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For more information, contact:

Cynthia Gregg, MD, FACS
Cindy Wu, MD

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

Facial Plastic Surgery:
Aesthetic Balance Inside and Out

“The art of facial plastic surgery,” observes Dr. Cynthia Gregg, one of the area’s preeminent plastic surgeons, “could be summed up in the word ‘balance.’ It is certainly about achieving harmony in facial features. But it’s also about balancing what the patient feels internally and how they look externally.”

She notes that different factors motivate patients seeking plastic surgery. “For many patients, there’s a specific problem they want to fix—a visible ‘imbalance’ or asymmetry such as a scar or a protruding nose, or even the ‘scars’ of years of sun damage. But, just as often, my patients come to me seeking to address a different kind of imbalance—a disconnect between how they feel inside and what they see in the mirror. That’s the emotional component—and probably the most important part—of what I do.”

At age 66, a patient we’ll call Melissa
found that the person she saw in her
mirror was at least 10 years older
than the person she felt like inside,
and decided to do something about it.
“Big bags under the eyes and droopy eyelids run in the women in my family;
we all have it,” she explained. “The
result of the surgery was amazing.
I didn’t realize what a significant
difference it would make—and I am
so happy that I had it done.” Dr. Gregg explained that Melissa had upper
and lower lid blepharoplasty—eyelid surgery. The photos show the results,
three months after surgery

A powerful example of this emotional component, says Dr. Gregg, is the case of a domestic abuse survivor, whose beatings had left serious facial scars. “In such cases, you cannot equate the size of the physical scar with the emotional scar. Removing her facial scars was a relatively simple surgical procedure for me, but its impact was a life-changing relief for her.”

Restoring the
Balance of the Face

“The aesthetic goal in my surgery,” says Dr. Gregg, “is about finding or restoring symmetry in facial features. And what’s most often true when one part of the face doesn’t match the other, is that aging is the culprit. In describing the face, I use the analogy of a fully inflated beach ball, with a lot of volume to it. But as we age—starting in our thirties—we lose volume; the ‘beach ball’ starts to deflate. But that doesn’t happen from every part of our face at one time. Actually, we tend to age from the top down—forehead, to mid-face, to lower face.”

She adds that since no one starts out perfectly symmetrical, aging can spotlight not just tissue imbalances but inherent bone asymmetries. “That is why, in any rejuvenation program, it is so important to consider all aspects of the face, including the skin, in achieving a natural-looking, balanced result.”

Breast Reduction: Resolving a Proportional Imbalance

Dr. Cindy Wu, who joined Dr. Gregg’s practice last year, describes breast reduction surgery as a way to repair an off-balance physique. “This is a matter of proportional imbalance,” she says. “And it’s not a minor problem. Often women with large, heavy breasts have difficulty standing up straight. They have difficulty sleeping. They want to exercise, but they can’t because it hurts their back, and neck, and should-ers. It truly affects their quality of life.”

Her focus as a surgeon is two-fold: removing enough tissue to lighten this burden and achieving an aesthetically pleasing result. “My focus is on broader propor-tionality,” she explains, “I’m seeking to balance the breasts in relation to the hips and the shoulders, not merely to reduce their size.” This often means guiding her patients toward a target size that is different from what they anticipated, but which will yield the most proportional result.

After a breast reduction, another aspect of proportion and balance may arise—since the abdomen may now look out-of-balance. Tummy tucks, says Dr. Wu, often follow as a second procedure to address this newly visible imbalance.

Among the many techniques Dr. Gregg uses to address the loss of volume are Botox and filler injections. “These are wonderful, non-surgical additions to our tool kit,” she says. “The majority of fillers today—which are made of hyaluronic acid, a natural product—are extremely effective and produce a lovely, natural look. Botox, which helps to relax wrinkles, has also been a real advancement.

“The beauty of these fillers is that they allow for subtle volume adjustments. For Dr. Wu and me and our three nurse injectors, these adjustments are a real art form. Everybody’s face is unique, so we are always asking ‘how do we put their face back in balance to correct the aging that’s happened?’ It needs to be done well, respecting the harmony and balance of the individual’s face.”

In contrast, Dr. Gregg sometimes sees patients with overfilled lips, or overfilled cheeks that don’t match the rest of their face. Such unnatural looks may result from an over-reliance on fillers in an effort to avoid surgery. The result “is a picture out of balance. When you look at someone’s face and it doesn’t look right, but you’re not sure why,” she explains, “it’s because it’s not balanced.”

Similarly, Dr. Gregg notes that balance has to do with broader proportionality and not just symmetry. “You can’t just look at one part of the face and say it’s too big or too small,” she says. “It’s how all the parts work together. When I think of balance, I’m reminded of how Leonardo da Vinci looked at the face in thirds and profiles—emphasizing the proportional balance of its features.

“I see this issue frequently when a patient comes to me wanting to reduce the size of their nose. But I’ve found that at least 30 percent of the patients who seek a rhinoplasty have a receding chin. Using computer imaging, I can show them how we can restore balance and harmony to their face by reducing the nose slightly and increasing the chin slightly achieving a lovely balance.”

Even minor changes like lifting an eyebrow can yield dramatic improvements in symmetry and appearance. Still, says Dr. Gregg, “the goal in our work is not to achieve perfect symmetry, but to achieve an aesthetic balance—to look natural, whatever your definition of beauty; to look like you. And when you have that balance, the whole face opens up and everybody sees all of you.”

When You Feel Different Than You Look

“The most significant imbalance we encounter,” says Dr. Gregg, “is the emotional one—between what someone feels inside and how they look outside. Picture the woman who—internally—feels 10 or 20 years younger than her chronological age. She may be working out, eating organic food, have lots of energy, and an interesting, happy life. But when she was growing up, she had a lot of sun exposure; maybe she even smoked. So, when she looks in the mirror, she sees sun-damaged aging skin and a woman who doesn’t match the one inside. She’s 29 inside and the world sees 59.

“Your face is such a part of your psyche,” she says, “and people respond to us—whether it’s right or wrong—based on that. So, for each patient we take this emotional component into account, along with all the other axes of balance: asymmetries in different parts of the face; the impact of aging on skin and volume; the balance of facial features. And we consider a wide variety of techniques—surgical and non-surgical—not only to restore balance among facial features, but to make the connection between external and internal mental, spiritual, and emotional health. By restoring aesthetic harmony, we hope to facilitate greater balance in our patients’ lives.”