It's interesting how many people write to me saying that they have reached a retinol “plateau”. It usually takes a few years for this to happen. Initially they are delighted by the results – retin A works very quickly to give a clearer, brighter looking complexion. But over time there is a cost and that can be a heavy one of thinner, duller and more fragile skin. So if you are thinking about starting out with retinols, it’s good to understand what you are getting in to. And if you shy away or want to wean yourself off retinols, what would be a good alternative regimen? Since this is one of the FAQs in my email box, I thought it would be worth sharing in a post.
Retinol is vitamin A in its whole molecule form, which can be broken down into thousands of smaller components, including retinoic acid (or tretinoin, the active ingredient in Renova and retin-A). Doctors tend to prescribe retinols because there’s a ton of research on them and patients (if they don’t find them too irritating – I’ll come back to this in a moment) tend to be happy with the results. But it is important to understand how those results come about.
Vitamin A itself does not have a direct effect on skin, but is only effective after specialized enzymes in the skin cells convert it into retinoic acid (tretinoin). Retinoic acid facilitates communication between cells, encouraging aging cells to turnover. This repeated shedding of the upper dermal layer forces the skin to produce new cells. These new cells look a lot better than the old ones, but they come a price.
The downsides of heavy duty exfoliation include thinning skin. Although new cells are facilitated by the retinoic acid, it may be that the Hayflick Limit (the number of times skin can regenerate itself before reaching its limit, at 52 times), is being speeded up. Certainly, many of the women that write to me report that after years of retinol, their skin seems thinner, duller and more delicate. There are other issues to consider as well, such as irritation – redness, scaling and itching are relatively common – and severe allergic reactions that can include blurred vision (see Junko’s post on her experience with tretinoin). Propensity to sunburn is also increased. And then there is the not insignificant issue that retinol has been shown to produce excess free radicals.
So what are the alternatives?
A more gentle approach to exfoliation is a good place to start. Glycolic acid will brighten the complexion considerably. It exfoliates by reacting with the upper layer of the epidermis, weakening the binding properties of the lipids that hold the dead skin cells together. The stronger the concentration, the more there is a likelihood of irritation and sensitivity to sunlight. For ideas for effective but gentle glycolic products, see our 2011 Five Best. You have to experiment with how often you need to use a glycolic product, but a general guideline would be 2-3 times a week to begin with and once you start to see a marked improvement, you can cut down to once a week (twice at most).
I often recommend Your Best Face Restore for weaning off retinol and typically users say that it helps their skin calm down considerably. Although there are mixed reports on whether it brightens the skin post retinol (read Erica’s experience of discontinuing retin A and trying out Restore). I haven’t used retinol, but I do consistently find Restore to be both soothing and revitalizing.
Arbutin is one of the key ingredients in Restore and is worth looking out for if skin lightening is your goal. A natural source of arbutin is bearberry, which can be found in John Masters Organics’ mist and in La Vie Celeste’s glycolic mask and moisturizer. Recovering retinol users could also think about gravitating towards a good vitamin C product for brightening and help with hyperpigmentation. Nutra-Lift does a very good value one, Maximum C (1oz for $34 in the TIA shop) and at the other end of the spectrum there is E’shee’s ($117 in the TiA shop), which is super stable and very gentle (I just recently started using it again and I am loving it). There’s also a mid-range ($85 in the TIA shop) one called Collametics.
Also worth incorporating is hyaluronic acid to help combat dryness. Note that straight up hyaluronic acid tends not to work in dry climates (it works by pulling in and retaining moisture) and should be used with other things. But products with a decent dose of hyaluronic acid (see our Five Best for some recommendations) help plump out the skin and a spate of supporting research has recently made it the darling of dermatologists – so at least you and your doc will have something to agree on again.