Step by Step Guide to Starting a Retinoid

You’ve been thinking about it for a long time, you’ve done the research, watched some videos, and know enough to be nervous. Here is everything you need to set yourself up for success. 

Preparing Your Skin for a Retinoid

You cannot start a retinoid until your skin is ready for it. If your skin is irritated or inflamed it will NOT go well. As such, the first step is to ensure your skin is calm and ready for what you are about to ask it to do. 

To set yourself up for success you need to have calm skin with an intact skin barrier.  This requires establishing a gentle regular skincare routine catered to your unique skin needs.  Once established, this evening regimen will support your skin as you add in a retinol to minimize unwanted side effects.  This skincare regimen would include the following steps:

Every Morning

1. Splash your face with water:  Do not wash your face unless it is oily because over washing your face can strip away the important oils that maintain your skin barrier. 
2. Dry your skin: Use a gentle towel.
3. Apply your morning treatment: Choose one that includes Vitamin C (only if it agrees with your skin, if not SKIP). My favorites are
•  Doctor Rogers Day Preventive Treatment
•  Skinbetter Alto Defense Serum
•  Skinceuticals serum 10 AOX+ 
4. Apply moisturizer: It should be a product that is rich and nourishing that provides important fatty acids to build your skin while fortifying against moisture loss. I prefer plant based products that have oils, squalane, niacinamide and centella asiatica that calm and strengthen the skin.
5. Apply a mineral sunscreen:  My favorite is Dermaquest.

1. Wash your face: I recommend a thorough yet gentle cleanser that doesn’t contain parabens, sulfates, fragrances and dyes. You don’t want to strip natural oils or use a face wash that exfoliates.  Use warm, not hot water. Don’t scrub. Here is a video on how I wash my face.  My favorite products for this are Doctor Rogers Face Wash and Dore Le Cleanser.
2. Apply moisturizer:  It is ok to use the same moisturizer morning and night.  Use it around your eyes, neck and chest. If you have oily skin you may want a lighter weight moisturizer for the day and a heavier moisturizer at night 

The goal with this skin care regimen is to support your skin and to remove potential irritants BEFORE subjecting your skin to the stress of a retinoid. AVOID layered application of multiple leave-on products with potentially conflicting ingredients that may inadvertently irritate and compromise your skin’s health. 

Choose What Retinoid to Use

Retinoid products come in a wide variety of formulations.  Recall that Retinoids are a group of chemicals that are derived from Vitamin A that trigger events on a cellular level through various signaling mechanisms.  You can refer to this blog if you want a refresher on how retinoids work and what they do.

If you have thin, sensitive or dry skin, you’ll absorb more of any skin ingredient and be more likely to be irritated than if you have thick or oily skin.  In general, people with dry skin will need to use products with lower percentages than people with oily skin. There is also a new bio-retinol (Bakuchiol) that is not Vitamin A derived but works in a similar fashion for skin improvements but with less irritation. I’ve also written articles for Dermstore and New Idea to help you understand. 

Retinoids can be found in serums, creams, oils, gels and more allowing you to pick your texture preference and what agrees with your skin. My strong recommendation is to use a SEPARATE product for your retinol be it a serum or oil to use BEFORE your moisturizer so you can add it or remove as your skin can tolerate.  

What Retinoid to Use

Retinyl Palmitate (Least Strong):  Needs to be converted to retinol first, then retinaldehyde, then retinoic acid.  Also known as vitamin A palmitate. A milder derivative commonly used in night creams, serums, and eye products for wrinkles and acne.

Retinol (Stronger): Needs to be converted to retinaldehyde first, then retinoic acid. One of the most popular OTC retinoids. Available in strengths from 0.01% up to 1% in various anti-aging serums, creams and oils. Less irritating than prescription retinoids.  Extremely unstable when exposed to air or sunlight. 

Retinaldehyde or Retinal (Even Stronger): Needs to be converted to retinoic acid.

Retinoic Acid (Strongest):  Able to bind receptors in the skin (Retinoic Acid Receptor and the Retinoid X Receptor).  Synonymous with tretinoin (Altreno®, Atralin®, Avita®, Refissa®, Renova®, Retin-A®, Tretin-X®). 

Bakuchiol: Bio-retinol: Although bakuchiol is not a retinoid, it has similar anti-aging effects.  It is derived from the seeds and leaves of the babchi plant.  It stimulates collagen and cell turnover, plus it has antioxidant and anti-inflammatory properties. It functions in skin through the retinoic acid receptor and other biological pathways to improve skin.  It is emerging as a hot new skin care ingredient given its ability to reduce wrinkles, improve tone, and target acne with less side effects than what is typically seen with retinoids.  This is why I chose to include it in my Night Repair Treatment.

Strength Matters: Percentages and Potency

Once you select a formula, check the label for retinol concentration. Amounts vary widely from 0.01% upwards based on skin tolerance. While stronger might seem better, it is more about finding the percentage that works for your skin. If you are new to retinoids or have sensitive skin, it is always better to start with a lower percentage and ALWAYS follow with a moisturizer. 

Applying your Retinoid

1. Retinoids encourage skin cell turnover, meaning that old skin cells fall away and new skin cells replace them.  This new skin is delicate and needs to be protected both with a moisturizer and sunscreen.  
2. Retinoids are very unstable in the sun and are rapidly broken down rendering them much less effective.

Avoid using hot water on your face or taking a hot shower. That will dry out your skin and weaken your skin barrier, making it absorb more of whatever you put on it and making it more likely to become irritated by the retinol.  

This is a common question. Here is the deal, the reason to moisturize BEFORE is to limit the absorption of the product to decrease the risk of irritation by the retinol. Which ends up just being a waste of product. Instead, pick a product that is the correct strength for your skin and do not use very much. Then you do not need to dilute it down with a moisturizer beforehand. 

The key is to start low and slow. Apply only a small amount (pea-sized).  For my own patients, I have most women start on a 0.25% retinol and men on a 0.5% retinol.  Dot a drop in small sections around your face (forehead, nose, chin, cheeks) and use your fingertips to gently smooth over skin until fully absorbed. Avoid aggressive rubbing and avoid the area right around your eyes and corners of mouth, which are more likely to become irritated. 

1. For the first one to two weeks, apply it only twice per week 
2. For the next two weeks, apply it every 2nd night 
3. After 4 - 6 weeks of use, you should be seeing benefits already and have a good idea of how your skin is tolerating it. If it's tolerating well, increase usage to nightly application.
4. Skin's tolerance is built after about 8 - 12 weeks. At that point it is fairly easy to use nightly. This is when the real results start to show! 

Any tingling, burning or reddening means you are pushing your skin too hard. Adjust by skipping the next dose for extra recovery time. When you reintroduce, use a reduced application amount.  Don’t let yourself get too discouraged that you are losing ground.  You’ll get there!

If you are nervous or have a history of very sensitive skin, you can do a ‘patch test’. Put a small amount of the product behind your ear, just underneath your jaw or the inside of your arm. Check out the site 48 hours later. If there is no reaction you can move to your face with more confidence.

Remember that retinol removes the top layer of dead skin, which makes it slightly more sensitive to the sun. Both UVA/UVB protection is vital not just on sunny days but year-round. Doubly make sure to reapply every few hours when outside for maximum safety.  You can check out this blog or video for some tips.

What to Expect

The first time you use retinol, your skin should be healthy and the application process should be uneventful, at most with mild stinging that resolves completely when you apply your moisturizer.   If you experience more than this, your skin is not ready or the product you have selected is not right for your skin. Wash it off with warm water and a gentle cleanser and apply your moisturizer. 

After the first few applications, you might notice increased flaking skin and whiteheads.  It could be redness, new pimples, blackheads, and small bumps.  These are all things that naturally happen, but with retinol it is sped up due to the increased cell turnover and it all sort of comes at you at once.  Oils are pushed to the skin surface faster, pores get overwhelmed, and old skin flakes off faster than normal.  This purge shouldn't cause concern since they give way to refreshed cells and clear pores longer term.  You can gently wipe the buildup away with a soft wet washcloth, but take care not to scrub too hard and if you start slow enough, this purge is typically quite mild. 

Potential Side Effects

While the FDA approves retinol use, transient irritation can occur as skin acclimates, especially when initiating new products. Common symptoms involve dryness, redness, peeling, and itchiness.  When severe, it is called Retinol Burn.  Areas around the eyes and mouth are more susceptible to this.  If it happens, it is best to stop and let the skin barrier recover for a few days.  Cover it with a good Healing Balm or Vaseline. 

If your skin tans easily and becomes irritated when using retinol, you can develop unwanted pigmentation and hyperpigmentation. This is another reason to start slow and always use your sunscreen.  This is more common in people with darker skin tone. Stop immediately and contact your healthcare provider.

Retinoids increase your risk of sunburn according to several studies. To reduce such risks, wear mineral-based sunscreen everyday and skip the retinol step when on sunny vacations. 

Retinoids for Sensitive Skin

Some people still have difficulty adding retinol to their routine even when doing the above steps and using low percentage retinol.  One approach involves “buffering” by mixing an amount smaller than the typical ‘pea size’ and diluting it with a heavy moisturizer to create an even LOWER percentage product with added hydration.

Another option is to use a different ingredient that also promotes cell turnover.  I cannot tolerate retinoids despite trying all sorts of tricks.  As such, I switched to bakuchiol and alpha hydroxy acid, which are well studied, effective and less irritating than retinoids.  This is precisely why I’ve included it in my Night Repair Treatment.  Additionally, new sensitive skin formulas feature ‘encapsulated retinols’ that release gradually over hours. 

Using Retinol With Other Products

I'm often asked if retinol can be layered with other active ingredients. The short answer is yes.  However, always add active to your skincare regime one at a time to give your skin time to adjust. Irritation is more likely when you start mixing actives.  

I try to make it a goal to have two active products in your skincare regimen.  One would be done in the morning and one in the evening.  A day treatment with vitamin C and a night treatment with ingredients that promote cell turnover, like retinol, bakuchiol and/or alpha hydroxy acids. 

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