From Nip to Tuck

We never tire of talking about our flaws. Years past we may have judged others who went under the knife, vowing to let nature run its course and grow old gracefully. Fat chance of that now! With the stigma of getting work done so last decade, we covered cosmetic medicine in 2014. With so many improved options and new procedures available that restore a youthful appearance, often with little discomfort or downtime, we thought it was high time to visit the topic again. To that end, we consulted with experts in the field from Fairfield County and New York City. They filled us in on new treatments, enhanced techniques, the next generation of fillers, and any changes to tried-and-true procedures that might prompt you to consider an alteration. What a difference two years make: Whether you go big or small, there is bound to be something in our guide to beauty to fix what’s bugging you.
In the fast-changing landscape of cosmetic procedures, the options for lifting, toning and rejuvenating seem to multiply at a dizzying rate. Following are two of the hottest treatments to come to market in the past year.
WHAT IT IS: An FDA-approved, minimally invasive surgical procedure that addresses cellulite on the buttocks and posterior thighs.

WHAT IT DOES: A device releases the connective tissue bands—septae—that weave through fat and dimple the skin’s surface. Each depression is treated individually, starting with an injection of lidocaine to numb the area. After the device is positioned, it sucks up a pinch of tissue. A tiny needle automatically slides under the skin and cuts the band.

WHAT TO EXPECT: An in-office procedure that takes from forty-five minutes to an hour. There is some chance of bruising and minimal discomfort. You may return to normal exercise activity after three days; your physician may recommend wearing a Spanx-like compression garment. Results last up to two years, if not longer.

COST: From $3,000 to $5,000, depending on size of treated area.
WHAT IT IS: The first FDA-approved injectable designed to treat submental chin fat, or the “double chin,” often a hereditary condition that has nothing to do with a person’s fitness level.

WHAT IT DOES: Kybella is a synthetic form of deoxycholic acid that occurs naturally in the body and dissolves fat. The injection not only kills the fat in targeted areas but also the cell envelope containing the fat. Once destroyed, fat cells don’t grow back.

WHAT TO EXPECT: A fifteen-minute, in-office procedure. Mild to moderate pain during the procedure; expect bruising, swelling, redness, numbness and hardness in the treatment area but not enough to interfere with daily life. Requires two to four treatments, each about a month apart. Will start to see fat reduction and skin tightening after a month.

COST: $900 to $1,800 per treatment.
Now in the pipeline from the folks at Ravence Therapeutics: RT001, a topical formulation of botulinum toxin (Botox) that is currently in phase 3 clinical development trials for the treatment of crow’s feet. Imagine: Your doc simply rubs it on and removes it thirty minutes later. No muss, no fuss, and best of all, no needles!

Reliable and popular, many of these procedures have been around for years, while others are relatively new to the armamentarium. Thanks to improved techniques and more sophisticated technology, these classics have gotten even better, and more effective.

MAN-SCAPING trend alert
Since 2010, the number of surgical and nonsurgical procedures on men has increased. BLEPHAROPLASTY (up 34 percent), FACE-LIFT (44 percent), BOTOX (84 percent) and HYALURONIC ACID (94 percent) —American Society for Aesthetic Plastic Surgery
WHAT IT IS: Surgical procedure that removes excess sagging skin, muscle, and fat on the upper and/or lower eyelids. Extreme ptosis (drooping) may involve elevating the height of the eyelid.

WHAT IT DOES: Contours and smooths the eyelid area via incisions made in the normal folds of the upper and/or lower eyelid to create a more refreshed appearance.

GAME CHANGER: Instead of surgery on the lower eyelid, the doctor may inject lightweight filler into the tear trough—the crease between the fat pad and eyelid area—to add volume.

WHAT TO EXPECT: Local anesthesia with or without twilight-sleep sedation, one week of bruising with up to two weeks of swelling, depending on the patient. Typically, this surgery lasts a lifetime, but it may require a touch-up years later. A one-time procedure, with follow-ups for suture removal.

COST: From $5,000, plus surgery center fees, if needed.
WHAT IT IS: A non-invasive body contouring procedure for fat reduction. Particularly useful for abdominal “muffin top” fat, love handles and inner thighs.

WHAT IT DOES: The cooling process, called cryolipolysis, kills fat cells. Once frozen and crystallized, the dead fat cells are naturally eliminated from the body.

GAME CHANGER: CoolSmooth Pro, which treats outer thighs with a flat applicator that cuts the traditional treatment time in half, and the Cool Mini applicator, designed for submental chin fat.

WHAT TO EXPECT: An in-office procedure that takes from forty-five minutes to a couple of hours. You may experience slight bruising and numbness for up to two weeks. You may require one to two treatments, and will see results in two to four months.

COST: From $1,200 to $2,500 per session.
WHAT IT IS: Surgery that restores a more youthful face and neck contour.

WHAT IT DOES: Facial and neck tissue is lifted and repositioned. Traditionally, incisions follow natural creases around and behind the ears. For patients who have aging in the mid-face but without a severe amount of excess skin in the jawline and neck, surgeons use a short-scar “pony-tail friendly” technique that eliminates most incisions around the ears.

GAME CHANGER: Volume restoration: A combination of fat transfer, Botox and filler on cheeks, around the jawline and in the forehead can dramatically enhance overall results. For men: A direct excision to remove the “turkey wattle” beneath the chin, which avoids scarring behind the ears.

WHAT TO EXPECT: Local anesthesia with twilight-sleep sedation. You’ll be showering and walking around two to three days later. Bruising for about a week, with swelling for a week or two after that. This is a one-time procedure, with follow-ups, and lasts ten to fifteen years.

COST: Approximately $10,000-$18,000.
HAIR LOSS trend alert
More than 56 million Americans suffer from hair loss. Sixty percent are men and 40 percent are women. Many are finding satisfaction with PLATELETRICH PLASMA THERAPY, a treatment that involves injecting the patient’s own platelets into the scalp to stimulate hair growth and prevent existing hair from falling out.
WHAT IT IS: A powerful laser treatment that addresses sun damage, freckles, sunspots, acne scars and more.

WHAT IT DOES: The laser penetrates the skin to resurface fine lines and correct pigmentation and skin irregularities.

GAME CHANGER: Infini, a minimally invasive procedure that combines micro-needling with fractional radio frequency that is particularly well-suited for deep acne scars and is safe to use on skin of color.

WHAT TO EXPECT: For Fraxel, a topical anesthesia followed by ten days of recovery. Face will feel sunburned at first, followed by three to six days of “peel and heal” as sun damaged skin migrates to the surface and sloughs off. For Infini, topical anesthesia and a few days of swelling. Results for both treatments last indefinitely with a good skin-care regimen. Typically a one-time procedure.

COST: Fraxel, from $1,200 for the face; $400 to $500 for scar revisions. Infini, $750–$1,500.
WHAT IT IS: A treatment that combines intense pulsed light therapy (IPL) and fillers to restore a more youthful appearance to the surface of the hands.

WHAT IT DOES: The pulsed light addresses age spots and sun damage, while the filler is injected just underneath the skin to restore volume.

GAME CHANGER: Recent FDA approval for Radiesse, a calcium hydroxylapatite filler that induces skin to create a long-lasting scaffolding effect and gives an improved appearance to wrinkles. Previously Radiesse was used as a facial filler primarily in deep nasolabial folds.

WHAT TO EXPECT: Both treatments can be done the same day. There is no anesthesia for the laser; a local is used before filler if it’s not already built- in. You may experience redness for a day; brown spots flake off in two weeks or less. Most age spots stay away for a few years (with use of sunscreen). Most fillers last up to six months; Radiesse can last more than a year.

COST: From $2,000 for hand and forearm IPL; fillers start at about $900.
Considering a nip or a tuck but want to see the end result before you go under the scalpel? MirrorMe3D takes a 3-D scan of your face and prints out a model with the “after” already incorporated.
WHAT IT IS: Minimally-invasive surgical procedure that suctions fat deposits out from the body.

WHAT IT DOES: Removes fat from underneath the skin using a skinny vacuum tool called a cannula, or an ultrasonic probe. Smart Lipo is an alternative technique in which a laser liquefies the fatty deposits through the skin’s top layers. After the fat is melted, the doctor removes it through small incisions in the skin using traditional cannulas.

GAME CHANGER: Micro-liposuction. Using a Q-tip size cannula, the doctor can remove fat from hard-to-reach areas like jowls, knees, the neck and ankles.

WHAT TO EXPECT: Local anesthesia with or without twilight-sleep sedation. Depending on the area treated, you may feel mild discomfort for several days. Doctor may recommend wearing a Spanx-like compression garment. Results last indefinitely but proper diet and exercise must be maintained. A one-time procedure, with up-to-a-year monitoring.

COST: From $3,000 to $10,000, depending on size of treatment area.
POPULAR PROCEDURES consumer report
Liposuction leads the way in surgical cosmetic procedures, followed by breast augmentation, eyelid surgery, tummy tuck and nose surgery. —American Society for Aesthetic Plastic Surgery

In 2014, the most popular procedures were 6.7 MILLION BOTOX INJECTIONS, 2.3 MILLION SOFT-TISSUE FILLER INJECTIONS, 1.2 MILLION CHEMICAL PEELS —American Society for Aesthetic Plastic Surgery

After speaking to our panel of experts, and researching the ever-evolving world of invasive and non-invasive cosmetic procedures, several clear trends emerged:

Consumers are more risk-adverse and less keen to go under the knife, especially as non-invasive procedures get better, smoother and faster. There are machines that eliminate excess fat, modify cellulite, tighten jawlines, and lift sagging necks, and a host of lasers, light therapies, chemical peels, and lidocaine-laced fillers that help maintain a youthful glow. The popularity of so-called lunchtime procedures is on the rise, too—people like being able to get work done during the day and return to their desks, no one the wiser.

At the same time, those who do opt to go the surgical route can expect shorter operating times and fewer incisions, which mean less bruising and less downtime. Where once you might be out of commission for two-plus weeks after a face-lift, now seven to ten days is the norm.

It’s not unusual to see twenty- and thirty-somethings doing treatments to slow the aging process, even before it begins showing. Doctors attribute this phenomenon to education (younger patients are well-versed in the gospel of prevention), peer pressure (their friends are all doing it), affordability (a series of six laser treatments can run about $2,400 while a face-lift costs about $10,000), improved technology and accessibility. More men are having cosmetic work done as well, as they seek ways to meet the demands of a super-competitive, and often ageist, job market.

Gone are the days of one-treatment fits all. Doctors routinely develop plans that address an entire area—the whole face, for instance—utilizing a combination of lasers, Botox, fillers and fat grafting, to achieve the most natural looking outcome. Even previously overlooked—or underserved—body parts like necks, ears, hands and knees are getting their due, as doctors “tweak” these areas with a combination of surgery, lasers, skin-tightening devices and fillers. The most revolutionary new treatments we’ve seen include Kybella, an acid-based injectable that dissolves submental chin fat, and the Coolsculpting Mini, a handheld device that is FDA-approved for fat pockets under the chin and neck.

Finally, doctors are doing a whole lot of good when it comes to utilizing the tools in their cosmetic surgery armamentarium to help victims of trauma (think burns and accidents) and cancer survivors. Thanks to enhanced laser technology, fat grafting and fillers, they can reduce scarring and encourage new skin growth.
WHAT IT IS: A non-invasive procedure that dramatically rejuvenates the face.

WHAT IT DOES: Intense pulsed light therapy (IPL) gently targets sun- and age-related skin damage. It evens out overall tone, giving the face a more natural glow, while making the texture smoother.

GAME CHANGER: A radio frequency device called Infini that successfully treats patients of color and those with deep acne scars (see Fraxel).

WHAT TO EXPECT: An in-office procedure requiring no anesthesia. You may experience a few days of swelling or more depending on skin type. Results last for years, especially with a good skin-care regimen. May require two or more treatments depending on desired result.

COST: About $1,200. Infini, $750–$1,500.
WHAT IT IS: A surgical procedure that alters the shape of the nose.

WHAT IT DOES: Using a closed or open technique, which allows more direct visualization, the surgeon can take bumps down and trim drooping tips.

GAME CHANGER: A “tiplasty” addresses just the tip of the nose, and may include trimming excess cartilage and/or removing a pie-shaped wedge from flaring nostrils.

WHAT TO EXPECT: An outpatient procedure with local anesthesia. You will have to wear a nose cast, and may experience swelling and bruising for one week, with mild discomfort for a day or two typically treated with over-the-counter pain medication. No sports or heavy lifting for two weeks. Will see full results in three to four months. For “tiplasty,” there will be minimal bruising and downtime.

COST: From $3,000 to $5,000 for tiplasty; from $9,000 to $12,000 for rhinoplasty.
WHAT IT IS: A surgical procedure that restores the abdomen’s pre-pregnancy or post-weight loss shape. When combined with liposuction and/or a breast lift, often called a “Mommy Makeover.”

WHAT IT DOES: Through an incision that runs hipbone to hipbone, the surgeon removes excess fat and skin and tightens abdominal muscles. (Viable fat cells can be repurposed to other parts of the body in a technique called fat transfer.)

GAME CHANGER: A mini tummy tuck for those with excess skin around the midsection but who don’t need muscle tightening. Requires a smaller incision at the bikini line.

WHAT TO EXPECT: Liquid diet the day before. Long-lasting anesthetic; expect to take a week off. There is discomfort and bruising for two to three weeks. No heavy lifting or strenuous exercise for three to six weeks. Doctor may recommend wearing a Spanx-like compression garment for several weeks. One-time procedure with follow-up monitoring for up to a year.

COST: Approximately $15,000 for a full tummy tuck; $10,000 for a mini tummy tuck.
In a recent American Society of Dermatologic Surgery survey of more than 7,000 consumers, half were considering a cosmetic enhancement. Of those, 88% WERE CONCERNED ABOUT UNWANTED BODY FAT while 72% WERE BOTHERED BY SKIN TEXTURE AND DISCOLORATION
WHAT IT IS: Ultherapy is a nonsurgical neck- and face-lift using high-intensity, focused ultrasound. Thermage and Protégé Elite use deeply penetrating radio frequency energy to tighten the skin.

WHAT THEY DO: Sound and energy waves convert to heat in the deep debris, causing remodeling of collagen, stimulating overall lifting and tightening, and leading to a more sculpted, more defined look. All three can be used on different areas of the body, including arms, knees, face and neck.

GAME CHANGER: Protégé Elite uses monopolar radio frequency that effectively remodels collagen, especially in areas where the skin is thickest—jowls, jawline, neck, arms and knees.

WHAT TO EXPECT: For Ultherapy and Thermage, many patients opt for pre-procedure painkillers or light sedation to help allay sensitivity and discomfort. No pre-procedure sedation with Protégé Elite. No downtime, though you may notice pinking right after treatment. Bruising possible. Visible tightening in three to six months once new collagen forms. Results last up to two years. Single treatment for Ultherapy and Thermage; Protégé Elite works best when done in series of four to six.

COST: About $2,000 and up, depending on the area addressed.

These are the gold standards of cosmetic procedures: Neck tightening, breast lifts, brow lift and more. They’ve got staying power. The good news for consumers? Unlike our jawlines, they just keep improving with age.
WHAT IT IS: Surgery that removes excess skin, often called “batwings,” on the upper arms, often the result of significant weight loss.

WHAT IT DOES:Restores a more youthful appearance to the arms.

WHAT TO EXPECT: Local anesthesia with sedation, or general anesthesia. During the procedure, the surgeon makes an incision along the inside of the arm in a curve or Z-shape to minimize scarring. The skin is then tightened and excess removed. Often combined with liposuction. Bruising is minimal; up to three weeks to heal. Amount of skin removed can be tailored to needs of the patient; in a mini brachioplasty, the scar is concealed in the armpit areas.

COST: From $8,000.
Thanks to a host of new-and-improved fillers, eradicating facial lines has become an art form. Instead of targeting just one area, dermatologists are taking a more 3-D approach, addressing problems from the inside out—from bone and soft tissue to skin. Deep nasolabial folds, for instance, may have more to do with structural changes in the bones due to aging, rather than just a lifetime of smiling.

According to the experts, fillers fall into two categories: natural and synthetic. Most natural fillers are made with hyaluronic acid (HA), a substance the body produces to plump up facial skin and lips. Among the name brands you may recognize are Restylene and Juvederm (Perlane is now part of the Restylene family). The beauty of HA fillers is that they are reversible, and they are injected while you are awake, so you can monitor results.

Fat transfer is another popular technique in which your own fat is harvested from another part of your body and injected into your face to add contour. This is a permanent option, so many doctors suggest trying an HA filler first. Synthetic fillers such as Radiesse and Sculptra are used for plumping and contouring deep wrinkles and hollows.

The biggest game changer? Most fillers have anesthesia built in, which significantly minimizes pain, discomfort and bruising.

With that, and given so many choices, we asked our panel what they would recommend for our common complaints. Here’s what they suggested.

Use Restylene SILK, a clear gel formulation of hyaluronic acid. It is ultra soft and supple, and lasts about six months.

Try Restylene L, a medium consistency hyaluronic acid voluminizer. It lasts nine to twelve months.

Consider Juvaderm Ultra XC, another medium consistency hyaluronic acid voluminizer. It lasts up to a year.

Think about Juvaderm Voluma, a thicker hyaluronic acid that lasts a year or more. The filler of choice for “liquid face-lifts.”

Radiesse, a calcium-based microsphere that works by creating a scaffolding effect around the area being treated, is now being used to plump up backs of hands. Lasts up to a year.

Add volume with Sculptra, a synthetic poly-L-lactic acid that works to stimulate the body’s own collagen. (Sculptra was originally FDA-approved in 2004 to bulk up the faces of HIV patients.) It can last up to two years.

Bellafill, a new FDA-approved dermal filler comprised of bovine collagen and synthetic microspheres. It lasts up to five years.
IN THE NEWS don’t sweat it!
Good news for excessive underarm sweaters— a non-invasive procedure called MIRADRY delivers precisely controlled electro-magnetic energy to the region where sweat and odor glands reside, and destroys them for good. Bonus? No more stains or antiperspirant marks on your clothes.
WHAT IT IS: Surgery that elevates and reshapes sagging breasts.

WHAT IT DOES:Brings the nipple/areola complex back up to the crown of the breast, removes sagging skin and redistributes breast tissue above the fold for a more youthful appearance. Implants may be added for fullness.

WHAT TO EXPECT: General anesthesia; two to three weeks of soreness; no exercise for three weeks. Patients wear a supportive bra to eliminate tension on stitches. The procedure has longevity, but the skin may need retightening in ten to fifteen years. Saline implants don’t need to be replaced; some doctors recommend replacing silicone implants at the ten-year mark. Expect post-operative follow-up visits.

COST: Approximately $10,000 for a lift, up to $15,000 with implants.
WHAT IT IS: Surgical procedure that lifts wrinkled forehead skin, saggy eyebrows and frown lines. This procedure may be combined with a blepharoplasty.

WHAT IT DOES:Depending on the degree of brow ptosis (drooping), different types of lifts (coronal, endoscopic, anterior hairline or a direct brow lift) may be used. All aim to achieve a refreshed brow, properly positioned along the upper orbital rim.

WHAT TO EXPECT: General or local anesthesia with twilight- sleep sedation. You may experience up to two weeks of bruising and swelling. Expect several follow-up visits in the early post-operative period.

COST: $10,000.
WHAT IT IS: Also known as a “Brazilian Butt Lift,” a surgical procedure that enhances the buttock area, either through silicone implants, fat transfer or removal of excess skin with lifting of existing fatty tissue.

WHAT IT DOES:In addition to providing lift and shape, augmentation increases the projection and volume of the buttocks.

WHAT TO EXPECT: Procedures are performed under general anesthesia in an operating room. The fat transfer technique places autologous tissue into the gluteal muscles. Often combined with liposuction in the waist and thighs. Expect to wear a compression garment for three weeks, and soreness for up to two weeks. Avoid sitting and sleeping on your back for five to seven days (we’re not kidding).

COST: $6,000–$9,000, depending on amount of liposuction involved.
WHAT IT IS: The first FDA-approved laser technology to treat cellulite.

WHAT IT DOES:A minimally invasive bidirectional laser is threaded through a small cannula and inserted through two tiny incision sites. It releases the structural fibrous bands that cause the dimpling beneath the skin, levels bumps of fat and stimulates collagen production to the surface of the skin for a smoother, more marbleized appearance.

WHAT TO EXPECT: An in-office procedure under local anesthesia and sleep sedation. It takes about one hour to ninety minutes. You may experience mild discomfort, treated with over-the-counter pain medication, and bruising and swelling for seven to ten days. May need to wear a compression garment. No exercising for about a week.

COST: From $5,000 to $10,000.
In 2014, Americans spent $12,000,000 on surgical and non-surgical cosmetic procedures for the second year in a row. —American Society for Aesthetic Plastic Surgery
WHAT IT IS: A non-invasive technique that is used to improve the appearance of skin on the face, neck and hands.

WHAT IT DOES:A chemical solution is applied to the skin, which causes it to exfoliate and eventually peel off, leaving behind skin that appears smoother and less wrinkled. Peels come in a variety of strengths: superficial Alpha Hydroxy Acid peels give an all-over glow; Beta peels penetrate deeper and are ideal for persistent skin conditions such as acne. Your doctor can customize combinations for the best results. A full face Tri Chloric Acid (TCA) peel may require some sedation.

WHAT TO EXPECT: There is no downtime, though there can be a burning sensation followed by stinging. Cold compresses help alleviate the discomfort. Expect minimal peeling from lighter solutions; medium-depth peels can produce redness and peeling for up to a week.

COST: About $150 per peel, slightly less if you buy a package of six. A full face TCA peel is about $7,000.
WHAT IT IS: A surgical procedure that rejuvenates and restores the vaginal area.

WHAT IT DOES:Removes excess skin from the labia minora (often elongated as a result of multiple vaginal births), which can cause discomfort, soreness and/or embarrassment.

WHAT TO EXPECT: General anesthesia in an outpatient setting; bruising, swelling and some soreness. You will be prescribed antibiotics and pain medication. No showering for the first forty-eight hours, plus minimal exercise for the first two weeks. Expect to see final results within one month. A one-time procedure requiring a post-operative follow-up.

COST: $5,000–$6,000.
WHAT IT IS: A surgical procedure that alters the size, position or proportion of the ears, such as ear pinning for those that protrude significantly (less of a stigma for boys these days, thanks to the influence of President Obama) or reducing the size of large ears.

WHAT IT DOES:Ear pinning takes from two to three hours. Commonly, the surgeon makes a small incision in the back of the ear, and then sculpts the exposed cartilage to bend it back toward the head. Another technique involves removing skin and using stitches to fold the cartilage back on itself to reshape the ear without removing cartilage. Surgery can also address “top ear,” when the tip folds down and forward, and torn earlobes.

WHAT TO EXPECT: An outpatient procedure with local anesthesia. Typically no visible incisions; some soreness and swelling. A bandage for two or three days, and a sweatband at night to help support the ears. One-time surgery, with a follow-up visit to remove sutures.

COST: From $2,000.

Our thanks go to our panel of surgeons and dermatologists who contributed their time and knowledge to the production of this feature. For more information about their services, please call them or visit their websites.

Board Certified Plastic and Reconstructive Surgeon
850 Park Avenue New York, NY 10075 212-988-4040

Board Certified Ophthalmologist and fellowship trained Oculoplastic Surgeon
Greenwich Ophthalmology Associates
2046 West Main Street Stamford, CT 06902 203-869-3082

Board Certified Cosmetic and Laser Surgeon
Westport Dermatology and Laser Center
489 Post Road East Westport, CT 06880 203-226-3600 & 36 Old Kings Highway North Darien, CT 06820 203-226-3600

Board Certified Dermatologist and Fellowship Trained Skin Cancer, Laser and Cosmetic Surgeon
Connecticut Skin Institute
999 Summer Street Suite 305 Stamford, CT 06905 203-428-4440

Plastic Surgeon
55 Wall Drive Suite 405 Fairfield, CT 06824 203-655-0099 & 722 Post Road Darien, CT 06820 203-656-9999

Board Certified Plastic and Reconstructive Surgeon
Carnegie Hill Plastic Surgery
1150 Park Avenue New York, NY 10128 212-369-5300
Peau Advance Skin Care
1472 Boston Post Road Darien, CT 06820 203-309-5701

Board Certified Dermatologist and Cosmetic Surgeon
Nichols MD of Greenwich
469 West Putnam Avenue Suite 201 Greenwich, CT 06830 203-862-4000

Board Certified Plastic and Reconstructive Surgeon
Nordberg Plastic Surgery
2001 West Main Street Suite 150 Stamford, CT 06902 203-324-4700

Board Certified Oculofacial Plastic Surgeon
Connecticut Eye Plastic Surgery
148 East Avenue Suite 1A Norwalk, CT 06851 203-857-0115



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