Well-aging Tips #1

First and foremost, I like to use the word “well-aging” rather than “anti-aging”. I think of aging as a natural process that people should embrace rather than fear of and the word “anti-aging” may sound a little too intimidating. There’s as much that we can do to take good care of our self, especially through skincare, to prevent premature aging but not halting the process overall. So, who’s with me?

What is well aging?  [wel eyj-ing]

“Individual’s perceived satisfaction in adapting to the physical and functional changes of ageing, while experiencing connectedness and a sense of meaning/purpose in life”

So now without further due let’s talk more about the process of skin aging itself and how we should take a good care of yourself to prevent premature aging

There are two types of distinct phenomena as we age:

  • Innate or intrinsic aging

The biologic clock’, that affects the skin in the same manner as it affects the internal organs, i.e. by slow, irreversible tissue degeneration. This is just like a car, no matter how much you’ve taken good care of it, some issue will come out a lot easier as it age

Things that we can’t control as much other than try to live a healthier lifestyle

  • Extrinsic aging

The one that is caused by external factors such as sun exposure, exposure to smoke, pollution, etc

Things that are partially under our control

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The bad news is that lifestyle nowadays with all the pollution, sun exposure, and other behaviors might actually accelerate this process. So now, the big question is on how to prevent this from happening prematurely?

TIPS #1 SUNSCREEN EVERY SINGLE DAY. PERIOD

Photoaging of the skin is caused by damage to the skin on a molecular level by exposure to ultraviolet (UV) radiation. It plays the major contributing factor in aging (more than 60%!) 

 

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source: https://www.nejm.org/doi/full/10.1056/NEJMicm1104059

Evidence #1

I bet most of you must’ve seen at least this picture once. This is a case report that are published from the New England Journal of Medicine (2012), this picture of one-sided significant photoaging that is caused by UV exposure from driving without any UV protection for over than 25 years! You can obviously see the prominent wrinkle and sagging of the skin. Not convincing enough? So let’s move on to another evidence

 

 

 

 

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Source: Plastic and Reconstructive Surgery: April 2009 – Volume 123 – Issue 4 – p 1321-1331

Evidence #2

An identical twin study, I think it’s obvious which one has more photodamaged skin. Definitely the one on the RIGHT side. You can notice the amount of skin pigmentation as well as the wrinkle from the one on the right.

Twins (natural age 61) with significant difference in sun exposure. The right one had approximately 10 hours per week greater sun exposure than twin A (left)

And surprisingly, the perceived age difference from this study was 11.25 years!!

So now, the #1 key 1 to well-aging is SUNSCREEN / SUN PROTECTION! So now, have you applied your sunscreen every single day? If you’ve answered “YES” you may proceed to the next step. But if you haven’t already, NOW is the best time to look for a sunscreen that is suitable for your skin type

 

TIPS #2 Retinoids 

Retinoids and all their derivatives are also called the “royal family” of skincare. Have you ever wonder why? Because they are the “gold standard” topical treatment for aging with a long history and strong evidence of efficacy

“Retinoid, retinol, retinoic acid, Retin-A what are those, are they the same?”

Retinoids is an umbrella term for both the prescription-based (most commonly referred to retinoids) as well as the OTC retinol and their derivatives.

In short, some are actually part of the royal family, one is the queen the other one is like the great-grandchildren of the queen while some actually are just a “royal-family” wannabe, but they are often confused and considered the same. So before we talked in depth about each of them and their derivates,

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A little history about Retinoids

How does “Retinoid” work actually?

So from all forms of retinoids, the active ingredient that our skin cells can interpret is retinoic acid. The other precursor forms need to undergo conversion to retinoic acid in order to work.

The conversion is almost like an obstacle, where they might lose their effectiveness and application of retinoids on its’ active form, retinoic acid, is like having a head-start in a race

I pictured each of the derivates as a racer, the end goal of the race is to become a retinoic acid with an obstacle in the middle (conversion) just like a challenge in a race. The more conversion it needed means the more distance and obstacle it has from the retinoic acid form. This distance might actually affect their effectiveness (just like a tired racer). While the one which is applied at its’ active form, which is retinoic acid, is more like having a head start in a race.

See below figure as a reference, retinol, which is widely available in your OTC skincare products need to undergo 2 obstacles:

#1 Conversion to retinaldehyde

#2 Conversion to retinoic acid

A study showed that retinol is 20-fold less effective than retinoic acid. But is it always a bad thing though? not necessarily, we’ll talk about it further later…

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Now let’s get to know each one of this racer

  1. Retinoic Acid

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Meet Retinoic Acid. The active form and most well-studied form of retinoids out there. They are also most commonly generalized as the “Retinoid”. I will discuss three major retinoids available. Most retinoids need doctors’ prescription. Up until recently, in the US, Adapalene was approved as the first FDA approved OTC treatment of acne

Hack: RetinoiD ends with a D, means you have to get them prescribed from a Doctor * That’s also why I illustrate it wearing a suit, because it’s kind of “exclusive”

  • OTC (in the US)
  1. Adapalene (Brand name: Differin, Epiduo (+BP), the brand name may differ based on which country you live in). FDA approved as a treatment of acne. This is less irritating than another prescription-based retinoid however it has less evidence in reversing the sign of aging
  • Prescription-based
  1. Tretinoin (Brand name: Retin-A, Renova, Vitacid). This one is FDA approved for aging. It is also called the queen of evidence and might be irritating
  2. Tazarotene (Brand name: Tazorac). It is also called the prince of evidence with a pretty good record on reversing the sign of aging

 

There are different concentration of retinoic acid available, consult to your dermatologist for more details on which one will suit your type and address your skin concern

#1 Evidence on Retinoic Acid

After 12 weeks:Epidermal thickening, Improvement in fine lines

*This why at least you have to keep on using it for at least 12 weeks to see maximum results. Although you might also notice the differences earlier (or later)*

After 6 months: Improvement in fine and coarse wrinkling, abnormal pigmentation of skin, roughness and elasticity

#2 Side effects of Retinoic Acid

Before you start your retinoid journey, you should note that there are side effects on usage of retinoic acid usually called “Retinoid Reaction”: Redness, Stinging, Scaling, Xerosis, Pruritis, Purging. However, afraid not, This condition is concentration-dependent, which means the higher the concentration the higher chance you’ll have them. This side effect tends to subside over time.

“TIPS: Follow your physicians’ guide and don’t hesitate to ask for more tips & tricks on how to incorporate them in your skincare routine. Apply just a “pea-sized” amount, layer it with your moisturizer, start with lower frequency, use it only at night (first) and don’t forget your SUNSCREEN during the day!”

2. Let’s meet the other racer aka the other derivatives

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They all have the same goal actually, to run and reach the retinoic acid form in order to do its’ job. But the distance from where they start matters, more distance means more obstacle (conversion) might exhaust them and they might not be as effective as the direct retinoic acid.

On the better side, they are all created to compromise the downside of the others. While one is effective but has a higher chance of side effects, people might give up on this due to the side effect that they experienced. So the other forms, with lower effectiveness but less side effect, is made and so on. The family is expected to keep on expanding (notice the increased amount of runners). These forms can be more suitable for people with sensitive skin

Here is a spreadsheet on each of the runner profile based on their evidence, amount of conversion needed and some other name that might actually refer to each of their major forms

* Evidence is not as strong as retinoic acid (fewer participants, shorter period, conflict of interest, etc)

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And here are some of the famous OG skincare products that contain each of these retinoids forms

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So again, all these OTC /skincare forms are not tightly regulated, there is not enough strong evidence that supports all their effectiveness but there are several studies that show promising results. So I do think they worth to try, especially for those who are just in their mid-20s’ (raise your hand). Because prevention is always better than to treat. In fact, they are created as a “gentler” alternatives of the queen retinoic acid. So it might be the way to go if you just wanted to start

Which product is the best?

There’s no definite answer to that. There is a lot to consider from formulations, the concentration, what they are paired with. So far, I’ve only tried the Paula’s Choice Retinol Boost as well as the Mad Hippie Vitamin A Serum, I used them regularly every night and I love both of them for different reason. I’ll let you know when I’ve come out with my full review about them!

Trends with Retinoids (OTC or skincare) and what to expect: 

  • Microencapsulation

There’s a hype about this technology, where it works to release the retinoid derivatives slowly in more targeted manner. It claims to reduce the amount of side effect and boost their effectiveness. Any strong evidence? Not really. Analogically, it’s like giving the runner a better pair of shoes, will they definitely reach the end, not necessarily but better chance (maybe)

  • Paired them with Retinoic Acid

Yes, like I mentioned before there’s a Retinyl-Retinoate. So basically they are pairing the retinol esters with retinoic acid. So it actually release a readily formed retinoic acid and retinol. Interesting, isn’t it?

  • Combined with peptides and other anti-aging ingredients

Oh, yes combined them with the all so called ingredients that can reverse aging. You name it. This is like giving the runner a new pair of shoes and an energy drink. They are all in hope to boost the efficacy and show result with the least amount of retinoic acid needed combined with other start ingredients. The most popular rising star is definitely, peptide! Expect to see more of this in the future

Okay, so that’s about the end of the Retinoids introduction, I hope you’ve get a better idea about what they are in their different forms. So the next commonly asked question, when should I start using it? 

There’s no exact number as well for this! I would say like start when you feel like your skin need it. In my personal opinion, people on their mid 20s (especially those who just started using sunscreen in their early 20s) can make a good use of these ingredients! Especially when you’re also been dealing with adult acne, although there is limited evidence on their effectiveness on acne, since they work by improving cell turnover and comedolytics, this might be the all-in-one ingredients for your skin concern (acne and premature aging). If you’ve noticed fine lines, loss of skin bounciness or irregular pigmentation, maybe you want to start your retinoids journey now (although there are other options available as well, we’ll discuss it further next time)

Let me answer some FAQ:

#1 Is it safe during pregnancy or breastfeeding?

Retinoids are not safe to use during pregnancy (although this has only been proven at a certain amount of concentration, despite the various amount of concentration available in the market). But it is just best to avoid this product during pregnancy. While the OTC options are unlikely to cause a problem while breastfeeding, but again, there’s no evidence saying that it’s safe. So is it worth the risk?

#2 Can I use it together with my AHA or other acids?

There’s a popular belief that the AHA will disrupt the effectiveness of the retinoids (especially the retinol and their derivatives), etc. I have no definite answer for this, there’s no evidence to show this in human skin condition, yet

But let me say from a dermatologist point of view, it’s just best not to use them altogether since they each may cause irritation just by itself. So using them all together means doubling the chance of irritation. So, my answer would be NO!

But how if they are already formulated together? Ah, yes There is some product that has combined them all together, are they safe? The answer is yes or no, depending on the formulations and how your skin will react to it. Everyone has a different kind of “threshold” so it’s your skin to judge if they are safe to use on your skin.

#3 What product that compliments retinoids?

First, of course, sunscreen! Any product that has anti-inflammatory properties, niacinamide with retinoids can be a great combo altogether.

#4 How to incorporate them into my routine?

There’s no exact right or wrong for this as well. But I will say, in my personal opinion, come closest to the skin. I usually apply them on clean and dry skin. Although not scientifically proven, applying them only slightly damp face can increase the chance of irritation. Apply a moisturizer cream afterward to help seal moisture and help with the dryness

#5 Peptide vs Retinoids?

Retinoids, for now, there are more evidence available up to date

#6 Retinol (OTC) for acne?

Evidence of retinol (OTC) for treatment of acne is limited (especially with the various concentration available), it’s hard to say with the various concentration available on the market. (remember that they are not retinoic acid that historically used as a mainly acne medication). Acne’s etiology itself is multifactorial and complicated. Despite their antibacterial and comdelytic properties (not on human), If you’re aiming on treating acne, retinol (OTC) is not the exact right answer I would say, try using a doctor-prescribed proven acne medication retinoids (Adapalene, Tretinoin) or other alternatives depending on the type of acne

#7 Tips for first-timer? 

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That’s all for the first of this well aging series! I hope you all a great skin health and see you guys on the #2! Follow my Instagram for more skincare-related post and skincare product review

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