvovaginal plastic surgery procedures is the most commonly requested?
D. Labiaplasty.
Defined as a reduction of the labia minora, labiaplasty has become the cornerstone of vulvovaginal plastic
surgery. Multiple factors are suspected to be driving this trend, including aesthetic concerns (particularly in
Western cultures) through the media, Brazilian waxing, and some functional issues such as rubbing or
hygiene.
REFERENCE
1. Koning M, ZeijlmansIA, BoumanTK, et al. Female attitudesregardinglabia minora appearance and reduction with
consideration of media influence. Aesthet Surg J 2009;29:65
VULVOVAGINAL AESTHETIC SURGERY
2. What is the most widely accepted upper limit of normal length of labia minora, measured from the labial
base to the labial edge?
C. 5 cm.
In evaluating labia minora enlargement and hypertrophy from baseline, most providers feel that 5 cm in
length, measured from the base of the minora to the labial edge, is the upper limit of normal.
be in the range of Felicio classification type III.
1
1
2
This would
REFERENCES
1. Tepper OM, Wulkan M, Matarasso A. Labioplasty: anatomy, etiology, and a new surgical approach. Aesthet Surg J
2011;31:551
2. Felicio Yde A. Labial surgery. Aesthet Surg J 2007;27:322
VULVOVAGINAL AESTHETIC SURGERY
3. What is the most common reason for patients to request revision vulvovaginal plastic surgery?
C. Clitoral hood redundancy.
Clitoral hood redundancy often becomes noticeable following a labiaplasty that does not address the clitoral
hood concomitantly or after overly aggressive trimming of the labia minora. It often presents with apparent
hypertrophy of hood after aggressive edge trim labiaplasty.
patients seek revision vulvovaginal plastic surgery.
2
1
Hood redundancy is the most common reason
REFERENCES
1. Hunter JG. Commentary on: Labioplasty: anatomy, etiology, and a new surgical approach. Aesthet Surg J
2011;31:519
2. Alter GJ. Labia minora reconstruction using clitoral hood flaps, wedge excisions, and YV advancement flaps. Plast
Reconstr Surg 2011;127:2356
VULVOVAGINAL AESTHETIC SURGERY
4. What is the most appropriate treatment method for a patient presenting with enlarged mons fat?
E. Surgical resection.
Enlarged mons fat is typically associated with labia majora hypertrophy as a result of fat excess and stretched
skin. Unfortunately, these are rarely ever addressed by diet and exercise. Often times, this fat needs to be
resected as a part of an abdominal contouring procedure. Liposuc tion may be of limited use given the excess
skin laxity described above which would result in a suboptimal aesthetic outcome.
1,2,3
Chapter 63&Female Aesthetic Genital Surgery 475
REFERENCES
1. Mirzabeigi JN, Jandali S, Mettel RK, et al. The nomenclature of “vaginal rejuvenation” and elective vulvovaginal
plastic surgery. Aesthet Surg J 2011;31:723
2. AlterGJ.Aestheticlabia minora and clitoral hood reduction usingextendedcentralwedge resection. Plast Reconstr
Surg 2008;122:1780
3. Moore KL, Dalley AF. Clinically Oriented Anatomy. 4th ed. Philadelphia: Lippincott Williams & Wilkins; 1999
VULVOVAGINAL AESTHETIC SURGERY
5. Addressing which of the following structures will most effectively correct ptosis of the anterior vaginal
commissure?
E. Mons pubis.
By lifting and tightening the mons pubis, the anterior commissure is effectively elevated from its previous
ptotic position.
1,2,3
REFERENCES
1. Mirzabeigi JN, Jandali S, Mettel RK, et al. The nomenclature of “vaginal rejuvenation” and elective vulvovaginal
plastic surgery. Aesthet Surg J 2011;31:723
2. AlterGJ.Aestheticlabia minora and clitoral hood reduction usingextendedcentralwedge resection. Plast Reconstr
Surg 2008;122:1780
3. Moore KL, Dalley AF. Clinically Oriented Anatomy. 4th ed. Philadelphia: Lippincott Williams & Wilkins; 1999
VULVOVAGINAL AESTHETIC SURGERY
6. Which of the following preoperative assessment approaches can help in preventing postoperative vaginal
splaying?
A. Adduction/abduction of patient's legs.
Evaluating the labia majora with the legs abducted and adducted is critical, as the relationship of the labia to
the inner thighs is distinguishable in this maneuver. Recognizing this preoperatively helps to prevent possible overresection of the labia majora and secondary tethering of skin, a complication which can often lead
to vaginal splaying.
1,2,3
REFERENCES
1. Alter G. Female genital aesthetic surgery. In: Nahai F, ed. The Art of Aesthetic Surgery: Principles and Technique.
2rd ed. New York: Thieme Publishers; 2011
2. Mirzabeigi JN, Jandali S, Mettel RK, et al. The nomenclature of “vaginal rejuvenation” and elective vulvovaginal
plastic surgery. Aesthet Surg J 2011;31:723
3. Felicio Yde A. Labial surgery. Aesthet Surg J 2007;27:322
VULVOVAGINAL AESTHETIC SURGERY
7. All labiaplasty procedures are performed with the patient in which position?
D. Lithotomy.
All techniques are performed with patients in the lithotomy position under local anesthesia. Additionally,
positioning the stirrups so that the hips flex at 90 degrees in the lithotomy position will help maximize
venous drainage. However, in the initial evaluation, the patient should be examined in both standing and
lithotomy positions. An examination chair with retractable stirrups facilitates visualization and promotes
patient comfort. In the standing position, the labia minora are noted for the degree of projection beyond
the labia majora, and the labia majora are noted for ptosis, volume, and fullness.
1,2,3
REFERENCES
1. Dobbleleir JM, Van Landuyt KV, Monstrey SJ. Aesthetic surgery of the female genitalia. Semin Plast Surg
2011;25:130
2. Alter G. Female genital aesthetic surgery. In: Nahai F, ed. The Art of Aesthetic Surgery: Principles and Technique.
2nd ed. New York: Thieme Publishers; 2011
3. Gelder C, McCallum AL, Macfarlane AJR, Anderson JH. A systematic review of mechanical thromboprophylaxis in
the lithotomy position. Surgeon 2018;16(6):365–371
476 Part IX&Body Contouring
VULVOVAGINAL AESTHETIC SURGERY
8. When combining clitoral hood and labiaplasty procedures, what is the proper order in which to address these
multiple concerns?
B. Labiaplasty first.
When clitoral hood reduction procedures are coupled with labia minora procedures, the labia must be
addressed first. This enables the surgeon to avoid overexposing the gland in aggressive clitoral hood reduction. Excess folds of the clitoral hood are addressed after the labia minora are treated.
1,2
REFERENCES
1. Hunter JG. Commentary on: Labioplasty: anatomy, etiology, and a new surgical approach. Aesthet Surg J
2011;31:519
2. Alter GJ. Labia minora reconstruction using clitoral hood flaps, wedge excisions, and YV advancement flaps. Plast
Reconstr Surg 2011;127:2356
VULVOVAGINAL AESTHETIC SURGERY
9. In which vulvovaginal procedure should a plastic surgeon most strongly consider the involvement of a
urologist?
D. Clitoropexy.
Given the technical difficulty of the clitoropexy operation, it is not uncommon to result in malposition of the
clitoris. Thus, strong consideration should be given to collaboration with a urologist.
1,2,3
REFERENCES
1. Alter GJ. Labia minora reconstruction using clitoral hood flaps, wedge excisions, and YV advancement flaps. Plast
Reconstr Surg 2011;127:2356
2. Alter GJ. Pubic contouring after massive weight loss in men and women: correction of hidden penis, mons ptosis,
and labia majora enlargement. Plast Reconstr Surg 2012;130:936
3. AlterGJ.Aestheticlabia minora and clitoral hood reduction usingextendedcentralwedge resection. Plast Reconstr
Surg 2008;122:1780
VULVOVAGINAL AESTHETIC SURGERY
10. What is a potential result of labia majora direct excision/reduction?
D. Friction discomfort on ambulation with clothing.
Overresection of labia majora fat and skin in direct excision/reduction procedures may cause a gaping
introitus leading to vaginal dryness, discomfort with clothing, discomfort with activity, and an inability
to completely abduc t the legs. Also, a perceived increased prominence of the clitoral hood or labia minora,
as well as a contrast of skin color and hair pattern may occur. These potential results of surgery should be
discussed in the preoperative consultation and informed consent.
1,2,3,4
REFERENCES
1. Tepper OM, Wulkan M, Matarasso A. Labioplasty: anatomy, etiology, and a new surgical approach. Aesthet Surg J
2011;31:551
2. Felicio Yde A. Labial surgery. Aesthet Surg J 2007;27:322
3. Hodgkinson DJ, Hait G. Aesthetic vaginal labioplasty. Plast Reconstr Surg 1984;74:414
4. Alter G. Female genital aesthetic surgery. In: Nahai F, ed. The Art of Aesthetic Surgery: Principles and Technique.
2rd ed. New York: Thieme Publishers; 2011
64. Noninvasive Body Contouring
Stelios C. Wilson
See Essentials of Aesthetic Surgery, pp. 927–933
PREOPERATIVE EVALUATION
1. Which of the following patients would be an appropriate candidate for noninvasive body contouring?
A. A 45-year-old man with BMI of 32 who has recently undergone a 100 lb weight loss.
B. A 32-year-old female with a BMI of 23 with small areas of stubborn flank lipodystrophy but who otherwise
was unwilling to undergo a surgical procedure.
C. A 37-year-old female with a BMI of 36 with a large area of concern of anterior abdominal wall, flank, and back
lipodystrophy.
D. A 41-year-old woman, mother of three children, with rectus diastasis looking for improvement in abdominal
contour but unwilling to undergo a surgical procedure.
E. A 48-year-old man with a BMI of 29 and actively losing weight following laparoscopic sleeve gastrectomy.
INFORMED CONSENT
2. Which of the following should be counseled to the patient when describing noninvasive body contouring
procedures?
A. There will be no procedural discomfort.
B. There will be minimal to no postprocedural erythema/edema.
C. There is no risk of temporary sensory deficits.
D. No guarantee of final aesthetic outcome.
E. Most noninvasive procedures require only one treatment.
METHODS
3. Which of the following would be considered to be invasive body contouring?
A. Cryolipolysis.
B. High-intensity focused ultrasound (HIFU).
C. Low-level laser therapy.
D. Radiofrequency energy.
E. Power-assisted liposuction.
CRYOLIPOLYSIS
4. What is the mechanism of action of cryolipolysis that occurs by placing cooling panels to a localized area?
A. Allow vasoconstriction of the peripheral blood supply that perfuse the local adipocytes.
B. Cause apoptosis-mediated cell death and subsequent inflammatory response.
C. Decrease volume by limiting edema and improving the egress of lymphatic fluid.
D. Tighten the skin and subcutaneous tissue through myofibroblast activation.
E. Tighten the skin and subcutaneous tissue through heating via low frequency electromagnetic waves.
CRYOLIPOLYSIS
5. Which of the following medical problems is a contraindication to cryolipolysis?
A. Sickle cell anemia.
B. Factor V Leiden.
C. Cold-induced dermatologic syndromes.
D. Protein C deficiency.
E. Thalassemia.