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3550 NW Cary Parkway, #100
Cary, NC 27513
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Managing Moving Tissue

Tired, sad, and angry. Those are the adjectives Dr. Cynthia Gregg’s patients often use to describe their own eyes. “As many of us age,” Dr. Gregg explains, “the fatty deposits under our eyes bulge forward and often fat can migrate downward, resulting in the look of heavy bags under the eye. It’s a look that causes the whole face to appear tired and droopy.”

Dr. Gregg and her patient appreciate the outcome of upper and lower blepharoplasty.

And while this is a common problem among aging men and women, starting for some as early as their late twenties, it is one with a relatively simple and straightforward solution. “Blepharoplasty—eyelid surgery—is one of the most popular procedures I do,” says Dr. Gregg, one of the Tri-angle’s premier facial plastic surgeons. “And while it’s fairly uncomplicated, the results are a more refreshed, youthful look that can really be quite dramatic.”

A Good Candidate

Susanne Rallis is a registered nurse who in the past occasionally worked as an operating room assistant to Dr. Gregg. “I watched her do the eyelid surgery procedure, and I was impressed by her skill, her compassion, and above all, by the outcome of this work,” she says.

“I certainly was a good candidate for this. Even in my twenties, I had bags under my eyes—just like my mother and my sister. The more I watched Dr. Gregg do this procedure, the more I wanted it for myself. Finally I told her I was ready. The reason was pretty simple. I looked tired—as if I was aging rapidly.

“So I had this done, and I consider it my ‘weight-loss’ program. I feel like I lost a pound or two of fat under my eyes—and I couldn’t be more pleased with the outcome. I no longer look like a deer in the headlights. It’s a very natural, youthful look.” (see before-and-after photos)

The Procedure

The procedure Dr. Gregg performed on Susanne Rallis to achieve such a dramatic outcome is one that has been evolving over the last few decades, and Dr. Gregg stays current on all the latest researched techniques.

Susanne Rallis, RN, before and after eyelid surgery.

“It used to be,” Dr. Gregg explains, “that we would make an incision underneath the eyelashes of the lower lid—leaving a visible scar—and remove the fatty tissue causing the bag. Then we would also remove some of the skin from under the eye in an attempt to pull it tighter and create a more youthful look. What we realized was happening, however, was not a younger look, but rather a more ‘surgically fixed’ look.”

In contrast to this practice of excision—tissue removal—Dr. Gregg says her approach now is much more about movement—movement of tissue back into its original place.

“The thing is,” she explains, “it isn’t that more fatty tissue has accumulated, it’s that it has moved; moved down and moved more towards the surface just underneath the skin. So now the way I approach the lower eyelids is to first, make the incision behind the eyelid where it leaves no visible scar—this in itself makes a huge difference. Then, instead of removing anything, we are simply shifting the fatty tissue back into place. The tissue that has dropped down, we pull up. The tissue that’s bulging underneath the eye, we reposition.”

In addition to leaving the body’s natural tissues intact—although moved about a bit—this procedure relies on the body’s own natural mechanisms for healing to make these changes permanent. “As the body heals,” Dr. Gregg explains, “small adhesions—scar tissue bonding two planes together—are formed, holding the newly repositioned tissues in place. The research tells us it takes about eight weeks for adequate healing to occur, so we use dissolvable sutures to maintain position. Then, as this natural healing process takes over, the sutures dissolve on their own and disappear.”

The Results

This approach not only leaves less obvious signs of a surgical procedure, it also avoids the hollow, sunken look that’s created when tissue is removed. “Hollow isn’t youthful,” Dr. Gregg says with a smile, “and that’s what used to happen—the eyes, instead of bulging, would look hollow following surgery. Youthful and refreshed is a full, soft look, and that’s what this latest procedure offers.”

And as for Susanne, the nurse, she says even years later, she is still getting compliments on her looks following her work with Dr. Gregg. “People frequently tell me that I look younger than my age—by decades! Is it because of the way I act? Am I perpetually immature?” she asks with a laugh.

“Actually, what I know friends are responding to is Dr. Gregg’s artistic and surgical genius. She is an artist of the highest caliber, and, thankfully, she has the technical surgical skills to fully realize her artistic vision. Like so many of her patients, I am deeply grateful to her for the major contribution she has made to my quality of life.”

Training and Experience

Dr. Gregg is double board-certified by the American Board of Facial Plastic and Reconstructive Surgery and the American Board of Otolaryngology—Head and Neck Surgery, a Fellow of the American Academy of Facial Plastic and Reconstructive Surgery, the American Academy of Otolaryn-gology—Head and Neck Surgery, American College of Surgeons, and the North Carolina Medical Society.

Before opening her private practice in Cary in 1999, she was an Assistant Professor of Facial Plastic and Reconstructive Surgery at Duke University Medical Center.

Dr. Gregg performs the full range of facial plastic surgery procedures, including forehead and brow-lift surgery, facial scar treatment to correct protruding ears (otoplasty), nasal surgery (rhinoplasty), eyelid surgery (blepharoplasty), face-lift surgery (rhytidectomy), and mid-face lift.

Each Patient Unique

Dr. Gregg considers each of her patients a unique case and emphasizes that there is really no one-size-fits-all procedure. “A patient may come in thinking they want to have one particular type of procedure done,” Dr. Gregg says, “but it really isn’t until after an examination and discussion about the results they would like to achieve that we can decide together which path will best meet their cosmetic goals—whether surgical or otherwise.”

Dr. Gregg remembers her journey with Susanne; “When I first met with her, I agreed that she did indeed have a prematurely tired look. As we get older, the eyes age first. Often the first signs of aging show up in our thirties and forties. Our brows may drop, even just a few millimeters. As the brows drop, it adds weight to the upper eyelids. In other instances, the brows may be fine, and the issue is excess skin—soft tissue over the eyelid that adds weight to it—which was the case with Susanne.

“First impressions are powerful. I may look at someone and think, ‘She looks tired,’ when, in fact, she may feel really great. Often there’s a disconnect between what a person is ‘saying’ with their appearance and how they actually feel. And it’s that disconnect that brings them to this practice. They simply want to look as good as they feel.”