A model's livelihood depends on clear, flawless skin. So it's no surprise that when Park Avenue dermatologist Dr. Macrene Alexiades figured out how to fix a complexion in less than 30 days, IMG modeling agency became devoted clients. She now has over 6,000 patients, of a variety of ages and professions. "I’ve seen every type of acne, every type of situation, every type of brown spot," Dr. Alexiades explains. Here, the beloved doctor shares her secrets for curing every skincare issue from wrinkles to rosacea.
You have a reputation for being able to transform someone's skin in only 30 days, even though skin naturally has a six-week cycle. How do you do it?
I like challenges a lot, and I have very high standards. I had had a few of the IMG models come to me with really terrible skin. At that time, I wasn't thinking "Oh, I want to take care of all these models." I was thinking, "Wow, here’s a woman who needs this fixed ASAP for her work."
So I had somebody who had, really, a very bad situation, and I was able to clear her in less than a month. When the agents saw the results, and saw that she could work again, and that there was no retouching, they started calling me and sending me more models. So then I was just doing my thing where I was trying to clear people within a month, because I was invested in getting them back to work as soon as possible, too, and it just became a pattern.
And when I started batting a thousand, they started sending them all to me, so now I see all of them. I basically see every single IMG model that they have on their roster, and what’s cool about that is they all have different needs, but all the needs are the same. Many times, they have to be at a casting the same day or the next day.
What are typical skincare issues that you deal with?
So my challenges are as follows: number one is to clear up whatever the problem is. So let’s say it’s acne, or rosacea, or even wrinkles, or sun damage, and to do so with no downtime.
Then number two is to do it quickly so that they can go back to their work, and the treatment won’t interfere with that. I would say 30 days is fair for a lot of things. The one thing that would be the exception to that is if somebody has very severe cystic acne and they’ve never been treated.
I had a patient who came to me who, they wanted her for Victoria’s Secret, but she hadn’t been shot. It was just she had such bad skin, and my goal was to clear her. She had hundreds of pimples. So, for her, it isn’t possible to bypass the turnover of the skin. So, back to your question, there are limits. I can’t work that kind of miracle, unfortunately, but by a month, she was about 75 percent clear.
That’s still pretty amazing.
Yes, and they were so happy. By the end of month two, she could go ahead and start working, and casting, and shooting, and all of that. So, I have accumulated certain tricks that I do, certain treatments that I can do the same day where I get an immediate flattening of pimples, an immediate benefit, an immediate luminosity so that they can go ahead and do a casting, even though they may not be 100 percent clear.
What are your tricks?
Lasers, usually, and occasionally, I’ll do peels. With injections, I can get them flat the same day, but extractions usually leave a droplet of blood. The problem with the peel is it isn't a same-day treatment, but by the next day or the day after, they would look superb, and then by a week, they would look even better than superb, like flawless. So that’s why I like the peel a lot. It’s a quick, low-cost, but highly effective clearing tool.
What kind of peel?
Oh, I have cocktails I use. So there’s something called rapid cognition, which I’m sure you read about in Malcolm Gladwell’s books. Those books are me. Everything he writes about, it’s my brain. It’s the way my brain works. I will look at a patient, and a million calculations happen in my head so that I spit out the proper protocol, and it’s better than a computer in many ways because I’ve seen so many patterns over the last 20 years.
I have 6,000 patients, so I’ve seen every type of acne, every type of situation, every type of brown spot. So I already know what kind of cocktail would really work well instinctually. I usually use a mix of peeling agents, and they could be anything from glycolic and other alpha hydroxy acids, to chemical acids like trichloroacetic acid, to brightening agents or anti-acne agents like sal acid, mandelic acid, some brightening agents or like amino acid derivatives, and I do a cocktail depending on what the patient needs, and I do it in a certain sequence so that I don’t end up with scabbing. All of these are just tricks and things that I’ve accumulated over the years.
For example, today, I had a patient, and her problem was pigment, and I knew right away that her type of pigment would do well with a particular type of peeling agent, so I was able to get rid of the pigment the same day. It happens in front of you, yeah. That’s not exactly melanin. It’s probably something called lipofuscin, which is like a degraded byproduct of cellular debris, because those really clean up very quickly. You can bleach that out of the skin right away, and then they can go to a photo shoot, and they look nice and clear.
Is excess melanin often misdiagnosed?
Yes. A lot of times I think even dermatologists don’t understand melasma. They don’t understand that it’s only partly pigment, so that’s why you really need to be well versed at it. You have to understand the pathogenesis of melasma, that there’s vascularity under that that’s feeding the brown.
I have to be very careful which lasers I choose to treat when I have somebody who has a casting the same day or is shooting the next day. So I use devices that are called non-ablative. There’s no downtime. So these include lasers like the 1064, which is very safe regardless of skin type, and I have several 1064-nanometer lasers in here and D-YAG lasers. I can do a lot with them.
They can fight acne. They can fight pigment. They can fight redness, and they can boost the luminosity, the radiance, and the wrinkle reducing of the skin. So one of them’s called the Genesis, and now right now, I’m developing a new protocol called PICO Genesis. So what I got this year was a PICO device that has the 750-picosecond as well as the nanosecond range, and what I’m doing is I’m developing a protocol for getting rid of all those light brown spots that people start developing in their twenties that makes the skin lose its luminosity, its luster.
And the picowave is also what’s used on tattoo removal, right?
Yes. So it is the best treatment for tattoos. We start with tattoos in the nanosecond range for the big tattoo particles, and then, as the particles get smaller, that pulsation doesn't work anymore, which is why it was so hard to get rid of the residual pigment in so many tattoos. The other problem with tattoos is there are gap colors that just aren’t well suited. So now we’re filling in those gaps with additional wavelengths. So PICO has really refined the field. So instead of taking, say, 10 or 15 treatments, now it only takes three to five.
And for dark spots, how many treatments does it take?
It’s three treatments a month apart. But what’s nice about the PICO Genesis, the protocol I’m developing, is that you can do it the same day as a photo shoot or whatever. It will not cause scabbing. What I have seen, however, is when I use the shorter wavelength, the 532, you can get hives from that, so I’m sort of cognizant of that. So I’m in the process of developing that protocol. I’m actually going to be publishing a paper on it, so I’m working all the different types of parameters that can be used. So that’s been fun. That’s been a great challenge for me. So I’m constantly searching for no-downtime technologies so that I can get my people back in the workplace the same day.
You see clients of all ages. When to skin problems tend to start?
I have a whole bunch that are at the 16-years of age and oily. Like between 15 and say, 18. They, by and large, have two main issues, and that’s acne, or acne scars, and blemishes from their acne. So I’m fixated on that and getting them clear and keeping everything nice and flat so that they have their photo shoot and there’s no retouching. So that’s them. Then I’ve got my next wave, which are the ones who are probably already around 30 or late twenties.
The ones that are in their mid-twenties, their acne's under control, they usually don’t complain about the sun damage. They ironically don’t have the greatest and healthiest lifestyles, as you probably know. A lot of them smoke, and they get tattoos, and they do all this kind of stuff. The ones who are in their late twenties/early thirties, though, because they do so many photo shoots outdoors, and, by and large, a lot of them have very light skin, they start to accumulate sun damage. So they have been coming in, and a lot of them have to be treated very gingerly, because there’s a few things that happen.
One is you want the devices for dealing with the sun damage, but then they also start to show the signs of aging, and so, with them, my goal is to preserve their look. So when I do Botox or filler, you can’t see it. I will not change the brow. I won’t change what’s special about that model, because, guess what? You have pictures. We have a living history of that face. So if I don’t get it absolutely perfect, you’ll see it in their next photograph, and I have seen things go awry where they’ve been over-filled, and it really is very intrusive in their ability to be photographed and look true to themselves.
So that’s what I’m known for, is that my filler doesn't show, and I do it very slowly so that I don’t make a mistake. So it never is a point where you have to take...I’ve never, knock wood, had to take something out. The biggest criticism I think that people may have of me is that I tend to be a little on the minimalistic side. So, if anything, I underdo rather than overdo, and they have to come back to me, but my word of advice to everybody is wouldn't you rather, come back, and you get a little bit more. What's the big deal?
It’s like getting your dress tailored and they cut too much fabric. You’re screwed. They can’t let it out if they’ve cut that fabric off, but they can always make an adjustment and tighten it a little more, and that’s really what we’re talking about here, and so it’s important to work with me as a team to get that perfect result by doing it in small increments. So that’s what they do in their early 30s. By the time my models (and I have some of the top models) are in their forties, fifties, and sixties, we’re talking about doing it all. It is a full-time job for them to maintain their face. They’re in here relatively frequently, maybe once a month, because they’re traveling all over the world. They pop in, and we do something to kind of keep the treatment boosted and keep it going, and again, my filler doesn't show, and I’m proud that I’m doing some of the most amazing faces in the world, and one of them, who is one of the most amazing faces, actually said that I was unbelievable. That made me so happy.
And it's all secret, right? No one knows who they are?
No, and you know, when they are in there, they hide. They’re under the hat and the glasses. They do all of that stuff, or they come in on the weekend. I do that sometimes for people.
I know you can't name names. But the ones that we assume...
Yeah, the ones who are everybody’s like, wow, she looks really good.
They doesn't age.
I’m very proud, and I see the pictures, and I see the covers, and I’m just like, wow. To have somebody who is 60, or whatever, and still be a cover model? That’s so freaking cool.
For rosacea and redness in general, what do you find is the best?
Rosacea’s one of my fortes. So rosacea and redness, it’s due to two things. One is histamine, too much histamine in your blood that causes you to flush and blush, and it could be due to triggers, foods that contain histamines or 5-HT, which is the precursor to histamine, which comes in things like eggplant, avocado, bananas. So if you eat that every day, don’t. Once in a while is okay, but not every day. And then other things that make you flush, like red wine or hot water.
So don’t take a hot shower. Lukewarm, or keep the lukewarm water on the face, and just, you know, reserve the hot for the back, your torso. So first and foremost with rosacea is avoiding triggers. Oh, and sun. For some people, it’s sun induced. You can heal yourself by avoiding the triggers. Next, you do need to calm the skin down. So you can either do the prescription route, or if you want to do homeopathy, 37 has a dozen anti-redness agents. Coffee extract, tea extract, yerba mate extract, feverfew, chamomile, bisabolol.
What are these? Vasoconstrictors in plant form, and in the olden days, ladies used to put teabags under their eyes to de-puff. It’s because of the constrictive abilities of aminophyllines and theophyllines. Oh, and cacao extract, which has the methylxanthines. So these are like natural caffeines that constrict the vessels. So if you do that, plus the other anti-inflammatory agents, like the mushroom extract, that’s in 37, you will have an anti-inflammatory and a vasoconstrictive effect that will keep the skin quiet. So it’s a homeopathic remedy, really, for rosacea. There’s meds, the topical prescription agents, metronidazole, Finacea, which is azelaic acid, sulfur preparations, and then you have lasers, and these are the vascular lasers. So pulsed dye laser or long-pulsed 532 or 1064 laser. All of these work really like a charm.
How does the sulfur come into this?
I mean, sulfur’s been around for ages. I have swum in these caves where Cleopatra used to go to and put the sulfuric rock on her face in Greece. So cool, and I think she had rosacea, and by the way, she was Greek. I don’t know if you know that. She was a Ptolemy.
Oh, I didn't know that.
Oh, yeah, Cleopatra was a Ptolemy. She was Greek, and so had rosacea, and she used to swim in these caves in Crete, which is obviously across from Egypt, and she would put the sulfuric rock...it was her beauty sort of mask, and you know it was reducing redness. It was so obvious to me, and it was very, very cool. So it has an anti-inflammatory effect, an anti-bacterial effect. Rosacea’s a strange disorder because we really don’t understand it 100 percent. There are these organisms called Demodex folliculorum mites that are there, so it could've had an anti-microbial effect as well. So all this in concept, but the nice thing about sulfur is you don’t develop resistance to it_._
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