The HintMD Guide To Retinoids, Retinol & Everything In-Between

A tricky little business, retinoids. With terms like retinoic acid, retinol and tretinoin all being constantly talked about in the skincare business, we even confuse ourselves sometimes.

Then you throw those similar-sounding brand names like Retin-A into the mix and, well, mind… officially… blown.

But here’s the thing, retinoids – the broad term that encompasses all forms of retinoic acids and retinols – are superheroes when it comes to skincare ingredients, so anyone interested in achieving and maintaining beautiful skin should really know what’s what. Offering a whole host of anti-aging and beautifying benefits, retinoids stimulate the skin to turnover more efficiently, and also help soften it by thinning the outermost layer of the epidermis, the stratum corneum. They can also visibly improve the plumpness of your skin by increasing the presence of skin-nourishing glycosaminoglycans, (GAGs).

“Numerous unbiased studies have been performed on the effects of retinoids,” explains Walnut Creek-based facial plastic surgeon Dr. Haena Kim.

“Results show it has the ability to thicken the skin and re-organize collagen and elastic fibers, not to mention the help it provides for pigmentation issues. Recent research also points towards an innate ‘antioxidant effect’.”

So, bearing all this in mind – as well as the fact that most adults could benefit from some form retinol treatment in their skincare plan – we decided to grill Dr. Kim about the wonderful world of retinoids.

Deep breaths. Brains into gear. Here we go…

Let’s get back to basics, retinoids are basically vitamin A, correct?

“Yes. Vitamin A is a fat-soluble vitamin that we naturally obtain via food and it is critical for cell growth and differentiation. The active form of vitamin A is called retinoic acid, and in the body retinoic acid molecules attach to retinoic acid receptors (RAR) directly in the nucleus of cells, which is where the cell’s genetic information is held. This attachment triggers and activates specific genes that stimulate the skin to turnover more efficiently. Basically retinoic acid is the form of vitamin A that does all the good stuff!”

So if retinoid is the broad term that encompasses all forms of retinoic acid, what is tretinoin?

“Tretinoin is the topical form of retinoic acid and seen as the gold standard of retinoids. Some patients simply cannot tolerate tretinoin, however and can only use retinol products. ”

And retinol is…?

“Retinol is a precursor of retinoic acid and has to go through two steps before it becomes retinoic acid. As a result of this processing, retinol doesn’t create as many side effects as retinoic acid – if any at all – and this is why it’s the darling of many anti-aging products.

“For retinol to equate the effects of retinoic acid, however, it has to be at a higher concentration. The difficulty with so many over-the-counter brands is that it’s questionable how much retinol is even in that product.”

Got it. So, which retinoid is best for the skin?

“This totally depends on what your skin will tolerate, so you should always get advice from a board-certified physician before diving in head first and potentially doing more harm than good.

“Personally, I’ve tried many different formulations – from a topical tretinoin to over-the-counter products purchased in department stores – and the best results I’ve seen have been from either a true tretinoin or from Neova Dual Matrix [Retinol + DNA].

“I use a retinol product currently because I was having sensitivity issues with even the lower percentages of a prescription tretinoin. I was continually having to wait several days for the side effects to dissipate and then would often forget to add it to my evening regimen when the time was right. Using a retinol product nightly means I don’t have to worry about keeping track of when I last used it for fear of having those side effects return. And anything that makes my skincare routine easier and more straightforward is always a bonus in my eyes!”

Any tips for retinoid first-timers?

“Whichever type of retinoid you’re prescribed, I always stress the importance of a slow, step-wise introduction. I advise starting every other night for a week or two, and if there are no signs of irritation or concerning side effects then I recommend increasing to nightly usage. If after nightly usage there is some irritation or excessive redness then I advise going back to every other day.

“My recommendations for increasing percentage of tretinoin is done on an individual basis as each person will have a different response, and some patients can’t tolerate an increase in strength of tretinoin at all.”

What kind of visible benefits should be expected from a retinoid treatment?

“I call it the ‘photoshopped’ effect. In person, there’s a softened appearance to the skin along with an added glow, but in photographs you will look like you’ve had something far more impressive than just a topical agent added to your skincare plan. Results take time to become apparent, so most patients don’t realize the change since they see their face every day. But when we do a side-by-side comparison of their before and afters, the effects are undeniable, but always beautifully natural.”

Any precautions to be taken into consideration when introducing a retinoid into a daily routine?

“Even though retinoids are generally applied at night, people should be more cautious about their length of sun exposure – sun sensitivity can be a real issue if sunblock isn’t worn regularly.

“During the initiation period, a certain amount of redness, peeling, itching and even burning can occur. These symptoms are totally normal, but often the main reasons patients tend to stop using retinoic acids. If this is the case, converting to a topical retinol will minimize these side effects, while eventually aiding in converting the patient back to a more potent retinoic acid in the future.

“I also recommend that women who are pregnant or are actively trying to have children should stay away from any topical or oral vitamin A product as some studies have shown that high doses of vitamin A can be harmful to an unborn child.”

Written by: Georgia Gould