Remember, you must be patient with tretinoin. While microscopic changes start immediately, it takes about three to six months before you will see any visible improvement in the mirror. Maximum results are achieved after 12-24 months of nightly use (depending on concentration), and after that you only need to apply it two or three days per week for maintenance. If you stop using tretinoin, the skin will gradually regress. You may want to take before-and-after, close-up photographs of your face to check your progress.

People who don't do this often greatly underestimate their results, because the effects of tretinoin are gradual and generally modest. The gradual nature of its effect may be one reason why tretinoin is not used by more people.

Even if you are one of those people who does not see significant improvement in the mirror, tretinoin will improve your skin on a cellular level, and can slow down the development of lines, wrinkles, and discolorations in the future. Some doctors have found that people achieve much better results using tretinoin and cosmetic acids on alternate nights (discussed below).

Costs

With a prescription, you can buy a 45 gram tube of generic tretinoin (0.025% gel or 0.025%, 0.05%, 0.1% cream) at pharmacies for between $50 and $75. This is obviously very expensive, but a 45 gram tube will last at least three months. Only a pea-sized amount is used for the whole face. 20 gram tubes cost between $25 and $40.

Some generics and foreign brands may be available in 60 gram tubes. Usually, the larger tubes are a better value per gram. Note that the other effective retinoid, tazarotene, currently costs about $65 for a 30 gram tube.

Prices on tretinoin vary widely at pharmacies, so call around for quotes when you get your prescription. Mail-order pharmacies may be less expensive. The Avita brand and generics cost less, but some pharmacies may only carry one concentration in a generic. The Ortho Retin-A, Renova, and Retin-A Micro brands are more expensive.

If you are on a low budget, get a prescription for a large tube of the highest-concentration 0.1% cream and use only a water-drop-sized amount for your face. You can spread it easier by moistening your face first with a little water. You can make the tube last a whole year this way.

Beware Internet Pharmacies

It is possible to buy tretinoin over the Net or by mail from foreign sources at much lower cost than in the U.S., but beware that you could get product of dubious quality. There are some reputable Canadian and British mail-order pharmacies which have low prices and quality brands - you can check various consumer websites for recommendations.

With any mail-order pharmacy it is best to use a credit card on your first order, rather than a check or money order, to protect against fraud. (You can contest the charges on your creditcard if your order is not sent.)