Moderator: Welcome to today’s episode of True to Form with your host, President and Co-founder of Crystal Clear, highly regarded speaker and two time Inc. 500 Entrepreneur, Tim Sawyer. True to Form is a podcast that highlights leaders making headway in the Aesthetic, Anti-Aging, and Elective Medical industries. Learn from the experts to discover the secrets to success and the pitfalls to avoid, when it comes to growing your aesthetic revenue with the authentic, the transparent, Tim Sawyer.
Tim Sawyer: Hello and welcome to True to Form podcast, the podcast that connects you to the people, technology and hot topics that shape the elective medical community; brought to you by Crystal Clear Digital Marketing. Visit them at www.crystalcleardm.com. I am your host Tim Sawyer. And to our returning guest, welcome back and for our first time listeners, we appreciate you joining us and encourage you to become a subscriber. Last week we spoke with Dr. Michael Gold, world renowned dermatologist. If you missed it, we certainly encourage you to check it out.
With all that said, this week we have an extra special guest, my good friend, for the past three years, Dr. Avron Lipschitz. Dr. Avron Lipschitz is a board-certified plastic surgeon and entrepreneur. With a lifelong interest in art, design and aesthetics, Dr. Lipschitz has built a thriving plastic and reconstructive surgery practice, Athena Plastic Surgery in Palm Beach and on the Treasure Coast of Florida. Dr. Lipschitz strives for natural results using the most advanced techniques and his team provides exceptional care, patients range from soccer moms to CEOs and multinational executives. Avron loves to start and grow new businesses, and has a strong entrepreneurial spirit. I have seen it in him for the past four years and it’s been amazing to watch, I am grateful for that, Dr. Lipschitz.
In addition to the practice, he is the owner of Athena Cosmetic Surgical Center, Medspa and is co-owner with his wife Joanne of fashion design labeled Nouvelle, Palm Beach, a luxury soap brand. He has impeccable academic credential scoring in the top 1% of surgery residency and having trained in plastic surgery with the world’s leaders at John’s Hopkins, University of Maryland and UT Southwestern. Dr. Lipschitz has also published dozens of scientific papers and presented internationally. So without further ado, I would like to introduce my good friend Dr. Avron Lipschitz.
Dr. Avron Lipschitz: Hi, Tim, hi everyone, thanks for having me on your show.
Tim Sawyer: Well, let’s start with, first of all, you live in the coolest part of the country, no greater, better place to live than Palm Beach and Stuart. And certainly a super competitive market but also a vibrant market as well, one of the fastest growing and obviously epicenters in Elective Medicine. So talk a little bit about how you got started, your practice and what can we expect over the next three to five years.
Dr. Avron Lipschitz: Well, I started practice in 2011. I came straight out of residency and started the practice in Stuart. I did some basic demographic analysis, looking at the number of plastic surgeons to the population. And I am a numbers guy, I am very much data-driven and I decided to open the practice in Stuart. I looked all over South Florida as you said, people love this area and in particular, my wife loves this area, so she said let’s move to South Florida. So I looked at the different areas and figured out that I could make a good practice based in Stuart and North Palm Beach, based on the number of plastic surgeons in the area, the need and the demand for plastic surgery. Again I am very data-driven and so that’s one of the things I appreciate about our marketing partnership with you guys. But also everything that I do is based on analysis of the basic financials. So I started the practice in Stuart in a very modest way that has stood us in good stead, we started small and tested the market and grew organically and now we have got a pretty substantial practice.
Tim Sawyer: So let me ask you this, Dr. Lipschitz, I mean you are a young guy, you came out in 2011. You are a data-driven guy you said you are a math guy. What was the math back then for you and ultimately what led you to the decision to decide private practice, because for some people they love that and for other people that can seem a little risky?
Dr. Avron Lipschitz: You know some things have changed dramatically from when I started and some things are very similar. The fundamentals of you know good quality care of patients having a good reputation, making sure that you do a good job on everybody and the outcomes obviously that hasn’t changed. And the ability to get good results and word-of-mouth of course that’s baseline and the organic growth has not changed. On the other side of that is things have really evolved quickly in marketing and sales, in the cosmetic surgery industry over the last five, maybe 10 years, it used to be a very much word-of-mouth business and now it’s become a big portion of what we do now is sales and marketing and we have had to all grow and understand those part of the business. It’s kind of an adapt or die situation, if you did not keep up with that side of plastic surgery or aesthetic medicine there is no practice anymore, in my opinion.
Tim Sawyer: Wow, that’s a bold statement, Dr. Lipschitz. And just so everyone knows, we are talking to a double board-certified plastic surgeon who is using words like sales, marketing and retail. And you know as you travel the country, speaking with other well-established plastic surgeons, you know those things can sometimes like I said rub people the wrong way, but yet here you are doing great. And you have actually taken the approach that you are going to run your practice like a business, you have an appreciation an aptitude for that, you are a data-driven person. And I am just curious, where did that inspiration come from, to kind of dig in, on that side of the practice, on the business side? Where did that inspiration come from to run it like a business and understand that there truly is a retail component?
Dr. Avron Lipschitz: Great question, you know I, first of all, love learning new things, understanding and growing new areas in my own mind. And you are a 100% right in plastic and reconstructive surgery training you do not get, not even a minute probably of practice management, education, marketing and sales education, you don’t get business fundamentals education at all. The truth is when you come out of practice you are very poorly equipped to deal with the realities of solo practice or of managing a practice. You learn very amazing technical skills and patient-management skills, but the fundamentals of building and managing a business are just not taught.
So for me, learning those skills was actually a very interesting and ongoing challenge. And I really and that’s what I love spending time doing, I learn about, it’s not just sales and marketing of course, its Human Resources, it’s Finance, it’s fundamentals of Business Management and to me that’s the personal challenge and I love doing it and I think anybody who is smart in medical school and residency, should take on that mantle. I actually personally believe that that more should be done in the training process. And I think one of the reasons that doctors in general are being forced out of practice and into kind of a employed situation or working for hospitals and out of their own; losing control of their own practice is because we haven’t been taught the fundamentals of Business Management.
Tim Sawyer: Well, let me just say this Dr. Lipschitz and this is going to irritate some people, but I have to share this scenario with you. So a couple of weekends ago, I was in Beverly Hills, love Beverly Hills and I was at a wonderful event, well-run the LAMCA. And I was invited to give a talk and I am going to say there were 100 to 125 surgeons in the room, a few dentists. And so I go to the room and I am a little early getting ready for my talk and room is full, packed. And so and I am there, I was invited there to give a talk, my best 15 minutes on Organizational Leadership. And as you know I have been blessed and fortunate in my life to be part of and lead too Inc. 500 companies and I certainly have some credibility and experience in leadership. And as I get up to talk, more than 50% of the room, half of the folks in the room took that talk as an opportunity to use the men’s room, use ladies room, grab a coffee, talk amongst themselves and they get up and walkout. And while this may partly be sour grapes on my part which maybe it is, it feels like to me that it’s not a priority or is it that surgeons in general, don’t value that in their business, help me understand.
Dr. Avron Lipschitz: To me when I have a guy who is like you, who is obviously experienced and has incredible business knowledge. I take that as an opportunity too into the room, I know how to do Rhinoplasty and I know the finesses of the face, but then it’s not that I know everything about you know clinical medicine and that I am the, you know –; but when I have an opportunity to learn something from somebody who is very knowledgeable in practice managements and business management, because the fundamentals of business are no different from the fundamentals of practice management. And people that understand business are good at managing practices because it’s the same, it’s same, it’s really is the same knowledge. And so if somebody is prepared to you know share their wisdom and I take full advantage of that.
And yes, if we don’t have, we all have time to spend time learning about you know nuances of and the finesse and we and in some ways surgeons, doctors but surgeons in particular are in the, we have been torn in two directions, one is you want to be an expert in your field not only that you want to be an artist and you are an artist, you are a designer and you have to be meticulous and brilliant at what you do. On the other side you have to manage your practice and you have to take personal responsibility in managing your practice, you are the leader of your practice. If you shirk that responsibility, you are not going to do well, there are going to be problems; problems will arise, you cannot, there is not enough give, there is not enough leniency in the industry anymore that you can walk away from your personal responsibility to manage your practice in 2019. If you do, somebody else is going to take that mantle and take advantage in some way that is not going to be your vision for your practice.
Tim Sawyer: Well that’s true. And that’s kind of a good segue to one of the things I really want to talk about today and that is that obviously there has been this huge proliferation in non-invasive technology. And there has been a shift among some of your colleagues to embrace some of that technology, not everybody but some. And obviously what you should be able to accomplish with a knife, you can now to some extent get a similar result with a non-invasive device or laser. And so it’s interesting because recently, couple of weeks ago, I was at the American Medical Spa Associations, Medical Spa Show in Las Vegas, awesome event by the way for anybody listening, I highly recommend that you go. And I found myself in an interesting position and I talked about this on previous podcast where I sat on a panel with Dr. Jay Burns who as you know is a plastic surgeon, as well as Dr. Sheila Nazarian, also a plastic surgeon. And it just the juxtaposition of that alone was neat, was that we were at a Med Spa Show, talking with the plastic surgeons and it seems to be that there is this convergence happening and I know with the development of your new building you have made the decision to incorporate some of those services into your practice and I know you have got multiple locations and probably different things happening in different locations. But you have decided to incorporate some of that into your practice. So I am curious to you know what went into the decision making and ultimately what has your experience been like?
Dr. Avron Lipschitz: Right, so first again, I go back to the numbers and the benchmarking and the demographics. I always start there because I look at where the growth in the industry is. And so if you look at, how many facelifts were done in 2001 versus 2019; versus how much Botox was injected in 2001 versus 2019? And what you see is an exponential growth in Botox and a flat-line in facelifts. And that to me is just a very clear indicator and anybody who is not reading those tea leaves is not reading and not moving forward in their practice. Because the world is moving to a non-invasive demand and so if you don’t move with that demand you are going to get stuck somewhere where you don’t want to be.
Tim Sawyer: I hope people caught that because that’s a really great point, Dr. Lipschitz, its math.
Dr. Avron Lipschitz: It’s math. And so we have a nice surgical practice I have a strong surgical practice. There has been good growth over there because reputation has allowed me to grow in the surgeries, but our significant growth in addition is the non-invasive as you described and that includes everything from injectables and facials to lasers and skin-tightening devices. And there is many great you know new technologies that are on the market. What’s nice for a plastic surgeon is that I am not required to do all of them, I just I am going to, I have to manage them, some of them I would do myself, but I can also delegate that to an aesthetician or a nurse practitioner and I can still be in control of the practice, but benefits directly and indirectly.
And if you look at it in the right, with the right frame of mind, it’s actually a huge opportunity because if you incorporate in your practice successfully, first of all it’s, it’s own money generator without you being the provider. Secondly there is a lot of cross referral coming from my Medspa, so my aesthetician will do for example an IPL treatment, Intense Pulsed Light and then the patient will ask the aesthetician, well would you, “Who do you think I should go to for Botox or who do you think I should go to for breast augmentation?” And then the aesthetician or the nurse practitioner will cross refer to me. As long as that’s managed well, that is a wonderful like introduction for me. And it is about the best ROI that you could possibly get for marketing and sales, because you have a provider who the patient trusts and you don’t have to advertise for surgeries which are very expensive to advertise for or sometimes even injectables and this cross referral coming from a place that the patient trusts and you know there is much higher conversion rates in that instance. So I love the Medspa concept to build my personal practice and I am taking advantage of the Medspa as an owner as well.
Tim Sawyer: That’s interesting, Dr. Lipschitz, you are taking a very data-driven math approach to your business. And it’s something that not a lot of people can do, right I mean you are taking the ego out of the business itself and the work that you do, that’s interesting.
Dr. Avron Lipschitz: I like that Tim, I love that. I am so not ego-driven, and I work hard not to be, you know it’s, if you can work with others to advance the practice and everybody benefits.
Tim Sawyer: That’s right and I think as an entrepreneur and a business guy, I prefer, I love the concept of one-to-one versus one-to-many. And in your, in this particular case when you think about a plastic surgeon, it is literally one of those businesses where you can say, “Hey, you know you only have two hands.”
Dr. Avron Lipschitz: I mean you can do more operations but there is a limit to how many surgeries you can do (1). And (2) is you know I just think that there is, you got to take advantage of the new desire and demand for these technologies. In addition you know, Tim I don’t outsource everything, I don’t make, I don’t, I actually inject a lot of thing, a lot of products myself, I enjoy injecting Botox. If a patient can come, if I can get a patient in front of me and I can inject them, that patient will often convert to a surgery much easier than a patient who I have never, that I am advertising through on some abstract Google advertising or they see me in a magazine and it’s like, it’s very distance. The person who is in front of me, the one-to-one as you said is much easier patient to work with than the one-to-many. Like you are advertising to thousands of people and you don’t know what’s that, you know how many of those people actually are going to even bite on that advertise.
Tim Sawyer: I want to continue this conversation further. And this comes up a lot so there is an ongoing debate of the value, the importance, the economics around incorporating Medspa type services into your plastic surgery practice. However there is no debating that there is this convergence in the proliferation of non-invasive technology along with techniques in invasive technology. There is no debating that the average age of a Botox user is going way down as well as their first visit for a treatment or procedure. And on the surgery side, to me and this may seem a little crass if I hate to put it in these terms but it would seem to me, if you are just functioning on the surgery side that you are missing out on 20 years of potential revenue, right because you are not going to see these folks, if you could see them at 22, 23, 24 for preventative maintenance and anti-aging objectives. You may not see that patient on the surgery side till they are you know 40, 45, 50; outside of breast augmentation. And so the pushback I get is, well Tim, you know I have got a very specific brand, a very specific type of practice and I don’t want to water that down by introducing the non-invasive stuff. So you are doing both well and it’s growing. Are you creating one brand or how are you navigating that?
Dr. Avron Lipschitz: I mean that’s a very hard question. I mean that’s the hardest thing, I grapple that every day because as a plastic surgeon, you are broadly trained and you have to decide in which direction you are going to take your practice. So you are trained from everything from reconstructive surgery, to you know facial aesthetics and cosmetic work of the face and body and everything in-between. Now the beautiful thing for me, about plastic surgery is that there is a lot of crossover again. And I am a big cross, I always love it when there is few things going on. So for example in the Rhinoplasty, patients breathing is impaired that’s a reconstructive problem. But the nose shape is like abnormal and so you combine a reconstructive and cosmetic procedure. And I think there is almost no, a very few plastic surgeons that are exclusively doing one or the other.
And in addition it’s kind of a, what’s the word, it’s a carry-on or more of the same scene where you, your reconstructive practice you can feed your cosmetic practice and actually it’s vice-versa as well. Now the problem comes in is where do you put your brand? And that is a very personal decision that you as a provider as a surgeon have to make. So do you want to become known as the guy that only does facelifts or do you want to become known as the guy that is kind of able to do face and body cosmetic, do you incorporate reconstruction into this and that is, when you talk about brand in my opinion you have to look inside, internally and you have to be comfortable with the brand that you are putting out. So the one thing you really don’t want to do is become the brand that you don’t feel comfortable with. So if you, the breast if you are very, if you love doing breast surgery and breast reconstruction and breast work, be careful about becoming the, you know Rhinoplasty guy or getting somebody who is, who talks you into doing a lot of advertising for facelifts or becoming you know a reconstruct, you know some other kind of reconstruction person. I think it is important to brand yourself in a certain way.
Now it becomes more complicated in that you brand yourself versus your practice brand. My personal, what I love about plastic surgery, about my job every day I come in and I love taking care of a lot of different problems. And I am like the Director of Plastic Surgery at the local, at the Cleveland Clinic Martin Memorial. I do a lot of, I love doing reconstruction. I still do a significant portion of you know skin grafts and flaps. And I am the dermatologist refer, the Mohs reconstruction patients to me, that’s very gratifying for me to do. On the other side, I enjoy doing you know cosmetic surgery of the face and body, but I have, what’s the word, I have limited it for example you know I don’t do a lot of Brazilian butt lifts, I don’t do a lot of like urogenital surgery.
Tim Sawyer: And my instincts tell me, it would be disproportionate to your market given the demographics you are in, in that particular part of Southern Florida.
Dr. Avron Lipschitz: I am a data-driven guy and you know I have not done a survey on how many Brazilian butt lifts were done in Stuart, Florida. But I think it’s pretty low. And so I don’t offer it as a service and I move on. But I do know that facelifts or facial rejuvenations, facelifts are in high-demand up here and I love doing them. You know what you have to do I think as a plastic surgeon as anybody, you look at your own environments, figure out, think about your environments, think about your own you know what you can offer to that environment and work with those two, you got to think of it from those two perspectives, because it doesn’t help to be you know a facelifts surgeon in an area where there is only, where there is a lot of young people but if you can become a Brazilian butt lift guy.
Tim Sawyer: Well I have a friend who does a ton of Rhinoplasty, he is an International Rockstar, you see his face everywhere, you know who he is, but in his quiet moments, he will tell you, to be perfectly honest, he will say, “Tim you know, 95% of the treatments and procedures I do that those people come from 10 miles away, you know a 30 minute drive which is probably 10 miles in his marketplace.” And so you have to know, not only know your marketplace but you have got to cater to that right you have got to know who you are dealing with.
And so I want to shift gears a little bit and you are super progressive guy, you understand what’s fad, what’s trendy and what makes economic sense. You know where you are going and you have gotten there, I am a huge fan and obviously admire everything that you have accomplished. And you took on a big project, you have created your own surgical center. And after going through that process, share your experiences, is there anything that you would do differently around that?
Dr. Avron Lipschitz: Well, I think first of all that’s the best thing I ever did for my practice. I was building an operating room and for so many reasons and in the beginning it’s kind of, you have to have just faith and believing that this is the right decision. But I am so happy that I did it, because it allows me to first of all control my surgical environment and control my schedule. It also gives me a lot of and gives me a lot of autonomy in that way. But occasionally I will come across the patient who goes, “Ah wish you were in a hospital,” but that’s so occasional, it’s a rare that I just, okay. And then I can control the costs and the technique and the anesthesia and I feel like it’s just, it’s a great sales tool honestly, but you have got to be careful to when and how to build these operating rooms, because if you just come out of the blocks and just start building operating room and you don’t have the surgical base to support the operating room, it’s very expensive and unmanageable endeavor and it can –. And there are operating rooms around you know my area that have closed down because they just don’t have enough surgeries.
And I only built my operating room four or five years into practice but we have been open now for three years and it’s every year has been better and better. And I learned a tremendous amount, I love learning new things and I learned so much in building the operating room and managing it now, that it’s been again like probably the best thing that I have ever done for the practice. Now you know it’s amazing for you know the cost of, I figured this out, so the cost of like one cool sculpting machine, I could build a whole operating room, if you are careful about. That’s how and I think about things, I think about things like you know, why, so to buy a new laser and there are some lasers that are even more expensive than building an operating room, operating room is actually, relative, if you do it well, and if you; you plan it well, you can do it very, very inexpensively and but safely. And you know we are accredited by Florida State and [inaudible] [00:30:06] be in control.
Tim Sawyer: And I think that’s important is to keep cost out of control, and you know one of the things that you hear these horror stories where somebody is got a consultant, they are working with and they say, “Well in your part of the country, if you are going to have your own surgical center/operating room, the most important thing is you need to have a money over the operating table” and also in your project goes from you know $200,000 to $2 million and you are never going to get that money back, it’s funny when you think about it.
And then the last thing I want to ask you about, you are from South Africa and probably not a lot of people picked up on that from your accent, I think. But you are from South Africa, and I am curious what’s you know based on what data research you have, what’s the market like in South Africa and would you ever consider expanding there?
Dr. Avron Lipschitz: Well, that’s a great question. I think internationally plastic surgery is, plastic surgery and the cosmetic aesthetic, medical industry is expanding, it’s growing. And it’s growing in the United States, it’s growing across the world. And in South Africa it’s growing as well, the environment is very different and it’s a culturally, it’s culturally different so you need to understand the, what you are getting into if you are going to go to a place like South Africa. I would feel very confident if I were to open up a practice in South Africa, the same way as I would be fine to open up a practice in a different state.
Tim Sawyer: Right.
Dr. Avron Lipschitz: For me it’s a logistic problem, how do you fly 27 hours and stay productive. And so that’s why I have kind of stuck to staying in the United States and in my local environment, just like you said everything comes from 10 miles around so you know you have to build a reputation wherever you go. Now you know does that mean, so the big question really Tim, is you know are these scalable models and I have asked you this before. And I don’t know, I am still I think we are still dealing with a very difficult industry to scale.
Tim Sawyer: Got it. And so two things I want to share with you, as we wind down, very personable, very personal to me. And that is the notion that if the purpose of having money is to do what you want and you are actually doing what you want as opposed to you know we live in the aesthetic space and obviously it’s you know a bigger houses, bigger cars, bigger this, bigger that. But if you could avoid comparative living, and the pressure that goes along with comparative living, thinking oh I need a bigger this, I need a bigger that. And you can stay dialed in, on that notion that you are doing what you want. You could actually make more money in the long-run right because you are hyper focused.
And the other one is the notion and Adam DeGraide who you know and are friends with my business partner and our CEO once told me that familiar beauty fades fast. And it seems like you have been able to avoid the latest, greatest, the flashy, the hey there is there is a squirrel and stay focused and that can really help in the long-run right because if you chase that flashy trend, that new device, it can fall out of favor and when the beauty fades, you are stuck with the bill. And so I gave you a lot of credit for that and you know that I again respect you.
And you have been able to stay focused in a very short period of time, you have launched your practice, a private practice, it’s now successful. You have built the surgical center and congratulations for you on that, you have incorporated medical spa services based on data and math and you are running your practice like a business. And I think everybody who is listening should take a second to reflect on that and admire that and kudos to you. And so having said all of that, first of all I really enjoyed our conversation today, but talk about, what’s the next three to five years look like for you, and what is your takeaway from this conversation and any pros or wisdom that you would like to share with our audience before we break?
Dr. Avron Lipschitz: Well, right now so first of all, we are thrilled to provide all wide range of cosmetic service in Palm Beach Gardens and the Treasure Coast of Florida. We do everything from facials and hydrafacials, hydrafacials are huge it’s probably our most popular non-invasive procedure right now.
Tim Sawyer: Hydrafacial?
Dr. Avron Lipschitz: Hydrafacials, so we bought a hydrafacial machine and it has taken off like a rocket. I mean, Tim I have both devices that have turned into doorstops and you know I am sure and I have you know old plastic surgeons have had this problem, this hydrafacial, this ain’t no doorstop, there is a high-demand for it and it is a wonderful introduction for patients into the practice. And you know patients go from hydrafacial to Botox, to face and it is for me that’s being a huge, I mean it’s just being great over the last few months. So hydrafacials and then you know we from a practice point; our personal practice growth point of view, are in the process of opening up new offices in the tradition [inaudible] [00:36:03] area, expanding our growth into Palm Beach and Palm Beach Gardens. I am bringing on nurse practitioners right now they are in the training process.
And I again the way I am growing is I am combining my reconstructive and cosmetic skills and I want my nurse practitioners to do the same thing. You know I know that there is a model of, okay the inject the nurse practitioner or the PA who only does lasers, believe me I have seen them and if that rings true for you, if that’s your interest, your business model, great. For me I love the idea of a nurse practitioner who can actually do reconstruction, that can do wound care for example, that can do dermatology that can grow the reconstructive side of the practice at the same time as I grow the aesthetic side. And it gives us a double-edged sword, it’s a very powerful tool that we provide services that are both reconstructive and cosmetic.
And yeah some case, there is a lot of stuff that cannot be done unless you are plastic surgeon, you know surgery is I think really should be the realm of the plastic surgeon, you know big reconstructions but there is so much that we do that’s non-invasive in both the cosmetic and the reconstructive sphere by the way. And so that’s where I am growing first you know from the business point of view. And so that’s what makes me, so that’s what exciting me right now that’s where I am, yeah that’s my that’s our vision for the future.
Tim Sawyer: Well, thank you Dr. Lipschitz, obviously I could talk to you all day. And here is what I know and let’s close with this. You and I think a lot alike, we are kindred spirits, I have grown to know you over the past four or five years, got to know you first as a friend, somebody I respect, somebody that I admire. I know that people will be hearing a lot more and seeing a lot more of you as time goes on and I know people, what a great podcast if people will get a ton out of this. And anyone who lives even remotely close, to any of your offices down in Palm Beach, Stuart, pop by see Dr. Lipschitz, check out the surgical centers, it’s a great vibe, you would love to spend some time when you get to know the people, I am sure he will take care of you.
And also lastly, Dr. Lipschitz want to say, how grateful we are and want to thank you, at Crystal Clear for allowing us to serve your practice over the past several years. So we want to thank everybody once again for joining us and we encourage you tune in, next week for another exciting podcast with True to Form, your host Tim Sawyer. Thank you and have a great day.
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