This is the RPD podcast where we are always reaching for truth and beauty. Remember, the brands on the show are not paying to be here, so we get to ask the questions you want answered because you deserve to be informed so you can make the best choices for yourself. And with that said, I'm Amber, and today my fabulous cohost is Dr. Makreni Alexiadis. I hope I got that right. She is a fabulous Greece native. By the way, Greece is one of my favorite places in the world. But a Greek name, so I'm hoping I'm pronouncing that right. She also holds three degrees from Harvard, is a practicing dermatologist in New York City and an all -around amazing, brilliant woman. I'm so honored to have you on the show today, Dr. Makreni. How did I do with the pronunciation? Like a native. Like a fellow Greek, I'm so honored. I mean, so, you know, prior to this, you know, when we were just chatting a minute ago, Greece is one of my favorite places in the world. I've been there three times now. Never to skiros where you are, but it is just magical. Are you? You were actually born in Greece. I wasn't born in Greece, but I'm a dual citizen. I spent half my life here, half my life in America, back and forth. And so that has really inspired me and given me a worldly view and a balanced view. And the Greeks, we were taught the Socratic method from birth, which is to question and to probe and to find the meaning of life. So it has really benefited me as a physician and a scientist and a creative and an artist. And I'm grateful to be able to bring that kind of global viewpoint to everyone. I love that. And again, I find that the Greeks of all the places that had been were the most familial, the most warming, the most, you know, come on into my house, come do this. And also the best tomatoes I've ever had in my entire life. Like it's just the best food ever. Thank you. Well, it's sun and believe it or not, not that much water in the summer and soil makes for fruits fantastic and vegetables. So delicious. You know, so listen, full disclosure, we are recording this. It is still summer, but this will air in September. So with that said, you know, I'm so excited to have you here because you are truly an expert in everything lasers. In fact, you told me you were writing a second textbook while you're there in Greece. Yes. I usually take this time when I'm not seeing patients to work on my academics, which is particularly textbook writing, which requires undivided attention. My first textbook is Alexiadis's cosmetic dermatologic surgery that was published by Walters Kluwer. You can get it on Amazon and it is the first of its kind. It's a disorder based text that takes the reader down an algorithm of the best medical cosmetic, which includes injectables, heels and lasers and surgical treatment options. And it's good for both patients as well as colleagues, dermatologists, plastic surgeons, physicians, who really need to know what the gamut is, the panoply of treatment options that are available. And then my second textbook is on photodynamic therapy. That is with the publisher of Selvia. That is the book that I'm finishing right as we speak. And that is an area of specialty of mine as well. In addition to lasers, it's the use of light to cure disease. Oh, I love that. We've been talking so much about different light therapies, red light therapy, blue light therapy. But I'm hoping that today, that you are really known as a laser expert. And since, by the time this airs, last weekend will have been the unofficial end of summer, even though summer doesn't end for like another few weeks, this is a really great time for people to start thinking about different sort of laser therapies that they can do, right? And so I'm just wondering, when we hit the fall, what are some of the most popular things that you were seeing in your offices? Great questions. And you are right. My patients are planned out months in advance. So I do my fall laser planning in the spring. So patients come in the spring, they start to complain about the things that start to present themselves when we start to get sun exposure, such as brown spots, melasma, hyperpigmentation. And those are not conditions you want to treat in the summer, particularly with lasers, because lasers kick up the heat in the skin, and you can get a tanning like result from that. So we pause on the use of lasers for pigment until the fall. So it starts back up pretty much end of September, beginning of October. And the other is, is that lasers against pigment are not as effective in the summer when you're getting all your sun exposure. So it may actually be working, but it looks to the patient as if it's not working because they're tanning in the summer. So all my laser cases are already fully booked all the way through to the holidays. I mean, yes. And you do have, I don't know, are we allowed to name drop? Can you tell any of the celebrities? Well, I think it's like public knowledge. I leave it to my celebrities. If my celebrities want to mention me and give me some love, and some of them do like Sienna Miller, Brooke Shields, and those guys, it's wonderful, Nikki Hilton. But I really adhere very, very, very strictly to HIPAA. And I know like, I mean, people have called me a billion dollar box office success, which I cherish that title. But my lips are sealed and I just, but I derive a great deal of satisfaction, pride and joy actors at keeping and models in their business, in their work, well until their elder years, which is really a source of pride for me. So on that, do you feel like there are certain things that you recommend kind of everybody does? Of course, we all have different skin types. We all have different conditions, but are there certain procedures now that you were loving, especially coming into the fall, clearly we are too late to book with you, sad, sad, but are there things that you are kind of loving out there for people to be doing this time of year? And are there certain treatments that you love for this time of year? There is no end to what I can do. I mean, I have to say, I was at a dinner party that night and one of the ladies was saying how plastic surgeons or dermatologists told her there was like nothing to be done for her. I have to say, I mean, I am fortunate that I have the embarrassment of the riches of knowledge and experience in both injectables and devices, but really there is no end to what I can do. I can treat in the summer. I am just saying that there are certain devices you do not want to do in the summer, such as fractionated devices, Q -switch devices, picosecond technologies, those are better done in the fall, but I have great treats for everyone all summer long. One of my current favorites is radiofrequency microneedling, which I am honored and acknowledged as, single -handedly, the dermatologist, scientist, and laser specialist who brought this whole genre to market. I sought and attained the FDA approval between 2006 and 2010 for the prototype radiofrequency microneedling device. That one was called the Profound. And since then, we have had a huge crop, a whole generation of devices, such as Morpheus is one that people know about. But there are many different types of genius, infamy, intensive, they are utilized in a way that is safe for all skin colors, all skin types, and can be used in the summer months. So that is one of my all -time favorites for skin tightening, wrinkle reduction, rejuvenation, all summer long, with no risk of downtime or hyperpigmentation. Okay, so let's go back to the fall now, right? So because that's what we're kind of, the season we're coming into, good to know though that radiofrequency can be done year -round, what are your fall -specific treatments? What are the things that you're starting to address now, you know? Okay, so come September, you're done with your summer, Labor Day is over, now we're in the saddle, we're looking at this rung of treatment that is really dedicated to this time of year. When you're in September, be aware that there's still this delayed what we call seasonal lag. You can get this first week in October that's very sunny and warm and it really helps you to be outside. So please delay a little bit in treating your brown spots and hyperpigmentation with devices until October, however, in September, I do start to do some rejuvenation on people who I trust and know are really not going to go out in the sun, so that might include intense pulse like IPL, that is great for getting the summer off. All the sun damage you've accrued over the summer, you can start treating in September and if you're somebody who really is not going to go out in the sun, whether it's because you have kids in school or you yourself are working and you know that even if it's an Indian summer, you won't be outside, then you can treat with rejuvenation lasers such as fractionated resurfacing known as Fraxel, picosecond lasers such as Picogenesis or its predecessor, Genesis laser. These are all devices that are great for rejuvenation, for getting rid of sun damage, which you've accrued over the summer in short order so that especially if you can do a trio, which a lot of times these devices are done three months in a row, a month apart, three treatments. If you do September, October, November, you're ready for holidays. You're ready for Thanksgiving and winter holidays. Now I have to ask you, and I don't want to put you on the spot because do you have a lot of these devices in your office? Oh yeah, I have over 50 lasers and devices in my office. So here's where I'm going to put you on the spot then. Is there one that's like kind of your favorite? It's like asking who is your favorite child. Oh no. No, I mean, you know, my girls will tell you, like they're all my favorites. For example, I have specific devices that are my go -to and my favorite for eyelid tightening. So my claim to fame is that I replaced the plastic surgery with devices and injectables, right? And I'm replacing cosmetic procedures with active ingredients through my macrine actives. So that's been kind of the progression of my career over the last, and I have to say I've been in science for over 40 years, so I've been working really hard for many decades, but the progression was initially replacing plastic surgery with devices and injectables. And I go through phases of what my favorites are and then taking all that knowledge and translating it into active ingredients. So ultimately we can do all this at home, but I will just give you some of my highlights. All right, so if you don't want plastic surgery, be on the lookout for skin laxity, in my opinion, other than like having brown spots and sun damage, which of course does, you know, make you look not so great. I think it is equally important to keep an eye out for jowls and loss of the beautiful like elasticity of the skin that you want, especially in the jawline and neck. If you start to see jowls, if you start to see laxity, intervene earlier with non -surgical alternatives so that you don't end up needing surgery. Give you an example, I've been taking care of a classmate of mine from Harvard undergrad that we were class of like 89 and she doesn't look any different than when we were in college. Why? I have her face memorized and she believes in me so much and in the science and what I've done. She comes every four months like clockwork for all these years, 20 years, getting skin tightening with me with radio frequency devices, infrared light. She doesn't have any jowls, of course, a little bit of filler. And then she uses my actives. So if you were to really prioritize devices in my practice, I would say you want to keep on top of two classes of devices. One are the skin tightening technologies, whether it's around the eyes, jawline or neck or body, if you're down to body now. And then the rejuvenation technologies that we just talked about, IPL, fractionated technologies, genesis type devices to keep the sun damage and wrinkles at bay. And then if you need something more aggressive, you can always go to a CO2 laser, which I'm a specialist specialist in that as well. And that really is in my hands, an art form. I tailor the carbon dioxide and the erbium lasers, which are really our Cadillac devices for those who have more significance on damage in most cases or wrinkles and aging. But honestly, even people who have very light skin that starts to wrinkle a little bit prematurely in their 40s, maybe candidates already. And that, too, prevents the need for, say, blepharoplasty, which is eyelid surgery. It may prevent the need for a facelift because it'll give you enough of a strong rejuvenation.