[Duhan Plastic Surgery Calf Reduction] - [How to Get Rid of Calf Muscle Bulges]

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Easy Calf Reduction Surgery

A non-surgical selective neurocoagulation procedure for slimmer calves

Using ultrasound nerve search and coagulation surgical equipment

Guidance on “ultrasound-guided selective nerve block surgery,” which creates slimmer calves

The recent trend in the aesthetic and plastic surgery field is to properly reflect patient needs and continuously demand minimally invasive methods, clear effectiveness, and

a way to ensure procedural safety.

At our clinic, in addition to non-incisional ultrasound selective nerve block equipment, we use an ultrasound diagnostic device to perform a procedure that has fewer side effects and can significantly reduce the recurrence rate.

This is a new concept in calf reduction surgery (ultrasound-guided selective nerve block surgery), not an incision-free procedure and not a muscle recession procedure that involves severe swelling and pain from medium/high-frequency muscle cauterization.

Basic equipment set for calf nerve block surgery

The basic equipment for nerve block surgery uses an integrated device that combines nerve search and nerve block into one so they can be performed at once.

When the nerve search device touches the nerve and the muscle moves in response, the mode is changed and the nerve is blocked immediately.

What is ultrasound-guided selective nerve block surgery?

With the basic equipment for nerve block surgery, it is very difficult and time-consuming to find nerves that cannot be seen.

Also, when a nerve deviates from its normal route, it becomes very difficult to find, and there are many cases in which the procedure is not performed properly.

If the nerve is not found properly, the procedure’s effectiveness decreases, side effects may occur, and the recurrence rate may be high.

To make this nerve search faster and more accurate, an ultrasound imaging device equipped with a high-frequency probe is used.

By quickly and accurately searching for the nerve while checking with ultrasound, multiple nerve branches can be effectively blocked in a short time.

Ultrasound-guided nerve block surgery is a procedure that has the advantages of improving treatment effectiveness, reducing side effects, and significantly lowering the recurrence rate.

What is ultrasound-guided selective nerve block surgery?

With the basic equipment for nerve block surgery, it is difficult and time-consuming to find nerves that cannot be seen.

Also, when a nerve deviates from its normal route, it becomes very difficult to find, and in some cases the procedure is not performed properly.

If the nerve is not found properly, the procedure’s effectiveness decreases, side effects may occur, and the recurrence rate may increase.

To make this nerve search faster and more accurate, an ultrasound imaging device equipped with a high-frequency probe is used.

By searching for nerves while looking at the ultrasound, the nerves can be found faster and more accurately, allowing many nerve branches to be effectively blocked in a short time.

Ultrasound-guided nerve block surgery has the advantages of improving treatment effectiveness, reducing side effects, and significantly lowering the recurrence rate.

Equipment for ultrasound-guided selective nerve block surgery

In addition to the basic equipment for nerve block surgery, an ultrasound diagnostic device, which is a visual examination device, is used so that nerve branches can be found quickly and accurately.

With only the basic equipment, there are limits to finding nerves, and in cases where there are many nerve branches or the nerve travels along an unexpected route, finding them is very difficult.

The success or failure of the procedure depends on finding the nerve branches accurately within a short time.

For this, ultrasound equipment helps improve procedural accuracy and shorten the procedure time.

Advantages of ultrasound-guided selective nerve block surgery

● Nerve branches can be found quickly and accurately, so the procedure is highly effective.

● It significantly shortens the procedure time compared with using only the basic equipment.

● By accurately finding the nerve branches, other tissues are not damaged, so side effects are minimal.

● Because the procedure time is shortened, there is less pain after the procedure and recovery is faster.

● Because the procedure is performed through accurate nerve search, the recurrence rate is significantly reduced.

Causes of thick calves

The causes of thick calves or visibly bulging calves are muscle and fat, but in most cases muscle is the main cause.

Anatomy of bulging calves

The cause of bulging calves is the gastrocnemius muscle, the outermost muscle of the calf.

The gastrocnemius muscle is divided into medial and lateral portions, and usually the medial side is more developed.

Below the gastrocnemius muscle is the soleus muscle, and below that are several other muscle layers arranged one on top of another.

The thickness of the gastrocnemius muscle is usually 2 cm when relaxed and becomes about 3–4 cm thick when contracted, creating bulging calves.

The purpose of selective nerve block surgery is to reduce the volume of the outermost gastrocnemius muscle, which causes bulging calves.

Leg movement involves the calf and foot through several other muscle layers, including the soleus, while the outer gastrocnemius has no special function. Therefore, even without the gastrocnemius, leg function is not affected at all.

Selective nerve block surgery works by blocking the gastrocnemius nerve branch from the tibial nerve so that the gastrocnemius no longer has motor activity.

A muscle whose nerve has been blocked cannot contract or relax, so it loses mobility and gradually atrophies over time.

The surgery blocks the nerve by using the principle that unused muscles atrophy.

Conventional methods for reducing calf muscle size

● Muscle resection through incision

This method involves making an incision near the back of the knee and inserting an instrument to pull and tear out the gastrocnemius muscle.

This method leaves a large scar behind the knee and removes muscle unevenly, resulting in an uneven shape, so it is far from the aesthetic needs of the present.

● Nerve resection through incision

This method involves making an incision behind the knee, finding the nerve going to the gastrocnemius, and cutting it. Since only the medial side can be treated, it can easily create bow legs, and because it requires an incision, it leaves a large scar behind the knee, making it far removed from aesthetic purposes.

● Muscle recession using medium/high-frequency cauterization

This method uses medium/high-frequency energy to electrically coagulate the gastrocnemius muscle and cause it to atrophy.

It is a method of burning away the muscle, and due to scar tissue formation from burns within the muscle, the effect of calf muscle recession surgery is reduced. Because swelling is severe, walking after the procedure is difficult, so it is not commonly performed.

● Neurolysis using drugs on the motor nerve of the gastrocnemius

This method injects drugs around the nerve going to the gastrocnemius muscle. However, it is difficult to inject precisely along the nerve path, and the effect of nerve block from the medication is insufficient.

The treatment effect may be somewhat reduced or the recurrence rate may be high.

In addition, side effects may occur as the medication spreads to unwanted areas.

Disadvantages of conventional surgical methods

● Nerve resection or muscle resection leaves unsightly scars behind the knee after surgery, far from what patients want.

● Muscle resection can cause a bumpy contour due to irregular removal of muscle, and it may lead to varicose veins in the lower limbs due to muscle removal.

● Nerve resection leaves a large scar behind the knee and may result in O-shaped legs as a sequela.

● Neurolysis has inconsistent effects and may cause side effects when medication spreads to unwanted areas.

● In the case of medium/high-frequency cauterization, scar tissue remains inside; the effect is also limited, and swelling and pain are severe.

Non-incisional selective nerve block surgery

Concept: Using a nerve blocker to identify the pathway of the motor nerves that control the gastrocnemius muscle in the calf, then selectively blocking only the gastrocnemius motor nerves while minimizing damage to other tissues.

http://www.calfs.co.kr

Non-incisional selective nerve block surgery - procedure

Non-incisional ultrasound selective nerve block surgery selectively blocks only the branches of motor nerves by using special medical equipment that finds, confirms, and blocks nerve branches under local anesthesia.

1st step - Use ultrasound to identify the location of the nerve and mark it on the skin.

2nd step - While lying face down, apply a small amount of local anesthesia at the spot where the needle will be inserted.

3rd step - While checking with ultrasound, determine the location of the nerve and insert the needle into the nerve area.

4th step - Confirm with the nerve search device whether the gastrocnemius nerve is touching the needle.

5th step - Switch to nerve block mode and generate electrical heat that blocks nerve transmission from the needle tip to block the nerve.

If nerve block is performed on both the medial and lateral gastrocnemius, a total of 4 nerve sites are blocked on both sides.

6th step - Go home immediately after the procedure.

In the examination room, the nerve pathway is identified through ultrasound examination.

Because the path and depth of the nerves differ from person to person, accurately identifying the nerve pathway is an essential process for a successful procedure.

After locating the nerve, the area to be blocked is marked.

The nerve pathway is drawn on the marked area with design ink.

The nerves are divided into medial and right-sided nerves, and they extend with many branches like tree limbs.

All of these small branches are also searched for and marked with ink.

In most cases, the nerves in both legs do not travel in exactly the same way.

Even in the same person, the nerve pathways on the left and right sides are often different, and the number of branches is often different as well.

Accurate nerve search can increase the success rate of the procedure and minimize the recurrence rate.

In the operating room, after sedation and local anesthesia are administered, the nerve block needle (search needle) is prepared in nerve search mode.

The nerve block needle is inserted into the locally anesthetized area.

After confirming that it has passed through the fascia, the needle tip is guided under ultrasound to the area where the gastrocnemius motor nerve is located.

The nerve branches are searched for quickly with ultrasound and blocked.

To improve the effectiveness of the procedure, the nerve branches must be found accurately within a short time and coagulated firmly so that nerve regeneration and recurrence do not occur.

In addition, by preventing damage to other important tissues besides the nerves to be blocked, the procedure can be performed without side effects.

Blood vessels are not that difficult to find on ultrasound, but locating nerves requires a lot of experience.

Because the diameter of a nerve is only about 1–2 mm, searching for it is difficult, and finding it on ordinary ultrasound is almost impossible.

It can be located with a high-frequency ultrasound of 7.5 MHz or higher, and accurate searching from the root of the nerve to its branches is necessary.

When the tip of the needle touches the gastrocnemius motor nerve, repeated contractions of the gastrocnemius begin.

After confirming muscle contraction, the mode is switched from nerve search mode to nerve block mode and electrical coagulation is performed.

After coagulation is complete, the mode is switched back to nerve search mode to confirm that the muscle no longer contracts.

If the muscle does not contract, the nerve has been blocked.

Because the blocking effect should be permanent, the proximal part of the nerve is also checked again during the procedure.

Usually, 7–8 sites are blocked in one muscle, and the more nerve branches are blocked, the more effective the result.

If all four muscle areas on the medial and lateral sides of both calves are treated, about 30 nerve branches in total must be blocked to prevent recurrence and achieve a clear treatment effect.

Usually, when both the medial and lateral sides are treated on both legs, the procedure takes about 30 minutes to 1 hour.

If only the medial side is treated, the procedure finishes in about 30 minutes.

You can go home immediately after the procedure, and before leaving, you raise your heels to check that no bulging calf muscle appears, then go home.

When leaving, you can wear a compression band.

Usefulness of ultrasound diagnostics in nerve block surgery

The auxiliary equipment used in nerve block surgery, in addition to the basic equipment, is ultrasound imaging equipment.

An ultrasound diagnostic device equipped with a 7.5 MHz high-frequency probe is useful for identifying the location of structures such as blood vessels and nerves.

The key to nerve block surgery is how accurately and effectively the nerve branches can be found.

The nerves that need to be found are the main trunk and branches of the nerves going to the gastrocnemius.

Usually, the number of nerve branches blocked within one gastrocnemius muscle is about 7–8.

The more nerves that are blocked, the better the procedure’s effectiveness.

To find nerve branches effectively, rather than the conventional method of randomly inserting the search needle here and there, it is better to look at the ultrasound image, accurately determine the nerve pathway, and guide the search needle to the nerve at once, which improves the accuracy and effectiveness of the procedure.

Without ultrasound equipment, in some cases where the nerve does not respond well to the search needle, the procedure may be nearly impossible.

Only when the nerve responds can electrical coagulation be performed, and if the nerve does not respond even when the search needle touches it, the procedure becomes impossible.

In such cases, if it is confirmed on the ultrasound screen that the search needle is touching the nerve, there is the usefulness that electrical coagulation can be performed even if the nerve does not respond.

Immediate effect after non-incisional selective nerve block surgery

After the procedure, if you raise your heels, you can visually confirm immediately that the bulging muscle is no longer tense.

This surgery can achieve satisfying results with a single procedure and has no scars or postoperative discomfort, so it is a highly welcomed procedure.

Post-procedure course of non-incisional selective nerve block surgery

● If only the medial side of the calf is treated, the procedure finishes in about 30 minutes. After the procedure, you simply wear the compression band provided by the clinic.

● Immediately after the procedure, you can raise your heels and confirm right away that no bulging appears in the calf.

● There may be a slight pulling pain after the procedure, but it does not interfere with daily life.

● Swelling and bruising are almost absent.

● Due to gradual muscle atrophy, a slight pulling and stiffness in the calf for about one month is a normal recovery process.

● A visible feeling that the calf has become slimmer can be noticed after about 15 days to one month.

● The maximum effect appears after 3–6 months, and if there is no recurrence, the procedure effect is permanent.

Precautions after non-incisional selective nerve block surgery

1. Due to gradual muscle atrophy, a slight pulling and stiffness in the calf for about one month is a normal recovery process.

There may be some discomfort when walking, but if you naturally stretch the muscle by walking, the pulling sensation will gradually go away.

The period for the pulling sensation to disappear may be as short as 2 weeks or as long as more than one month.

2. It is better not to wear very high heels for about one month.

Because the muscle shrinks as it atrophies, there may be a pulling sensation.

To help with this, wearing shoes with low heels or sneakers and doing light exercise such as walking can help stretch the muscle, improve the procedure’s effect, and relieve the pulling and stiffness more quickly.

3. If you continue wearing high heels immediately after the procedure, the muscle length may become shorter and a toe-walking side effect may occur, in which the heels do not touch the ground.

However, if you live wearing low heels or sneakers for about a month, this problem will absolutely not occur.

4. There are cases where clinics with little experience in calf procedures tell patients to wear high heels after the procedure.

This should never be done.

When you wear high heels, the muscle remains contracted, so if that state continues, it is natural for the muscle length to shorten.

If the muscle length shortens, the heels will no longer touch the ground.

Please keep in mind that such statements come from a lack of understanding of the principle of muscle atrophy and may lead to preventable side effects.

Before-and-after results of non-incisional selective nerve block surgery

The 4 principles of calf recession surgery

There should be no recurrence. - It is important to perform the procedure properly so that it does not recur.

The effect must be clear. - The result of muscle recession should be close to 100%.

There should be no side effects. - There should be no side effects by avoiding damage to other tissues.

Immediate return to daily life should be possible. - Bruising, swelling, and pain should be minimized so daily life can resume immediately after the procedure.

Important key to successful nerve block surgery

The key to successful nerve block surgery is how quickly and accurately the nerve branches can be found.

Because the procedure is performed without an incision, invisible nerve branches must be found quickly so that as many branches as possible can be blocked, allowing a satisfying muscle recession effect to be achieved.

The biggest weakness of nerve block surgery is that the search needle of the basic search equipment cannot find nerves quickly.

Depending on the individual, some nerves do not respond properly to the search needle, and there are also nerves that do not travel along the normal route. In such cases, the practitioner has to poke around with the search needle to find the passing nerve branches with difficulty.

Therefore, if the nerve branches cannot be found properly, the procedure is not performed properly, so the effect is greatly reduced or in some cases almost no benefit is seen.

To obtain the desired muscle recession effect, as many nerve branches as possible must be found and coagulated in a short time. This requires the practitioner to have extensive experience and know-how, and ultrasound imaging equipment must also be used together to improve the procedure’s effectiveness.

Causes of nerve block surgery failure

● When the practitioner has insufficient experience with nerve block surgery

● When the patient has a body type in which the nerves do not respond well to the search needle

● A careless procedure that blocks only one or two proximal sites without blocking many proximal and distal nerve branches

● When nerves cannot be found with the search needle because they deviate from the normal route

● When the practitioner fails to block the nerve going to the gastrocnemius and instead blocks the nerve going to the deep soleus muscle or the sural nerve

● When the nerve to the gastrocnemius is blocked too close to the back of the knee, damaging the tibial nerve as well

The greatest key to successful nerve block surgery is accurately finding the nerve and blocking as many branches as possible.

If the nerve is not found properly, there will be no effect or recurrence will happen quickly.

For this reason, using ultrasound imaging together allows the nerve pathway to be identified accurately during the procedure, maximizing the effect.

Side effects of nerve block surgery

● Pain in the heel area or decreased sensation due to damage to the tibial nerve

● Weakness in the leg due to damage to the nerve going to the soleus muscle

● Uneven contours in the calf due to partial nerve block or recurrence

Side effects of nerve block surgery occur when the exact position of the nerve cannot be found.

Only when the procedure is performed accurately based on extensive experience can the treatment effect be increased and side effects prevented.

If it occurs after calf recession surgery at another clinic

Guidance from our clinic

In cases where bulging muscles recur

● Recurrence due to nerve regeneration after nerve block surgery

All tissues regenerate when damaged.

Nerves also have very strong regenerative ability, so if the procedure is incomplete, the nerve can regenerate again.

Nerve regeneration means recurrence.

If recurrence occurs, the nerve must be blocked again. Repeat surgery is much more difficult and complicated than the first procedure.

The reasons are:

First, dense scar tissue forms around the nerve that was treated once, surrounding it like a protective barrier, so the nerve does not respond to the search needle and cannot be found easily with conventional methods.

Second, even if the nerve is found, the nerve surrounded by dense scar tissue cannot be properly blocked by the existing coagulation heat.

The coagulation temperature does not exceed 90 degrees at most, so heat of about 90 degrees makes it difficult to penetrate the dense scar tissue and block the nerve.

To solve this problem, the nerve must be visually confirmed and its exact location identified, which requires the help of ultrasound imaging.

In cases of recurrence, repeat treatment is almost impossible without the help of ultrasound imaging.

Also, the found nerve must be blocked by making the search needle penetrate the scar tissue barrier and touch the nerve as closely as possible.

The coagulation time must also be made longer.

● Recurrence due to muscle regeneration after medium/high-frequency procedures

All tissues regenerate when damaged.

Muscle tissue also has very strong regenerative ability, so if the procedure is incomplete, the muscle can regenerate again.

In addition, parts that cannot regenerate are filled in by hard scar tissue, which reduces the volume-reduction effect.

The reasons for recurrence are:

First, even if part of the muscle is damaged and necrotic by medium/high-frequency energy, other muscle cells can be duplicated and regenerate.

Therefore, with ordinary procedures, muscle cells are likely to regenerate, so the effect is inevitably reduced.

Second, even if there are parts of the muscle tissue that do not regenerate because they have been necrotized by the heat of medium/high-frequency energy, these areas are filled with collagen formed within the body, and as it turns into hard scar tissue, it reduces the volume-reduction effect.

In other words, scar tissue takes the place of the muscle.

To solve this problem, rather than burning away the muscle again with medium/high-frequency energy, it is necessary to replace it with ultrasound-guided selective nerve block surgery to induce natural muscle atrophy.

Even if recurrence occurs after a medium/high-frequency procedure, selective nerve block surgery is still possible.

When contour irregularities occur in the treated calf

● Incomplete nerve block

After nerve block surgery, the calf line may become uneven and bumpy.

This is recurrence, but it can be considered partial recurrence rather than complete recurrence.

That is, among the many nerve branches, some may have been blocked while others may not have been.

The muscles controlled by blocked nerves atrophy and become smaller in volume, but the muscles controlled by unblocked nerves remain the same as before, so the blocked and unblocked areas differ in volume and become uneven.

Ultimately, this is an incomplete procedure or partial recurrence, so if the nerve branches that were not properly treated are found and accurately treated again, the contour will naturally improve.

● Incomplete muscle operation with medium/high-frequency energy

When muscles are cauterized with medium/high-frequency energy, some parts of the muscle regenerate, some are replaced by scar tissue, and some may become somewhat sunken.

Reasons for contour irregularity:

First, some parts of the muscle become necrotic due to the heat of medium/high-frequency energy and the volume decreases, while other parts do not, creating differences in height and causing contour irregularities.

In other words, the effect is not uniform and is only seen in some areas.

Second, excessive necrosis of muscle tissue can cause part of the calf to sink in like a pit.

This is a severe depression caused by muscle necrosis along with necrosis of the fat layer above the muscle due to complications from the muscle necrosis.

Third, when scar tissue fills the area where the muscle has necrotized, the scarred area remains the same in volume, while areas where scar tissue does not form well lose volume.

This causes contour irregularity.

To solve this problem, rather than burning away the muscle again with medium/high-frequency energy, it is better to replace it with non-incisional ultrasound-guided selective nerve block surgery to induce natural muscle atrophy.

If overall uniform muscle atrophy is achieved through nerve block surgery, the irregularity can be reduced.

In addition, if excessive depression occurs along with fat necrosis, fat grafting can be performed after the muscle has completely atrophied to naturally fill the depressed area.

When O-shaped legs occur because the lateral muscle develops relatively more after medial nerve resection

● O-shaped legs due to lateral muscle development

In cases of nerve resection surgery performed at another clinic by making an incision behind the knee and removing the medial nerve, the lateral muscle often develops compensatorily because it was not treated.

In such cases, only the outer side of the calf bulges out, creating very unattractive O-shaped legs.

Nerve resection is a radical surgery that causes the muscle to atrophy completely, so the lateral nerve is excluded from the surgical target in case of side effects. This is why O-shaped legs often occur.

If O-shaped legs occur, the lateral nerve can be treated with nerve block surgery rather than surgery, helping to balance the legs. Therefore, if O-shaped legs have developed, it is a good idea to consider nerve block surgery.

A toe-walking side effect caused by incorrect post-procedure instructions

● Toe-walking in which the heels do not touch the ground

The toe-walking side effect in which the heels do not touch the ground is caused by wearing high heels continuously immediately after the procedure.

It is absolutely not a side effect caused by an incorrect procedure.

If toe-walking side effects occur, you should walk barefoot around the room as much as possible so the contracted muscle stretches and lengthens again.

Walking barefoot in the room or walking outside in shoes with almost no heel will naturally stretch and straighten the muscle.

After toe-walking side effects occur, taking off shoes may make walking inconvenient, so you may end up continuing to wear high heels.

However, this makes the symptoms worse.

At the early stage of toe-walking problems, the best thing to do is quickly take off the high heels and switch to shoes with no heel as much as possible, continuing to walk and exercise until the muscle lengthens and straightens again.

Usually, if you practice walking in shoes without heels within 6 months after the procedure, the toe-walking problem can resolve on its own in most cases.

Comparison of non-incisional selective nerve block surgery with other surgical methods

Category	Incisional muscle resection	Incisional nerve block surgery	Medium/high-frequency muscle recession	Neurolysis	Ultrasound-guided nerve block surgery
Scar	3–4 cm behind the knee	3–4 cm behind the knee	No scar	No scar	No scar
Procedure time	1–2 hours	1–2 hours	40 minutes to 1 hour	30 minutes to 1 hour	30 minutes to 1 hour
Effect and prognosis	Uneven legs may result from irregular muscle removal.	The effect is high. Only the medial side is treated, so the lateral side becomes thicker as compensation. It may look O-shaped.	The effect is low. The reduction in thickness is small.	The effect is inconsistent, and medication may act on unwanted areas due to spread, causing side effects.	The effect is high. The legs become much slimmer. Both the medial and lateral sides are treated, sufficiently reducing the muscle.
Discharge and function	Severe swelling, bruising, and pain require 1–2 weeks of rest. Walking is very inconvenient for about a month.	It is uncomfortable and difficult to walk for about 15 days. There is pulling pain for about a month.	Severe swelling and pain make walking inconvenient for about a month.	Immediate return to daily life is possible, but there is pulling pain for about 3–4 weeks.	Immediate return to daily life is possible, but there is pulling pain for about 3–4 weeks.

http://www.duhans.com

As with calf recession surgery, who performs it and how well it is done determines success or failure.

If the nerve block is not done properly, the nerve regenerates and recurrence occurs.

The key to nerve block surgery is finding many nerve branches quickly and performing firm electrical coagulation to reduce the recurrence rate.

It is not enough to casually block one or two nerves and expect calf recession.

Nerve block surgery is a safe procedure if it is performed properly and according to principle, so you do not need to worry about recurrence or sequelae.

At our clinic, based on more than 20 years of extensive clinical experience and know-how, we perform the world’s first ultrasound-guided non-incisional selective nerve block surgery. Its advantage is that it addresses the biggest problem of nerve block surgery—difficulty finding the nerves properly—and improves procedural accuracy to minimize recurrence.

Through ultrasound, nerve branches can be searched quickly and treated accurately.

Most clinics either use a nerve blocker and search for nerves by poking around in a rough, trial-and-error manner, or they only perform conventional methods such as radiofrequency or nerve resection.

After identifying the motor nerve pathway that controls the gastrocnemius muscle in the calf using a nerve blocking device, the method selectively blocks only the gastrocnemius motor nerve while minimizing damage to other tissues.

Because non-incisional selective nerve block surgery uses special medical equipment under local anesthesia to selectively block only branches of motor nerves, there is no scar, and there is no swelling or pain—only a slight pulling sensation due to muscle atrophy. After the procedure, the patient can immediately return to daily life.

Right after the procedure, if you raise your heels, you can visually confirm that the bulging muscle is no longer tense.

This surgery can achieve satisfying results with a single procedure and is highly welcomed by patients because there are no scars or postoperative discomfort.

http://www.duhans.com