By Bayardo Aviles
During recent laser convention that Dr. Stover and I attended in Austria, one of the speakers, who happened to be the inventor of the modern cosmetic laser theory, made a statement that reassured our belief in the use of Retin-A. In summary, he said that the best way of generating collagen and elastin in the long term, the two most important structural components of the skin that keeps the skin tight and full, is Retin A.
Retin A is one of the products that falls in the broader category called Retinoids. Included in this group are retinol, retinaldehyde, retinyl esters, and retinoic acid also known as Retin-A. Retinoids are some of the most widely used cosmeceutical ingredients today. The most well known is Retin A.
Retinoids have been extensively studied over the years and multiple studies have reconfirmed their efficacy in the treatment of acne, photodamage, and psoriasis. Studies indicate that retinoids when applied topically, start a chemical chain reaction (it is very complicated to understand it but it has been replicated over and over and it is widely accepted in the scientific community) that stimulates collagen and elastin formation and produce an overall normalization of multiple skin conditions.
Synthetic forms of retinoids
However, these benefits are not without some negative side effects, mainly skin irritation. Also, it cannot be used during pregnancy. Because of this negative side effects and the large amount of evidence of their efficacy, scientists are always trying to replicate the positive effects of retinoids and at the same time minimize the negative side effects. As a result, some synthetic forms of retinoids with less side effects have been developed, but their anti-aging efficacy is not well documented.
Some of these synthetic retinoids are: adapalene and Tazarotene. Both are available with a prescription. Retinoids are also found in many over the counter (OTC) skincare products, but at low concentrations that may not be effective to repair photodamaged skin.
The retinoids found in OTC products include retinoic acid precursors such as: retinol, retinaldehyde, and retinyl esters. Retinoids can also be labled in OTC as vitamin A. Although these retinoic acid precursors cause lower level of irritation, their efficacy is not as good as retin more severe cases of photodamage. We have been recommending Retin A, also known as tretinoin, to our patients since we started our practice in Hawaii in 2001. Typically, we recommend it as a component of the Obagi Nu-Derm system because this skincare system has other ingredients such as alphahydroxy acids and lightening agents that when combined with Retin A, improve overall skin health faster and more effectively.
To decrease the level of irritation caused by Retin A, we start our patients on a lower dose and gradually increase it over time. For patients that want to start even more gradually, we recommend they start with a slow release retinol. Either 0.5% or 1.0% every other day and then move to the lower dose of Retin A 0.025%, then to 0.05% and ultimately to 0.1% if desired. We determine the type of retinoid based on the condition of the skin, the goals of the patients and the timeline that we have to work with.
First step - how much photodamage does your skin have now?
We recommend a complementary cosmetic skin evaluation with the VISIA complexion analysis to document a baseline level of skin photodamage and from that evaluation we customize a plan for each patient.
- If you are not using a retinoid and you are concerned about aging skin, you need to get on one as soon as possible.
- To determine which one of them is the most appropriate for you please schedule a complementary VISIA cosmetic skin consultation and we will make a recommendation.
- If the health of your skin requires more than a cosmetic evaluation, that is if you have scaly, itchy, raised spots, then schedule a general medical skin check and the visit may be covered by your insurance.
By Marné CarMicha Walsh, M.S., P-AC
Welcome to part two of my blog article where I answer the question "which anti-aging creams really works." In the first article I talked about the importance of sunscreen to protect the skin from extrinsic factors such as sun exposure. Other factors included tobacco, chemicals, diet etc. Now I will continue with specific wrinkle cream ingredients and formulations such as Tretinoin (Retin-A), Renova, Retissa, Peptides, and Human Growth Factors.
If you are already protecting yourself from the extrinsic factors of aging with an antioxidant and an approved sunscreen, then it is time to incorporate vitamin A into your daily routine. The most effective form of vitamin A is the synthetic type called tretinoin, otherwise known as Retin-A. Tretinoin is found in a variety of formulations such as Renova and Retissa as well as many acne formulations. They all require a prescription and are not covered by medical insurance.
The closest over the counter, non-prescription product would be retinol. Retinol, a derivative of vitamin A, works in a similar fashion but is not as potent and therefore, less irritating. Retinol can be found at retail stores but the most potent forms are sold through medical offices and spas. Both retinol and tretinoin work by exfoliating, suppressing pigment and stimulating collagen production. Although it thins the dead top layer of cells, the new collagen thickens the deeper, live layer of cells, making the skin brighter and smoother. The down side to this product is that it can make your skin sun sensitive. In other words, if you enjoy outdoor activities on a regular basis, you would be more prone to severe sun burns while using it. Not applying it a few nights before extended sun exposure would help decrease the chance of this complication.
Okay, I use an antioxidant and sunscreen every morning as well as retinol in the evening. Now what?
Adding in products that hydrate effectively, prevent breakdown of existing collagen, thicken the epidermis, and gently exfoliate can optimize and preserve the benefits of the retinoid compounds.
- Advanced Glycation End Product Inhibitors: Glycation is a normal, intrinsic process of aging skin and contributes to the loss of function of collagen and elastin fibers. By interrupting this process, one can preserve the functional collagen and elastin fibers.
- Peptide therapy: Peptides are small pieces of collagen that have the potential to penetrate into deep layers of the skin. Their presence tells the skin that it might be damaged and therefore, signal the skin to make longer strands of collagen. Some neuropeptides appear to block muscle contraction, acting as a topical “Botox”. Other peptides are attached to antioxidants, like copper, transporting the copper into the deeper layers of the skin. Peptides come in many forms and names such as palmitoyl penta peptide, acetyl hexapeptide(Argireline), palmitoyl oligopeptide, and copper gluconate, just to name a few.
- Hyaluronic acid: Hyaluronic acid is one of the best skin hydrators because it has the ability to penetrate into the deep layers of the skin. It retains water and prevents water evaporation from the skin therefore giving the skin a “plumping effect”. Like peptides, hyaluronic acid is also used as a vehicle to transport other ingredients, such as antioxidants, into the deep skin layers.
- Human Growth Factors (HGF) and cytokines: HGFs and cytokines come in a variety of forms as well. They stimulate cell growth and collagen production. They were originally used as a wound healing agent for burn patients but over the last few years, many cosmetic products were derived from HGFs. HGFs are often combined with cytokines to work synergistically for the same purpose—repair damaged skin and thicken the epidermis with collagen.
So remember, when choosing an “anti-aging” cream, first start with protection, then make more collagen with a retinoid. Finally, keep the face hydrated and choose a product that will help prevent breakdown of the collagen.