A Routine Scare

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By Valerie Monroe

Can’t get enough Valerie Monroe? There’s more at https://valeriemonroe.substack.com.

ISN’T IT strange how humility seems to strike at just the right moment? For example, as soon as I start thinking about an annoying habit one of my family or friends has, I realize I’m doing it myself.

Along those lines: A few weeks ago I shared that a reader had a new mantra when perusing the beauty aisles: WWVD (What Would Val Do?). How thrilling that my advice might be taken seriously!

So, I was interviewing a well-known plastic surgeon recently about an intriguing new peel he’s offering (more on that in a later post), when he mentioned he rarely recommends a prescription retinoid for patients over 50, because “there’s a thinning problem over time.”

Wait, what? I said.

I told him I’m constantly telling readers (many of you 50+) that their skincare routine should include a retinoid (if their skin can tolerate it), as it’s the only thing proven to reduce fine lines and wrinkles and generate collagen and elastin (or slow its loss). Also, I said (with equal urgency), I’ve been using a prescription retinoid almost every night for more than 20 years—AND I STARTED USING IT WHEN I WAS OVER 50.

Is it a miracle I have any skin left on my face? Trying to calm myself, I remembered the dermatologist I see for my skin cancer check-ups told me on my most recent visit, as she examined my complexion with 1000X magnification glasses, that my skin looked “terrific.” (Maybe she meant what’s left of it.)

Confounded by what the plastic surgeon told me, I asked for a deeper explanation of his retinoid policy. He wrote:

Retinol [non-prescription] is unlikely to affect the skin barrier, but chronic use of prescription retinoids significantly disrupts the function of the external skin barrier. Barrier disruption triggers a destructive cycle of chronic inflammation and further barrier damage. Thinning of the skin barrier can be detected months after a prescription-strength retinoid has been discontinued. I recommend prescription retinoids be used judiciously and sparingly after 50. 

Hair slightly on fire, I emailed a dermatologist I know who’d posted an Instagram video in which she mentioned that retinoids may be less effective as we age, because we produce less of the collagen a retinoid protects. (I wasn’t sure I’d understood her message and asked her to clarify, as well as to comment on the plastic surgeon’s pronouncement.) Though she didn’t quite agree with his assessment, she responded:

I think of retinoids as abundance, mimetics, meaning they create a sense in the skin that there’s an abundance of resources, which helps with collagen production. But having constant abundance can also potentially be problematic and even destructive. This is why I’m investigating whether we may be better off pulsing retinoid use rather than using it continuously.

(In medicine, a “mimetic” is a molecule like a retinoid, or a peptide, or any other molecule that biologically mimics the action or activity of another protein.)

The bottom-line: There seems to be the potential that the person advising you, Dear Reader, the one who prompts you to consider WWVD?, might be chronically F*cking Up Her Face.

Why am I telling you this? Because I want you to understand just how challenging it is to make sense of all the information available about skincare, and how important it is not to place 100% of your trust in anyone (not even me).

I called my friend Sarah Villafranco, a former emergency room physician and founder of the excellent skincare brand Osmia, about my confusion. Sarah’s products are the only ones I’d use if I wanted organic. I expected her to tell me I should quit the retinoid and focus on a simpler, more nourishing routine.

“If you’re trying to diminish the signs of aging, retinoids work,” she said, plainly. Every dermatologist in the world uses a retinoid, she continued (at least every dermatologist I know does). Why? Because it does what it’s supposed to do and the side-effects are minimal. “I wouldn’t go into a blind panic about it and stop using it,” she said. If it looks like your skin is becoming irritated, she advised, then hold off for a bit—or use a lighter concentration or a gentler type (Villafranco likes the Ursa Major Lunar Bloom Retinal Serum). I offer more retinoid alternatives in this post.

I’m good for now with my continued recommendation in spite of the momentary alarm. (Though I’ll keep researching the subject.) As with everything, moderation is key; when you find something that seems to work for you, when your skin looks calm and healthy, you’re probably doing something right.

On a less panicky note: I wanted to share this magic nail polish discovery I found on Instagram, where I go to never buy anything. But this really works, giving your nails a discreet, pearly finish, which makes your hands look more . . . polished. Do you, like me, find it difficult to sit for a manicure? Two coats of this stuff gives you a nearly professional result with around a five-minute time commitment. An easy WWVD.