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To perform the procedure, a vacuum hand piece is placed over the dimpled tissue through which the surgeon will deliver a local anesthetic

doi: 10.1016/j.metabol.2017.08.014

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In other cases, the aetiology is not known, like for example in idiopathic pulmonary fibrosis (60), affecting mainly the elderly, or in systemic sclerosis, which presents with an autoimmune component and affects the skin as well as internal organs (61, 62)