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Shaking introduces mechanical stress that can break the delicate peptide bonds, a process called shearing

Higher doses and more intensive protocols suit acute healing needs

2020 Oct 23;12(11):3254

These are more common in post-bariatric patients than in non-bariatric patients, particularly with longer incisions such as a body lift (belt lipectomy), and vitamin B12 status is one of the nutritional factors I can influence to reduce (but not eliminate) this risk Deep vein thrombosis and pulmonary embolism are covered earlier in this article