Where cosmetic procedures (lasers, injectables, plastic surgery) are concerned, our team members tend to sit on the no- or low-intervention side of the spectrum. We all have different reasons for this; we also don’t view those who fall on the other side of the spectrum with judgment. That just happens to be where we are.

But we also recognize that many of you might be curious about your options: the pandemic has led to a double-digit increase in the number of people interested in cosmetic procedures, in a phenomenon that has been referred to as “the Zoom Boom.” So we wanted to share a perspective that didn’t sit squarely in our products-only wheelhouse.

Dr. Macrene Alexiades not only is the founder of a skincare brand we adore; she also has the best reputation in the business for helping a wide variety of patients in her office — from CEOs to supermodels — look fresh and vital without looking “done,” thanks to her skilled and judicious use of cosmetic procedures.

We couldn’t think of a better person to dig into this topic with us.

Ayla: Is there a typical point in their lives during which your patients first come to you for cosmetic procedures?

DR. MACRENE: The time in people’s lives when they come to me varies by individual, skin types, amount of sun exposure, and — to some extent — by culture and generation.

Those who are currently in their 40s and 50s tended to come to the dermatologist seeking cosmetic procedures at a later age than Millennials and Gen-Z patients, who seem to be seeking treatments as early as their early 20s.

Some cultures are afraid of cosmetic procedures and put them off, whereas others embrace them. Those who are light-skinned will start to accumulate sun damage, wrinkles and other changes as early as their mid 20s, whereas those with more deeply pigmented skin types may not show the signs of aging until later decades. 

However, to generalize, patients tend to come to me seeking treatment when they are disturbed by something they see and it negatively impacts their sense of self. With respect to aging specifically, this may include changes that make them look sad or mean or unhappy, and typically translates into wrinkles, creases, and sagging. They will often say, “My skin does not translate how I feel.” My job is therefore to restore their natural beauty so that their outside conveys how they’re feeling on the inside.

Ayla: In terms of common signs of aging, how much can we expect topical skincare products to do for us? And what can’t they do that one might need injectables, lasers, or other dermatological treatments for instead?

DR. MACRENE: I published my Alexiades classification of skin aging in the early 2000s. Since then, I have studied and validated many different treatment modalities to address the different signs of skin aging, including injectables, lasers, and energy-based devices. I have spent the last 15 years translating these procedures into active ingredients for Macrene Actives. I believe that active ingredients can replace cosmetic procedures to address all signs of skin aging.

Dara: Is there a point of diminishing returns for those cosmetic procedures available at a dermatologist’s office when a patient then needs to think about more invasive options (like face lifts)?

DR. MACRENE: There are a few key concepts to communicate with respect to decision-making in aesthetics.

First, as a physician and patient team, we have to decide: Has the patient arrived to the dermatologist’s office too late for topical treatments or cosmetic procedures to address all their concerns?

If this is the case, it is important to provide the patient with the gold standard, which is a range of surgical treatment options. Only when the patient has ruled out surgery, or if their skin aging is not severe enough to warrant surgery, do we then proceed down the road to cosmetic procedures such as injectables and device-based treatments.

Regardless of which modality patients choose, I highly recommend that they start on Macrene Actives because it will improve skin quality and they will therefore respond much better to cosmetic procedures and surgery. I have often been surprised by patients who opted to just use my skin care with astounding results after a year. In many cases, my skin care has replaced the need for cosmetic procedures and, in some cases, even surgical options.

Dara: After having seen so many patients over the course of your career, which ones have seemed happiest with how they look?

DR. MACRENE: Just recently, I had a patient come in very depleted and sad and asking me for a referral to a plastic surgeon. I did my Macrene magic on her, which included very conservative, judicious, artistic use of my injectables and a reinstatement of my Macrene Actives skincare. She returned with tears in her eyes, telling me, “Dr. Alexiades — a week ago, I came to you wanting to have a facelift. Today I’m here to say to you, ‘I love my face.’ Thank you!”

Dara: How has your work informed your own perspective on aging?

DR. MACRENE: My mantra that I express to my patients is that no one needs to be pleased except you. I am here to bestow the artistic gifts I was given in order for my patients to feel a sense of beauty and fulfillment of their own potential. I never impose my view on the patient and emphasize that there is no mandatory course.

Everything we choose to do in our lives is elective and is meant in order to find happiness. Therefore, I have my patients sincerely examine the balance between what makes them unhappy about their appearance, how much they are willing and interested in doing, and what their goals are.

When I restore my patients’ natural beauty, however that happens to be done, they are empowered to go into their lives with greater sense of joy, confidence and energy. They often say it helps them be better husbands, wives, mothers, fathers, sisters, brothers, citizens, workers, artists, musicians, actors, models, executives, you name it! 

My work is fractal: I walk through a door, help provide a patient with a greater sense of confidence through what I do, and it impacts everyone in their lives. In my view, my work has gone beyond the concept of aging and more towards the restoration of natural beauty and of people’s innate sense of happiness. 

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If you’re curious about specific procedures that Dr. Macrene tends to find most helpful for her patients these days, check out this interview and video. 

Shop the entire Macrene Actives lineup here, and if you'd like to hear more from Dr. Macrene, check out these posts on our blog:

Dermatologist Macrene Alexiades on skin firmness & elasticity

Collagen in topical and ingestible skincare: dermatologist Macrene Alexiades, MD weighs in

Dr. Macrene Alexiades on her new Macrene Actives line

A top dermatologist's acne tips

Any topic discussed in this article is not intended as medical advice. If you have a medical concern, please check with your doctor.