Rejuvenation for the Aging Face: Many Options


For Dr. Cynthia Gregg, one of the area’s leading facial plastic surgeons, Aging is all about movement—the steady, predictable changes in bone, skin, and muscle that alter our appearance and even our functionality.

For this is a 64-year-old female, three syringes of dermal filler were used for the rejuvenation treatment. Restylane Contour restored volume to her cheeks, helping to lift and support the under-eye area. Restylane Refyne was used to restore volume and hydration to her lips. RHA Redensity addressed her smile lines, the lines above the lip, and the lines below the corners of the mouth.

“As we age,” she explains, “the very shape of our face changes, moving downward and inward. It happens in stages, starting at about age 30, with different changes occurring in every decade of our lives. It’s a gradual process of loss—of the skin’s collagen, elastin, and ability to hold hydration. We also lose muscle and fat and, eventually, bone. When you add gravity, the result is drooping skin, flattened cheeks, sagging jawlines, and double chins.

“The rate at which this happens and what goes first is individualized and largely genetic,” she adds, “but eventually it happens to us all and is, at least in part, responsible for the look of aging.”

Beyond Surgery:
A Buffet of Options

Aesthetic Nurse Injector, Nena Clark-Christoff, RN, CANS, is one of the team of nurse injectors and aestheticians at Cynthia Gregg Face & Body Specialists who provide an extensive range of non-surgical treatments for facial repair and rejuvenation. “It’s a long list,” she acknowledges, “and the terms—such as microneedling, injectables, ultrasound, or lasers—can be bewildering. But each technique and tool has a specific purpose, whether to stimulate collagen, increase volume, or repair skin damage. Our goal is to find the best therapy to meet the specific, individual needs of each patient.”

“Importantly,” says Ms. Clark-Christoff, “anti-aging needs to be understood as a life-long process—of both prevention and rejuvenation. And the various tools and products that we offer are used at different stages of the aging process.”


“We’re seeing many younger patients—in their 20s, well before facial aging starts,” says Ms. Clark-Christoff. “They’re not coming in for rejuvenation, but for what we call prejuvenation—preventive care. It starts with counseling on developing healthy habits for skin care, sun protection, and diet.”

She notes that prejuvenation can also include treatments that help prevent—or at least postpone—the need to have something corrected later. For example, neuromodulators (such as Botox and Dysport) relax the muscles so that the wrinkles don’t happen. Other treatments help prevent age-related collagen decline.

Ages 30 to 50: Fillers

“As we get into our 30s and 40s, that’s when we see the beginning signs of aging,” says Ms. Clark-Christoff. “And now we’re starting to do some correction—typically with fillers. The good news is, the earlier you start, the less you are likely to need to do later.

“A good place to start is in the cheeks. Because one of the first signs of aging is that we lose some of that mid-face volume, and there’s downward movement of facial tissue, and you start to get jowl formation.

“And it can be a subtle change in the 30s and 40s,” she adds. “People often tell me ‘I don’t know what it is; I’m just starting to look old.’ What they’re seeing is the effect of the loss of volume in the mid-face. Fillers can restore the mid-face volume and a more youthful appearance.”

The 40s and 50s:
Restoration and Repair

“In addition to fillers, there are a number of restorative therapies—such as microneedling and ultrasound—that benefit patients in their 40s and 50s, by helping to stimulate collagen production,” says Ms. Clark-Christoff.

“The ultrasound therapies we offer are especially powerful tools—for a variety of restorative purposes,” she says. “Ultherapy uses ultrasound energy to lift and tighten skin naturally, without surgery or downtime. And one of the newest technologies—Sofwave—provides a non-invasive method for building collagen, treating facial fine lines and wrinkles, and lifting brow, jaw, and neck.

The 40s and 50s tend to be the ages when people seek to repair skin damage, notes Ms. Clark-Christoff. “And we offer a number of techniques, depending on the nature of the problem, including microneedling, chemical peels and lasers. These are great options for people who want to address facial texture, tone, and wrinkles, to eliminate brown spots, and to correct sun damage and broken blood vessels.

“People in this age group typically need volume replacement,” she says. “We lose fat in our face and are starting to have some bone resorption. This is also an age when the cumulative effects of sun damage appear, so we’re losing collagen as well. And, by then—from frowning and squinting in the sun—we’ve often developed creases that don’t go away. So, what’s needed are fillers and neuromodulators—to restore the lost volume and relax the wrinkles.

The 60s+: Maintenance and Repair

“The emphasis in older patients is on repair and maintaining restorative treatments,” says Ms. Clark-Christoff. “This may also be the time when surgery is a better option. At this age, people are beginning to lose bone and fat, and they’re getting thin—not just up in the cheekbone, but throughout their facial structure. For many of these patients, Sculptra—which is a biostimulatory filler that makes your body produce collagen—has proven extremely beneficial.”

Understanding that process, explains Dr. Gregg, “allows us to reverse it—to turn back the clock in many ways. We can replace lost collagen and hydrate and tighten drooping skin, repair sun damage, and fill and lift to replace lost tissue. But, like aging itself, rejuvenation is not a single event, but a process—a response at different times to the changes experienced by each individual patient.”

Stages of Aging—and Rejuvenation

“Finding the right response—at the right stage—is part of the art of rejuvenation,” says Dr. Gregg. “And it starts before the aging process begins, with something we call ‘prejuvenation’—a newly coined term for the preventive care that minimizes problems of aging skin.”

One of the critical questions to be addressed is whether surgery is the appropriate choice for a patient, she says. “With younger patients—even those in their forties—it’s not likely that there will be something that I can change anatomically with surgery that will make a difference. That’s because it’s early in the aging process and facial changes are evolving.

“I’ve found it useful to use a sewing analogy when explaining this to my patients,” says Dr. Gregg. “It’s like a question of ‘hemming’ versus ‘ironing.’ If you bring me a pair of pants that are too long and wrinkled, do I hem them or do I iron them? If there’s nothing for me to hem—in other words, there’s no laxity that I need to lift—nothing I can do surgically will fix the problem. We then turn to non-surgical options to ‘iron’ the wrinkles.

“However, I’ll also explain to them that, in five or ten years, there may be a lot of skin or muscle laxity, and I can go in and surgically lift or remove it to achieve the desired result. Surgery would then be an appropriate choice.”

Many, Many Options

“One of the most exciting aspects of my work,” observes Dr. Gregg, “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 facial rejuvenation. 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.”