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Member Spotlight - An Interview with Macrene Alexiades, MD, PhD

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Macrene R. Alexiades, MD, PhD

What does it mean to you to receive the Best Overall Clinical and Best of Session Clinical Applications – Gynecology and Women’s Health awards?

When I received word that I had been granted the Best Abstract of the Session Award, I was overjoyed. I wasn’t expecting it, and this made it even more special. When a day or two later I receive notice that I had been chosen for the best overall abstract of the entire meeting, I was over the moon!  I’ve been conducting research in the laser and device world for over two decades. In many cases, the work that I do is without remuneration. I do it because I have a passion for research from a young age and I enjoy science tremendously. I have diligently and dutifully submitted my work to ASLMS on an annual basis with no expectation of receiving any sort of reward. When one receives an award unexpectedly, it makes it all the more joyful. The award represents the culmination of my work and my tireless commitment to advancing our field.  The crown jewel was of course receiving the Richard E. Fitzpatrick award for my work in women’s health. This is especially poignant because I see women’s health as a neglected area in medicine. When I started working on this over a decade ago, I did not anticipate that I myself would get involved in the research. To provide women with treatments for very common ailments that greatly negatively impact their quality of life gives me a sense of purpose. I am grateful to the ASLMS for acknowledging that this is likely going to be the most important contribution I’ve made in lasers.

How does receiving the award impact your research?

This is a wonderful question. I have been doing research since the age of 12. I have always been self-motivated and self-driven. However there does come a time where you feel as though there are forces, political forces, against an area of research that one could never have anticipated. This is one of those times. I have felt that the area of devices in women’s health was an important breakthrough for addressing very common conditions affecting women’s genitourinary health and was surprised and disappointed to observe the resistance and political aspects against the advancement of this area. The award came at a pivotal moment when I felt I needed that extra boost to keep focused on my research and stay the course. I am confident that the data will evince itself and give way to approvals of these very safe and efficacious technologies, but acknowledgment from my peers as to the magnitude of this contribution is immeasurably important.

How did your background lead you to research and development for energy-based treatment of genitourinary syndrome of menopause?

My research spans many decades. I started out in entomology, which is the study of insect development, both at a university in New York as well as at Harvard. Subsequently, I worked in plant molecular biology for several years at Harvard. This was followed by a Fulbright scholarship in bioengineering. I then did an MD-PhD program at Harvard including molecular genetics in brain development. When I entered dermatology, I started working in autoimmune diseases. My research entered the laser arena around the year 2000. I have remained working on lasers and devices since that time. In the mid-2000s, I conducted the FDA trial that led to the approval of the DEKA SmartXide Dot system. The approval that I worked on was for rhytids. However, around the same time, that company approached me for help with placement of these technologies into urologist and gynecologist offices for the potential treatment of genitourinary conditions. I assisted in that effort at that time.  Several years later, I was approached once again to help bridge the gap between the laser science and applications and the hands-on treatment of the genitourinary and atomic area of women. This required me to provide the urologists and gynecologists with the basic science and the technological know-how as well as the practical hands-on use of lasers - to a field of physicians who have little to no experience with such technology. Therefore, the treatment of women’s genitourinary syndrome of menopause with lasers and technologies requires the input of a laser specialist. It represents an inter-disciplinary area of medicine.

Why is this research important to the field?

Treatment of women’s health with devices is a critically important area of medical research. To date, the treatments for these very common conditions have been disappointing. The majority of women in or after menopause suffer from the genitourinary syndrome of menopause. This includes atrophic vaginitis, urinary incontinence, and pelvic prolapse. Women have been suffering in silence from time immemorial. This condition interferes with sexual intercourse, causing pain, tears in the vagina, and bleeding. It often results in the need to wear diapers because of urinary incontinence under various conditions. And it causes other difficult sequelae especially in cases of severe prolapse where the bladder and rectum can literally herniate into the vagina. Prior treatments including localized estrogens have been disappointing. Mesh and slings have resulted in class action lawsuits due to erosion. We are in dire need of reasonable practical treatment solutions to restore form and function to women.

What are some key developments in this field?

The two key developments in this field are the application of fractional laser technologies and radiofrequency for the treatment of women’s genitourinary conditions. Fractional lasers provide a resurfacing effect that restores a youthful vaginal lining and normal or near-normal vaginal function. Radiofrequency increases collagen and elastin in the vaginal wall reducing vaginal laxity and potentially helping to improve issues of prolapse.

How has your involvement in ASLMS contributed to your career? 

The ASLMS is the most important organization worldwide for helping support and promote the development of lasers and energy-based technologies for medical applications. It has provided a community of peers to support and advance my research work and to give me the feedback and positive reinforcement I need to keep going in my own work. It also provides an environment where your work can be presented in abstract form and you can receive important feedback regarding additional testing that can be done. This will often result in a change in whether you pursue a particular course of treatment or a validation or invalidation of a particular protocol. The ASLMS therefore provides an important prelude to published peer-reviewed processes.

Why should those early in their careers use resources such as the ASLMS? 

The ASLMS provides the education and knowledge in lasers and devices that are often missing from residency programs. I highly urge all residents to get involved in the Society early on. I am currently finishing up my textbook, “Alexiades’s Cosmetic Dermatologic Surgery.” It is a disorder-based reference text that incorporates the vast majority of laser and light-based, as well as injectable and other cosmetic, procedures that have been developed over the last two decades while I have been coming through my career. When I was a resident, programs were very resistant to incorporating any cosmetic treatments in the education plan. This textbook emphasizes how cosmetic treatments are in fact appropriate treatments for conditions and disorders that are perceived as either medical or cosmetic. Therefore, the best laser light technologies are an important component of the treatment options that all dermatologists, plastic surgeons and other physicians must have in order to provide full care to the patient.

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The American Society for Laser Medicine and Surgery is the world’s largest scientific organization dedicated to promoting research, education and high standards of clinical care in the field of medical laser applications. It provides a forum for the exchange of scientific information and participation in communicating the latest developments in laser medicine and surgery to clinicians, research investigators, government and regulatory agencies, and the public.

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