A 6-month, randomized, double-blind, vehicle-controlled study was conducted with 0.05% tretinoin cream once daily in the treatment of photodamaged facial skin. Significant amelioration of many of the signs of photodamage were achieved with minimal side effects. Clinical grading showed significant improvement both in the assessments based on changes in clinical scores and in pre- and posttreatment comparisons of standardized photographs. Fine wrinkling, coarse wrinkling, sallowness, looseness, and hyperpigmentation were significantly improved with tretinoin therapy. Furthermore, a self-appraisal questionnaire indicated that tretinoin-treated patients, but not vehicle-treated patients, were able to perceive improvement in their facial appearance. An objective method based on digital image processing of silicone rubber casts obtained from the crow's-feet area also indicated that the skin surface topography was smoother and less wrinkled in the tretinoin-treated group compared with the vehicle-control group.