“Whether we’re talking about surgery or simply skin care,” observes Cary plastic surgeon Cynthia Gregg, “facial rejuvenation is a very personal, individual experience. We all care deeply about how we look and present ourselves. But when we set out to change our appearance, priorities are often very different—and unique to each.

“That understanding,” she adds, “is at the very heart of my practice. The art—and indeed the joy—of facial plastic surgery, is the process of finding the right path for each patient. So many things come into play—their goals, of course, but also their anatomy, lifestyle, and health issues, as well as the techniques and tools available today. The process is subjective and personal as well as technically precise. And, while each rejuvenation plan is unique, all are based on a very simple truth: people want to look as good as they feel.

Facial Plastic Surgery: Art and Science

Dr. Gregg’s technical expertise is unquestionably of the highest importance in her practice. She 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 Otolaryngology-Head and Neck Surgery, American College of Surgeons, and the North Carolina Medical Society.

She would argue, however, that the “art” of facial plastic surgery is equally important. “Successful surgery,” she explains, “is the result of a collaborative process. Not only do I need to understand the patient’s needs and wishes, but the patient needs to understand what’s possible and the options available to them. The considerable consulting and planning time that precedes any procedure is the key to a successful outcome.”

The Right Plan for Each Patient

Determining the best path for achieving a patient’s aesthetic goals is a critically important process, and a holistic one, explains Dr. Gregg. “It begins with an understanding of what they want to accomplish. The first thing I always do is give them a mirror and ask: ‘Show me what bothers you; what brought you here?’ It could be their skin, or their brows, eyes,  jaw, neck. Probably the most common complaint is that they look ‘tired’ or ‘old.’ And that is very likely a natural effect of the aging process (see box).

“Equally important is their health history. I need to know about their underlying health issues, the medicines they are on, their allergies, their family history, and prior surgeries. These are all pieces of the puzzle—that help in developing a plan to achieve the desired outcome.

“Throughout that process, I’m thinking ‘surgical and nonsurgical—what are their options?’ And I’m also educating them, explaining that aging is multifactorial.

“Then we explore options. My goal always is to guide them to the things that will give them the most natural result, and it’s usually a combination. We’ll then come up with a plan, keeping in mind considerations about their lifestyle, and the best choices medically and financially.”

Surgery Or . . . ?

“One of the critical questions in developing a patient’s plan,” says Dr. Gregg, “is whether surgery is the appropriate choice for meeting their goals. However,” she emphasizes, “the surgery decision is only part of the plan. Many people come in thinking that a single procedure will fix their problems. But aging is multifactorial and so is rejuvenation. If you want to look natural—which is how I want you to look—you’ve got to address all the factors that contribute to aging. And you can’t do that with a single procedure.”

Happily, many of those factors can be addressed without surgery. “One of the most exciting aspects of my work 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 surgery. Today, we offer patients what I like to call a ‘buffet’ of options—many of them non-surgical. Without surgery, 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.” (see photos)

When Surgery Is Required

“There are some effects of aging,” notes Dr. Gregg, “that cannot be addressed with non-surgical options. In fact, one of the most common complaints bringing people to see me is one that is addressed with blepharoplasty—eyelid surgery.

“Often, when I ask prospective patients what they want to change, they complain that they not only look older, they look ‘tired,’ ‘sad,’ even ‘angry.’ That’s because, as we age, our eyelid skin thins and the muscles supporting it weakens, causing drooping upper lids, and heavy bags under the eyes. All this contributes to that overall ‘tired’ look. Blepharoplasty reverses that process, resulting in a natural, soft, refreshed, and youthful look that can really be quite dramatic.” (see photos)