There was a time when doctors (dermatologists and cosmetic surgeons) told us that nothing would help wrinkles and sagging other than treatments that (funnily enough) could only be administered by them. Out would come the prescription for retinol or that face-transforming needle. Now we know a little better and over-the-counter anti-aging treatments have improved dramatically so that those of us – providing we have realistic expectations – can visibly improve our appearance with alternatives to the doctor’s office.

Retinol

Retinol is considered a thorough exfoliator, and this repeated shedding of the upper dermal layer forces the skin to produce new cells. Retin-A was the first creams on the market and still only available by prescription. The active ingredient is tretinoin, the acid form of vitamin A. It was originally prescribed as an acne treatment and it recent years has been used against wrinkles. However, it is not approved as an anti-ager by the FDA, whereas Renova (made by the same company) is. Tazarotene is also a tretinoin and is in the prescription only Renova alternative, Avage, by Botox manufacturer Allergan.

There are serious concerns about the side-effects of retinol and tretinoin, including toxicity, photosensitivity resulting in free-radical damage, skin thinning and irritation. So I believe that retinol is best used sparingly, at night and in a formula that brings other actives – ones that encourage collagen production without continuously forcing exfoliation, such as peptides, growth factors and antioxidants. This is the criteria for my Five Best with retinol of 2013 selection. Of these, Skinfinite Platinum PM Cream 1% Retinol ($79 in the shop) has the strongest dose of retinol that is time-released to ensure that it does not irritate. Whilst BRAD Biophotonic Ultra Elastin Lift ($210 in the shop) is bolstered by potent anti-agers, including hyaluronic acid, Argireline, Matrixyl 3000 and Snap-8 (octapeptide).

If your doctor has been prescribing retinol/tretinoin for acne (Acutane cream, for example), consider using blue LED light therapy, such as Baby Blue Quasar ($349) or Clear Rayz ($249). Our exlusive Ultra Renew PLUS ($159 in the shop) and Truth Renew ($109 in the shop) devices also have blue LED, along with red and green lights. Round out these treatments with Envy Medical Skin Clarifying Acne Treatment Pads ($25 in the shop) – many acne-suffering members of the Truth In Aging community dub these life-savers.  

Microdermabrasion

Microdermadrasion is an esthetician performed exfoliation treatment. It works by passing ultra-fine aluminum oxide (or diamond) crystals in a vacuum tube over the face or chest. The immediate results are subtle, but skin may feel a little softer. Cumulatively, there should be cellular renewal and stimulated collagen production. (See the video of my microdermabrasion treatment).

Recently, we’ve been testing two at-home devices and have been impressed by the results. Even Nisha, a trained esthetician liked the PMD Personal Microderm System ($179) when she reviewed it for us. I, too, have found it to be quite a powerful little device and a useful addition to my anti-aging arsenal (review coming soon). PMD has aluminum oxide tips and another device to our liking, Riiviva, has diamond tips and is slightly more sophisticated with more levels of abrasion and suction ($299).

Laser (anti-aging)

Fractional laser resurfacing, also known as fractional photothermolysis, targets areas of the skin that are precisely spaced out at a microscopic level and heats some skin zones while others are left undisturbed. Instead of emitting a solid beam, the laser puts out clusters of minuscule beams that punch invisible holes in the skin. In creating a grid-like pattern of micro-wounds, it stimulates fresh collagen production beneath the skin’s surface and allows the untreated areas of tissue to remain stable for quicker recovery.

We first came across the FDA-cleared handheld cosmetic laser called PaloVia back in 2011 ($499). Since then, it has got accolades from members of the Truth In Aging community (see Dennis’ review). PaloVia was cleared by the FDA for periorbital wrinkles, but between you and me, it can used wherever needed.

Laser hair removal

Unwanted hair means wielding wax or blades (forget creams), or a trip to the derm for permanent hair-removal techniques, such as electrolysis or laser. At-home alternatives have proved in the past to be painful and/or useless. That is, until we tried the Silk׳n Flash&Go hair removal device ($299) with equal parts enthusiasm and skepticism. This light-based hair removal device uses selective photothermolysis – the hair shaft needs to selectively absorb light energy and transform it into heat. Our reviewer loved the (pain-free) results of her tester so much she refuses to give it up.

Botox

The popular wrinkle smoother has its devotees, but also its detractors. In 2009, the FDA required Allergan to put a “black-box” warning on the label of Botox, explaining that the material has the potential to spread from the injection site to other parts of the body… such as the brain. Even Nicole Kidman says she’s over Botox.

Despite claims, the effects of Botox cannot really be replicated topically, but there are some ingredients that purport to work in a similar way by inhibiting expression lines.  The effects will be subtle at best, but if you are squeamish (as I am) about Botox, then check them out. Argireline (acetyle hexapeptide 3) is the best-known of the neuropeptides (for more neuropeptides see below and also read our post on Botox-in-a-jar ingredients. It works by limiting the neurotransmitters that tell your facial muscles to move (a process known as exocytosis). Read more on Argireline. In addition to Argireline, there are several other peptides that work as neurotransmitters. SNAP-8 is an octapeptide (eight amino acids), Myoxinol is oligopeptides taken from okra seeds, and Syn-Ake is dipeptide diaminobutyroyl. Read more on neurotransmitters.

In the right formulas, these ingredients do help with lip lines and crow’s feet (don’t expect them to work on cavernous creases). I like Tilth Beauty Resurrect Eye Cream ($62), which majors on four versions of perfluorodecalin, an ingredient that dissolves and delivers oxygen to the skin and contains Argireline. There’s also Taun Facial Repair Formula ($79), which in addition to Argireline has another popular peptide, Matrixyl 3000. Probably the heaviest topical gun in this category is E’shee Bota Therapy ($189), with Argireline, Matrixyl and hyaluronic acid.

Hyaluronic fillers

Restylane and other impermanent injectable fillers simply work by providing volume and puffing out the face (especially around the nasolabial folds). The substance injected in a Restylane treatment is sodium hyaluronate. According to an independent study, Restylane relaxes the fibroblasts, which are then re-stretched by the filler, and form collagen. So it may also be doing more than just a temporary job. Read more on Restylane.

If you don’t fancy all those needles and the risk of chipmunk cheeks, then approach at-home alternatives with managed expectations. There are a few topicals that help lift and firm. Osmotics Lipofill Non-Surgical Filler ($73) is especially for loss of volume. It has rye extract that is said to act as an internal tensor and boosts the skin’s abilities to firm and lift, as well as sodium hyaluronate. Majoring on hyaluronic acid (sodium hyaluronate in a different molecular size) is E’shee Multi-tensor Extreme Face Lift ($159), with copper and whey protein.

Frankly, face plumping and firming is best achieved at home with LED and ultrasonic. The two are combined with Ultra Renew Plus ($149 in the shop) or there is a souped-up LED device by Baby Quasar ($795 in the shop).

VASER Shape

I was just given a fascinating demonstration of VASER Shape, a salon ultrasound treatment for fat and cellulite reduction and its sister treatment VASER Lipo. A longer article is to come soon. In the meantime, know that VASER Shape uses 3 Mhz ultrasonic waves and the before and after pictures at the New York office of Dr. Sharon Giese of back, tummy and thigh fat reduction were impressive for a non-invasive treatment.

Ultra Renew Sculpt ($129 in the shop) is a 3 Mhz handheld device for use at home. It also has red and infra-red LED light to help tighten and reduce crepiness, as well as EMS for giving those dimply areas a little pummel and massage. A good companion is Osmotics Blue Copper 5 Age Repair Body Lift ($95) with lots of copper peptides to firm the skin, and good results on stretch marks. It won’t give you doctor’s office results, but as with all physician alternatives, realistic expectations, diligence and patience will be rewarded.

Hydroquinone

Once upon a time, the FDA proposed a ban on hydroquinone. Nonetheless, it is sold today at up to 2% OTC and up to 4% on prescription. This skin whitener is extremely controversial. Restricted in Japan, Australia and the European Union. Hydroquinone has been found to be carcinogenic and some studies also report abnormal function of the adrenal glands and high levels of mercury in people who have used Hydroquinone-containing cosmetics.

For a potent alternative for dealing with dark spots and hyperpigmentation, consider kojic acid. Kojic acid, which is derived from fungi, inhibits the essential enzyme in the biosynthesis of the skin pigment melanin. It too has some issues as it is highly irritating to the skin and there is some animal data suggesting weak tumor promotion. The good news is that the International Agency for Research on Cancer (IARC) says it is "not classifiable/not likely to be human carcinogen." Kojic acid is the star of the show in Medik8 White Balance Click ($80 in the shop), a cleverly packaged and very effective dark spot eraser over time.