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Irritation and sensitivity Retinol alone can cause: Redness Peeling Dryness Burning sensation Increased sensitivity Adding peptides usually helps: Most peptides are soothing Support skin barrier repair Reduce inflammation When irritation occurs despite peptides: Reduce retinol frequency (every other night instead of nightly) Use lower retinol concentration (0.25% or 0.5% instead of 1%) Apply peptides in morning, retinol at night (not together) Add more moisturizer Take retinol break for few days pH incompatibility concerns The pH issue: Retinol works best at pH 5.5-6 Some peptides work best at different pH ranges Mixing products with very different pH can reduce effectiveness In practice: Modern formulations account for this Short contact time between layers minimizes pH issues Many successful products combine peptides + retinol in same formulation Solution: Don't worry excessively about pH

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In rulemaking following the December 2018 final rule, we modified the approach for determining an ACO's eligibility for participation options in the BASIC track and ENHANCED track, along with the number of performance years an ACO may remain under a one-sided model of the BASIC track's glide path