Question: I’ve been on Retin-A therapy for about a year. I’d like to know if I can undergo microdermabrasion or if I need to be off Retin-A first.
Answer: As long as the Retin-A is not irritating your skin, you can safely undergo a microdermabrasion while still using that product. In fact, the far majority of our patients that we see for skin care are on Retin-A on a virtually daily basis. If the concentration is appropriate for their skin type, they really should not have any significant irritation to the skin and, therefore, these patients can undergo routine microdermabrasion on a regular basis.
That really depends on the significance of wrinkles that you have and the area of the face that you are concerned about. Fine lines and wrinkles around the eyes can certainly be improved visually by the use of Retin-A, but overall the result will be rather subtle and patients with fine lines will be able to visually notice this more than patients that have deeper lines. Retin-A in and of itself is a very superficial peeling agent and it also causes a small amount of swelling in the skin that creates the illusion of wrinkle reduction. This effect is only present while the patient is using Retin-A and is really not a long term effect. There are certainly more effective long term treatments for wrinkle reduction of the skin and these include treatments such as Micro Laser peels, ProFractional laser treatments, erbium or CO2 laser resurfacing, as well as the new technology of Ultherapy. I would highly recommend a consultation with our extremely experienced staff at Quintessa Medical Spa to determine which option would be best for your skin type.
Yes, I believe that most of my patients would benefit from the use of Retin-A on a daily basis. Some patient’s skin is more sensitive than others and this has to be titrated so that an appropriate amount of Retin-A can be used, but any sort of irritation and redness can be minimized. Retin-A is a very nice agent to improve cellular turnover. This in and of itself is a very light peeling agent and will rid the skin of the topmost layer called the stratum corneum and allow the skin to look more fresh and hydrated. Further, it is very useful to help with pigmentary issues due to the fact that it does increase cellular turnover. This therefore allows the skin’s own natural processes to rid itself of unnatural pigmentation in a more timely fashion. Retin-A in combination with hydroquinone is a very effective means of improving pigmentary issues in patient’s skin and if this is too irritating, we typically then place the patient on a combination therapy of the Retin-A, hydroquinone, and a topical steroid, which commercially available is called Tri-Luma. The bottom line is I feel that the far majority of my patients should be on Retin-A on a daily basis and that they just need to adjust the amount used to prevent any sort of irritation to the skin.
I’m not personally familiar with Refissa, but from the information on their website, it seems to be regular old Retin-A with an emolient for a moisturizer. There doesn’t seem to be anything special about the product. Regarding your questions, yes, it can be used with Obagi, and it is as effective as Retin-A because it is Retin-A. Micronized Retin-A has an advantage over regular Retin-A, but it appears that Refissa really has no significant advantage over any other Retin-A brand.
Depending on the patient’s skin type and problems, I would most likely recommend the Obagi Skin Care System as this is one of the more aggressive approaches for skin rejuvenation and maintenance. I would have the patient on the Clear, which has hydroquinone in it. I would also recommend the use of Retin-A on a daily basis of tolerated. It is recommended that the patient discontinue the Retin-A and hydroquinone two to three days before the intense pulse light treatment and then they can resume it the day after the treatment again. Obviously a very good sunblock on a daily basis is expected of patients so that their skin can be rejuvenated to the highest degree and they will maintain this rejuvenation with the help of the sunblock.
There are several modalities to consider when treating dark spots after a TCA burn. These are due to postinflammatory hyperpigmentation and this type of pigmentation can be very difficult to completely eradicate; however, with multimodality treatment, we can very successfully improve the appearance of these types of lesions. Treatment includes regular and judicious use of sunblock. Do not confuse sunblock with sunscreens. Sunblock would have titanium dioxide and/or zinc oxide in the ingredients and this would be a sunblock preventing any significant UV from damaging or causing further pigmentation to the skin. This is by far and away the most important step in a treatment regimen for postinflammatory hyperpigmentation. Other additional treatment options would include hydroquinone applied at least daily if the skin is able to tolerate it. If hydroquinone tends to irritate the skin, this can further produce postinflammatory hyperpigmentation and I would therefore place the patient on Tri-Luma, which has hydroquinone and Retin-A as well as a steroid to reduce the inflammatory reaction. Broadband light or intense pulse light can also be used on postinflammatory hyperpigmentation, but must be used in combination with the aforementioned treatments to prevent further pigmentation from the injury. Ultimately these areas will greatly improve over time, but there really is no quick fix for postinflammatory hyperpigmentation and most patients will take at least several months to show significant improvement and possibly six months or even longer for resolution of these lesions.
Retin-A is a wonderful product that I recommend to virtually every one of my patients; however, I do not recommend it for wrinkle reduction and certainly would not recommend it for under eye hollows. Retin-A essentially increased the cellular turnover of the skin. It can provide a very small amount of very fine wrinkle reduction, but this would be very difficult to really appreciate visually. Fillers; however, are excellent at filling in depressions in the under eye if placed extremely precisely and carefully. Products such as Restylane or Juvéderm Ultra can do a wonderful job of filling in these troughs or depressions in the lower eyelid and this will essentially give the illusion that the lower eyelid bag has disappeared. This can create a very natural rejuvenated eyelid appearance without surgery. The only two drawbacks are that it is not a permanent solution, but will last approximately one year. The other drawback is that if not placed properly, can actually create a worse problem than the original under eye hollow. Fortunately any sort of difficulties with over injection of these types of products can be treated rather easily and therefore any complications from filler material in the lower eyelids can be corrected with injection of hyaluronidase.