March 31, 2021
Dr. Hotze introduces the newest addition to our Aesthetics Team at Hotze Health & Wellness Center, Dr. Mark Barlow, Board Certified Plastic Surgeon. Discover how you can reverse the signs of aging with BOTOX®, fillers and more!
Click here to view our Event Invite to meet Dr. Mark Barlow at our Aesthetics Event on April 8th from 5 to 7 pm at the Hotze Health & Wellness Center!
0:48: Dr. Hotze: …we are bringing on a new service here at the Hotze Health & Wellness Center, plastic surgery. That’s right, plastic surgery at the Hotze Health & Wellness Center, and we’re affiliating with Dr. Mark Barlow.
1:47: Dr. Hotze: …there are four particular services that we’re going to offer here at the Hotze Health & Wellness Center with Dr. Mark Barlow. The first is Botox treatment, the second is fillers, the third is blepharoplasty or eye lift, and the fourth is lips.
5:02: Dr. Mark Barlow: Botox is one of the botulinum toxins we have that are cleared for use in people. And basically, the toxin binds to the joint between the nerve and the muscle and inactivates it, so then the muscle doesn’t get the impulse to move. So a lot of people have elevens or crow’s feet or four headlines, like I do, that they don’t like, and they want to treat them. So put a little toxin in, you get three to four, maybe five months eventually, of stabilization of the muscle. And so wrinkles that are starting don’t get deeper and actually relax a little if you intervene early enough. I’ve got people in their even 30s coming routinely because they don’t want the wrinkles to form. And so, by blocking them, they never do.
6:18: Dr. Hotze: …when a person has Botox treatment, how frequently is that done? Dr. Mark Barlow: It’s every three to four months at first.
6:54: Dr. Mark Barlow: There are several different classes of fillers, and they have different properties. So probably the most commonly injected ones are going to be hyaluronic acid-based things like Restylane, Juvederm.
10:21: Dr. Hotze: …and then how long will it last? Dr. Mark Barlow: So it depends also on the filler. So the hyaluronic acid, most of them are 9 to 12 months. Some of the ones we use for deeper feel like Voluma lasts maybe 12 or 15.
11:11: Dr. Hotze: So tell us about a blepharoplasty, which is an eye lift surgery. Dr. Mark Barlow: Sure. So there’s a couple of things that feed into that. Partly, we lose the padding in our foreheads. So then there’s less sort of pump to hold the skin, if you will. So the skin settles, so my brows are pretty low…but then the excess skin is very easily addressed. For a lot of people, their upper lid only has extra skin and not extra fat.
12:56: Dr. Barlow: I do a lot of fat grafting. My preference is to grab the fat from wherever it’s the last place the person loses weight. So I’m counting on them not to gain weight, but if they go up or down a little bit, I kind of want it to be their stable fat location. So for a lot of people, it’s the lower tummy or love handles.
17:27: Dr. Hotze: …what are the reasons people get lips done? Dr. Mark Barlow: Right. Same thing as kind of the rest of the face, the lips do tend to involute. They get smaller over time. Our upper lip gets longer and flatter.
17:46: Dr. Barlow: So very commonly using hyaluronic acid in lips just for volume replacement. And that generally means around the mouth, not purely in the red part of the lip.
21:49: Dr. Hotze: Everybody likes to look their best. And this is one way we felt like we can offer a better service to each one of you is by providing the opportunity for you to be able to work with Dr. Barlow on helping your facial appearance.
22:04: Dr. Hotze: And if there’s any other plastic surgery needs, Dr. Barlow also does that. He’s one of the lead plastic surgeons in Houston and he’s the head of the plastic surgery department at his hospital down in the Clear Lake area. So he’s very well-trained and very well-experienced. He has the expertise to help you look your very best, and I hope you’ll take advantage of this. Don’t hesitate to give us a call here at the Hotze Health & Wellness Center at 281-698-8770 or visit www.HotzeBeauty.com if you’re interested in that.
Stacey Bandfield: Welcome to Dr. Hotze’s Wellness Revolution. I’m Stacey Bandfield with Dr. Steven Hotze, founder of the Hotze Health & Wellness Center. We have a great guest for you today. In fact, this is a new service that we’re offering at the Wellness Center and we are just so excited about it, aren’t we, Dr. Hotze?
Dr. Steven Hotze: Thank you, Stacey. You’re exactly right. It’s an exciting program today. At the Hotze Health & Wellness Center, we want to help you get on a path of health and wellness naturally so that you enjoy a better quality of life, you feel better. But as you feel better and improve internally, you want to look good as well. And we are bringing on a new service here at the Hotze Health & Wellness Center, plastic surgery. That’s right, plastic surgery at the Hotze Health & Wellness Center, and we’re affiliating with Dr. Mark Barlow.
Dr. Barlow graduated from the University of Texas in Austin, ended up with an engineering degree and went off to MIT and Harvard where he spent five years studying engineering and biomaterials. At that point, he decided to go into medicine and he came back to medical school at the University of Texas at Houston, and then did a five year surgery and plastic surgery program at the University of Texas in Galveston. And he’s been in practice in the Clear Lake area since then.
I’ve known Dr. Barlow for a number of years. He’s treated and performed surgery on literally thousands and thousands of individuals. And so, in visiting with him, we thought it would be a great opportunity for him to affiliate with us at least on a day a week where he could provide you, our guests, with some special services.
And there are four particular services that we’re going to offer here at the Hotze Health & Wellness Center with Dr. Mark Barlow. The first is Botox treatment, the second is fillers, the third is blepharoplasty or eye lift, and the fourth is lips. And Dr. Barlow is going to explain those to us today so you can understand what that entails and what kind of benefits you’ll have from that.
But most importantly I want you to remember that all of us, not only do we want to feel well, we want to look our very best. And the most important place to look well is in your countenance, in your face. And as you know, as we age, things tend to sag. We don’t look as good as we get wrinkles, and we just don’t look like…and we can, women, I know, try to cover it up with makeup, but it doesn’t work in men. We just kind of let ourselves look like a bunch of old Lone Rangers or our Marlboro men, but it’s sure something that we need to consider as a great possibility to help you improve the quality of your life by improving your appearance.
So, Dr. Barlow, thank you so much for joining us today.
Dr. Mark Barlow: Good morning, and thank you for having me. What I like about plastic surgery, it was either restorative or improving function or appearance.
Dr. Steven Hotze: Right.
Dr. Mark Barlow: So much of surgery, general surgery is pretty much it’s ablative. You’re removing something because it’s caused a problem or gone wrong. In orthopedic surgery, it was interesting, but it wasn’t the same creativity that you need to do plastic surgery because people come in with any myriad of things they consider problems. Some are functional problems. Some are, “I don’t like the way this looks or the way this feels. I lost 100 pounds, what do I do with all this skin?” So a lot of it is either restoring function or giving them back something they maybe never even had.
And so, that to me is interesting because every problem is a little engineering problem, but then there’s the art and finesse of how to actually make the tissue respond. Designing in metal is one thing. You just cut it and it works. Skin is elastic. The underneath changes with time. Just the whole thinking process and then the implementation, myself with my hands, is what has been attractive to me.
Dr. Steven Hotze: And you really have an engineering background, so you like working with your hands, you like working on things. And I was the same way when I did…I did one year only of surgery after I got out of…my first year out of med school, I did a surgery internship, so I like you can fix something. You can go and take care of a problem. And the wonderful thing about plastic surgery, you can really help people improve their appearance, which increases their confidence and really the way they feel about themselves, their self-image. And that’s so very important.
Now, talk about the…I mentioned that we’re going to talk about four things that you do in the office, simply that you would be doing here at the Hotze Health & Wellness Center. We’re going to talk about Botox. We’ll talk about fillers. We’re going to talk about blepharoplasty, eye surgery, and also lip surgery around the lip or fillers around the lip. So why don’t you talk to us first about Botox? That’s simple. Explain to us about Botox, and what the use of Botox is.
Dr. Mark Barlow: Okay. So Botox is one of the botulinum toxins we have that are cleared for use in people. And basically, the toxin binds to the joint between the nerve and the muscle and inactivates it, so then the muscle doesn’t get the impulse to move. So a lot of people have elevens or crow’s feet or four headlines, like I do, that they don’t like, and they want to treat them. So put a little toxin in, you get three to four, maybe five months eventually, of stabilization of the muscle.
And so wrinkles that are starting don’t get deeper and actually relax a little if you intervene early enough. I’ve got people in their even 30s coming routinely because they don’t want the wrinkles to form. And so, by blocking them, they never do.
So we figured out this would work because people would have blepharospasms, so one eye would twitch all the time. And it was really annoying because it’s off-putting, and it’s annoying to the person. So they started little doses of toxin. Toxin in the wrong place kills you. That’s what botulism is. But the purified toxin around the eye, okay, the spasm stops, the patient’s happy, but five years later they’re like, “Well, I don’t have crow’s feet on this side like I have on this side.” And so, that’s sort of what led people to think, “Oh, we can do this for aesthetic purposes.”
Dr. Steven Hotze: Right. And so, when a person has Botox treatment, how frequently is that done?
Dr. Mark Barlow: It’s every three to four months at first. If you consistently treat, the muscle sort of atrophies in between, and has to get stronger afterwards and once the signal comes back. And so, I have people who come twice a year that have done it for several years.
Dr. Steven Hotze: Good. And the next procedure that we’re going to be performing here, or you’ll be performing here, at the Hotze Health & Wellness Center is fillers. So tell us about fillers. Where are fillers used? What do they do? What are they made of? What does it accomplish?
Dr. Mark Barlow: Sure. There are several different classes of fillers, and they have different properties. So probably the most commonly injected ones are going to be hyaluronic acid-based things like Restylane, Juvederm. It’s a clear gel. The outer layer of the skin is the epidermis. The next layer is the dermis, which is collagen, which is the strong stuff, elastin, which is stretchy, and then, sort of all the stuff around it is mostly hyaluronic acid. So it’s what’s in our skin anyway.
When I was still in med school probably, they were using mostly collagen as a filler, and it came from a cow. And that’s fine, it holds volume. But then a lot of people got allergies because it’s bovine and not human. So then, some people extracted hyaluronic acid from rooster combs because we eat roosters, so what do you do? The comb’s like waste material. So you get that and make it a gel, and that’s also good except for the allergy problem. And then, they finally figured out how to do recombinant human hyaluronic acid out of yeast or bacteria. I don’t remember. It depends on the company. But basically, it’s our genetically identical hyaluronic acid.
And now we have a whole family and there’s two or three big companies that do it, Allergan being one, Galderma being the other, that have different moduli of elasticity, so different stiffness, different viscosities. So you can have a stiffer one that maybe is a little more like bone for deep fill. You’ve got softer ones that are maybe better on lips because they don’t feel lumpy at all. Those are the most common. Then there’s some, there’s at least three other broad classes that do a little more structural replacement of volume.
So one of the problems that happens when we age is everything’s “Oh, I don’t like that I’ve got jowls now.” Well, the jowls started in your cheek, and they’ve settled. So part of it is skin quality, which we can, general wellness helps with that. But then there’s laser treatment or skin pen with micro-needling that also helps improve the skin quality.
But part of it is we actually deflate more than we sag. And so, restoring cheek volume tends to lift the jowls back up. I mean, look at an 18-year-old person’s face, they are much plushier than we are by the time you’re in your 50s, like I am, and that’s just volume loss. And I weigh almost the same thing I wore…I mean, I’m a little bit heavier than I was in high school, but not by a lot. So that’s just sort of the general nature of that.
And so, restoring the volume along the tear trough area in the cheeks, we lose our chin pads, and then we get a crease down here and our chin looks small. All these things accentuate the drop of what cheek volume we have to make our jowls. So it’s sort of a multimodal approach for many people.
Dr. Steven Hotze: Well, how will that affect…fillers, how will that affect the gobbler effect that I’ve got right here on my neck?
Dr. Mark Barlow: So part of it is settling from the cheek, and part of it is thinning of the skin, the tissues in the neck, too. So we had more volume in our neck. So for most people, a combination of fill, it really starts up at the orbital rim level, down through the cheek, not in the jaw line so much, but in the chin. And then, some fill in the neck. I do a lot of combo in the neck with filler and Botox to try to get the platysmal bands out, to relax that, but then to actually give some volume back so that you don’t see only muscles and veins, which looking at an old person’s neck, and that’s kind of what you see.
Dr. Steven Hotze: Look at mine.
Dr. Mark Barlow: Yes.
Dr. Steven Hotze: Okay. So fillers are important. And the procedure to do fillers normally on a person, it’s going to take what? 15, 30 minutes, how long?
Dr. Mark Barlow: Yes. Somewhere in that range.
Dr. Steven Hotze: Okay. And then how long will it last?
Dr. Mark Barlow: So it depends also on the filler. So the hyaluronic acid, most of them are 9 to 12 months. Some of the ones we use for deeper feel like Voluma lasts maybe 12 or 15. The way they do their advertising, it lasts up to 18 months. Well, that’s like you get it, but then you get a little more somewhere along the way.
Dr. Steven Hotze: So routinely, if somebody is going to take care of their wrinkles or the furrowing they’re having up in their face and the sagging, they’re going to do that, they want to keep up on an annual basis.
Dr. Mark Barlow: Pretty much an annual basis is what to expect.
Dr. Steven Hotze: Okay. Tell us about eyes. A lot of people, as they get older, begin to get saggy upper eyelids. You look at my eyelids.
Dr. Mark Barlow: Mine too.
Dr. Steven Hotze: And you can see how they’ve begun to sag, a little puffiness under the eyes. So tell us about a blepharoplasty, which is an eye lift surgery.
Dr. Mark Barlow: Sure. So there’s a couple of things that feed into that. Partly, we lose the padding in our foreheads. So then there’s less sort of pump to hold the skin, if you will. So the skin settles, so my brows are pretty low, and I could probably use a brow lift, except I’m also having my hairline move back, so where do you draw the line? But then the excess skin is very easily addressed. For a lot of people, their upper lid only has extra skin and not extra fat.
20, 30 years ago, everybody’s blepharoplasty pretty much was take all the skin you can and any fat that wants to pooch out. Well, then you ended up with sort of a marble and a socket, and their orbital area was so deflated, they actually looked worse than…yes, the skin’s not making a shade, but they don’t look good. So now we’re very careful with fat. Sometimes fat repositioning, so I’m adding fat along the rim where we tend to lose it, which accentuates if there is fat pooching out in the lower lid, not having fat right below it where everything attaches to the bone makes it way more obvious.
So for a lot of people, it’s only skin, for some people with skin and fat. And that’s easily done, prep the skin, injectable local, once the local’s in, you don’t feel anything.
Dr. Steven Hotze: That can be done in the office?
Dr. Mark Barlow: That can be done in the office.
Dr. Steven Hotze: Now, is that just uppers in the office? Can you do lowers in the office as well?
Dr. Mark Barlow: It depends on the lower. If I’m digging after fat for the lowers, for want of a better word, then I usually do those with at least deep sedation because it’s harder to get enough numbing in there that the fat doesn’t hurt as it’s being dealt with.
Dr. Steven Hotze: Right. Now, we were talking about earlier fillers, and I read where fat is sometimes used as a filler. Now, where do they get the fat to fill?
Dr. Mark Barlow: I do a lot of fat grafting. My preference is to grab the fat from wherever it’s the last place the person loses weight. So I’m counting on them not to gain weight, but if they go up or down a little bit, I kind of want it to be their stable fat location. So for a lot of people, it’s the lower tummy or love handles. Numb that area up, use a cannula under just manual suction for a lot of people with just a syringe. Basically, get the fat out and get centrifuge, so I can isolate good stable, graftable fat, and that’s what I use.
Dr. Steven Hotze: Now, why would you use fat as opposed to some of these products that are on the market, the hyaluronic acid?
Dr. Mark Barlow: The advantage of fat is it’s yours, and it works as a graft, so it lives there in the new location. So part of it, I use a very tiny cannula that puts basically little spaghetti stripes of fat in multiple planes, multiple vectors, but it’s small enough that fat, the blood supply can grow into it and keep it alive. So it lives there and persists.
Dr. Steven Hotze: Okay. So what would be the reason somebody wouldn’t use fat all the time, as opposed to hyaluronic acid?
Dr. Mark Barlow: There’s more sort of operative time because now I got to prep somewhere to take a little bit of fat out, so they’ll have two places that hurt instead of one. And it’s not ready to go. So a lot of people just want to pop in and get it done and go, which is off-the-shelf, is great. Most people, I say, “Let’s do at least one round of off-the-shelf stuff. And if you like the look and you like how you feel, then let’s talk about fat.”
Same thing with Artefill as a filler, that tends to last for years and years and years. So it’s tiny little beads of basically a polymer plastic that are big enough, they don’t get extruded like a splinter, but small enough our body doesn’t gobble them up. And so, what does a body do? It just lays collagen around them. So it’s a collagen thing. And I always say, “Well, for those also, let’s do at least around where you see how I fill you before you commit to me for five or 10 years or more.” I mean, the plastic really doesn’t go anywhere. The data I think is out the eight years now that it’s stable fill.
Dr. Steven Hotze: Right. And the fat, if you used fat for the filler, that would last how long?
Dr. Mark Barlow: As long as your fat would last. I mean, it gets…
Dr. Steven Hotze: Indefinitely?
Dr. Mark Barlow: Indefinitely. The nice thing with fat, too, is because it’s not only mature adipocytes, it’s what’s in the fat tissue, which includes potentially at least some pluripotent stem cell-like things. We can’t say they’re stem cells because no one’s studying that.
Dr. Steven Hotze: Sure.
Dr. Mark Barlow: And if we said it was, and then they’d probably stop us from doing it. But there’s clearly improvement in the skin that gets the fat years down the road compared to before.
Dr. Steven Hotze: Sure. Well, we know mesenchymal fat cells, I mean, if you get your stem cells from the fat, those are mesenchymal fat cells, and we know fat has stem cells in them. That’s where you get them. If you’re going to get them from the belly, you’re getting mesenchymal stem cells. So I can see how that could be…
Dr. Mark Barlow: Yes. Dr. Coleman did some of the earliest work on structural fat grafting. He’s up in New York, and one of the things he shows when you go to conferences, yeah, that the fat looks nice, but the skin gets better for years and years and years because of this newly transplanted stuff, and it’s in his process.
Dr. Steven Hotze: Yes, very interesting.
Dr. Mark Barlow: Yes.
Dr. Steven Hotze: So what percent of your fillers would you say are fat? What percent do you use hyaluronic acid?
Dr. Mark Barlow: So the injectable-type patient who just comes in, “I want filler,” pretty much, they’re all going to be off-the-shelf stuff. People are going for a facelift or blepharoplasty or some other surgical procedure anyway, they’re like, “Oh, yeah, I want to do that definitely because I’m asleep, and it’s like a freebie to me,” because maybe I’m doing lipo on them too, and then I would just throw it away, but now they get to use it.
Dr. Steven Hotze: Sure.
Dr. Mark Barlow: So for the pure fill people, it’s probably only 5%. It’s relatively small who only want fat, and they’re not doing anything else. It’s just the way it kind of shapes out.
Dr. Steven Hotze: Okay. And how much longer, if you came into the office and you wanted to do fat, how much longer, would that be an hour procedure because you’ve got to draw that up and spin it out.
Dr. Mark Barlow: Yes.
Dr. Steven Hotze: You have to go spin it and you put it in centrifuge, spin it, I guess, and just take it off. Can you take it off immediately?
Dr. Mark Barlow: Yes. It’s three minutes at 3000 RPM.
Dr. Steven Hotze: Okay. There you go.
Dr. Mark Barlow: Yes, so hour, hour-and-a-half at most, it depends on how much we’re putting in and where.
Dr. Steven Hotze: Okay. And then, finally, some people have their lips improved or they think they have them improved. I don’t know. I’ve seen all different kind of results on these lips. I’ve seen some lips that get big and it just looks bizarre. So what are the indications for a person that wants maybe some improvement in the lips? Maybe they got too thin, they don’t look right, I don’t know, what are the reasons people get lips done.
Dr. Mark Barlow: Right. Same thing as kind of the rest of the face, the lips do tend to involute. They get smaller over time. Our upper lip gets longer and flatter. So one of the things, look at a mouth that’s barely open. In a young person, you see kind of upper teeth and maybe the split between upper and lower. Older people, it’s all lower teeth because everything’s kind of settled.
So very commonly using hyaluronic acid in lips just for volume replacement. And that generally means around the mouth, not purely in the red part of the lip. The other thing that happens, look at a young lip versus an old lip, the white roll that kind of defines where the lip stops goes away. So I have a lot of women who tell me, “I want my white roll better, so my lipstick doesn’t bleed.” And it takes out some of the little radial lines, the little up and down creases.
Dr. Steven Hotze: Sure.
Dr. Mark Barlow: Like they’ll tell me, “I never smoked, and it looks like I have a smoker mouth.” They don’t like the lines. And so, that’s one way to get rid of those. The other thing that can be done for some people is take out a little skin at the right at the base of the nostril and actually remove skin to help roll the skin, the upper lip. So the skin gets shorter, and then more vermilion, or red part, shows.
Dr. Steven Hotze: Right. Well, explain to our listening audience how you’re going to function here at the Hotze Health & Wellness Center. We’ll schedule appointments. People will come in. Say they want to have some filler done, will they need to have two visits or will you be able to visit with them at that time, and then do the procedure during the same day?
Dr. Mark Barlow: It can be either way. So either they can come in and get a consultation, we’ll come up with a treatment plan, and then the next day I’m ready to pull the trigger now, or I want to stage it. I mean, I have people do many, many different ways. My sort of practice is to go conservatively. My wife always accuses me of taking their money like I’m spending my own, and I’m a little frugal. But I’d rather sort of sneak up on the end point, and then, bam, there it is. Because, for some people, it’s a very dramatic change.
I mean, and one, it’s expensive, but two, it’s everybody in your family circle is going to know you’re different. Some people just want it, they don’t care. Some people are like, “You know what? I need it to be a little bit more gradual. Let’s do some of the cheek now and a little lip, and then, I’ll come back in a few weeks, just enough time for people to get used to it.”
Now, right now with the masks, that’s all been a little bit different because who sees you with a mask anyway. It covers all, if you get a bruise, it’s covered. And by the time we take our masks off, people aren’t going to remember what you looked like before exactly anyway.”
Dr. Steven Hotze: Well, tell us about that. On the fillers, do you have much in the way of bruising?
Dr. Mark Barlow: You can. I mean, it’s a small needle, but it’s a needle, and they’re usually pretty short to keep the push force down for me for good control.
Dr. Steven Hotze: So how long does it take after a filler before everything’s cleared up?
Dr. Mark Barlow: It depends on the person. Some clear bruises faster. I like to use Arnica montana as a sort of herbal help for that. It’ll cut the bruising duration down by half or more. We can do some laser therapy with the reds and the LED to help minimize that. Untreated, some people have bruises for three weeks in some form or another. It’s not a big purple block anymore, but it has to go through the green to yellow to fully fade and transition.
Dr. Steven Hotze: And how about on blepharoplasties, you’ll have the same…
Dr. Mark Barlow: It’s similar. You’ll have most of the puffy will be a couple of weeks. You’ll have suture that I remove in a week. Typically, I don’t like dissolving ones because to actually break them down is inflammatory, and the skin is so thin on the lid that it leads to a scar taking longer to look normal. So the scar for blepharoplasty, for the lower lid, it’s hidden right under the roll where the lashes are. For the upper lid, it’s in the crease. There’s a tarsal plate is the stiff part right at the lid margin. And then, where that tends to fold is where the scar gets hidden. And it will be pink like any new scar for several months. And then once it fades…
Dr. Steven Hotze: You never see it.
Dr. Mark Barlow: You never see it.
Dr. Steven Hotze: That’s great. Well, Dr. Barlow, this is going to be exciting rolling this out here at the Hotze Health & Wellness Center and being able to offer this to our guests. So I hope each one of you takes an opportunity to consider the possibility of not only improving your health by getting on a good health and wellness program so you feel well internally, but consider the potential you have in improving your appearance.
And that’s always important. Everybody likes to look their best. And this is one way we felt like we can offer a better service to each one of you is by providing the opportunity for you to be able to work with Dr. Barlow on helping your facial appearance.
And if there’s any other plastic surgery needs, Dr. Barlow also does that. He’s one of the lead plastic surgeons in Houston and he’s the head of the plastic surgery department at his hospital down in the Clear Lake area. So he’s very well-trained and very well-experienced. He has the expertise to help you look your very best, and I hope you’ll take advantage of this.
Don’t hesitate to give us a call here at the Hotze Health & Wellness Center at 281-698-8770 or visit www.HotzeBeauty.com if you’re interested in that. So thank you again, doc, for joining us.
Dr. Mark Barlow: My pleasure. Thank you for having me.
Dr. Steven Hotze: I want to thank each one of you for joining us, as well.
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