A patient came in last year having used retinol for six months with no visible results. She had faithfully applied it twice a week, as instructed, to her whole face. She had experienced some initial flakiness, which had settled. But the changes she’d hoped to see — better skin texture, reduced lines, improved tone — hadn’t materialised.
When I looked at what she was using: a 0.025% retinol in a cream formulation, applied twice weekly to dry skin over moisturiser.
The formulation and protocol were the problem. The principle behind the ingredient was correct.
The retinoid family, clarified
“Retinol” has become a catch-all term for the vitamin A derivative category in consumer skincare, which creates confusion about what different products are actually doing.
The retinoid family, in order of increasing potency and prescription requirement: retinyl palmitate (over-the-counter, weakest), retinol (over-the-counter, converted to retinoic acid in skin through two metabolic steps), retinaldehyde (also OTC, one step from retinoic acid), adapalene (formerly prescription, now OTC in some markets, synthetic retinoid), and tretinoin/all-trans-retinoic acid (prescription, the most potent, directly active form).
Each conversion step reduces efficacy by approximately 10-fold. A 0.025% retinol product is meaningfully less potent than a 0.025% tretinoin product. The packaging doesn’t always make this clear, and consumers frequently assume that two products described as “retinol” with similar concentrations are equivalent.
What retinoids actually do
The evidence base for topical retinoids in skin ageing is the most robust of any non-prescription skincare category. Tretinoin specifically has been studied in controlled trials for over forty years.
Retinoids work through nuclear retinoic acid receptors in keratinocytes and fibroblasts. They increase epidermal cell turnover — accelerating the shedding of the outer skin layer and the generation of new cells. In fibroblasts, they upregulate collagen type I and III synthesis and downregulate matrix metalloproteinase activity — slowing collagen degradation.
The clinical consequences of sustained retinoid use: improved skin texture and tone, reduced fine lines and depth of established wrinkles, improvement in mottled pigmentation, thickening of the epidermis (which thins with age), and improved blood flow to the dermis [1]. These are measurable, histologically confirmed changes — not marketing claims.
In my practice at SW1 Clinic, retinoids are the topical intervention I prescribe most often and believe in most strongly. They are the only OTC category for which the anti-ageing evidence is genuinely compelling.
The Asian skin consideration
Here is where clinical judgement becomes essential.
Asian skin — Fitzpatrick phototypes III-V — tolerates retinoids less readily than lighter skin types. The higher melanin density means that irritant reactions, which retinoids can cause during initiation, are more likely to trigger post-inflammatory hyperpigmentation. The “retinoid uglies” — the initial period of flaking, redness, and sensitivity that most retinoid users experience in the first four to eight weeks — can leave hyperpigmentation marks in Asian patients that take months to fade.
This doesn’t mean Asian patients shouldn’t use retinoids. It means they should initiate differently.
My protocol for Asian skin: start with retinaldehyde rather than retinol if possible (more potent, more predictable, still OTC), or the lowest concentration retinol available. Apply every third night initially — not twice weekly and not every night. Apply to completely dry skin, fifteen to twenty minutes after washing (residual moisture increases absorption and irritation). Use the “sandwich method” if sensitivity is high — moisturiser before and after application to buffer the delivery. Build frequency over three to four months, not three to four weeks.
Crucially: use SPF consistently and rigorously when on retinoids. The increased cell turnover increases UV sensitivity, and in Singapore’s year-round UV environment, retinoid use without adequate SPF will produce more harm than benefit through pigmentation exacerbation.
When I prescribe tretinoin — and when I don’t
Tretinoin is the prescription-grade retinoic acid. In Singapore, it is available by prescription from registered physicians, typically at concentrations of 0.025%, 0.05%, and 0.1%.
I prescribe tretinoin for patients who have established photoageing — not just early fine lines, but genuine textural change, significant mottled pigmentation, and moderate wrinkle depth — and who are committed to managing the initiation period appropriately. The results with tretinoin at adequate concentrations are substantially better than with OTC retinoids. But the initiation demands are also greater, and in Asian skin, the risk of hyperpigmentation during initiation is higher.
I do not prescribe the highest concentrations as a starting point. I begin at 0.025% with the same cautious initiation protocol I use for OTC retinoids. Patience is required on both sides of the prescription pad.
For patients with very reactive or very sensitive Asian skin, adapalene — which acts on different retinoic acid receptor subtypes and produces less irritation than tretinoin — can be an excellent starting point. The anti-ageing evidence base is less extensive than for tretinoin, but its tolerability profile makes it a practical entry point.
The bakuchiol question
Bakuchiol is a plant-derived compound marketed as a “natural retinol alternative.” Several studies have compared it to retinol and found comparable effects on pigmentation and some skin ageing parameters, with lower irritation rates [2].
I am cautious about how enthusiastically to recommend it, for two reasons.
First, the study quality is lower than for the retinoid literature — smaller sample sizes, shorter durations, and the comparative retinol doses used are generally low. Whether bakuchiol performs comparably to well-used tretinoin is a different and unanswered question.
Second, bakuchiol is significantly more expensive than retinoids for equivalent amounts. For a patient who tolerates retinoids well, there is no clinical reason to switch to bakuchiol. For a patient with genuine retinoid intolerance where all initiation strategies have been tried, bakuchiol is a reasonable alternative. Not for everyone else.
What you can actually do
If you’ve tried retinol and abandoned it because of irritation: the issue is likely initiation approach, not the ingredient category. Try the slow protocol — retinaldehyde or low-concentration retinol, every third night on dry skin, with moisturiser buffering and impeccable SPF.
If you’ve tried retinol and seen no results: check concentration (below 0.3% retinol is likely too low for significant anti-ageing effect), check application technique (should be applied to face, not in a carrier with rich moisturiser that dilutes delivery), and consider whether prescription tretinoin would serve you better.
If you’re new to the category: start the conversation with a physician rather than navigating the product landscape alone. The retinoid category has more variables than almost any other topical, and getting the entry point right saves months of trial and error.
Retinol is not marketing language. It is a molecule with fifty years of clinical evidence behind it.
What it isn’t is simple to use correctly, particularly on Asian skin in Singapore. That’s what the consultation is for.
References
[1] Kang, S., et al. (1995). Application of retinol to human skin in vivo induces epidermal hyperplasia and cellular retinoid binding proteins characteristic of retinoic acid but without measurable retinoic acid levels or irritation. Journal of Investigative Dermatology, 105(4), 549–556. [VERIFY — confirm before publishing]
[2] Dhaliwal, S., et al. (2019). Prospective, randomized, double-blind assessment of topical bakuchiol and retinol for facial photoageing. British Journal of Dermatology, 180(2), 289–296. https://doi.org/10.1111/bjd.16918 [VERIFY — confirm before publishing]
[3] Mukherjee, S., et al. (2006). Retinoids in the treatment of skin aging: An overview of clinical efficacy and safety. Clinical Interventions in Aging, 1(4), 327–348. [VERIFY — confirm before publishing]
