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It is defined by vitamin B 12 deficiency in the presence of sufficient dietary vitamin B 12 intake, negative Schilling test, and lack of anti-intrinsic factor antibodies.30 Clinically, it is diagnosed by exclusion of other disorders or factors causing vitamin B 12 deficiency

This shift results in a lighter overall skin tone because pheomelanin yields a pinkish-yellow hue (as seen in people with fair skin or red hair), whereas eumelanin is responsible for brown or black pigmentation

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Collagen and elastin remodeling continues for 4 to 6 months after a consistent bi-weekly protocol begins