The Beginner’s Guide To Retinol & Retinoids: How To Prevent Dry, Flaky Side-Effects

As a product formulator and practicing esthetician with over 30 years of experience, I consider myself well-versed in retinol and retinoids. Fun fact: I personally knew one of the dermatologists who was instrumental in getting this ingredient FDA approved as the first topical preventative aging product (read the full story of when I met this dermatologist. It’s a good one). So without further ado, keep reading to learn my expert tips for getting maximum benefits from a topical vitamin A product, whether it’s a prescription form (retinoid) or in an over-the-counter version (retinol).

First things first. In an ever-changing world of skincare advancements related to preventing and reversing the appearance of lines, wrinkles, indented acne scars, large pores, and brown spots, there are TWO facts that have remained constant for the past 30+ years.

  • Fact #1: Certain types of vitamin A, the ingredient behind retinol and prescription retinoids, can reverse visible signs of aging. Using a topical product containing these ingredients can increase cell thickness, affect gene expression, thin the stratum corneum, and increase the production of collagen. With continued use, vitamin A can slowly improve the skin’s appearance (NCBI Study). It smoothes skin texture by lessening visible wrinkles, lines, indented acne scars, large pores, and brown spots. Simply put, this ingredient can deliver smoothing and resurfacing results. Thus, it can help the skin mature in a more desirable way.
  • Fact #2: You must take special care of your skin to manage and prevent potential side effects such as dryness and irritation (especially if you’re using a prescription formula). In the early ’90s when tretinoin first became FDA-approved for treating sun damage, not much was known about controlling its side effects. If misused, the effects were often intolerable. I once had a client who was using a prescription retinoid improperly. She smiled, and in front of my very eyes, areas of her face cracked and started to bleed. I couldn’t believe what I was seeing! These days, the side effects of retinol and retinoids are completely manageable (NCBI Study). All you need to do is take special care of your skin by following my expert tips.

The Most Common Types of Vitamin A Ingredients

1. Retinoid (Tretinoin)

This ingredient is derived from vitamin A and is only available in prescription formulas (with the exception of Adapalene, or Differin, which is now sold without a prescription). When applied to the skin, it converts directly to retinoic acid. It then binds to cell receptors and activates the cell maturation process in the skin. Brand names include Retin A, Retin-A Micro, and Renova.

2. Retinol

This is an ingredient found in non-prescription formulas. When applied (assuming it’s an encapsulated, stable, and well-formulated product), it converts slowly to retinoic acid. It’s time-released, which means it’s delivered into the skin gradually, over a period of hours, instead of all at once like retinoids are. Because of this, retinol users often experience less irritation than retinoid users. Therefore, retinol is ideal for sensitive, reactive skin types, as well as those with less sun damage. Despite being a gentler option, retinol is still effective and can deliver the same results as a prescription with long-term use.

Note: Biochemically, retinoids and retinol perform the same function, which means you’ll get results regardless of which one you choose to use. Results may take a little longer to achieve with retinol-based products, but that’s exactly what is needed for vitamin A newbies and people with sensitive skin types.

3. Retinyl Palmitate

This is a storage form of vitamin A. It’s a blend of pure retinol and palmitic acid, and it’s much weaker than retinol. The process of retinyl palmitate converting to retinoic acid is considerably more complex, and the amount that ends up reaching the cellular receptor is very small. It simply cannot compare to the efficacy of pure retinol. When used in a formula, this ingredient can improve the chemical stability of retinol and act as an emollient and antioxidant, but you typically shouldn’t count on it to deliver the same smoothing and brightening results as retinol. Retinyl Acetate, Retinyl Linoleate, and Retinyl Propionate are in this same category.

4. Retinaldehyde

This is a stable precursor to retinoic acid. When it’s stable and encapsulated, it can convert slowly within the skin to retinoic acid just like retinol.

It’s important to note that just because a product contains one of the vitamin A ingredients listed above does NOT mean it will necessarily deliver results. You must consider how the formula is made, which percentage is used, how it’s delivered into the skin, and how stable it is. You’ll usually have to do a bit of research to find all of this out. If a brand is not readily sharing this information, I consider it a red flag, because it could be representative of the product’s lack of true efficacy. Any good formulator knows this is very important information to share with their customers; they should share their product stats proudly. (Read four things to look for when choosing a retinol product.)

How To Decide if You Should Use Retinol or Get a Prescription Retinoid From Your Doctor

I start all of my clients on retinol, regardless of how much sun damage they have. Here are some guidelines for making this decision for yourself.

 Start Using a Prescription Retinoid if You’re…

  • NOT sensitive at all. If you are sensitive, there’s no need to read this section, as a prescription retinoid is not best for you. (Most people have a certain degree of skin sensitivity, which is why I suggest using retinol first. If you fit the following conditions, though, you can eventually transition to using a prescription retinoid.)
  • Someone who’s over the age of 35 with a long history of sun damage. You may feel like your skin shows more visible signs of aging than other people your age.
  • Someone who, regardless of age, has pitted, indented acne scars from your younger years.
  • Someone who, regardless of age, has melasma from the sun, heat, pregnancy, or hormones. You’ll benefit from something stronger to work deeper and faster. Again though, if you have sensitive skin, it’s best to start with retinol.

Skip a Prescription Retinoid and Use Retinol if You’re….

  • Someone who, regardless of age, has thin, dry, and/or sensitive skin. This includes anyone who has rosacea, a history of eczema, or simply an easily-irritated skin type. These skin types may never adjust to a prescription retinoid due to the delicate protective barrier that’s easily compromised.
  • Someone under the age of 35 with no major acne issues who is already using vitamin A to prevent wrinkles, lighten discoloration, reduce pore size, and smooth skin texture. Sticking with retinol and occasional chemical peels is perfect because you’re already getting ahead of the aging process. There’s not as much repair and reversal work to be done in those younger than 35.

When to Start Using Retinol to Prevent Signs of Aging

Assuming that blemishes are not your main concern, I generally recommend starting to use retinol between the ages of 26 and 30. The exact age will depend on your specific skin type, although I don’t suggest starting it before 26. There are two reasons for this. The first is that many people who are younger than 26 are still dealing with breakouts. Despite what you may have heard, retinol or retinoids do NOT help cystic or pustular acne. However, prescription retinoids CAN be effective for managing closed comedones. I discuss this more in detail below.

The second reason is that vitamin A speeds up the skin’s metabolism, which begins to slow in your early 30s. When you’re younger, your skin is already very metabolically active. Using retinol or retinoids too early might backfire and stir up breakouts, rashes, and more. Basically, it could disrupt the skin’s natural balance.

What to Know Before Using Retinol or a Prescription Retinoid

Avoid Using Retinol or Prescription Retinoids While Pregnant

Of course, it’s always best to consult with your doctor. In my experience, though, most advise against using vitamin A until after giving birth due to potential risks. I have not personally come across any reported evidence of either topical retinol or retinoids causing harm, but doctors are extra cautious with expecting mothers, and understandably so.

Retinol Can Be Used During the Summer as Long as You’re Serious about Sun Protection

Retinol and retinoid products deliver the best results when used two to five nights a week year-round. Using it on and off can slow progress, so it’s important to commit to using it consistently, even during the summer months. As long as you’re someone who practices sun safety and is very conscientious about preventing suntans and sunburns, then you should be just fine.

However, if you are someone who enjoys tanning or someone who hasn’t yet mastered the art of sun protection, I would suggest discontinuing your retinol or retinoid seven days before intense outdoor sun exposure. Start it back up again a week after you’ve been in the sun—assuming you don’t have a sunburn, of course. While this will slow down results, it’s super important to prevent skin inflammation and irritation.

You’ll See Better and Faster Results If You Use Exfoliating Acids in Your Routine, Too

When dry, dead cells are regularly removed from the skin’s surface, vitamin A is more easily absorbed. You’ll definitely want to start using an exfoliating acid serum, but more on that later.

Retinol and Retinoids Don’t Deliver Visible Results Quickly, so You Must Be Patient

Unlike an exfoliating acid peel that delivers immediate results, vitamin A works incredibly slowly to create change in the skin. I generally tell my clients that they won’t start seeing improved textural changes for two to four months. With continued use, you’ll see more and more positive changes. Do not give up. Stick with it!

You’re Not Going to Get Anti-Acne Benefits With Retinol. You Might with a Prescription Retinoid, But Only For Certain Types of Breakouts

Yes, prescription retinoids like Retin-A were, in fact, originally developed in the ’70s for treating acne. It wasn’t actually discovered until later that the ingredient also helped with wrinkles. That explains why, for a long time, retinoids had the reputation of being a go-to for acne. The truth is, they’re not for everyone. All skin is different and so are the type of breakouts that each person experiences. (This explains why you may hear about a product working like magic for one person and then making another person’s breakouts worse!)

The type of acne prescription retinoids work best for is comedonal acne. This is the type that appears as whiteheads, blackheads, closed comedones, and clogged, non-inflamed bumps. Retinoids restore the organization of cells through cellular turnover. This, in turn, prevents cells from getting trapped and blocked in the pore-lining which in turn, prevents those little non-infected bumps from forming.

Prescription retinoids do not work well for sore, inflamed pustular acne or cysts. In fact, when someone has infected pustular and cystic acne, retinoids may actually make them worse. It’s far better to use products that have more proven breakout-fighting benefits, such as salicylic acid, tea tree, beta-glucan, niacinamide, manuka, sulfur, lactic acid, and benzoyl peroxide. (On that note, beware of skincare brands that claim their retinol product can treat acne AND wrinkles as a one-stop-shop. This is false and anyone sharing this is simply not informed of how retinol really works. Trust me on this!)

As for retinol, since it contains a lesser dose of vitamin A, it doesn’t work as hard as retinoids do to clear clogged bumps. If breakouts are your main concern, I usually advise focusing on clearing blemishes first. Once the skin is clear, you can start using a retinol product to prevent the visible signs of aging. However, there is now a 1% Differin (adapalene) gel retinoid formula available without a prescription. It’s worth adding to your routine to see if it alleviates breakouts.

One more note on retinol and breakouts—I suggest using an exfoliating acid serum that contains salicylic acid on nights you’re not using the retinol to increase vitamin A’s efficacy. I’ll discuss this more at length in a bit. I recommend the Renée Rouleau BHA Clarifying Serum to all of my clients, as well as the Zit Care Kit for making all kinds of blemishes disappear quickly.

It’s Best to Avoid Oil-Based Retinol Formulas If You’re Prone to Clogged Pores

Some retinol formulas are kept stable in a blend of pure oils. This gives them a somewhat greasy feel on the skin. While dry skin types can always benefit from oil saturation, oily and breakout-prone skin types should avoid these types of formulas. (After all, the underlying cause of blemishes is oil—oil breeds bacteria and bacteria lead to blemishes.) Choose your formulas wisely!

If You Have a History of Eczema, You Should Use Retinol—Not a Prescription Retinoid

Vitamin A is very active and breaks down the skin’s protective moisture barrier through its aggressive cellular turnover process (basically, it causes dryness). That explains why people who have eczema-prone skin find that retinoids can cause flare-ups. In this case, it’s best to only use retinol.

Even If You Only Apply a Prescription Retinoid to One Area of Your Face, It Can Affect Your Entire Face

Some people apply prescription retinoids strategically in an effort to target a specific area. For example, some people apply it only around their eye area. They think this will help eye-area wrinkles while sparing the rest of their face from dryness. In reality, the ingredient travels underneath the skin. Even if you apply a retinoid strategically, it will work everywhere, which means you can experience dryness everywhere.

A Step-By-Step Guide to Using Retinol

As I said before if you’re new to using vitamin A, I suggest starting with a non-prescription version such as retinol. To reiterate, the reason is that you want to introduce vitamin A slowly. Most people who start with a prescription (without proper usage instruction) eventually give up because their skin becomes too dry and irritated. If you have a prescription and haven’t been able to use it successfully, consider putting that on hold for now. Start with non-prescription retinol first to introduce it to your skin gradually. Advanced Resurfacing Serum is the retinol product that I personally use. It’s also the one I recommend to my clients. The formula is effective because it combines stable retinol AND skin-firming peptides that help prevent loss of tone.

1. Start by Using Your Retinol Product 2 Nights on, and 1 Night Off

Repeat this throughout the week. For best results, you must use retinol consistently (and often!). Your skin has other needs, though, so you don’t want to use it every single night. Plus, using it too often could prove too much for your skin, since it’s such a biologically active ingredient.

Following the two nights on, one night off rule will result in four nights a week. If you are over 40 with a history of sun damage and your skin isn’t overly sensitive, you can use it four to five nights a week. However, no one should use it for more than five nights a week. This can eventually result in increased sensitivity and a waxy and unnatural appearance.

On the other hand, if you’re under 40 and your skin is fairly sensitive, you might start by using it only twice a week. Then after two months, you can work up to using it three nights a week. Eventually, work up to four nights a week. When in doubt, start slow and increase as you go along. If you’re experiencing dryness or irritation, you’re either using too much or using it too often. This is a sure sign that you should cut back. Remember: using retinol or retinoids successfully is a marathon, not a sprint.

2. Avoid Applying Moisturizer Immediately After Applying Retinol

Using a cream or lotion right after applying retinol may dilute it slightly. It’s best to let it absorb for 20 minutes. Or, you can use a retinol serum that has a lotion-like texture. This can offer hydrating and protective benefits, thus skipping the need for moisturizer altogether.

3. Maximize Results and Minimize Potential Side-Effects By Using an Exfoliating Acid Serum on Opposite Nights

This is really important. Retinol works to encourage dull, sun-damaged skin cells to rise to the surface for easy removal. Using a gentle, alcohol-free exfoliating acid serum once or twice a week (such as one with glycolic, lactic, salicylic, or mandelic acid) will accelerate these cells’ removal. Vitamin A can then absorb deeper into the skin to perform its best. Using both will reveal a smoother, more even-toned texture.

A lot of people use exfoliating toners that contain acids. They often ask me where they should plug that into a retinol or retinoid routine. I never suggest that my clients exfoliate every day, so I don’t recommend using an acid-based toner every morning and night. This is regardless of whether or not you’re using any vitamin A products. If you want to use an exfoliating toner, I would suggest using it on the nights that you use the retinol or retinoid. It can act as a pre-treatment/primer to allow the vitamin A ingredient to absorb deeper into the skin.

Did you know that acids actually help correct dryness? When people experience surface dryness (due to age, drying products, airplane travel, etc), their first instinct is to apply face oil or a heavy moisturizer. This is helpful for pushing moisture into the top layers of the skin, but the dry, expired cells want to (and desperately need to) come off. Over-moisturizing may interfere with and slow down cell turnover. Regularly using exfoliating acids is like saying “out with the old and in with the new” to your skin. This is why top dermatologists and skincare professionals recommend acids so widely.

4. Once a Week, Skip the Exfoliating Acid or Retinol and Use a Hydrating Serum Containing Antioxidants, Epidermal Growth Factors, or Peptides

Your skin requires a variety of ingredients to age healthily. Therefore, you don’t want to constantly stay in exfoliation/cell turnover mode by only using acids and retinol. It’s just like your exercise routine. When working out, it’s best to alternate between various types of exercise, so you’re getting a little bit of everything. Your skin appreciates the same variety. The Renée Rouleau Firm + Repair Overnight Serum is the one I often suggest to my clients.

5. To Boost Results, Get a Professional Chemical Peel or Give Yourself One at Home

Once you’ve been on your new retinol routine for two months, it’s good to kick it up a notch. Try introducing your skin to a chemical peel—especially if you’re someone who has large pores, wrinkles, and discoloration from sun damage. A peel is essentially a stronger version of retinol. It’s intensifying your skin’s collagen-boosting activity to encourage faster smoothing results. Synergistically, they both support one another in the quest for smoother, more even-toned skin.

There are many types of peels, so you’ll want to consult with a trusted skincare professional to find out which type and what frequency is best for your skin. I generally recommend that clients get light to medium chemical peels (ones that make your skin shed for a few days after) six to eight times a year. You can get lighter peels every other month.

The Renée Rouleau Triple Berry Smoothing Peel is great to use three to four times a month. There are no harsh side effects, only beautiful results to increase the skin-smoothing benefits of retinol. You can also give yourself a DIY chemical peel at home if you happen to have a tube of a prescription retinoid lying around.

6. If You Think You Want to Start Using a Prescription Retinoid, Introduce It Slowly After 6 Months

Of course, you’ll have to consult with a doctor about this. There are so many different kinds, but your doctor can suggest what’s best for you and your specific skin goals. You should start with the lowest strength.

How to Introduce a Prescription Retinoid Into Your Routine

Weeks 1-4: Substitute Your Retinol Serum with a Prescription Retinoid One Night Per Week

After cleansing, immediately apply an alcohol-free toner. Leave it damp, then apply a thin layer of a lightweight moisturizer to the skin before applying your retinoid. The moisturizer cannot be heavy or greasy at all. Wait for five minutes and apply a pea-sized amount of the prescription to the entire face. (I recommend treating the neck and chest with retinoids, too. Use an extra pea-sized amount for this area as well.) Let dry for 20 minutes and follow with another application of moisturizer. This time, you can use your normal moisturizer. Ideally, use one that keeps the skin’s moisture barrier intact and sensitivity to a minimum. The Renée Rouleau Phytolipid Comfort Creme is a great option for new retinoid users.

Note: There has been much discussion in years past about whether or not using a moisturizer underneath vitamin A affects its performance. Most believe that it does not interfere with penetration. Instead, the right moisturizer can keep the moisture barrier intact to prevent dryness. This is truly the secret to making a prescription tolerable. I always recommend the Renée Rouleau Sheer Moisture Lotion to my clients due to its light texture and stable antioxidants. Retinoids can cause “micro wounding” in the skin, and antioxidants help stop the resulting inflammatory response. This makes Sheer Moisture a perfect companion to prescription formulas.

Weeks 4-10: Repeat the Above Process But Now Substitute Your Retinol Serum with a Prescription Retinoid Two Nights Per Week

Think of your prescription retinoid as a workout for your skin. You don’t want to lift the heaviest weights on day one. Instead, you want to take it slow and gradually build up to it over time.

Weeks 10+: Repeat the Above Process But Now Substitute Your Retinol Serum with a Prescription Retinoid Three Nights Per Week

For most people, I suggest sticking with this routine for the long run. You’ll alternate nights between your original retinol serum (eventually you can drop this), a retinoid, an exfoliating acid serum, and a hydrating serum. You’ll use your prescription retinoid three nights a week while giving your skin an amazing variety of other active ingredients. They’ll all work synergistically to improve the look of your brown spots, wrinkles, and large pores.

If you have very sun-damaged skin, you may want to increase the prescription retinoid to four nights a week after six months. Also, consider upgrading to a new one with a stronger percentage. I do, however, discourage people from getting too excited and using it too frequently. Over time, this can cause the skin to appear tight, shiny, and waxy, almost like a plastic Barbie doll. I can spot someone who is overusing prescription retinoids a mile away, and it’s not a great look. It just doesn’t look natural.

The Bottom Line

I’ve seen the results retinol and retinoids can provide on so many of my clients’ faces in the past 30 years of my career. While I’m super proud of the retinol formula I created, there are other great ones out there, too. You just have to do your due diligence since it’s a tricky ingredient with which to work, and not all formulators know how to make the best products.

I’ll leave you with one last thought. As I mentioned previously, using a retinol or retinoid is a marathon, not a sprint. It can take a while to see results, meaning you won’t get immediate gratification. To truly reap its benefits, without incurring dryness or irritation, deliver a slow drip of it to the skin. I recommend using it regularly for the rest of your life…or until a better anti-aging product takes its place! And if that’s the case, I’ll be sure to let you know. For now, head on down Retinol Road.

Next, find out how to adjust your skincare routine when using a prescription retinoid.

The post The Beginner’s Guide To Retinol & Retinoids: How To Prevent Dry, Flaky Side-Effects appeared first on Expert Skin Advice from Renee Rouleau.

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Minimize Scarring: How to Care for a Facial Wound From Start to Finish

In July 2020, my good friend Thurman was riding an electric scooter when he hit a pothole and flew over the handlebars. He happened to be in Austin working on Tankproof, his nonprofit organization (of which my company is a huge supporter!). He FaceTimed me from the emergency room and wow, his face really got torn up badly. Now, over a year later, his wounds are thankfully healed up and I’ve been helping him deal with the scar left behind. Scars are a really challenging skin concern because they’re formed so deeply within the skin. I’ve written about different types of acne scars, but for this post, I wanted to address scars caused by an injury in hopes it could help you if you should find yourself in this type of situation. 

When you injure yourself, whether or not a scar forms isn’t always within your control (and getting your injury seen by medical professionals is always the first priority). That said, by sharing Thurman’s story, I’ll talk about what you can do to minimize scarring from a wound at various stages of healing. I’ll also share additional insights from Dr. Sam Lam, a board-certified facial plastic surgeon at Lam Facial Plastics, who has been helping advise Thurman on how to reduce scarring and hyperpigmentation.

Phase 1: In the ER

When Thurman FaceTimed me from the emergency room right after his accident, I happened to be having dinner with a friend of mine who is an ER doctor. He walked Thurman through what he could expect in terms of general wound care and stitches and told him to ask if there was a cosmetic surgeon on call in the ER. Luckily, there was! They numbed his face before thoroughly cleaning out his wound then stitching it up.

After he got back home to Baton Rouge, Thurman made an appointment with a local plastic surgeon to have the stitches checked out and make sure everything was in order. Dr. Lam agreed that this was a good move—once your injuries have been taken care of and you’re in the clear, you can turn your attention to aesthetics.

“When you have an open wound,” says Dr. Lam, “the first thing is to get it cared for and stitched up as quickly as possible. The longer it sits open, the greater the risk of infection. After this, I would advise beginning a relationship with a plastic surgeon who can help you manage the healing process to reduce scarring and hopefully avoid the need for future scar revision.”

Phase 2: Caring for the Wound to Minimize Future Scarring

For the first few weeks after getting stitched up, your priority should be caring for your wound according to your doctor’s instructions. Following their advice diligently is one of the best things you can do to minimize future scarring. 

“The main thing was keeping it clean,” Thurman says. “They also had me apply antibiotic ointment to keep it moist.”

Ointments used for wound care are usually petrolatum-based, which means they’re also very thick and occlusive. This allows them to form a protective seal over the skin. While this is ideal for healing, in some cases it can lead to enlarged or clogged pores.

This is what happened to Thurman, who developed a few milia on his cheekbone (you can see one of the bumps in the photo on the right). Milia are small, hard bumps that form within pores as a result of keratin becoming trapped beneath the surface of the skin. I believe Thurman’s scar tissue was especially vulnerable to this because it was basically raw tissue, and the pores were being re-formed. The thick ointment kept some of these new pores expanded as did the location of the scar—our cheeks are stretched a lot from facial movements such as smiling and talking. 

Once Thurman’s wound had started to heal and was no longer raw, I performed extractions to remove the milia for him. I also had him get a prescription retinoid and confirm with a dermatologist that it was safe to start using it on his scar. He continues to use it twice a week to help shrink the appearance of enlarged pores.

Dr. Lam’s Recommendations

Per Dr. Lam’s suggestion, Thurman had also started using silicone patches to cover his scar and improve its appearance. Silicone patches can minimize scarring by increasing the hydration within the outer layers of the skin. This can also help regulate collagen production, which may result in a flatter scar. Additionally, silicone patches can help keep scar tissue protected by shielding it from bacteria. 

During the early stages of healing, Dr. Lam notes that he also likes to have patients use hypochlorous acid: “I love medical-grade hypochlorous acid. It allows wounds to heal well by reducing bacteria and other contaminants, and it naturally minimizes contamination without risk to the tissue integrity.”

Be sure to consult with your doctor before using anything at home to make sure it’s a good fit for your wound.

Phase 3: The Scar Settles, and Hyperpigmentation Sets In

Once the skin heals and a scar is no longer fresh, one of two things can happen to your skin’s pigment: the first is hyperpigmentation, and the second is hypopigmentation.

Hyperpigmentation refers to areas of skin that become darker than your natural skin tone as a result of trauma or overstimulation. In response to an injury, your skin’s melanocytes (the cells that give our skin its color) are activated. In some cases, they become a little overzealous in their healing response and end up creating more pigment than they’re supposed to. This is why acne leaves marks behind.

Hypopigmentation, on the other hand, is exactly the opposite. An injury damages melanocytes and causes them to die off, resulting in a loss of pigment. This is why some scars turn white after they heal. This loss of pigment is incredibly hard to reverse, but there are some laser-resurfacing procedures that may be able to improve it. 

Managing Thurman’s Hyperpigmentation

At this point, Thurman’s wound was completely closed up and hyperpigmentation had set in (his scar had turned dark). Hyperpigmentation was something we needed to be particularly aware of with Thurman because of his skin tone. The deeper your skin tone, the more active your melanocytes are. If melanocytes are more active, to begin with, there’s an even greater risk for hyperpigmentation as the result of injury or trauma. It can also be a lot harder to reverse hyperpigmentation since melanin activity is harder to suppress, so I really encouraged Thurman to stay on top of this from the beginning.

Sun Protection

The first and most important aspect of this was keeping the scar protected from the sun. The whole goal is to get melanocytes to calm down and to signal to them that the skin is no longer under threat. UV light is a major trigger for hyperpigmentation because it stimulates melanocytes, so keeping sensitive scar tissue protected from the sun is a must. Of course, I made sure Thurman was properly applying sunscreen to his face and neck, taking extra care to cover his scar. Additionally, I believe it helped that he was still wearing a protective face mask much of the time. (Maskne may be a real nuisance, but the extra sun protection can be a bonus!)

Topical Vitamin C

Vitamin C is a powerful antioxidant that can offer additional protection against UV rays when paired with sunscreen. I had Thurman use the Renée Rouleau Vitamin C & E Treatment because it uses a form of vitamin C called tetrahexyldecyl ascorbate. This is a very effective, fat-soluble version of vitamin C that has to be converted by the skin’s own enzymes, making it much gentler than L-ascorbic acid. Since scar tissue is very sensitive, I didn’t want Thurman putting something that acidic on it every morning before applying his sunscreen.


For this reason, I also didn’t have Thurman start to exfoliate until after all of the fresh, pink scar tissue had healed and transitioned to hyperpigmentation. At this point, I had him add the Renée Rouleau Pore + Wrinkle Perfecting Serum into his routine one to two nights a week. 

Phase 4: Professional Treatments

One of Dr. Lam’s preferred treatments for scars is Botox injections. 

“To me, Botox is the most incredible healing agent,” he says. “In double-blind placebo-controlled studies, even a few units of Botox placed a week after a scar has been shown to help with healing. I like to do it soon after surgery or stitches, but honestly anytime in the first six months is helpful. The sooner the better.”

When Thurman reached out to Dr. Lam about ways to improve the appearance of his scar, Dr. Lam cautioned against anything too invasive for fear of either creating more hyperpigmentation or, worse, permanently depigmenting the area. He recommended Botox as a less invasive alternative, and Thurman plans to try it out. 

Surgical Interventions

According to Dr. Lam, it takes most scars a year to fully mature. Depending on the severity, a lot of them will improve on their own. This is why Dr. Lam advises waiting a year before considering surgical intervention. If you’re still unhappy with the appearance of your scar at this point, he says there are a number of procedures that can address different aspects of scarring, from irregular pigmentation to raised or uneven borders. His advice is to find an experienced surgeon with good reviews and many years of practice who also has extensive before and afters that you like. From there, your surgeon will be able to advise you on the best procedure for your scar type.


As you can see, managing a scar is a long and tedious road. Certain scars are inevitable but know there are steps you can take to minimize their appearance and if they still bother you, procedures and treatments that can improve them later on. 

As for Thurman, he says he’s happy with the way things played out and notes that being kind to yourself is important when dealing with any kind of recovery from injury.

“There are definitely psychological struggles that accompany it,” he says, “and they kind of ebb and flow. My advice to anyone going through a similar situation or healing process is just to be patient and be kind to yourself.”

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