Articles Tagged with: hair loss treatment
hairbrush for thinning

Hair Loss Prevention

hairbrush for thinningMen aren’t the only ones losing their luscious locks. A reported 20 million American women suffer with hair loss each day. For many, it’s caused by again, hormonal fluctuation or the Pill. For others, it’s the result of work or family stress (Telogen Effluvium)

Take the time to follow these Do’s and Don’ts and stay proactive in building healthy hair for life.

Do: Manage Stress

Stress may disrupt hair’s retinol growth cycle, eventually causing loss. Take time to de-stress each day with yoga, mediation, and other calming activities.

Don’t: Stress Out

According to the American Hair Loss Association, stress causes changes in the biochemistry of hair follicles, leading to hair loss (Telogen Effluvium).

Schedule an Appointment for a Hair Loss Evaluation Today

If you are concerned about your hair loss and are ready to do something about it, we invite you to schedule an evaluation at the Hair Institute of Miami. Drs. Nusbaum and Rose are internationally acclaimed hair restoration surgeons with more than 40 years combined experience. To receive a personalized evaluation and treatment plan, contact us online or call or office directly at 305-925-0222.

Hair Transplants- Safe for Teenagers?

Children’s Hair Loss: What You Need to Know

Children's Hair LossIt can be hard to be a kid sometimes. Things can be even more difficult for a child who is losing their hair. Feeling different, being picked on, teased, or bullied because of hair loss can be devastating and disruptive for a child. But there are solutions that can address this issue, which is more common than you might think.

It is estimated that approximately 3 percent of all pediatrician visits annually involve a hair loss problem. Young children as well as teenagers can experience the symptoms of thinning, balding, or shedding which we normally associate with male pattern baldness in adult men.

There are many reasons a child could suffer from hair loss, and you should always consult with a physician if you notice your child losing hair. Some of the most common causes of hair loss in children include:

Alopecia Areata

Alopecia Areata is a specific type of baldness that occurs in concentrated, rounded areas. It may occur on the scalp or on other portions of the body. At times, Alopecia Areata may manifest itself in several locations at once. For example, hair loss may simultaneously occur on the crown of the head, the sides of the head, and on the arm.

It is estimated that somewhere between 1-2% of Americans suffer with Alopecia Areata, including children.

Tinea capitis

This unpleasant infection, commonly called ringworm of the scalp, is a frequent culprit in children’s hair loss. It often appears as round or oval scaly patches of hair loss on the scalp. It can usually be treated with anti-biotics.

Hairstyle Issues

If a child or teenager applies an unnatural and excessive amount of tension to their hair over an extended period of time, it can cause a condition known as traction alopecia. For example, wearing unnecessarily tight ponytails, pigtails, or braids for a long period of time can cause hair to become damaged and fall out. Since this condition is a behavioral one as opposed to a genetic condition, it can be easily remedied simply by identifying and halting the behaviors that cause it.

Unconscious Hair Pulling and Plucking

Another behavioral cause of children’s hair loss, albeit one with a psychological component, is Trichotillomania. This disorder occurs when a child or teenager pulls their hair until it is uprooted, often leaving large areas of thin hair, damaged follicles, or total baldness. The best course of treatment for this type of hair loss is to consult a mental health professional or behavioral therapist to learn more about why the behavior is occurring, and how behavioral modification can be implemented to reduce this harmful conduct.

Poor Diet

If a child is malnourished or has an unhealthy diet, their body will have a hard time getting the macronutrients, vitamins, and minerals it needs to maintain healthy hair. While eating well may not be enough to reverse pattern baldness, eating foods for healthy hair can certainly help to improve the health and longevity of existing hair.

Learn More About Hair Loss and Restoration

Schedule a hair loss evaluation to learn more about effective treatment with the world-renowned experts at the Hair Transplant Institute of Miami. Please contact our clinic today at 305-925-0222.

New Hair Loss Gene Discovered- APCDD1

New Research Reveals Over 250 Genetic Signals for Hair Loss

New Hair Loss Gene Discovered- APCDD1While male pattern baldness affects most older men, research on genetic predisposition to baldness has been minimal – until now. In a recent study published in the journal PLOS Genetics, a Scottish research team from the University of Edinburgh found nearly 300 genetic ties to hair loss, helping identify potential chromosomal markers of male pattern baldness.

The study analyzed over 52,000 male participants between the ages of 40 and 69-years-old. This is the largest genetic report on male pattern baldness to date.

“We identified hundreds of new genetic signals,” said Saskia Hagenaars, co-lead author of the study, in a news release. “It was interesting to find that many of the genetics signals for male pattern baldness came from the X chromosome, which men inherit from their mothers.”

Based on the genetic variants between a discovery sample (40,000 subjects) and a target sample (12,000 subjects) that distinguished patients with no hair loss and severe hair loss, the team developed an algorithm to forecast who may develop male pattern baldness. The higher the patients genetic (polygenic) score, the more likely they were to suffer from male pattern baldness. Among participants with a sub-median score, 14 percent showed severe hair loss while 39 percent had no hair loss. Meanwhile, 58 percent of patients who scored within the top 10 percent showed moderate-to-severe hair loss.

genetic hair loss

Fig 3. Distribution of hair loss by male pattern baldness polygenic score decile in the independent sample. Source: PLOS Genetics

For the most part, the genes identified are associated with hair structure and development. These findings could support early diagnosis and better treatment of male pattern baldness in the future.

 “We are still a long way from making an accurate prediction for an individual’s hair loss pattern,” said principal investigator Dr. Riccardo Marioni. “However, these results take us one step closer.”

As noted in the report, male pattern baldness affects approximately 80 percent of men by age 80. Balding can lead to substantial emotional issues, including diminished self-confidence, social isolation and depression. Past research has also linked baldness to an increased risk of prostate cancer and cardiovascular disease.

Download and read the full study here.

microblading

The Pros and Cons of Microblading for Hair Loss

microbladingOne of the newest trends in the fight against hair loss is microblading. What started as a beauty treatment to help fill and shape eyebrows is now being used on the scalp to conceal thinning and shedding. But what exactly is microblading, and is the procedure worth the time and cost?

To best determine if the hair tattoo is right for you, it’s important to first understand how the process works. The procedure involves a handheld tool that essentially tattoos your scalp to create the illusion of thicker hair. Unlike scalp micropigmentation, where a digital machine is used, microblading is done completely by hand. A small blade deposits ink across your scalp to mimic the appearance of more hair.

Microblading needles are about three times smaller than regular tattoo needs. This allows a hair loss specialist or tattoo artist to draw very fine, hair-like strokes for natural-looking results. And, because the manual process allows for precision, only the areas of the scalp lacking sufficient growth are targeted.

Microblading Pros and Cons

The treatment is available to both men and women – which is good, considering nearly 40 percent of all hair loss patients are female. Consider the following benefits:

  • Tattoo pigment matches natural hair color and skin tone.
  • Results appear immediately and fade gradually over time.
  • Microblading works well across the hairline for patients with progressed traction alopecia, a hair loss condition often caused by tight hairstyles such as braids and extensions.
  • When used beyond the hairlines, results look similar to a buzz cut. This can be suitable for men (or women) who already sport ultra-short hairstyles.
  • Pain is manageable – akin to a small rubber band snap or eyebrow plucking.
  • Results last for approximately 18 months (with intermittent touch-ups), but can vary depending on the patient and their lifestyle.

While this procedure is beneficial for some, not every hair loss patient is a good candidate. Microblading doesn’t counteract diffuse thinning – a common characteristic of female pattern hair loss (FPHL), a form of androgenetic (hereditary) alopecia. In addition, microblading does not work well on patients looking for increased volume. Microblading does not increase hair count or add thickness to thinning hair.

Both scalp micropigmentation and microblading are temporary treatments. These procedures do not prevent progressive hair loss or encourage new hair growth. To the touch, your hair won’t feel any different than it did prior to the treatment. This can be a major drawback for patients concerned about texture.

Finally, microblading does not offset baldness. To generate natural results, the tattoo must be concealed by surrounding hairs. For patients with advanced male pattern baldness or alopecia areata, microblading may not be a practical option.

At the Hair Transplant Institute of Miami, we work with patients looking for long-lasting, noticeable hair regrowth. We increase hair count and curb future hair loss through a range of procedures, including high-tech hair transplant surgery and low-level laser therapy. To book a consultation and discuss your options for authentic hair restoration, call us at 305-925-0222.

 

female hair loss

The Emotional Toll of Female Hair Loss

female hair lossAlmost 40 percent of all hair loss sufferers are women. Despite the astounding statistics, male pattern baldness is more commonly discussed – and aesthetically accepted – than female hair loss. Famous actors like Dwayne “The Rock” Johnson and Vin Diesel make balding look fashionable. Women, on the other hand, rarely opt to shave their scalps, even while suffering with thinning or shedding locks. Instead, female hair loss sufferers are left with widening parts, limp locks and a diminished sense of self-confidence.

Men who suffer from hair loss can certainly suffer a blow to their self-esteem. For women, who often favor long and thick hairstyles, hair loss adds further psychological and emotional damage. Hopefully, better education and widespread discussion can normalize female hair loss and help patients find comfort in knowing they aren’t alone – and that treatment is available.

How Does Female Hair Loss Occur?

Female hair loss due to androgenic alopecia transpires due to the miniaturization of hair follicles, which causes strands to appear shorter, thinner or more delicate and prone to breakage. Over time, miniaturization encourages hair follicles to discontinue production, thus limiting the overall active follicle count on the scalp. Genetic hair loss in women rarely results in total baldness. Women who suffer from total baldness may have alopecia areata, an autoimmune disorder, or chemotherapy-induced hair loss.

According to the American Academy of Dermatology, female pattern hair loss (FPHL) affects roughly 30 million American women. Female pattern baldness is the most prevalent cause of progressive hair loss in women. The symptoms of FPHL are a widening part and thinning crown, generally differing from the receding hairline seen in male patients.

Like male pattern baldness, female hair loss is understood to be a genetically predetermined condition. But, other risk factors include the following:

Underlying Illness

Lupus, anemia, diabetes, ringworm, polycystic ovary syndrome and thyroid dysfunction are all commonly associated with hair loss, which is why visiting a hair loss specialist or physician to diagnose your condition is critical. Hair loss is often the first sign of a more serious illness, so ruling out other motivating medical conditions helps physicians determine ideal treatment options while minimizing further health damage. 

Menopause, Pregnancy or Post-Partum

Hair loss due to aging can worsen with menopause, particularly when considering the massive hormonal changes during the change of life. Estrogen levels fall during menopause around age 50, frequently manifesting as thinning or shedding on the scalp. Similarly, women who are pregnant or who have just given birth might experience hair loss due to hormonal shifts.

Stress

After a traumatic event like a death in the family or job loss, hair loss is common. When your body undergoes severe emotional shock, normal functions like hair growth are put on the back burner. In fact, serious distress “shocks” follicles into a resting state, which means they aren’t active to produce replacement strands after ordinary shedding. Stress-induced hair loss is known as telogen effluvium (TE) and can resolve itself, assuming anxiety and tension dissipates. 

Poor Nutrition

Eating too little to lose weight fast often means you miss out on key nutrients that keep the body functioning. Hair follicles require proper nutrition to function, and eliminating these from your diet can harm the growth cycle. If you see hair loss while dieting, consult a nutritionist to review your caloric needs, current intake and dietary recommendations.

 

Women’s hair loss is treatable. Early detection helps increase your odds of reversing follicle miniaturization and regaining a healthy, full head of hair. At the Hair Transplant Institute of Miami, patients suffering from female hair loss can undergo both low-level laser therapy or hair restoration surgery, depending on individual candidacy and hair loss patterns. To schedule a consultation to diagnose your hair loss condition and move forward with treatment, reach out to us at 305-925-0222.

hair care resolutions

3 Hair Care Resolutions for 2017

hair care resolutionsMost New Year’s resolutions fail – but not due to lack of desire. Research shows that setting lofty and unrealistic goals sets you up for failure come February. So, if you’re looking to lose 30 pounds in two months or make an extra $10,000 in the near term, you might want to reassess your ambitions.

The key is to start small and pave a path toward the prosperous year ahead. For hair loss patients, thinning, shedding and balding can hold you back and diminish your desire to chase after other personal objectives, like weight loss or career goals. Boost self-esteem and give yourself encouragement with the following hair care resolutions for 2017:

Give Hair a Break

Between hairdryers, hot styling tools, sun exposure and harsh shampoos, your strands face a great deal of adversity. Unfortunately, hair habits that lead to damage cause breakage, dehydration and dullness. Join the “no heat challenge” and dry naturally during the workweek as part of your hair care resolutions. If you’re prone to flyaways and frizziness, use a deep conditioning treatment once per week to maintain smoothness and strength. In addition, apply hair oil to dry strands to keep pieces in place throughout the day. When all else fails, a loose top-knot or low bun looks chic and put together with little prep involved. Men can use a pomade for a styled and sophisticated ‘do.

Drink More Water

Your hair needs to hydrate, too! Dehydration tends to show up on your scalp, most obviously with dandruff and dullness. In addition, dehydration can sometimes trigger hair loss. Hair shafts are made up of approximately 25 percent water, and lack of moisture causes the shaft to weaken. Boosting your H20 intake as part of your hair care resolutions helps hair grow and shine, but also promotes healthy, younger-looking skin. Water is also essential to proper circulation and flushing toxins, so drink at least 64-oz per day to keep your health and appearance at its peak.  

Stop Procrastinating 

You can only hide your hair loss for so long until it negatively impacts your self-esteem, emotional wellbeing and productivity. Set yourself up for a healthier and happier New Year by addressing and treating hair loss head-on. At the Hair Transplant Institute of Miami, we invite patients to join us for a consultation to diagnose hair loss conditions and discuss comprehensive treatment plans. Our philosophy is to create a medical environment of understanding, comfort, practicality and positivity. Call us at 305-925-0222 or schedule an appointment online to jumpstart your journey toward self-confidence. The best way to set your hair care resolutions is by aligning future intentions with your current lifestyle. Our facility allows patients to undergo hair loss treatment without sacrificing personal lifestyles and existing routines.

 

Here at the Hair Transplant Institute of Miami, we understand you have a busy schedule and even bigger ambitions. Hair care resolutions for 2017 aren’t only easy to uphold, they help boost much needed self-esteem to encourage you to chase after the other things you want out of life.

We would like to wish all patients, readers and followers a healthy and Happy New Year!

women's hair loss

Coping with Female Hair Loss During the Holidays

Short-term hair loss solutionsThe holidays are the most joyous time of year – right? Unfortunately for those suffering from female hair loss, December’s festivities are flooded with feelings of discomfort and anxiety. When you’re a woman suffering from female hair loss, your initial reaction is to hide. And during one of the most social seasons of the year, coping with female hair loss is anything but easy.

Roughly 20 million women in the United States suffer some sort of hair loss condition, whether it be androgenic alopecia, telogen effluvium, anagen effluvium due to chemotherapy, traction alopecia or alopecia areata. While the statistics are staggering, knowing you aren’t alone in this journey can help ease your woes. In addition to finding outside support via other hair loss patients or a highly-experienced hair loss specialist, consider the following four tips to cope with female hair loss this holiday season:

Don’t Go into Hiding

Female hair loss is not your fault; nor should you be forced to suffer any more than necessary. Isolating yourself to hide the symptoms of hair loss is only going to make you feel worse in the long run. Memories created around the holidays are not something you want to miss out on, if possible. While it’s not easy to hide your self-consciousness in a social situation, letting go and having fun are the best distractions during an emotionally dim period. Spending time around others who love you for you helps boost lost self-confidence. Plus, cancelling left and right is bound to bring on inevitable guilt. Imagine coming up with several bogus excuses each time you feel forced to decline a holiday invitation. The stress of getting caught in a lie or suffering a serious case of FOMO (fear of missing out) is far worse than your changed appearance.

Spend Time on Yourself

The stress of getting ready in a rush is far worse for women who have thinning hair or balding to conceal. Adopting a new hair-do is exciting assuming you have the time to practice and style your locks to your liking. Make time for grooming and styling before a big event and remember – practice is key! For women with androgenic alopecia, or diffuse thinning, a deep-swept side part can do wonders to conceal a widening middle part. Visit your hair stylist for a bang trim to capture a chicer look. Framing your face with beachy waves helps hair look fuller, so make sure you have a working curling iron or wand by your side.

For a thicker up-do, consider a high boosted bun with assistance from your wardrobe. First, cut the foot off a high sock (preferably washed or unused) and roll it into a doughnut shape. With your hair in a high pony, place the sock at the end of your strands and slowly roll down so strands completely cover the sock. If you are concerned about thinning around the scalp on display, complete the look with an embellished hair band or festive holiday ribbon.

If you’re hair loss is more obvious to the point of balding or patchy loss, invest in a well-made wig. Wigs are popular among celebrities like Kylie Jenner who don’t suffer from hair loss, so the shopping process is nothing to be ashamed of. Buying a wig online is an option, but the fitting and style is more difficult to determine without trying it on first. If you do decide to shop online for a wig, leave yourself ample time for returns. In addition, hair wraps and hats are both stylish and holiday appropriate. Wear a beautiful, elegant silk scarf in a traditional holiday color or don a cute Santa hat as a nod to the big jolly man himself.  

Consider a Long-Term Solution

Some hair loss cases, including telogen effluvium, are temporary due to a traumatic event or sudden lifestyle change. However, many hair loss cases are genetic or prolonged. While tips and tricks for disguising hair loss work in the short-term, you can’t fake it forever. Considering hair loss restoration may be critical. Visit a qualified hair loss physician or specialist who can diagnose your hair loss condition and rule out any other medical concerns. From there, you’ll receive treatment recommendations based on your lifestyle and objectives. Many female hair loss patients opt for a non-invasive treatment therapy, such as a laser cap for hair loss, natural-looking hair loss surgery or a combination of the two. Whichever treatment(s) you decide to undergo, give yourself the gift of self-confidence for the holidays.

 

Female Hair Loss Treatment in Miami

At the Hair Transplant Institute of Miami, our primary goal is to bring relief and comfort to hair loss patients. We offer consultations to diagnose cases and rule out underlying conditions before prescribing personalized treatment programs, all with compassion and honesty at the forefront of our practice. Miami’s top hair loss physicians, Dr. Bernard Nusbaum and Dr. Paul Rose, each offer decades of experience coupled with extensive research, cutting-edge technologies and highly satisfied patients. The Hair Transplant Institute of Miami is no. 1 in total Artas® Robotic Hair Transplant procedures in both Miami and the Southeast region, and among the top five nationwide. To get started on your hair restoration journey at our leading Miami hair clinic, contact us directly at 305-925-0222.

 

Happy Holidays!

Does Balding Negatively Affect Work Life?

Hair Transplant Myths, Debunked

Does Balding Negatively Affect Work Life?Contrary to popular belief, hair transplant surgeries are not as obvious as they were in the past. Long gone are the days of obvious hair plugs and embarrassing surgical scars. With modern technology and advancements in the field, hair restoration surgery can be done under minimally invasive conditions for streamlined and natural-looking results.

Although hair transplants are increasingly popular among patients suffering from male pattern baldness and other hair loss conditions, there are still many falsities and misconceptions about the practice. In order to debunk some of these hair transplant myths, consider how we’ve helped revamp the practice:

  1. Scars are Obvious

While linear scars were more noticeable in the early days of hair transplant surgery, technology has helped the professionals eliminate obvious post-surgical blemishes. Nowadays, patients may see light scarring that is easily covered when hair at the donor site regrows. At the Hair Transplant Institute of Miami, our surgeons make minimal scarring a priority in strip donor procedures. Dr. Paul Rose developed the Ledge Closure technique which helps direct hair at the wound site to grow through the scar line, virtually concealing any indications of a past surgery. This leaves patients happier with their overall results and more confident in showing off their fuller locks.

  1. Surgery = Plugs

Hair transplant surgery received a poor reputation in its early stages, when procedures worked to fill in balding but often resulted in an obvious plug-like look. Today, however, hair plugs are a thing of the past. We’ve replaced these former practices with advanced procedures that leave virtually no signs of transplant, just natural-looking regrowth. In fact, hair transplants are barely recognizable among the general public, so you can stay discreet with your hair loss history. In a 2010 study from the International Society of Hair Restoration, 85 percent of Americans could not identify a hair transplant patient.

  1. The Process is Painful

Most hair transplants do not involve much pain and only require local anesthesia to numb the surgical site. Some patients experience discomfort during the injections, but much of the ache is relieved by an oral sedative. Once the scalp is numb, patients won’t feel much of anything during the procedure itself. After the surgery, taking care of your scalp carefully for optimal results is key. Brushing or washing vigorously can damage the natural scabbing process, so be as gentle as possible in the few days following surgery. With follicular unit grafting, our surgeons shampoo and check healing the day after surgery. Overall, healing time can vary by person and individual health factors. Typically, patients are ready to be out and about a week after the operation with no discomfort. If you have a big event approaching, try to schedule your hair transplant surgery at least one month in advance to ensure scabbing and swelling has time to subside. 

Hair restoration is still a nuanced field and many patients don’t know what to expect in the early stages. But, for qualified candidates, new technologies make transplants relatively easy, effective and discreet. To schedule your consultation and determine if you can benefit from hair transplant surgery, contact the Hair Transplant Institute of Miami at 305-925-0222.

women's hair loss

Short-Term Hair Loss Solutions

Short-term hair loss solutionsHair loss compromises self-image, confidence and emotional well-being. However, being proactive by scheduling a hair transplant, using topical treatments, taking prescription medications or undergoing low-level laser therapy (LLLT) is a step in the right direction. While the aforementioned therapies are typically successful, growth does not happen overnight. In the meantime, patients have a few options to limit the appearance of hair loss while waiting for restoration treatments to take effect.

Hairpieces or Wigs

Wigs are a fun way to express your style. For hair loss patients, wigs might be necessary to keep up appearance and avoid embarrassment, depending on the individual’s sentiments about their condition. Many women spend years growing and grooming their hair long, strong and shiny, making excessive thinning especially upsetting. While wigs are typically safe, extensions, especially the temporary clip-in kind, are not recommended. These styles put excessive strain on the follicle at a time when follicle health is vital.

Keratin Hair Fibers

Hair fibers are used to conceal diffuse thinning at the root. These small particles provide instant coverage for a fast and convenient fix. After cleaning and styling hair, lightly sprinkle fibers over the thinning area. Then, lightly pat hair until the fibers blend in with your roots. Make sure to comb hair before use, as bristles can loosen the fibers from their place on your scalp. 

Hats and Coverings

Many patients suffering from thinning or balding locks rely on hats to conceal their conditions. Did you know you can wear a hat to conceal hair loss while treating your condition simultaneously? With the Capillus272™, a small insert containing laser diodes is placed underneath your favorite sun or baseball cap. From there, just wear the portable, battery-powered device for 30 minutes, 3-4 times per week. Cool (and safe) laser technology nourishes inactive follicles and promotes circulation to encourage growth.

Hair loss doesn’t have to put you into hiding. With a few simple steps, camouflaging your hair loss temporarily recuperates confidence earlier and can even expedite the growth process. For more information on permanent hair loss solutions with Miami Hair, such as transplant surgery, contact us at 305-925-0222.

Stem Cells and Hair Loss

A Closer Look at Stem Cell Therapy for Hair Loss

Stem Cells and Hair LossDr. Paul Rose and Dr. Bernard Nusbaum are proud to offer a fresh, innovative and effective approach to hair loss – stem cell hair growth. While a fairly new procedure, stem cell therapy for hair loss is safe and successful. Plus, you can use this treatment in conjunction with transplant surgery, platelet-rich plasma (PRP) injections, topical treatments such as Rogaine and low level laser therapy (LLLT) treatments.

What are Stem Cells?

Stem cells are the building blocks of the body; they provide instruction on how to construct new cells. The fatty tissue on the body contains a high number of stem cells applicable to hair loss treatment.

The stem cell hair loss treatment is a simple outpatient procedure with local anesthesia and a mild oral sedative. Our physicians perform a small liposuction procedure on the patient, typically on the belly or love handles for optimal results. From there, the fat is processed to isolate and concentrate stem cells. Then, our physicians inject the stem cells directly into the scalp.

The total time for the procedure depends on the individual, but extraction takes about 20 minutes total. While doctors extract stem cells from the fat, patients can wait comfortably in private rooms.

After the procedure, patients must have a family member or friend give them a ride home since driving on the sedative is illegal. You can expect to return to your normal routine the following day.

Can Stem Cells Spur Hair Growth?

In short, stem cells have been shown to assist hair growth, but clinical research is still being conducted. Because the procedure is so new, researchers are unsure of whether the hair will continue to grow or if re-treatment is necessary.

For more information on Stem Cell Hair Treatment in Miami, contact the Hair Transplant Institute of Miami at 877-443-9070. Dr. Rose and Dr. Nusbaum provide the latest in hair restoration and loss treatments, not limited to stem cell related procedures.

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