Tip-plasty consultation with Dr. GanjehKhosravi (nose job in IRAN)

A tip-plasty consultation with plastic surgeon "Dr. Hooman GanjehKhosravi" about rhinoplasty , facial plastic surgery,filler, Gels, Tip-plasty vs Rhinoplasty, cares , Allergies, Nose arch and some tips in cosmetic surgery in IRAN.

This article covers the following topics :

Introduction of Dr.Ganje Khosravi

Hello doctor, please introduce yourself

Hello, dears. I am Dr. Hooman Ganjeh Khosravi, a surgeon and ENT specialist, and I have been doing rhinoplasty for 8 years now. 

Excellent. Is the office still in Tehran?

Yes, I am still in Tehran in Saadatabad.

Free rhinoplasty consultation with Dr. Khosravi by Direct link and number +989125042633 on WhatsApp.

Non surgical nose job (Enzyme, filler, Gels & others)

Many people ask about the enzyme and everyone thinks that this enzyme should be injected until there is a small problem. I wanted to see what is the reason for the injection? Is it good? Bad? And when is it good to do that? In general, what do you think about enzymes, nasal lift with thread, nasal lift adhesive, and injection of fillers and gels into the nose instead of surgery?

See, first of all, let me answer the main question about enzymes. Enzyme injection has no scientific role in the nose lift. In rhinoplasty, we open the skin of the nose or, depending on the type of surgery, open it from the inside, measure the cartilage and shrink it according to size. We only get enough of the nose hump. We do all these things, but often the two sides of the nose are not 100% the same. How is it possible that you inject a substance into the skin that makes everything small, makes it the right size, and makes everything great? This is impossible at all. Unfortunately, these are advertisements that most of all, fat noses are caught in this trap. Because most of all, they are rejected from surgery, they do not operate and they fall into the trap of this enzyme.

Enzyme injection, calcium injection has no scientific status at all. We sometimes use gel injections in some parts of the nose, for example, for a person who has operated and has a slight dent, a little gel can be used. This is by no means a substitute for rhinoplasty, not at all. It has the scientific status that in brief cases, the gel is sometimes used in certain places, such as on the dorsum, such as the radix, not in the nasal fins, for example.

Calcium and hydroxyapatite injections and these are unfortunately mostly used by people who do not specialize in rhinoplasty. Other works such as Aidan, nose tape , etc. are advertisements that are used, unfortunately. After a while, Aidan left and a device called “Beauty Nose” came instead, the same people actually imported Beauty Nose. It is said that you put this device on your nose, it eliminates the hump, it narrows the bones, it raises the tip of the nose, makes it smaller, or brings it closer to the face. Even with surgery, not all of this can be done so well and cleanly. If it could be done with the same nasal device, all of us doctors would starve to death, this is impossible.

This does not work and unfortunately sometimes causes a permanent problem for the patient. I have seen skin loss using these devices, I have seen permanent damage to the columella due to the use of enzymes in this area. These are very dangerous and should not be used. Why does it affect? Well, it removes a thick layer of skin, and due to the removal of the skin, the nose becomes a little smaller, but its changes are never predictable.

Nose Lift with Thread

excellent. Can you explain about nose lift with nasal thread and tape?

Because there are few clients who want their nose to be lowered and most of them want their nose to be raised. We change the structural physics of the nose, for example, we shorten or pull part of the cartilage, or we put a base to raise the nose, or we sew to the back. That is, we fix the structure. But what can be done with the thread in the nose lift? The scalp of the nose is sewn to the top of the nose, without the structure being modified. This may temporarily raise the nose, it may keep the nose like this for several months, but after a month or two the nose goes down. Only if there is a chance and it does not cause infection or permanent damage to the skin. Therefore, these works have no scientific basis at all and should not be used, even if changes are made, they are often temporary (in the case of thread lift).

In the case of nose adhesives, a long time ago, when rhinoplasty was performed, when the posterior structures of the nose were removed, a gap was left between the septum and the cartilage, which was taped back by force of the adhesive. This is the basis of using U-shaped tape(pulling upwards).

New techniques are no longer like this, we fix the structures ourselves and we are not dependent on it sticking up in the process of healing. When the nasal adhesive was invented, it wanted to do all that work with just one adhesive. You just stick everything like a spring, finally this spring is released and it goes back to its place. It will not have any permanent or basic effect.

Nasal lift and postoperative risks

excellent. And in the case of nose lift with thread, this is the same thing that keeps it for a while, because I saw a lot of people and heard that using it and that thread destroyed the tissue under their skin and caused a lot of problems.

So right. We have an extra risk at all in the noses that have been manipulated. That extra risk is skin damage. We do not know what layer the thread is in, the thread may have destroyed layers in our surgical path, then the skin may be damaged during surgery. This injection of the enzyme may have caused the pieces to stick together, sticking down, we could not lift those parts well. And these are the risks that are imposed on these patients due to the profitability of some people.

Nose Filler nose job

If a person makes a mistake, such as injecting a gel, if that person decides to have a rhinoplasty, should that gel or filler be removed before the nose job? And do the surgery after a while? Or not, can that gel come out during nose surgery?

I had many clients with a history of previous nasal gel injections. Of all the nasal lifts mentioned, gel injections have the fewest side effects. This means that injecting the gel is much better for lifting the skin than lifting with sutures, enzymes, calcium and hydroxyapatite.

 But the gel is a bit better, if the amount of gel injection is high, it is better to apply the enzyme before the operation to eliminate it, especially if the gel is in the tip of the nose, it is better to do this.

People who apply gel in the Radix area, basically we can easily reach that area during surgery and we can evacuate it ourselves. Therefore, if the gel is injected with a shelf life of one year in the tip of the nose, it is better to enzyme it before surgery or wait for 6 to 8 months after the injection.

Some gels have a shelf life of 3 years, in these cases, we must send the patient before the operation to take an enzyme or we will make them ourselves to remove the gel and after that we will perform the surgery.

Tip-plasty vs Rhinoplasty

Dr. Khosrowari, one of your specialties is tip-plasty. Can you talk a little bit about this?

It has been heard that tip-plasty is not a good option for everyone, who can be a good candidate for breast tip-plasty and for whom do you think it makes sense instead of open nose surgery?

it's true. First of all, I must say here that tip-plasty surgery is a type of surgery. It's good that you first asked those questions about nose lift and enzymes and calcium and so on. Unfortunately, our general practitioners do these things and say we had a tip-plasty. It is not true.

 tip-plasty is a surgery for the nose, but it has a major difference with full rhinoplasty. I do in tip-plasty, which means that what I do is that we can collect the tip of the nose, we can remove the hump to some extent; This range depends on the condition of the bone. We can raise the tip of the nose, lower it, or shorten it in some cases. Sometimes we can increase its height, we can do these things, but there is one main difference and limitation, and that is the nasal bones.

In tip-plasty surgery, we can not change the bones on either side of the nose, that is, in the front view, the width of the nose does not change and the bone does not break. Who are the right people for the job? Those who have thin bones. When you have thin bones, we can remove the hump, shrink the tip of the nose, raise it, and the changes in the nose will be practically the same as a complete rhinoplasty performed by me. Of course, this limitation is also an advantage. The advantage is that you do not need plaster, you can start exercising professionally from 5 days later, you can sleep on your side and you do not need to control laughter. These are actually the advantages of this method.

Tip-plasty cost vs Rhinoplasty cost

What about the cost?

As for the cost, it's different, of course. Something about 30% less expensive than rhinoplasty, because it does not have anesthesia and does not need to be in the hospital and is done in the clinic.

 So there is a difference in cost. But the most important part before surgery is to choose the right patient to know who is the candidate for this surgery? Those who do not have much width in their nose or do not have much deviation. In these cases, we can do tip-plasty surgery and get very good results from their operation.

Tip-plasty in reconstructive surgery

Doctor, what about those who are candidates for reconstructive surgery? Can they do tip-plasty? Because I saw a lot of friends that in the initial operation, the ostomy was done, the deviation of the nose was removed, but well, the tip of the nose is still enlarged, or the cartilage of the nose is displaced, or the nostrils are very asymmetric. Can these friends also solve their problem with tip plasty?

You asked a very good question, In reconstructive surgery if we divide the problems into two general categories; Some of the problems are major like:

 Large defects such as Saddle Noz, those who have a severe dent in their nose or bone aberrations, in these cases we have to go to more complex surgeries that are performed with rhinoplasty or complete surgery.

But we had a lot of patients who had tip-plasty surgery as a reconstructive nose job. There are people whose bones are in good condition but the tip of the nose is still large, or their bones are in good condition but the tip of the nose has fallen off over time after surgery; For example, the surgery was done 15 years ago, the nose fell out, and well, it is normal for it to fall out after 15 years. This sagging can be completely corrected with type-plastic surgery. If the patient has a problem with the tip of the nose shrinking or there is a large width in the tip, tip-plasty surgery is the best option for them.

In short, in minor defects, such as drooping nose, deviated tip of the nose, large tip of the nose, or small indentations in the nasal fins, these can be completely corrected with tip plastic surgery and no further surgery is required. But if there are bigger problems, then we have to go to complicated surgery.

Indent of the Nasal Fins

This question is about the indent(pinch) of the nasal fins. How can this be fixed and why does it happen? What is the reason and what can be the solution?

If you mean the soft triangle area in the nose, it does not exist independently; In fact, the structure of this area depends on the cartilage of the tip of the nose. So if you do not want this area to sink into a patient, you need to keep the nasal structures normal.

That is, after you have gathered the tip of the nose and raised it, the structure of the nose should be preserved and not weakened; It is like you build a building and then, for example, you do not put the columns right, well, it sinks from one place to another and comes down, this is where it sinks. So the first thing to do in primary surgery is to make sure the angle between the lateral and internal cartilages is right; This point was a bit specialized.

Now what point should patients pay attention to? Squeezing the tip of the nose too much always causes this area to sink in, like Michael Jackson's nose. Before his death, he had offered $ 3 million for someone to have his nose repaired so that he could breathe properly, but no one was willing to have his nose repaired for the fourth time, because sometimes it could not be repaired.

So the first and key point is that in the initial surgery, the amount of contraction of the nose must be such that the nose does not sink. But if this has happened and now the patient has come to us to do something about it, we have to add a structure to it; So we make a very small incision inside the nose and put a cartilage as a jack in this part and raise this area higher. Raising it does not make the nose bigger, but it does correct the dent, this is actually a cartilaginous structure that we are adding.

Let me make a third point, and this may in fact be a question for many, sometimes patients make mistakes; After the operation, the fins become a little bigger than normal, and patients close the nose with tape on both sides in order to fix this problem. This is one of the problems that if the tape sticks like this for two months, it will cause a dent. So in the nasal tapes, the blades should not be caught in any way to collect the nose.

 If patients follow this point, many of the problems in this area will disappear and correct themselves; This is a key point for patients. After surgery, never gather the nostrils with the tape that comes from the side of the nose, just hold the tip of the nose yourself.

Indent Above the Nasal Fins

Doctor, what happens if there is a dent above the nasal fins?

This again depends on how much the upper part of the tip of the nose is contracted, again in the initial surgery we have to pay attention to whether our contraction is more than usual or not? If it becomes more due to this contraction, a dent will be found in the nose.

 Many people may like a bit of a dent in the nose, I personally keep it in my patients if anyone has this slight dent. But if it becomes too much, unfortunately the bad news is that after the operation, it can not be fixed by taping and other work, and sometimes a repair operation is needed.

The important point is that the tip of the sharp nose is now practically obsolete in the world. They do not sharpen the tips of the noses much anymore and try to keep a short circle, which is also the reason for preventing the dent of the nose; Sharp tips of the nose will definitely have a dent, the tips of the nose, if they have a slight round, will not cause this dent. Therefore, it is very important that the amount of compression and removal of nasal cartilage does not exceed a certain level.

Asymmetry of the nasal fins

Doctor, asymmetric nasal fins are a problem that many friends have after rhinoplasty.

  Will this resolve on its own or not? And if it does not resolve, what can be done to resolve it?

And for those who have minor problems (such as asymmetric nasal fins) that have not been resolved, can all minor nasal problems be resolved with a tip-plasty surgery?

that's exactly right. When patients come to me, I tell them that type-plastic surgery is enough for many of these minor problems, and in these cases the results are practically the same as rhinoplasty. Note that the two sides of the face are not 100% symmetrical in any person. We do not have 100% symmetry in nature at all, and the best painters in the world always make the two sides asymmetrical when they want to paint portraits. That is, if a painter draws the same two sides of the face, they say he is not a professional painter.

I always tell my patients that the two sides of the nasal fins are never symmetrical, it is not symmetrical but it becomes more similar. I have a professor who is 70 years old, for 40 years he says that if you find someone after the operation or before the operation that the two sides were 100% symmetrical, I will operate on you for free, now I have been saying this for many years and so far No one found.

 But this does not mean that the two sides should be very different, the nostrils should be closed on one side and open on the other, no, they should be similar. Many times, after surgery, you have asymmetries for 7-8 months. Why? Suppose you bring the structure of a crooked nose to the midline, and these skin pockets that are above the structure are not yet in place; That is, the infrastructure of everything is good and uniform, but the skin is asymmetrical, this usually goes well in 7-8 months, over 70-80% of cases like this.

Is it necessary to add more work sometimes? Yes, there is always the possibility of correction in anyone who has surgery.

 What can be done? Sometimes, when it is necessary, after a year, we make one side bigger or smaller with a small cut, for example, one side needs cartilage to be added, so we add it. These are small flaws, not big flaws; But remember, these can never be 100% symmetrical, there are always slight differences.

Another point that I am asked, and perhaps in your questions, is about the vertical asymmetry of the nostrils. The ups and downs of the nostrils have nothing to do with the nose, it is like building a building on a slope.

The fact that the building is sloping is due to the fact that the base is sloping. The nose is the same, when the nostrils are vertically asymmetrical because these jaws are higher or lower on one side, these asymmetries are never corrected; This is bad news, but the good news is that no one sees it so easily in someone else's face. We are the only ones who carefully look at our faces in the mirror and notice the smallest differences.

One of the dear doctors says a good thing: "Before the nose operation, our criteria are in the centimetre scale, and when we have the nose operation, our criteria become the millimetre scale, and well, it gets very bad."

Exactly. Maybe we are the same, I think that if someone does something, he looks at himself more carefully and the details become more important to him.

Dr. Khosravi, regarding this issue that you mentioned, I always tell the audience that you should look straight at the camera and take a picture of yourself, then reverse the picture with editing software. Well, the face has completely changed. Yes, the left side of the face comes to the right and vice versa, then you realize that now it is ridiculous and you see something inconsistent from your face. Because the two sides of the face are never symmetrical, and when it is reversed, it looks abnormal, and it certainly is the same with the nose.

Yes. This is the case for all components of the face.

Nose arch problem, Concerns and solutions

Doctor, one of the most frequently asked questions is that they say, for example, it has been 7-8 months since their operation and nasal arch were not known, and the doctor was supposed to arch their nose. So, is this arch possible to appear after 7-8 months or not? If not, what is the solution to the arc?

For my patients, I usually draw a 1: 1 ratio on their image before surgery, and say that your face is about 80-85% similar to the one I'm drawing for you.

When you operate normally, it means that I am a surgeon, that the type of surgery I perform is natural and has a gentle arch, and I do not give a strong and fancy arch to the noses I operate on.

 In the early months, the nose becomes swollen and large again, and you practically think that there is no arch. Over time, usually between 6 and 9 months, this arch of your nose shows itself, and the last place it happens is in the area of ​​the tip of the nose. Therefore, it is too early to decide on the final outcome and reoperation in the first months after surgery.

Now, in the case of fancy noses, from the first months, let's assume that an inch has been removed, naturally it has a gentle arch, it reaches 1-2 years and the arch becomes severe.

In natural surgery, the nose is flat early and sometimes has a hump, a gentle arc slowly appearing a year after surgery. Now suppose this change happened, but it did not reach the desired result. Well, sometimes surgery is needed again. If a re-arch is needed, we need to see where the hump is left, sometimes there is nothing left, extra tissue is formed.

If the hump is in the bony area of ​​the upper third of the nose, only one incision is made from inside the nose, re-surgery is not really necessary, the upper part of the nose is scraped, which usually takes 5-10 minutes.

Sometimes there are lower parts, which are very rare. Usually, the closed method is used and a piece is removed without opening the nose. Of course, there are a few cases at the bottom and more at the top.

So patients do not rush, let it be a full year, I had patients who, for example, took a year and a half to reach the final result, and then everything was great, especially the fat noses. But if there is a problem, it usually requires a small amount of work inside the office, such as scraping, and the best person who can help them is always their own surgeon, because he knows what he did in the initial surgery.

Nose job & Gym | cares

Doctor, what do you think about the gym? When do you think people who do nose surgery can start a fitness club and heavy exercise? Exercises like swimming, running, like aerobics when can it be done?

First of all, in the surgical procedure that I do (tip-plasty surgery), you can do professional exercise 5 weeks after the operation. This is because the nasal bones are not displaced, and when this does not happen, the structure of the nose is very tight. I have operated on 14 national team players and professional athletes so far, including taekwondo, athletics, rock climbing, ice hockey and many other sports.

If an athlete's nose is suitable, the best option for him is tip-plasty surgery, because he can do professional exercise in 5 weeks.

But in rhinoplasty or complete surgery, where we replace the bones depends on the structure of the nose. In some noses we do very severe manipulations, that is, the bones are very crooked and we move them a lot and change everything.

 For example, in the nasal septum, which has many fractures and various catches, this nose has the potential to move again!

 The nose has the potential to have a lot of problems if something happens to it again. In these cases, we say it is better to start jogging after 2 to 3 months, swimming after 3 to 4 months and sports such as going to gym, can start after 7 months.

But there are some noses whose structure we changed less. In these cases, we take the time forward, the best guide for each person is himself. If you start exercising, you have a sore nose or the next day there is a lot of swelling in your nose, which means it is still too early for you and you should not start exercising.

More intense and martial arts take at least a year before they can begin.

It was experienced by us that every time we did an exercise or activity that was pressing on our nose, we noticed that our nose felt pulsating afterwards, and this was an alarm, which means that we should not do it.

Exactly. The best guide for each person is the person himself, because he realizes that this is a red flag for him and he has to stop.

Postoperative Breathing

Doctor, can you explain about postoperative breathing? Considering that the focus of our conversation has also become tip-plasty, is breathing OK after tip-plasty? Does it mean that the swelling inside the nose is naturally less than the complete operation or not?

Now, in general, for those who perform open rhinoplasty, breathing after the operation becomes a problem, they think that Respiratory system is affected, they should put everything aside and go for a repair operation. Please talk about this too.

If rhinoplasty had been performed properly, you would have lost 10 to 15% of the internal volume of your nose, which would not have been acceptable for the brain and would not have had a permanent respiratory effect. But in the early stages after rhinoplasty, our brain thinks something has happened and mentally doubles this volume, in other words, Yahoo, you think you have lost 50% of your airway.

 Do not worry, you have to endure these two months. Of course, it is different for people, for some the problem may be solved in a week, for others it may take longer, but if everything is done correctly, it is temporary.

That is, the mucus inside the nose is gently treated, the tissues are not damaged, the blade is in the midline, the tentacles are properly cared for during surgery; Gently treat all tissues during surgery, it usually takes a short time and should not take longer. People with allergies are an exception, and they may take a little longer.

People with Allergies

I myself, because I had allergies, I think this was a problem for me for 5-6 months, the nasal tentacles were a little more inflamed and there were problems.

Exactly. It is best for people with allergies to take their allergy treatments very seriously from 1 to 2 months before rhinoplasty, and to continue their treatment during the one-year recovery period.

These people can control the postoperative condition much better if they have already started allergy treatment. In the case of tip plasty, we no longer have that 10% to 15%, 10-15% of the nose volume is not lost because the bones are not smaller and more compact. So you have only one swelling, that is, if we want to consider the swelling of a person after rhinoplasty vs tip plasty in general; Swelling is less in the tip plasty. So breathing is better from the beginning.

 Of course, I do not use tampons at all in nasal surgery, whether in rhinoplasty or tip-plasty surgery, I do not use tampons; Therefore, patients can breathe through the nose from the beginning. But in general, this is not a cause for concern, and in the first 2 months, if the nose has preserved its internal structures, after 2 months, everything usually returns to normal.

Probability of recurrence of the nose hump

The audience talks about the return of the nose hump after the operation, saying that the hump that was removed by shaving or scraping, they feel that it has returned after the operation. Is it due to swelling or could it be problems such as recurrence of nose hump?

We do not have nasal regrowth, nasal regrowth in men is only around 16 to 18 years old and in women it is a bit earlier and it ends, that is, we do not have anything called nose hump recurrence.

In noses that have a lot of hump, 1 to 2 millimeters of hump may remain during surgery, but it is not common. What happens most often is that in the process of healing and healing the skin to the underlying tissues, a dead space is created between the upper layers such as the skin and the underlying bones.

Inside this dead space, interstitial water collects like puffiness under the eyes. Sometimes this space is no longer filled with interstitial water and excess tissue is formed; This extra tissue looks like a hump on the top of the nose, and clients think their hump has grown back or left by a surgeon.

This was the worst case scenario possible, if it happened it would need to be scraped off after a year and it would go away.

Now why do I say one year? Because many times you see these small humps while that interstitial water is in the same dead space and no tissue has formed yet and it gradually disappears.

I had patients who had a slight bulge above their nose in the 6th and 7th months, and by the time they get better in a year, over 80-90% of cases will get better in a year.

Patients are worried that sometimes this hump is left, do they need to do something? Under one year is not recommended at all because if they do it sooner, sometimes we have to refill what we created. So do not worry, these are small problems, sometimes you need something to do, but most of the time it does not, and it goes away with patience.

Nose massage after Rhinoplasty & tip plasty

Very good. Doctor, the audience is asking about steroid, do you think steroid is effective or not? How about a nose massage? Some doctors tell their patients to do a nose massage to relieve nasal hump problems. Does everyone have to have a body massage or if someone does a massage without a prescription, will something bad happen to them?

We have so many different techniques in surgery, there are so many ways to get a good nose. A surgical procedure by me may be very good, but my colleague does the same method and it is not good at all or vice versa.

For some patients, we use crushed cartilage in the upper area of ​​the nose, scientific studies have shown, crushed cartilage that is placed there, if massaged, they will be absorbed up to 40% more. In other words, the surgeon adds cartilage to beautify an area of ​​the nose, then you massage it and 40% of it disappears, then we have to fill that part again and do something else for them; So if someone else's doctor told him that massage is good for you, it does not mean that it is good for you.

Because I use different methods, even for my own patients, I tell some people to massage and some people do not massage. Today, one of my patients who came to the office, we used the tissue of his head in his nose in surgery, so this patient should not massage his nose in any way, massaging is equal to moving this tissue. But another patient comes and we did not do any of these things, but he found a slight bulge on his nose, we know that we did not add anything and there is tissue in the nose itself, so I tell him to give a massage; Therefore, a single prescription for all people cannot be prescribed and it depends on each person.

As for the steroid you asked, steroids are effective in the nose, but their effect is not shrinking the nose, the effect is that sometimes everything is fine, but somewhere it is very tight; This is where the extra tissue forms, we inject corticosteroids in that area to get rid of the extra tissue. We never use corticosteroids as an anti-inflammatory, but unfortunately the general public thinks that when corticosteroids are taken, the nose shrinks, which is not the case, but its side effect. The main purpose is to remove excess tissue.

Free rhinoplasty consultation with Dr. Khosravi by Direct link and number +989125042633 on WhatsApp.

Postoperative nose cleansing

excellent. To clean the inside of the nose after surgery, patients use a hairpin, tweezers, toothpicks, and sometimes a round needle and finger. People say that our noses bleed after we did these things. Is this blood worrying now or not?

First of all, none of the things you said are right and none of them should be used in the nose. In the first 4 weeks after surgery, it is better to use nasal spray, I know it is a bit hard but it must be endured so that it softens with the spray and empties. Even you are not allowed to fin in the first 4 weeks, after that time you can use fin and syringe washing, which is a basic and scientific case.

But if we assume that someone used a pin, key, ear cleaner and bled; The good part is that you can never get to the sensitive parts with these devices, and you usually have damage in the front parts, and the bleeding is related to the stitches that were made in the front part of the nose, in the incision of the nose blade. These are not things to worry about. The bleeding is minor and is in the front area, with a few days of using sprays and sometimes ointments such as mupirocin, it gets better.

Rare cases where a person has sent the object in too much and the nasal tentacles have been damaged or cut deeper; They sometimes need some work and arrangements to stop the bleeding. But in general, the best thing is not to do these things and do not use these devices, just use a large number of sprays 10-12 times a day to clean the inside of the nose and do not reach these steps.

You can find some other useful articles about cosmetic surgery and also rhinoplasty in other categories

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