With a roster of well-known patients (which, unfortunately for us, she’ll never disclose), Macrene Alexiades has become known as the Park Avenue dermatologist who keeps her patients looking younger than they are in the most natural way. 15 years ago, the born-and-bred New Yorker launched 37 Actives skin care, named after the whopping number of active ingredients crammed into each jar. The line, which now boasts an extra rich formula, a neck cream and foundation (a lip filling treatment launches next month…), has garnered an intense cult following. In January, she’ll launch a 37 Actives travel kit, as a limited edition with Net-a-Porter. Currently, she’s working on a 2,500-page textbook called Cosmetic Dermatology, and if Macrene Alexiades’s predictions prove correct, topical products will soon advance to such a formidable stage, they’ll make in-office procedures obsolete. Until then, we’re sticking close to her workplace—and those magic hands of hers.

How would you describe your philosophy?I know what patients are supposed to look like and I just keep them there. I don’t make them look different, which is what’s happening out there. People are getting over-injected and they look kind of strange.

But you are now using fillers more than ever, right?I am using it more than ever, but probably least of all than everyone else.

You’re using it on more and more patients, but less of it with each patient?Less of it and I get better results, I think. So I’ve saved a lot of people from plastic surgery and that makes them happy. And they do look good, and that makes me happy. I’ve gotten it down to a point where I put very tiny amounts in. And the way I do it over time, it builds your own collagen, as opposed to altering your architecture. And then my little secrets for getting a facelift type of result with filler by putting it judiciously in hidden areas.

Like where?I hide the filler in the hairline in places where it doesn’t show. I was going to go into plastics, so I really understand the vectors of the face. My placement of the filler gives the facelift result without it even being on the face. Some doctors are doing the facelift result but it’s shows on the face and they start to look too cheeky and too full. And when they get too much cheek, it doesn’t look nice. You want to have it just right.

Have you done anything to your face?No, but I’ve been using our Filler Lip Treatment for two months now. A colleague here has that classic Irish lip—cupids bow in the front, but then there’s like no lip to the side. It’s very pretty. You can’t mess with that lip, you can’t put filler in there, it’s going to look crazy. So she, like me, used the treatment for two months, twice a day. It has hyaluronic acid filling spheres, so it actually gets into the lips. But it also has another 20 active ingredients, like ceramides and peptide. Anyway, she took before and after photos on her iPhone and her lips are twice the size. But it respects her own architecture so she just looks like she has the lips she had when she was 16.

What do you think about the Silhouette lift? It’s sort of an update on the thread lift.There are many ways to do this, using the aptos thread, and now they’re doing these little anchors that they stick in to pull up the skin. It all is fine. I, personally, don’t want a foreign body in my face. Here’s what concerns me: one time I was watching the Aptos threading procedure with another female dermatologist. She leaned over and she said, “It’s so violent.”

Good point….I looked around the room and I realized it was all men. Here we have men coming up with very aggressive treatments for women and I find that very bizarre. I would never do that to a woman, because I’m a woman.

Are you into Kybella?Yes, that I’m into. It’s a natural substance that occurs in the body—deoxycholic acid. And it dissolves fat. It basically up-regulates a chain reaction that causes the fat to dissolve, which is really handy. I was principal investigator of the trials that led to FDA approval, so I worked with it. What I love about it is that it’s artistic, it’s customizable. So you see the fat, you know where it is, and you just inject where the fat is. Compared to, say, the Cool Mini, where you slap the device on and it suctions it. It’s not as artistic. It’s clunky. It’s this oval thing that you’re sticking on. Even when I put it on the body, I worry about the placement to get a really natural result.

Does it hurt?Not really. It burns a little bit afterwards, and you get red and you can get a little bit of a wattle that lasts a couple of days but the results are phenomenal. Patients are so happy.

What are you working on?I’m working on a tripolar radio frequency device that’s basically three Thermages in one.

That sounds like hell. Does it hurt?No, because it employs the Mobile Technique that I invented in 2008. I defined the tissue temperature on the surface that you needed to obtain to get skin tightening, as well as the temperature thresholds for obviating pain sensations. So you have the results of Thermage without the pain. Most of the technologies today deal with a mobile delivery system. I just finished the protocol on this one. It can get the job done in about 15 to 20 minutes versus the old Thermage which took 45 minutes, and you can see the results in one single treatment. And it’s not expensive.

Where do you use it?Lower face and neck.

Sign me up for that!No pain, no downtime. It’s very safe. Same technology as Thermage. I’m loving that. It’s not FDA approved yet, but it’s great, a big step forward. I’m looking for things that are no pain, no downtime, no risk. And of course, the needle based radiofrequency, which I helped pioneer, which you wrote about at the starting gate. They didn’t even accept my papers on that one.

What skin care advice would you give someone when they’re 30, 40 and 50?To the 30-somethings, and the 20-somethings: Get started with topical anti-aging actives early. The earlier you start, the younger you will stay. No question about it. I believe that actives will replace procedures.

You've got 37 of them, but give me the top five.Peptides, DNA repair, hyaluronic acid, antioxidants, essential fatty acids. I covered my bases with that list.

What about 40?By 40, you have to start applying some more actives to your chest, neck and hands. Your face may look good, but your neck and chest won't, so you'll still look your age. If you don't take your actives seriously, then you'll have to get procedures like lasers that can stimulate collagen and make up for the fact that you haven’t been on top of it, and injectables, judiciously used as I described.

Fifties?By 50's, I have the needle radio frequency, but I have other ways that keep people looking like they’re in their 40s.

Like filler in the hair line? That's basically a brow lift, no?A browlift, a facelift. I’ve also been doing necklifts by putting filler back behind the ear.

Holy cow…Which fillers do you use there?Voluma or Juvederm Ultra Plus works the best. These are patients who've been with me for 15, 20 years and they trust me because they've unbelievably avoided face lifting. They’re in their sixties and look fifty. I had this dream, thinking how cool it would be to do little punch biopsies behind the ear, like every six months. Eventually, it would add up to a facelift and you'd only have a 3 mm scar. I told my patients and they were like, “Do it!” But I haven't had the nerve to.

Wait. You’d biopsy to just promote collagen growth?No! To tighten the skin. You know how plastic surgeons cut behind the ear, then pull? My idea was to do little punch biopsies and tiny mini-tugs on a regular basis. And yes, it could promote collagen, too. I so wanted to do it, but it was too crazy, too cowgirlish. So instead I've been putting filler back there. It's expensive, because it's a surgical filler, but it's not as expensive as a $40k facelift.

Does it hurt? All I seem to care about is the pain…No! There's actually not that many nerve endings there so they don't feel it, and they swear to god, they see a difference.

How long have you been doing that?About a year. But you’ve got to start using the actives topically at an early age.

And so many people think that starting young means getting Botox or fillers at 25.I know. They think that’s preventative. If they end up in the wrong hands, it could be very bad. Thankfully, IMG Models has been sending me all their models. I get them clear, I get rid of their acne scars and I keep them looking normal.

What do you do for acne scars?I put together topical regimens for what each one needs, then I decide which technology to use to clear the acne and the scars at the same time. I’ve been using the Genesis laser a lot, because they can go back to work right away. I’ve been getting rid of the acne in one month. That’s unheard of. I couldn’t do that ten years ago.

Do you give them any internal meds?No pills! There’s the whole retinoid category, of which I choose what will work best for them. Then there’s the retinoid alternatives, sulfur-based drugs, topical antibiotics and anti-immune agents.

No Accutane?Accutane isn’t a good choice for models. I guarantee you, if you take Accutane, you’ll get a scar in the wake of every pimple that you have. It’s just not great. You do it if it’s urgent, or you do it in a teenager who’ll do well without scarring. But someone older, not great, because Accutane impedes wound healing.

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