Skincare: Fact vs. Fiction

As a Board Certified Plastic and Reconstructive surgeon, many patients come to my office specifically for skin care consultations. I’ve found patients often confused about the basic techniques that maintain skin health, how to avoid skin cancer and slow skin changes from aging, lifestyle and the environment.

As sales of medical-based skin care products easily exceed a billion dollars per year, patients are inundated with some outrageous claims and unrealistic promises about results that can be achieved by using many of these products.

Here is a tag line that was associated with a medical grade skin care line that recently made me laugh out loud: ‘The complete non-surgical facelift’

It leaves me wondering if this skin care line also comes with fairy dust and a magic wand. All humor aside, these kinds of claims leave patients with little concrete information and unrealistic expectations.

Fact: Retin-A Really Works

Seeking the advice from a Board Certified Plastic and Reconstructive Surgeon or Dermatologist can help debunk skincare miracle myths.

In my skin care consultations, I obtain a comprehensive history and physical assessment that focus on past skin damage, skin cancer history and a patient’s current skin issues. A treatment plan is formulated and the patient is educated on how this treatment plan will work for them. What surprises most of these patients is that in addition to sunscreen, a Retin-A based product (topical tretinoin) is by far the most important topical skin care treatment that can be included in their treatment plan.

To make my point, I often say:

“If you are stranded on a tropical island for 10 years and you only have access to one skin care product (besides sunscreen, of course) that will maintain youthful appearing skin….no question, Retin-A is the choice.”

So how does Retin-A, a product that was developed over 25 years ago as a derivative of Vitamin A, take precedence over all the new topical medications, lotions, gels and ointments? It is simple: time has shown that Retin-A really works, both by itself and in concert with other treatments including lasers and deep peels. Avoiding overly complicated scientific explanations, Retin-A thins the outermost layer of the skin (stratum corneum), thickens the deep layer of the skin (dermis) while stimulating collagen production. Below is a basic list of the research-proven disorders proven that Retin-A treats:

  1. Acne (primary use per FDA)
  2. Hyperpigmentation (age spots, sunspots, freckles)
  3. Actinic Keratosis (precursor to skin cancer)
  4. Fine wrinkles
  5. Poor Skin Texture (deep pores)
  6. Keratosis follicularis (skin disorder of small, red bumps)
  7. Verruca plana (flat warts)

It all sounds great when you review that list. A topical cream that treats acne, gets rid of brown spots and reduces the visibility of fine wrinkles and deep pores while treating pre-cancerous skin lesions. Sign me up!

Unfortunately, as life teaches us all, everything has a cost. In the case of Retin-A, it is the expected side effects. Topical Retin-A application can make the skin red, flakey and irritated. It also makes the skin more photosensitive thus decreases the amount and time of sun exposure that can cause sunburns. It is these types of effects that lead people to discontinue the application or refuse to initiate treatment.

As we have gained more experience with this product, our ability to control these side effects has immensely improved. Take my practice for example. Although my office is in Aspen, Colorado, and the environmental effects are magnified (bright sun, rather dry climate, high altitude) I am able to continually maintain my patients on topical Retin-A creams. We have opted for combining topical Retin-A with an Obagi Nu Derm treatment protocol that helps reduce these side effects while augmenting the effects of Retin-A. In those patients with extremely sensitive skin, I often reduce the concentration of the Retin-A while keeping the application to every other day (versus daily). The only subset of patients for whom I avoid Retin-A application are pregnant women or women who are not using contraception during their during child-bearing years.

Many Products Make Outrageous Claims. Retin-A Really Works.

Useful Web article from (warning: this is a for-profit site)

Useful Scientific Articles:

  1. Griffiths CE. The role of retinoids in the prevention and repair of aged and photoaged skin Clin Exp Dermatol 2001, 26(7):613-618
  2. Griffiths CE, Dabelsteen E, Voorhees JJ. Topical retinoic acid changes the epidermal cell surface glycosylation pattern towards that of a mucosal epithelium. Br J Dermatol. 1996 Mar;134(3):431-6
  3. Glaser DA, Rogers C. Topical and systemic therapies for the aging face. Facial Plast Surg Clin North Am 2001, 9(2):189-196
  4. Whitmore, SE. Restoration of collagen formation in photodamaged human skin by tretinoin (retinoic acid). N Engl J Med 1993;329:530-535.