Retinol

Retinol is the single most important non-prescription skin care active ingredient we have to fight the signs of skin aging, second only to sunscreen. All skin experts agree,    

Vitamin A and its derivatives are among the most effective substances slowing the aging process.... Vitamin A and its derivatives, particularly retinol, are substances slowing the aging process most effectively. (1)

If you want to keep your skin young, fight skin aging and/or reverse the signs of skin aging, you want to be using a retinoid in your skin care routine. Of all the retinoids, my opinion as a dermatologist who has practiced for over 30 years and closely followed the scientific literature on skin aging, is that retinol, as in my Retinol Ultra-Intensive Anti-Wrinkle Night Cream and Advanced Corrective Eye Cream, is clearly the best non-prescription retinoid to fight skin aging. 

What is Retinol?

Retinol is Vitamin A. It belongs to the family of ingredients called retinoids. Retinoids applied to skin have been scientifically-proven to fight wrinkles, uneven hyperpigmentation and dull complexion tone and texture. They are some of the best studied ingredients in skin care for these problems. I've used retinoids in my dermatology practice for over 30+ years and have seen the results daily. I've used retinoids on my own complexion over this same time and appreciate the benefits they've provided for my own 60+ year old previously sun damaged skin. 

There are 3 groups of retinoids. The first group works the best to slow and reverse skin aging in my observation:

1. Natural retinoids: retinol (vitamin A) and its metabolites – retinal, tretinoin, isotretinoin,
2. Synthetic analogues of vitamin A used as oral medicines (etretinate, acitretin),
3. Synthetic topical retinoids (arotinoid, adapalene, tazarotene).

Retinol, retinal and retinoic acid have the same biological features as vitamin A.

Tretinoin is also called retinoic acid and sold as Retin-A. It is the best studied retinoid for anti-aging skin care efficacy. Retinol, which is non-prescription all-trans-retinol, is converted in the skin to retinoic acid.

Retinol Facts

I am going to describe how retinol works and how to use it to get the most benefit from your skin care routine.

How does retinol work for your skin?

Retinoids work by activating special receptors in your skin called retinoid receptors. This means that retinoids have unique pathways to change your skin. Retinoid binds to the retinoid receptor and activate biochemical changes that lead to anti-aging effects that you’ll see in the mirror. 

How does retinol fight the signs of skin aging and pigment problems?

• 
  Retinol stops the breakdown of skin collagen that happens after UV sun exposure; UV rays activate the matrix metalloproteinase (MMP) enzyme cascade that leads to the breakdown of your skin collagen. Retinol turns off the MMP enzyme.;
• Retinol stimulates cells in the skin to make collagen. The cells are called fibroblasts and when they make new collagen it reverses wrinkles and skin thinning from sun damage;
• Retinol brightens skin appearance to give you glowing skin by exfoliating and improving the structure of the dead cell layer on the skin surface;
• Retinol improves crepey skin appearance by increasing epidermal layer thickness and structure in the top, living skin cell layer; 
• Retinol normalizes pigment problems in the epidermis to fight uneven skin hyperpigmentation; and
• Retinol increases skin hyaluronic acid, the water binding powerhouse, to give skin a moister, dewier and more youthful appearance. It does this by stimulating skin fibroblasts to make hyaluronic acid.

Retinoids can stop the degenerative cycle of skin aging.

Your skin gets more and more wrinkled over time from both UV light exposure and aging. This is because both cause a self-perpetuating cycle of collagen loss due to free radicals. Retinoids are capable of stopping the cycle and it’s never too soon or too late to intervene to stop the cycle.

Retinol is the best non-prescription retinoid to use to fight the signs of skin aging.

There are other non-prescription retinoids, but they don’t all work equally well to fight the signs of skin aging. Of the over-the-counter (non-prescription) retinoids, retinol is the one to use. The others, which are technically called pro-retinols (a.k.a. retinyl palmitate, retinyl acetate, and retinyl linoleate), are much weaker at providing all of the retinoid goodness that I mentioned above. I don’t recommend them.

Retinol at higher concentrations will give your skin more age-defying results.

It’s also more irritating. Start at lower levels and work up as your skin adjusts. Also, you can help your skin tolerate higher retinol levels when you use products that calm skin inflammation such as green tea. Also, some retinol products are made in slow-release formulations. My Retinol Anti-Wrinkle Night Cream uses both of these methods for skin tolerability. 

What concentration of retinol is used in skin care products?

Retinol products are made in 0.25%, .3%, .5% and 1% retinol. You need a concentration over 0.4% to capture the age-fighting benefits of retinol. The concentration may be noted as a percent or with an 'X'. 0.4% will be 4X and 1% will be 10X. My Retinol Ultra-Intensive Anti-Wrinkle Night Creams come in 1%  noted as 10X - the highest strengths allowed. This is a professional cosmeceutical retinol product that you would expect from a dermatologist. First time retinol users may need to start slowly and even dilute the 10X retinol in half with their nightly moisturizer. I explain this in my use instructions on the product page. 

Is retinol good for acne?

Yes, retinol helps fight acne by:

1. Preventing dead cells from clogging pores and causing blackheads and pimples; and
2. Preventing acne scars by preventing pimples that form from clogged pores.

Retinol is less irritating to your skin than retinoic acid (Retin A and Renova).

Irritation is the main problem that people complain about with tretinoin (Retin A, Renova) and tazarotene (Tazorac). Retinol products are simply less irritating, making them better suited for sensitive skin.

If you do need to use tretinoin, don't miss my guide to using and layering tretinoin into your skincare routine.

Not all retinol products contain active retinol.

That’s because retinol is fragile and must be formulated and packaged carefully to preserve activity.

4 Tips to find the best retinol cream or serum.

Look for a retinol product with:

1. Pharmaceutical grade Retinol;
2. High, professional Retinol concentration in a product;
3. Packaging that protects ingredients from air and light; and
4. Hypoallergenic base that does not contain unnecessary fragrance or other ingredients which can be absorbed excessively by retinol treated skin.

My top choices for professional and pharmaceutical grade retinol products include: 

Retinol Ultra-Intensive Anti-Wrinkle Night Cream is formulated with the highest allowed retinol concentration. The product page notes my instructions for starting 'low and slow' with this powerful retinol. 

Advanced Corrective Eye Cream, made with just the right amount of retinol for the delicate eye area. 

 

How do you apply retinol to your face?

• 
  Retinoid products are best used as your night cream because retinol breaks down on contact with light.
• You can apply retinol during the day under a mineral zinc oxide sunscreen that protects retinol from light.
• Retinol can be applied alone or layered with other skin care products like moisturizers or glycolic acid AHA products but not with benzoyl peroxide.
• I usually recommend starting every other night and working up to every night.
• Sensitive complexions might need to avoid using retinol on sensitive areas of the face such as eyelid folds or around the nose creases.

How long does it take to see results from Retinol Night Cream?

In my dermatology practice, I see results that evolve over time when a person starts using retinoids:

• You can expect to see results in a week in terms of improved skin tone and texture. Skin will look brighter and healthier because of the rapid impact on the dead cell layer.
• Fine lines and wrinkles will begin to look better in the first few weeks due to the changes on the dead cell layer.
• Surface pigment problems will be reduced within the first month.
• Pores will be less clogged within a month or two.
• There will be a reduction in milia in a month or two.
• It takes several months to reduce deeper pigment problems.
• It takes a 3 to 6 months for dermal collagen production to build up to help reduce wrinkles.

References

1. Zasada M, Budzisz E. Retinoids: active molecules influencing skin structure formation in cosmetic and dermatological treatments. Postepy Dermatol Alergol. 2019;36(4):392-397. doi:10.5114/ada.2019.87443

2. Reza Kafi, MD; Heh Shin R. Kwak, MD, Improvement of Naturally Aged Skin With Vitamin A (Retinol), , Arch Dermatol. 2007;143:606-612

3. Kikuchi K, Suetake T, Kumasaka N, Tagami H, Improvement of photoaged facial skin in middle-aged Japanese females by topical retinol (vitamin A alcohol): a vehicle-controlled, double-blind study.  J Dermatolog Treat. 2009;20(5):276-81

4. Sachs, DL, Choosing Topical Retinoids for Aging Skin,  Dermatology Focus, Summer 2013 Vol 32 No 2 page 4

5. Sewon Kang, Elizabeth A. Duell, et. al., Application of Retinol to Human Skin In Vivo Induces Epidermal Hyperplasia and Cellular Retinoid Binding Proteins Characteristic of Retinoic Acid but Without Measurable Retinoic Acid Levels or Irritation, J Invest Dermatol 105:549-556, 1995

6. James Varani, Roscoe L Warner, Mehrnaz Gharaee-Kermani, et. al., Vitamin A Antagonizes Decreased Cell Growth and Elevated Collagen-Degrading Matrix Metalloproteinases and Stimulates Collagen Accumulation in Naturally Aged Human Skin,  J Invest Dermatol (2000) 114, 480–486;

7. Weiss JS, Ellis CN, et. al., Topical Tretinoin for Photoaged Skin: a Double-blind Vehicle-controlled Study, , JAMA. 1988, 259: 527-532

8. Kang S, Leyden JJ, Lowe NJ, et al., Tazarotene Cream for the Treatment of Facial Photo Damage: a Multicenter, Investigator-Masked, Randomized, Vehicle-Controlled, Parallel Comparison of Tazarotene 0.01%, 0.025%, 0.05%, and 0.1% Creams and Tretinoin 0.05% Emollient Cream Applied Once-Daily for 24 Weeks.  Arch Dermatol. 2001;137:1597-1604.

9. Sewon Kang, MD, Gary J. Fisher, et. al., PhD, Mechanisms of Photoaging and Chronological Skin Aging,  Arch Dermatol. 2002;138(11):1462-1470