M.D. Forte is a small line of physician-sold products that's focused on the benefits of alpha hydroxy acids (AHA) as they relate to improving the appearance of wrinkles. M.D. Forte was owned by Allergan (of Botox fame) for several years but also was once associated with another doctor-oriented line called M.D. Formulations. Ownership history aside—and it was quite a business peccadillo, with lawsuits and hurt feelings all around, but that's another story—the focus of this review is whether or not M.D. Forte has any real fortitude for skin.
The good news is that there is a substantial amount of research proving that AHAs (particularly glycolic acid, which M.D. Forte uses) offer numerous anti-aging benefits for skin. Regular use of a well-formulated AHA product results in smoother skin, improvement in skin's moisture-binding capacity, enhanced collagen production, and a reduction in signs of sun damage, including wrinkles and sun-induced skin discolorations (Sources: Plastic and Reconstructive Surgery, April 2005, pages 1156–1162; Cutis, August 2001, pages 135–142; Journal of the European Academy of Dermatology and Venereology, July 2000, pages 280–284; American Journal of Clinical Dermatology, March-April 2000, pages 81–88; Skin Pharmacology and Applied Skin Physiology, May-June 1999, pages 111–119; Dermatologic Surgery, August 1997, pages 689–694, and May 2001 pages 1–5; Journal of Cell Physiology, October 1999, pages 14–23; and British Journal of Dermatology, December 1996, pages 867–875). Now that's a lot of research!
But there also is bad news, not about AHAs per se, but about the amount of AHA M.D. Forte uses. In this case, too much of a good thing isn't necessarily good for skin, at least not on a regular basis. In fact, the large amount of AHA included in several M.D. Forte products may actually be harmful for skin.
Most of the M.D. Forte products contain between 12% and 30% glycolic acid, which is above and beyond what any other company is currently using. Routinely applying 15%–30% AHAs in an effective acidic base (a pH of 3 to 4 allows AHAs to be effective) to skin on a daily basis may result in pronounced stinging, redness, and irritation. Continued irritation to the skin can cause negative results, just the opposite of what you want for your skin. There has always been a trade-off with using well-formulated AHA products: some amount of irritation (though many formulas contain anti-irritants to counter the problem) with lots of benefits. You always want to tip the scale in favor of the benefits (smoother skin with a plumped, less lined appearance), while incurring minimal risk, and for most people, that's entirely possible by using a pH-correct AHA product containing 5%–10% glycolic acid. Using higher concentrations can be overkill—and there just isn’t any research to support the safety of using such high concentrations daily on a long-term basis.
The Cosmetic Ingredient Review board assessed the available data on the effectiveness and safety of glycolic acid, and concluded that AHAs are safe as used provided that the concentration of glycolic acid does not exceed 10% in a pH of 3.5. Higher concentrations (30%, for example) were deemed safe if used "in products designed for brief, discontinuous use followed by thorough rinsing from skin, when applied by trained professionals, and when application is accompanied by directions for the daily use of sun protection." The FDA concurs with this assessment, but goes even further, stressing the importance of sun protection while using any AHA product (Sources: 2007 CIR Compendium, 2007, pages 117–120; and www.fda.gov).
M.D. Forte attempts to get around these concerns by stating on their Web site that their high-concentration AHA products are balanced to achieve optimum concentration and comfort. They explain this dubious claim on the basis of partial neutralization, as follows: "Partial neutralization creates a reservoir of glycolic acid molecules that permits both first- and second-phase penetration. Because the glycolic acid is released over an extended period of time, higher concentrations of acid can be used to achieve maximum results. Importantly, partial neutralization also raises the product pH closer to the pH of normal skin, further reducing irritation potential to provide maximum efficacy, minimum irritation, and beautiful results."
That really doesn't tell you anything of value. In fact, simply controlling the rate of penetration won't make an AHA product with 30% glycolic acid and a pH of 3.8 less irritating. After all, 30% glycolic acid is still 30% glycolic acid, regardless of how slowly it penetrates skin; the irritation occurs on the surface as well as after it is absorbed, a double whammy. And the term neutralization, as it relates to pH, is out of whack: without question a pH of less than 7 is still acidic. And given that the average pH of our skin is typically between 5.5 and 6.0, a pH of 3.8 (or even of 4.4., as it is in some M.D. Forte products) is not going to make these AHA products uniquely compatible or more comfortable than any other AHA products. Instead of devising this partial neutralization angle, M.D. Forte should have formulated their AHA products by reducing the concentrations of acid with a cadre of skin-beneficial ingredients such as ceramides, antioxidants, and anti-irritants. As is, all of the AHA products in this line are as basic as it gets. The pH-correct offerings will indeed exfoliate skin, but there are other effective AHA products that are safer, contain more skin-beneficial ingredients, and cost far less.
Despite all the hype M.D. Forte makes for their products, it's important to keep in mind that AHAs are not the only ingredients that are of value to skin—lots of others play vital roles as well. Most important, you don't need AHAs in every skin-care product you use—cleanser, toner, scrub, moisturizer, or treatment product. Just one per face or body, used once or twice a day, is plenty. After all, there is only so much skin that you need to remove to be beneficial, after that, you'll be taking off too much and causing problems.
As a reminder, whether you choose an AHA product from M.D. Forte or another line, please be extra cautious: be sure to use a well-formulated sunscreen rated SPF 15 or greater. This is crucial because when AHAs exfoliate they return the skin to some amount of its pre–sun-damaged level (which is a good thing because pre–sun-damaged skin is far healthier and looks younger!) and it is vital to protect the "new" skin from exposure to more damage.
For more information about M.D. Forte, call (866) 563-3678 or visit www.mdforte.com.