Background
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It all started in 1990. I was 21. I had just broken up with my girlfriend. All of a sudden I started to lose a lot of hair.
My pillow was covered in hair every morning when I woke up. The shower drain was clogged with hair when I got out of the shower and every time I brushed my hair, I would have to brush the hair off the back of my shirt.
I made an appointment at a leading hair loss clinic immediately. I was told I had poor circulation of the scalp, embedded dandruff and oil blocking the follicles, which was causing my hair to fallout. |
They wanted me to sign up on a $1700 program that was guaranteed to stop the hair loss immediately.
As desperate as I was to do something quickly to stop my hair falling out, I wanted to get other opinions, so I told them I wanted to think about it. They said "What is there to think about? If you don't do anything right now all your hair will be gone in 2 years".
It was a typical high-pressure sales pitch, which put me off. I read the fine print on the guarantee and it was dependent on using the clinic's own brand of products which would make me a customer for life.
I became suspicious so I contacted The Australian Consumers Association (Choice Magazine). They sent me a story they had done on the Hair Loss Industry called "The Bald Facts".
It covered everything, cause and effect, cures and camouflages, and most importantly what to do if you think you are losing your hair. The very first page told me, Male Pattern Baldness, is not caused by poor circulation of the scalp, embedded dandruff and oil blocking the follicles. It is a result of two factors – an inherited genetic predisposition combined with a certain level of male hormones.
Choice recommended seeing either a Dermatologist or a Trichologist (Trichologists are not doctors but specialise in hair and scalp problems). I contacted The Australian Branch of the International Association of Trichologists (IAT). They provided me with the names and locations of its members who are certified Trichologists.
Seeing a Trichologist
I saw a leading Trichologist and he told me what my options were (which weren't many, back then). The only thing proven to work on Male Pattern Baldness in clinical trials was Minoxidil 2%(a lotion available on prescription only at a cost of $70 a month).
I got a prescription and applied Minoxidil 2% to my scalp twice a day. After six months it wasn't working for me. My hair was still falling out, so I stopped using it.
I was devastated! There was nothing I could do to save my hair. I could only hope the hair loss slowed down. I kept in touch with my Trichologist every few months seeing if anything new was on the market to help prevent Male Pattern Baldness.
The hair loss did slow down but 5 years later in the middle of 1995 I was unable to style my hair the way I used to, and get away with it. People began to notice my hair was thinning, some made comments, others made jokes.
Every time I looked in the mirror or saw myself in a photo, I got depressed. If someone made a comment or worse a joke, I was shattered for days.
Losing your hair effects different people in different ways. Some people say they couldn't care less, while for others (including myself), losing your hair can be devastating, especially when it happens at a young age.
I felt it made me look older than I actually was, I felt less attractive to the opposite sex and I was less confident in social situations.
I stopped doing a lot of things I used to enjoy, so as to avoid the people who used to make comments and jokes. I avoided mirrors and wouldn't let people take pictures of me.
It was beginning to affect me psychologically so I started reading books on positive thinking, trying to convince myself it didn't really matter. But deep down, it really did matter. I had to look at my options again. I couldn't stop thinking about it. I wanted my life back!
My only options now were surgery or a hairpiece.
I first looked into hair fusion, although I never seriously considered this as an option. This option is high maintenance and I am a low maintenance kind of guy. The fusion technique involves a hairpiece, or "unit", that is meant to be tailor made to fit your hair and pattern of balding. Your own hair is pulled through the mesh base of the unit to hold it in place, along with clips or glue and double-sided tape. Because the unit is attached to your hair, it starts to lift off as the hair grows and so needs to be refused every 4 to 6 weeks.
One subscriber to Choice Magazine found out "units", have a limited lifetime. His lasted only 9 months before the hair started falling out. In that time it had also changed colour, having bleached or faded by the sun. Others complained the "unit" was very uncomfortable, did not look natural, and they always had to be on the lookout to protect it from the sun and rain.
Considering the replacement cost, plus the cost every month for a "refusion" and that the guarantee offered is dependent on using the clinic's own brand of shampoos, reconditioners and revitalisers, hair fusion can be very high maintenance and a very expensive option.
I also looked into wigs and hairpieces, the oldest method of disguising baldness. They are particularly good for people who have lost a lot of hair as a result of chemotherapy, or an accident. For men with male pattern balding, the only advantage a hairpiece has over hair fusion is that it can be taken off, making washing it and your own scalp easier.
I decided hairpieces, hair fusion were not an option. I spoke to my Trichologist and saw a hair transplant Doctor he recommended. At the time scalp reductions, flaps and plugs were the most common forms of hair transplantation. Minigrafts and micrografts were just starting to be introduced as the latest technology in hair transplantation.
I saw guys who had scalp reductions, flaps and plugs and I was not impressed.
Scalp reductions create a scar that sits in the middle of an area of the scalp, which is still often seen. Also the direction of the hair growth is altered, which results in an unnatural appearance.
Flaps leave scars both above and below the flap. It also makes the angle of hair growth the same as it was on the side of your head, which results in an unnatural appearance.
A plug contained 15 or 16 hairs, which meant the new hair looked a bit like rows of corn and didn't look very natural at all. These methods were not an option as far as I was concerned.
Minigrafts and Micrografts were the most natural looking option at the time, but Minigrafts and Micrografts were only being done in small numbers which meant several sessions were required to cover a large area of baldness. Due to the size and spacing required you would have a "tufty" or "pluggy" appearance after the first couple of sessions that could only be filled in with multiple sessions in the gaps between grafts. This may represent a period of 2 to 3 years to achieve the final result with the potential for some embarrassing moments during that period.
I wasn't prepared to have several operations and look like a freak for 2 or 3 years. Again my hopes were shattered. Here I was 26 years old going bald and there was nothing acceptable I could do about it. Again all I could do was try to accept it. I went out and bought a hair clipper and put a number 1 through what was left of my hair.
Waiting for a breakthrough
In 1996 a breakthrough came. It was discovered the drug Finasteride, which was being used for treating people with enlarged prostate glands had a fascinating side affect, some patient's hair started growing back.
This lead to the discovery Male Pattern Baldness is caused when male hormone testosterone is converted to a derivative, dihydrotestosterone (DHT). High levels of DHT cause hair follicles to age prematurely and shrivel.
Finasteride works by blocking an enzyme, 5-alpha-reductase, which converts testosterone to DHT. The drug can cause DHT levels to drop by up to 70 percent in eight hours. When DHT levels are low, follicles can strengthen and produce hair for longer. The only downfall is a possible loss of libido and difficulty in achieving an erection in less than 2% of patients.
It was simple, reduce DHT, reduce hair loss, and maybe grow some hair back. Now I had some hope. Only problem was the drug had to be tested in clinical trials, before it could be sold as a drug to prevent Male Pattern Baldness in Australia.
My Trichologist said it would be at least 1 year before Finasteride was released in Australia. He also told me about a herb (Saw Palmetto), that could do the same thing (and could cause similar side affects). I immediately went to a health shop and purchased some Saw Palmetto (Proseren) capsules and took 2 a day at a cost of $20 a month and took my chances. I had no side affects, but no noticeable improvement in hair growth. It did however slow down the hair loss. I saw less on my pillow in the morning.
I did this for about 1 year until Finasteride (marketed as Propecia) was available in Australia. I decided to change to Propecia, since it had been tested and proven to work on Male Pattern Baldness, where Saw Palmetto had not. I have taken Propecia ever since with similar results to Saw Palmetto, at a cost of about $70 a month (my health fund allows me to claim $500 a year of the total cost). Propecia is definitely helping keep the hair I have left. I know this because the rate of fallout is virtually nil. It took a while before this happened though.
I decided to stay on the Propecia for at least 12 to 18 months before I could confidently say if it was working or not. By mid 1999, I still had not had any regrowth, but I was holding what I had left, so I started looking into hair transplants again.
I found hair transplants had improved dramatically over the last 4 years. Follicular units had been discovered. It was found the hair at the back of the scalp does not grow individually, but in naturally occurring groups of 1 to 4 hairs. The discovery of the follicular unit allows doctors to mimic nature by transplanting hairs in the same way nature grows them.
It sounded good. Doctors remove a strip of scalp 1cm wide and up to 20 cm long, from the back and side of the head. The donor site is closed with stitches, staples or sutures until the wound heals. The strip of scalp is divided up and given to several technicians. Using microscopes to see these follicular units, the technicians dissect them precisely, and then replant them densely into the bald scalp in large numbers. The procedure was often referred to as a megasession.
For the first time in a while, I was excited. I learnt that a megasession consists of 1000-3500 follicular unit grafts placed in one sitting. Each one of these grafts would contain from 1 to 4 hairs. One follicular unit megasession equaled to 3 to 5 sessions using the commonly performed conventional methods with mini and micro grafts. The smaller follicular units could be placed so much closer together than traditional mini and micro grafts effectively negating the "tufty" appearance.
Since there are fewer sessions, there is less time off work, less discomfort and less anxiety regarding the procedure. There is not much difference in the price (since fewer sessions are required) and the end result is so much more natural.
It all sounded good, but I wasn't getting my hopes up. After what I saw before I was sceptical, so I decided to look into follicular unit hair transplants further.
My research
The Internet is an excellent source of information. This is where my search started.
Here are some of the web sites I looked at. I spent most of the time on the non-commercial sites to find out the positive and negative aspects of follicular unit hair transplantation. The Commercial sites only focus on the positive aspects of follicular unit hair transplantation. I also wanted to talk to as many people as I could who had follicular unit hair transplants and ask them about their experiences and results.
Non-Commercial Hair loss sites
http://www.hairlosshelp.com/ This is the best hair loss site on the Internet. You can ask questions to experts in the hair loss field including Dr Robert M Bernstein and Spencer Kobren. Dr. Robert M. Bernstein is the Medical Director of the New Hair Institute and is regarded as one of the masters of follicular unit hair transplantation. His own web site is located at http://www.800newhair.com/
Spencer Kobren is the author of a best selling book called "The Bald Truth" The First Complete Guide to Preventing and Treating Hair Loss. He also hosts a radio program called the "Bald Truth Radio Hour"(a talkback radio show devoted to the topic of hair loss). You can listen to this program via the web site. He also has his own web site located at http://www.thebaldtruth.com/
Alt.baldspot Is a newsgroup where anyone can write in and share their hair loss experiences, I contacted dozens of people, male and female who had hair transplants, I asked which Doctor they used and what type of procedure they had done. A lot of people were unhappy. Most of them had scalp reductions, flaps or plugs. I did not find many people unhappy with follicular unit transplants. The only complaint was it looks natural but the hair is not thick enough.
http://www.regrowhair.com/ This guy has had 3 follicular unit hair transplants done by Dr. Ron Shapiro and looks fantastic. This is his story and he actually takes you through a hair transplant procedure with photos of the progress of the hair transplant. There is also a lot of other good information about hair loss on this site. You can even E-mail him and ask questions.
http://www.regrowhair.com/ Another site about a guy who had a follicular unit transplant. There is much more detail and many more detailed photos of the progress of the transplant. This guy did a lot of research before he had a transplant. He interviewed leading Hair Transplant Doctors before making a decision. There is an articles and references section, a horror story section, a comments section where a lot of people have written in and shared their experiences and links to other sites. There is also a chat room were you can chat with other hair loss suffers.
http://www.regrowth.com/ This is an excellent site that covers everything to do with hair loss. Transplants, interviews with leading Transplant Doctors, treatment suggestions, product reviews, cover-up products and links to other hair loss web sites. There is a chat room where you can chat with other hair loss suffers. This guy also takes you through his own personal treatment program.
http://www.hairlosstalk.com/ Another web site, where people write in and discuss their experiences. Also has a lot of other good information about hair loss. There is a chat room where you can chat with other hair loss suffers. This site also has good story about a guy who had a transplant. This guy looks fantastic. http://www.hairlosstalk.com/mc7.htm
Commercial Hair loss sites
After reading everything I could find on follicular hair transplants and sending and receiving several E-mails, I found the following Doctors were the most recommended on Alt.baldspot, The Bald Truth Radio Program and people who I personally E-mailed and were happy with the results.
http://www.hair-doctor.com/ Dr David Seager. This is the Doctor other Hair Transplant Doctors go to when they need a hair transplant. Dr Seager has, over the years distinguished himself as an innovator in the field of hair transplantation. Dr David Seager was so confident in his method and his team he had them do a hair transplant on himself. His before and after photos are on his web site, along with other patients he has performed transplants on.
http://www.800newhair.com/ Dr Robert M Bernstein and Dr William R Rassman set up this medical group of board certified physicians devoted solely to hair restoration. They are very confident in their work having regular open house seminars where you can meet former patients. This web site has dozens of before and after photos of patients sorted in hair loss pattern types.
http://www.hair-transplants.org/my.htm Dr. Ron Shapiro's is so highly recommended at one stage he could not take on any new patients. His pioneering contributions to the follicular unit hair transplants have earned him the respect of his physician peers. This web site has lots of before and after photos of patients Dr Ron Shapiro has performed transplants on.
http://www.micro-transplants.com/ Dr Bobby L Limmer introduced the use of the microscope into the hair transplant procedure and has been at the leading edge of transplantation surgery innovations, giving more than thirty presentations at prestigious medical conferences and publishing more than a dozen articles in leading medical journals. He is recognised as one of the premier hair transplant surgeons worldwide.
Finding a Doctor
After studying the above web sites and speaking to people, who had a follicular unit hair transplant, I was convinced this was the breakthrough I had been waiting for. I now had to find a Doctor in Australia using the same procedures and getting the same results.
I spoke to my Trichologist and others registered with The International Association of Trichologists to get an independent view on the Hair Transplant Surgeons in this country.
I had consultations with 4 of the Doctors they all recommended, all were members of The Australian Society of Hair Transplant Surgery. Most Doctors gave me names and phone numbers of former patients. After meeting some of their former patients, I found they were all getting excellent results.
I have listed reasons for choosing Dr. White at the end of this story.
Before my procedure
I booked the operation and put in for 2 weeks annual leave. This would allow me time to completely recover from the operation. I did not tell anyone from work I was having a hair transplant and wanted to go back to work unnoticed.
After I booked the operation I felt relieved I had finally done something about my hair loss, which had been bothering me for a long time. I also felt very nervous. Even though it is minor surgery it is still an operation and I was worried about complications.
Hair restoration procedures differ from general surgery, however, in that they involve only the outer layers of the body. In Dr White's experience, post-operative complications have been infrequent and never serious. The most common being, minor swelling and occasional bruising around the forehead and eyelids on the 3rd day. This may last for up to a week. Part of my scalp may remain numb for some time due to temporary interference with the nerves in this area.
I was also worried about how I would look after the operation. Some people look better than others do after a hair transplant due to certain factors, After having so many consultations and doing so much research I knew the following factors about my hair and skin:
My hair is straight and dark brown in colour on fair to olive skin. My hair texture is medium and I have good donor density and scalp flexability. Dr. White described various aspects of restoring my hair and how these factors would contribute to the outcome of my transplant.
What were my expectations?
Hair transplantation does not create new hair. It simply relocates it from your donor area (the sides and back of your head) to your area of Male Pattern Baldness. Transplanted hair may look wonderful and full, but it will never be as thick as it once was. Some people are very satisfied to just re-establish a thinning look in an area where they were once bald. While others are not satisfied until they've achieved a look of having a full head of hair.
I was prepared for a natural thinning look, but hoping for a look of having a full head of hair. I believe it is better to look thin, than to look bald.
My expectations:
1. I want a natural look. With an even coverage of medium density.
2. I want it to blend in with my existing hair and not be detectable.
I went over these expectations several times with Dr White. Although it is impossible to predict what the final outcome will be, he guaranteed me I would look better after the procedure.
The procedure – Day of change
6:30am Boarded flight to Melbourne and ate a light breakfast on the plane.
8:15am Arrive at Melbourne airport and greeted by the National Hair Institutes chauffeur.
9:00am Arrive at the National Hair Institute feeling very nervous. I settled my account, then changed into a medical gown and took a seat in a chair that was very similar to a dentist chair. I was given a menu and I ordered lunch. |
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Then Dr White handed me a mirror and drew a line on my forehead that would represent my hairline. He rubbed it off 2 or 3 times until we both agreed it looked right. Dr. White would focus on using the estimated 2500 grafts on the front half of my bald scalp, going back about 10cm from the front hairline. This would establish my hairline and give me the most dramatic initial improvement.
9:15am I was given an injection, (to help calm the nerves and to relieve the pain of the local anesthetic injections) and some tablets to swallow (to help healing and to prevent infection). I was hooked up to a machine, which monitors blood pressure and heart rate. This machine was beeping like crazy until the injection kicked in, cause I was so nervous.
9:30am The hair in the back is taped up and a strip of hair 1 cm wide by about 20 cm long is shaven. Dr White gives me several injections of local anesthetic in the back of my scalp where my donor hair will be taken from. This was the most discomforting part of the whole operation.
9:45am The back of my head is now numb. Dr White now removes half of the donor strip and gives it to the technicians. The other half would be removed later when the technicians finished dissecting the first strip, this way the donor hair is out of the body for the shortest possible time. While the technicians prepare the donor strip, Dr White staples the donor area closed (he uses sutures on some people and staples on others). During this I could not feel any sensation of this happening at all.
10:00am The first strip of donor hair is divided up between the 6 technicians, and using microscopes they begin to dissect it into follicular units. The 1 hair follicle grafts, 2 hair follicle grafts, 3 hair follicle grafts and 4 hair follicle grafts are placed in separate trays and placed in a refrigerator until needed.
11:15am Dr. White gives me several shots of local anesthetic in the front top of my scalp. This is the area where he will be transplanting my hair follicles. Once the local anesthetic took effect the top of my head was completely numb. Dr White now removes the second half of the donor strip and gives it to the technicians. While the technicians prepare the donor strip, Dr White staples the donor area closed. The tape holding the hair in the back is removed and the hair drops down and covers the staples.
11:30am Two technicians begin placing the grafts (1 on each side), while the other 4 continue to dissect the second strip of donor hair. An incision is made with a hypodermic needle and the hair follicle graft is placed into the incision. I couldn't feel the incisions at all.
The 1 hair follicle grafts are placed in the frontal area of my scalp and the 2 hair follicle grafts, 3 hair follicle grafts and 4 hair follicle grafts are placed behind the 1 hair follicle grafts. To create hair that grows in a naturally random pattern, the incisions are made in irregular and varied patterns. The angle and direction of the incision is also varied to determine the direction the hair will grow.
The fineness of the incisions allows the technicians to make the incisions closer together, while still minimising any trauma to the scalp tissue.
12:30pm Time for lunch. I got up and immediately looked in the mirror (I could not contain myself) and was amazed to see all the short hairs sticking out of my previously bald scalp (the donor hairs are shaved down to less than 6mm to make them easier to handle). I ate my lunch and read my paper as I normally do. I was not in any pain at all. The back of my head didn't even feel tight after they took out the donor hair.
1:00pm I went back sat in the chair and watched TV while the technicians placed the grafts. Every hour the technicians are rotated and Dr White is frequently inspecting the progress of the transplant.
5:00pm All my grafts 2811(I only paid for 2500) had been successfully transplanted to the top of my head. A light bandage was placed around the donor area to help stop any bleeding.
5:15pm I was given some post-op instructions both verbally and in writing and given a number to contact Dr White in case of an emergency. I was given panadeine to take if needed (which I never did) antibiotics to prevent any kind of infection, anti swelling tablets and healing aid tablets to take for the first 4 days.
It appears the main concern in the first 72 hours besides infection is the grafts popping out. No exercise, lifting, leaning forward or sex for 3 days (not that it mattered). Any pressure on the head or elevation of blood pressure can cause the grafts to pop out.
5:30pm I put my baseball cap on and was driven to my hotel by Dr White's son Marcus.
6:00pm Checked into the hotel and ordered dinner. I spent the next half an hour staring in the mirror. I was surprised at how close the grafts were placed together and how different I looked.
7:00pm After dinner I watched TV for a while. I was still in no pain at all. I can honestly say hair transplants are not painful but the injections at the beginning of the procedure can be a bit uncomfortable.
10:30pm Went to bed. I had to sleep at a forty-five degree angle for the first 3 nights after the procedure to reduce the instance of swelling. I bought a neck pillow in preparation for this. It took me a while to get comfortable but once I did I fell asleep.
After the procedure
The day after
Woke up and still not in any pain (which surprised me). Ordered breakfast and caught a cab to the clinic. One of the technicians removed the bandage, washed my hair and inspected the transplant. She said it looked excellent and I didn't have any bleeding last night. She showed me how to wash my hair for the next few days. I had to use a cup to gently wet the transplanted area. I then used some gauze pads and a little bit of shampoo to gently, in an up and down motion dab the grafted area. I then rinsed the grafted area with the cup. I could not put my head under the shower or submerge my head under water or rub the grafted area for at least 5 days.
I caught a cab back to the hotel and took it easy the rest of the day. I was reading a book I had started some months earlier, and hadn't had the chance to finish. I thought it was ironic the chapter I was reading was called "Day of Change".
That night I started to notice some swelling around the forehead area, so I started to apply an icepack to my forehead every hour or so for 10 minutes.
Two days after
Still haven't experienced any pain. Picked up by the National Hair Institutes chauffeur and driven to the airport. When I arrived home, a friend called in to see me. He knew I went to Melbourne to have a hair transplant. When he saw me the first thing he said was "Wow, he really packed them in there, that is going to look excellent". He knows a guy who has had the older micrografts. He wasn't expecting me to have so many grafts so densely packed together.
The swelling was getting worse so kept applying the ice pack to my forehead every hour for 10 minutes.
Three days after
Still sleeping upright and in no pain but have experienced a lot of swelling around the eyes and face. I had a bit of a shock when I woke up because I thought both my eyes were going to go black and close. I used the ice pack every hour for 10 minutes. I spoke to Dr White and he told me this was normal and not to worry, he said the swelling would start to go down very quickly.
Four days after
Just like Dr White had said the swelling starts going down very quickly and I can sleep lying down for the first time since the operation. It takes a while to get comfortable due to the staples in the back of my head.
Five to ten days after
Swelling was completely gone after Day 5. It is getting more and more comfortable to sleep since I am used to the staples by now. At about day 6-7 I began to shower again. I could now gently rub the grafts in a circular motion and a lot of the scabs and crusts, which form around the grafts, came off. I spoke to Dr White about the redness of my scalp, again he told me not to worry because it would go away very quickly.
Ten to thirteen days after
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All the scabs and crusts have come completely off and the redness is gone just like Dr White said. I made an appointment with Dr White in Sydney and he removed the staples and he was very pleased with the progress of the transplant. He said I looked fantastic. The transplanted hairs look natural much to my relief.
Another one of my friends saw the transplant and he was amazed. He expected to see a head full of scars and dents. He said it just looks like you have shaved the front part of your head. |
This was really the only problem. It looks like you started to put a number 1 through your head and then stopped because you changed your mind. If it wasn't for the scar at the back I would have put a number 1 through the rest of my hair myself.
I went to my hairdresser and told her what I had done. I got her to cut the rest of my hair as short as possible without revealing the scar at the back. She was impressed and said, you wouldn't even know you had it done.
It looks a lot better now, because my hair is much more even. |
Two weeks after
Went back to work. I had the attitude of telling my workmates I had a hair transplant, only if they asked. I grew a beard in the 2 weeks I had off, and they were all making comments about how different I looked. A few guys looked up at my head but no one said anything. I think they can't figure it out, I went on holidays and came back much hairier. I have developed the habit of looking into the other person's eyes when I am talking to them to see if they are looking at my hair.
I am back to my usual routine of going to the gym 3 times a week.
Three weeks after
My transplanted hairs begin to shed. This is normal, (although I hoped it wouldn't happen). After they shed they will stay dormant for 3 to 7 months and then begin to grow. I will have to be patient now.
Four weeks after
The shedding starts to slow down. The hairs that remain are growing and I can't remember looking in the mirror this much. I have an appointment with Dr White and he tells me I have healed remarkably well. The donor scar, even after 4 weeks is barely visible.
Five weeks after
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The shedding starts again. Some days are worse then others. I still have about 30% of the transplanted hairs. Some of the hairs that broke off are starting to grow again.
My scalp remains slightly pink, I think I am noticing this more because most of the hair has now shed and the scalp is more visible. I went to the hairdresser this week and had another trim. She remarked about how I lost most of the transplanted hairs and asked if this was normal. I assured her it was but I could tell she was sceptical that the hairs would grow back.
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