Hi,
I am sorry you're not having the results expected, The Beauty of Peace. I am no expert, but since I was diagnosed with rosacea a few year back I have come in contact with very contradictory information on forum posts, academic journals, documentaries and youtube videos on the topic of skincare and photo-ageing, but one thing that seems pretty solid is that ageing is a complex combination of processes, as you know, and that sunscreen and retinoids are gold standards as far as topicals go. With all your care to avoid the sun and use topical retinoids (and I am assuming you always avoided the sun and used sunscreen, because since sun damage is cumulative, it is my understanding that you could just be showing now damage done decades ago... we know for instance that having a couple of bad sunburns in childhood can make you more prone to certain types of melanoma decades later), there is no assurances that you will avoid looking older in general, or look younger than most women your age. You can only be sure of looking younger than you would have had you not taken care of your skin.
Firstly I would seek out a more trustworthy method of comparison from now on; as some have pointed out, that is a dynamic test that can change simply by more people taking the test, and not at all what you would call reliable, specially because the goal is to improve your skin, not your skin in comparison to other people your age, because that can just be unrealistic (for instance, some people's genetics, and even whole classes of people, will put them in an advantage unbeatable even by the most comprehensive anti-aging skin care and lifestyle). Your doctor should be the one taking pictures and doing all the tests and scanning all the damage for future reference (that's how my dermatologist does it at least, and then we have a reliable reference to gage improvement; he also looks at my skin under a UV lamp, I am guessing because you can see damage not yet visible to the naked eye, but I am not sure and I have never asked; there are probably other methods perhaps more suited to you). Secondly, I think you are absolutely right in that retinoids are not all of the answer (and in that sense overrated), but that shouldn't discourage you from having in your arsenal pretty much the most proven topical for preventing and reversing photo-ageing after sunscreen.
Lastly, about sunscreen and sun protection, you are right to use hats and protective clothing, and avoid the sun during peak hours, since even the most efficient sunscreen can't protect you from all UV light. I think there is a consensus as well that sun filters are not enough, and you should be looking at proven antioxidants and perhaps DNA repair enzymes to use under sunscreen, which can improve your UV protection overall. I can't speak to the debate about zinc oxide versus European sunscreens; I have used both, but I think the most important thing is to use the recommended amount at least, and really be generous with it (which is why I just avoid zinc sunscreens these days; too much white cast to apply liberally); I avoid direct sun light if at all possible, but if I am at the beach or outside for extended periods of time, I will reapply throughout the day; I guess ideally we would reapply sunscreen throughout the day everyday?! I just cannot bring myself to apply more than twice daily on a normal day. Having said that, if you are using a reliable and stable sunscreen with UVA protection, be it zinc oxide or otherwise, in the recommended amount, the sensitivity retinoids are causing should not outweigh the benefits; as you know, retinoids have been tested with concomitant use of sunscreen, and have been shown to improve ageing skin; so as long as you are using sunscreen and being sun-smart, your retinoid should not make you more susceptible to sun damage than not using it; it's actually the opposite.
I am sure none of this is news to you, but I just thought I would leave my opinion. I wouldn't give up on prescription retinoids (specially not for a retinol product like ZO Radical Night Repair, which can just add another layer of problems with conversion of retinol to retinoic acid, which is different for different people...), perhaps just tweak with the frequency and strength till you find a comfortable routine (I am also assuming that after 13 years of use, you no longer have any irritation; if you do, then perhaps you should consider a lower strength, and not a higher one, because I don't think constantly irritated skin is the goal considering how inflammation is tied to ageing). I think the most important thing though is to understand that comparing yourself to other women or most women your age is a loosing game; all we can do is ensure we are taking the steps to be the best we can be, because we all have pasts filled with different genetics, lifestyles, sun exposure, etc., and in that sense you should have as your goal to improve your skin. And on that note, you can't beat sunscreen and (prescription) retinoids. And perhaps to deal with some of the visible issues bothering you, you will have to rely on something other than topicals, because they really have their limit; in that sense, perhaps lasers would be a more effective way to undo accumulated damage that the retinoids are not resolving.
All the best,
Lucas.
