Articles Tagged with: hair follicles
New Studies: Melatonin Cream Shown to Stimulate Hair Follicles

New Studies: Melatonin Cream Shown to Stimulate Hair Follicles

If you’ve heard of melatonin, it is likely in the context of getting a good night’s sleep. That’s because melatonin is a hormone that plays a critical role in our daily cycle of sleeping and wakefulness. An increasing number of people are taking melatonin supplements to help them if they have chronic insomnia or experience other disruptions to their sleep cycle, such as jet lag or shift work. But recent research suggests that melatonin not only can help you get the rest you need, but it can help you keep the hair you want if you are experiencing hair loss issues.

review recently published in the International Journal of Trichology looked at melatonin’s impact on hair loss. It concluded that topical melatonin solutions might provide effective treatment for hair loss caused by androgenetic alopecia, the most common condition that causes hair to fall out.  

The researchers compiled the results of five separate studies of melatonin and hair loss. One of the studies – involving 30 men and women – showed a significant reduction in the degree of severity of androgenetic alopecia after using melatonin for 30 and 90 days. Another study that involved 60 men and women suffering from hair loss found a significant reduction in hair loss among female participants, with less of an impact on men. In yet another study, researchers concluded that a melatonin solution applied to the scalps of 40 women with hair loss increased hair growth significantly compared to participants who were given a placebo.

While it is unclear how exactly melatonin may encourage hair growth, some experts suggest that it may have to do with the same circadian rhythms that govern the sleep-wake cycle. The hair growth cycle in humans is also under circadian control, which may account for the connection.

The authors of the review wrote that “Since safety and tolerability in all of the studies was good, the topical application of a cosmetic melatonin solution can be considered as a treatment option in androgenetic alopecia.”

Schedule an Appointment for a Hair Loss Evaluation Today

While melatonin may have a role to play in strengthening and keeping hair, research is still preliminary, and it may not by itself be able to reverse hair loss or stop it completely in its tracks. At the Miami Hair Institute, our skilled physicians diagnose and treat hair loss cases that can’t be reversed at home. We can help patients suffering from hair loss through advanced hair restoration surgery techniques and alternative non-invasive treatments.

To receive a personalized evaluation and treatment plan, contact us online or call our office directly at 305-925-0222.

cold caps chemotherapy

Cold Caps for Preventing Hair Loss During Chemotherapy

cold caps chemotherapyFighting cancer is one of the most taxing mental and physical struggles an individual can undergo. For women with breast cancer, hair loss is one of the most traumatic side effects of chemotherapy. New research published on the mid-February issue of the Journal of the American Medical Association (JAMA) shows that cold caps can lessen the potential for hair loss during cancer treatment, thus boosting patients’ quality of life and emotional well-being.

Two studies analyzed the DigniCap, the only cooling cap approved by the U.S. Food and Drug Administration (FDA), and the Paxman, which is currently under FDA review.

Patients were fitted with the DigniCap 30 minutes before a chemotherapy session. The cap, currently available at infusion centers across 17 states, keeps the scalp at a cool 37 degrees Fahrenheit. Although researchers haven’t specifically determined what makes these cold caps work, some believe they constrict the blood vessels on the scalp to slow blood circulation. Lack of blood flow limits toxin exposure that would otherwise harm hair follicles in the fight to eradicate sarcoma cells. Another theory is that because chemotherapy fights rapidly developing cells, cold caps could limit follicle growth and expansion, leaving them less likely to be targeted during treatment.

Over two-thirds of women with stage I or II breast cancer lost less than 50 percent of their hair following use of the DigniCap and four rounds of taxane chemotherapy. The 16 women who did not use the cap lost all their hair during treatment.

In the Paxman system study, half of the women lost less than half their hair following four rounds of anthracycline and taxane chemotherapy. Five women had no significant hair loss whatsoever, and the 47 patients who did not use Paxman cold caps lost all their hair. Currently, the Paxman is not available for medical commercial use in the U.S.  

Neither device showed any serious side effects aside from mild headaches due to the low temperature. One potential risk is that stopping treatment from reaching the scalp could allow cancer cells to spread there, but more research needs to be done to make such conclusions.

Right now, cold caps cost between $1,500 to $3,000, depending on the number of chemotherapy treatments needed. For those coping with chemotherapy-induced alopecia, cold caps could prevent drastic hair loss to keep patients’ self-confidence and resolve intact. But, more research must be done to evaluate the risk versus reward.

5 Benefits of an FUE Hair Transplant

Is Hair Health Important?

hair healthFor many men and women, hair health is not a priority. Their haircare routine is typically straightforward: shampoo, maybe conditioner and perhaps a little styling spray to look put together. Others take their hair health more seriously, particularly individuals who suffer from embarrassing hair loss conditions. But, does hair health truly matter?

The answer is multifaceted. Hair is a complex structure and has its own anatomy just like any other part of your body. At the base of hair – underneath the skin – there are living cells that work arduously to sustain growth, strength and shine. Therefore, the hair you see is often a reflection of your vitality and overall well-being. Improving the health of your hair isn’t just about looking great, it’s also about strengthening and supporting each strand from root to tip.

Hair Anatomy

Each strand, or shaft, is anchored by a follicle. The follicle is a tubular pouch just underneath the skin’s surface. Two sheaths surround the follicle to protect the shaft. The outer sheath runs alongside the sebaceous gland, which produces oils that naturally condition hair and give it its natural sheen. The outer sheath connects to the arrector pili muscle, and when contracted, causes hair to stand up – an effect more commonly known as goosebumps.

At the base of the follicle is known as the bulb, where cells build and nourish the shaft. These cells are connected to tiny blood vessels, or capillaries, which deliver hormones and nourishment to sustain healthy hair growth. When your body’s hormones are off balance or shifting as you age, the cells can’t re-build new shafts to replace everyday shedding. This is a condition known as androgenetic alopecia, also called male-pattern baldness of female pattern hair loss (FPHL).

Meanwhile, the shaft is made of a hard protein called keratin. The hair you see on your head, arms or legs is dead and no longer nourished by the follicle and its cells. Although it’s not living, the shaft is convoluted. Sometimes, an inner layer called the medulla is present, but this portion only exists in certain types of hair. The middle layer (which everyone has) is called the cortex, containing pigment to help give your hair its natural shade. The outer layer is called the cuticle. Most everyday hair care products designed to smooth or soften hair target the cuticle. Cuticle structure varies based on your hair type which can affect hair’s appearance. For instance, people with curly hair have drier, dull strands because sebum has a difficult time traveling down the kinks of the cuticle to condition shafts properly.

Why Hair Health Matters

Your hair has both cultural and social significance, which is why so many men and women who suffer from hereditary hair loss experience shame and discomfort with their appearances. Despite how much information we know about hair and its biological variations, human beings innately favor physical attributes in one another (and themselves) that suggest better health. One of these physical attributes is strong and voluminous hair.

It’s important to note that not everyone lacks beautiful, big hair because they aren’t healthy. While hair loss is sometimes indicative of an underlying health concern, most hair loss cases are due to predetermined genetics and hormonal fluctuations. Even pregnancy, one of the most natural (albeit magnificent) processes a woman’s body can undergo, modifies hair’s growth and form. Despite what human beings perceive, thinning and shedding doesn’t always indicate something is fundamentally wrong with your body. But, the emotional toll of hair loss certainly makes it feel that way.

If you suffer from androgenetic alopecia or another hair loss condition, improving your appearance by counteracting your hair loss can be a life changing experience. At the Hair Transplant Institute of Miami, we help hair loss patients boost their self-assurance by restoring hair to reflect the way they truly feel on the inside – strong, fit and vibrant. Call us at 305-925-0222 to schedule your hair loss consultation in Miami today.

Are You Suffering with Senescent Alopecia?

Senescent alopecia is a specific type of age-related hair loss that affects both men and women. As we age, hair growth naturally tails off in two important ways. First, the total time spent growing new hair decreases. This means that hair follicles spend an increasing amount of time resting, or producing no new hair at all. Second, the diameter of each individual strand of hair gets smaller over time. This leads to the appearance of “thin” hair, making the scalp increasingly visible over the years.

These two characteristics are distinctly different from androgenic alopecia, or pattern baldness. Across genders, androgenic alopecia is estimated to cause more than 80 million individuals to lose their hair. Whereas senescent alopecia is not always treatable, androgenic alopecia can be treated in a number of different ways. Both surgical and non-surgical treatments are known to produce exceptional results.

Senescent Alopecia, or Androgenic Alopecia?

When first confronting hair loss, it’s important to understand whether it is age-related (senescent) or caused by hormones, genetics, and other factors (androgenic). Understanding the difference can help you find a hair loss professional and treatment regimen that will work with maximum efficacy.

Men and Alopecia

For men, one of the defining characteristics of androgenic alopecia is an increase in DHT, a synthesized version of testosterone. DHT contributes to hair follicle miniaturization, a phenomenon in which follicles shrink over time and lose their ability to support a regular growth cycle. Hair thins, sheds, and eventually stops growing entirely. Below are the most common ways to differentiate between androgenic and senescent alopecia:

Androgenic alopecia:

  • Characterized by heightened levels of DHT
  • High DHT might be caused by genetics and/or hormonal changes
  • Hair loss occurs in patterns, beginning with hairline and progressing back toward the crown of the head
  • Common among men as early as age 20, as late as age 50
  • Also referred to as male pattern baldness
  • Identified and diagnosed with the Norwood Classification

Senescent Alopecia:

  • Characterized by shorter grow time and thinning of hair radius
  • Appears thin, more scalp visible through the hair
  • Does not necessarily progress in a predictable pattern
  • Not necessarily defined by high levels of DHT (though men who suffer with pattern baldness early in life my retain high DHT levels through adulthood)
  • Common among men over the age of 50

Women and Alopecia

For women, the line between androgenic alopecia and senescent alopecia is a less easy to find. This is due to the fact that middle aged women experience hair loss in a much different way than middle aged men. Whereas male androgenic alopecia occurs in a predictable pattern, female androgenic alopecia occurs in diffuse manner that more closely resembles senescent alopecia. Below are the most common ways to differentiate between the two:

Androgenic Alopecia:

  • Can be characterized by high levels of DHT
  • DHT levels affected by genetics and hormonal changes
  • Pregnancy, birth control medications, and PCOS are 3 common causes for increased DHT production and hair loss
  • Common in women following the onset of puberty through age 40
  • Identified and diagnosed with the Ludwig Classification

Senescent Alopecia:

  • Not caused by DHT
  • Most common among women over age 60
  • Characterized by shorter grow time and thinning of hair radius
  • Appears thin, more scalp visible through the hair

Treating Alopecia at the Hair Transplant Institute of Miami

At the Hair Transplant Institute of Miami, we offer the most advanced and comprehensive hair loss evaluations to determine the root cause of hair loss in both men and women. To learn more, contact us online or call or clinic at 305-925-0222.

Beyond Hair Plugs

Hearing the phrase hair plugs is enough to send a chill down your spine. Mention hair plugs in casual conversation, and there is an almost universal impulse to recoil. Unsightly and painfully obvious, hair plugs are perceived by many as a desperate and unsuccessful attempt to reclaim the confidence and youthful allure of “normal” hair.

Today, we can do better than hair plugs. Much better.

Hair plugs are uncommon today, given the rapid evolution of hair loss treatment that has occurred over the past few decades. The “pluggy” hair transplant procedures of the past are long gone. Today, they have been replaced by more advanced procedures that leave virtually no sign that a hair transplant has been performed.

Beyond Hair Plugs

Below are several pictures of real patients who have recently elected to have a hair transplant procedure performed by Dr. Nusbaum and Dr. Rose at our hair loss clinic. Together, they illustrate just how far we’ve come since the hair plugs of the ‘80s.

When asked, an overwhelming 85% of Americans cannot identify patients who have had a hair transplant procedure (i).

What Has Replaced Hair Plugs?

Today, there are two fundamental approaches to hair transplant surgery that have replaced hair plugs. The first is strip donor micrografting, and the second is follicular unit extraction (FUE). Both are known to deliver exceptional results.

Strip Donor Procedure

The strip donor procedure is an evolved form of hair transplant surgery. Following initial consultation, the hair transplant surgeon discusses the procedure with the patient, showing him or her how their hair will be surgically restored. Following consultation, the strip donor procedure is performed in 3 basic steps.

First, a linear strip of follicular units is removed from an area of the patient’s scalp designated as the donor area. Next, that linear strip, or micrograft, is separated into tiny clusters of follicular units and prepped for transplant. Finally, each follicular unit is transplanted to the recipient area in a way that restores the scalp with natural density, thickness, and undulation.

Follicular Unit Extraction

Follicular Unit Extraction is a highly refined method of hair transplant that is performed in a similar fashion as strip donor procedures, with 1 major difference. Rather than extracting a linear strip of donor hair, surgeons use a punch instrument to remove clusters of donor follicles individually. Following extraction, these donor follicles are prepped for transplant and implanted to restore the donor area.

New: Robotic FUE

In the past decade, few things have made a more positive and transcendent impact on the medical community as robotic technologies. In the field of hair restoration, robots and advanced high resolution imaging now help surgeons to perform FUE procedures with even greater accuracy, precision, and reproducibility.

Hair transplant robotics technologies, like the ARTAS by Restoration Robotics™, enable surgeons to extract a greater number of donor follicles, without the downside of physical or mental fatigue. Following extraction, surgeons manually transplant the donor follicles just as they would in a typical FUE procedure.

Learn more about robotic FUE with the ARTAS in Miami.

Am I a Candidate for Hair Transplant?

To learn more about hair transplant procedures, visit this page on surgical hair restoration techniques. To learn if you are a candidate for strip donor or FUE procedures, contact the Hair Transplant Institute of Miami online or call 305-925-0222.

Sources

(i) “2010 Hair Transplant Challenge Survey.” International Society for Hair Restoration Surgery. Accessed 17 June 2013.

Natural Substance from Beehives Shows Potential for Growing Hair

How serious is hair loss? According to a recent study, about 1 in 3 individuals who suffer with hair loss say they would give up sex for life, just for a new head of hair (i). And according to the International Society of Hair Restoration Surgery (ISHRS), just about 50% of respondents to the 2010 Hair Transplant Challenge Survey indicate they would choose a handsome head of hair over more money or new friends (ii).

Given the statistics above, it’s not surprising that hair transplant surgeons are so invested in researching hair loss cures. Hair plays a big role in shaping one’s appearance; without it, one can feel different, insecure, and less confident in everyday situations. According to additional statistics gathered by the ISHRS, just over half of men and women who experience hair loss say that nothing makes them feel more self conscious than the thought of “noticeable hair loss” (iii).

Over the past few years, several studies have emerged that indicate a natural hair loss remedy might be in the near future. Most recently, researchers at the University of Calgary made a discovery that might soon lead to a stem cell treatment for hair loss. And for those who don’t feel comfortable with the idea of stem cell therapy, another new study might seem a little easier, and sweeter.

Propolis: The Beehive Hair Loss Cure?

In Japan, a group of researchers uncovered an unlikely new substance for helping hair to grow again. It’s called propolis, and it is naturally found within beehives. Inside the hive, propolis is a resin-like substance that provides natural insulation. Outside the hive, propolis has demonstrated the ability to function as an anti-inflammatory, a key characteristic that researchers believe makes it a good chemical for assisting with new hair growth.

Commenting on the study, Ken Kobayashi explains, “I expect that propolis improves hair loss due to inflammation through the anti-inflammatory properties and the keratinocyte-proliferative effect,” (v).

Inflammation and Hair Loss

Sometimes, inflamed cells can be the reason why hair follicles become unable to sustain a healthy hair growth cycle. Explains Kobayashi, “normal hair growth needs active proliferation[…] without excessive inflammation.” Based on this premise, Kobayashi’s team of researchers at the Hokkaido University in Japan conducted a study to see if the proactive application of an anti-inflammatory, like propolis, would make for speedy hair growth.

To test this hypothesis, the research team divided laboratory mice into two groups. Both groups were shaved, and one group was given propolis while the other group was not. As predicted by the research team, propolis encouraged a significantly higher rate of natural hair growth for mice in the test group.

Hold Off on the Honey

If you suffer with hair loss, it might be too soon to rush out for the newest propolis extraction or hair loss gimmick. Additional testing must be performed. Moreover, the mice in the experiment were merely shaved and examined for natural hair regrowth; no mice exhibited signs of hair loss or pattern baldness prior to the experiment. In this light, it is clear that propolis must be tested on subjects that exhibit symptoms of hair loss, like androgenetic alopecia (pattern baldness), before researchers can say with reasonable certainty that propolis can, in fact, act as a true hair loss cure.

Sources:

(i) http://www.statisticbrain.com/hair-loss-statistics/

(ii) “2010 Hair Transplant Challenge Survey.” International Society for Hair Restoration Surgery. Accessed 17 June 2013.

(iii) See above.

(iv) Miyata S, Oda Y, Matsuo C, et al. Stimulatory Effect of Brazilian Propolis on Hair Growth through Proliferation of Keratinocytes in Mice. J. Agric. Food Chem. 2014.

(v) http://www.mnn.com/health/fitness-well-being/stories/beehive-resin-could-be-a-cure-for-hair-loss

Researchers Use Immune System to Trigger New Hair Growth in Mice

As the year comes to an end, yet another hair loss study has rocked the Internet with fascinating results! Just a couple weeks ago, researchers from the Spanish National Cancer Research Centre released findings that demonstrate how the immune system can be used to induce changes in the regenerative skin stem cells of laboratory mice. The study was published in PLOS Biology, and while follow up studies are needed, the hair loss community embraces these findings as much-welcomed insight on the potential for a “stem cell” hair loss cure.

Related news: Discovery of New Stem Cells May Hold Future Hair Loss Cure.

Commenting on the study, author Mirna Perez-Moreno explains, “We have discovered that macrophages[…] are also involved in the activation of hair follicle stem cells,” (i).

Macrophages are special immune system cells that play an important role in a process called phagocytosis. To protect the body, macrophages consume inbound pathogens while assisting in cellular repair (e.g. healing wounds). In the study conducted by the Spanish National Cancer Research Centre, the macrophages had an additional and shocking effect on the hair follicles of lab mice.

The discovery began, at first, as a simple observation. While administering anti-inflammatory drugs, Perez-Moreno noticed that some mice experienced hair growth shortly after receiving the medication. This led her to hypothesize that the cells of the immune system might play a vital role in communicating with the hair follicle stem cells. To evaluate the hypothesis, the team tested several individual immune system cells to see if they had an effect on hair growth.

As researchers took note, one specific type of immune system cell did appear to play a causal role in activating stem cells within the hair follicle: The macrophages.

Summarizing the findings of the study, authors explain, “Our study underlines the importance of macrophages as modulators in skin regenerative processes, going beyond their primary function.”

Eventually, researchers hope to use findings like this to develop treatments in which stem cells can be “activated” to promote cellular regeneration. Such treatments could provide far-reaching benefits in the fight against terminal illnesses and other serious health conditions. For men and women who suffer with hair loss, stem cell therapy promises to one day “reactivate” hair follicles to reverse pattern baldness without foams, prescription medications, or hair transplant surgery.

Sources

(i) http://www.medicalnewstoday.com/articles/287367.php

New Study: Oxidative Stress Might Cause Pattern Baldness

New Study- Oxidative Stress Might Cause Pattern BaldnessHave you eaten any blueberries lately? If so, hair surgeons say you might be less likely to suffer from androgenetic alopecia, or pattern baldness. According to a new study, certain vitamins and bioflavonoids could enhance the health and functionality of hair follicles, creating long and beautiful hair that will last long into adulthood.

Free Radicals, Oxidative Stress, and Balding. The idea that antioxidant super foods could hold the key to preventing hair loss comes from leading research institutions in the United Kingdom. The Centre for Cutaneous Research at the Queen Mary’s University of London, along with the Farjo Medical Centre and Unilever R&D, have published the findings in an abstract titled Oxidative Stress and Cell Senescence in Androgenetic Alopecia (AGA).

In the report, researchers contrast two separate cultures of hair follicle dermal papilla (DP): One from scalp that has experienced pattern baldness, and one from scalp that exhibits normal hair growth. By contrasting these two selections of DP, researchers were able to make a number of fascinating discoveries:

1. The derma papilla (DP) of balding scalp exhibited higher levels of reactive oxygen species (ROS).

ROS molecules are a special type of free radical that is sometimes produced when the body metabolizes oxygen. As professor of nutrition at Tufts University, Dr. Jeffrey Blumberg has dedicated his professional career to the study and science of free radicals, oxidation, and cell damage. He explains:

“While the body metabolizes oxygen very efficiently, 1% or 2% of cells will get damaged in the process and turn into free radicals,” (i).

Once produced, free radicals are known to swarm the body in search of an extra electron. Numerous studies suggest that this process causes damage on the cellular level, referred to as free radical damage. According to health experts at the Harvard School of Public Health, free radical damage may contribute to cardiovascular disease, vision loss, and other chronic conditions (ii). Now, according to researchers in the UK, it seems free radicals might also lead to pattern baldness by damaging hair follicles.

2. Higher levels of ROS corresponded to decrease cell motility.

Cell motility refers to the ability of body cells to naturally reproduce in a dynamic fashion. Motility is vital for wound healing, tissue regeneration, a number of other important biological functions. When comparing DP cultured from balding scalp to that of normal scalp, researchers found cell motility to decrease as oxygen levels increased, indicating that increased ROS might significantly impair the DP’s ability to support healthy long-term hair growth.

3. DP from balding scalp exhibits higher levels of cell senescence.

Cell senescence occurs when a cell is alive but no longer able to divide and proliferate. As cell senescence increases, the ability of the hair follicle to support natural hair growth decreases.

As a result of the 3 main findings above, researchers now believe “oxidative stress may exacerbate the onset of androgenetic alopecia [pattern baldness],” (iii).

This exclusive health report has been published by the Hair Transplant Institute of Miami. For additional information or appointment requests, please call toll-free 1-877-443-9070.

Sources:

(i) “How Antioxidants Work.” WebMD. Accessed 8 July 2013.

(ii) “Antioxidants: Beyond the Hype.” Harvard School of Public Health. Accessed 8 July 2013.

(iii) “Oxidative Stress and Cell Senescence in Androgenetic Alopecia (AGA)”

Fgf9 Protein Might Hold Cure for Baldness, Study Finds

Fgf9 Protein Might Hold Cure for Baldness, Study FindsResearchers at the University of Pennsylvania have made a surprising discovery that has the potential to make hair loss worries a thing of the past. The news is particularly exciting for some 500 million men and nearly 20 million women who suffer with thinning, shedding, or balding, as it may hold the key to permanently reversing the signs of hair loss.

Men and women who suffer with hair loss will have to wait for this new study to produce an effective cure, however. The research is based solely on trials conducted with laboratory mice, and extensive follow-up research and clinical trials are needed before hair transplant surgeons can hope to offer such a treatment to patients.

Fibroblast Growth Factor 9 (Fgf9) and Hair Follicle Growth

While studying the wound healing process in laboratory mice, researchers at the Department of Dermatology at the University of Pennsylvania found that a specific type of immune system cell could be the key to curing baldness. The cell, called gamma-delta (γδ), produces a vital protein during the healing process. That protein, fibroblast growth factor 9 (Fgf9), also appears to fuel the growth of hair follicles.

It is important to note, however, that the human immune system differs from that of mice. Specifically, humans are markedly deficient in gamma-delta cells. This fact has led researchers to speculate that lack of gamma-delta cells is the reason why humans might experience difficulty regenerating hair in areas where a wound has healed.

George Cotsarelis, M.D., served on the University of Pennsylvania research team that conducted this groundbreaking study. As lead author, Dr. Cotsarelis made the following statement in a press release issued by the Perelman School of Medicine:

“The findings help explain why humans don’t regenerate their hair after wounding. The study also points us to a way to treat wounds and grow hair,” (i).

Testing the Hypothesis: How Fgf9 Stimulates Hair Follicle Growth

Researchers tested the exciting new link between the protein Fgf9 and hair follicle growth by dividing laboratory mice into 2 groups: A control group, and a test group.

For the control group, researchers simply monitored the occurrence of hair growth during and after the wound healing process. For the test group, however, researchers reduced the expression of the Fgf9 protein. Test group mice exhibited a marked decline in hair growth, leading researchers to attribute the deficiency to a lack of Fgf9 protein.

As a follow up, researchers decided to test the opposite. When enhancing the expression of Fgf9, mice in the test group exhibited approximately 2-3 times the hair growth as those in the control group (ii). As a result, researchers have good reason to believe that Fgf9 plays a critical role in the development of new, healthy, fully functional hair follicles.

This health report has been produced by the Hair Transplant Institute of Miami. For additional information on our Institute, including hair loss evaluation and consultation services, readers are invited to contact our office directly at 1-877-443-9070.

Sources:

(i) “New Hope for Baldness Cure.” Medical Daily. Accessed 11 June 2013.

(ii) See above.