AESTHETIC MEDICINE
At Clínica Medform in Faro, the perception of the body as a whole leads to the observation of all cases in a multidisciplinary perspective and thus, together with the latest aparatology, we can offer a solution that approaches your expectations. Here, Aesthetic Medicine interacts with Dermatofunctional Physiotherapy, Plastic Surgery and Orofacial Harmonization.
PLASTIC SURGERY
- Liposculpture
Body Contour Surgery
- Augmentation Mammoplasty
Breast Augmentation Surgery
- Breast Reduction and Lifting Mammoplasty
Breast reduction and elevation surgery
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- Face Lifting
Surgery for sagging face and neck
- Abdominoplasty, Dermolipectomy and Miniabdominoplasty
Surgery for excess skin and abdomen fat
- Otoplasty
Correction of Aesthetic Changes in the Ear
- Blepharoplasty
Eyelid Correction
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- Scar Correction
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- Sign Removal
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- Reconstructive plastic surgery
LILIYA KISELOVA
Dermatofunctional Physiotherapist
Technical director
VIRGINIA SANTOS
Orofacial Harmonization MD.
Rui Lima
Plastic surgeon
DERMATOFUNCTIONAL PHYSIOTHERAPY
Dermatofunctional Physiotherapy is the specialty responsible for promoting and rehabilitating the functionality of the integumentary system. It acts in the evaluation, prevention and recovery of disorders / pathologies, surgical procedures and injuries of endocrine, metabolic, circulatory, dermatological, musculoskeletal or neurological origin that affect directly or indirectly the integrity of the integumentary system.
The dermatofunctional physiotherapist acts from prevention to the treatment of tegumentary (dys) functions, and his intervention is based on health promotion and rehabilitation in reparative and surgical contexts. Thus, we can see this professional working in several conditions such as: localized fat, fibroid edema (GEG), skin and muscle flaccidity, stretch marks, dyschromias, scars, wrinkles, skin pathologies (rosacea, psoriasis, xerosis, acne, dermatitis and vitiligo), cutaneous discontinuity situations such as burns and ulcers, pre-, trans- and postoperative care, lymphedema and mastectomies.
It also plays an important role in the fight against photoaging and in the early screening of skin cancer with its referral to dermatology.
Bearing in mind that the changes that involve the integumentary system and its related structures, commonly affect the subject's appearance, it is possible to understand the relevance of Dermatofunctional, which will act in terms of functionality, and will still play an important psychosocial role.
In Portugal, Dermatofunctional Physiotherapy started taking its first steps about 10 years ago. Although it is a recent past, it already has dozens of qualified professionals to intervene daily in it from north to south of the country, mostly under private practice in clinics and hospitals.
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Intervention Fields:
Postoperative Recovery Plastic Surgery
Postoperative Recovery Vascular Surgery
Post - Ocological Recovery
Pregnancy and Postpartum Aesthetics
Stretch Marks Treatment
Cellulitis
Flaccidity
Face Treatments
Acne
Slimming and localized fat
Intimate Zone Treatments and Women's Health
Treatments Burns and Scars
Hair Removal and Rejuvenation Laser
Alterations of Sanguinea Circulation
Hypopressive Gymnastics
OROFACIAL HARMONIZATION
Orofacial Harmonization is a set of treatments that seeks to provide a balance between the aesthetic and functional relationship of both the smile and the patient's face. Through procedures such as application of Hyaluronic Acid (Fillers), botulinum toxin (Botox), Support Wires, Bichectomy, Peels, Mesotherapy with multivitamins or Growth Factors (PRGF) to correct wrinkles and asymmetries, acne marks and scars, improve proportions facials and ensure a rejuvenated appearance of the face. In addition to taking care of well-being and health, we also managed to improve people's self-esteem.
Before leaving for the procedure, an evaluation is made of the structures of the face, smile and dental arches, in addition to the main complaints of the patient. Thus, with all this information, it is possible to propose a personalized plan.
In our clinic you can count on Dr.ª's extreme professionalism and friendliness. Virginia Santos national reference in facial harmonization.
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Find out more about:
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- Botox
- Filling with Hyaluronic Acid
- Peeling
- Lifting with Support Wires
- Plasma Rich in Growth Factors
- Dermaroller
INDIBA RADIOFREQUENCIA PROINIC MEDICAL
The INDIBA ® radio frequency technology generates three biological effects:
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-Biostimulation, Vascularization and Hyperactivation.
These processes increase metabolic cell activity, blood flow and circulation, improving the oxygenation of tissues and cells. The effects also support the creation of new collagen, detoxify tissues and support lymphatic drainage. When working at a specific frequency of 448kHz, INDIBA can also work at a sub-thermal level, allowing to provide treatments in sensitive areas and acute tissue repair (immediate postoperative, new scar formation and post-aggressive treatments).
Combining manual therapy with INDIBA technology will accelerate cell remodeling with results from the first session; The combination of manual therapy, exercise, other technologies and INDIBA will result in incomparable results for Cellulite, Flaccidity, Localized Fat, Edema, Postoperative, Postpartum.
INDIBA technology is highly recommended by professionals for pelvic health treatments for men and women. Great results are achieved in postpartum treatments, pelvic pain and incontinence.
Intervention Fields:
Postoperative Recovery and Plastic Surgery
Breast Reaffirmation
Body Flaccidity
Face Treatments
Postpartum Recovery
Reduction of Scars and Burns
Musculoskeletal Pain Control
Pelvic Floor Rehabilitation
Hair Treatments
LPG INTEGRAL MEDICAL ENDERMOLOGIE
The CELLU M6 INTEGRAL MEDICAL is the reference equipment for treatments in the area of health, beauty and sport. Clinica Medform is the official LPG representative in the Algarve and we have 3 LPG equipment.
It brings together in a single device two high precision techniques in body and face treatments. Combining efficiency and comfort, this LPG endermology equipment allows you to achieve results never achieved before in aesthetic medicine, post-operatively, including health applications and injuries associated with sports.
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BENEFITS in the field of Aesthetic Medicine:
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BODY: The only technique that releases fats that are resistant to diet and exercise, naturally and painlessly.
Results:
70% increase in lipolysis, without damaging adipocytes;
Improved blood circulation.
Decreased cellulite
Drainage
Improves skin quality
Localized fat reduction
Body Shaping
Firming
Anti age
Silhouette contours
Intervention after plastic surgery
Fibrosis reduction
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FACE: LPG was inspired by the fundamentals of regenerative medicine to create a new generation of anti-aging treatments.
Results:
+ 80% Endogenous Hyaluronic Acid
+ 46% production of endogenous elastin
+ 98% brightness
+ 21% smoothed wrinkles
+ 23% firmness
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Health Area:
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INDICATIONS
Rheumatology: Decreased stiffness and joint pain and elimination of tensions;
Orthopedics: Pre and postoperative, resorption of edema, improvement of joint mobility and pain;
Mastology: Release of adhesions, treatment of scars, reduction of lymphedema and pain;
Burns: Softening of scars, treatment of adhesions and fibrosis and pain;
Maxillofacial: Treatment of muscle spasms, edema, scars and pain;
Urology / Gynecology: Cesarean scar, skin relaxation and fluid retention;
Sports: Muscle preparation and recovery.
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RESULTS
Increased blood circulation;
Increased lymphatic circulation;
Fibrosis reduction;
Pain reduction;
Stimulates the production of endogenous hyaluronic acid;
Stimulates the production of endogenous elastin.
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IDEAL FOR TREATMENTS OF
Ache
Aesthetic medicine (pre and post operative)
Rheumatology (joint stiffness and tension)
Orthopedics (joint mobility and edema)
Pre and post-operative orthopedic
Mastology
Adhesions
Scars
Lymphedema
Burns
Muscle spasms
Urology
Fluid retention
Sport
Muscle preparation and recovery
FACIAL LIFTING WITH PDO THREADS
What does it consist of?
It is a new method of non-surgical LIFTING based on the multiple implantation of mini polydioxanone wires (PDO), which form a vector network that acts as support for the flaccid tissues and lack of volume in the face and body.
The PDO thread is a synthetic monofilament 100% absorbable by the body, used for many years mainly as a suture in internal surgeries, it was noticed that the scars were much less evident with the use of this thread and the skin with excellent appearance. Since then, several studies have been carried out for application to the face and body for intense stimulation of collagen and elastin.
The technique of this facelift has been disseminated in the world because it is an application of minimal invasion, allowing the very subtle insertion of the hair in the desired places almost imperceptibly through the dermis, promoting an effect very similar to the surgical facelift. In parallel, a therapeutic result is obtained in the improvement of tissues, activation of blood supply and lymphatic channels.
Promotes an effect of lifting the notorious tissue immediately and simultaneously favors the natural production of collagen. Stimulates skin rejuvenation, providing vitality, elasticity and greater luminosity. It improves the appearance of small wrinkles, nasolabial folds and sagging skin.
How is it done?
The application procedure is relatively simple and quick (30-60 minutes), it is an outpatient technique, requiring only local anesthesia. The therapy consists of the insertion of small needles loaded with mini threads of Polydioxanone (PDO) that remain in the dermis, after the removal of the needles.
The availability of different needle sizes facilitates treatment and adaptation to each zone and the patient's characteristics
The patient's return to his daily life is almost immediate, and he can even apply make-up.
What does the patient notice?
The tension caused by the implanted threads together with the edema caused by the trauma of the process itself, causes, from the first moment, a visible lifting effect.
The wires start to act immediately. From the third week onwards the real effects begin to be visible. The maximum effect point is reached after 2 to 3 months. They take between 6 to 8 months to be reabsorbed. During this time, its presence continues to stimulate the action of fibroblasts, increasing the production of collagen and elastin. This causes the effects to last over time after the strands disappear.
If necessary, you can repeat the procedure implementing new threads until you get the desired effect. You can perform touch-ups at any time.
Pre-treatment recommendations:
If you are taking painkillers, avoid aspirin, as it favors the appearance of bruises.
Avoid coffee, tobacco and stimulants in general.
Post-treatment recommendations:
Bruising, inflammation may appear. These are normal reactions to the procedure that disappear within two weeks. You can carefully wash the treated area after 4 or 5 hours, but avoid sudden movements, open your mouth excessively, laugh out loud or any other stimulus of the facial muscles during the following days. Do not massage the area during the first month. Avoid saunas and heat sources. You can use light makeup. Excessive makeup is not recommended in the treated area.
Indications:
Flabby tissue and facial wrinkles;
Dropped eyebrows or eyelids;
Naso-labial grooves (smile lines);
Jaw contour;
Body sagging (chest, abdomen, arms and thighs);
Support and densification of cheeks;
Redefining the contours of your face;
Profile improvement
Rejuvenation of the neck and décolleté;
Rejuvenation of the back of the hands;
Improvement of the periumbilical zone after pregnancy and weight loss.
Indicated for those who cannot receive applications of botulinum toxin or facial filling with hyaluronic acid, attenuating expression lines and marks.
Treatment advantages:
Non-surgical lifting;
There is no rejection or significant side effects;
Simple and quick procedure;
It can be combined and / or complemented with other techniques of aesthetic medicine such as filling, mesoplasty with vitamins, plasma rich in growth factors (PRFC), hyaluronic acid, botulinum toxin, vitamins, chemical peels, carboxitherapy, radio frequency, among others;
Effects will always be natural, does not produce deformations or changes in the strokes;
Return to normal activities almost immediately.
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Possible post-procedure reactions:
Reddish skin;
Persistent pain or inflammation in the early days;
Very low chance of infection if basic hygiene recommendations are followed.
It can cause bruising.
The patient does not need recovery time and can return to his daily activities immediately.
Contraindications:
Infection in the treatment region;
Active autoimmune diseases;
Pregnancy and breastfeeding;
Severe uncontrolled diabetes;
Acute cardiovascular disease;
Other serious illnesses.
360º CRYOLIPOLYSIS
CRYOLIPOLYSIS 360º is the latest and most effective method of combating localized fats, initially developed by scientists at Harvard Medical School. It allows non-invasively to eliminate localized fat, preserving the skin, nerves and blood vessels.
The equipment, with the handles of different sizes, are positioned in the treatment areas, a suction of the excess fat tissues is carried out into the handle and a controlled cooling of the fat is induced.
The equipment works selectively on the fat cells of the selected region, the fat is cooled to - 10º C for 35 - 50 min. The skin is protected by a specific gel film during the session.
At first, the patient feels a firm pull and an intense, but bearable cold in the applied region. Soon after, the sensation is tingling. Experts guarantee that these sensations are bearable and transient and that the patient does not feel pain during or after treatment.
Recovery after 360 ° Cryolipolysis is immediate (there is only a redness in the treated area and a swelling that quickly disappears) and the results can be seen within two months after the first application. In each session about 40% to 60% of the fat in the applied region is lost. The number of sessions varies according to the fat thickness of each region and the result expected by the patient.
Experts ensure that the results are permanent - as long as the patient is careful not to put on weight again.
COMMON QUESTIONS:
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1. What happens during treatment?
In the first stage, the fat area to be treated is marked. Then a protective film is placed in order to preserve the integrity of the skin and prevent injury. The treatment handle is then placed over the selected area, which through the vacuum delimits the area to be treated. After these procedures, Cryolipolysis begins.
2. How does it feel during treatment?
You will feel a sensation of intense cold during the first minutes that will dissipate quickly. The patient is comfortably seated or lying down during the treatment period.
3. Will I be able to return to my routine after treatment?
Yes you can. The treatment is not invasive, so you can go back to your routine afterwards. There are some temporary effects after treatment, which disappear in a few days: redness, flictus, ecchymosis, tingling or numbness in the treated area.
4. When will the results of Cryolipolysis be visible?
Cryolipolysis leads to the death of fat cells in the treated area. The elimination of these cells from the body, starts immediately and is complete within 120 days. After a week the results start to be visible. About 80% of the results are achieved within 2 months after treatment and the final result after 3 months.
With this state-of-the-art technique, the patient can eliminate 20 to 25% of the fat in the worked area, with a single application. It is ideal for those who want to get rid of unwanted excesses and can be applied to different parts of the body, especially in the areas of the belly, back and thighs.
ULTRA-CAVITATION
Cavitation is also known as Ultralipo or non-invasive liposuction. Given its efficiency, it is a good alternative to traditional liposuction, not least because it is a non-invasive and completely painless method.
What is Cavitation?
It is an ultrasound technology that causes the formation of micro bubbles in the adipose tissue, triggering the rupture of the cell membrane and fragmentation of the fat cells. Its content is composed mainly of triglycerides, which are dispersed in the interstitial space and are transported through the lymphatic system to the liver.
What are the advantages and results of Cavitation?
Firstly, Cavitation is a safe method and that, unlike other procedures, such as traditional liposuction, does not require hospitalization, cuts, anesthesia, or recovery time.
The results of Cavitation become evident in the first sessions. The body contour becomes more defined so that you can achieve a more elegant silhouette. However, this treatment can be done not only by women, but also by men and the most treated areas are the glutes, the thighs, the abdomen and the external and internal part of the leg. It can also be used in other areas with a high adiposity index.
Obviously, some care with food is recommended, as well as regular physical exercise, so as not to recover the lost fat.
Experts recommend that there be an interval of at least 3 days between sessions and recommend patients to drink two liters of water a day, during treatment, to help eliminate fat from our body.
How long is the treatment?
The treatment has a variable duration according to the area to be treated, the degree of adiposity and the organism of each person. In any case, six to twelve sessions per zone to be treated are generally recommended, with each session lasting an average of 45 minutes.
Cavitation is usually followed by the INDIBA proionic system activating the physiological lymphatic drainage that will facilitate the routing of triglycerides to the lymphatic pathways and to the liver.
Risks - What are the contraindications for Cavitation?
Cavitation is contraindicated in pregnant women, people with skin problems, cancer patients and patients with prostheses and / or pacemakers.
If you suffer from hypertension or have thyroid problems, you should report it to the therapist, as depending on the situations, they may constitute barriers to the application of cavitation treatments. In addition to these situations, cavitation should not be used on the lips, face, mucous membranes, neck, sinuses, heart area or in bodily areas with wounds and / or varicose veins.
HYPOPRESSIVE GYMNASTICS
Hypopressive Gymnastics is a combination of exercises for abdominal muscles, pelvic floor muscles and trunk muscles created in the 1950s by French physiotherapist Marcel Caufriezna in Belgium.
This combination of exercises produces a particular type of movement of the abdominal muscles (known as diaphragmatic aspiration maneuver) that has the property of pulling up the pelvis organs (bladder, uterus, ovaries, etc.), repositioning them and strengthening the pelvic floor. .
More than a third of women are unable to properly contract their pelvic floor muscles or maintain active abdominals at rest, simply because they have no proprioceptive notion of their location, and how to contract them.
Besides being an excellent exercise to train the contraction of the pelvic floor and abdominal muscles, more than that, it trains the dissociation (isolated contraction of each muscle) of these two contractions.
Recent studies show that hypopressive gymnastics has shown results in the improvement of genital prolapse of the most diverse degrees, as a way of re-education and active repositioning of Organs pelvic organs.
It is a method that is able to increase the resting tone, reducing the pressure on the abdominal cavity, and cause an involuntary activation of the muscles of the pelvic floor and abdominal band. Being a more comprehensive technique, it helps to normalize muscle tension, being very useful for posture (postural reeducation).
10 REASONS TO DO THE HYPOPRESSIVE METHOD
1. REDUCES ABDOMINAL PERIMETER
two . REDUCES BACK PAIN
3. IMPROVES SEXUAL FUNCTION
4. INCREASES SPORTS INCOME
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5. PREVENTION AND TREATMENT OF URINARY INCONTINENCE
6. PREVENTION OF HERNIAS
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7. EXCELLENT PRE AND POST-DELIVERY METHOD
8. IMPROVES PULMONARY CAPACITY
9. IMPROVES POSTURE AND BALANCE
10. IMPROVES AND PREVENTS THE “FALL” OF INTERNAL ORGANS
POST-SURGICAL REHABILITATION
After the intervention is carried out, the success of the plastic surgery depends on the reaction of the organism but, above all, that the patient is faithful to each medical indication in the postoperative phase.
1. Abdominoplasty
Plastic surgery to remove fat, flab, excess skin and stretch marks, this intervention improves the entire area between the navel and the pubis. The surgery lasts 2 to 4 hours, with general or, in some cases, local anesthesia. The first 24 hours may be the most difficult, as there is a greater likelihood of complications due to anesthesia. You will experience swelling and moderate pain at first, but it is controlled by medication. Confirm that you can return to the clinic or contact the doctor if unforeseen circumstances arise.
1.1. Postoperative care
To drain excess blood or fluids, small tubes are placed in the incision area during surgery. These are removed as soon as the drain is completed (the doctor will give instructions on how to clean the drains if necessary). A surgical dressing will cover and protect the intervention area. The bed will have to be positioned to raise the upper body and the knees. The administration of antibiotics and anticoagulants may also be necessary during the ten days after abdominoplasty . For at least 30 days, the use of a specific brace is recommended to prevent the accumulation of fluid in the area involved, to benefit recovery and subsequent healing.
2. Liposuction
Through a tube and a vacuum device, the surgeon removes the excess adipose tissue in the area to be operated. This surgery helps to eliminate fat from areas as diverse as the abdomen, buttocks, hips, thighs, ankles, chin, cheeks, neck and upper arm. On average, liposuction can take 1, 2 or more hours to complete and requires general or localized anesthesia, depending on the size of the intervention. Initially, liposuction causes some pain and discomfort, symptoms that are controlled with pain relievers.
2.1. Postoperative care
You should follow the surgeon's instructions to avoid infection, fibrosis, depression or other complications. About 2 to 3 weeks after liposuction , the patient is prepared to return to active life, although swelling and bruising may take between one and six months to disappear, depending on the body's ability to regenerate. In the abdomen area, a modeling belt is used to prevent the accumulation of liquids and favor the accommodation of the tissues. In the recovery period, it is important that you can be at rest. The results are evident, but to be long lasting, they need to be supported by a balanced diet and exercise. After 3 months, the area that has undergone liposuction has a normal appearance.
3. Augmentation mammoplasty
Silicone or saline breast implants are placed below or above the pectoral muscle, providing an enlargement of the breast and an improvement in its shape. This surgery is indicated to increase the volume of the breasts and for cases of asymmetric or sagging breasts. However, the effect is not immediate. In the first month, the implant begins to adapt to the body and, at the end of a quarter, it gains its definitive shape. In some patients, it may take up to 12 months to stabilize.
3.1. Postoperative care
It is one of the most sought after plastic surgeries at the moment and also one that requires less recovery time. After a few days, the patient can return to active life, as long as she does not make any physical effort. At first, you will feel a decrease in sensation in the chest, especially in the nipple area, as well as some discomfort and temporary bruising. In the first 3 to 4 weeks, efforts are prohibited to prevent the risk of implant rupture. You cannot wear a bra in order to avoid physical contact with the breasts. The scars disappear between 3 to 12 months after the surgery.
4. Rhinoplasty
It is a low-risk surgical procedure, sought by those who want to improve the appearance of the nose, after advice from a plastic surgeon, or the respiratory function, in this case, at the suggestion of an otolaryngologist. Rhinoplasty reduces or increases the size of the nose, corrects the very flat or pointed shape, eliminates the sharp back, changes the tips too low or raised, narrows the base of the nostrils, when too large or wide, or change the angle between the nose and the lip.
4.1. Postoperative care
The nose surgery is not very painful, but the patient may have some difficulty breathing on the first or second day after the operation. Edema and bruise around the eyes are normal. You may need to put on a splint for a week. Bruising will take about 15 days to disappear, at which point the patient is prepared to return to normal life. As it is a detailed surgery, the healing process takes a few months, depending on the person's cell regeneration capacity. It is very important to use sunscreen daily and avoid sun exposure.
5. Otoplasty
Plastic surgery that changes the shape, position and size of the ear . Due to congenital malformation or prominent ears, this intervention can be performed from 5 years up to adulthood. The doctor will examine the position, size and symmetry of the ear to understand which techniques are best. General anesthesia may be required for interventions that require the removal of larger cartilage or skin. After surgery, support splints will be placed to keep the ear in the new position, which will be removed a few days later. It is normal to experience discomfort and some itching.
5.1. Postoperative care
Golden rule for any surgery, quitting smoking is a pre- and postoperative condition, since smoking habits decrease the blood flow in the skin and can delay healing. It may also be recommended to stop taking medications, such as anti-inflammatories, and supplements that increase the risk of bleeding. Initially, you will notice the swelling in the area and it is important to rest. In the first weeks, every two days, you will have to go to the clinic to change the dressing (after six or eight days the stitches are removed). In the first weeks, you should also avoid sudden movements, sleep with your head raised and, if necessary, use a compression band.
Each plastic surgery requires specific care so that you can benefit from the real results of the intervention you have undergone. The proper execution of the surgery is a physician's obligation, but the responsibility for an adequate recovery rests with the patient.
CARBOXITERAPY
Currently, carboxitherapy is one of the best treatments for sagging and rejuvenating body and face, improving dark circles, stretch marks and cellulite.
The origin of this therapy is found in the thermal water station of Royat, in France, specifically in the 50s, when a group of cardiologists applied the therapy to patients suffering from different diseases related to poor blood circulation and the accumulation of fats .
Carboxitherapy is a non-surgical method which consists of the therapeutic use of carbon dioxide gas (CO2) subcutaneously, this gas is non-toxic and non-embolic.
Carbon dioxide works by dilating blood vessels and stimulating the formation of new blood vessels, promoting better blood irrigation in the tissues and, consequently, better oxygenation of the treated region. Carbon dioxide also acts in the breakdown of fibroses in the subcutaneous tissue. Some studies show the favoring of collagen and elastin formation and the lipolytic effect (breakdown of fat cells) resulting from carboxitherapy.
The application of carboxytherapy provides a slight detachment of the skin, causing slight pain. Therefore, it is recommended to start the sessions with smaller dosages, so that the patient will gradually get used to the technique.
Carboxitherapy is especially indicated for:
- Improvement of dark circles and wrinkles around the eyes;
- Face sagging;
- Sagging neck;
- Neckline rejuvenation;
- Rejuvenation hands
- Sagging and rejuvenating arms and legs;
- Improvement of stretch marks and cellulite. In addition, carboxitherapy can also be used as a complementary therapy to liposuction, and can be done in all regions of the body, including the breasts.
- Carboxitherapy acts in the treatment of scars and in the treatment of fibrosis resulting from plastic surgeries, such as liposuction, for example.
Risks of carboxitherapy:
The risks of carboxitherapy are rare, however, there may be some side effects such as:
- Pain and swelling at the injection site;
- Sensation of numbness or burning in the skin;
- Small bruises in the application area, in this case avoid sun exposure until it disappears.
Due to the existence of some side effects, carboxiterpaia is contraindicated in cases of skin allergy, obesity, pregnancy, herpes and heart disease, lung diseases such as COPD, kidney diseases, severe arterial hypertension, arterial thrombosis and people who use medication concomitantly. containing carbonic anhydrous, among others.