It seems like every week, there’s another new “miracle” ingredient being touted by the beauty industry for its impressive wrinkle-reducing, blemish-clearing, skin-brightening abilities. Yet ultimately, very few of them manage to compete with time-tested retinoids.
Retinoid is the umbrella term for all skin-care derivatives of vitamin A, but within this group are both over-the-counter retinol and prescription retinoids. “All of the forms take steps in the right direction, supporting skin functions that slow down as we age in performing more efficiently and engaging in activities at rates more compatible with youth,” explains Dr. Ava Shamban, a board-certified dermatologist in Beverly Hills, California. “The differences between them are strength, bioavailability, conversion, and the receptor-binding profile of the retinoid.”
While the lower concentration found in over-the-counter retinol must be converted to retinoic acid by our bodies, the high concentration of vitamin A found in prescription retinoids (the most popular of which is tretinoin) is already in the form of retinoic acid, meaning it’s more effective and fast-acting from the start. “Prescription retinoids are as much as 40 times more potent because they do not need to be metabolized from retinol to retinaldehyde to retinoic acid,” says Dr. Mary Lupo, a board-certified dermatologist in New Orleans. Retin-A, the leading brand of tretinoin, was really the first prescription retinoid. “The FDA approved it in the 1970s for acne, and, serendipitously, it was found later to improve photoaging,” Dr. Lupo notes. It’s still considered the gold standard for improving skin tone, reducing the appearances of lines, repairing sun damage, and treating acne. Before you start using Retin-A, here’s what you need to know.
1. Who can use Retin-A?
Because of Retin-A’s wide-ranging benefits, it’s worthy of a spot in almost everyone’s skin-care routine. “Basically, anyone in the patient population with sun damage and visible signs of photoaging and damage, cellular aging, and epigenetic or lifestyle aging that presents in lines, wrinkles, and laxity should use tretinoin,” Dr. Shamban says. “Those with texture concerns and pigmentation issues are all candidates. Acne is also a condition, but usually we prescribe a variation on the brand Retin-A for that.” Prescription retinoids tend to be very drying and can have harsher effects on skin than their over-the-counter counterparts, so those with sensitive or reactive skin should be especially cautious, but all prospective Retin-A users should always discuss the treatment with their dermatologist first.
2. How do you get Retin-A?
Retin-A is a prescription product, so only your doctor can prescribe it to you. “This is the Rx form, so it is distributed only after assessment, skin diagnosis, and prescription,” explains Dr. Shamban. There are brands and doctors who will prescribe it virtually, but if you can have a dermatologist do a physical analysis of your skin, that is the best way to ensure you’re getting exactly what you need.
Related: How to Use Retin-A: 7 Tricks Derms Swear By for Getting the Best Result
3. Does insurance cover Retin-A?
Like most prescription drugs, Retin-A can be covered by your insurance but only under specific circumstances. “Usually, only the generic—rather than newer, hydrating formulas, like Altreno and Arazlo—is covered,” Dr. Lupo says. While coverage differs greatly, depending on your carrier, many insurers will cover Retin-A only for the treatment of certain conditions. For instance, when used to treat acne, some forms are covered, but often, when used to combat signs of aging, it is not. Without any insurance coverage, Retin-A can cost roughly $100 for each supply, which can last anywhere from three to six months; patients may find manufacturer or pharmacy coupons to offset the price.
4. What can you not do while on Retin-A?
Tretinoin is a potent ingredient that makes skin far more photosensitive, so “extra attention to sun protection and avoidance is key,” says Dr. Shamban. “It’s also recommended that patients avoid other harsh skin products or exfoliants that can cause aggravation or irritation or may disrupt the skin barrier function.” You can still use these ingredients if your skin can tolerate it, but they should be modified and monitored while on Retin-A. Topical, chemical-based hair removers, facial hair bleaches, and facial waxes are, similarly, best avoided. There are no activities you can’t do while on tretinoin—though you should temporarily go off it before certain facial procedures—but it should not be used when pregnant or breastfeeding, since safety has not yet been determined.
5. How soon should you stop using Retin-A before procedures, and when can you start using it again after?
Many facial procedures should not be performed while using Retin-A. “Stop [Retin-A use], if possible, five to seven days before [your appointment], or adjust the procedure to make it more gentle,” Dr. Lupo suggests. A minimum of 48 to 72 hours is recommended before a laser, a chemical peel, Plasma Pen, microneedling, microdermabrasion, or any other skin resurfacing treatment. Depending on the procedure performed, you can resume using Retin-A 24 to 48 hours after full healing is complete (usually five to seven days).
Related: 9 Moisturizers Dermatologists Recommend Using While On Retin-A
6. How long before you see results?
Even though Retin-A’s vitamin A is already in the form of retinoic acid and works far more quickly than over-the-counter retinols, it can still take some time to see results. “There is a misconception about results,” Dr. Shamban says. “It can take up to three months to really see results, even from stronger versions.” Generally, dermatologists say it takes around 8 to 12 weeks to begin seeing results, though it can occasionally be sooner, so it’s important to stick with your Retin-A use for at least this long, even if you don’t feel like it’s yet paying off. “It’s a marathon, not a sprint,” emphasizes Dr. Shamban. “Using retinoids is for the long haul, and it is a cumulative commitment. Consistent use will help train your skin to be in its best shape over time.”
7. Do you use Retin-A forever?
One of the most common refrains surrounding Retin-A is that people wish they’d started using it earlier. Often, the only time young patients are prescribed tretinoin is for acne, and most people don’t begin using it to address signs of aging until those signs are already there. Many dermatologists recommend starting retinoids in your 20s or 30s, but if you’re starting Retin-A at such a young age, does that mean you’ll be on it for the rest of your life? “If you are using a form of retinoid specifically for acne, it may be a more temporary term,” Dr. Shamban explains. “But for anti-aging properties or to reclaim and reverse photoaging and damage, there really is no end date required. If your skin is handling the product and continuing to respond well, keep it going!” She suggests thinking of it as a sort of nightly commitment, in the same way that sunscreen is a daily commitment. “We age daily, so combating it daily is required.”
