A retinol breakdown.

One of the most common questions I get as an aesthetic nurse practitioner is, “I need help choosing a retinol. What is the difference between them all?” It can be so confusing especially since there are so many forms, and it can be quite overwhelming. Lucky for you, I am going to break it down to help make your decision a little easier!


Some get confused with the terms “retinol” and “retinoid” and typically the two terms are use interchangeably. However, retinoid is an umbrella term and all forms of retinols, or vitamin A derivatives, fall under this term. There are several types of retinols available.

From least potent and irritating (weakest) to most potent and irritating (strongest) we have:

  • Retinol Esters;
  • Retinol;
  • Retinal or Retinaldehyde;
  • Retinoic Acid.

Retinol esters, retinol and retinal/retinaldehyde are found in over the counter products and are less irritating than prescription strength retinoic acid, which is already made as an active form of retinol. Basically, all the other retinols are trying to get to the active form and when applied, your body has to covert it a certain number of times to get to that active form. For example, retinol esters are the least potent and must make three conversions to get it to the active form. Furthermore, retinol needs two conversions and retinal/retinaldehyde needs one. Because they need to undergo conversions, this makes them less irritating and can have slower results. For example, retinol esters will take the longest to show results and can take up to several months, and so on.


First, I would consider your skin type and your skin concerns. If you have very sensitive skin and/or no major issues with hyperpigmentation or acne, you should start very low on the strength. Consider starting with the retinol ester or retinol. If you are looking for more anti-aging benefits (reducing fine-lines and wrinkles), acne or acne scarring, and hyperpigmentation, then I would consider a retinaldehyde or low dose prescription strength retinoic acid and use it at a lower frequency (starting off 1-2 times per week). Starting at a lower frequency is very important if you are new to the retinol game.


If you are not interested in a retinol there is a new game changer known as Bakuchiol. It is a plant-based retinol alternative which provides great results without the irritation and redness. In theory, it follows the same active processes that retinols do; however, evidence is limited and further studies are needed. It is used to treat many of the same concerns that as retinol.


Overall, the most important thing is to focus on your skin type, color, tone, personal concerns and your expectations. Ask yourself: Are you ok with irritation and redness? Do you have frequent daily sun exposure? If so, consult your aesthetics specialist for alternatives. You can always start low and increase. Remember, start off using a pea size amount 1-2 times per week and DON’T FORGET YOUR SPF!  As well, if you are considering getting pregnant, currently pregnant or breastfeeding it is best to hold off and consult your practitioner.

Just as you are, your skin care needs to be individualized and does not have to be perfect. It may take some time to figure out and will need to change from time to time as your skin changes. Just enjoy the ride!

Aesthetically yours,
Emily Lacour, DNP, FNP-BC