Dr. Barbara Sturm came by her stellar reputation in the beauty industry as the innovator behind a bespoke cream based on a patient’s own blood. Since 2002, the German orthopedic surgeon-turned-aesthetic mastermind’s A-list clientele submit to having blood drawn into a special tube, which is then placed in a centrifuge to isolate red cells from platelet concentrate, from which Dr. Sturm then extracts plasma and infuses it into a formula known as “MC1” (or colloquially, understandably, Blood Cream). Up to 15% of people experience vasovagal syncope that causes them to faint at the sight of blood; Dr. Sturm has the mind to charge upward of $1,000 for it.
Though she goes where few others do by dauntlessly embracing the beautifying powers of bodily fluids, there is one surprising ingredient the cool, collected physician, a favorite of ageless wonders like Cher and Angela Bassett, won’t recommend: retinol. For many skin-care professionals, dermatologists and aestheticians included, topical usage of vitamin A and its derivatives is a no-brainer in the pursuit of clearer, brighter, younger-looking skin. For Dr. Sturm, it’s a non-starter — and her reasoning is simple.
“My whole background is anti-inflammation, and retinol and retinoids cause inflammation,” she says. “I don’t believe in attacking the skin and forcing healing and repairing every time, and I don’t think retinol should be in skin-care products you can buy in stores. My approach is respecting the skin as our largest organ with so many necessary functions, including our immune system, and staying away from aggressive ingredients.”
Indeed, retinol and retinoids work by encouraging the rapid-fire turnover of skin cells to reveal new skin underneath, exfoliating the top layer and penetrating deeper to boost collagen production, increase elasticity, and purge oil buildup from within the pores. While the benefits are backed by research, the process is not not aggressive, and the initial period of use is notoriously marked by dry, red, peeling skin. Retinol is safe when used properly; this is well-documented, and Dr. Sturm concedes that your dermatologist knows best when prescribing. But overdo it with too high a concentration or too frequent usage, and skin can emerge so damaged it takes weeks or months to recover. The potential for irritation, coupled with the even higher potential of misuse, has led more and more brands and formulators to join Dr. Sturm in skipping the longtime stalwart.
While Irene Forte doesn’t take quite as hardline an approach as Dr. Sturm, she still has some trepidations about including vitamin A in her eponymous skin-care brand. “Vitamin A is an important anti-aging, skin-clarifying ingredient, but quantities above a certain percentage typically become more like a pharmaceutical-grade product and an aggressive exfoliant,” says the founder, whose philosophy combines rigorous research and development with the natural Mediterranean mindset of her native Italy. “Our ethos is all about maintaining skin balance; we are effective and clinically proven but kind on the skin, as well as clinically approved for sensitive skin. Therefore, ‘traditional’ retinoids don’t necessarily fit.” Forte does incorporate low levels of retinyl palmitate as an antioxidant and natural preservative in her products, and she’s curious about the potential for more sensitive skin-friendly forms of vitamin A, as well as peptides with similar activities.
Alongside the star ingredient of clinically-tested cannabinoid, peptides (including the gold-standard Matrixyl Morphomics) feature prominently in Dieux's first-ever (and currently sold-out) serum, Deliverance — not as an alternative, but as a kind of companion to retinol, a soothing, barrier-strengthening foil that supports skin no matter what you choose to do with it. “Retinoids are probably my favorite skin-care ingredient because they’re well-researched, they're safe, and they work,” says Charlotte Palermino, the brand’s co-founder and CEO. “However, not everybody can use them, and a lot of people get sensitivity and irritation — not everyone, and not because it’s toxic or something, but because it’s resurfacing."
When Palermino first began working with cosmetic chemist Joyce de Lemos, now Dieux's co-founder and head of product, she says they noticed that many people were using products incorrectly to less-than-desirable results. “People who are new to skin care or unfamiliar with instructions or don’t listen to their dermatologist, they burn their faces off,” she says. “We saw a ton of resurfacing agents out there, and we wanted to create a serum that would play well with other products and wouldn’t have that effect.” For their first launch, says Palermino, they left out retinol because de Lemos can’t tolerate it on her skin, but that doesn’t mean it won’t appear in the lineup in the future.
What you probably won’t find in Dieux Skin is bakuchiol. A 2018 clinical study demonstrated that the plant-derived compound derived from the Babchi plant commonly found in traditional Indian and Chinese medicine, despite bearing no structural resemblance to retinol, has similar topical benefits to vitamin A with a decreased risk of irritation. The beauty industrial complex took this finding and ran with it, dubbing bakuchiol “nature’s retinol” and touting its ability to reduce fine lines and fade hyperpigmentation while being gentler and pregnancy-safe. (Vitamin A is not recommended for use while pregnant or breastfeeding.) These preliminary reports are encouraging, but they’re just that: preliminary. “I think bakuchiol is a great option for those with conditions like rosacea, eczema, and perioral dermatitis who can’t tolerate retinol,” says board-certified dermatologist Elyse Love, MD, “but it’s definitely too early to declare it as an equivalent alternative.”
The fact of the matter is that bakuchiol doesn’t need to be an equivalent alternative to retinol to be a valuable ingredient on its own: The plant has been used in Ayurvedic preparations long before 2007, which is when it was first brought to market for commercial use in topical applications. (There are also mounting environmental concerns; Psoralea corylifolia, the plant from which it is derived, is believed to be endangered.)
“I’m excited to see a traditional Ayurvedic ingredient be embraced by skin-care brands, and I think brands that use it should credit Ayurveda for its roots to create a broader awareness around South Asian beauty rituals and treatments,” says Michelle Ranavat, a first-generation Indian-American who merges modern technology with Ayurvedic botanicals in her skin-care line, Ranavat. “When we saw so many bakuchiol serums out on the market, we wanted to share our traditional take on the ingredient: using the entire bakuchi seed. Instead of an extract form, we use the Ayurvedic preparation that creates a rich paste from the seed and we use all of its nutrients in our Eternal Reign Renewing Bakuchi Crème.”
Notably, nowhere in the marketing for the Eternal Reign Renewing Bakuchi Crème will you find it compared to retinol — because there is no real analogous alternative to retinol and, moreover, there doesn’t need to be. There’s also understandable confusion between what constitutes an over-the-counter retinol and a stronger dermatologist-prescribed retinoid like adapalene (now available OTC), tretinoin, and tazarotene. “Retinols and retinoids can become overwhelming for the consumer because there are so many formulations,” says Dr. Love. “In terms of anti-aging, it’s generally thought that prescription retinoids and over-the-counter retinols are equally effective, although I don’t necessarily believe this. Retinols are, in general, much more gentle than prescription retinoids, so they’re typically the go-to for those who have no major skin concerns but want to increase collagen production to delay the formation of fine lines and wrinkles.”
Palermino says the industry is rife with misinformation about the risks and dangers of retinol. The popular myth that it thins skin has been debunked; ironically, research shows that it actually increases epidermal thickness. “Retinol can be irritating, but that doesn’t mean it’s bad for you,” she says. “There’s nuance to everything.” On whether she has any concerns about the safety of retinol, Dr. Love says, “No, period. Retinol should not be used during pregnancy or breast-feeding, but is otherwise thought to be a very safe long-term ingredient.”
For those who can't deal with retinol, there are options, and there is innovation to be found in both botanical and lab-made ingredients to enjoy the benefits without the drawbacks (Forte cites stabilized, time-released, encapsulated forms of retinol as being of particular interest). But if you've found success with it, there's no scientifically-backed reason to give it up; you can have your adapalene, and your bakuchiol, and your blood cream, too.