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Cynthia Gregg, MD, FACS
Cindy Wu, MD

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

Healing and Rejuvenation
in a Year of Stress

For nearly all of us, the year 2020 will rank as a milestone in our lives, as we have faced the challenges of change, uncertainty, upheaval, stress, and even opportunity resulting from COVID-19. Like most physicians, Dr. Cynthia Gregg and her colleague, Dr. Cindy Wu, responding to these challenges has meant an evaluation of their practice and adjustments to ensure that they can continue to offer safe, high-quality care for their patients.

Dr. Gregg, right, and Dr. Wu.

“Despite the challenges,” says Dr. Gregg, “this moment has also had a positive impact on our practice. Many of the adjustments we have made to respond to the pandemic have been beneficial—allowing us to address our patients’ needs more individually and more efficiently.
“But, on reflection, I think one of the most important benefits of dealing with the pandemic has been a renewed appreciation of the value of what we do for our patients’ health and over-all well-being. And that’s important in any conversation about women’s health.

“It’s hard to separate how we feel emotionally and how we feel physically—they’re intertwined—and stress is a critical factor influencing physical, emotional, and mental health,” notes Dr. Gregg. “And one thing you can say about the pandemic is that it has been incredibly stressful. Even though we are not on the front lines in a hospital, we can help make the people who are fighting the battles every day at home or at work feel good about themselves. That’s what our job is.”

The Impact of Stress

Stress, explains Dr. Gregg, is one of the major determinants of how we age. “When I meet with patients for the first time, there are four or five main factors of aging that I review with them—stress being at the top of the list. Understanding the stressors they are dealing with helps me understand how best to meet their needs.

Before and After an AQUAGOLD treatment

“For example, it is not uncommon in my practice to see a patient who has gone through a stressful event—such as a divorce, loss of a family member, or a job change. They get through it; but when they get to the other side of it, they look at themselves and say: ‘What happened to me?!’ That’s what brings them in to see me. And I can relate to this personally. When I lost my dad, I had that same experience. And, at the end of, I thought, ‘Oh my gosh, what happened to the way I look?’

“You do get some of that back as you recover and get past the stress in the event,” she says, “but the experience still accelerates the aging process. And in this year of COVID-19, we are all experiencing extraordinary levels of stress. It might not be the loss of a family member. But economic uncertainties, the challenge of teaching your children on-line, or the worries of caring for a frail parent—these are all huge stressors; and they all accelerate the aging process. Our goal is to help reverse that process.”

In addition to the impact of stress, Dr. Gregg notes other issues directly related to the pandemic. “Now that more people are wearing masks,” she says, “we’ve had more requests than usual for brow lifts and upper and lower eyelid surgery. That’s where we make eye contact right now,” she notes, “and my patients find that after those surgeries they look less tired, or angry, or sad.”

Those same masks can be the cause of a new condition that’s been dubbed “maskne”—or acne and rosacea flare-ups under the mask, Dr. Gregg adds. “Our nurses have been developing custom treatments to address these types of skin issues.

Support Across Life’s Stages

While the unusually high stresses of the moment are certainly a focus of Dr. Gregg’s, she sees her practice as providing broad support for women throughout the stages of their lives.

“You start aging at around the age of 30,” she explains. “That’s when we start seeing changes in our skin—pigmentation issues from the sun damage that we’ve accumulated up to age 30. In our thirties, we also begin losing collagen—about 1 percent a year—as well as losing elastin and hyaluronic acid. These all have an impact on our skin health and youthfulness.

“In our forties, we start losing muscle mass and volume, as well as the soft tissue underneath the skin. Then, in our fifties and sixties we actually begin losing volume of the bony structure support of the face—all of these changes show up in our faces. Menopause can particularly affect the skin,” she notes, “because that’s when women lose much protective estrogen and progesterone; thyroid hormone imbalances can also play a role.

“So, aging is really is multi-layered process,” she observes. “You have your skin changes, your muscle, soft tissue, and bone loss, as well as the effects of gravity—pulling everything down. And, importantly, these changes can be accelerated by other factors, such as hormonal changes—particularly during menopause—excessive sun exposure, smoking, and, of course, stress.”

Dr. Gregg notes that stress—always an issue—becomes even more of a factor as we age. “I think the eyes show a lot of our stress, especially starting in our 30s and 40s,” notes Dr. Gregg. “It’s the first place we age.”
Dr. Gregg offers a full toolbox of both surgical and nonsurgical options, to addressing these signs of aging. “Often, Botox can be a helpful first step in addressing aging eyes,” she says, “or Dysport around the brow can help lift and ease furrows and crows’ feet.”

Ultherapy and hyaluronic acid fillers are other non-surgical options to address signs of aging, she says. “And when those options no longer work well, we can offer a brow lift or upper-lower eyelid surgery to really rejuvenate the face. People love this surgery because then they look out the outside the way they feel on the inside.

“In every decade there’s something we can do to fight the aging process as it’s occurring naturally,” notes Dr. Gregg, “so our patients always look natural as they age.”

“Prejuvenation”: Staving Off the Aging Process

“In our field,” says Dr. Gregg, “we’ve always talked about facial rejuvenation—or ‘facial regeneration.’ And what’s interesting now is that we’re now focusing a lot on prevention—what’s called ‘pre-juvenation.’
“Previously, ‘prevention’ mostly referred to sun protection,” notes Dr. Gregg. “But now there have been many wonderful advances in ways to address the natural aging process—making it possible to prevent aging signs rather than just dealing with them as they show up.

“And we’re seeing women at much younger ages—even teenagers and those in their 20s—who want to know what they can do now to prevent the aging process, or at least slow it down, and how to keep their skin younger and healthier longer.”

The skin care lines Dr. Gregg offers her patients—such as Obagi or SkinCeuticals and Alastin—now include such “prejuvenation” products, specifically designed for preventive care.

“We can now offer treatments that are actually bio-stimulating,” she says, “stimulating your skin to make more collagen. Other treatments can add back into your ‘bank account’ of collagen or elastin or hyaluronic acid. It just gives you more reserves so that when you do go through a stressful event, you’re better prepared and it won’t show up as much.”

One new versatile option she and her team use, AQUAGOLD, is a micro-needling device with 24 carat gold plated needles that deliver different products to the skin depending on individual needs. (see photo, above) “We’re excited about this,” says Dr. Gregg, “because it’s a unique system that allows us deliver all types of different serums to the skin. We use it to deliver Botox, or hyaluronic acid, which is a filler.

“So if someone in their twenties or thirties is looking for a prejuvenating treatment, we can offer one approach. The woman in her forties or fifties might want to address a specific issue, such as the darkening of the skin or the size of their pores. Using AQUAGOLD, we can change the serum ‘cocktail’ and provide a completely different treatment.”

Special Care, Changed Practices in a Pandemic

Dr. Gregg notes that, although they have been able to successfully resume most services and medical care safely since the beginning of the pandemic, the menu of options has had to be limited. “We have, of course, implemented extensive screening, cleaning, and other safety requirements to keep staff and patients safe. But, because of the way COVID-19 is transmitted,” she explains, “we have had to adjust some of the facial procedures and treatments.

“For example, any aerosol generating procedures are currently off the menu. That includes CO2 laser resurfacing, and a few skin care treatments. I’m also not yet performing rhinoplasty surgery, because—since it is surgery in the nose and nasal cavity—it is one of the most aerosol generating procedures. We are still being very safe, following the science as we make choices about the services we offer.”