PM. Start alternate nights, titrate dose
|Caution:Sensitive skin, rosacea, potential interactions with other topicals||Best for:Acne, anti-aging, pigmentation|
|Comments:The number one ingredient||Mode of action:|
Chemical exfoliant, pigment suppressor, modulates genes
What is the science behind retinol?
Retinol belongs to the powerful family of molecules known as retinoids. These are vitamin A derivatives with multiple functions in the skin including reduction of pigmentation, improved cellular turnover, stimulation of collagen synthesis, & reduction of oil production.
What are the benefits of retinol?
Improved skin texture & quality. Retinol has antioxidant, anti-acne, anti-inflammatory, as well as antibacterial properties, hence its use in acne prone skin.
Anti-aging. Retinol decreases pigmentation but increases collagen production. This results in clearer skin texture with less wrinkles & smaller pores.
Anti-Pigmentation. Retinol reduces the activity of tyrosinase, the enzyme responsible for producing pigmentation, hence its role in the maintenance of melasma & skin pigmentation.
How & when to start?
Any age is a good time to start retinol, with the caveat that it should not be used in pregnancy. Most dermatologists advise starting at a lower concentration, namely between 0.3% to 0.5%. It is important to see how your skin reacts before moving to higher concentrations.
Here’s how to incorporate retinol into your skin care regime. The best time to use retinol is in the evening as this molecule is sun sensitive. Start every second night for the first fortnight, & increase as tolerated.
Step 1: Wash your face with a bland formulation. Do not use skin care acids such as glycolic, lactic or salicylic acids prior to using retinol, as interactions can occur.
Step 2: Wait a few minutes until your skin is completely dry. This is important, because if your skin is still damp, the retinol will be able to absorb more deeply into your skin and might cause irritation.
Step 3: Take a pea-size amount of your retinol and apply with your fingertips in upward and outward motions. If you are unsure how your skin will react, conduct a test patch. This means to try application of a small amount of retinol to the front or the back of your ear.
Step 4: Finish with your moisturizer 30 minutes after application of your ‘actives.’
Step 5: Remember to rise & clean your face in the morning. You should apply a broad-spectrum sunscreen the morning after, as retinol makes skin more sensitive to the sun.
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Can I use retinol daily?
Yes, providing you slowly work up to it. Start your retinol journey with a good formulation of around 0.5 %. Use this every second night paying close attention to skin irritation. You can increase this to nightly application over a period of 2-6 weeks. If you do experience unwanted side effects, back off.
If you have super sensitive skin, consider a gentler formulation such as retinyl palmitate.
Can retinol treat acne?
Retinoids including retinol is the preferred ingredient for the treatment of acne by dermatologists. They reduce acne outbreaks by preventing dead cells from clogging pores, reduce inflammation, decrease oil production & bacteria growth. By clearing acne and reducing outbreaks, retinoids may also reduce the formation of acne scars.
Can retinol treat acne scars?
Yes, but the evidence is weak. There are much stronger studies with prescription retinoids, namely with Differin or adapalene. Early control of acne will mitigate or at least reduce acne scars. If you would like to treat your early acne scars with topicals, either order Differin online from the United States (legal there without a prescription) or contact your local general practitioner (available in Australia).
Physical methods such as lasers, chemical peels, microneedling, RF, Tixel & sublative RF treatments give much better results than topicals alone. Ideally patients who exhibit acne scars should consider early intervention.
Does skin purging occur with retinol?
Purging is common with retinol & retinoids. These molecules work by increasing the rate at which your skin produces new skin cells by speeding up the process of skin cellular turnover. In the short term, it can lead to acne breakouts, skin peeling, & dryness. The purge phase usually lasts for two to six weeks. So hang in there.
During the purge cycle it is really important not to further irritate the skin. Stay clear from AHAs, BHAs, & benzoyl peroxide. A short course of anti-inflammatories such as EES or low dose doxycycline can help. You can obtain a prescription from your doctor. Skin purging is often seen with oral retinoid treatment as well .
What does retinol do for pores?
This is one of the most powerful pore cleansing ingredients. Retinol & retinoids can reduce oil production & decrease cellular shedding, in turn improving blackheads & improving pore size.
It normally takes 4-8 weeks before you see the maximal results, so be patient. For people with medium to large pores, retinol in combination with skin acids & simple laser procedures are best.
Can retinol reduce wrinkles?
Retinoids including retinol can reduce fine lines and wrinkles by increasing the production of collagen. They also stimulate the production of new blood vessels in the skin, which improves skin color. In the context of wrinkles, skin care plays an important role in prevention, rather than reversal. If you have established wrinkles, treatments such as clinical peels, lasers, Tixel, dermal fillers & Botox give more predictable outcomes. Nevertheless, dermatologists regard retinoids as one of the most potent anti-wrinkle ingredients. Maximal effects are seen after 10-16 weeks of use.
Do eye creams contain retinol?
Most eye creams contain a mix of retinol, caffeine, vitamin K, hyaluronic acid & peptides. Retinol can improve wrinkles by stimulation of collagen. Eye creams can be tricky to formulate, as the under eye are is super sensitive to skin care ‘actives’. Eye creams contain a much lower concentration of retinol compared to face creams.
Other ‘actives’ such as caffeine & vitamin K can modulate blood flow in this area, & can marginally improve dark circles.
Can retinol reduce skin pigmentation?
Yes. Retinol can be classified as a tier two pigment inhibitor. This ingredient is frequently prescribed to reduce melanin production, in turn improving melasma, age spots, freckles, post inflammatory pigmentation & other causes of pigmentation. It functions as a chemical exfoliant as well as a tyrosinase inhibitor. Maximal results are seen 6-10 weeks after starting.
Can retinol treat stretch marks?
Yes. Retinoids can give a marginal improvement in stretch marks. The reality is that there is no single best treatment for this condition. Early stretch marks are normally pink, red to purple in colour. THey respond best to retinoids & vascular lasers. Old stretch marks are white to silver in colour. These stretch marks respond best to retinoids and fractional lasers, Tixel or RF microneedling. Regardless of the age of stretch marks, most cases require 3-5 sessions for a modest improvement.
Why do dermatologists rate retinoids as one of the best ingredients for anti-aging?
Topical vitamin A based drugs called retinoids have the strongest anti-aging effects. These compounds have over three decades of scientific research & still remain as one of the very best anti-wrinkle ingredients.
Retinoids reduce fine lines and wrinkles by increasing the production of collagen. This is called neocollagenesis. They also stimulate the production of new blood vessels in the skin, which improves skin color. This effect is called angiogenesis. Retinoids also function as a chemical exfoliant as well as a pigment inhibitor.
What can not be mixed with retinol?
Don’t Mix: Retinol with vitamin C (ascorbic acid), benzoyl peroxide (BPO), and AHA/BHA acids. AHA and BHA acids are chemical exfoliants, which can dry out skin and cause further irritation if your skincare routine already includes retinol. BPO is a skin irritant & high concentration such as >2.5% should ideally not be mixed with retinoids.
The above rule is especially complex as it is NOT an absolute contraindication. For example Epiduo is a combination of a retinoid & benzoyl peroxide. Skin care experts combine AHAs prior to retinol or even strong prescription retinoids as part of their priming routine. Some patients tolerate BHAs as a gentle scrub prior to application of retinol. It really depends on the formulation of products, your insight, your innate skin sensitivity & any background dermatoses. Rules are not absolute.
What can be used with retinol?
Ingredients with a low irritant potential can be combined or used at the same time as retinol. Hyaluronic acid is a classical companion. This ingredient acts as a moisturizer. Used before retinol, hyaluronic acid can potentially make retinol work harder by aiding with skin penetration. Used after it can reduce the unwanted side effects of retinol, such as dry flaky & irritated skin.
Other compatible ingredients include azelaic acid, squalene, glycerin, emollients, petrolatum, ceramides & potentially niacinamide.
What is the strongest retinol cream?
The goal posts are constantly changing with over the counter retinol. The Ordinary makes high concentrations of just about everything, including DIY niacinamide & ascorbic acid. Be mindful that strong is not often the best, as side effects such as skin irritation are more common with stronger preparations. Formulations matter, especially when it comes to retinol.
What is the difference between prescription retinoids and retinol?
Retinol is the term for over-the-counter vitamin A derivatives; retinoid is the term for all products with vitamin A. All retinols are retinoids, but not all retinoids are, strictly speaking, retinol. The retinoid family, from weakest to strongest goes something like this- retinyl palmitate, retinol, retinaldehyde, then retinoic acid. The first 3 molecules must undergo conversion to retinoic acid before being biochemically active.
It is important to note that weaker does not mean it is less beneficial for your skin, as most people will experience skin irritation with retinoic acid- it’s just a matter of time or concentration (more complex than that as barrier function, absorption, molecule vehicle, background inflammation etc… all play a role.
Why are retinoids - retinol the number one ingredient prescribed by dermatologists?
Because they work. There are two sides to this story. Firstly, medical dermatologists (what I use to do over a decade ago), usually see the pointy end of skin conditions, namely skin disease rather than cosmetic dermatology. In this context we use retinoids to treat really severe skin conditions including plaque psoriasis, cystic acne, rosacea fulminans, congenital ichthyosis, PRP (pityriasis rubra pilaris), skin cancers & over a hundred more conditions. Google these names to see how scary these skin conditions are. This accounts for our ‘pointy end’ use of retinoids.
Now the fuzzy stuff. Cosmetic dermatologists also employ the use of retinol or prescription retinoids to prevent wrinkles, sun damage & modestly reduce pigmentation. Retinoids still remain as one of the most frequently prescribed compounds in skin care as it has the most amount of research over the past three decades. This is why all dermatologists rank retinoids as part of their ‘top 3’ essentials. Personally my top 3 include sunscreen, retinoids & hyaluronic acid (as a filler not as a serum).
How fast are the results following retinol use?
4-16 weeks, depending on your skin care goals. Retinoids function as a chemical exfoliant, compacting the outer stratum corneum, accelerating cellular turnover whilst building up epithelial cells over time. The initial effects are seen as early as 3-4 weeks, however maximal collagen production usually takes 12 weeks.
Be patient with your retinoid use. The biggest mistake I see is that patients dive straight in to the retinol peel. This can result in side effects such as redness, flaky, irritated skin. Start slow, build up. Slow in, fast out.
What is a good retinol product?
I won’t give formal recommendations as it depends on your budget as well as your skin type. My suggestion is that you start with a lower concentration of say, 0.5%. This is one skin care ingredient that you should start slowly with a less powerful, but more stable formulation. My favourite retinol formulations include Obagi, Aspect Doctor, as well as more cost effective solutions such as The Inkey List & The Ordinary.
Do you moisturise after retinol?
You can moisturise before, after or at the same time as applying retinol. The latter is advantageous when you are starting out as you are diluting the formulation. Moisturizing before, in theory will result in better absorption, whilst moisturizing after will decrease retinol side effects such as drying, flaking & irritable skin.
Who should not use retinol?
People with sensitive skin, including those who suffer from rosacea, dermatitis, or eczema should initiate retinol with absolute caution. For this skin type, consider starting with niacinamide, then retinol as vitamin B is less irritant compared to vitamin A.
Another option is to use a weaker retinoid, such as retinyl palmitate. This requires an extra step to be converted to retinol, then finally to retinoic acid. Simple steps including the frequent use of a moisturizer & titration of your skin care actives can smooth out your retinol journey. Be guided by your skin care expert.
Which is better, retinol or hyaluronic acid?
It’s like asking which is your favourite child? Retinol is an incredible compound designed to accelerate cell turnover, in turn improving skin quality. Higher concentrations can smooth skin and boosts collagen production. Retinoids function best at prevention rather than reversal.
Hyaluronic acid helps draw water into the skin providing a plump, glowing complexion. Placed within the dermis (aka Dermal Fillers), HAs reverse skin ageing by replacing volume, & stimulates your immune system to produce collagen.
As a rule, I generally prescribe a retinoid to all my dermal filler patients. Superficial placement of hyaluronic acid can improve the unwanted side effects of retinoids, including skin irritation, dryness & flaky skin. Hence retinoids & hyaluronic acid function synergistically.
*Disclaimer: I am a procedural dermatologist. This means I believe that hyaluronic acid works best under, not on the skin. I do initiate prescription retinoids for some of my patients post procedure. If you would like to obtain prescription retinoids your family physician can write one up.
Can I use retinol on my neck?
Yes, however your neck skin may be more sensitive to retinol. You can start every second night, titrating as tolerated. Don’t forget retinol can be sun sensitive, hence you will need to take extra precautions, namely don’t forget your sunscreen.
What are the side effects of retinol?
Side effects are universally seen with retinoid therapy. Important concept to understand as this is one of the most powerful molecules in dermatology. This threshold is dependent on 2 factors. Firstly your skin’s irritation threshold, and secondly the concentration of retinoic acid.
If you have very sensitive skin, there may be an adjustment period to retinols. During this period, skin can become more fragile with a tinner outermost cell layer (thinner stratum corneum). This results in increased sensitivity, which clinically results in redness, peeling and flaking. If you can get through this adjustment period & know how to titrate your retinol, this ingredient can help thicken the epidermis.
Skin purging is another side effect of retinol & retinoids. This usually occurs in the first few weeks of therapy & settles down within a fortnight or two, often without intervention. Purging is most commonly seen with oral or high strength prescribed retinoids.
What are retinol- retinoid peels?
Retinol peels can be classified as a superficial peel. The typical concentration @cliniccutis ranges from 1% to 4% retinoic acid. This peel requires a clinical assessment prior to the procedure. Retinoid peels can address conditions such as pigmentation, melasma, sun damage, acne, oily skin, open pores & blackheads. Downtime following this peel, defined as how long it takes your skin to stop shedding, ranges from 1 to 6 days. Occasionally my nurses & therapists may ask you to prep your skin, or alternatively perform an acetone scrub prior to the peel. We occasionally combine this treatment with Tixel or Hydrafacials for better results.
How long does retinol peeling last?
Retinol induced peeling only lasts for a few days, most often less than 48 hours. Retinoic acid peeling (eg from tretinoin, adapalene, tazarotene) may last 72 + hours, whilst retinoic acid peels (usually 1-4% retinoic acid), may take up to 6 days before settling down.
What does a skin care routine involving retinol look like?
A sensible skin care routine that involves retinol goes something like this;
AM: Cleanser, SPF, Make up, with the option of antioxidants (Ferulic acid, Ascorbic Acid, Tocopherol)
PM: Cleanser, Retinol, (Option to incorporate niacinamide, various pigment correctors).
*Though not an absolute contraindication, if you have tolerant skin, the addition of skin acids can prime the skin for better results. Examples of these chemical exfoliants include glycolic, lactic & salicylic acid. Ascorbic acid, like skin acids, are not absolutely contraindicated, & can be added to your routine if tolerated.
** Sounds complex? Be guided by your skin care expert
*** Disclaimer: I am a procedural dermatologist, namely I cut, inject, laser or do scary peels. Skin care though important is in the realm of medical dermatology. This can be discussed with your provider or dermatologist.
Davin’s view point on retinol
This still ranks as part of my Top 3 best ingredients ever invented for skin. The other two are sunscreen & injectable (not topical) hyaluronic acid. Retinoids, in the context of prescription retinoids, are not easy to titrate. Side effects are universally seen, it is just a matter at what concentration & how sensitive you are, namely your skin’s threshold.
The absolute majority of people would dive head first, buying super potent retinol from companies such as The Ordinary. Look, I don’t have anything against them, in fact I do believe they give great value for money as nothing is cheaper and stronger. It is just that most patients can not use it as directed. This results in skin irritation, dry skin, redness, flaky skin & blotches. I suggest starting at a lower concentration (whatever you are thinking, half it !!). Once you master this & understand your skin’s threshold, slowly increase.
Formulations matter. This is especially so with retinol. Cheap is not the best, conversely expensive is not the best, nor are prescription retinoids the answer. Be guided by your skin care specialist.
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