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Skin ageing is two processes layered on top of one another: the intrinsic passage of time, which is largely genetic, and photoageing, which is cumulative ultraviolet damage. The second is the larger contributor on exposed skin, and it is the one that responds to treatment. A registered doctor reviews the questionnaire and photographs and decides whether a topical retinoid is appropriate.

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Two processes, not one

Intrinsic ageing happens everywhere on the body, at a pace set mostly by genetics. Fibroblasts become less active, the epidermis thins, cell turnover slows, and the skin becomes finer, drier and laxer. The result is smooth, unblemished but thinner skin with fine lines — the way habitually covered skin, such as the inner upper arm, ages. Photoageing happens only where light reaches. Ultraviolet radiation generates reactive oxygen species and upregulates matrix metalloproteinases, the enzymes that break down collagen, while simultaneously suppressing new collagen synthesis. Elastic fibres degrade and accumulate as disorganised material in the dermis, a change called solar elastosis. The visible result is different from intrinsic ageing: coarse wrinkling, a leathery or yellowed appearance, irregular pigmentation, visible vessels and a rougher texture. The difference is easy to see on any face with an occupational asymmetry, and it explains why prevention and treatment both centre on light.
Smoking, air pollution, chronic sleep deprivation and repeated large weight swings all contribute independently. So does infrared and visible light, which plain ultraviolet-only sun protection does not block.

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How a doctor assesses it

The anti-ageing questionnaire runs to sixteen steps and carries twenty individual blocking answers — the largest number of any dermatology pathway here, because a retinoid is a demanding medicine and the list of people it does not suit is long. Photographs are offered as a choice rather than being compulsory, but a case submitted without them is flagged as missing them, and a doctor with no image is grading a description. The doctor is assessing the degree of photoageing, the state of the skin barrier — a compromised barrier is the main reason a retinoid is not tolerated — the current routine and whether it already contains an active that will conflict, the sun-protection habit, and any prior experience of retinoids, since that predicts tolerance better than almost anything else. The Glogau classification is the usual shorthand for photoageing, running from type I (no wrinkles, early pigment change, typically the twenties and thirties) through to type IV (wrinkles throughout, sallow colour, actinic keratoses, typically the sixties and beyond). It is useful precisely because it sets a ceiling: a topical medicine acts most visibly at the earlier grades.

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What a doctor may prescribe

Tretinoin 0.05%

The strength a patient can order directly on this pathway, and the best-evidenced topical for photoageing. It normalises keratinocyte differentiation, increases epidermal turnover and stimulates new collagen synthesis in the papillary dermis.

Other tretinoin strengths

Tretinoin 0.025% and 0.1% exist on the formulary but are doctor-only: they are not patient-orderable and are dispensed only where the reviewing doctor specifically selects them for the case.
Pregnancy. Topical retinoids are not used in pregnancy or when trying to conceive, and their use during breastfeeding is avoided. The pregnancy step in the questionnaire is a hard gate for this reason. Effective contraception is part of the conversation a prescriber has before a retinoid is issued, and that decision belongs to the doctor.
There is no oral medicine for skin ageing on this service, and no injectable, device or procedural treatment. Botulinum toxin, dermal fillers, energy-based devices, medium and deep chemical peels and microneedling all require an in-person practitioner.

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Realistic timelines

A retinoid is a slow medicine. The order in which improvements appear is consistent enough to be useful as a progress check.
1

Weeks 1–6 — retinisation

Dryness, flaking, tightness, stinging and sometimes a transient worsening of texture and breakouts. This is the adjustment phase and it is the point at which most people abandon treatment. Reduced application frequency and a bland moisturiser are how it is managed.
2

Weeks 6–12

Irritation settles. Texture and surface smoothness are usually the first things to change, followed by a more even tone.
3

Months 3–6

Pigmentation and fine lines typically begin to improve. Photographs taken at the start under consistent lighting are the only honest way to judge this, because change at this pace is invisible day to day.
4

Months 6–12 and beyond

Collagen-mediated change — the improvement in fine wrinkling — is the slowest to arrive and continues with sustained use. Benefit regresses if treatment stops.

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What a topical retinoid cannot do

Being clear about the ceiling avoids most of the disappointment.
  • Deep static wrinkles and folds — nasolabial folds, deep glabellar lines and marionette lines — are structural. A retinoid will not lift them.
  • Skin laxity and jowling. Loss of support in the deeper tissues is not a topical problem.
  • Volume loss. Facial fat pad and bone changes are not addressed by anything applied to the surface.
  • Telangiectasia and established solar lentigines respond better to light-based treatment than to a cream.
  • Actinic keratoses are precancerous lesions and need proper assessment and lesion-directed treatment in person, not a general anti-ageing routine.

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What does not work

Layering several actives at once — a retinoid alongside acids, vitamin C and exfoliants — is the most common self-inflicted problem. It damages the barrier, which produces more irritation, more inflammation, and in susceptible skin more pigment. It also makes it impossible to know which product caused which effect. Skipping sun protection while using a retinoid is the other one. It undoes the treatment and increases photosensitivity at the same time. Daily broad-spectrum protection is not an add-on to a retinoid routine; it is the condition on which the retinoid makes sense.

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When to see someone in person

Any rough, scaly, persistent patch on sun-exposed skin that does not heal, any lesion that bleeds or crusts repeatedly, any new or changing pigmented lesion, or any sore that has not healed in a month needs an in-person examination. Photoaged skin carries a raised risk of skin cancer, and a consultation about wrinkles is not a skin cancer check.

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Common questions

Tretinoin 0.05% is the patient-orderable strength on the anti-ageing pathway. The 0.025% and 0.1% strengths exist but are doctor-only — a doctor selects them for a specific case, and they cannot be requested directly.
Not reliably. Higher strengths increase irritation faster than they increase benefit, and irritation is the main cause of people stopping. Consistent use of a tolerated strength usually outperforms intermittent use of a strong one.
Combining several actives is one of the main causes of barrier damage. Whether and how to sequence them is something to raise with the reviewing doctor, and the questionnaire asks what you are already using precisely so that conflict can be spotted before a prescription is issued.
They are optional on this pathway — you can choose to send them later. In practice a doctor grading photoageing without an image has very little to grade, and an ungradeable case is unlikely to result in a prescription.
The benefit is maintained by continued use and regresses when treatment stops. Most people move to a lower frequency for maintenance rather than stopping outright, and the doctor advises on that at review.
No. Cosmetic retinol has to be converted in the skin to retinoic acid, and it is a considerably weaker version of the same pathway. Tretinoin is retinoic acid itself, which is why it is prescription-only and why it is more irritating.

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Start a consultation

Anti-ageing consultation

Answer the anti-ageing questionnaire and a registered doctor reviews it. They decide whether a topical retinoid is appropriate and at what strength — and declining is a normal outcome. See what it costs and how the review works.
This page is reference information, not medical advice and not a prescription. Whether a medicine is appropriate for you is decided by a registered doctor after reviewing your consultation.