Choosing the Right Hair Restoration Clinic

A Hair Restoration Clinic Should Have a Certified Trichologist

What is a Trichologist and why are they important for a hair restoration clinic? A trichologist is a specialist in trichology, which comes from the Greek word Trikhos, meaning hair. Trichology is the para-medical science of the hair and the scalp, cosmetic chemistry, and life sciences. It encompasses the science of the structure, function and diseases of the human hair and scalp as well the diagnosis and treatment of these diseases and disorders (Dr. David H. Kingsley, PhD, WTS). An experienced Certified Trichologist can advise and offer men and women who are having hair/scalp-related problems, hair loss or scalp conditions. They help people with concerns of hair loss, breakage, oily scalp, and scalp psoriasis. HPI’s trichologists and specialty team can also aid in problems related to all forms of alopecia and trichotillomania (the hair-pulling disorder).  A Trichologist examines the hair and scalp to recommend treatment(s) specifically for the severity of hair/scalp concerns.

A Trichologist cannot prescribe medications or make a diagnosis, so they work along side a Doctor or Practitioner. However, the Trichologist offers a different insight to hair conditions that a M.D. or Practitioner may not be as familiar with, to help design the right treatment protocol and prescriptions, if need be. HPI is a well-known hair restoration clinic in Nashville, that has an MD, Nurse Practitioner, RN, Trichologist and Aesthetician all working together to provide the BEST solutions to ALL our clients.

  • Dr. Jack Monaco
  • Kimberly Vaughn, Trichologist
  • Reena Bhatka, Nurse Practitioner

Advanced Treatments for Hair Restoration

First thing is first, make sure you are not being pushed just to have surgery. Hair Transplant surgery can be a great option, but it is not for everyone. Surgery should really be a last resort, there are so many avenues to hair restoration before surgery. The right clinic will have a variety of treatments to offer you, based on your specific concerns. The top priority should be accessing the true cause of hair loss and developing a plan from there. May sure you and your provider explore all options and that you are educated on those options, you will not be sorry in the end!

  • Start with blood work or an epigenetics report, these tests will tell your provider what is going on internally that can potentially be causing the thinning or loss.
    • Based on the results from the above tests, you may just need a diet change, topicals or supplements to regenerate the hair
  • If the provider feels you need treatment, make sure they discuss ALL options with you and how those options work. Most treatment plans are going to be a multi-therapeutic approach to achieve the best results.

Treatments, outside of surgery, that should be considered:

COVID-19 Hair Loss Post Recovery

According to the American Academy of Dermatology, some patients experience hair loss 2-3 months after recovering from COVID-19. Telogen Effluvium is a temporary form of hair loss. It increases the number of hair follicles in the telogen (shedding) phase by more than 50%. Those who experience telogen effluvium show signs 2-3 months after a traumatic event, like the COVID-19. Researchers believe the “shock” the virus has caused to the body’s immune system is causing this hair loss post recovery. The virus itself may not be causing the hair loss, but the stress and trauma it wreaks on the body is the culprit. 

Telogen Effluvium Caused By COVID-19 

Telogen effluvium is debatably the second most common form of hair loss in both men and women. Other forms of hair loss manifest in concentrated parts of the scalp. Telogen effluvium appears as a diffused thinning all over the scalp. Typically, the crown loses more hair than the sides and back of the head. The hairline is not usually impacted. Telogen effluvium does not cause total and permanent hair loss. 

Understanding TELOGEN EFFLUVIUM Hair Loss Post COVID-19

In order to understand telogen effluvium, it is best to first have a understanding of how a “normal” head of hair works. The average person has 120,000 to 150,000 strands of hair on the scalp, and sheds an average of 100 hairs a day. These hairs shed following a resting period of three to four months, after a several-year-long growth cycle is complete. Different hairs are in different stages of the growth cycle at different times. However, if you suffer from telogen effluvium a disproportionate number of hair follicles shift suddenly into the resting (catagen) stage. This usually results in the shedding of a large number of hairs within a short period of time. 

Causes: 

Treatment for Hair Loss Post COVID-19

The treatment for telogen effluvium can depend on the cause. Most cases of telogen effluvium can be waited out, as they will resolve themselves.

Treatment options may include:

*A multi-therapeutic approach will always be the best option to help the scalp and hair return to normal.

PepFactor Scalp

PepFactor Scalp is an advanced scalp and hair health treatment formulated with the world’s first and ONLY authentic basic fibroblast growth factor (bFGF) combined with Copper Peptides. This natural formulation works to offer regenerative properties for hair regrowth. Pepfactor works quicker than other growth factor or plasma treatments. This treatment stimulates collagen and heals tissue surrounding the hair follicles, which in turn improves hair and scalp health to regenerate hair. Most patients see results within the first few weeks after the first treatment. Results are best when done in a series and results may vary between individuals.  

Laser Hair Removal FAQs

How does the laser work?

The laser targets the melanin, the color, in the hair to destroy the follicle to prevent it from producing hair in the future. Those wanting to treat peach-fuzz, blonde, white or grey hair are NOT the ideal candidate for laser hair removal, due to the lack of pigment in the hair.

How long does laser hair removal last?

The results from a single treatment are permanent. However, we must treat all hair growth cycles, that is why you will need multiple treatments. Treatment results vary between clients, but for most clients, 8 treatments are needed for optimal results. You will notice slower growth and thinner/lighter hair as you progress through your treatment plan.

**Hormonal changes can cause additional hair growth, even after completing a full treatment plan.

Is Laser Hair Removal Painful?

Laser hair removal is not 100% painless, but new technology allows for very comfortable treatments with minimal to no discomfort. Our laser has a TEC cooling system for ultimate epidermal protection. This helps minimize any discomfort, if any, during your treatment.

What Do I Need to Know Before I Go for My Treatment?

Discontinue any tanning, natural or sunless, up to 14 days before your appointment. Having additional pigmentation on the skin can cause a burn. On the day of or the day before, shave the area to be treated. Longer hair can cause discomfort.

What If I Have Ingrown Hairs?

The laser treatment will help prevent future ingrown hairs. Laser hair removal is an excellent treatment for those who suffer from pseudofolliculitis barbae (1), (razor bumps).  Pseudofolliculitis barbae is an inflammatory response surrounding ingrown hairs from shaving. It can occur anywhere hair is shaved or plucked. It is most found on the neck, back of legs, underarms, and bikini areas.

Pseudofolliculitis barbae occurs in nearly 60% of African American men, when curved/curly hair grows back into the skin causing inflammation and a foreign body reaction. Over time, this can cause keloidal scarring which looks like hard bumps of the beard area and neck. Shaving sharpens the ends of the hairs like a spear. The hairs then curve back into the skin causing pseudofolliculitis barbae (2).

 

What if i have a tattoo?

Since the laser is attracted to pigment it is not recommended to have laser hair removal on areas that are tattooed, but it is easy to work around them to keep you and your artwork safe.

Are There Any Risks I Should Know About?

Risks and side effects are rare, but you should be aware they can occur. Almost all side effects are preventable. Hyperpigmentation (dark spots)/Hypopigmentation (white spots) can occur when a client has a tan or is using self-tanners. Laser burns can occur but are uncommon. It is important to follow all pre-treatment recommendations and to discuss any concerns with your provider prior to treatment.

WHAT IS THE DIFFERENCE BETWEEN IPL AND LASER HAIR REMOVAL?

Laser & IPL Hair Removal

IPL (intense pulsed light) can work for skin treatments and hair removal, but it is important to know that it does not work the same as a laser. IPL is versatile in its treatment because it uses multiple wavelengths. The laser hair removal device uses one wavelength to focus on the pigment of the hair follicle. IPL Hair Removal is not a permanent solution, hair usually returns in 6+ months. Laser hair removal is more expensive up front, but it is cheaper in the long run.

What is the Cost of Laser Hair Removal?

Treatments can be done every 4-6 weeks. Cost depends on the area(s) being treated and their size. The cost for a small area can be as little as $20 and can range up to $1500 for the entire body per treatment. Discounted package pricing is also available.  

How Does the Cost Compare to Waxing or Shaving?

Consider how much money you may spend on a nice razor or waxing service that both must be repeatedly done and replaced. Some people will spend upwards of $20,000 in a lifetime on hair removal, like waxing and shaving (3). How much of your time do you waste waxing and shaving?

Is LAMBDA FX safe for darker skin tones?

LAMBDA FX combines Nd:YAG and diode which is the best for dark skin and dark hair. YAG bypasses the melanin in skin and is the safest option for medium to dark skin tones.

Click below for a consultation with one of our laser hair removal technicians!

New Service: Hair Follicle Test: How does it work?

Not getting the results you have been looking for with your current hair regimen? hair supplements? hair treatments? HPIHair‘s new Epigenetic Hair Follicle Test could be a fresh start to your hair growth journey. Do not waste any more time or another penny on another online hair care regimen. In as little as 60 minutes HPI’s hair experts will have the answers to what is truly causing your hair concerns. So how does it work?

Single Hair = Rapid Results

Our hair tells ALL…..

Hair reacts to signals from the environment that cause our emotions to manifest feelings and it responds to those feelings. For example, when some people feel fear they may notice the hair on their arms and legs to stand up. Hair strands will contain a range of signals/frequencies that have an abundance of epigenetic information. This information is extremely valuable to our daily lives, health, hair growth, hair loss, scalp condition, and overall wellbeing!

Understand Your Hair Loss

Our Hair Follicle Test all starts with four individual hairs from the nape of your head. Those hairs are then processed within 15-20 minutes. Epigenetic reports reflect in a minimum of 30+ pages, potential functionality impacts caused by Environmental Irritants such as Toxins, Electro Magnetic Impacts, Nutritional Diet, Lifestyle and Underlying Food and Gut Stressors. Each report also provides a 90 day nutritional food plan and further advice to optimize wellbeing. This report allows our hair experts to design a treatment regimen tailored to YOU specifically. The regimen may include suggested diet changes, supplements, topicals, medical treatments or a combination of things to give you the optimal hair restoration results.

Is an epigenetic Hair follicle test Right for Me?

Are You Suffering From Any of the Below:

  • Stress related hair loss
  • Dry brittle hair
  • More shedding than normal
  • Itchy, sore scalp
  • Post COVID-19 hair loss

See if a Hair Follicle Test Could Benefit You!

Do Home Laser Devices Work to Re-Grow Your Hair?

By treating the base of the hair follicles, red-light energy can stimulate and re-energize the mitochondria of the cells. Mitochondria are the “powerhouses” of cells, reviving them is effectively the same as breathing new life into a retired power plant. Once recovered to the point of healthy function, the mitochondria can reproduce by themselves and repair the scalp just like they were meant to. This results in noticeably thicker, healthier hair and, eventually, even new hair growth from previously dormant follicles. Low-Level Laser Therapy really does work! 

Getting the Dosage Just Right

Low-level laser therapy depends upon regular use and consistent “dosages”. Because of this, any high-quality LLLT device needs to have some means of ensuring proper application, lest any benefit of the treatment become lost due to improper use. When used exactly as your provider has recommended, LLLT will produce coherent stimulation all across the scalp, resulting in a treatment that is perfectly safe, totally painless, and actually effective. The correct dosage will mean optimal absorption of healing red light, healthier hair, and a happier scalp.

5 Ways LLLT Re-Grows Your Hair

At-home devices deliver cool-temperature Low-Level Laser Therapy directly to the scalp at the follicle to help you re-grow hair. Here are five of the most notable ways in which this therapy can have a massively helpful effect on the quality and health of your hair:

1. Inhibits 5-alpha Reductase

5-alpha reductase is the enzyme responsible for converting the common sex hormone, testosterone, into the hair loss hormone known as DHT (dihydrotestosterone). Researchers have found that the more 5-alpha reductase enzyme a person has, the more likely they are to suffer from hair loss. The lasers inhibit the production of 5-alpha-reductase in the user, thereby halting the conversion of testosterone into DHT. This in turn slows and eventually halts the loss of hair due to DHT.

2. Activates Shock Proteins

Heat shock proteins are known to aid in cellular health. In the scalp, the shock protein known as HSP27 is utilized. The LLLT technology works to activate this specific shock protein and others, allowing them to boost hair follicle stem cell growth. Essentially, this process encourages hair re-growth at the innermost layer of the cell, the outer root of each sheath, and within the top layer of skin (at the epidermis cells where a structural protein called keratin is produced).

3. Boosts Oxygen Delivery

Laser devices boost oxygenation to every cell of the scalp. When the low-level infrared lights interact with your scalp, the laser separates two key factors of the hair loss equation: nitric oxide (NO) and an enzyme known as cytochrome c oxidase (CCO). These elements then bind together, moving oxygen on a cellular level and lowering cellular respiration. As a result, more life-giving oxygen is delivered to hair follicles along with essential nutrients for new hair growth.

4. Increases Blood Flow

As the cells of your scalp begin to receive more oxygen, the small capillaries of your scalp are finally allowed to “breathe”. Nitric oxide acts as a vasodilator, helping to widen the tiny blood vessels. Old blockages are released and the flow of blood increases even as the delivery of oxygen is improved. This process is often referred to as vasodilation and, as you might imagine, it is vital to the growth of new hair and considered a foundational requirement for sustainably healthy hair.

5. Causes Acute Inflammation

Inflammation is a natural response of your immune system and can be used to encourage hair regrowth. While too much inflammation can contribute to hair loss (remember our discussion regarding fibrosis and calcification, smaller “doses” can be significantly beneficial to the hair growth process. The focused effect of red light on the scalp helps to instigate this helpful form of inflammation, thus aiding in the growth of new hair without becoming uncomfortable or resulting in any negative side effects.

Shop Our At-Home Laser Devices- CLICK Here!

  • Grows new, healthy hair
  • Doubles the follicle size of existing hair
  • Slows down and stops hair loss
  • Hands-free operation allows the user to carry out other tasks during treatment
  • Suggested at-home use is 30 minutes every other day

Low-Level Laser Therapy Works!

Hair loss can be devastating for both men and women, it can impact their confidence and social skills. AGA – Androgenic Alopecia is the most common type of hair loss disorder across both sexes. Large percentages of 50-75% of men and women are affected by AGA as they age, 40 and over[13]. However, there is hope for those dealing with hair loss!

Ray s Laser

How Does Low-Level Laser Therapy (LLLT) Work?

LLLT is an approved treatment by the Food and Drug Administration (FDA), known to help increase blood circulation to the hair follicles [6]. Laser therapy has demonstrated proliferative effects in a variety of tissues and cell types, including hair follicles [7]. LLLT induces proliferation, migration, oxygenation, anti-inflammation, adhesion and transition of hair follicles from telogen (non-growing) to anagen (growing). All studies including LLLT found significantly more dense hair following treatment protocols. SUCRA (surface under the cumulative ranking) scores proved Low-Level Laser Therapy to be one of the most effective hair growth treatments, followed by scalp injections, finasteride and minoxidil [78].

Low-Level Laser Therapy is increasing hair density and promoting growth in both men and women, protocols are assigned by their providers. Higher quality laser devices are available in professional offices and there are also at-home devices readily available to the consumer. We suggest you still see a provider to determine the best treatment laser & treatment protocol for your individual hair loss needs.

Shop Our At Home Laser Devices- CLICK Here!

  • Grows new, healthy hair
  • Doubles the follicle size of existing hair
  • Slows down and stops hair loss
  • Hands-free operation allows the user to carry out other tasks during treatment
  • Suggested at home use is 30 minutes every other day

References

  1. Rousso DE, Kim SW (2014) A review of medical and surgical treatment options for androgenetic alopecia. JAMA Facial Plast Surg 16(6):444–450. https://doi.org/10.1001/jamafacial.2014.316
  2. Delaney SW, Zhang P (2018) Systematic review of low-level laser therapy for adult androgenic alopecia. J Cosmet Laser Ther 20(4): 229–236. https://doi.org/10.1080/14764172.2017.1400170
  3. Afifi L, Maranda EL, Zarei M, Delcanto GM, Falto-Aizpurua L, Kluijfhout WP, Jimenez JJ (2017) Low-level laser therapy as a treatment for androgenetic alopecia. Lasers Surg Med 49(1):27–39. https://doi.org/10.1002/lsm.22512
  4. Kalia S, Lui H (2013) Utilizing electromagnetic radiation for hair growth: a critical review of phototrichogenesis. Dermatol Clin 31(1):193–200. https://doi.org/10.1016/j.det.2012.08.018
  5. Gupta AK, Foley KA (2017) A critical assessment of the evidence for low-level laser therapy in the treatment of hair loss. Dermatol Surg 43(2):188–197. https://doi.org/10.1097/DSS.0000000000000904
  6. Nct (2017) BiRestore^ Light Therapy Apparatus. https://clinicaltrials.gov/show/nct03331003. Accessed Oct 2018
  7. Gupta AK, Mays RR, Dotzert MS, Versteeg SG, Shear NH, Piguet V (2018) Efficacy of non-surgical treatments for androgenetic alopecia: a systematic review and network meta-analysis. J Eur Acad Dermatol Venereol. https://doi.org/10.1111/jdv.15081
  8. Adil A, Godwin M (2017) The effectiveness of treatments for androgenetic alopecia: a systematic review and meta-analysis. J Am Acad Dermatol 77(1):136–141.e135. https://doi.org/10.1016/j.jaad.2017.02.054
  9. de Freitas LF, Hamblin MR (2016) Proposed mechanisms of photobiomodulation or low-level light therapy. IEEE J Sel Top Quantum Electron 22(3). https://doi.org/10.1109/JSTQE.2016.2561201

Permanent Make Up & Scalp Micropigmentation

“I couldn’t be happier with the process.  Julie is a true artist and professional. Her technique, color blending and attention to the small details of my eyebrows couldn’t be more spot on!” – Brena

We offer professional permanent makeup and scalp micropigmentation services for anyone. We specialize in these techniques for those who are suffering from hair loss; chemotherapy, alopecia areata, totalis, univresalis, and genetics.  Men and women alike experience this challenge and we can help!

Scalp Micropigmentation-Female Hairline

Scalp Micropigmentation has been a popular go-to for men to create a more full looking buzz cut or fresh edge for some time now, but techniques have come a long way since then. Thu uses small “follicle” tattoos to recreate and lower thinning hairlines for women. This technique also adds depth back to the hairline, showing less exposed skin when the hair is pulled back. She has also seen great results with scalp micropigmentation to hide scars on the head where hair stopped growing after injury.

Microblading is our most popular form of permanent makeup. Microblading creates individual hair strokes to restore thinning eyebrows with a natural look. Thu’s brows are perfectly measured and designed to your liking.

Microbladed Eyebrows – Female

We Offer:

– Brow Shading/Microblading
– Top & Bottom Eye Liner
– Lip Liner
– Full Lip Color
– Ombre Lip Color
– Scalp Micropigmentation

Click Here To See Thu’s Portfolio Here!

Karen Wellington Foundation

What is KWF and how did Kimberly get involved?

The Karen Wellington Foundation’s mission is simple:

“We put FUN on the calendars of women and families LIVING with breast cancer by sending them on special vacations, relaxing spa days, dinners out, concerts and other FUN-ONLY activities​. 

Our goal is to get each of the 100+ women on our ever-growing waiting list to a beach, a spa, a concert… somewhere FUN as quickly as possible. For women actively battling breast cancer, there is no time like the present! This goal will be made possible by generous people who donate a week of their vacation homes or timeshares, their airline miles, sporting event and concert tickets, or cash in order to help us connect a person in need with the chance to get away.”  (Source: KWF’s Mission)

Who Was Karen?

In Karen’s words, “I’m basically a mom, and I dabble in a lot of other things.” Yeah, a lot of things. Karen raised two young kids with her husband, played tennis, coached soccer, became an accomplished painter, ran a successful freelance retail merchandising business and even sang in a local band, “The Snake Oil Salesmen.” And lived with breast cancer for 10 years from the age of 30 to 40.

Karen liked to plan parties.  She loved celebrating for others. She didn’t like the limelight, but she was the best birthday cake designer in town, with wonderful creations of art and chocolate!

There also were many days where Karen just felt lousy. She was as human as any of us. Karen was very involved in her kid’s daily lives, volunteering as a room mother, pizza mom, soccer coach and auction volunteer for St. Ursula Villa. Every Christmas, Karen helped them express the importance of the season in the family’s yearly Christmas card, where she urged them to “be creative” and use your brain.

Karen volunteered with the Breast Cancer Alliance, the Cincinnati Youth Collaborative, the Junior League and Stepping Stones Center. Her gifts continue to live on in the work of  The Karen Wellington Foundation, the Karen Wellington Memorial Campership Fund at Stepping Stones Center, AK Steel Magnolia Award and through Foundation gifts to individuals and organizations that encourage people to LIVE more fully with breast cancer.

Karen set an extraordinary example for all of  her friends and family as someone who was courageous and victorious in overcoming obstacles with tenacity, faith, kindness and laughter, lots of laughter. Her light will shine brightly forever in the hearts of her many friends and family members and through her children Robby and Angeline.  (Source: About Karen)

How Did Kimberly Vaughn Become Involved with KWF?

Kimberly began her career in Cincinnati and focused on helping women, men and children throughout their difficult hair loss journey. After Karen’s first cancer diagnosis she knew that with treatment her hair would begin to fall out. Karen started to see Kimberly in Cincinnati for all her hair needs. Kimberly worked with Karen throughout her entire cancer journey, Kimberly valued her time with Karen and developed an inspiring connection with her. Kimberly reminds of how Karen truly LIVED her life, despite her cancer diagnosis.

Karen Wellington Foundation

Upon moving to Nashville and taking over HPIHair, Kimberly knew she wanted to remain involved with this foundation dedicated to her late client. Kimberly felt a calling to start the Karen Wellington Foundation: Middle Tennessee Chapter to bring the same mission to women LIVING with cancer in the Middle Tennessee area. Kimberly developed this chapter in 2019 with a team of devoted and caring individuals.

Kimberly’s Middle Tennessee Chapter surprised two recipients with “Fun Boxes” during the COVID-19 quarantine. These recipients will be treated to a family vacation, as well, when they feel safe to travel again.

HPIHair treats hair loss for just about any reason or cause. HPI’s staff understands how devastating losing your hair to chemotherapy or radiation therapy treatments can be. Dealing with cancer can be draining physically, mentally and emotionally, and the aggressive treatments used to battle this disease can be even tougher on your confidence and comfort.

Taking control of your hair loss during treatment and recovery is the first step in the healing process.  HPIHair will tailor a customized plan for every individual that walks through our door! HPI’s professional, caring team will treat you like family. The team will help restore your confidence and whether your hair loss is temporary or the result of an auto immune disease or a genetic condition.

Morning Source Interview with Kimberly Vaughn

Donna Vissman with Morning Source interviews Kimberly Vaughn of HPI Hair concerning hair loss issues and solutions.

How HPI is addressing Covid 19 safety and sanitation

**Scheduling a virtual chat or hang out can be extremely helpful in times of isolation or when we should integrate social distancing.

HPIHair has you covered!  Schedule a virtual private video consultation while you are spending time at home. Our expert hair loss specialists will spend time diving into your hair loss journey.  During this time of social distancing and health concerns, take time for yourself and schedule your video chat today.

HPIHair will be open regular hours with a clean healthy facility.

Our concern is always on creating a pleasurable client experience for all clients.  Due to the nature of our environment and close working proximity we thought the tidbits of information below could be helpful.

Wondering what to do with the family or children……. Maybe a good time for a movie?  I had my heart set on taking my son to see Onward.  Seems the large theaters are open with regular schedules with a few exceptions.  Hmmm- how close are those chairs?  Can I touch the armrest?  Where do I set me water or soda cup?

Thinking we would be safer in the Alamo Drafthouse theater.  Appears they are the only theater implementing a “seat separation” policy and cleaning theaters between showings!   Onward here we come…..Chris Pratt is very nice on the eye, even though he is wearing a grey animated suite with pointy ears! Haha.

Q-What is the cause of the Coronavirus?

A- There is inconsistent information. According to Bloomberg, “with 90% confidence, it is a bat-borne virus,” this coming from Linda Wang, who heads the emerging infectious disease program at Duke-National University of Singapore Medical School.

NBC News reports, the coronavirus, which first sickened people in China in December, is thought to have passed from animals to humans, like many similar pathogens.

Q-Is Coronavirus the same as COVID-19 ?

A- Yes, the official name created by the CDC for this strain of Coronavirus is COVID-19

Q-Can I catch the virus if standing close to the provider during a treatment?

A-The WHO tells us that COVID-19 is mainly transmitted through contact with respiratory droplets rather than through the air.

Q-What should the public do to help prevent spread of COVID-19?

A-Wash hands for 20 seconds with soap and water after any human interaction, avoid shaking hands, and avoid large crowds.

Q-What is HPI doing to help prevent the spread of infection?

A-Disinfect chairs, equipment, etc with every use. Making sure to wash hands after each human interaction. Offering virtual services to provide safety and avoid spread of infection.