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Cynthia Gregg, MD, FACS
Cindy Wu, MD

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

Facial Rejuvenation Doesn’t
Necessarily Mean Surgery

“One of the most exciting aspects of my work,” observes Dr. Cynthia Gregg, a preeminent facial plastic surgeon in Cary, “has been the extraordinary expansion of new products and techniques for facial rejuvenation. In the early years of my career, options were much more limited, and typically restricted to surgical procedures. Today, we’re able to offer our patients what I like to call a ‘buffet’ of options—many of them non-surgical, and all of them improved methods of providing natural facial rejuvenation.

Before and after Botox treatment

“While surgery was previously the primary method of addressing the facial changes associated with aging,” she notes, “we now have many non-surgical therapies to treat these issues. Using Botox, fillers, and prescription-level skin treatments, we can lift and fill changing faces, erase wrinkles, and rejuvenate skin. And what is especially important, these products and procedures allow rejuvenation in a most natural way.

“Botox and fillers are two of the primary tools in our toolbox,” says Dr. Gregg. “But what I try to explain to people is that there’s a difference between when you use Botox and when you use a filler. Botox is used for dynamic, active wrinkles that you want to get rid of. Fillers are used to treat static wrinkles—the ones you have at rest because of volume loss or skin thinning.”


Botox is the brand name for botulinum toxin type A,” explains Dr. Gregg. “I use the term generically, because although there are several different versions—including Botox, Dysport, and Xeomin—people are most familiar with Botox. However, each brand has slightly different properties, and in our practice, we choose the right one for the individual person or to best address a specific portion of the face.

“This is a medication that needs to be respected and understood,” emphasizes Dr. Gregg. “If it’s used well, you can get wonderful results with it; but, as with any medication, it has side effects and you can have adverse events if it’s not used correctly. To use Botox well, you’ve got to understand the anatomy of the muscles where you want to put it, and you’ve got to understand the dosing.

“Getting the dosing right, for example, is extremely important. Not only does it affect the outcome, but it helps determine the frequency of the procedure. The manufacturers say that a treatment should last three months; we find that our patients can go four, even five months between procedures. That’s because our team is well-trained, board certified, and highly practiced at how to use it correctly to get the desired results.”

Although Botox originally received FDA approval for wrinkles between the brows and has since gotten approval for crow’s feet, Dr. Gregg also uses Botox for many additional purposes. “We use it most for wrinkles and muscle activity above the cheekbones, but we also find it useful to relax wrinkles around the mouth, giving a little bit of what they call the ‘Botox lip lift.’ Sometimes, it can be helpful in relaxing the masseter (jaw) muscle, decreasing the appearance of a square, boxy jaw.”


Fillers, says Dr. Gregg, are among the most significant advancements in facial rejuvenation technologies. “When I began my practice, the first fillers were made of bovine collagen and very limited in use and durability. The breakthrough came in 2005, with the development of fillers using hyaluronic acid, a natural substance found in the body. Hyaluronic acid—a water loving molecule—is the body’s natural plumper and hydrator in the skin, but it diminishes with age. So, fillers based on hyaluronic acid are an ideal and natural way to address the signs of aging in the face.

Advances in Post-Surgery Pain Management

Surgery comes with inherent risks, one of which is post-surgical pain, observes Dr. Cindy Wu, who performs body surgery—including breast reduction and augmentation —at Cynthia Gregg Face & Body Specialists. “In addition to the need to manage pain, there is a concern about responsible prescribing and protecting patients from the risks of addiction.

“My approach to post-operative pain involves an opioid-sparing protocol,” explains Dr. Wu, “in which a combination of non-opioid medications is used in a specific timed sequence to begin managing pain before surgery begins. By using this approach, my patients need fewer opioids post-operatively while still achieving appropriately controlled pain at home.

“During a breast procedure,” she explains, “I do what’s called an intercostal nerve block in addition to traditional anesthesia. With a nerve block, I am putting local medication right at the site where the nerves come out, permitting us to use less systemic medication. And that means less chance of that post-anesthesia ‘hangover’ that leaves you feeling groggy, disoriented, and nauseated.”

This approach, says Dr. Wu, “also provides pain relief for hours after surgery. New local anesthetics can last for up to 72 hours, and for many of my patients, this is long enough to get them through the days that would typically bring the most discomfort, so that by the time the medication is wearing off, the body is already well on the way to recovery.”

“However,” she cautions, “like Botox, hyaluronic acid must be administered properly. It’s frequently listed among ingredients in over-the-counter moisturizers, but because it’s such a large molecule, you can smear it on your face all day in a moisturizer, and you’re never going to get it in your body. The only way to get more of it in the skin, where it needs to go, is to inject it.”

Many Choices, Individualized Treatments

In addition to the older hyaluronic acid fillers, explains Dr. Gregg, newer variations have different technical characteristics and strength and firmness, offering even more options for a natural result. “I know that some practices will work with just one brand. But I find that too limiting, because each of the companies has something in their technology that might work better for certain people.

“For example, we might use a large molecular weight filler such as Juvederm Voluma, Restylane Lift, or RHA4 to put on the cheekbones or other places that need lift, volume, and support underneath the skin. Or we may choose a softer, more mobile option such as Restylane Kysse, Juvederm Volbella, and RHA2 for natural-looking lips.

“Too often, we see new patients who are afraid of fillers because they’ve seen pictures of someone who looks overdone. I understand that and I respect that fear, but our goal—always—is to achieve a natural-looking result. Which is why looking at the face three-dimensionally is so critically important. For example, sometimes the symptom they don’t like is around the mouth, but the cause may be found elsewhere in the face. It’s all about balance and proportions; we’ve got to put the filler in where it’s going to make a difference.

“My nurse injectors,” says Dr. Gregg, “are exceptionally skilled at what they do. We’ve all had excellent training and take every new training course that comes out to stay on top of the newest, most advanced techniques. This level of expertise serves our patients well.”

Prescription-Grade Skin Care Treatments

Non-surgical treatments offered by Dr. Gregg and her colleagues also include a wide range of skin care options. “Skin care products have also improved dramatically in recent years,” notes Dr. Gregg. “These include prescription-level skin care treatments, such as tretinoin (Retin-A) and a newer treatment for lashes, Latisse.”

Retin-A, she explains, can be used for both anti-aging and for acne treatment. For acne patients, it helps to unclog pores, smooth scars, and improve texture. For anti-aging, it helps stimulate collagen production, improve wrinkling and hyperpigmentation, and maintain the youthful appearance of the skin.

A newer product, Latisse, is FDA-approved to help with eyelash growth, lengthening, and darkening, helping to counter aging-related changes to lashes.

“It’s absolutely amazing to me to compare the facial rejuvenation ‘toolbox’ I had in the ’90s,” says Dr. Gregg, “to the one I have today. We have many, many choices for every patient—from surgery to skin care—and are able to select the best approach for each individual.”