I always tell people the secret weapon in my anti-aging arsenal is not eye cream or Botox, it's Retin-A. Retin-A is one of many retinoids (a Vitamin A derivative) on the market which are proven to "significantly" reduce fine lines and wrinkles, according to dermatologist Maryann Mikhail of Spring Street Dermatology in NYC. "I never recommend any of the other expensive products out there claiming to do this," she said.
Mikhail's retinoid endorsement is one of many I've read from leading dermatologists. But while these products are purported to turn back time, using them comes at a price. Retin-A, Renova and Retacnyl almost always cause redness and peeling the first couple weeks of use. I've had many friends get a tube of Retin-A and never use it because they're afraid of the side effects. I've had other friends stop using Retin-A after they freaked out over the resulting redness and peeling. One friend reported to me that she actually got acne from her tube of Retin-A.
So what gives? Just how risky are retinoids? I asked Mikhail these questions and more and her answers changed the way I use Retin-A (my product of choice). It turns out you can start on a retinoid regimen with little problems, but there are a few secrets to properly using them.
Make Sure You're Using the Right RetinoidI swear by Retin-A 0.05%, but if you have sensitive skin or are extra worried about peeling and sensitivity, you may want to ask your doctor to put you on a milder Vitamin-A derivative allowing you to gradually work up to the extra-strength stuff.
"For my retinoid novices, I usually start with adapalene or tretinoin and 'graduate' to tazorac when I feel their skin can handle it," said Mikhail.
Retinoids basically boil down to 3 types: adapalene (Differin), tretinoin (Retin-A, Renova, Atralin, Avita, Refissa and Retacnyl) and Tazorac, according to Mikhail.
"In general, adapalene is the most mild, tretinoin is in the middle and tazorac is the most intense (makes you peel the most)," she said.
Once you're on the right prescription dose, here's how to start using it properly.
Thou Shalt Not Abandon The ProductOne of the biggest mistakes people make with a new skincare routine is to abandon it. It takes a couple weeks for skin to acclimate to a product and even more time for skin to start showing the benefits of the product. One way to help skin adjust to retinoids is to start slowly, something my friends who tried Retin-A did not do. Like me, they used a nickel-sized glob every evening to cover the face and neck.
"The secret to proper retinoid use is to take it slow," says Mikhail, who suggests using a pea-sized amount for the whole face and neck, starting one night a week for the first 3 weeks and increasing slowly as skin becomes accustomed.
"Studies have shown benefit from use even just a few times a week if that's all you can tolerate," Mikhail says. In my experience that "pea-sized" amount barely covers my forehead. It seems to go further when I've first moisturized my skin. You can also mix the cream or gel with moisturizer so you have more product to work with.
Understand What it Fixes & What it Doesn'tSomeone once asked me if Retin-A would fix the deep lines that were developing on the sides of her nose. Others ask me if Retin-A will make their crow's feet magically disappear. According to Mikhail, prescription-strength retinoids decrease pore size, prevent whiteheads and blackheads and improve the signs of fine lines and wrinkles, but they won't fix deep lines or crow's feet.
As for those deep lines around the nose, injectable fillers like Restylane are your best bets. You could also gain weight. Women over age 40 with extra padding on them tend to look younger than skinny women, who've lost the fat in their faces as they've aged. Think of that famous Catherine Deneuve quote, "When you get older, you have to be ready to trade your ass for your face."
Do I Have to Get a Prescription? What About OTC Products?My research shows over-the-counter retinols (a lower-dose Vitamin A derivative) do not have the effect of prescription-strength retinoids. Some European countries, Canada and Mexico, sell retinoids over the counter, so if you're traveling to other countries, you can pick up Retin-A or Retacnyl in pharmacies without a prescription. Keep in mind there are risks associated with retinoids, so I strongly advise using it under a doctor's supervision.
The Side Effects of Vitamin A ProductsRetinoids will cause redness and peeling in some patients. As for my friend's claim that she broke out from Retin-A, Mikhail said this could happen, "Your friend who swore Retin-A broke her out is right on - in a lot of acne patients, it does do that in the first 2 or 3 weeks of use. I like to think of it as the retinoid bringing all the pimples under the skin out at once. After that initial hump, they do clear up."
If you find your skin has become dry and reddened on Retin-A, stop your skincare regimen and slather on extra virgin olive oil at night instead. According to Dermatologist Jessica Wu in Harper's Bazaar, olive oil contains fatty acids comparable to those found in your own skin, so it makes for a very gentle and incredibly moisturizing moisturizer.
Warning: Retinoids Aren't for EveryoneIf you are using a retinoid or any Vitamin A derivative, you will be extra sensitive to sun. You'll be at high risk for sunburn, so make sure to wear sunscreen every day with regular reapplications. I also advise wearing a hat. I usually stop Retin-A use during the summer.
Also, if you are pregnant or trying to get pregnant, do not use retinoids.
If You Use This, Must You Stop Scrubs & Peels?While using retinoids, you should avoid chemical peels and scrubs, which can be too harsh on skin. Mikhail recommends to her clients gentle cleansers and moisturizers, such as Purpose, Cetaphil and Aveeno.
Maryann Mikhail, MD, is a dermatologist with Spring Street Dermatology, (212) 431-4749.