For more information, contact:

Cynthia Gregg, MD, FACS
Cindy Wu, MD

3550 NW Cary Parkway, #100
Cary, NC 27513
Telephone: (919) 297-0097

Changing How People Feel
About How They Look

People seek out Dr. Cynthia Gregg, one of the Triangle’s premier facial plastic surgeons, for a variety of reasons. “But whether they are considering a face lift, a brow lift, rhinoplasty, or some other procedure,” observes Dr. Gregg, “basically they want to alter and improve how they present themselves to the world.”

And, adds her colleague, Dr Cindy Wu, a plastic surgeon specializing in breast and body surgery, “for so many of my patients, surgery is an investment in self-care—a desire to restore normalcy in their lives.”

For a child, protruding ears
can be an unbearable burden. This young man rejoices
in his new look with ears
tucked neatly into place.

For both doctors, this translates into a special concern: how people feel about how they look. And most often, notes Dr. Gregg, “they are looking for a change because there is a significant disconnect between how they feel on the inside and how they look. In short, they want to look as good as they feel.”

Emotionally Charged Work

“There’s a huge emotional component in all the work we do,” observes Dr. Gregg. “In some cases, it is very obvious, such as when we remove or change a physical attribute that makes them self-conscious. That could be reconstructive work removing scars from the face of a domestic violence victim or cancer survivor; improving the protruding ears of a child; or altering a large nose. All these adjustments can have a profound and positive impact on a person’s emotional health.”

However, Dr. Gregg notes that many, if not most, of her patients come to hers for subtler changes. They want to repair the effects of aging or sun damage, and their basic message is: “I don’t look as good as I feel.”

But, she emphasizes: “These changes are no less important—and no less emotionally charged—than removing a scar or changing a nose. Simply put, they want to feel that they are reflecting to the world who they are on the inside.”

That desire, agrees Dr. Wu, is expressed by many of her patients as a desire for “normalcy.” “People may be uncomfortable in their own skin for a variety of reasons,” she observes. “For example, I commonly treat women post-pregnancy who tell me: ‘I want to have my body and my breasts back.’

Repairing acne scarring can have a tremendous emotional impact.

“They have extra skin on their abdomen from pregnancy, they might have a gap or separation in their muscles called a diastasis, and that contributes to the rounder appearance of their abdomen,” she explains. “And despite intensive efforts with diet and exercise, sometimes the body just doesn’t bounce back.

“That transformation back to their pre-baby body is really very significant,” says Dr. Wu. “They are now more comfortable in their skin—since there is no longer a disconnect between how they look and how they feel. And it is also a tremendous boost to their self-confidence.”

Small Changes, Outsized Impact

Sometimes, observes Dr. Gregg, “I’m taken by surprise by the changes that have the largest impact on my patients—which underscores the very personal emotional nature of these procedures. Even a small scar for a domestic violence survivor can be enormously important. And, just recently, for example, after a simple upper eyelid lift, the patient said to me: ‘Thank you for changing my life.’ It was that important to him.”

That observation was echoed by Dr. Wu, who frequently sees major emotional changes in her patients as the result of breast reduction surgeries. “After breast reduction, weight is literally lifted off their shoulders,” she notes. “And there is a lifting of an emotional weight as well. The surgical change allows them to move more easily and make other life changes, such as losing weight. And, again, being more comfortable in their own skin increases their self-confidence.

“There’s a similar impact on my patients who have surgery to correct the problem of excess skin after they have lost a significant amount of weight,” adds Dr. Wu. “They see the results and tell me that they finally feel like the newer, thinner person they are. There’s a lot of emotion tied to the extra skin.”

Different Points of View

The personal, emotional nature of altering one’s appearance can present significant challenges. “The time I spend with each patient—understanding their needs and wishes, and helping them to understand their options—is every bit as important as the time I spend in the operating room,” notes Dr. Gregg.

The physical scars left by domestic violence are
constant reminders of the emotional scars below the surface; removing them
can be profoundly healing. When Janie Burkett came to
Dr. Gregg, her request was to “take his hands off my face.”

“One of my responsibilities, for example, is to offer an alternative perspective. A recent example illustrating this is a patient who was fixated on her neck. My own assessment was that it was not an area for major improvement, and I explained to her that research has shown that—in seven seconds—you make a first impression that starts with your eyes and then with your mouth. And now with masks, they can’t even see your mouth. Her response was that the first thing she saw in a mirror was not her eyes, but her neck. I was able to reassure her that no one else was doing that.

“All of us in this field,” says Dr. Gregg, “have to be able to pick out the emotional/mental issues we cannot fix by changing a physical attribute. And that becomes a really big part of when we say no to somebody. If we don’t understand their perspective, we could do the best surgery or filler or skin care in the world and it will never change what bothers them, because it is not attached to a true physical attribute.”

Both doctors stress the importance of knowing when to say no to a prospective client. “The biggest concern, of course,” says Dr. Gregg, “is when the patient has completely unrealistic expectations, such as someone with body dysmorphic syndrome. It’s also a problem when depression or anxiety is underlying their motivation for change.

“But, although we know when it’s appropriate to say no,” says Dr. Gregg, “our job is really to find the right path forward to help people feel better about how they look.”

Beyond Surgery: A Buffet of Options

“Dr. Wu and I focus on surgical solutions for our patients’ aesthetic and reconstructive needs,” says Dr. Gregg. “And, in years past, surgery was almost the only way to address the issues of aging. But today—thanks to so many remarkable technological advances—there are an amazing number of non-surgical treatments available to lift tissue, erase wrinkles, and repair damaged skin. It’s what I like to call a ‘buffet’ of options that don’t require surgery. And we have an exceptional team of nurse injectors and aestheticians who work with our patients to find the optimal way to reach each patient’s goals.”

In a conversation with Health&Healing, two members of that team—Nena Clark-Christoff, RN, and Jennifer Quigley—shared their unique perspectives on the shared goal of helping people to look and feel their best. They have different focus areas—Ms. Clark-Christoff is a nurse injector who works with fillers, Botox, and other treatments; Ms. Quigley is a medical aesthetician specializing in custom skin treatments. Both appreciate fully how making people feel better about themselves can affect both physical and emotional health. And over the past eighteen months, they’ve seen the ravages of pandemic stress not just on the psyche, but reflected on the skin.

As we age, we experience drooping skin in the cheek area, flattened cheeks, sagging jawline and a double chin.

Health&Healing: What can you offer to help with the effects of natural aging, compounded now by extreme stress?

MS. CLARK-CHRISTOFF: I always start with explaining how aging happens. I have a little flip chart that show the process of aging. People think, “only I get jowls.” No, it’s just normal. As we age, the very shape of our face changes, moving downward and inward. (see photo, right)

The fillers we inject can help all these natural shifts in facial structure. I can start giving back volume where you lose it, or where gravity pulls you down. Then I can add volume to the lips. Chins are newly FDA-approved for filler, too.

Stress, sun exposure, smoking, diet—all those variables further affect your skin quality, and the way your face ages. But it may be that stress plays the biggest role. We have certainly seen the impact of this pandemic on our clients faces, and have felt it ourselves.

I’ve been a nurse for over 30 years and when COVID came, my first reaction was that I wasn’t doing my part—other nurses were dealing with life and death struggles, I was doing Botox and fillers. But then I learned something important—and this gets us back to the connection between emotional and physical health. Many of our patients in the last year and a half have been doctors and nurses, often dealing more directly with the pandemic. And, again and again, they said to me: “Nena, you are my one piece of normalcy. Coming here has been the one thing that has helped me to cope and feel better.” So, I feel good about my work—I’m doing something to help people get through this awfulness.

MS. QUIGLEY: I have seen an influx of odd, unexplainable things happening on faces throughout the pandemic. Whatever we’re carrying inside, it’s going to come out on the outside—whether it is something like stress or even a disease.

And I’ve heard, so many times: “Jen, this pandemic has aged me.” Maybe they’re not having breakouts, but they’re still feeling the stress. And, as Nena has said, by nurturing themselves, they are able to deal with that stress. It’s healing. So, for that patient, I’m going to construct a good at-home routine where she can take care of herself.

MS. CLARK-CHRISTOFF: We have so many options to offer our clients, and one of our most important jobs is to help develop a plan that accurately addresses their needs.

Some people just want to dip their toe in the water and go slow. Other people are more like: “fix my face!” But if someone has been under tremendous stress, I might encourage them to go a little slower. We don’t want this to feel physically or emotionally traumatic.

The important thing is to just listen to our patients. They usually give you cues about what they’re looking for and what their pace is.

H&H: How do you determine what the patient wants—and how to meet their goals?

This patient received a series of three full-face IPL (Intense Pulsed Light) photofacial treatments, aligned with a medical grade skin care routine at home. Her concerns were overall skin tone (uneven coloring from sun damage) and texture (fine lines and wrinkles). The results shown were over the course of four months. She will maintain professional exfoliation in office and skin care at home.

MS. CLARK-CHRISTOFF: I usually give the client a mirror and say, “Show me what brought you in today.” Understanding what bothers them is crucial. Over the years, I’ve learned that what I see may not be what they see. So, my first step is to understand what they’re concerned about.

MS. QUIGLEY: Three things I look at are: concerns, conditions, the season. I start with: “what are your concerns?” That’s what Nena just described—the things that bother them.

Next, I need to know what type of skin conditions they have. “Conditions” might include something like you’re breaking out for the first time in 10 years, or you have rosacea, or you’re under tremendous stress and you have a red patch on our face.

And then I look at the season, because that can make a dramatic difference. Skin care needs in the summer are significantly different from those in the winter.

But mostly, I’m going to calm them down. It’s calming them down emotionally—through education and information. And it’s literally calming the skin. I put them on pharmaceutical or medical grade products, and I keep it simple.

MS. CLARK-CHRISTOFF: We always have a plan of what their goals are and what our goals are. Besides the services Jennifer offers, two of the products we use are what we call bio-stimulatory. One of them is Sculptra. I inject it and then your body starts to make collagen around it. Radiesse is also bio-stimulatory. We use it to help smooth crepiness in the arms, hands, knees, neck. Other injectables we do are the neuromodulators, such as Botox, Dysport, and Xeomin.

MS. QUIGLEY: During summer time, I do more entry level treatments, such as DiamondGlow, because there’s no down-time. It’s a medical grade, mechanical exfoliation with a diamond chip in the wand. It’s cool, it’s refreshing, it’s invigorating. Patients love that.

I typically start with something entry-level like that. I also have two different lasers. One laser, IPL, is for tone, that primarily is for red and brown color. My other laser is a ResurFx. It’s more for smoother skin. Or I can use microneedling to get at acne or deeper scarring.

H&H: What motivates you to do this work?

MS. CLARK-CHRISTOFF: People come to us because of different stresses in their lives. It could be that they’re just recently widowed, or divorced, or have lost their job. I’ve seen such stories repeated over and over. And we see many women who are mothers—and who are doing everything for everybody else. Often, we’ll see them at those times when they need something for themselves. I can tell by the way they carry themselves when they come back for follow-up that they just feel so much better about themselves!.