Walk into any pharmacy or grooming emporium and you’ll be met by shelf after shelf of salves promising the impossible: turning back the hands of time and clearing your skin of every blemish.
But can anything—short of a good old-fashioned needle to the kisser—actually give you those kinds of results? If you have a decent amount of patience and you’re willing to make a physical or virtual appointment with a dermatologist, the answer is a resounding yes.
That’s because you can only get top-shelf retinoids, a buzzy ingredient that has been a secret among skincare enthusiasts for a few years now, with a prescription. “There is a plethora of data showing that consistent retinoid use minimizes fine lines, evens skin tone, smooths texture, and decreases acne,” says Dr. Carolyn Treasure, a board-certified physician and founder of Peachy, a New York-based skincare studio that focuses on the three pillars of skincare—Botox, sunscreen and retinoids.
But it’s easy to confuse this seemingly magical ingredient with retinol, which is often the active ingredient in over-the-counter products that purport the same benefits (younger-looking, clearer skin). “While they act through the same pathway, retinol is the less active form, rendering it 20-fold less potent than prescription tretinoin,” Treasure says, referring to the name for a potent, naturally occurring form of retinoids.
In short, retinoids are a medically-proven ingredient that can actually make a difference. But if you want to know more, we assembled answers to some of the most commonly asked questions about them below.
What are retinoids, and how do they work?
Simply put, retinoids are “derivatives of vitamin A that get converted into retinoic acid in the skin after application,” says Dr. Evan Rieder, a dermatologist who works at NYU Langone and specializes in both general and cosmetic dermatology. “Retinoids increase the rapidity in which the outer layers of the skin turn over,” he explains. “This can be helpful for unclogging pores, removing dead skin cells, preventing acne and also as an antiaging medication. With regular use, people are able to achieve a glow-like appearance to their skin and less crinkliness.” Dr. Rieder likes them so much he recommends them to almost all of his patients, “as most of them have some type of aesthetic concern with their skin.”
How long will it take to see results with retinoids?
Sadly, it won’t happen overnight. But that doesn’t mean they’re not worth your time. “Tretinoin makes changes on a cellular level,” says Dr. Treasure. “Because of this, charges are long-lasting, but it can take several months for you to see the full results.” She says its effects take, on average, four months to fully express themselves. However, with consistent use, improvements can be seen sooner—like a lessening of “tactile roughness” in as soon as one to two months, a “rosy glow” (the actual scientific term) during the second or third months, and the minimization of fine lines afterward. “Tretinoin is truly the gold standard in any skincare regimen, and almost everyone would benefit from including tretinoin in their skincare routine,” Dr. Treasure said. (People who are pregnant or breastfeeding, however, should avoid them.)
How will my skin react to retinoids?
“The mechanism of rapid cell turnover makes these products particularly drying,” says Dr. Rieder. “Especially when they are introduced in high quantity and too frequently.” Dr. Treasure agreed. “While your skin quickly grows accustomed to this, patients may experience this redness, dryness, or can see mild acne flares during the first two weeks,” Dr. Treasure said. At Peachy, she noted, they formulate tretinoin treatments with a lower dosage and slowly bump it up, and each patient gets a custom formulation which also includes vitamin C, niacinamide, and hyaluronic acid to help offset the more severe reactions and pump up the hydration. But agitation, redness and dry flakiness aren’t unheard of.
Why is now a good time to start using retinoids?
Well, depending on when and where, exactly, you read this, you may have two things going for you: a quarantine and masks. Spending more time indoors can help cut down on irritation, as retinoids can make the skin more sensitive to sun exposure. And if you do have to go out into the world, those essential cloth face masks may hide any dry skin or reddening that some beginners experience.
So what should a retinoid newbie do?
“I always tell patients to start with a pea-sized amount every other night and to moisturize twice daily,” Dr. Rieder says. “Often people have difficulty with application and tolerability so I even made an intro video to retinoids on my Instagram page to help troubleshoot and offer alternative methods of application when things are not so straightforward. Start slow, moisturize frequently, be patient, and don’t get discouraged by mild side effects in the beginning.”
What about over-the-counter retinol?
“Over-the-counter retinols have not been FDA approved, are less rigorously studied, and are about 20 times less effective than prescription tretinoin,” said Dr. Treasure. “That said, they act through the same pathway, and it is possible to see some of the benefits with over-the-counter retinols. However, to get the full benefit one should use retinoids.”
“Retinoids are an umbrella term that encompasses both retinol and retinoids. Although both are available OTC, retinol requires multiple steps to become activated, thus is considered less potent,” Dr. Rider said. “The retinoid adapalene gel is OTC and has a higher concentration of active ingredients than retinol, thus you can expect quicker results from its use. Differin Gel and La Roche Posay Adapalene Gel are worth trying if you can’t get in to see a board-certified dermatologist,” he said. “Or while waiting for an appointment.”