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These changes are largely the result of : - Rapid weight loss - Significant loss of muscle and connective tissue - Reduced structural support under the skin The Result : - Sagging facial skin - Sunken cheeks - Flattened or loose gluteal tissue - Accelerated appearance of aging This is not simply fat loss it is loss of tissue integrity, which becomes more noticeable when muscle mass is stripped away

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called 'active vitamin B 12 '), and homocysteine (5)

2 Materials and methods Approximately 90% of the papers mentioned in this review (total number of papers included in this review: 103) were found by a search in the Web of Science/Google Scholar databases using the keywords tendon injury, IGF-1, tendon regenerative healing, tendon repair, tenocyte, mechanisms (the search was performed during the period of May to September 2024 and only literature written in English was reviewed) (Figure 1)

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