Each year, 45 million Americans — many of them women — are consumed with thoughts of muffin tops, love handles and other parts of their bodies, especially as the season for beach and bathing suits looms. Figures from the American Society of Plastic Surgeons show that $11 billion was spent on cosmetic procedures in 2012, accounting for 1.6 million procedures.
For those seeking to battle their perceived problems, a procedure called CoolSculpting is gaining prominence because it doesn’t require pills, exercise, needles or surgery.
“I really like this procedure,” said nationally known, board-certified cosmetic and reconstructive surgeon Kimberley Goh from her office in Myrtle Beach. “It tells the cell it’s time to die. [The cells] go, and they don’t come back.”
The procedure is based on Cryolipolysis (a registered trademark) and was developed by Harvard University scientists Dieter Manstein M.D. and R. Rox Anderson M.D. They discovered that cooling the skin will kill fat cells without harming the skin or tissue surrounding them.
Five years ago, Goh contacted representatives of Zeltiq Aesthetics, which manufactures the apparatus for CoolSculpting. She was satisfied with what she learned and decided to become certified and purchase the needed equipment.
Zeltiq was founded in 2005, and its CoolSculpting procedure has become the most accepted, noninvasive body-contouring method. It has sold its equipment to medical practices in more than 60 countries and reports more than 1 million treatments have been performed worldwide, 427,000 alone in 2013.
Goh is an advocate of CoolSculpting and has been offering the procedure since 2011. She emphasized that it is a body-contouring treatment, not a weight-loss method.
“It’s noninvasive,” she said, explaining that the procedure is U.S. Food and Drug Administration approved.
Audrey Grice, licensed practical nurse for 23 years and licensed esthetician for almost six years, said the four physicians in Wilmington Plastic Surgery decided in 2011 that CoolSculpting would be part of their practice. They and Grice became certified, and she has performed 1,500 treatments.
“It’s for fat that won’t leave,” she said. “Every patient has had good results.”
She has had several treatments herself, some on her upper and lower abdomen and some on her flanks. “It’s wonderful,” she said. “It’s customizing to the person’s body type.”
She emphasized that it is not an appropriate treatment for the obese because it’s not a weight-loss plan. It is appropriate for those who eat well and exercise but have “jiggling fat.”
Goh said she has interested patients contact her office for a free consultation to determine if they qualify, what their goals are and what treatment plan to pursue. Most treatments are last one hour and involve a device being placed on the problem area. Excessive fat is drawn into the device and cooled to 34-degrees Fahrenheit.
“Twenty to 25 percent of the fat cells are gone forever [after one treatment],” Goh said. “The cells go on a hunger strike and die.”
Patients resume their schedules as soon as the treatment is over. They may experience some bruising and reddening, but no scarring results. Skin is not permanently affected, and freezing does not occur because the area is not cooled to the freezing point, 32 degrees Fahrenheit. The procedure has proved to be safe, and the same area can be treated several times until a patient reaches the desired result.
“A candidate has a localized collection of fat,” Goh said. “It doesn’t work well when fat is spread evenly. After the treatment, clothes fit better, but you don’t change size. You have a moderate change.”
The procedure does not tighten skin, produce a loss in weight or require anesthesia or surgery. It does remove fat, reduce bulges and save time.
The procedure works well around the waist, hips, abdomen and thighs. Goh said she won’t do the procedure on the neck, and few people would benefit from having it on the arm because it doesn’t tighten the skin. In her experience, about 50 percent of those who have a consultation do not qualify because they need to lose a large amount of weight, have a medical condition that eliminates them or have another situation that exempts them.
Possible candidates should ask themselves if they can “pinch an inch,” if they exercise and if they are in good general health.
Kimberly Cooper, certified CoolSculpting technician, surgical technician and certified nursing assistant in Goh’s practice, said she’s had the procedure on both flanks and on her upper abdomen.
“I am very happy with it because it’s nonsurgical,” she said, “and there’s no downtime. You can have it done and go back to work. It’s an easy way to get rid of some unwanted areas that diet and exercise don’t always get.”
At Facial Aesthetic Center in Myrtle Beach, a medical spa, licensed esthetician and office manager Catherine Pelton said she took the training and began performing the CoolSculpting procedure in January 2014.
“Patients love it,” Grice said. “They come back for more and more and more. They come for CoolSculpting because it is not uncomfortable. It’s easy and there’s no surgery.
“Results often improve a patient’s self-image. Surgery is a great option, but it’s not always the best option. [CoolSculpting] is another tool in the toolbox to get patients where they want to be.”
FOR MORE INFORMATION
Learn more about CoolSculping at www.coolsculpting.com.
The outlook used to be pretty bleak for those who had lost movement in their limbs due to severe nerve damage, but over the last year or so, some incredible advances have been made that are restoring shattered hope for many.
The amazing breakthroughs include spinal cord stimulation that allowed paralyzed men to regain some voluntary control of their legs, a brain implant that enabled a quadriplegic man to move his fingers, and a system that allowed a paralyzed woman to control a robotic armusing her thoughts. Science has definitely been on a roll, but this winning streak isn’t showing any signs of slowing down. Now, the world’s first “bionic reconstructions” have been performed on three Austrian men to help them regain hand function. This technique enabled the newly amputated patients to control prosthetic hands using their minds, allowing them to perform various tasks that most people take for granted.
The men that underwent the procedure had all suffered serious nerve damage as a result of car or climbing accidents, which left them with severely impaired hand function. The nerves that suffered injury were those within a network of fibers supplying the skin and muscles of the upper limbs, known as the brachial plexus. As lead researcher Professor Oskar Aszmann explains in a news release, traumatic events that sever these nerves are essentially inner amputations, irreversibly separating the limb from neural control. While it is possible to operate, Aszmann says the techniques are crude and do little to improve hand function. However, his newly developed procedure is quite different, and is proving to be a success.
Before the men could be fitted with their prosthetic hands, the researchers had to do some preliminary surgical work in which leg muscle was grafted into their arms in order to improve signal transmission from the remaining nerves. After a few months, the fibers had successfully innervated the transplanted tissue, meaning it was time to start the next stage: brain training.
Using a series of sensors placed onto the arm, the men slowly began to learn how to activate the muscle. Next, they mastered how to use electrical nerve signals to control a virtual hand, before eventually moving on to a hybrid hand that was affixed to their non-functioning hand. After around nine months of cognitive training, all of the men had their hand amputated and replaced with a robotic prosthesis that, via sensors, responds to electrical impulses in the muscles.
A few months later, the men had significantly improved hand movement control, which was highlighted by a test of function known as the Southampton Hand Assessment Procedure. As reported in The Lancet, before the procedure, the men scored an average of 9 out of 100, which soared to 65 using the prosthetic. Furthermore, the men reported less pain and a higher quality of life. For the first time since their injuries, they were able to perform avariety of tasks such as picking up objects, slicing food and undoing buttons with both hands.
“So far, bionic reconstruction has only been done in our center in Vienna,” said Aszmann. “However, there are no technical or surgical limitations that would prevent this procedure from being done in centers with similar expertise and resources.”
Seventeen years after losing the use of his hand in a motorcycle crash, Marcus Kemeter volunteered to have it amputated and replaced with a bionic version.
“It wasn’t hard for me to decide to do the operation,” said Kemeter, 35, a used-car dealer in Austria. “I couldn’t do anything with my hand. The prosthesis doesn’t replace a full hand, but I can do a lot of stuff.”
Kemeter’s artificial hand was made possible by a new medical procedure developed at the Medical University of Vienna, which combines reconstructive surgery with advances in prosthetics and months of training and rehabilitation, according to an article published Wednesday in the Lancet, a U.K. medical journal. The researchers performed the procedure on three Austrian men from 2011 to 2014.
The technique, called bionic reconstruction, offers hope for patients like Kemeter who have brachial plexus injuries, which can result in severe nerve damage and the loss of function in the arms.
The nerves of the brachial plexus start in the neck and branch out to control shoulder, arms and hands. They can be damaged in collisions from car and motorcycle accidents, and in sports like football and rugby. In the past, surgical reconstruction for brachial plexus patients could restore some function in their arms but not hands.
The injuries result in an “inner amputation,” permanently separating the hands from neural control, said Oskar Aszmann, a professor of plastic and reconstructive surgery at the Vienna university who is the lead author of the Lancet study.
The damaged limbs “are a biologic wasteland,” Aszmann said in a telephone interview. The solution is transplanting nerves and muscles from the legs into the arm, creating new avenues for signals from the brain.
“We can establish a new signal and we can use these signals to drive a prosthetic hand,” he said.
The process represents a significant step for patients with brachial plexus injuries, said Levi Hargrove, a researcher in prosthetics at the Rehabilitation Institute of Chicago.
“It provides them with an option,” he said. “As mechanical prosthesis become more advanced and more functional, this should only improve.”
The ultimate success of the procedure won’t be known for years and will depend on how often patients use their new hands, said Simon Kay and Daniel Wilks in a Lancet article accompanying the study. Kay is a hand surgeon at the Leeds Teaching Hospital, while Wilks is at The Royal Children’s Hospital in Melbourne.
“Compliance declines with time for all prostheses, and motorized prostheses are heavy, need power and are often noisy,” they wrote.
Kemeter, who lives in the Lower Austrian town of Hollabrunn, damaged his shoulder in a 1996 motorcycle accident. That year, he had surgery that grafted new nerves to his arm, which restored some function to his shoulder and elbow. Over the next decade and a half, his arm withered and atrophied, with his fingers permanently clenched.
“I could feel everything but I couldn’t do anything with the hand,” he said.
In 2011, Aszmann transplanted Kemeter’s nerves from his lower leg and muscle from his thigh to his injured forearm. After waiting three months for the nerves to grow back, Kemeter’s arm was connected to a computer, where he could practice manipulating a virtual hand.
“The brain has forgotten to use the hand,” Aszmann said. “We have to retrain them.”
The next step was connecting the prosthesis to the new nerves, with Kemeter’s biological hand still in place, to train him to use the device. That helps patients with the decision to amputate, Aszmann said.
“When it’s obvious this mechatronic hand can be of great use to them, then the decision to have the hand amputated is a very easy one,” he said. “If I have to convince someone, they’re not a good patient.”
Finally, after the amputation wounds healed and the prosthesis was fitted, the adjustment to the new appendage took only a few days.
“I can do much more than before,” Kemeter said. “Carrying big things, for example, wasn’t possible with only one hand. Now I can do it.”
Related News and Information: Bionic Hands Move Close to Human Control With Sensation of Touch Innovative Prosthetic Arm From Segway Inventor Cleared by U.S. First Bionic Leg to Harness Nerves Allows Mind Control Movement.
Monica Topliss pauses while eating breakfast in her Bangkok hotel to explain why she flew 7,300 kilometers from her home in Australia to go under a Thai plastic surgeon’s knife.
“The whole thing, airfares and hotel included, cost me 15,000 Australian dollars ($13,050), when back home, it would have been twice as much,” Topliss, a 48-year-old executive chef and author of cookbooks, says of the breast enhancement procedures and cosmetic dentistry she has just undergone. “And the surgeon did such a good job. It’s like the clock has been turned back 20 years. What’s more, I’m having a wonderful two-week holiday as well. Even the hospitals are like five-star hotels.”
Come for the gold-spired temples and sun-kissed beaches; stay for the low-cost, U.S.-accredited medical services. Or vice versa. That’s the Land of Smiles today, Bloomberg Markets magazine will report in its December issue. Foreigners seeking treatment for everything from open-heart surgery to gender reassignment have made Thailand the world’s No. 1 destination for so-called medical tourism, luring as many as 1.8 million overseas visitors in 2013, according to Patients Beyond Borders, a consulting firm based in Chapel Hill, North Carolina.
That ranks Thailand, a developing nation with a per capita gross domestic product of just $5,700, ahead of the U.S. — and also Thailand’s more prosperous Southeast Asian neighbors, Singapore and Malaysia — as the preferred destination for international patients. Last year, medical tourists pumped as much as $4.7 billion into the Thai economy, according to government statistics. “While the U.S. is still first choice for the ultrarich, Thailand is unquestionably No. 1 among everyone seeking affordable care,” Patients Beyond Borders founder Josef Woodman says.
Medical tourism is far from the only industry in which Thailand punches above its weight. The country is also among the world’s biggest exporters of products as diverse as computer disk drives, canned tuna, rice and rubber. It’s the region’s leading auto manufacturer and last year ranked as one of the top 10 global tourist destinations.
These strengths have earned Thailand considerable goodwill among investors, who have proved willing to stick with it even through months of political and social trauma. In the past year, the country has been shaken by deadly street protests, a military coup, three months of negative growth and a slump in tourism, which accounts for 10 percent of GDP. Even so, the benchmark SET Index jumped 22 percent this year through Nov. 18, compared with a 1.7 percent fall in the MSCI Emerging Markets Index.
‘So Far, So Good’
All while a junta steers the economy. “It’s so far, so good,” says Mark Mobius, executive chairman of San Mateo, California–based Templeton Emerging Markets Group. Mobius, who oversees about $45 billion from his offices in Hong Kong and Singapore, is so bullish on Thailand that he has made the nation of 68 million the largest geographical component of his $13.2 billion Templeton Asian Growth Fund, ahead of China and India.
Apart from strengths in manufacturing, agriculture and tourism, Mobius is also impressed by Thailand’s resilience in the face of previous political and economic shocks. “I think they will pull through, like they have in the past,” he says.
Medical tourism is doing its part. A gauge of 15 Thai hospital stocks, boosted by medical tourism, leapt 54 percent in 2014 as of Nov. 18. Among the prime beneficiaries of these soaring valuations are three of Thailand’s billionaire dynasties.
They include the family of the late Chaleo Yoovidhya, who in 1987 co-founded Red Bull GmbH, the world’s biggest energy-drink company, with Austrian billionaire Dietrich Mateschitz. The media-shy Yoovidhyas, whose 51 percent stake in Red Bull is worth about $10 billion, according to the Bloomberg Billionaires Index, own Bangkok’s Piyavate Hospital, where Topliss underwent her breast surgery.
Prasert Prasarttong-Osoth, 80, a physician-turned-entrepreneur who founded Bangkok Airways Co. (BA), Thailand’s oldest private carrier, owns 20 percent of Bangkok Dusit Medical Services Pcl (BGH), Thailand’s largest hospital operator. Bangkok Dusit stock rose 55 percent through Nov. 18. And the Sophonpanich family, whose patriarch, Chin Sophonpanich, founded Bangkok Bank Pcl, Thailand’s biggest lender by assets, owns 45 percent of Bumrungrad Hospital Pcl. (BH) Shares in Bumrungrad, which markets itself as Southeast Asia’s largest private health-care facility, have also jumped 55 percent this year.
“Hospital operators are among our top picks,” says Peerapong Jirasevijinda, who helps manage $15 billion at Bangkok-based BBL Asset Management Co. “We are still really upbeat even though they have rallied so much recently.”
The Thai military, which has staged 12 coups since 1932, hasn’t always inspired such confidence in investors. After the previous putsch, in 2006, the junta briefly imposed capital controls, prompting fund managers to dump stocks. This time, investors have been betting that the current crop of generals, led by army chief–turned–Prime Minister Prayuth Chan-Ocha, will get it right. In September, foreigners were net buyers of Thai stocks for a third straight month. The $657.1 million inflow was the highest since December 2012, although that was followed by an outflow of nearly $500 million in October.
Prayuth, 60, seized power on May 22, following six months of street protests against the elected government of Yingluck Shinawatra. He has thus far kept a lid on Thailand’s seemingly unbridgeable divisions between the urban elite and rural poor.
Since 2006, the country has repeatedly been thrown into turmoil by demonstrators representing color-coded rival factions — the so-called Yellow Shirts largely backed by the Bangkok middle classes and royalist establishment and the Red Shirt supporters of the populist former prime ministers Yingluck and her brother Thaksin, both of whom won elections only to have their governments deposed by coups. In the worst incidents, 92 people died when Red Shirts occupying Bangkok’s city center were driven out by the military in 2010, and Yellow Shirts shut down airports for a week in 2008, stranding 400,000 travelers. Prayuth has declared martial law and has succeeded in keeping protesters off the streets.
The general has also placed himself on the front line in the battle to revive an economy that shrank 2.2 percent in the first quarter of 2014. Appointing himself head of the Board of Investment, he promptly signed off on $4 billion of foreign investment that had been awaiting approval from the government he deposed. He also pledged to press ahead with his own, modified version of a $60 billion, 10-year program to upgrade railways, roads and ports.
Under Prayuth, Thailand has avoided a technical recession in 2014, growing 1.1 percent in the three months ended on June 30 and another 1.1 percent in the quarter ended Sept. 30. In October, Sommai Phasee, Prayuth’s finance minister, predicted that the economy would end up growing 2 percent in 2014.
Investors are betting the government’s infrastructure spending will provide a bonanza for the nation’s construction companies. As of Nov. 18, the SET’s Thai Construction Services Index had joined health-care stocks in jumping more than 50 percent for the year. The largest company in the index, Ch. Karnchang Pcl (CK), had soared 82 percent, and the second biggest, Sino-Thai Engineering & Construction Pcl (STEC), had doubled in value.
Such investor euphoria may be premature, according to former Thai Finance Minister Korn Chatikavanij. Korn, a former Thailand chairman of JPMorgan Chase & Co., says the junta’s policies are too conservative to stimulate the economy; he predicts the stock market’s run will end soon because there is no assurance when the country will return to more-growth-focused civilian rule.
Prayuth has said elections won’t be held until at least late 2015 and then only after his junta approves a new constitution and enacts unspecified measures to “reform” Thai politics and society. “The market will do well over the long term but disappoint before that,” Korn says.
The country’s rulers are facing major economic challenges, according to Siam Commercial Bank Pcl (SCB), Thailand’s biggest lender by market value. While the government has predicted the economy will grow 4.5 percent in 2015, Sutapa Amornvivat, SCB’s chief economist, said at a conference in October that she believed growth will average only 3.5 percent in the medium term. Sutapa said Thailand would struggle to overcome high levels of household debt, an aging workforce, a slowing Chinese economy and increased competition from faster-growing Southeast Asian neighbors. The World Bank is also downbeat, predicting Thailand will grow 1.5 percent this year and 3.5 percent in 2015 — slower than any other major Asian economy.
On Oct. 6, Thais were reminded of another risk — an inevitable royal succession — when King Bhumibol Adulyadej, the world’s longest-reigning monarch, underwent surgery to remove his gall bladder. Since ascending to the throne in 1946, the revered Bhumibol, 86, has been an enduring presence through coups and revolving-door civilian regimes. His heir is Crown Prince Maha Vajiralongkorn, 62. Though palace officials pronounced the king’s surgery a success, Thai stocks fell 1.7 percent that day.
Amid such challenges, medical tourism is one industry in which Thailand can compete — on services, prices and style. Patients flying into Bangkok’s Suvarnabhumi Airport are greeted at special arrival desks before being whisked to hospitals where, in grand hotel-type lobbies, English-speaking concierges, as well as interpreters skilled in some 30 other languages, shepherd them to private rooms.
Once discharged, patients can recuperate in five-star hotels that charge as little as $100 a night. Medi Makeovers, a Sydney-based medical travel agency, is now the biggest corporate customer of Bangkok’s 500-room Grande Centre Point Hotel Terminal 21, according to Somchai Meesri, the hotel’s general manager.
“They take 10 percent of our rooms, ahead of Japanese clients such as Toyota and Honda,” says Somchai, whose hotel is owned by Land & Houses Pcl (LH), Thailand’s biggest residential property developer. Medical tourists also stay longer, resting up after their procedures. “The average stay for other guests is three nights,” Somchai says. “For medical tourists, it is 10.”
Though Thailand has long aspired to medical excellence — the present king’s father graduated as an M.D. from Harvard University in 1927 — it wasn’t until 1997 that it began to tap a global market. That year, Bumrungrad opened the 500-bed Bumrungrad International Hospital with money borrowed in U.S. dollars. Six months later, Thailand was at the epicenter of the Asian financial crisis. The Thai baht collapsed along with the domestic market for premium private hospital care. “Our U.S.- dollar debt doubled on a local-currency basis,” says Chai Sophonpanich, Bumrungrad’s chairman.
In desperation, the hospital began to woo wealthy foreigners and expatriates living in nearby Asian countries, where medical services were less developed. Then, after the Sept. 11, 2001, attacks in the U.S., a new market in the Middle East opened up. “Patient flow increased as a result of more-stringent immigration policies by the USA and European countries for Middle East travelers,” Chai says. Within a decade, the number of Bumrungrad’s Middle Eastern patients leapt to 130,000 a year from 20,000. In 2002, Bumrungrad became the first hospital in Asia to win accreditation from the Joint Commission International, the global arm of the main standards-setting body for U.S. hospitals. Since then, 29 more Thai hospitals have also received that accreditation, including Bumrungrad’s main rival, Bangkok Hospital, the flagship of Bangkok Dusit.
Last year, Bumrungrad attracted 250,000 medical tourists, including 20,000 Americans and 8,000 Australians. Three weeks after paying $7,500 to have her nose reshaped and breasts enhanced in Bangkok, Australian Calli Graham sips coffee beside Sydney’s Bondi Beach and declares herself content. “It’s the best money I ever spent,” Graham, 30, says. “I got fantastic treatment and the satisfaction of knowing I am helping the economy of a developing country. It’s a win-win.”
Recently I attended an international medical student congress, Medical Student Journal Club – Pro et Contra, which took place on 23. and 24. May 2014 in Ljubljana, Slovenia.
It was a great congress, with a lot of interesting debates preesented by great speakers.
Myself, I have also registred as an active speaker, together with a colleague of mine, Barbara Šijaković. We debated on topic “Reconstructive surgery should focus on development of cadaver body parts transplantation rather than bionic prosthesis implantation“.
Below is a transcript of our debate.
And just for elaboration, the whole keynote was actually made with only videos tu support theses.
Reconstructive surgery should focus on development of cadaver body parts transplantation rather than bionic prosthesis implantation
Luka: Hello, it’s me up here again. So, I thought I could start with an old Marx brothers joke. No wonder it looks like the same room, because it is the same room. Ok, it doesnt go…
Well, since it’s Saturday afternoon and this is the last debate of this congress, we’ll try to be as interesting and short as possible. My name is Luka, on my left a college of mine, Barbara, and, already introduced, our mentor, Nina Suvorov, MD.
Before we actually start with the debate, let us ask you a question. Imagine you’ve lost your hand sometime in the past and now you are presented with two options. Either hand transplantation or bionic prosthesis. Which would you, right now, choose. Would you go for hand transplantation, or would you rather go with a bionic prosthesis. How many of you would choose hand transplantation? And how many bionic prosthesis? Interesting; 60% for bionics and 40% for transplantation. We’ll keep that number in mind.
Barbara: Now, before we begin, let’s clear the terms. Luka, could you tell us what a reconstructive transplant is?
Luka: Thank you, Barbara. A reconstructive transplant, or also called a composite tissue allograft, is an operation that involves transplantation of bone, tissue, muscle and blood vessels. According to WHO “transplantation is the transfer or rather engraftment of human cells, tissues or organs from a donor to a recipient with the aim of restoring function(s) in the body. And in cases when transplantation is performed between different species, e.g. animal to human, it is named xenotransplantation.”
Now, Barbara, would you care to briefly explain what a bionic prosthesis is and how it works?
Barbara: Bionic creativity engineering is basically implementation of biological systems in the developing modern technology. Bionic hand isn’t just the hook. It mimics the real human hand. In some cases bionic hand even superposes human hand, as we shall see later.
There are different bionic prostheses, today I’ll talk about i-Limb Ultra, the one most advanced for now.
Here is how it looks: we can see power button here, the digits are motorized. It’s made out of plastic, titanium and silicone.
And just some mechanical properties…
This is a myoelectric prosthesis, which means it uses electrical sensors to detect contractions in the selected muscles of the residual limb. These contractions are than translated into movement of the bionic hand by a specific algorithms.
Luka: Ok, so which is better? Let’s start with transplantations of the hand. We will focus mainly on the hand, since leg prosthetics are nearly perfect, but with hand it’s different. You have many small and fine movements that are incorporated in every day’s life and you simply cannot function without a hand.
Just some short history for the beginning. The first hand transplant was actually performed in Ecuador in 1964, but the patient suffered from transplant rejection after only two weeks. Then, there was basically a long period of nothing. Up until January 1999. The first successful hand transplantation. Now, you should notice, we are talking about transplantation, not about replantation. The first successful replantation was performed in Shanghai, China, in January 1963.
So, in January 1999 the first person (a baseball player) underwent an operation. This kind of operation is probably one of the longest there is. It takes approximately 12 to 16 hours. In comparison, a typical heart transplant takes 6 to 8 hours and a liver transplant, 8 to 12 hours.
Hand transplantation is an extremely complex procedure, but may not be as difficult as a hand replantation in that a replantation usually involves crushed or mangled bones, tendons, and ligaments.
Barbara: Would you care to elaborate on how this is done? Read more…