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Archive for the ‘umbilicoplasty’ Category

Case Study – Neoumbilicoplasty after Tummy Tuck

Wednesday, August 10th, 2016

 

Background: There are many benefits to tummy tuck surgery including a better shaped waistline due to the elimination of loose skin and extra fat. One of the ‘smaller’ benefits is in the creation of a new umbilicus. (belly button) A distorted and misshapen belly button often occurs due to the development of loose skin around it. As a  result it can become stretched and lose its original taut and smaller appearance.

The final step in tummy tuck surgery is the creation of new umbilicus. Often referred to as getting a new belly button, this is only partially correct. Actually the original stalk of the belly button is maintained albeit shortened. What is new is the hole that is made through the overlying abdominal skin to bring it back up to the surface of the external abdominal wall.

Located in the center of the stomach, the appearance of the umbilicus is an important aspect of a tummy tuck result. While the size and shape of the belly button has aesthetic appeal, its midline and vertical orientation can be judged to be most important. No matter how good its shape may be, a belly button that is off center or sits too high or low can look odd. For this reason great attention is paid to getting the correct alignment for the placement of the delivery point of the old umbilical stalk. Getting it wrong can be problematic as belly buttons can be very difficult to reposition.

Case Study: This 55 year-old female had previously undergone a full tummy tuck. She was unhappy with the appearance of her new belly button as she felt it was too low. Her skin had relaxed somewhat in the year since her surgery.

Umbilicoplasty with Mini Tummy Tuck design Dr Barry Eppley IndianapolisUnder general anesthesia a ‘mini tummy tuck’ skin excision was performed in the shape of an inverted T. The skin excision pattern included the location of the belly button. The sin closure created a tighter lower abdomen. A new belly button (neoumbilicoplasty) was created at a higher level in the midline of a horizontal line drawn between the iliac crests. The neoumbilicoplasty technique used was a four-flap method tacking the corners of the flaps down to the abdominal fascia. The skin flaps were secured down by a tie-over bolster which stayed in placed for ten days.

Umbilicoplasty with Mini Tummy Tuck result Dr Barry Eppley IndianapolisAll skin flaps survived to create a new belly button in exactly the location where she wanted it. It shows that in some cases the creation of a completely new belly button is better than trying to work with a misplaced and/or distorted one.

Highlights:

1) The umbilicoplasty portion of a tummy tuck is one of the most visible aspects of the result.

2) A malpositioned belly button can be a very difficult problem to solve after a tummy tuck due to the tight skin and the shortened umbilical stalk.

3) In some cases of umbilical deformity a complete new belly button has to be created to put it in the right position. (neoumbilicoplasty)

Dr. Barry Eppley

Indianapolis, Indiana

Four Flap Neoumbilicoplasty Technique

Friday, June 19th, 2015

 

While the belly button or umbilicus is only scar tissue, it has a significant aesthetic impact on the appearance of the abdomen. The pleasing characteristics of the umbilicus have been well described with a sufficient inward depth, superior hooding and a slightly vertical almond shape. The belly button on women often end up astray from these shape characteristics primarily due to pregnancies. But there are numerous other events that can also distort its shape, many of them being of surgical origin (e.g., laparotomies) or birth defects (e.g., gastroschisis) In rare cases the entire belly button may even be lost.

Surgical reconstruction of the lost or deformed belly button, known as umbilicoplasty, has been described by numerous techniques. Most of them are some form of local skin flaps that are tacked back down to the abdominal fascia. The plethora of described umbilicoplasty methods indicates that none are ideal or can assure optimal results.

neoumbilicoplasty techniqueIn the May 2015 of the Archives of Plastic Surgery, the paper entitled ‘Four Flaps Technique for Neoumbilicoplasty’ was published. The authors report their experience with umbilical reconstruction using a technique they call the “four flaps technique”. This is a method to make an umbilicus when none is present. This method uses the surrounding tissue by simply elevating four flaps to create sufficient depth and an aesthetically pleasing shape with some superior hooding. It leaves minimal scars inside the umbilicus with no external scars. It provides a method to create an umbilicus on a flat abdominal wall where there is complete absence of any remaining umbilical tissue. It has the advantages of being simple to perform and uses well vascularized skin flaps.

There are numerous methods for reshaping a deformed or distorted umbilicus but few methods for creating one from ‘scratch’ so to speak. I have seen a similar or nearly identical umbilicoplasty method described for a neoumbilicoplasty in a full tummy tuck where the original belly button stalk has been discarded. This four flap method provides the simplest and most assured method of creating an acceptable umbilicus.

Dr. Barry Eppley

Indianapolis, Indiana

Aesthetic Guidelines for Belly Button Reshaping (Umbilicoplasty)

Saturday, August 30th, 2014

 

The belly button (umbilicus) is the most visible anatomic landmark on the abdominal wall in women and men. While it is nothing more that a residual scar from the cut umbilical cord at birth, it carries a unique aesthetic value. Being without a belly button can make one look a  bit ‘alien’ as it is a unique human physical trait.

Umbilicoplasty Belly Button Reshaping Dr Barry Eppley IndianapolisDespite having a belly button not everyone is happy with the way it looks. If it has a nice funnel shape (innie) centered between the hips, then one might never pay much attention to it. But many people have numerous disfigurements of their belly button from pregnancy, surgery, hernias or weight gain/loss. Belly buttons can be misshapen, off center, protruding or even completely missing. (or lost in surgical scar or an enveloping abdominal pannus)

When performing belly button repair (umbilicoplasty) it is important to know what its optimal position and shape should be. Numerous studies have been done studying what makes up the ideal belly button in terms of its position vertically and horizontally as well as its length and its shape. One such study was reported in July 2014 issue of the Aesthetic Surgery Journal entitled ‘Computer-Aided Analysis of the ‘Beautiful’ Umbilicus’.Using software developed for analyzing aesthetic parameters of the umbilicus, they found that the most beautiful belly buttons had a midline horizontal position, a vertical ratio of 46:54 (with respect to the xiphoid process and lower limit of the vulvar cleft), a midline horizontal position, a length that is 5% of the length from the xiphoid process to the lower limit of the vulvar cleft, and an oval shape with either no hooding or some superior hooding.

This study supports what has long been known about what makes an aesthetically attractive belly button. In short, it is small, taller than it is wide and has an overlying flap of skin. (hooding) An innie is far preferred over an outie. (although there are some people who have an outie and are fine with it)

Belly Button Reshaping in  Tummy Tuck Dr Barry Eppley IndianapolisjpgUsing this information helps determine how umbilicoplasty surgery (belly button reshaping) is performed. Various techniques exist for successful belly button reshaping depending upon the problem. Many of them can be done alone as an isolated  umbilicoplasty or as part of a bigger operation such as a tummy tuck or abdominal scar revision.

Dr. Barry Eppley

Indianapolis, Indiana

The Fate of the Belly Button in Tummy Tuck Surgery

Sunday, July 14th, 2013

 

The tummy tuck is the most commonly done excisional body contouring procedure. By the removal of a small (mini tummy tuck) or large (full tummy tuck) segment of skin and fat in the lower half of the abdomen, the remaining upper half of the abdominal skin is brought down over what was removed. Like the unraveling of a drop curtain, the entire abdominal surface becomes much flatter.

But in the middle of this abdominal contouring surgery sits the belly button. (umbilicus) The belly button has no functional purpose other than to serve as a reminder that we were in fact born. But even though it has no bodily function, most people do not want to be without it. I have asked many tummy tuck and abdominal panniculectomy patients if they want to lose their belly button and universally no one does. Most reply that they would not look human without it. At the least it is a source of adornment for some women.

So keeping the belly button during a tummy tuck appears to be very important. But how is to done? There are numerous perceptions about how the belly button is managed during a tummy tuck. Some say a new one is made, others say the old one is just moved. In reality, both opinions are right…and wrong.

What happens to a belly button during an abdominoplasty depends on whether it is a full or mini- tummy tuck. In a full tummy tuck, the original stalk of the belly button is maintained (sometimes shortened as well) in its same position. The outer part is detached from the overlying abdominal skin which is going to be removed. The upper abdominal skin is brought down over the remaining umbilical stalk to close the large lower abdominal wound.  A new hole is then made in the new overlying skin and the original stalk brought back up through and sewn to the skin. Thus in a full tummy tuck a new hole for the belly button is made (hence the outer scar) but it is the original umbilical stalk and location.

In a mini-tummy tuck, abdominal skin is removed below the existing belly button. The stalk of the belly button is released from the muscle wall and  it ‘floats’ downward with the overlying skin as it is brought down to close the lower abdominal wound.  The stalk is then reattached to the abdominal wall in a lower position. This is why there is no scar around the outside of the belly button even though it actually moves lower from where it once was.  Thus in a mini-tummy tuck the original stalk of the belly button and its attachment to the abdominal skin is maintained but it is moved lower.

In tummy tuck surgery, a new belly button is never made. Its attachment may be moved lower or a new hole made for it to emerge through repositioned abdominal skin. But you always keep your original belly button one way or the other.

Dr. Barry Eppley

Indianapolis, Indiana

Mini-Mommy Makeover Procedures

Sunday, May 19th, 2013

The concept of a Mommy Makeover plastic surgery procedure is about combining abdominal and breast reshaping in one operation. The breast and abdominal components are not new and include many well known procedures such as tummy tucks, breast implants, liposuction and breast lifts in whatever combination each individual women needs. While the effects of a Mommy Makeover can be dramatic, breast and abdominal procedures are major surgery with significant recovery as well.

But there are numerous other procedures of lesser magnitude that could also be lumped into the Mommy Makeover category and consist of a variety of ‘nips, tucks and sticks’ that create effects that mothers would also like. Here are some of the most noteworthy.

BOTOX  For reduction of those facial expression lines that come from the stress of balancing mother and wife roles, Botox injections are probably the most common injectable Mommy procedure.

Vi/PERFECT PEELS With only a few days of redness and flaking, these medium-depth facial peels are essentially painless to go through and provide a real boost to one’s complexion. A few of these a year will keep a mother’s skin radiant and glowing.

C-SECTION SCAR REVISION For those women that don’t need a tummy tuck and have a noticeable c-section scar with just a little pooch above it, widely cutting out the scar can produce a flatter upper pubic area. This scar revision can be combined with some lower abdominal liposuction for an additional and wider flattening effect.

UPPER LIP PLUMPING Some well placed Restylane or Juvederm injections into the upper lip has an instant youthful volumizing effect. This is particularly evident if the cupid’s bow and philtral columns are accentuated.

NIPPLE REDUCTION Breast feeding can elongate the nipple which can be a source of embarrassment and out of proportion to the size of the areola. Under local anesthesia, the nipple length can be reduced by half or more.

EARLOBE REPAIR Fixing stretched out ear ring holes or complete tears through the lobe can allow old or new ear rings to be comfortably worn again.

BELLY BUTTON REPAIR (Umbilicoplasty) Pregnancies can change an innie belly button to an outie due to a small hernia through the umbilical stalk attachment. Tucking the peritoneal fat back through the hole and reattaching the stalk of the belly button back down to the abdominal wall will recreate that an old inne look again.

EXILIS For those stubborn fat areas that just won’t go away despite some diet and exercise, this non-surgical fat treatment can easily fit into a busy mom’s schedule. It takes a series of treatments to see the effects but there is no downtime with 30 minute in-office treatment sessions.

These mini-Mommy Makeovers provide changes that do not require major surgery or recovery and can fit into anyone’s hectic schedule.

Dr. Barry Eppley

Indianapolis, Indiana

Plastic Surgery’s Did You Know? The Shape of the Belly Button

Sunday, May 27th, 2012

The belly button, known medically as the umbilicus, is the only change in contour of an otherwise flat or round abdomen. While it was at one-time a vital connection between mother and fetus providing the sole nourishment for development, it remains only as a scarred reminder of its significance after birth. While belly buttons can have many shapes, most have an indented or inverted shape known as an innie. This is nothing more than a funnel-shaped scar that attaches down to the abdominal wall. More uncommonly, one may have an outie which appears as a bulge inside of the outer ring of the belly button indentation. This can be present at birth or can appear after pregnancy. In either case, the outie belly button may be a hernia. Changing an outie to an innie belly button, known as an umbilicoplasty, often involves a small hernia repair.

Creating A New Belly Button In Tummy Tuck Surgery

Sunday, August 21st, 2011


The belly button, also known as the umbilicus, is a funnel-shaped scar located in the midline of the abdomen usually about 2/3s the distance between the chest and the pubic region. It is, of course, the remnant of where the umbilical cord was attached to the newborn. It is the only topographic aesthetic feature on an otherwise flat or round abdominal wall. While it has great variability in size and shape amongst humans, an inverted appearance that is not too large is desired.

In a tummy tuck, making a ‘new’ belly button is the last portion of the operation. It is new only from the perspective that it requires a skin incision through the abdominal skin flap which has been stretched down. The original stalk of the belly button is the same, its exit out through the skin is new. While a relatively small procedure in comparison to the scope of the overall tummy tuck, it is an important aesthetic feature that many patients may use to pass judgement on the results of their surgery.

When I am making a new belly button during a tummy tuck, the objectives are three-fold. First and most importantly, place the belly button in the midline directing on a vertical line between the xiphoid process and the pubis. Secondly, make the shape of the belly button vertical in orientation and not round or horizontal. This is accomplished by how the belly button is cut out from the original abdominal skin segment that was removed and the skin pattern made in the abdominal skin through which it reappears. (make it a vertical dome-shape) Lastly, keep the scar surrounding the belly button as hidden as possible by having it pulled inward.

One of the keys to accomplishing some of these tummy tuck belly button goals is fascial suture fixation. Permanent sutures are placedat various locations around the belly button from the underside of its skin to the underside of the abdominal skin and then down to the abdominal fascia. By tying these sutures down, the entire belly button area (and central abdominal region) is pulled inward creating a funnel or ‘drain in the center of the floor’ effect.

These fascial sutures also distribute the pressure on all sides of the belly button and give it a more pleasing shape. The location of these sutures also creates a vertical shape by being placed at the 12, 4 and 8 o’clock positions. This creates a favorable contour feature of the abdomen and pulls the circular belly button scars inward to a more hidden location.

While the re-creation of a belly button is the smallest portion of performing a tummy tuck, it requires finesse and attention to some details to get more than just a round ‘mushroom’ of an umbilical result. These same belly button surgery principles can be applied to revisions of a prior unsatisfactory tummy tuck result as well.

Dr. Barry Eppley

Indianapolis, Indiana

Umbilicoplasty: Changing an Outie to an Innie Belly Button

Sunday, July 10th, 2011

The belly button goes by a variety of names including the navel and umbilicus. Whatever it is called, it is a very recognizeable anatomic structure and is the one scar that all humans share. But that centrally located scar can have a variety of shapes which fall into two main categories, an innie and an outie. Why one develops versus the other is purely coincidental and has nothing to do with how the umbilical cord is clamped at birth. Cord clamping is done several inches away from the navel and does not affect its eventual shape.

The outer belly button can be socially bothersome for some. Because the vast majority of the population has an inne, those that have an outie can feel it is unusual and abnormal. I have had more than one patient tell me that they felt stares and ridicule as a child or teenager. Some go to great lengths to keep covered. This may bring them to seek surgical change of this abdominal ‘malformation’. The number of women (and some men) seeking an umbilicoplasty procedure has been magnified by this era of navel beautification where piercings and tattooing have become popular. Humorously, on a website dedicated to the Top 25 Celebrity Bellybuttons, not a single outie appears amongst them.

When converting an outie bellybutton to an innie requires understanding of why it appears as such.An inverted bellybutton is a tethered scar band that attachs to the fascia in the midline between the two vertically-oriented rectus abdominus muscles. These muscles are not truly united but connected by their enveloping fascia. The inne scar attaches to this fascia between the muscles. Commonly during a mini-tummy tuck using the umbilical float technique, cutting the base of the inverted belly button from the fascia will reveal a small opening and fat protrusion from the intra-abdominal cavity, demonstrating from whence it originally came.

The outie bellybutton in most cases is the result of this small hole persisting as the cut umbilical stump heals during birth. This allows a small stalk of peritoneal fat to protrude through resulting in an umbilical scar that heals with a dome due to the presence of this fat rather than an inversion. This is why you can push on an outie and make it go in, and then have it pop right back out. You are pushing this fat back inward and, sometimes if you push deep enough, you can even feel the fascial defect. Thus, every outie is in reality a ‘mini’ umbilical hernia. This also explains why a woman can have an inne which converts to an outie after pregnancy, the pressure of the intra-abdominal fetus unmasks the inherent fascial weakness at the base of the belly button.

In an outie umbilioplasty, the goal is an improved navel shape. The aesthetically attractive navel is one that is described as vertical, narrow, symmetric and with an upper hood in women. For men it is acceptable to just have a rounder inversion without a hood. The realistic goal in an umbilicoplasty is to make the inversion vertical and narrow.

The procedure can be done under either local or IV sedation anesthesia. The incision can be made either vertical through the skin dome or in a half-moon shape at its base. As soon as one goes through the skin, the protruding stalk of fat will be seen. Dissection is done around the stalk of fat to the surrounding rectus fascia. The fascial defect is isolated and the fat either amputated or pushed back inward. Several large sutures are placed across the fascial defect to approximate the fascial edges. Excess skin is then trimmed from the edges of umbilical skin and sutured down to the fascia with dermal sutures in a vertical fashion. This creates the innie shape. The skin edges now deep inside the new inne are then closed with running small dissolveable sutures. The new inner is then packed with Vaseline gauze and covered with a clear water-proof dressing. The entire umbiliplasty operation takes less than one hour.

Afterwards the only physical restriction is no working out that would stress the abdominal or stomach muscles for one month after surgery. The gauze dressing ore removed one week later. Patients report only mild discomfort in the first few days after surgery.

Converting an outie to an inne bellybutton employs the principle of a mini-umbilical hernia repair and inward skin plication as part of the umbilicoplasty. It is a very successful procedure that can help those patients feel more comfortable with the shape of this central abdominal region.

Dr. Barry Eppley

Indianapolis, Indiana

Plastic Surgery of the Belly Button (Umbilicoplasty)

Sunday, February 22nd, 2009

The belly button, navel, or medically known as the umbilicus, is the scar from the umbilical cord which was divided at birth. This results in a depression in the skin which is attached to the underlying muscle fascia or covering sheath of the muscles. The divided cord scar typically forms a cavity or an “innie”. In some cases, an “outie” develops due to extra skin left behind from the umbilical cord. Many people feel that an “innie” is more appealing in appearance than an “outie.”

The shape of the belly button comes from the how the scar attaches to the underlying fascia, the looseness of surrounding abdominal skin, the fat under the skin, and how flat or protuberant one’s abdomen is. As a result, belly buttons vary greatly in their size and shape. While hidden for decades, the bellybutton has more recently become an attractive and sexy physical feature with the current fashion trends which flaunt an open midriff and an exposed belly button. Its recent fashion importance is illustrated by estimates that about one-third of college women now have pierced belly buttons. I see many middle-aged women in my practice who also have such piercings, trying to appear youthful and sexy.

Attractive belly buttons have been judged to be small and vertical in orientation, or have a T shape with a thin vertical hollow capped by an upper hood of skin. Belly buttons that are horizontal or irregular, often from the effects of pregnancy, weight gain or age, or if one has an outie are considered unattractive.

Most people are not aware that there are plastic surgical techniques to sculpt the belly button, known as an umbilicoplasty. Umbilicoplasty surgery can be done alone or as a necessary part of most tummy tuck surgeries. When done alone, it can be done under local anesthesia as an outpatient procedure. All incisions are placed inside the belly button. The skin inside the belly button is reshaped, and often small amounts are removed to help the reshaping. The skin is then sculpted by sutures into a newly shaped belly button. This result will be permanent once healed. One can return to work the same day and begin exercises in just a few days. All sutures inside the reshaped belly button are dissolveable. In some cases, usually where a protrusion exists, a small hernia is present which can be fixed at the same time. In these cases, I prefer to go to the operating room and perform the procedure under general anesthesia. Umbilical hernias are often covered by one’s medical insurance.

As part of a full tummy tuck where the skin and fat cutout goes above the exiting belly button, a new belly button must be formed after the tummy tuck is closed. A new outer hole is made (I prefer an inverted heart-shape pattern) and the stalk of the belly button is brought up and sewn to it. I like to keep the belly button stalk short so that when it is sewn to the outer skin it pulls down, creating a ‘drain in the center of the floor’ effect which helps in making a more youthful appearance.

Dr. Barry Eppley

Indianapolis, Indiana

Different and Unusual Procedures in Plastic Surgery

Thursday, July 3rd, 2008

As plastic surgery has worked its way into the mainstream of American society, it is no surprise that procedures are being done today that were not imaginable a mere ten years ago. And I am not referring here to surgery wonders of technology and scientific advancement (although that exists also), I am talking about what patients desire to have done. This is a reflection and commentary on contemporary American culture, not necessarily how far the science of plastic surgery has come.
As I talk with friends and colleagues about some of the plastic surgery procedures that I do today, I have come to realize that some of them may be considered ‘unusual’ . Certainly, some of them are different than traditional perceptions of plastic surgery. Many are relatively minor procedures that can be performed in the office and probably reflect the trend toward treating smaller concerns. They are the opposite of bariatric plastic surgery, for example, where a new subspecialty of plastic surgery has developed to treat the sequelae of gastric bypass and massive weight loss patients. The emergence of larger plastic surgeries and big procedures doesn’t occur very often but every few decades. But the emergence of more minor plastic surgery procedures occurs much more frequently. Here is a list of my unusual plastic surgery procedures that have emerged and become popular in the past decade.
Buttock Implants/Fat Injections – The appeal of a larger, more rounded buttocks is certainly a body image of recent note. Whether done by transferring fat from one body part to another or by an implant placed through an incision near the tailbone, the desire for buttock enhancement could not have been envisioned ten or twenty years ago. There is actually a great number of patients who would like buttock reduction but no single good procedure exists for that problem.
Labial Reduction – Whether due to discomfort from rubbing on clothes or during inetrcourse or simply to ‘look better’, reducing the size of a woman’s labia is now a common procedure. One would never have thought that such a concealed part of the anatomy would create a demand for treatment. A very simple and effective procedure, labial reduction restores the outer appearance of the vagina to a more youthful appearance.
Earlobe Reduction/Enhancement – As woman age and with the lifelong use of ear rings, the ear lobes will frequently get longer. The size of the ear lobe can easily be reduced (earlobe reduction) in the office and it is a procedure that I often do at the same time of a facelift. Aging may also make one’s earlobes get quite thin and almost shriveled in appearance in very thin females. Injectable fillers, such as Juvaderm or Radiesse, can give an immediate rejuvenation effect to the earlobes that may last as long as a year.
Eyebrow/Eyelash Hair Transplants – The science of hair transplantation has evolved to the point that single hair (follicle) transplants are now routinuely done in scalp hair restoration. It is quite logical that single follicular transplantation be applied to very small areas such as the eyebrow and even the eye lashes. The alternatives of permanent makeup, colored pencils, and false eyelashes made opting for actual hair tranplants a difficult decision. But some few patients do.
Umbilicoplasty – While every full tummy tuck patient gets a new bellybutton (umbilicus), some non-tummy tuck patients want one also. Most commonly, it is to change an outie to an inne belly button.
Nipple Reduction/Nipple Enlargement – I have seen it both ways. The concern of large nipples is that they can be very visible through clothes…and at all times. Reducing the size of the nipple is a simple procedure and some women may lose a little sensation. Most recently, I have started to some men that want their nipples reduced also! Conversely, nipple enlargement or enhancement is about changing an inverted nippled (which is turned inward) to one that has some outward projection. While not quite as predictable (long-term result) as nipple reduction, the nipple can be released and brought more outward.
Corner of Mouth Lift – The downturning of the corners of one’s mouth with age gives a sad or angry appearance. A simple procedure in which a small amount of skin is removed and the corners lifted up and the mouth line leveled gives a nice and subtle improvement. Such a procedure is a simple office operation or is often done as part of a facelift. This is actually an old procedure that has now been ‘reinvented’ or rediscovered.

One wonders what this list will be in another ten years!

Dr. Barry Eppley

Indianapolis, Indiana


Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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