For years, prescription retinoids (face medications like Retin-A, Renova, and Tazorac that contain the vitamin A derivative) have been assumed to be the best antiaging products. Indeed, decades of clinical research show that they speed cell turnover to smooth wrinkles, fade sunspots, and build collagen. But now there are claims that they can also thin the skin and cause chronic inflammation (peeling, lobster-red faces), actually leading to premature aging. The issue is dividing the beauty world. Who's right? Read on and make up your own mind.
It's hard to argue with the science behind retinoids, says Miami dermatologist Dr. Leslie Baumann. "They are prescription drugs. For FDA approval, drug companies have to do scientific studies that absolutely prove retinoids get rid of wrinkles. It is the only thing on the market that has such concrete evidence." (Over-the-counter products with the vitamin A derivative retinol are similar but less powerful, and don't require FDA approval or undergo the same stringent tests.) Dermatologists balk at the idea that retinoids thin the skin because, as New York City derm Dr. Eric Schweiger argues, retinoids actually increase the thickness of the dermis—the deep layer of skin where wrinkles form. Since patients have to build up a tolerance to retinoids over several weeks before they can use them daily—and slathering on more than the recommended pea-sized amount results in a guaranteed flake-fest—using them too often or applying too much can give the impression that your skin is getting thinner, says Schweiger. Washington, D.C. dermatologist Dr. Tina Alster concedes that too much skin inflammation will break down collagen—which translates to lines and sagging. "But it's only a problem if people are chronically rip-roaring red and itchy," she says. "If you're on retinoids for a long time and you don't have that intolerable inflammation, you're not destroying your skin. You're helping it."
Most skin gurus who dislike retinoids are not dermatologists and see skin research in a different light. According to New York City facial plastic surgeon Dr. Michelle Yagoda, "The key is looking at the retinol studies and understanding how much collagen can really be built," she says. "It doesn't matter if it gives you 10 percent less of a wrinkle—that's so microscopic, our eyes can't distinguish it." Says Yagoda, retinoids are easy to prescribe, so patients are rarely offered an alternative. (In her experience, glycolic acids are just as effective and better-tolerated.) While most experts agree that retinoids do produce quick results, many claim they might not be worth it. "Sure, your discolorations and lines might be getting a little better," says Simon Erani, lead researcher for the skincare company Somme Institute, "but you're not noticing how your skin looks papery and thin." Erani believes any inflammation (detected in his subsurface skin photos of people who'd been using retinoids for at least eight weeks) will damage skin in the long run, which is why he's excluded it from Somme's formulations. New York City aesthetician Susan Ciminelli says she can spot retinoid users right away: "Their skin looks brittle because it has lost its cushion." She believes that retinoids strip the skin, while the path to a youthful glow involves adding natural moisture and emollients. (For her own product line, she favors the hydrating power of seaweed and algae.) "What you want is thick, juicy skin," she says. "Juicy skin is young skin."
The bottom line: There's one thing everyone agrees on: Excessive inflammation should be avoided to slow down damage and aging. So if using retinoids makes your skin uncomfortably flaky, red, or irritated, seek out gentler measures. The point is to soften, not deepen, those worry lines, after all.
Originally published on November 2, 2009