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Hyaluronic Acid as Filler and Moisturizer

Today I’d like to tell you about hyaluronic acid, one of my favorite skin care ingredients. And the reason it’s one of my favorites is because it’s so important both on the surface of the skin and inside the skin.

On the surface of the skin it, is a great humectant ingredient in moisturizers, so it makes moisturizers work very well.

Humectants are simply materials that retain moisture and the reason hyaluronic acid is such a great moisturizer is because it holds so much water because it is a very, very long molecule, longer than most humectants and as a result there are a lot of different interstites or little spaces in that molecule where it can hold water, so it just holds lots and lots of water.

But in reality, we don’t normally find hyaluronic acid on the surface of the skin, we normally find it in the dermis inside the skin in the second layer and inside the dermis of the skin, it’s this pink material, in that pink material you have a lot of hyaluronic acid and a lot of water.

Well because the hyaluronic acid binds water, it binds it very well there so it forms a lot of volume and that volume helps support the collagen fibrals and all of the organs and it’s very important in maintaining the volume of the dermis. Anything that maintains volume here helps prevent lines and wrinkles up here.

As we get older we normally lose collagen and hyaluronic acid both as a function of age and also as a function of sun damage. And as a result, lines and wrinkles form because this area contracts and everything falls in. So, hyaluronic acid is a very valuable ingredient in filler materials that dermatologists use to inject into the skin to help restore volume and thereby fix lines and wrinkles.

But here’s the catch, for the same reason that hyaluronic acid is such a good moisturizer because it holds onto so much water, and for the same reason it’s such a good filler material, you can’t get it into your skin by rubbing it into your skin to fix lines and wrinkles because that molecule is just much, much too big. So, while I encourage you to look for moisturizers with hyaluronic acid in them as ingredients, enjoy your hyaluronic acid as a topical moisturizer but if you want it to fix lines and wrinkles, you’ll have to see your dermatologist.

Should People in Their Twenties Use Wrinkle Cream ?
Even women in their twenties ask me, should they be using anti-wrinkle creams, and actually, the answer is, yes, even though they don’t have any wrinkles. When I say anti-wrinkle creams, I’m talking about things like the newer peptide creams which have become very popular in the past five years, the older retinoids like Retin-A and Renova, and even the exfoliants we’ve been talking about which have been popular in the last 10 or 15 years, like glycolic acid and salicylic acid.

Wrinkles are caused by a loss of collagen, and the material in the skin that the collagen sits in which is called a semi-liquid matrix. Think of Jello with fruit. The fruit is suspended in the Jello. The fruit is the collagen and the Jello is this semi-liquid matrix. And as you lose either of these components in the skin, the skin loses volume and it sags and falls in, and that’s what causes a line or a wrinkle.

All of these anti-wrinkle creams work the same way. They all make the body either produce more collagen or produce more of this semi-liquid matrix, both of which occupy volume and help to prevent the skin from falling in and preventing wrinkles, Now, even though people in their twenties don’t have wrinkles, they’re already losing their collagen and the material it floats in. They just haven’t hit critical mass, so you actually don’t see the line or the wrinkle because they haven’t lost enough of it, but they’re losing it.

So if you start these anti-wrinkle creams early in your 20s, you’ll start the production of both of these materials and, as a result, you’ll delay the onset of your wrinkles and lines by 5 or 10 years. You may not have been destined to get lines until your 20s, 30s, 40s or 50s, but whenever you are going to get it, either determined by your genetics or by the amount of sun you’ve had, you’ll delay the onset of them because you will be producing the material that helps to fight their recurrence.

Think of it as preventive maintenance for your skin and started early. Wrinkles are caused by a lost of collagen and the material in the skin that the collagen sits in which is called a semi-liquid matrix. Think of jello with fruit, the fruit is the collagen and the jello is this semi-liquid matrix. As you lost either of these components in the skin, skin loses volume and it sags and falls in and that is what causes a line or a wrinkle. All of these anti-wrinkle creams work the same way, they all either make the body produce more collagen or produce more of the semi-liquid matrix. Both of which occupy volume and help the skin from falling in and prevent wrinkles.

Even though people in their twenties don’t have wrinkles they are already losing collagen and the material that it floats in, they just haven’t hit critical mass so you actually don’t see the line or wrinkle because they haven’t lost enough yet but they are losing it. So, if you start these anti-wrinkle creams early in your twenties you will start the production of both of these materials and as a result you may delay the onset of these lines and wrinkles by five to ten years.

You may not have been destined to get your lines or wrinkles until your twenties, thirties, forties, or fifties but whenever you were going to get them either determined by your genetics or by the amount of sun you have had, you will delay the on set of them because you will be producing the material that helps prevent their occurrence. Think of it as preventative maintenance for your skin.

What Is Retin A ?

Today I’d like to talk to you about Retin-A and tell you what it is, what it’s used for, and what the issues or side effects are that some people experience when they use it.

Retin-A is a brand name for a drug called tretinoin, and tretinoin is a derivative of Vitamin-A; it’s really the acid form of Vitamin-A, so another name for Retin-A is retinoic acid.

It’s a fairly versatile prescription medication which is used both to treat acne and to treat photo-aging. Both of those treatments are based on Retin-A’s ability to decrease cell turn over which is really what all exfoliants do.

In the treatment of acne its exfoliation powers, just like other exfoliants, results in extrusions of the clogs in the follicles and actually dissolves the clogs in the follicles to make them come out easier and also help to prevent more clogging of more follicles.

When treating photo-aging it again works like other exfoliants, first in helping to remove the dead cells in the surface of the epidermis which makes the skin look brighter, more lustrous and more even, also helps to remove some of the dead cells which have extra browns in them. So it helps to correct brown pigmentation and like most other exfoliants, it sends a message to the dermis to fibroblasts to wake up and make some more collagen. When that happens, it helps to fill in fine lines and wrinkles.

Some people who use Retin-A do experience side effects and the most common one is irritation and flaking and that’s because it’s a fairly potent, strong medicine. To help reduce that irritation, it was reformulated into what’s called Retin-A Micro and in the micro form its encapsulated in these little spheres that are time release capsules so it releases the active ingredient which causes the potential irritation more slowly and helps to avoid the irritation.

Anyone who uses Retin-A can become more sensitive to the sun which means you more easily get a sunburn so of course you need to have strict sun protection with sunscreen. In addition, people who have used Retin-A for long periods of time can increase the appearance of some small broken capillaries in their skin. And lastly, because Retin-A can have potential harmful effects to a forming fetus, you can’t use Retin-A if you’re pregnant.

Retin-A, like all other forms of tretinoin like Avita, Renova and Yanova, should be used only under the direction and by prescription of a physician. Retin-A is a fairly good exfoliant, but as chemical exfoliants go, I prefer glycolic acid because I prefer to be more versatile, more effective, and have fewer side effects.

Can You Use Retin-A and Antioxidants?
There is a lot of confusion about what you can use Retin-A and other retinoids with and what you cannot. The real issue here is the fragility or instability of retinoids like Retin-A, adapalene, Atralin and Tazorac. That instability means you cannot use those chemicals with acids, acids like glycolic acid or salicylic acid, both of which are used to treat acne and also for exfoliation.

However, you can use Retin-A and other retinoids and those acids as long as you are using them two opposite ends of the day, so one does not touch the other.

However, when it comes to antioxidants and retinoids, I am happy to say: there is no conflict, there is no problem. They can be used together as long as they are layered properly, so they both can come into contact with the skin. So, with acids like glycolic and salicylic, they cannot be used at the same time as retinoids, but at opposite ends of the day, and with the antioxidants, they can be used with the retinoids. And do not forget one other thing: In order for antioxidants to work, they cannot be used in sunlight. So use your antioxidants at bedtime.

The Difference Between Retin A and retinoids?
I would like to make a very important distinction for you between retinol and Retin-A. Retinol is a cosmeceutical ingredient which is put into skin care preparations.

Retin-A is a prescription cream which has been shown to be effective for acne and helps to reduce wrinkles, and is also useful for facial rejuvenation. Now, first of all, there is no retinol in Retin-A. And, second of all, when retinol ingredient in a preparation is applied to the skin, 5 or maybe 10 percent of that retinol can be converted into Retin-A.

Retinol is a soluble form of vitamin A, and the manufacturers of skin care preparations promote retinol as an ingredient that helps to reduce wrinkles and helps in facial rejuvenation. And what they are hoping is that you are going to confuse retinol with Retin-A because Retin-A does do those things, but retinol is very, very weak.

I mentioned that there can be a small conversion. At best, if 5 or 10 percent of retinol is converted into Retin-A in a cream that you put on your skin, you are just not going to get a meaningful result. And there is no assurance that that small amount of Retin-A that is created will be absorbed into your skin because no studies have been done to demonstrate that. So, the bottom-line here is: retinol is not a very effective wrinkle fighter or facial rejuvenation helper. And if you do want those benefits, if you want the real result, then use the real product, then get a prescription for Retin-A.

But again, in the United States, Retin-A is only available by prescription.

How to Remove Acne Scars?

Despite good hygiene and even despite good dermatologic care, people with acne sometimes still get acne scars and they ask me, "What can I do to get rid of them?" First and most importantly, we have to get your acne under control.

There is no point in treating old acne scars if you are still getting breakouts of bad cysts which is what new scars usually come from.

Assuming that your acne has come under control there are two types of acne scars that people get. 

First is called an "Ice Pick Scar" because the shape of the scar almost looks like an ice pick has pierced the skin. As an example [Dr. Schultz holds up a cone-shaped disposable drinking cup] this drinking cup is very tapered and angular and deep compared to the width.

So ice pick scars tend to be deep and angular and the only way to really get rid of them is by cutting them out.

Two weeks ago a patient of mine with both types of scars came in to have twenty-two ice pick scars cut out.

It was an hour procedure, a little bit of local anesthesia, one or two tiny plastic surgery stitches, and a week later they healed beautifully and he is very happy. Really, that is the only way to treat those types of scars.

When you have the more common shallow "Crater Scars", [Dr. Schultz holds up a dinner plate] they are much wider than they are deep, and these scars can be treated in several different ways.

Temporarily, fillers can be injected under the skin to lift up the bottom of the scar to make it flat. The fillers can be permanent, or they can be temporary depending on what you and your doctor decide to use.

If they are temporary, they probably need to be freshened up and retreated every three to twelve months. But there are also procedures that will get rid of these types of scars permanently. They are called ablated procedures.

We used to do dermabrasion for that but today instead we usually use laser procedures that ablate or remove the upper layers of skin. It does cause about ten days of down time during which time the skin has to heal and reform and it looks like you have a really bad sunburn during that period. It is a time where you would not be going to work.

After the procedure is done and the skin has healed (in about ten days to two weeks), you will have pinkness for about a month to two months which is easily covered by makeup. But, most importantly, you then have permanent improvement if not curing of the crater type scars.

So the good news is if your acne is finished, it is time to fix your scars and depending on the type of scars you have, there are procedures that will remove them and put a smile on your face.

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Confinement Period - journal of a first time mother

Day 27 into my confinement period ...

Most of the first time mother probably have no idea what do we do during the confinement period, so I wanna share what I had been doing this month here...

I deliver my baby girl on 2/10/15, it's a Friday evening, via SVD, after PROM and going through about 16 hours 1st stage of labour plus about 30 min 2nd stage of labour, analgesia only IV pethidine cause I refuse epidural analgesia, augmentation of labour start in labour room, total 4 hours of augmentation prior to 2nd stage, episiotomy was done on crowning after given LA, baby girl with birth weight 2.9kg delivered, Apgar score 9/9. I was sent back to ward 3 hours post delivery, then discharge well the next morning. Erm, just ignore this paragraph as this is how a doctor document her own delivery story.

Let's back to my topic, my confinement lady reach my house after I was discharged from ward. So 3/10 mark the first day of my confinement period and oso Day 1 of life for my baby girl (cause she was borne on 2/10 evening, so the Matron told me that day consider day 0). It's abit chaotic on the 1st day, cause my house is not equipped at all since we seldom cook, so my husband and my mother in law needs to go around to buy lots of things esp some kitchen ware. Then cause I was sort of 'grounded' on upstairs (because post delivery lady not suppose to walk here walk there n not suppose to climb stairs), so I can't help with the kitchen, I can only stay in the room with my baby, trying to breast feed.

First few days was bad, for me, my husband and the whole family esp my mother in law, cause my husband need to go around from shops to shops, then go to market and Chinese herbs shop to buy my confinement's meal ingredients. He also need to buy a lot of cooking utensil or fetch my mother in law to her house to bring some of her cooking utensil here.

For me, on the day I reach home, I felt so sweaty and smelly, so after my confinement lady cook the "bathing water" (it's actually boiled water with the packet of "confinement herbs pack" inside, those herbs can be bought from any Chinese herbs shop), I immediately took a shower, including washing my hair... Then I was "advised" to wear socks and shoes in the house, cause I am not suppose to let "wind" go inside my body. =_=lll

Unfortunately, once i finish showered and blew my hair with hair dryer, some relatives start coming to my house for "baby visitation", and since my baby is inside my room, so everyone came into my room, including the confinement lady. Then I was being nagged again "har, u so fast wash ur hair edy?! U not suppose to shower at so night! Where's your socks and shoe? etc etc....." I just reply with an embarrass smile and continue entertain those who came visit the baby.

That night, my husband came back very late, cause he is out there buying things. When he came home, apparently everyone in the house already know I wash my hair edy and they ask my husband to "inform" me to follow those confinement rules and give cooperation to the confinement lady. I agreed to shower only once a day, using the confinement bathing water, and wash my hair every other day. Cause since I will be staying at home most of the time, so there's no need to wash hair everyday.

Oh one more thing, about breastfeeding the baby. I will blog about it next time, but I do remember, that first day, I am quite depress that my breast milk production is not so much and my baby is still crying even after I feed her for so long duration. Then my husband and his family decided to buy some milk powder to top up the feeding. I know it's ok to top up on the first few days since my milk production is still less, however, the way they told me about topping up the milk powder made me felt so insulted.

After that, I researched on the daily requirement of infant, and found this:

So I am sure my breastfeeding was enough for my baby, just that too many over-concerned parents and relatives with lots of "useful" advice made me feel so stressful. Just like the saying "Too many cook spoil the dish", so my baby end up need to start on powder milk on the first day of life, and I become very very stress up for not having enough breast milk. Now reflect on the news " Young mother commit suicide due to lack of breastmilk ", I roughly can understand that lady's feeling, and I am sure those relatives could be the co-murderer in this event due to their negative word and comments, such a tragedy. This call the "Power of Word", in a negative way.

That's summed up my first day back from hospital. Tired physically and mentally.

Second day, it's a Sunday, early in the morning, nurse from Klinik Kesihatan already called me wanted to come for Post natal Home Visit. They arrived at about 830am, check the baby and measure my vitals plus examine my episiotomy wound. Then, my nightmare started... Cause my baby was found to be slightly jaundice, and my episiotomy wound is not well sutured (according to the nurse), so I was advised to seek treatment at hospital for the wound and also baby's jaundice. My husband was on the way to church for Sunday service initially, he drove back home to fetch me and brought me and my baby to private hospital (cause we don't want to go to GH's A&E department).

We struggled abit cause I still felt painful at my wound area, then need to carry my baby, thanks God the staff at Columbia Hospital Seremban was quite friendly, they gave me a wheel chair and offer to push me to registration counter while my husband park his car. Cut the story short, end up my episiotomy is just fine after check by the Gynae consultant, and my baby TSB level is just at the borderline level, no indication for phototherapy yet. We went back home and many people start visiting and asking questions on the visitation to hospital, it's so damn annoying! During that time, when the baby cry, I wanted to breastfeed the baby, but soooooo many people around, and they just don't have the common sense of giving me and the baby some space so we can established the breastfeeding relationship. My second day end up with me being more depress on unable to breastfeed my baby well despite the nurse from KK keep telling me I actually have more than enough breast milk for my baby, and also annoyed by those people who lack of common sense.

I started to use my breast pump on the third day post delivery. Based on my experience, Be Consistent and Not Giving Up at the starting period is the key of successful breastfeeding. This is the proof...

Ok, I am suppose to talk about our daily life during confinement period. My "established" daily routine only started after 3 weeks post delivery (it's actually the last month of my confinement period) because of my baby's jaundice and again... those lack of common sense people and those "useful" advice. Thanks God we hire a confinement lady and she take care of the baby at night, so we got to rest during night time.

Basically, my day starts goes like this:
630am wake up and then start to pump milk
715am drank milk and supplement protein powder, check on the breastmilk stock, sort out the earliest packet and defrost it by putting the bottle under room temperature
730am brush my teeth and wash my face abit
8am check on my baby, if she needs feeding, start to breastfeed her, or bottle feed her with pre heated breastmilk.
845am breakfast, it's red wine Mee sua (omg can't believe I had been eating this daily for 27 days edy)
930am pump mik
1030am feed the baby
1130am shower for the baby, with the help of confinement lady of course
1230pm lunch 
1pm feed the baby
130pm pump milk
230pm rest and shower with the "confinement bathing water"
330pm rest ( finally....., but booo~~ this the time usually people will b in my house "visiting" baby and disturb my baby's sleep)
4pm feed the baby 
430pm pump milk
530pm rest (and reflect on life, lol)
630pm dinner 
7pm pump milk 
730pm feed the baby
8pm rest (ok this will only happen if ppl don't come camp in the house again... )
830 help baby to wipe face and change clothes, preferably long sleeve, as sleeping clothes
930pm drank some herbal soup
10pm feed the baby 
1030pm pump milk 
11pm push the baby cot to confinement lady 's room, baby will stay with confinement lady at night.

In summary, ur daily routine is only pump milk, feed the baby, and eat the confinement food. In between, help baby to shower, change diapers and busy entertaining those visitor who always appear in the house, routine usually b disturbed once there's visitor.

I m abit worry as I finishing my confinement period. 
To b accurate , I edy finish my confinement period cause I edy shower the "flower bath" today, and my confinement lady told me I can go out anytime I want and no need to wear "confinement attire" edy.
After this, I'll need to take care of my baby 24 hours /7 days edy, and oso cook for myself, do my own laundry and work up to lose weight!! Pray that I can handle this, i actually prepared to face this alone edy, but seem like so many "kind" person wants to interfere my plan, so annoying. Anyway, pray that my baby can grow well, and I can continue breast feeding as long as I can.

Till then.

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Half way through confinement period

So I edy half way pass my confinement month. Just few rants and thoughts and comment on this. I really hope those ppl who had no ' common sense ' can understand .

The first month after delivery is call confinement period !!

It's the time for mother to REST and oso bond with the baby - NOT to entertain all the guest and whoever relatives who are over concern and wanna come visit the baby. It's common sense right, if u go to visit the baby EVERY SINGLE day , how can the mother and baby rest? 

My baby is now Day 18, but I NEVER had a day which I can really REST and spend time with my baby , because so many ppl keep coming over my house. When these ppl came to my house, they will stay for so long, and even if the baby is sleeping , they wanna bring the baby out to 'play'. HELLO!!! My baby is a human being , she is NOT a Toy ok. Just because of their selfish act, sometime, when my baby almost wanna sleep, these ppl come n disturb baby, they will said 'oh, baby wanna sleep edy', then they still keep teasing the baby, said something like 'baby, open ur eyes, ur XX come n see u lo', 'baby, can u hear me', 'baby u r so cute, b a good girl ya'... Very INCONSIDERATE right ?! Just imagine, if I know u almost want to sleep edy , but I still teasing u, talking to u, don't let u to sleep, what will u feel?!

The first week worst, everyone came, then keep bring my baby downstairs, say wanna see baby, but I see that as a form of DISTURBING baby sleep. I don't understand, can't these ppl just leave me n the baby alone , at least for the first month, let us rest, let my baby establish some normal routine. It's so obvious that when so many ppl around, how can I breastfeed my baby ? Then I pump out breast milk, but when ppl come and 'play' with the baby, if my baby needs feeding, then they will said' ok, let's feed the baby with the breast milk in fridge '. Oh yeah, we memang feed the baby these way, but can't they just consider my feeling when saying this in front of me . Usually if I'm alone with the baby, when baby wanna feed, I'll feed the baby first, then only ask my confinement lady warm the stored breastmilk and continue feed her with bottled breast milk. But once so many ppl is around, I can't just told them, 'can u guys just go back now and let me breastfeed my baby'... I don't understand, really don't understand why some ppl just so lack of Common sense!!!

Second weeks onwards I decided to b cruel and nasty abit, I told those ppl who visit Do not bring my baby to downstair! Yeah I remind my husband so many time about this until he felt annoyed. But yeah , after that, ppl start giving me n my baby some space . I felt glad i manage to reduce the disturbance to my baby by setting that nasty rule. 

Oso, when those ppl come, I need to answer to their weird questions, over and over again. ESP my baby got jaundice for a long period, I'm already very very tire bringing her to hospital/KK to for check up and follow up. And I'm quite sure it's due to breast milk jaundice and I know the jaundice will resolve as time goes. Then here come many 'Smart' and 'experience' relatives, who likes to give lots of different advices. I'm someone who don't like to argue back, so will just smile to them even in my heart I deeply disagree with them. But I'm very tire of answering ppl's question, and listening to those negative comments given by those '38' aunties....

Then when I mention about breastmilk jaundice, someone told me, why not u no need give breastmilk edy, just give powder milk. This really makes me feel hurt and shameful. Really, when a mother decides to breastfeed the baby, and work hard to pump every 3 hours in a day, and research and try all sorts of ways just to increase her breastmilk so that her baby can get the best nutrition, how can someone just said this type of thing to the mother? I really really hurt after hearing that. Seriously, if u leave me and the baby alone, I think prob my baby and I will b fine, she prob won't have prolonged jaundice. If those 'concerned' relative leave me and my baby alone , don't come my house so often, I think prob my baby will b healthy today....

But, today, my baby admitted to hospital because of prolonged jaundice due to UTI. Yeah, when so many ppl keep come to my house, how can I take care of my baby well? Sigh . I know I shouldn't simply put the blame to others, but I felt really really sad cause my baby needs to b subject to intravenous antibiotic. She is just 18 days old. 

Anyway, yeah , because my baby is in hospital nursery , where the parents are not allowed to room in, so I'm back home , alone, without my baby. I miss my baby. Thinking on positive way, prob it's good as well cause the nursery don't allow visitor other than parents. So my baby finally can b feed and rest well there, without disturbed by others ... 

Dear Beatrice baby, mummy pray that u will recover soon. Mummy wants to bring u home as soon as possible, but mummy hope u can b feed and rest more in nursery without disturbance, so we will pray that you can b discharged as soon as you are completely recovered.

Till then. 

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