Retinoids: The breakdown. What’s the difference between Retinol, Tretinoin, Retin-A, Alpha Ret?
Retinol. You've heard of it, and it's likely you're using it. But what's the difference between Retinol, Retin-A, Tretinoin, Alpha Ret, etc. ?
They are all retinoids, a group of vitamin A-derived skincare products, and the difference between them is their strength/concentration and delivery method. The body cannot synthesize vitamin A, and it must be obtained through diet, or in this case topical application.
Retinoids have been known to be beneficial to the skin, apparently since ancient Egyptian times, and were further developed into today's prescription strength tretinoin in the 1960's. I like to say that retinoids are the vegetables of skincare. No one really debates their beneficial qualities, from acne to fine lines, wrinkles and collagen production, they are certainly beneficial. Topical retinoids work by increasing the rate of skin cell turnover, blocking inflammatory mediators in the skin, and augmenting collagen synthesis. Great stuff, huh?
Retinoids exist on a spectrum of low strength to high strength that starts with Retinol, which is a low-strength over the counter product you can buy anywhere from Walgreens, Sephora, or on the internet in various luxury branded skincare products. Retinol is an unstable molecule, and requires conversion by the body for it to become active in the skin. It's hard to know how much retinoid any given person gets from retinol because of the need for it to be converted to the active form, but the upside is that it tends to be well-tolerated and less inflammatory than the traditional full strength retinoids like Retin-A and Tretinoin.
Medical grade retinoic acid products are available through physician led practices, just like prescription medications. These include the classics: Retin-A and Tretinoin, among others. These vary in concentration, but are roughly 10-20x higher in concentration than over the counter strength retinol. Now, the downside of full strength retinoids is that they tend to make the skin flaky, dry, and inflamed-feeling for the first month or so of usage (assuming it's used daily) before the skin "gets used to it" and stops feeling so irritated. Many people don't want to tolerate the process of their skin "becoming retinized" and they stop using their full strength retinoid out of annoyance with the initial side effects.
Because full strength retinoids are often difficult to tolerate, one med grade skincare company, skinbetter science, has developed a full strength retinoid that is designed to be non-inflammatory: Alpha Ret. In the vast majority of people, even with nightly use, Alpha Ret doesn't make the skin flaky, dry, or irritated due to the retinoid molecule being encapsulated in lactic acid (also a beneficial alpha hydroxy acid) making a time-released delivery method which is much more tolerable, and equivalent in strength to the traditional medical grade retinoids. Alpha Ret also contains glycolic acid, niacinamide, ceramides, hyaluronic acid, antioxidants, and more. It's a great product: a tolerable full strength retinoid with several other rockstar skincare ingredients. It's $135 for 30 ml, designed for nightly application, the container lasts 3-6 months. For me, this is the one product I still apply when I really do not want to do my skincare regimen... I will at least put on my Alpha Ret.
In summary: retinoids increase the rate of skin cell turnover creating dewy youthful skin and helping treat wrinkles, acne and augment collagen production. Retinol is over the counter and is much less strong than medical grade retinoids Tretinoin and Retin-A. Alpha Ret is a full strength retinoid that is much more comfortable to use than the traditional retinoids. Clearly, we love Alpha Ret at Skinbeam and it was the original reason we brought on the skinbetter science skincare line.
Bottom line, retinol is better than nothing, and totally fine if your age starts with a 2 and you don't have any major skin concerns. :) If you aren't buying your retinoid through a physician-led practice, it's going to be retinol, the lowest concentration of retinoic acid. Example: La Mer. $500-700 products, very well marketed, lovely texture, however: not medical grade. My credit card is crying for La Mer users. In my opinion if you're going to spend hundreds on skincare, it had better be medical grade products which contain higher concentrations of active ingredients, and have clinical research studies to prove efficacy. Skinbetter is medical grade and way cheaper than La Mer.... don't even get me started.
Last thing: YOU MUST USE DAILY SPF. Period. Especially if you are using any type of retinoid including retinol. Retinoids sensitize your skin to UV. Photoaging (sun exposure) is a big factor in skin aging. USE DAILY SPF. Every skin color. Even if you're just running errands. Even if it's cloudy. Your car windows don't protect you from the sun. Put on the sunscreen every day.
Cheers!
Benefits of Antioxidants in your Skincare Regimen
You may have heard that antioxidants are great in your skincare regimen. Maybe you've already incorporated Vitamin C. But do you want to know how it works? Here we go:
*When applied topically, as in a skincare product, antioxidants protect your DNA by scavenging DNA damaging free radicals. You've probably heard of free radicals being unhealthy in the body....
<blows dust off chemistry book>
They are unstable molecules with an unpaired electron, looking to give it away or snatch an electron from a complete and stable molecule, thus destabilizing it. When your DNA is the molecule being attacked by a free radical, there may be errors in the following cell divisions from the damaged DNA. Other proteins (collagen) and lipids in the body are also vulnerable to free radical attack. UV rays, X rays, air pollution, cigarette smoke, pesticides and some of our own metabolic processes expose us to free radicals. Accumulation of free radical oxidation in the body is attributed to many processes of cellular aging, atherosclerosis and cancer. Antioxidants are stable molecules capable of donating an electron to the rampaging free radical, thus neutralizing it and preventing its cellular damage. Hooray! Antioxidants can be obtained through your diet (blueberries!) and via topical application (skincare!)
*They increase skin immunity by increasing Langerhans cells, which are the outermost guard of the immune system in the skin.
*Antioxidants also help prevent collagen breakdown, and vitamin C has a role in collagen production in the skin.
*Additionally, they reduce hyperpigmentation by working in the melanin production process.
*Finally, theoretically, antioxidants should help reduce skin cancer formation by reducing free radical damage to DNA, and therefore reducing gene mutations. Research is ongoing regarding this benefit of topical antioxidant application for skin cancer prevention.
*Vitamin C is a well known antioxidant in skincare, but there are many many other antioxidants that can be applied topically for additional benefit (Vit E! Coenzyme Q10! Acai, Green Tea, Cocoa, Turmeric! More!). We recommend skinbetter science: Alto Defense Serum and Alto Advanced because they're really strong. These two products have a large number of antioxidants included - vitamin C plus 18 others, and Alto Advanced is formulated to attack free radicals that are produced by our own bodies (endogenous).
Another quick-and-easy way to get your vitamin C on, along with sunscreen is UV Elements by EltaMD. It's a combo of mineral SPF 44 plus hyaluronic acid and vitamin C with tint and a dreamy texture for pretty skin.
You may go get your antioxidant serum and Acai bowl now.
How do Neuromodulators like Botox & Dysport actually work?
How Tox Works:
"Tox" is a fun and non-brand-specific nickname for neuromodulator or neurotoxin which we use to relax away wrinkles, and for other medical applications as well. The famous botulinum toxin is a naturally occurring molecule produced by a bacteria, Clostridium botulinum, and it is synthesized in the laboratory under the brand names of Botox, Dysport, Xeomin, Jeuveau, Daxxify for aesthetic use. These medications only work when injected below the skin, and are administered in very tiny doses so as to affect only very specific muscles for medical aesthetic purposes.
Each of the different brands of neuromodulator is very similar in its effect, with subtle differences in strength and duration between brands. At Skinbeam we carry Dysport and Botox, and may consider adding Daxxify in the future depending on how their first year on the market goes.
Tox is a long-acting muscle relaxer, with Dysport and Botox lasting 3-4 months. Bigger doses last longer (4 months) and when you reduce the dose, you reduce the duration. Some people wonder: if it's a muscle relaxer, how can it lift the brows? We can use tox to produce a brow lift by selectively treating muscles that pull down on the brows (glabellar complex, orbicularis oculi) while leaving the lower forehead muscle (frontalis) alone to a certain extent, because it's the only muscle that lifts the brows up! It's a balancing act between relaxing away forehead lines, while leaving enough of the forehead muscle working to keep those brows lifted!
Tox physiology for physiology wonks:
Caution: nerd alert! Tox works on the acetylcholine receptor which transmits motor impulses from the nerve to the muscle. The medication binds to the acetylcholine receptor and functionally destroys it permanently. Boom. When there is no neuromuscular transmission via the acetylcholine receptor, the muscle stays in the relaxed state even when the brain sends motor signals for it to move.
Then what? How does the medication "wear off?" It's not so much that it wears off. It's the body making new acetylcholine receptors. All parts of the skin, subcutaneous tissue, and muscular layers are continuously being regenerated by the body, including acetylcholine receptors. These are naturally regenerated about every 90 days, and at that point, there is typically some or all muscle movement regained. The duration of the tox is related to how thoroughly the medication has wiped out the acetylcholine receptors in the area. Bigger doses knock out more receptors, and smaller doses may leave some receptors still working.
Here's the fun link to microneedling with PRP: as a regenerative treatment, microneedling with PRP helps the layers of the skin regenerate faster, and it's theorized that the regeneration may increase return of new acetylcholine receptors, potentially making tox offset faster. This is why it's generally recommended to separate tox treatments from microneedling with PRP.
After 3-4 months, the results from tox injections dissipate, and your face very gradually returns to how it would have been if you hadn't been treated. There is a preventive effect to being treated with tox which is related to the skin spending long periods of time without being creased, as well as a bit of muscular atrophy that can occur after several re-treatments with tox.
Questions or comments? Get in touch on Instagram @skinbeam_aesthetics or (714) 450-6735
Cheers!
Cannula for Dermal Filler Injection
Patient Education Topic: What is a cannula and why does it matter to dermal filler injection?
Well, all of that hyaluronic acid goodness needs to get under the skin somehow, right? When you think of injections, your mind automatically goes to needles. Indeed needles are a good tool for injecting dermal fillers like Restylane and Versa. Needles are preferred for injection of filler in some locations of the face (frequently lip filler), and are often favored for precision. The downside to using a needle to inject dermal filler is that needles are readily capable of piercing an artery or a vein. The concern here is that filller could be deposited accidentally into that artery or vein, causing (very!) rare problems like vascular occlusion (clogging of the artery) or in some (extremely!) rare cases, vision loss.
One useful practice to reduce the likelihood of accidental vascular injection is aspiration, or pulling back on the plunger of the syringe, and observing for backflow of blood. This is a common practice, and something that I do with every needle pass. Another way to decrease the likelihood of piercing an artery or a vein is to use this handy blunt-tipped injection device for filler: the cannula.
Cannulas kind of look like needles, but they aren’t sharp on the end, and the port where the filler comes out is actually on the side near the tip. A needle is used to create a port in the skin where the cannula initially enters, and then the cannula traverses under the skin to deposit dermal filler. Cannulas are great for cheek filler, marionette lines, temple filler, jawline filler, and sometimes the nasolabial folds. The idea is that if the cannula bumps into a blood vessel, it’s less likely to pierce it, making this injection technique safer from a vascular occlusion standpoint, and probably bruising as well.
The face is a literal minefield of blood vessels, and vascular concerns will always be top of mind for injectors when it comes to patient safety. Aspiration when a needle is used, and cannula use are two ways to increase the safety of dermal filler injections. Additionally, safe injectors will be packing a refrigerator full of reversal agent for hyaluronic acid dermal fillers, and as a patient, it’s okay to inquire about safety. You’ll want to know that your injector is a good ‘girl scout’ and has a plan to prevent and treat complications.