If you want dramatic, visible changes to your skin, you are probably going to need products available only from your doctor. Even then, don’t expect miracles.

Retinoids, or vitamin A derivatives, remain the only proven topical prescription remedy for wrinkles. Dermatologists think that they work by stimulating the growth of more collagen or perhaps even new skin cells. Clinical studies show that retinoids smooth out a few fine lines and wrinkles but don’t banish them completely, nor do they affect frown lines and other deep wrinkles. They also help fade age spots and even out blotchy pigmentation.

But these compounds are inherently irritating. New users can expect their skin to be red, itchy, and peeling for a few weeks. Eventually the irritation clears up but some people experience persistent dry skin as long as they use the products. Retinoid-treated skin also gets red more quickly in the sun.

In low concentrations, hydroxy acids like glycolic or lactic acid are ingredients in some over-the-counter wrinkle creams and home exfoliators. They strip away the top layer of skin cells, so whatever slight effect they have ends when the cells grow back.

Much stronger acids are used in doctor’s offices to do chemical peels--in effect, a controlled chemical burn. As the skin heals, the theory is that it will grow back smoother and more evenly pigmented.

But your skin can be red and sore for weeks on end, and extremely sensitive to ultraviolet light. Moreover, no reliable studies have shown that these peels are consistently effective.