Anti-aging skin care

Question 1

What causes skin to age?

Answer

Two different aging processes affect how our skin looks: chronological aging and photoaging.

• Chronological or intrinsic aging: what happens naturally to our cells between birthdays

• Photoaging or extrinsic aging: premature aging caused by ultraviolet (UV) radiation from the sun

How much photoaging you experience depends on your skin phototype and the amount of time you spend absorbing UV rays. Prolonged or repeated sun exposure can cause skin damage like:

• Fine lines and wrinkles

• Hyperpigmented age spots (dark spots)

• Loss of elasticity

Question 2

Who can benefit from prescription anti-aging skin care treatments?

Answer

If you're over 30 years old, have a light or medium skin tone that sunburns easily (skin phototypes I to III), and you've spent a lot of time outside without broad-spectrum sunscreen protection, then you're likely to see the effects of photoaging on your skin.

If this bothers you, there are a number of clinically proven anti-aging and anti-wrinkle prescription creams and dark spot correctors that can help undo some of this sun damage.

Question 3

Can I use tretinoin (Retin-A) as an eye cream for wrinkles?

Answer

You should use precaution when applying any medication around the eye area, but when used as directed, retinoid skin care products like tretinoin may help reduce fine lines and lighten dark eye circles.

Question 4

What's the difference between prescription and over-the-counter anti-aging treatments?

Answer

Prescription medications

The Federal Drug Administration (FDA) has approved several prescription medications that are clinically proven to slow or reverse some of the effects of photoaging. These anti-aging, anti-wrinkle creams, serums, lotions, and gels are called topical retinoids.

Retinoids are synthetic and naturally occurring forms of retinol (vitamin A) that are about 10 times more potent than retinol. Topical retinoids and retinol can have similar anti-aging effects by boosting skin cell turnover, but retinoids tend to work faster because they're prescription-strength.

Over-the-counter (OTC) treatments

Countless companies promote the anti-aging properties of their cosmetic products. But because face lotions, eye creams, moisturizers, and serums aren't technically drugs, these claims aren't regulated by the FDA. Informally known as cosmeceuticals, many of these drugstore products contain active ingredients that clinical research has shown to reduce fine lines and wrinkles, boost skin elasticity, and even out skin tone.

Here are some of the more vetted OTC ingredients you can look for on cosmeceutical labels:

• Alpha hydroxy acids (AHAs) like glycolic acid, lactic acid, and citric acid

• Alpha-lipoic acid

• Azelaic acid

• Bakuchiol, a plant-based retinol alternative (phytoretinol)

• Beta hydroxy acids (BHAs) like salicylic acid

• Ceramides

• Coenzyme Q10

• Collagen peptides

• Ferulic acid

• Hyaluronic acid

• Melatonin

• Nicotinamide, also known as niacinamide, a form of vitamin B3

• Polyphenols and flavonoids (plant compounds) like coffee berry/caffeine, grape seed, green tea, Ginkgo biloba, and ginseng

• Retinol, retinaldehyde, and retinyl esters like retinyl palmitate

• Soybean derivatives, which are rich in flavonoids and amino acids

• Vitamin C (L-ascorbic acid)

• Vitamin E (alpha-tocopherol)

In general, vitamins, polyphenols, and flavonoids are considered antioxidants that work by neutralizing the free radicals that cause oxidative stress in our bodies. Retinols and peptides are considered cell regulators that work by influencing collagen production.

Other therapies and procedures*

The following cosmetic therapies and procedures can also reduce the signs of photoaging in skin, although they tend to be more expensive and invasive:

• Botulinum toxin injection (Botox Cosmetic, Dysport, Daxxify)

• Chemical peel

• Face lift (rhytidectomy)

• Laser resurfacing

• Photodynamic therapy (PDT)

• Skin or dermal fillers (soft tissue injections)

*These therapies aren't offered through telemedicine, and they may not be covered by health insurance.

Question 5

Can I get a prescription for hydroquinone?

Answer

If you're interested in requesting a prescription for hydroquinone, a topical skin-lightening treatment that treats dark spots and other mild facial hyperpigmentation issues, you'll need to request treatment for dark spots and melasma.

Question 6

How can I protect my skin from the effects of aging?

Answer

How your skin ages is largely determined by your genes and your skin phototype. For example, people with darker skin tones (phototypes V and VI) might start seeing the effects of photoaging 10 or 20 years after their peers with lighter skin.

But sun exposure, smoking, and air pollution can all accelerate the natural aging process. Can you delay aging? Research shows that it's possible to maintain a more youthful appearance by taking the following steps:

• Wear broad-spectrum sunscreen (SPF 30 or above) every day, even when you're not in direct sunlight

• Eat a healthy diet, loaded with antioxidant-rich foods like colorful fruits and vegetables

• Stay hydrated

• Keep your face moisturized

• Avoid tanning beds and prolonged sun exposure

• Don't smoke—it damages skin cells

• Get plenty of sleep

Question 7

What are the potential side effects of retinoids?

Answer

Because retinoids can cause skin irritation, redness, and peeling, healthcare providers typically prescribe the lowest active dose when you start treatment. The drug's concentration can be increased over time as your skin becomes more tolerant. Side effects tend to peak within the first 2 weeks of treatment.

Question 8

Can retinoids like tretinoin cream treat deep wrinkles?

Answer

Deeper wrinkles and creases usually respond better to anti-aging procedures like dermal fillers or botulinum toxin (Botox) injections, rather than topical wrinkle treatments like creams. Cosmetic procedures aren't available via telehealth and may not be covered by health insurance.

If you’re interested in treatment for deeper wrinkles and creases, please see a primary care provider to guide the next steps in your treatment.

Question 9

Clinical sources

Answer

1. Milosheska, D., & Roškar, R. (2022). Use of Retinoids in Topical Antiaging Treatments: A Focused Review of Clinical Evidence for Conventional and Nanoformulations. Advances in therapy, 39(12), 5351–5375.

2. Mukherjee, S., Date, A., Patravale, V., Korting, H. C., Roeder, A., & Weindl, G. (2006). Retinoids in the treatment of skin aging: an overview of clinical efficacy and safety. Clinical interventions in aging, 1(4), 327–348.

3. Vrcek, I., Ozgur, O., & Nakra, T. (2016). Infraorbital Dark Circles: A Review of the Pathogenesis, Evaluation and Treatment. Journal of cutaneous and aesthetic surgery, 9(2), 65–72.

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Anti-aging skin care

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Common prescription wrinkle creams

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Frequently asked questions