Dermatologist's Guide to Your Best Skin

Steps for Starting a Retinoid

You’ve been thinking about starting retinol to your skincare routine for a long time, you’ve done the research, watched some videos, and know enough to feel a bit 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. The first step is to get your skin in shape and ready for what you are about to ask it to do. This requires establishing a gentle daily skincare routine.

Every Morning

1. Splash your face with water:  Do not wash your face with a cleanser unless it is oily as overwashing can strip away the important oils that maintain your skin barrier.
2. Dry your skin: Pat dry using a clean towel.
3. Apply your morning treatment: Choose one that includes vitamin C. Important: only include this step if your skin is not inflamed, otherwise skip.
4. Apply moisturizer: Your moisturizer should be rich, nourishing and provide 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. Petroleum based is a less expensive option but only sits on top of the skin and is not able to help the skin build a healthy barrier. The drier and more sensitive your skin, the heavier moisturizer your will need.
5. Apply a mineral sunscreen: To prevent further sun damage and break down of collagen. 

Every Night:

1. Wash your face: I recommend a thorough, yet gentle cleanser that doesn’t contain parabens, sulfates, fragrances or dyes. You don’t want to strip your skin’s 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. 
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 day and a heavier moisturizer at night.

The goal with this skin care regimen is to support your skin and 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

Retinoids are a group of chemicals derived from vitamin A that trigger events on a cellular level through various signaling mechanisms. Retinoid products come in a wide variety of formulations. 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 of actives than people with oily skin.

Serum, Cream or Oil 

Retinoids can be found in serums, creams, oils 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 and use it with your moisturizer so you can better control the ingredient. This allows you to control how much retinol you use, so you can add or remove from your routine as your skin can tolerate.  

What Retinoid to Use

• Retinyl Palmitate (Least Strong): This needs conversion to retinol, then retinaldehyde, and finally retinoic acid to be active in the skin. Also known as vitamin A palmitate, it is the mildest derivative of retinoic acid and can be used as an antioxidant in skin care. Despite bad press in recent years, it is quite safe. It is found naturally in our skin and is the most common form of vitamin A storage in mammals.
• Retinol (Stronger): This converts to retinaldehyde and then to retinoic acid. Retinol is one of the most popular over-the-counter options, available in strengths from 0.01% to 1%. It’s less irritating than prescription retinoids but still well-studied, boasting many benefits to the skin.
• Retinaldehyde (Even Stronger): Also known as retinal, it requires only one conversion step to become retinoic acid. Thought to be tolerated equally well to retinol despite being possibly stronger.
• Retinoic Acid (Strongest): Also known as tretinoin (e.g., Altreno, Atralin, Retin-A), this is the active form that binds directly to skin receptors (Retinoic Acid Receptor and Retinoid X Receptor). It is the most studied form and also the most irritating for those with sensitive skin.
• Bakuchiol: A Plant-Derived Retinoid Alternative While bakuchiol is not a retinoid, it offers similar anti-aging benefits. More on this below. 

Strength Matters: Percentages and Potency

Once you select a formula, check the label for the active ingredient’s concentration. Amounts vary widely from 0.01% upwards. While stronger might seem better, there is no benefit from using something that is too much for your skin. 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.

Applying Your Retinoid

Apply at Night for Two Reasons

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.

Wash Your Face 

Avoid using hot water or scrubbing your skin before using a retinol. Doing so will dry out your skin and weaken your skin barrier, causing your skin to absorb more of whatever you put on it making it more likely to become irritated by the retinol.  

Should you use a moisturizer before or after using Retinol?

This is a common question. Here is the deal, if you moisturize before using your retinol, it limits the absorption of the product. Yes it decreases the risk of irritation by the retinol but also just wastes product. Instead, pick a product that is the correct strength for your skin and do not use very much. That way you do not need to dilute it down with a moisturizer beforehand. Always follow your retinol with a moisturizer. 

How Much Retinol to Use? What Strength Retinol to Use? 

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 and cheeks) and use your fingertips to gently smooth over skin until fully absorbed. Avoid the area right around your eyes and corners of mouth, which are more likely to become irritated. 

How Often to Use Retinol? Start Slowly 

The key is to start low and slow. 

1. For the first 1 - 2 weeks, apply it only twice per week.
2. For the next 2 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!

Retinol for Sensitive Skin

There are many of us who cannot tolerate retinol, it is simply too irritating. Do not despair - try bakuchiol. While bakuchiol is not a retinoid, it offers similar anti-aging benefits. Derived from the seeds and leaves of the babchi plant, bakuchiol promotes collagen production and cell turnover and has antioxidant and anti-inflammatory properties. It works through retinoic acid receptors and other pathways to improve skin, reducing wrinkles, enhancing tone, and addressing acne—all with less irritation than retinol. This is why I chose to put it in my Night Repair Treatment. 

A 12-week study comparing 0.5% bakuchiol and 0.5% retinol found similar improvements in skin, but retinol users experienced more irritation.

Key Advantages of Bakuchiol

• Effective: Studies show bakuchiol is just as effective as retinol in reducing wrinkles, fine lines, and hyperpigmentation.
• Sun Safe: Bakuchiol is stable in air and sunlight and not known to make skin more sun-sensitive but, as with any skincare actives, daily sunscreen is still recommended.
• Better tolerated: In clinical studies, retinol caused more stinging and facial skin scaling than bakuchiol.
• Additional benefits: It is also an antioxidant and anti-inflammatory making it a great option for sensitive skin, rosacea, or eczema.

At each step along the way assess how your skin is doing!  

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 discouraged - 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.

Apply sunscreen every morning (at least!)

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, you should experience mild stinging that resolves completely once 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. 

The Retinol Purge

After the first few applications, you might notice increased flaking skin and whiteheads. This can pop up as redness, new pimples, blackheads, and small bumps. These are all things that naturally happen, but retinol speeds this up due to the increased cell turnover making everything come to the surface at once. Oils are pushed to the skin surface faster, pores get overwhelmed, and old skin flakes off faster than normal. But it’s all for a good cause as the purge should give way to refreshed cells and clear pores longer term.  

Potential Retinol Side Effects

• Irritation: 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 and areas around the eyes and mouth are more susceptible to this. If it happens, it is best to stop use and let the skin barrier recover for a few days. Of course, cover it with a good Healing Balm or Vaseline. 
• Hyperpigmentation: 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.
• Photosensitivity: 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 to help combat irritation 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 so I switched to bakuchiol and alpha hydroxy acids, 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 actives to your skincare regime one at a time to give your skin time to adjust. Irritation is more likely when you start mixing actives.  

The most safe and effective way to maximize results while limiting the risk of irritation is to have two active products in your skincare regimen. One for the morning: a day treatment with vitamin C, and one for the evening: a night treatment with ingredients that promote cell turnover, like retinol, bakuchiol and/or alpha hydroxy acids. 

Rarely do you need more than this on a regular basis. But if you do, add additional actives slowly and stop them before you give up on your core day and night treatments. Some actives I recommend:

• Salicylic Acid: Salicylic acid is a BHA that is helpful to fight acne in oily skin. The challenge here is that it can quickly overdry your skin. I recommend salicylic acid for patients with oily skin and large pores. They can use it in the AM before their day treatment and still use retinol in the PM but if skin becomes dried out stop the salicylic acid! One of my favorites is Paula's Choice 2% salicylic acid toner.
• Benzoyl Peroxide: Benzoyl peroxide is a topical antibiotic commonly used to treat and prevent acne but the combination with retinol can be very drying. Try retinol in your night routine and the benzoyl peroxide in your morning routine or alternate the products different nights to decrease the risk of unwanted irritation. Also start with lower concentrations, for example 2.5% vs 10% to decrease the risk of unwanted complications
• Hydroquinone: This is a bleaching agent used to treat melasma or unwanted pigmentation.  It is most commonly found in prescription combination products with tretinoin and a mild topical steroid, the brand name is Tri-Luma. This product would be used at night instead of your retinol.

In conclusion, incorporating a night turnover treatment to your skin care routine is a great way to keep skin looking healthy and beautiful. But before you start any regimen, it’s imperative your skin is healthy and you use the right treatment product for your skin. I hope this step-by-step guide helps you find success in your night turnover journey! 

These recommendations are not sponsored. They are the result of Dr. Heather D. Rogers, MD evidence-based research and extensive clinical experience. 

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