32 Y/o Asian American from Texas; FUE Hair Transplant with Transest in Istanbul, Turkey; 4100 Grafts (Jan 8th 2016)

***Note: This review will be very lengthy and...

***Note: This review will be very lengthy and detailed since I'd like to be as thorough as possible about my background and experience in the hopes of helping others make their decision regarding this procedure and whether or not they decide to go with Transest in Istanbul, Turkey (www.transest.com) as their provider. BACKGROUND: I have always had very thick and coarse hair growing up and every time I went to the barber, thinning scissors had to be used (ironic, right?). If you’re reading this, I’m sure you are already aware that different factors play a part in why some people lose their hair and others don’t… genetics, health, lifestyle habits, age, medical treatments, medication side effects, etc. I’m not entirely sure how female baldness happens (it’s likely similar to male pattern baldness perhaps?), but my understanding regarding the genetics portion for men is that baldness can be an inherited trait passed along from the mother’s side if you happen to receive the X chromosome that carries it. So the men in your mom’s family can be an indicator of whether you might become prematurely bald. But since none of the males in my mom’s family have any baldness whatsoever (in addition to her father, who had a thick head of white hair even until he passed away in his 70’s or so, she also has 8 brothers… none of them are thinning or balding). So why me?With genetics ruled out, I mentioned other factors above and the two that play a role in my specific case are hormone levels and medication side effects. As you may know, males have a certain amount of testosterone that falls on a range from low, normal, high, etc, and this may fluctuate with age. There’s a saying that bald men are the most virile, and although this may not be entirely accurate, this comes from the fact that since dihydrotestosterone (DHT) is a by-product of testosterone, many people assume that high testosterone levels = high DHT levels and high DHT is associated with baldness in men and women. Well, DHT levels can be high regardless of the level of testosterone, just FYI. But I think in my case, the medication I’ve been taking for over 12 years for a personal issue played the major role in my hair thinning/hair loss because I believe it raised my DHT levels significantly. I started my medication when I was about to turn 21 and I didn’t start to notice my hair falling out until I was about 24/25 years old. I woke up to significant amounts of hair on my pillow and in the shower drain. Right now I am 32 years old. TREATMENTS BEFORE FUE: At around 29, I started to use Rogaine foam on my scalp and have been using it ever since. I started to take Biotin supplements as well and made sure to buy shampoo that included vitamin E. In the last three years, I did notice some minor improvement but I still was not satisfied with the results. Although Rogaine may help some individuals regrow hair, for me it mostly helped to stop any further hair loss from occurring. THE DECISION TO DO FUE: In the last 8/9 months, I started to do some research and discovered what Follicular Unit Extraction (FUE) hair transplants were and grew more excited about the idea of one day doing this procedure. I’ve seen/read about transplants gone wrong or turned out with unsatisfactory results because other methods used to look like obvious hair plugs (like a doll’s head) or ones that leave a huge horizontal scar on the back of your head like you had brain surgery (the “strip” method). Neither of those appealed to me because I wanted something natural-looking and used my own hair with as little side effects or scarring as possible. And FUE seemed to satisfy those desires because it basically involves taking hair from the back or sides of your head where you still have healthy hair (your donor site) and moving it to the areas where you are thinning/balding. Each follicle graft is transplanted one by one leaving a very tiny barely noticeable circular dot of a scar on your donor site (or no scar if you heal well), and a single follicle has about 2-4 individual hairs in each “bulb”.
In terms of potential social stigma, I guess I really didn’t mind who in my circle of friends and family, etc, know about my hair transplant desires. But I guess it did help a little to read how some celebrities openly reveal that they’ve had a hair transplant or two done in the past (Matthew McConaughey, Dennis Miller, Mel Gibson, Edward Norton, Kevin Costner, Sylvester Stallone, Sean Penn, Billy Bob Thornton, etc). Of course those celebrities can easily blow $50k+ on the best clinics, but as an average American, I had to look up how realistic this procedure would be for me in terms of cost and whether I might have to wait until I’ve saved up or wait until I was in my 40’s to do it. In the U.S., the FUE procedure costs can vary on a wide scale based on number of grafts, clinic reputation and experience, and geographic locale in the U.S. You can imagine how some places in Beverly Hills, CA or Manhattan, NY can get pretty up there, but based on my research for Texas, I would be looking at about $5-$7 PER GRAFT. So say I had 1500 grafts x $5… I’d be looking at a minimum of $7,500. But for any real noticeable difference in hair density, you’d probably have to get at least 2000-2500 grafts done. The maximum that any clinic could probably do in a single session comfortably and to minimize any potential risks is about 5000 grafts. And that’s only if your “donor site” on the back or side of your head is healthy enough to even provide that many. Some folks go in for more than one session the following year or so, depending on their level of hair loss and what density they are seeking to get. So if I did a single, maximum-graft session, I’d be looking at a steep $25,000-$35,000 price tag. I was about to forget about the whole thing altogether when I ran across this website RealSelf.com and started to follow several guys’ FUE hair transplant experiences and results from all over the U.S. and the world. The results from clinics in the U.S. (even in places like Los Angeles, etc) were not that noticeable and many were not satisfied or did not think it was worth the price they paid. On the international front, I started to wonder why clinics in Istanbul, Turkey kept popping up in several of the posts with amazing results and positive accounts from guys that came from Europe, Canada, USA, Middle East, Asia,… just all over the place. And my jaw dropped when I saw what they paid for their procedure – less than $2000 for something I’ve seen go for at least $10-15k in the states?! I was very skeptical and reached out to several guys and heard back from them and sure enough, everything was legit. That’s when I realized that FUE could actually happen for me sooner rather than later. All I had to do was wait for the right time when I would have available days off of school or work and the right price for a flight to Istanbul, which can sometimes go as high as $1100-1200 R/T. In the meantime, I decided to reach out to one of the clinics that I saw pop up often with great results (Transest)…
MY EXPERIENCE WITH TRANSEST & ISTANBUL: I initially communicated with Transest through Facebook since they had a Page. After I sent a photo or two, they said I’d probably need about 4500 grafts. They put me in touch with their English-speaking liaison named Aytec and we communicated through WhatsApp. I sent more pictures and asked about the process and cost, etc even though I already had a very good idea based on the sharing of experiences from some of their past patients on the RealSelf forums. I appreciated the fast response from Aytec regarding my questions and he told me that Transest would not be able to reserve any appointment dates without a confirmed flight itinerary. But as luck would have it, I received an email notice from one of the discount travel sites I’m subscribed to and tickets to Istanbul were going for around $600! And since I also happened to be on winter break from school, then I jumped at the chance to set my FUE plans in motion. After I booked my flight for $640 R/T, I sent the details to Aytec who provided me an email confirmation that included some details about the procedure and how to prepare, in addition to the price (1690 euros, or 1850 USD). No deposit is necessary, but payment was to be made in full (preferably in cash) upon arrival to the clinic. The set price they gave me is guaranteed (not a potentially tricky ‘quote estimate’) and it includes the FUE procedure and post-op meds, 2 nights hotel stay at Midmar Deluxe Hotel not far from the airport, a mid-procedure meal for lunch break, and all transfers (airport pickup from driver holding sign with your name when you leave the terminal, hotel pickup to clinic on procedure day and the follow-up visit the next day, then back to the airport). Any additional stays beyond 2 nights will be out-of-pocket for you. Your appointment date is normally in the morning the day after you arrive in Istanbul.I flew out to Istanbul from Texas on January 6th, which meant I would be arriving on January 7th. My procedure date was set for January 8th. Only 2 nights are required, but I decided to stay an additional 5 nights since this will also be a vacation for me, not just a brief medical tourism thing. As I’m writing this, I’m on my 4th night out of 7 total here in Istanbul. To prepare, I packed some extra gauge pads, medical tape, vitamin E oil, bacitracin antibiotic ointment, my regular Biotin supplements, a good neck pillow, some Type F Europe Schuko plug adapters, and this portable face cradle thing that would allow me to stick between a mattress and boxspring to make a makeshift massage table headrest so I can sleep face down after the procedure. Based on what I read from other patients, it was uncomfortable having to sleep upright after the procedure and although a neck pillow helps a lot, I thought it would be creative to try and sleep face down. More on that later. Do not bring or take any blood thinners including aspirin, ibuprofen, etc. No alcohol consumption the day of the procedure and afterwards. No need to bring any hats unless you want to wear one before the procedure, but you can’t wear one afterwards. Bring a small umbrella in case it rains. All the shirts I brought were also button-downs since you want to avoid any t-shirts or sweaters that you would have to pull over your head and potentially rub against the grafts or donor area. In addition to these items, I would recommend getting the Turkey tourist e-visa online, which takes just a few minutes and costs $20.The flight to Istanbul was long (about 10 hours). Luckily nobody was sitting next to me so I had two seats all to myself to stretch out and lay down. I arrived to Istanbul around 9:30am on Jan 8th and the Transest driver named Mustafa was right on time. He’s very friendly and nice, but speaks little English. Regarding English, you should know that almost all of the clinic staff, doctors, technicians, etc, speak very little to no English so the only person you are able to communicate verbally with is Aytec the liaison who will also be in the clinic for the procedure. Otherwise, you will need to rely on hand gestures for communication to anyone else. Once I was picked up from the airport, Mustafa called Aytec to confirm and allowed me to speak to Aytec on the phone for a brief welcome, a reminder on what to wear, etc, and that I will see him tomorrow when the driver picks me up from the hotel at 8:40am. We got to the Midmar Deluxe Hotel and it was a very nice but smaller room than I expected. Enough space for what you need though. Overall, the hotel was wonderful (it’s a 4-star hotel after all). The breakfast selection was huge and tasty, there’s an onsite fitness room, Turkish bath/sauna/steam/Jacuzzi, and other amenities available at no extra cost (massages are extra of course). But I really enjoyed my stay and wish I could stay longer, but after the 2 nights that were included were over, I didn’t want to have to pay 80 euros per night additional, so I booked my stay at another hotel (Lotus Hotel), which was $95 total for all my other 5 nights. I had a bit of jetlag when I got to Midmar Hotel so I took a few hours to rest up before I went to explore some of the city and navigate the public transportation system. I also knew that I wanted to have a Turkish bath experience before my procedure since I’d be unable to do one afterwards. The next morning, I made sure to have a big breakfast as I was told it would be a while before lunch. I met two other patients from Transest at the hotel lobby around the time our driver was supposed to pick us up. One man was a 27-year old Caucasian from England who just had his procedure the previous day and was going with us back to the clinic for his follow-up. The other man was Sudanese-Swiss in his 40’s who would be having his procedure that same day with me. We hopped in the car and headed to the clinic, which was in a professional building. I was greeted in person by Aytec and he took me into his office for a brief consultation where I also met with Dr. Ayse Ozturk just for a few seconds to examine my head and confirmed that my donor site was good and that I could do the maximum that my donor could provide (roughly 4500). In actuality, it turned out to be 4100 grafts in the end, so pretty close. I presented my passport to Aytec and also completed payment in full. He took some before pictures and explained the process once more. Aytec was very professional and thorough but also definitely a straight forward business man that knew his stuff. I was then led to the room where my procedure would be taking place and a technician had me change into a hospital gown, then shaved my head on the spot down to half-inch using electric clippers. I was cleaned up and sanitized before being told to lay face down on the operation table to initiate the local anesthesia injections. To compare my experience with user “CaliD3” (https://www.realself.com/user/1230058), for some reason my blood was not drawn into any test tubes for plasma or HIV, etc, like he mentioned in his post, so I did think that was a bit strange now that I think about it, but I actually forgot to inquire. Too late now I guess. If any Transest clinic members read this, I hope this part of the procedure can be kept consistent so that there’s no confusion about who is required to have pre-tests for disease control, etc. Not just for our protection, but your staff’s protection – just FYI. From what I could see personally though, they did seem to practice general sterile protocol with everything else. ***PHASE 1 (duration: 3 hours) – start time (around 10am)So the first phase of the procedure is administering the local anesthesia injections and proceeding with the extraction of the 4100 follicle grafts from the donor area on the back of my scalp and the sides behind the ears. I already knew that the anesthesia portion would be the most painful part of the entire thing from what I’ve read and now I can confirm that it was definitely true for me. As an FYI, I have 5 tattoos on my body and broken two bones in my life so far, so I’d say I have a pretty high tolerance for pain, but this type of pain was completely new and unexpected and I had to exercise deep controlled breathing to remain completely still during the injections… all 50 of them I estimated. I have undergone 4 major invasive surgeries that have required me to go completely under anesthesia so I know what those anesthesia injections feel like at first. If you’ve had surgeries, you know what I’m talking about when I describe the sharp stinging cold sensation when the liquid enters your body… because the needles and actual injections I have no problems with, it’s the anesthesia going inside that’s painful as hell. Unlike complete anesthesia where you just feel the one uncomfortable stinging injection before you wait a couple minutes for it to kick in and then you’re knocked out unconscious, these local anesthesia injections for the FUE are the stinging sensations on repeat for about 50 times all over your scalp. After the first 15-20 injections of pure hell, it started to get better as the numbing sensation kicks in. The idea is you will be completely awake and conscious during the entire procedure but won’t feel any pain while they are extracting and transplanting the grafts. So anyway, after about 30-45 minutes of that, the team began to extract the 4100 grafts which basically feels like someone shaving your head with a little vacuum attached. You can’t feel any sensations except for slight pressure and hearing the whirring vacuum sound. It’s a handheld motorized suction tool specifically designed for this procedure. The team collected all the grafts on pieces of gauge contained in several petri dishes. You remain in this face down position for the whole 3 hour duration for this phase from anesthesia injections to completion of the follicle extraction.***PHASE 2 (duration: 45 min-1 hour) – start time (around 1pm)After the first phase, you get up to sit on the side of the table so that the doctor can draw the hairline outline in marker. I didn’t really have any loss at all from my hairline so that marker line they drew was pretty much where my hairline already was, maybe about 0.5 cm (if that) lowered. I’m sure this would be a crucial step for guys who have a deeply receded hairline in that horseshoe shape, but for me, didn’t notice any difference really. Afterwards, I lay back down but on my back instead while the doctor opened up the “channels” which is where they place each individual hole where the new follicle will be moved to. Still can’t feel any pain but the sensation is very minimal pressure and the sound is similar to sticking a toothpick into a pumpkin (if you’ve ever done an elaborate jack-o-lantern design, you know what I mean). But at least this phase allowed me to see the artistry and eye for symmetry that the doctor’s role and experience would come into play, because the rest of the procedure could (and was) carried out by the clinic technicians. ***LUNCH BREAK (I’m a fast eater so took maybe 15-20 minutes) –
Unlike CaliD3, I was not lucky enough to get the chicken and was unsatisfied with the meal option. I was basically eating it because I knew I had to provide my body with sustenance. First of all, the food was cold. Secondly, they gave me chopped liver (literally) as the main meat. Throughout my whole life, I have only met probably 3 or 4 people that actually enjoy eating liver – I mean who likes LIVER!? Very odd choice, so I just stuck with everything else – potatoes, rice, bread, soup. The yogurt is an acquired cultural taste that I wasn’t used to, so I only had one bite of that.***PHASE 3 (duration: 4.5 hours) – start time (around 2:15pm)This phase is the longest and made my body the stiffest I’ve ever been because you have to remain almost perfectly still on my back the whole time while a team of 2 technicians worked tirelessly to place each of the 4100 grafts intricately into the thousands of opened “channels” that the doctor poked in my scalp in a grid-like fashion. By the start of this phase, they had already injected more local anesthesia around my scalp since the first round was about to wear off, but no pain was felt at all. About every 30 minutes, they would use a spray bottle with some sort of fluid (could have been water for all I know) that helps to maintain moisture on my scalp for the grafts to properly settle into their channels. Not much more to describe here. When all was said and done, I got to sit up and stretch, then they rubbed some ointment on the donor area and bandaged the back of my head. Then I changed out of the gown into my regular clothes and gathered my belongings. It was about 6:30pm by this time.I went to Aytec’s office again where he gave me a Transest folder with a 2-page list of post-op instructions, along with the medication I would need to take for the next several days. Three sets of pills… in case you want to know the brand names, they are Cipro (an antibiotic), Majezik (a nonsteroidal anti-inflammatory to help with pain/redness/swelling), and Prednol (a corticosteroid to treat inflammation also). Aytec told me I would be coming back to the clinic the next morning at 11am for my follow-up. I would also be checking out of the hotel at this time. The driver, Mustafa, took me back to the hotel where I ate some dinner and took one of the pain pills. Before I got ready for bed, I washed my body with a hand towel, soap, and water instead of getting into the shower so I don’t risk any water splashing on my head. I slept face down using the face cradle setup (but the next day, Aytec told me not to do that because the blood from my head should not be allowed to create any additional pressure and that sleeping upright is recommended so blood could flow downwards. I guess that makes sense. I didn’t sleep too well that night and neither did the other patient I found out. I kept waking up every 1-2 hours, but I think it’s because our mind/bodies were kind of restless as we didn’t really do any physical activity all day since we were lying down the whole time. ***NEXT DAY FOLLOW-UP:I was picked up by Mustafa along with the Sudan-Swiss patient around 10:45am and we got a chance to compare our results and share our thoughts on the way to the clinic since he spoke English. He stayed about 2 hours longer than I did. I mentioned to Aytec later that I hope the clinic did not double-book us for the same day since I was worried that it meant it was possible that me and the other patient had only half of the normal staff each that would work on someone (could have sworn I read somewhere that somebody had a team of six working on them, but I don’t know if that was combined and alternating out, because there isn’t even room for more than 2 people to be gathered around your head working on you, so maybe I misunderstood). Aytec assured me that they normally have 2 patients max per day but sometimes there may be only 1, so just all depends on scheduling. I was already prepared that the procedure would take about 8 hours, and sure enough it was about 8.5 hrs.
For the follow-up, Aytec examined me and removed the bandages from the back of my head himself and dabbed some antiseptic ointment on my donor area before placing the notorious black headband to help with the swelling. He then proceeded to explain that we would each get a free Haarex lab brand shampoo specifically made for post-hair transplant care to use after the third day without washing my scalp. He said it would last about 1 month and that I should buy 3 more bottles for $40 each. I only opted to buy one more additional bottle. Aytec also explained that the doctor recommended I get some sort of plasma injection before I leave that would help prevent my existing hair from suffering any similar thinning fate as time goes on, but since I wasn’t prepared to spend an additional 250-350 euros, I politely declined and said that in 10-15 years down the road, if I happen to experience more unexpected hair loss, then I may think about doing a second FUE session since I’m still relatively young at 32 years of age. My other fellow patient in his 40’s did end up choosing to do the supplemental plasma injection treatment. I’m sure it couldn’t hurt to do it, but I just opted not to.
After we left the clinic, we dropped off my fellow patient at the airport since he only stayed the 2 nights required for the procedure and headed back home. Aytec was kind enough to have Mustafa drive me to the other hotel I was transferring to, which is further away and closer to the Istanbul attractions and sights. I thanked Aytec and the Transest staff for their time and hard work, then tipped Mustafa to show my gratitude for his chauffeur services. When I got to my other hotel, I decided to do some sightseeing since it was such a beautiful clear day. I took a nap for a few hours since I didn’t get enough sleep the previous night. When I woke up, I got ready to visit the Istanbul night scene and left around 6:30pm and was out until 2am. I was supposed to be back earlier in the night, but unfortunately I encountered a physical attack that gave me quite the scare, especially as a tourist in a foreign land. Without going into too much detail, some random guy thought I was being rude to him when I started to walk away since we clearly could not understand each other or communicate when I was looking for directions back to my hotel, so he decided he would get violent and slapped me very hard on the back of my head. Aside from the fact that I’m just glad he didn’t go further like trying to punch or knock me out, I became concerned about the state of my grafts since there was some minor bleeding after that incident. Early the next morning, I contacted Aytec and showed him the pictures of the back of my head after the slap, but he said to just let the little bit of bleeding dry up before I wash it on the third day and that the grafts appear to be fine. I eventually fell asleep for 10 hours and took the whole day today relaxing and resting up at the hotel. I had already walked around the city for so many hours the previous night that it was time to take it easy. Plus it’s a Sunday and lots of places are closed, let alone the fact that it’s cold and raining. It’s about to be 3 days after my FUE procedure, so I’ll be able to wash my scalp for the first time and will just need to be very gentle with it. The swelling has gotten worse, and it was already explained to me that around the third day mark, I should expect the heaviest swelling. Hopefully it subsides soon with the medication I’ve been taking. I’m starting to look like that villain “The Leader” from the Hulk comics with the huge brain forehead bulge going on. So far, I’m happy with the Transest clinic services and their competitive pricing, so based on the process alone, I would definitely recommend them. I give them 4 out of 5 stars. I am saving the last star for several months to a year down the line when I can find out whether the FUE results turn out exactly as I hoped. Based on other patients’ results, I expect good things to come. Now it’s just the waiting game. I’ll return every so often to update this with progressive photos, but if you have any questions, please do not hesitate to ask! Hoping to pay it forward from all the personal accounts I’ve read from others and the questions that they answered for me during my research process. Thanks for reading!

Jan. 15th, 2016 (1 week post-op)

It's been exactly 1 week since my FUE procedure and the swelling has almost completely gone away. If you do FUE, I recommend that for the first couple of days, you keep a small wet hand towel in the freezer (or a cold compress) so that you can place it over your forehead, face and the sides of your temples to help reduce the swelling. Although Transest gives you a black headband that you wear for at least 2 days to help the swelling from moving down towards your eyes, the cold towel helps even better.

When 3 days post-op came, I used a cup to lightly pour cool, temperate water over my scalp to wash it for the first time using the specialized Haarex shampoo they gave. I do this once a day now and afterwards when I let the water air dry, I rub bacitracin antibiotic on the donor sites which have started to scab a little. For the recipient site, I place a generous amount of Vitamin E oil on my palm and lightly pat all over in order to keep the grafts and my scalp moist and protected. I'm trying to minimize scarring and delay the scabbing process for as long as possible.

I will be staying out of direct sunlight (wearing a spacious 10-gallon cowboy hat if I'm going to be out in the sun for longer than 30 minutes)... since I'm in Texas, nobody cares about my cowboy hat, lol. I've also decided that I won't be letting water from the shower head hit my scalp for about 1-2 months. I'm only going to use the "pouring water from a cup" method to wash my head once a day because I want to give plenty of extra time for the grafts to really take hold.

Jan. 15th, 2016 (1 week post-op) -- DONOR SITE PIC, closeup of back of head

Forgot to add this photo to my 1 week post-op update. It shows a close-up view of my donor area, which seems to be healing well and scabbing over. Based on this photo, it seems like Transest could have filled in more of my crown area for more density, but I would understand if they were running out of donor areas to take more grafts from without compromising the way the back of my head looks to avoid huge "patchy" areas or scars. So no big deal.

Feb. 8th, 2016 (1 month post-op)

The past few weeks have gone by pretty fast. There are moments when my scalp is really itchy so that gets a bit annoying. The grafts are still in the process of scabbing away - when I touch the top of my head, they just feel like small, hard granules. Under normal light, it just looks like I keep my head shaved pretty short in a buzz cut, but under bright direct light, you can kinda see my donor site still healing. About two weeks post-op, I started to use Rogaine normally like I used to, but instead of rubbing/massaging the minoxidil in, I just gently pat all around the top of my head and crown area. Still taking Biotin supplements and your regular type of daily multivitamin. Also still using the Haarex shampoo they provided me until it runs out. No other oral medications are being taken at this time, although I may look into starting finasteride (aka Propecia).

I was told that by month 4, I should expect most of what is currently growing on top of my head to fall out before the new hair starts to grow in.... not looking forward to that shedding process. For now, I will just update once a month on the 8th until the full year is done with. Thanks for stopping by!

4 month post on pics

4.5 months post op (better lighting in these pics)

Still using minoxidil topical ointment in the mornings and evenings. I also take Biotin vitamin supplements. Recently got an Rx for finasteride (aka Propecia) so I may start taking those to see if the next few months improve drastically with the oral medication. Even though I believe that the hair that was transplanted will stay put, I'm just taking these extra steps to make sure that the original hair that was already on my head stays healthy and doesn't become thin or fall out in the next couple years. My next update will be at 6 months, so stay tuned. Thanks for reading!
Turkey Plastic Surgeon

Procedure performed by team of doctors and technicians from Transest. Interaction was limited due to very little to no English spoken by the team, but translator on site. Experience was professional and satisfactory. Will wait until results can be determined before reviewing doctor and technicians skill level and expertise.

4 out of 5 stars Overall rating
4 out of 5 stars Doctor's bedside manner
4 out of 5 stars Answered my questions
3 out of 5 stars After care follow-up
4 out of 5 stars Time spent with me
5 out of 5 stars Phone or email responsiveness
5 out of 5 stars Staff professionalism & courtesy
4 out of 5 stars Payment process
4 out of 5 stars Wait times
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