Tag Archives: hyaluronic acid
Link

Nonsurgical Lip Enhancement

29 Nov

Finally! A new video blog to help navigate the types of hyaluronic acids for lip injections!

https://youtu.be/kM5yxHLDnCM

Xoxo, LK

(I have like 15 half finished videos ūüôä I’m going to be posting more regularly-I swear!) check out my before and afters on instagram @EstheticsCenterNE

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Restylane Silk for Aging Lips

12 Apr

  

A New Addition to the Restylane Family

Restylane Silk is now FDA approved for submucosal implantation for lip augmentation and dermal implantation for correction of perioral rhytids (smoker’s lines) and it is currently available on the US market.   This product provides a subtle solution to aging signs around the lip and mouth area.  It’s greatest quality is subtle enhancement; your lips will not look “done” or “artificial.”  

  

Hyaluronic Acid for Lip Augmentation

Although Restylane Silk is the first product to be FDA approved for lips, we have been using other products for years.  Juvederm and Restylane are commonly used to augment the lips in an “off-label” treatment (FDA approval costs millions of dollars and takes many years.  These products are all very safe to inject in the lips by a trained professional).  

These products, along with Belotero, are all in the hyaluronic acid family.  Hyaluronic acid (HA) is a sugar your body naturally produces; these products are synthetic gels.  Because your body naturally makes this sugar, the chances of being allergic are almost zero.  This family of products IS reversible, if for any reason, you are unhappy with the results.

The molecular structure of Silk is smaller, and the product flows to where it is needed.  It doesn’t over bulk, and is a perfect finishing agent for fine lines.  

Which product is best is really dependent on who the client is, and what result they want.  If you are looking for subtle and natural lip augmentation, Restylane Silk is the product for you!  

My Experience 

At the beginning of March, I was told this product would be available and I was so excited to try it.  Lip augmentation has always been a specialty of mine, and I was told “I would love this product for the vermillion border” (where the color changes from pink to skin-toned).  

 

I was excited to try it, but my idea of an “ideal” client for this product was way off!  I first tried it on a 24 year-old patient.  She (and I for that matter) were not impressed, it looked like nothing was done.  Then I realized I was supposed to be using it for a whole different population of client.  The older patient who didn’t want to look like anything was done!   Oops… Probably should have read the email about the product FIRST. 

So then I tried it on an employee in her 50’s.  The results blew me away!  Like always, the pictures do the results no justice.   

The final result is very natural looking.  It is hard to see from the picture, but the before has a defined ridge above the lip, which is SO much improved with the Silk injections.  (The spray tan and make-up can throw you off in the after pictures.) 

The technique used to inject this product is VERY different than previous products used to treat lips.  If incorrectly injected, the product will not give you the best results, cause swelling, and has been reported as painful by patients.  This product requires the knowledge and expertise of a skilled injector.  

I had a few clients trial the product (including my awesome mom!).  They sent me their after pictures via text.  Again, not the greatest quality pictures, but every client was extremely happy with the results and gave great feedback.  (Thank you ladies!). 

    

Final Thoughts

Because the typical Silk client is older, make sure you consider timing in booking an appointment for this procedure.  Like any injectable product, swelling and bruising are always a possibility.  You want to avoid icing post-procedure to allow the product to smoothly integrate into the tissue.  If you have a big meeting at work the next day, you probably should reschedule (…the meeting OBVIOUSLY!  Who wants to wait for such amazing results!  Plus, then the meeting will go better with your new confidence!).   

How long will a bruise last?  Remember everyone is different.  Some people don’t bruise at all.  Check out my blog on bruising info.  

Other Uses

I read Silk was also a fabulous filler to use in the glabellar crease… Blog post coming soon!   

For questions or to book an appointment with me, call my office at 781-235-4957.  You can also book online at http://www.LauraKimberleyRN.com.  


Juvederm vs Restylane for Lip Augmentation

9 Feb

Trying to decide which product you want to go with for lip augmentation?  Check out this post!  

For more basic information:

Lip Augmentation: Basic Information for Patients.

Lip Augmentation: Basic Information for Patients

4 Feb

Interested in Lip Augmentation?  Check out this video and learn the basics!

Video

Introduction to Injectable Fillers

9 Nov

I touch upon the basics of what a filler is and the different families of filler products.

Peanut Head: Volume Loss at the Temples

29 Jul

I’d argue the most over looked sign of aging is loss of volume in the temple. As we age, the temples lose fat and begin to narrow, shifting the balance of the face downward. Volume loss here contributes to the appearance of drooping and sagging of the cheeks and eyes (see Structural Changes in the Aging Face for other changes).¬† It begins as early as in your 20’s. It is most notable in athletes who have very little fat on their bodies, I’ve found especially runners.

As you can see, the area of total volume loss is pretty big when you actually look at it. In order to achieve the youthful contour of the temple, a patient will require a lot of product here. Adding filler to the temple is easy and almost painless, but deciding what filler to use can be difficult, they all have pro’s and con’s.

Juvéderm

This is usually my first choice with patients. For some reason… people tend to be nervous about filling this area! The great thing about Juv√©derm is that it’s disolvable. The bad thing about Juv√©derm is… you need a lot of it to fill this area, and that can be expensive. I’ve found great results by diluting the product before injection. The patient can see the result immediately. It may not last as long this way, but it is a good starting point. Most people love the result and usually step up to Sculptra when they notice they need a “refill.”


Radiesse

I personally don’t use Radiesse in the temples. It always reminds me of the scene from the Real Housewives of Beverly Hills when Adrienne Malouff’s husband injects Taylor and she has this big bump in her temple and Adrienne goes “is it supposed to look like that?” Although you get more volume with Radiesse, you also have more of a chance for lumps in this area. It’s not as smooth as Juv√©derm (which is literally defined as a smooth consistency gel). It’s just not my preference, but for extreme volume lost I can see it being more cost effective.


Sculptra

I personally have had Sculptra injected into my temples. Sculptra is not a filler, but a biostimulator. Over several weeks post injection it promotes collagen production. It may take more than one treatment (usually 1-3 vials 1-3 treatments) to achieve the desired result. This is the longest lasting, and most cost effective product if you consider the longevity, but up front can be expensive. If you are the type of patient who is doing multiple fillers at a time, you should probably step up to Sculptra.


Fat Transfer

Fat injections can also be used in the temples but are only cost effective if a large amount of volume is needed for the entire face. I recommend only allowing a plastic surgeon perform this procedure (although a nurse can do it in Massachusetts). The fat is harvested from another area of the body (usually the lower back) via liposuction and transferred to areas of volume loss in the face (usually not just the temple). There is a lot of swelling and bruising with this treatment and not all the fat will graft (stay alive after transfer). It is also an expensive and invasive procedure. This being said, it can yield great results for patients who really need it.


The Procedure

Numbing cream is applied to the temple. The product selected is mixed with lidocaine and deposited on the bone until achieving desired volume. There is very little pain associated with all injectable products. Bruising isn’t typical; however, there are many vessels in this area, so it can happen. Expected cost depends on the product selected, but expect to use at least 1-2 syringes during time of treatment.

Good luck!

Belotero: The Buzz

18 Sep

I’ve been waiting to announce this for months!

Merz Aesthetics (the company that makes Radiesse) has released a new product: Belotero Balance. The product was FDA approved in November, 2011. My office was involved in clinical trials, so I (of course) got a sneak peak at the product, and have been anxiously awaiting it’s arrival.

Why am I so excited you ask? Well, first, I think Merz makes awesome products (Radiesse is my favorite to use!). Second, and most important, this product can go into vertical lip lines! That’s right. No more “smoker’s lines!” I have SO many clients who complain about “smoker’s lines” around their lips!

Prior to this product’s release, there were two ways to treat the vertical lip line: with Botox or with HA Fillers.

Botox


  • Some people like it, some people don’t. I’ve personally never had Botox injected in my lips (I have however had many, many syringes of Juv√©derm), but I’ve been told it is a strange sensation. It feels weird to spit out your tooth paste, or use a straw, or kiss, because the muscle that is used for these things is “relaxed.” Obviously, you don’t want to relax it too much, or you’ll look like a stroke victim, so I’ve found it doesn’t last long in the lips.

Fillers (Juvéderm and Restylane)

  • As you can see from the picture below (this is a great example), by injecting product into the border of the lip (vermillion border), the vertical lip lines do visibly improve, but they are still there.

  • OR, you can have what I like to call “the monkey face effect” (I couldn’t find an excellent picture of this, but I’ve seen some real bad monkey faces. I would have tried to take a picture of this, but I’ve found people don’t respond well when you tell them they look like a monkey face from their filler. Or a cat face.)

Anyways, Back to Belo…

The Hyaluronic Family

Belotero is a hyaluronic acid injectable gel, like Juv√©derm and Restylane. Belotero more easily integrates into the skin and adapts to facial contours than other HA’s because it is softer. This results in a more natural and subtle look (but may require more product in some areas). Belo is designed to treat superficial facial lines and moderate to severe wrinkles that are closer to the surface of the skin. Unlike Belo, fillers such as Juv√©derm leave a bluish hue under the skin called the Tyndall Effect, when it is injected too superficially, like in vertical lip lines. Injections of Belo last up to 12 months, which is comparable to Juv√©derm (Restylane lasts about 6 months‚ÄĒdoes anyone even use Restylane anymore? Anyone?).

Belotero is made of sugars which naturally occur in our skin. No allergy test is required, and treatment is very safe. Like with all injectables, bruising and swelling are always a possible. My friend Colleen who is a dental hygienist is going to hate me for saying this again, but, for those of you in Boston who don’t tell anyone you do this stuff (even though EVERYONE does it) the best excuse for bruising is a “dental appointment.”

For fine superficial folds/fine lines. Including:

  • Periorbital folds or “crow’s feet” (also referred to as Periorbital lines)
  • Perioral Lines (aka Smoker’s lines)
  • Tear troughs
  • Deep forehead lines

For medium wrinkles, moderate-to-deep folds, lip contouring, and facial contouring. Including:

  • Glabellar crease, or frown line (the line that forms between the eyebrows).
  • Nasolabial folds, or smile lines (from the edge of the nose to the corners of the mouth).
  • Mentolabial crease, or chin folds (horizontal line that forms across the middle of the chin).
  • Marionette lines (from the corners of the mouth to the chin and jawline).
  • Earlobes (which of course aren’t in my picture! Oops!)
  • Lips and philtrum (which is the area between the nose and the upper lip)

(Do you like my feather lashes? I love Halloween Eyelashes!)

The world of Aesthetic Medicine is always changing. New products are being developed as we speak. For the latest info on the best new technology, stay tuned! I’m psyched for my newly approved Sientra Silicone Breast Implants! One more month until surgery!!!!

XOXO, LK

What Goes Where?

4 Aug

Prior to 2002, there was one type of facial filler: collagen. Many products have been developed over the past ten years which have caused collagen to become obsolete. There are now multiple categories of fillers, all made of different materials. The products in these subcategories have properties which make them better in treating some signs of aging than other areas or other products. Remember, fillers are different than Botox (it’s not all just Botox!). So what goes where?

Hyaluronic Acid (HA’s)

Synthetic forms of hyaluronic acid (a sugar that your body naturally produces) include products like Juv√©derm, Perlene and Restylane. HA’s increase fullness and enhance the viscosity of the naturally occurring hyaluronic acid in your body. Although it may cost a little more, Juv√©derm is currently the longest lasting product (in some cases lasts twice as long, and therefore is worth the extra $100 or so per syringe). I have performed over 200 Juv√©derm procedures, and have personally been injected with this product many times!

*note: My face is just a model, I haven’ had all this work done I swear! I just love “Paint.”

  • Best for superficial lines (not very deep, not folds).
  • They are used in areas where “plumpness” is desired (like your lips!)
  • They can be used in cheek augmentation, vertical lip lines, and nasolabial folds, but might not be the best product. Cheeks and Nasolabial folds typically require a lot of filler, and cost-effectiveness wise, this isn’t the product. But if you just need to fix a little sagging, it can be used in the cheeks. If you want to overpay for deep nasolabial folds, then this product also can be placed in this area.
  • Vertical Lip Lines are usually superficial, which would make Juv√©derm a good product, HOWEVER, if it is not placed right, the result is a monkey face.

Tips on Hyaluronic Acid

  • When I’m filling lines in the glabella, I always administer a dose of Botox to the area 2 weeks before injecting Juv√©derm. This allows me to inject directly into the line; it is easier to aim at a stationary target! How do you know if you will need Botox and Fillers? If you have a line in between your brows at rest (a “1”, “11”, or “111”) and you pull that line apart with your fingers, do you still see a crease in the skin? If yes, you need both, if no, Botox is enough.
  • I always apply numbing cream 20 minutes before injections.
  • I never inject too close to the outer rim of the eye (distal orbital rim), it usually irregularities in the contour of the face.
  • Injecting into the tear trough is a very advanced procedure. I can’t tell you how many times I’ve seen this area over filled (which looks TERRIBLE). My recommendation: it is better to under-fill and book a follow-up. This area requires a minimal amount of product, and my personal policy is to allow a client to come back at no charge if they require a small amount more (within reason).

Particulated Fillers

These products, like Radiesse and ArteFill, contain synthetic beads or particles in different liquid carriers. They last longer than HA’s, because the body doesn’t break them down as fast. They are also thicker than HA’s, which means they satisfy a larger area of volume loss. These products are injected deeper in the layers of skin (never superficially like HA’s are). Why? Because they’re made out of beads in liquid… and in superficial skin that would make bumps! This means they NEVER get injected into the tear troughs or into the lips. EVER. For very, very deep glabellar crease, Radiesse can be used (but usually an HA is a better choice).

  • These products are for moderate to severe volume loss. As you age, facial skeletal changes, general tissue volume loss, and the effects of gravity flatten out your cheeks. If you look at the contour of my face on right side of my face (your left), you will see how round my cheek is. I think you can see in this picture that the apples of my cheeks are round as well. A lot of women will look in the mirror at their nasolabial folds and want to go straight for filling only those, but that doesn’t give the youthful round shape back to the face. On some people I like to do cheek augmentation with Radiesse as well as nasolabial folds. I always do cheeks before folds, because the cheek bone is the scaffolding for the lower face skin. When you change that, the depth of the NL fold will also change. Always top to bottom, never bottom to top, when it comes to your face fillers! **When you have extra weight on your face, you keep the roundness. Skinny people have really flat cheeks when they age. HA. Take that skinny people.
  • The marionette lines, prejowel, and oral commissure are usually treated as one area that needs to be fixed. They’re kind of like vector components of each other (for all you Geometry dorks out there, *brushes shoulder off*).
  • Again, skeletal changes that occur as you age cause your chin to recess and along with volume loss, change the angles of your jaw and chin. This is another area a lot of people overlook when spending that quality time in the mirror pulling at their face in the “this is what I would look like if I had a face-lift” pose. Even if you do have a traditional facelift, you aren’t doing anything about the volume loss. This contributes to the unnatural look of a face-lift.
  • Radiesse and Juv√©derm can be used in conjunction to fix contour irregularities in the nose.

I hope that cleared up the two main classes of fillers. It’s a lot of information!!! The next post will be about Sculptra, which gets grouped in with fillers… but this is already too long! Lol.

xoxo SPRAY TAN ‚Äď O ‚Äď REXIC LK

Everybody’s Doing It!

29 Jul

“My wife’s into that Botox Stuff” ‚Äď weird guy on the cape trying to give me vodka. ????

Anyways, it seems like everybody’s into “that Botox stuff.” But no one will admit to it!!! What’s the deal people? I mean… I fully admit to being an addict. I love my Botox! I guess I’m a little on the young side (although my birthday is coming up July 31!! Yeah!). So who exactly is doing this “Botox stuff”? Here’s some excerpts from my business plan on the “consumer profile” (I wrote this in 2009, so… there is updated information… but… I haven’t updated my stuff. I HATE making graphs on the computer… but if you gave me some colored pens and a whiteboard I would be ALL over it!).

Consumers

A survey by the Aesthetic Cosmetic Surgery Education & Research Foundation (ASERF), 2009, found the typical patient “married, working mother between 41-55 years of age with a household income of under $100,000.” These women were also found to be “health-conscious,” exercising, and eating right. Nearly 7/10 of the responders regard Botox and dermal fillers as an important part of their aesthetic routine.

Smart, health-conscious women ahhhhh? That makes me happy.

Age Distribution

Number of Procedures Performed in 2009, according to the ASAPS:

Injectables:

18 and under

19-34

35-50

51-64

65+

Botulinum Toxin Type A

12,000

371,501

1,256,608

734,751

182,098

Calcium hydroxylapatite

0

9,844

55,635

41,118

11,880

Hyaluronic Acid

3,919

168,629

604,262

420,069

116,159

I’m assuming any of these 18 and under year olds are using Botox for non-cosmetic use, or for correction of facial deformities. Or… they are on “Toddler’s and Tiara’s.”

Percentage totals of Number of Procedures Performed in 2009, according to the ASAPS:

Injectables:

18 and under

19-34

35-50

51-64

65+

Botulinum Toxin Type A

0.5%

14.5%

41.1%

36.2%

7.7%

Calcium hydroxylapatite

0%

8.3%

47.0%

34.7%

10.0%

Hyaluronic Acid

0.3%

12.8%

46.0%

32.0%

8.8%

Gender

In a recent survey by RealSelf.com, of the people who would get cosmetic work, the percentage of men is climbing. Ya, it’s true! Men are vain too! And not just gays! I was sitting in a bar eating by myself (yea… I was banished from my dinner party…) and I met a couple from New York. They were so much fun! The husband and the wife did botox… and they’ve been together for 12 years. And they still liked each other. And other people (like me) had a blast talking to them. …You know me and my tangents. Anyways. Good looking people are happy and stay married longer. I’m not sure if it’s true or not… I actually made that up. But men really are doing the “botox stuff”!

Would Get Cosmetic Work:

18-34

35-44

45-54

55+

Men

64%

67%

64%

47%

Women

82%

82%

80%

71%

From 2008-2009, minimally-invasive procedures increased 2% in the male market (ASPS, 5). And I assure you, it’s not just gay men doing this! I have a pretty large percentage (ok… I have a few) straight men doing this “Botox Stuff.”

                                Source ASPS, 2010 (8, 10)

Location:

The Northeast Region charges the highest amount in fees in the minimally invasive cosmetics procedures industries.

According to 2009 Regional Distribution Data by the American Society of Plastic Surgeons, New England holds 20% of the Botox market and 31% (the largest) of the soft-tissue filler market.

Percent of Total Procedures Performed by Region

Region 1 Region 2 Region 3 Region 4 Region 5
Botulinum Toxin

20%

14% 23% 15% 28%
Calcium Hydroxylapatite 35% 16% 20% 15% 15%
Hyaluronic acid 31% 12% 18% 8% 31%

Source: ASPS 2010 (15)

The Northeast Region has the highest percentage of filler procedures performed (we are Region 1). Midwest is the yellow region 2. Region 3 is light blue. Region 4 is greenish. Five is purple. Interestingly, the Noretheast and West Coast are comparable in the procedures performed. I wonder how much L.A. and New York skew that though. And Miami probably skews region 3. Just saying. Statistics are only as good as their interpretation.

Income level

Data collected by the ASPS in “Demographic Changes among Plastic Surgery Patients” demonstrates that income no longer plays a significant role in elective procedures (1). With the adjunct on patient financing options, the numbers continue to increase.

According to an Allergan Representative, the average income level for a Botox Cosmetic patient is $50,000 nationally.

Social Class

Middle to Upper Class due to income level.

Education

Education level has not shown to be a significant factor in market; however the consumer of the Northeastern market wants to be educated on products/procedures before undergoing them.

Ethnicity:

                Source: ASPS 2009 Cosmetic and Reconstructive Demographics

Most Commonly Requested Minimally-Invasive Procedures for Ethnic Patients

African-American

Asian-American

Hispanic

Botulinum Toxin Type A

Injectable fillers

Injectable fillers

Injectable fillers

Botulinum Toxin Type A

Botulinum Toxin Type A

Source: ASPS 2010 (17)

Boston Market

And I’m not talking about chicken. Finding this information was pretty difficult, but I think I know my market pretty well. If you are under 35, you are probably not thinking about Botox or fillers… but honestly you should be. Remember, volume loss starts at 25. Being preventative is super important, and will cost less and look the most natural in the long run. At the very least, please use medical grade skin care!

If you’re over 35, it’s a good idea to start with the area that bothers you most. Have a long consult with your injector. Work out a schedule/plan with your provider, and make sure you talk about prices! That plan should ALWAYS start with good skin care!!!

I know your mom might disagree… but…

If Everybody’s Doing It, Shouldn’t You Be Too?


xoxo,

LK

Ahhhh… Big Ange is getting the “Botox Stuff.” LOVE IT! (Ok… well maybe she’s not the best ambassador of the Botox Nation. When do I get a t.v. show?)

Things You Never Would Think To Find In A Girl‚Äôs Bathroom

6 Jul

How I’ve gone from your typical teenage girl to … an aesthetic specialist (for lack of a better term).

I remember when I moved into my first apartment in college, and I asked my mom for a make-up table, because there were 4 of us with one bathroom. I used to wear a lot of make-up. Case in point:

Summer of 2004. My candy raver phase? I guess. Over tweezed eyebrows. Check. Spots on my shoulder from too much tanning beds (which is actually caused from a fungus for all you spotted tanners out there… GROSS). Check. Face make-up too light. Check. Choice in jewelry… no comment. Oh. And I have roots. I think I might have been going to see Roger Waters with my college boyfriend. Man, college is a time for mistakes!

Hey, I also found my college bathroom circa 2004. (I am the original facebook generation… back when you needed a .edu to join).

UMASS. That should explain anything off you might see in this picture. But as you can see. Small space for four people. And a cat.

Anyways. Normal bathroom. Right? Also, I’d just like to point out that I used to eat nothing but candy. But I always brushed my teeth. As evidenced by me brushing my teeth

So I’ve gone from this:

To this:

Well… now fast forward 8 years. I wear very basic make-up that takes me literally five minutes to do, but in return I have the weirdest stuff in my bathroom repertoire! Used for purposes I’m sure very few could guess! So here’s an insiders sneak peak to my bathroom. I hope you find this as ridiculous (and funny) as I do. Welcome to the bathroom of a high maintenance princess.

Shot 1:

I took this pic a few months ago and sent this to one of my co-workers. I thought it was absolutely comical that I had this stuff on my bathroom sink counter.

I believe the tweezers were for applying fake eyelashes. I learned to stop tweezing my own eyebrows. Please refer back to the college years if you are curious as to why.

I suppose pliers wouldn’t be a strange thing to have in the bathroom. I’m not sure what you would actually use them for or how to actually spell that word… but I use them to take out my hair extensions if they’ve gotten a little loose. Not normal.

Revitalash I use to grow my eyelashes longer and stronger for lash extensions… and because sometimes I ruin my lashes with the strip adhesives. Gotta have lovely lashes.

Shot 2:

My make-up bag. Fake Eyelashes. Behind that… Fake hair aka Diva Weava.¬† I wouldn’t be a Barbie Doll if I didn’t have Fake hair.¬† And my fav hair tool: my pink GHD

That is a legitimate paintbrush in the middle there.

Shot 3.

Shot 4: Stuff that is Usually on My Bathroom Counter

  1. Baby Powder: for my roots because I only wash my hair twice a week.
  2. Dry Shampoo: because sometimes baby powder isn’t my scene.
  3. QuickTan: Because sometimes you have to go from white to orange in 20 minutes or less.

What I’ve Done.

And then I also did a quick draw a few months ago (back when I was blonde) on all the stuff on my face that was changed. It was kind of shocking to me. I wasn’t going to post it… because there are always people out there that like to tear you down. But I guess I’m somewhat amused by it. And comfortable enough to say, bring on the controversy.

            

  1. Botox in my Glabella and Forehead
  2. Lip Augmentation  Pucker-Up, Princess РDamn Sexy Lips.
  3. Sculptra to my temples
  4. Cheek Augmentation
  5. Eyeliner tattoo
  6. Eyelash extensions
    Lovely Lashes!.
  7. Hair extensions
  8. I have juvederm under my eyes as well.

No Surgery Needed!

“Plastic surgery and breast implants are fine for people who want that,

if it makes them feel better about who they are. But, it makes these people,

actors especially, fantasy figures for a fantasy world.

Acting is about being real being honest.”
Kate Winslet

Dear Kate Winslet,

I appreciate your support for people to make their own choices on

Plastic Surgery. I assure you, I feel great about myself.

More confident than Superman. Oh wait. Is he real?

Or is that part of my delusional fantasy world?

Is that sarcasm? Or real honesty?

XOXO

LK

Like my Patriotic Red Extensions from July 4th? Happy Birthday America!

Thank you for giving me the freedom to be delusional and honest.

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