The most frequent advice I get from dermatologists is to drink water, wear sunscreen, and use retinol.
But there's a lot of ambiguity when it comes to shopping for retinol. Which versions of it are effective, and which are masquerading as effective? How often should you apply it? Why does it cause irritation? How long do you have to use it before you see results? Can you mix it with lotion? Do some products "cancel out" the benefits of retinol if mixed together? And on and on.
I asked four dermatologists —Dr. Dendy Engelman of MDCS Dermatology, Dr. Mohiba Tareen of Tareen Dermatology, Dr. Jason Emer, Dr. Shari Sperling of Sperling Dermatology, and a medical aesthetician with 10 years of experience as a facialist, Candace Marino, to answer the most common retinol FAQs. Find all the answers below.
WHAT IS RETINOL?
Retinol is a form of pure vitamin A, which is used in skincare to combat signs of aging. As we age, we lose vitamin A, and this depletion contributes to the normal signs of aging. Retinol is used to reverse and further prevent that process.
WHAT DOES RETINOL DO?
According to Dr. Engelman, "Retinol, and especially retinoic acid, work to increase cell turnover, build collagen, improve discoloration, hydrate skin and reduce acne by replenishing the body of vitamin A." And, according to Dr. Tareen, "Retinol is the only applied topical agent that has been shown to actually stimulate collagen and plump the skin due to the formation of new blood vessels."
Technically, retinol is just one of the many different types of retinoids. (Retinoid is the catchall phrase for A-based formulas). You'll see the name retinoic acid in prescription products, and names like retinol and retinaldehyde in over-the-counter (OTC) products.
WHAT ARE THE BEST OVER-THE-COUNTER RETINOL CREAMS?
The strongest retinol creams, like Tretinoin, will require a prescription. But, if you're looking for over-the-counter (OTC) options as a cost-effective, convenient alternative — or to use in tandem with a prescription retinol cream (for instance, on the nights when you're not using a stronger prescription because you're acclimating) — then these are the options dermatologists recommend.
Dr. Tareen, Dr. Engelman, Dr. Sperling, and Merino all independently recommended Differin Gel, which is relatively affordable at prices as low as $13 at major retailers like Target, Walmart, Amazon, Bed Bath & Beyond, and Ulta. It used to require a prescription but was approved for over-the-counter sale by the FDA in 2016. It's the OTC retinol product many dermatologists will recommend for patients who count acne and scarring in their primary concerns because it includes Adapalene, which is designed to treat acne. "Differin Gel Contains a powerful retinoid to clear acne and prevent future ones" explained Dr. Engelman, "as well as to prevent acne scarring."
Dr. Engelman also recommends Elizabeth Arden Retinol Ceramide Capsules ($84) as the best OTC retinol option for dry skin. "These are incredible for dry skin. They're formulated with ceramides, which help to hydrate the skin and can combat some of the irritating and drying effects that retinols have on the skin. Additionally, they have olive, sunflower, and avocado oils in the formula, so they add additional hydration to the skin while providing all of the benefits of topical retinol."
Other well-known options recommended by Dr. Emer:
Neutrogena Ageless Intensives Deep Wrinkle Moisture, $15.96
CosMedix Serum 16, $80
Neocutis Nouvelle Plus Retinol Correction Intensive Anti-Aging Cream, $150
Roc Retinol Correxion Deep Wrinkle Night Cream, $17.19
SkinCeuticals Retinol 1.0, $88
HOW SHOULD YOU LAYER YOUR RETINOL PRODUCTS ON THE SKIN?
Dermatologists are still a bit divided on this question, but a clear majority recommend starting with your thinnest consistency product and moving to the thickest.
Dr. Engelman recommends the following order (based on consistency): start with products like toning water, followed by serums and ampoules. Next, apply any prescription topical treatments (like retinol), then lotions, creams, and finally sunscreen at the end. If you're applying multiple serums, start with the thinnest. You should also allow each layer to be fully absorbed before applying the next one, which will probably only take about 30 seconds to one minute.
Start with a clean face and, if you want to be extra strategic, apply products when your skin is damp. "Your skin will be more pliable than dry skin," Engelman explains, "and this allows [the product] to penetrate deeper." But, if your skin is still acclimating to retinol and especially sensitive, Dr. Sperling recommends washing your face, waiting 30 minutes, and then applying it.
If you're especially sensitive to reintol, Dr. Tareen recommends using the "sandwich technique" — applying a light layer of moisturizer first, followed by the retinoid, and then another layer of moisturizer only in the places where your skin typically gets dry.
Layering products correctly is important if you want your products to work. If you place one product on your skin, like a serum, and follow up with another product whose molecules are smaller than the first, like a toner, then the second product cannot penetrate the first layer. The serum's large molecules will essentially "lock out" the molecules of the moisturizer. So, if you've already applied the serum, skip the toner — you're just wasting the product.
WHAT PERCENTAGE OF RETINOL SHOULD YOU USE?
Unless your dermatologist prescribes more, stick to formulas with 1% retinol or less. According to Dr. Emer, "You may want 0.25% when first starting out, then increase slowly to 0.5 and then to 1.0 overtime. Switch up strengths every two to four weeks when exfoliation and irritation are tolerable."
WHICH ITERATIONS OF RETINOL ARE EFFECTIVE AND WHICH AREN'T?
"All derivatives of Vitamin A are effective," Dr. Engelman explained. "[but] they vary on effectiveness."
To work quickly, the vitamin A ingredient needs to be closest to its active form (retinoic acid), which is what you'll find in prescription retinol creams. OTC options are often a few steps removed from retinoic acid, which is why they take longer to work.
The weakest version is retinyl palmitate (it has to convert first to retinol, then to retinaldehyde, then to retinoic acid), according to Marino. It may be good for people who have hypersensitive or very dry skin, but, if you want something stronger, then you'll want to find something with retinaldehyde in it, since it's one step closer to retinoic acid.
Dr. Emer advises avoiding Retinyl acetate, Retinyl propionate, and Retinyl palmitate; the body does not convert enough of it to retinoic acid for it to be very helpful.
It's also recommended that if you have sensitive skin, you don't combine active products like benzoyl peroxide, sulfur, resorcinol or salicylic acid, which are often found in acne treatments. The combination can increase irritation and decrease retinol's efficacy.
HOW OFTEN DO YOU NEED TO USE RETINOL TO SEE RESULTS?
Generally, it takes a few weeks to see results, but some OTC options may require months of regular use. Most dermatologists said you'll need to use retinol for a few weeks before you see results, but you should see improvements by 12 weeks with most products.
HOW OFTEN SHOULD YOU APPLY YOUR RETINOL CREAMS?
In the beginning, Dr. Engelman, Dr. Tareen, Dr. Sperling, and Marino recommend starting out by applying a retinol one to two nights per week to build up your skin's tolerance. Then, increase your frequency to every other night, as you can tolerate it. The goal is to eventually train your skin to use it nightly.
When using retinol creams, you may experience some dryness and sensitivity, but not necessarily. "This adjustment phase is known as Retinization," Marino explained. "During this phase, one can expect dryness, flakiness and mild redness, which is caused by the retinol's breakdown of dead surface cells."
Even sensitive skin can be "trained" to tolerate retinol, according to Dr. Engelman.
HOW LONG DOES IT TAKE FOR YOUR SKIN TO ADJUST TO RETINOL?
Usually, most people's skin will adjust within six to 12 weeks, according to Dr. Tareen.
"Cell turnover is typically 21-28 days," Dr. Emer explains. "With retinol, it can be increased to a 7-14 day shed. So, in general, it takes two to six weeks for your skin to get used to retinol. Redness, irritation and flaking are normal for that period, as well as when you increase in strength (as you progress) or when you combine with actives like glycolic acid or salicylic acid (if you have acne) or hydroquinone (if you have pigmentation)."
CAN YOU MIX RETINOL WITH LOTION WHEN APPLYING?
In order to get the best effects, Dr. Tareen recommends not diluting your retinol by mixing it with lotion. If you need to, she recommends applying layers of moisturizer instead. "It's not wrong to mix in moisturizer, just less effective."
But, Dr. Tareen and Dr. Emer agree that you shouldn't mix retinol with certain ingredients. If your lotion has alpha-hydroxy acids or benzoyl peroxide in it (commonly found in acne-fighting products) then you may not want to mix the two. They can make retinol less effective and may worsen irritation.
HOW MUCH RETINOL SHOULD YOU APPLY?
Each dermatologist advised using a pea-sized amount, or just slightly more than that to cover your entire face. Dr. Tareen recommends dispensing a pea-sized amount to the back of your hand and then taking a drop of that to the forehead, nose, cheeks, and chin — and then connecting the dots by rubbing it in gently.
And don't stop the benefits at just your face. Dr. Engelman and Dr. Emer recommend placing a thin layer over the face, neck, chest, and even hands.
DOES RETINOL EXPIRE?
Yes. You'll want to check the date on your tube before use.
DOES RETINOL HELP ACNE?
Yes, retinol is the best medication for most acne, Dr. Tareen explained. "Retinol is the only medication that affects the four causative actors of acne: P. acnes bacteria, inflammation, sebum production, and keratinization (over-growth of dead skin cells)."
Dr. Emer points to its exfoliating powers for opening and cleaning out the pores, as well as decreasing oil production and inflammation.
DOES RETINOL LIGHTEN THE SKIN?
No. Retinol does not affect the melanocytes (pigment-producing cells), according to Dr. Tareen. "The skin can look brighter with routine retinol use because of the normalization of the skin barrier and because your skin looks more even with fewer blemishes. Skin also looks rosier with retinol use because retinol turns on the production of good blood vessels in the skin."
DOES RETINOL THIN THE SKIN?
Yes and no. Retinols do thin the outer layer of the skin (the stratum corneum), but, according to Dr. Tareen and Marino, that's one of their advantages. "As we age, the outer stratum corneum can get dull and rough. So we want retinols to thin the stratum corneum so that skin can look smoother and more polished." Dr. Tareen explained. "Retinols actually thicken the dermis (the collagen packed layer of the skin) so you look plump and fresh."
A thinner outermost layer also helps your products penetrate deeper. "Retinol is going to exfoliate the stratum corneum - the outermost layer of the epidermis which is comprised of dead skin cells." Marino said. "In doing this you're allowing better product penetration to ensure proper hydration since your hydrating products aren't working through the dead barrier."
DOES RETINOL HELP WITH ACNE SCARS?
Yes, though not drastically. By stimulating collagen and thickening the dermis, retinols help to fade pits left by past acne, according to Dr. Tareen and Dr. Sperling, but Dr. Emer notes that the effects will be minimal. "It can make the texture of the skin appear smoother, but scarring [often] requires more deep treatments like lasers, peels, fillers, subcision, etc."
DO THE RESULTS LAST IF YOU STOP USING RETINOL?
Yes, but most dermatologists say you'll want to resume using it for optimal results. "Retinols help turn back the clock. If you have to stop them (for example while pregnant), your skin is still better from the time you were using them," explains Dr. Tareen. "[but] best to re-start your retinol again when you can."
Most dermatologists recommend using it at least twice weekly to see results.
CAN RETINOL CAUSE HARM?
Yes, retinol can be harmful if you are pregnant or using it too frequently before building up a tolerance. If you're pregnant and looking for an alternative, Marino recommends Active Serum by iS Clinical ($138) which features a multi-acid complex to accelerate cellular turnover as a temporary alternative. Dr. Engelman mentioned Bakuchiol, "an antioxidant that has been proven to help with oxidative stress, as well as acne. It mimics vitamin E to help heal and hydrate the skin. It is antibacterial so it helps to regulate breakouts. Lastly, it protects the cell from oxidative stress by regulating the mitochondria. This limits cell damage from free radicals and therefore combats aging." Bakuchiol was popularly used in Beautycounter's line Countertime. You can read more about it here.
This article was originally published on insider.com.
