Can You Imagine BOTOX Results without the Needles?

Anti-wrinkle procedure, needle injections —these daunting phrases associated with using Botox as a wrinkle reducer may be no more. New preliminary research suggests that a gel based topical Botox called RT001, could help reduce facial wrinkles—without the pain of needles.

A few facts on RT001- Topical Botox:

•  Has been shown to produce significant improvement in the crow’s feet wrinkles in 89% of the 553 patients already treated
•  Similar to the injectiable form, the gel relaxes the muscles responsible for causing skin wrinkles beneath the skin
• Is not yet FDA approved and therefore will not be available until 2013 or 2014
• Preliminary results are significant and exciting, but not quite as successful as traditional injectable Botox
• Results of topical Botox have proved to last up to three months 

After reviewing the results of the studies on RT001, Dr. Rucker is hopeful it will deliver as promised. He has many patients that want the results of Botox, but refrain from it due to needle phobia. In the meantime, he strongly recommends Tri-Peptide Cell Activator as an effective alternative. Where Botox relaxes the muscles that cause wrinkles, the Tri-Peptide Cell Activator stimulates collagen production to plump the fine lines and creases. So if you are wary of needles, the Tri-Peptide Cell Activator just might be your new best friend. 

5 Factors That Contribute to A More Natural Appearance and Feel in your Breast Augmentation

1. Scar Around Implant - If a scar develops around the implant, this can result in a firmer feel and a less-than-natural appearance. I routinely use an antibiotic rinse in the implant pocket during the augmentation to combat this problem and have seen the occurrence of this capsular contraction around the implant to be much less frequent.  

2. Over the Muscle vs. Under the Muscle - I have a personal preference to place the implant beneath the chest wall muscle. In the 1,500 breast augmentations I have performed I have placed the implant in the space beneath the muscle in 95% of my patients. My reasons for sub-muscular placement are as follows:

• A more natural appearance
• Easier to detect any breast lumps, which may appear at a later date
• Less concern with breast feeding
• Less of a chance of scarring around the implant
• Less of a chance of seeing rippling on the side of the breast

3. Silicone vs. Saline - 90% of my patients has chosen Silicone over Saline for their implants. A significant number of patients that have chosen Saline over Silicone return in 1 to 3 years and request an exchange to Silicone implants. My rationale for choosing Silicone over Saline is:

• Silicone is much more natural feeling
• In my experience, there is less of a chance of leakage
• There is a smaller chance of detecting rippling on the side of the breast with the use of Silicone.

4. The Size of the Breast Skin Envelope - This is a less-mentioned, but very important factor.  If the breast skin has been stretched during pregnancy, it is more difficult to obtain a natural feel and appearance without doing a breast lift at the same time as the augmentation. The lift coupled with the augmentation produces a much more natural appearance and a more perky appearance of the breast. 

5. Smaller Normal Breast Tissue vs. Larger Normal Breast Tissue - The amount of breast tissue prior to the augmentation contributes significantly to a natural feel after augmentation. The implant is more easily hidden in the larger breast tissue and takes on a more natural feel and appearance.

Botox™ at RUCKER MD's Enza Medispa

Looking for the best deal on Botox™? Look no further than RUCKER MD's Enza Medispa!

Because we believe everyone should be able to feel comfortable in their skin, we would like to share a few tips to note when searching for the best Botox™ deals. One of the most common questions we get is about pricing. When price shopping for Botox™, always ask yourself: does this price seem too good to be true? Here are some clues that it just might be:

•     The place is really using and off-brand, not Botox™. The Enza Medispa uses ONLY Botox™, directly from Allergan.

•     The Botox™ may be diluted. A vial contains 50 mL of Botox™. Some places will water it down in order to make it go further. This results in a Botox™ treatment that doesn’t last long or isn’t as effective

•     The product may be expired. At the Enza Medispa, we always use FRESH Botox™ and never save any left-over Botox™. Each application is from a brand new vial. 

We hope this helps you when deciding where to go for Botox™ and whom you can trust!

Profiles Fall / Winter 2012

The NEW Profiles is here! Click below to see our online edition.

• 1st Annual Pink Ribbon Charity Golf Classic Recap
• Giving Mother Nature a Boost
• Saying Good-Bye to Wrinkles
• Tips for Luscious Lips
• Eating Healthy for the Holidays
• Botox Blunders

Also check out our specials on the back-page for the Enza Medispa.

Watch your mail-box or check out these newspapers for your own copy:
Nov 7th: Pioneer Press, New Richmond News, River Falls Journal, & Hudson Star Observer
Nov 10th: Leader Telegram
Nov 11th: Chippewa Herald

Open publication

Avoiding Botox Blunders

BOTOX® injection is the most commonly performed aesthetic procedure in the United States with over 5 million anatomical sites injected in 2011 alone. It acts by partially and temporarily paralyzing the facial animation muscles beneath the skin, thereby decreasing the skin wrinkles that are formed due to the action of these muscles.

BOTOX® has many cosmetic uses including:

• Treatment of frown lines between the eyebrows.
• Worry lines across the forehead.
• Crow's Feet at the corners of the eyes.
• Fine lines around the mouth.
• Excessively sweaty armpits, palms, and feet.
• Relief from migraine headaches. 

What are the risks?  

• Bruising & swelling. Quick Fix: Ice area after procedure to treat; avoid aspirin prior to treatment.
• A droopy eyelid, which is the result of an improper injection.
• Overall unacceptable results. This can easily be avoided. 

How To Avoid Botox Blunders and Poor Results:  
After treating over 100,000 injection sites, in my opinion, these are the most common causes of a poor result:

• Improper injection technique: An injector not familiar with the muscular anatomy may execute an improper placement, causing unwanted side effects and a less than optimal result. My Opinion: “Seek treatment from an experienced licensed physician.”
• Not enough material used at the injection site: I use 5 units per injection site and I have found most patients require the treatment of 8 to 14 sites to receive an acceptable result. My Opinion: “50 units per treatment for an even face. Always ask how many units will be used. A common statement we hear is: 'I was treated for half the cost but did not receive the results that I desired.’”

• Use of an outdated BOTOX solution: Injecting a less potent Botox solution can cause poor results. The product has a shelf life of only 48 hours and the potency drops off significantly after that time. My Opinion: “Use the product the same day it was prepared.” 
• “I don’t want to look like Nicole Kidman”: Here we have a prime example of overtreatment.  The forehead muscles were over treated, resulting in a done appearance. My Opinion: “Never overuse a good product." 

All inquiries are welcome: Feel free to contact Barb Bridell (our patient coordinator) 1-800-456-8222 or barb@enza.com. 

First Annual Pink Ribbon Golf Classic for the American Cancer Society

Local Plastic Surgeon Dr. Joseph Rucker raises over $20,000 for the cure for Breast Cancer and the American Cancer Society

RUCKER MD Plastic Surgery Clinic hosts Pink Ribbon Charity Golf Classic on Friday, September 14^th, 2012.

Eau Claire, WI – On Friday, September 14^th RUCKER MD hosted the 1^st Annual Pink Ribbon Charity Golf Classic. The event benefited the American Cancer Society to raise funds for breast cancer research. Guests of the Pink Ribbon Charity Golf Classic played 18-holes of championship golf on a perfectly sunny day and participated in an evening reception with dinner and guest speakers Ann Harris and Lois Joseph from the Breast Cancer Awareness Association in Minnesota.

The event raised over $20,000 through generous sponsorships, and excellent raffle, and golfers alike. Among the day’s events were free chair massages courtesy of The Salon Professional Academy and Da Vinci Therapeutic Massage, and chances to win brand new cars, courtesy of Eau Claire Ford and Eau Claire Auto Group. Many other sponsors such as Larson Allen, RBC, and Dental Health Center were present at their sponsored holes to greet golfers with different giveaways.   

More than 100 guests attended the evening reception which was kicked off with cocktail hour and followed by a gourmet dinner and Pink Ribbon cupcakes from Simply Cakes bakery. The raffle was drawn featuring various items such as a Pelleve® package from the Enza Medispa, color Nook from Charter Media, and gift certificates to local businesses such as Charly’s Market and Houligan’s.

Dr. Rucker expressed his sincere appreciation for the generosity from the guests and sponsors as well as his renewed commitment to find the cure for breast cancer. “We are grateful to our sponsors and our donors for their support for the fight against Breast Cancer. Through this event, we have raised over $20,000. In addition, I am making a commitment to personally donate towards the cure for every Breast Reconstruction procedure I perform.”

Dr. Rucker and staff will present the check for$20,000 to the American Cancer Society on Saturday, October 20^th, 2012 at Making Strides Against Breast Cancer in Eau Claire.

Breast cancer is the most commonly diagnosed form of cancer. In 2011, an estimated 230,480 new cases of invasive breast cancer were diagnosed among women.

For more information, please contact Kiana Tom at 715.832.1774 or kiana@enza.com

Is Breast Reduction right for you?

During my 25-year career as a plastic surgeon I have noticed that one of the most misunderstood concepts is the difference between a breast reduction and a breast lift.

The woman who is a candidate for breast reduction will often present with a history of an enlarged breast size since high school. She may have found it difficult to participate in athletic activities, and she will often present with complains of back pain, neck strain, chest wall heaviness, bra-strap grooving and, on occasion, rashes beneath her breasts. She will often have a breast size of D cup or larger. She may have tried conservative methods of easing her symptoms including physical therapy for her back, heat treatments, chiropractic care, muscle relaxers and even pain pills. She may have heard about the breast reduction procedure from a friend or may have been referred to us by her family physician.  

The woman seeking a breast lift presents with essentially no symptoms; her complaints are that her breasts have begun to sag over the years. This sagging may have been accelerated by a large weight loss or following a pregnancy. She often feels that her breasts are now too long, the nipples too low and that she has lost her natural cleavage.

So in essence, we have the breast reduction patient presenting with symptoms because of the sheer weight of her breast, and the breast lift patient because of the shape of her breasts. The breast reduction procedure may well be covered by insurance because it is an attempt to alleviate the potentially harmful symptoms that come with the weight problem. With the breast lift candidate, the aim is to only improve the shape, and it is therefore considered a cosmetic procedure – one not covered by insurance.

It is worth noting that fifty percent of my breast lift patients also opt to undergo a breast augmentation at the same time. They feel that they can better achieve that natural-looking cleavage with breast enlargement.

What to Expect

• The Procedure: The breast reduction and breast lift procedures are very similar. The only major difference is that in a breast reduction, a predetermined portion of both the breast tissue and skin is actually removed. In a breast lift, only a portion of the skin is removed to lift and reshape the breast. Most breast reductions will go from a D cup to a small or medium C cup. Breast lift patients will go from a C cup to a perky C cup. In both procedures the nipple areola complex is left attached so as to preserve sensation and the ability to breast feed. The two-and-one-half-hour breast reduction procedure is done in a hospital setting under a general anesthetic, and there is usually an overnight stay required. The breast lift procedure is done on an outpatient basis and may require a general anesthetic. In some situations it may also be done with a local anesthetic and sedation in our office operative suite.In order to gauge the improvement of symptoms, we conducted a survey. Of approximately 100 breast reduction patients, 95 stated that their symptoms and quality of life had significantly improved following reduction mammoplasty.
• The Risks: There is a potential for complications in any operative procedure. The most common being infection, scarring and sensation changes. During your consultation a detailed discussion of these potential risks will be given to you.
• The Recovery: After performing nearly 1,500 breast reduction procedures and 600 breast lift procedure I have found most patients rate the pain, on a scale from 1 to 10, with ratings between a 2 and 5 for both procedures. The patient may be off work from one week with the breast lift, to two to three weeks with the breast reduction.Light activity is tolerated well in the first week. Most patients are never so incapacitated that they cannot take care of their own basic needs. You will return to see the doctor one week after your procedure. All of your dressings are removed; your postoperative recovery and activity levels are again discussed as well as an anticipated date for your return to work. Light employment is tolerated after two weeks with heavy lifting and regular activity in three to five weeks. You are also given detailed instructions for care of your suture lines so as to help prevent excessive scarring. Your final consultation usually occurs five months after your procedure.
• The Decision: The most common thing that I have heard from my breast reduction patients is, “I should have done this ten years ago!”

My staff at RUCKER MD Plastic Surgery Clinic and I hope that this information will be of help to you if you are considering breast reduction (mammoplasty) surgery. The staff has gained a considerable amount of experience and knowledge in helping nearly 1,500 patients during the preoperative, operative and postoperative periods of reconstructive breast surgeries.

Please feel free to contact Dr. Rucker’s office at 800.456.8222 with any concerns or questions that you might have about undertaking breast reduction surgery. 

New Plastic Surgery Article Finds Most Patients are Pleased with Results of Breast Reduction

A new PRS study finds that women generally rate the appearance of their breasts following breast reduction surgery as "good" to "very good" - but plastic surgeons are more critical of the cosmetic results.
Since starting my practice in 1984, I have performed approximately 2,000 breast reduction cases. This procedure has by far been the most appreciated by my patients. The presenting symptoms I see most commonly are:

• Upper and lower back pain,
• Chest wall heaviness.
• Shoulder grooving.
• Rashes beneath the breast.
• Upper extremity numbness of the hand is the most extreme finding.

Before

After

As far as the cosmetic result, proper  breast mound development to avoid that flat operated on look is imperative. 
Most of my patients have gone from a DD cup to a perky C cup.

• 80% of our patients have recovered full nipple sensation and the ability to breast feed.
• We have found that this procedure has been covered by insurance in over 85% of our patients. 

To view more before/after photos and learn about this procedure, visit ruckermd.com

Q & A: Tummy Tucks and Liposuction

Q: I’m totally confused after two consultations for the Tummy Tuck procedure: one physician suggested liposuction during the procedure and the other said this can cause problems. Also, will I need a vertical scar during the procedure? 

A: Regarding Liposuction with the Tummy Tuck:

• Many feel that liposuction in the upper abdominal area during a tummy tuck can cause poor healing issues above the pubic area.
• Many physicians are willing to do some limited liposuction in the upper abdominal area in a healthy non-smoking patient.
• I prefer limited liposuction above and more aggressive fat removal at the waist with the possibility of a small in office liposuction procedure done down the road if necessary.

Regarding the need of a vertical scar from the umbilicus to the pubic area:

• In the vast majority of patients I feel a vertical scar is not necessary. 
• The patient that may benefit is one that has lost a considerable amount of weight and has skin laxity from top to bottom as well as side to side. 

For more information, please visit my websites: www.ruckermd.com and www.enza.com. Feel free to leave comments and questions below.

What is the Best Way to Permanently Remove Under Eye Wrinkles

Crepey, lower eyelid skin can be improved, but in my opinion it can't be removed permanently. The recommended treatment plan would depend upon the patient's age and the degree of wrinkling in the lower eyelid skin.

1. For the older patient with significant lower eyelid wrinkling, I recommend a more aggressive approach:
1. Laser Resurfacing of the lower lid and an aggressive skin care maintenance program including a Tri-Peptide Wrinkle Reducing Serum. In most cases this approach can improve the wrinkles of the lower lid by 40 to 70%.
2. For the younger patient with less eyelid wrinkling, I would recommend a less aggressive approach. One should expect a 30 to 50% improvement with this approach.
1. Profractional Laser or Pellevé three times per year
2. Microlaser Peel once per year
3. Enza Essentials™ Tri-Peptide Cell Activator/wrinkle-reducing serum twice daily

Since aging and permanent wrinkle-removal is non-avoidable, maintenance is the key to avoiding and reducing unwanted wrinkles.
For more information, please visit my websites www.ruckermd.com and www.enza.com. Feel free to leave any comments and questions below.

Sensitive Asian Skin: How to Treat for Sun Spots, Lines, and Redness

42 Yr Old Asian with Sensitive Skin: Chemical or Laser for Sun Spots, Lines and Discoloration?

I have a question regarding the pros and cons of chemical vs. laser for my skin type – fair, Asian skin that SCARS easily, capillaries, sun spots, fine wrinkles, burns minimal, uneven red pigment tone on the cheeks and chin. I would like to get rid of the sun spots, lines, discoloration, and capillaries, but fear either treatment will leave my skin more discolored and scarred. Any suggestions? - 42 year old Asian with sensitive skin.

Sensitive Asian Skin: What we recommend for Sun Spots, Lines and Redness

1. A skin care regimen that avoids excessive abrasion and exfoliation, but that contains a light moisturizer and a natural anti-inflammatory component. We recommend this personalized system from Enza Essentials. Click here for more information. 

2. A non-invasive anti-wrinkle treatment, such as Pellevé. Avoid chemical peels and aggressive lasers because of the sensitivity of your skin.

3. For sun spots start with 8% Hydroquinone with sunscreen; when hyper pigmentation starts to resolve - reduce concentration to 4% for maintenance.  

4. For the redness I would recommend a non-invasive vascular laser treatment.

In closing, I strongly recommend to avoid any treatments that are going to irritate your sensitive skin.

For more information, please check out my websites, www.ruckermd.com and www.enza.com. Feel free to leave your comments or questions below. 

Facial Wrinkle Reduction

New Anti-Aging Skin Serum Reduces the Effects of Father Time: A Dermatologic Plastic Surgeon, Dermatologic Pharmacologist and their Aesthetic Team have spent the last 20 years in the extensive study of anti-aging and anti-wrinkle research and treatments.This research has resulted in the development of a clinically-tested product to drastically reduce skin wrinkles by tricking aged human skin cells into regenerating themselves by replacing old damaged skin collagen with newly reformed collagen. Dr. Joseph Rucker, a board-certified plastic surgeon has developed the Tri-peptide Cell Activator, which also embraces stem-cell technology. This serum has been tested in clinical trials and has demonstrated an ability to:

• Significantly reduce skin wrinkles                            
• Improve skin texture
• Reduce pore size
• Produce a healthy, youthful glow

before                                         after

This exclusive formula developed by Joseph W. Rucker M.D. F.A.C.S contains:

• Palmitoyl Tripeptide-3 (a powerful collagen cell activator)
• Stem Cell: rare swiss Apple extract
• Resveratol: One of the most powerful anti-oxidants available
• A pH balanced formulation to improve penetration and performance

“After utilizing, testing and formulating multiple wrinkle-reducing formulas, this product has significantly surpassed my patient’s and my own expectations.”  Joseph Rucker M.D. F.A.C.S

Testing of the Tri-Peptide Cell Activator was done with the assistance of a carefully chosen patient group under the strict guidelines of usage and follow-up evaluation. All patients tested noticed a significant improvement in skin texture and wrinkle reduction. Below is the experience of one of Dr. Rucker’s patients.

“I was a trial patient for the wrinkle-reducing serum. I used the serum for four months and came in every three weeks to have pictures taken to document the results. I was very happy with the results, especially after seeing the “before and after” pictures! I received many compliments - even questions about “going under the knife”! However, the trial ended and Dr. Rucker indicated the product would not be available for four months. After I stopped using the product, I began noticing quite a dramatic increase in wrinkles on my face (especially around my eyes)!  I went into Dr. Rucker’s office to see if the cream was available. The staff looked at me and almost gasped at the increase in wrinkles and general haggard look around my eyes.  I am using another product from Dr. Rucker and am hoping to be the first one to purchase the incredibly effective wrinkle-reducing serum when it becomes available.”

Sandy Hume

January, 2012

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For more information and to purchase the Tri-Peptide Cell Activator visit enza.com

Profiles Summer 2012 is here!

Profiles Summer 2012 is here! 

Click here to read on: 

• Spot-free skin
• What's really to blame for aging skin?
• Pelleve wrinkle reduction system
• Mommy makeover
• Can you get a tighter tummy?
• Top running foot injuries in women
• Creating the perfect smile
• Raising the bar with Crossfit

The 7 Reasons Your Skin Care Line Doesn't Perform

Having Skin in the Game--

Why are we all so disappointed?

The skin care industry is a multi-billion dollar business estimated to be worth $43 billion per year in the United States alone. Whether you get your products at the drugstore, department store, online or at your physician’s office you can be sure that every potion and lotion is promising youth in a bottle. Most don’t make good on that promise. If your trusted skin care line is no longer effective, it’s not your imagination. Here are the 7 good reasons why it might not live up to the hype. 

What’s in the pretty bottle?                                                                                                             

Keep in mind that the amount of money spent on marketing a product often eclipses the cost of the ingredients. There is a distinct difference between highly promoted products that rely upon packaging and national campaigns vs. those born of clinical testing and analysis of proven results. All products should be tested to the highest standards to ensure their effectiveness and safety prior to release to the public. Ingredients are not all created equal. Pharmaceutical grade skin care offers ingredients in strengths not available on the mass market.   

Type casting: Poor product to skin match is more than skin type

Do you have dry, oily or combination skin? The answer might not get you to the best product. It makes sense that matching the correct product with the patient is the key to good results. Skin type certainly plays a role in product choice but it is not the primary determinant we’ve all been led to believe. Over the course of my career, I have found that lifestyle, age, priorities, nutrition, genetics, environment all trump skin type. Your specific “profile” will play the starring role in developing a skin care regimen that really works.  Do you see yourself in any of these profiles?

• Athletic Teen with Acne
• Outdoor Active Teen on Acne Medication
• Active Senior Receiving Medispa Treatments
• Stressed Young Mother
• Middle-Aged Athlete Experiencing Early Signs of Aging
• Sun-Worshipping Senior with Dry Complexion
• Middle-Aged Rosacea Sufferer
• Expectant Mother with Hormonal Acne
• Menopausal Woman with Occasional Breakouts
• Early 30s Woman Developing Fine Lines

Detailed information on the various profiles and their recommended treatment plan,  can be found on enza.com 

Riding the hormonal wave? 

It doesn’t seem fair but hormones through life significantly affect the quality and elasticity of skin. Your skin may be oilier due to an increase or instability in hormones during puberty, pregnancy, or menopause. As skin ages, it produces fewer natural moisturizing oils in part due to a decrease in hormone production. Think about three women, all 30 years old. One is discovering fine lines and taking birth control pills, another is pregnant and the third is a stressed young mother. Each woman will need different skincare despite their ages being the same. All have a hormonal component that must be considered when prescribing products.     

Environmental warning—

The environment in which you live, work and play can influence your skin. Where you live, where you vacation and seasonal changes each have their impact. Your current routine may work perfectly in the summer but turn ineffective or even harsh in the winter. Cold weather brings lower levels of air moisture, which can produce drier skin. A change in climate may affect the dryness of your skin.  Dry Southwestern climates are obvious causes of dryer skin changes because the heat can actually bake moisture out of your skin.  During hot summer months, in more humid climates your skin may be more prone to retain excess oils, especially if your skin is naturally oilier. When skin doesn’t retain moisture, you need a heavier moisturizer and a creamier cleanser. Conversely, in humidity choose lighter products — like a gel or foam cleanser and a lotion instead of a cream.

Letting it all sink in…

Regardless of the effectiveness of a product, it will be of little help if the ingredients are unable to penetrate into the skin. Absorption problems can block even the best skincare lines. The pH balance of the product is one of the most important factors—it must be in a specific range to not only allow, but promote absorption. When an invisible, unintended barrier is challenging the product, you’ll get a less than optimal result because the deeper collagen layers are never reached. This is the most important reason that our ENZA skin care line is in a league of it’s own.

Routine exfoliation allows topicals to better penetrate the skin and maximize their effectiveness. Cleanse first to wash away impurities and then exfoliate to remove dead skin cells and draw out impurities in congested pores. Good exfoliation reveals the softer, smoother, more evenly toned skin underneath. Exfoliation can be mechanical e.g. skin brushing with a device or chemical in the form of facial peels. Depending upon your needs Enza offers seven product suites.

Two examples include preventative care and reverse aging care. In the former we suggest using the lightweight Sustaining Cleanser to lift away dry cells and smooth wrinkles, followed by the Cool Sustaining Toner to restore a natural glow. The final Sustaining System product, Fine Facial Polish, should be used two to three times per week to exfoliate and absorb acne-causing oil. Complete your daily routine with the Sustaining Glow Crème to polish away discoloration. In the latter case, the Enza Essentials Saturation System including the SaturationCleanser, Saturation Toner and Herbal Crème is a great daily regimen.  Two to three times per week use the gentle Saturation Aloe Scrub to help reverse the signs of aging.

Know your brand and stick with it!

Good skincare requires commitment to both a regimen and a product line. There’s an advantage of staying true to your brand. The best products work synergistically so you get more out of standardizing on a brand you trust than “playing the field.” That free bag of cosmetic samples is very seductive but soon you’ve tried so many brands it’s difficult to say if any really had any impact on your skin. You must also commit to daily use for at least 4-6 weeks to see results. Consistency and commitment are the name of the game. Consulting with a physician or a certified skincare expert is the best starting point so you know the time and money spent will be worthwhile.  

Your lifestyle is written all over your face.

Leading a healthy lifestyle is as integral a part of having great skin as using good products. You can use the best products in the world, but if your habits are unhealthy, your skincare probably won’t work. Getting too little sleep, smoking cigarettes, drinking too much alcohol will compromise any attempt at healthy skin. Poor nutrition in the form of excess carbs, fats and sugars also robs the skin. Likewise, skipping sunscreen, sunbathing or tanning indoors, interferes with your product’s potential benefits.  In closing when contemplating a new skin care direction chose wisely and consider all of these important listed points.   

Joseph W.Rucker M.D.

For more information, check out my websites at www.enza.com and www.ruckermd.com

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Breast Augmentation

Many females with small breasts are dissatisfied with their body image. Breast Augmentation (augmentation mammoplasty) is a procedure designed to enhance fullness by enlarging a woman’s breast through the surgical placement of a breast implant.

The primary goal is to:

• Enlarge a naturally small breast, which is often an an inherited condition

• Restore breast volume lost following a pregnancy or weight loss

• Achieve better symmetry when breasts are moderately disproportionate in size and shape

Augmentation mammoplasty, also referred to as breast enhancement or breast enlargement, involves placing silicone or saline breast implants either behind the breast tissue (illust. B) or beneath the chest muscle (illust. A) to add size, shape and fullness to the breast and to make the body more proportional.

Implant placed behind the chest
wall muscle.

Implant placed above the chest
wall muscle. 

Breast augmentation does not correct sagging breasts. Women who desire to improve contour as well as increase fullness, may want to consider a breast lift in conjunction with breast augmentation.

The best candidate: Adult woman of any age can benefit from breast augmentation. It is recommended that breasts be fully developed prior to the procedure. Breast augmentation does not generally interfere with a woman’s ability to breast feed. Good candidates for breast augmentation are defined as:

• Women who have a personal desire for enhanced breast size; not influenced by the opinions or desire of others.

• Healthy women who do not have a life-threatening illness or medical condition that can hamper healing.

• Women with a positive outlook and specific goals in mind for improving their own body image.

All patients will need a pre-operative consultation to review their medical history and perform a physical examination to determine if they are indeed, a candidate for the surgery. During this consultation, the procedure, recovery, expected outcome and possible risks or complications are discussed.

The Procedure: Breast augmentation is performed under a general anesthetic on an Out Patient basis. In the preoperative area, any last minute concerns are discussed and the chest wall is carefully marked to ensure accurate implant placement. Although there are several ways to insert the implant, I prefer to make a small (2-inch) incision beneath the breast. The implant is then placed behind the chest wall muscle. (illust. A) I prefer this approach for several reasons:

• It is easier to develop the pocket to house the implant

• To avoid the nerve which gives sensation to the nipple

• No nipple areola distortion, which may occur when placing the entrance incision around the nipple.

• Placement of the implant behind the chest wall muscle gives a more natural look.

The procedure takes approximately one hour. A support bra is then placed on the patient and they are discharged home, usually 2-3 hours after the procedure.

                                                before                                                 after

                                               before                                                 after

Breast Implants: The implants differ, being filled either with saline (salt water) or silicone gel and come in varying sizes and shapes. In my experience, 80% of our patients prefer the feel and shape of the silicone.

Recovery Time: Most patients rate the pain level as a 5 on a scale of 1 to 10. Patients are given written instructions and prescriptions for pain control and an antibiotic. Light activity is tolerated well in the first week. We see the patient one week after their procedure, when dressings and sutures are removed, recovery and activity levels are reviewed and an anticipated date for returning to work is discussed. Light employment is tolerated after two weeks, heavy lifting and regular activity in 3 to 5 weeks. Patients are given instructions for care of sutures to help prevent excessive scarring. A final consultation is scheduled five months after their procedure.

Patients are happy with breast augmentation and often experience an increase in self-esteem and confidence. Most go from an A or B cup to a C plus cup after the procedure. You may review pictures of breast augmentation cases at ruckermd.com.

Visit Dr. Rucker on RealSelf for answers and tips to the following questions:

2 Days After Mastopexy and a Breast Augmentation; Hematoma Maybe Seroma?
Are my Expectations Possible for Breast Size/Look?
What Size Would You Be For My Frame to get From B to C?
Are my Breast Implants Too Close Together?
Breast Lift or Just Nipple Reduction?

To schedule an appointment or for information regarding breast augmentation, visit www.ruckermd.com or call 800.456.8222 or 715.833.2116

Mommy Makeover

Childbearing can be one of life’s most rewarding experiences, but it can also take a toll on the mother’s body, often causing women to lose their hourglass figures. Each woman is affected differently, with age and genetics playing a significant role in how her body recovers. Even with the assistance of a personal trainer and a proper diet plan, both of which I strongly recommend, many women may find it difficult to get it all back together after pregnancy. This can cause a dilemma for mothers. They may feel guilty for thinking about themselves at a time when they feel they should be focused on their family. Many of our patients find that it’s essential to focus on both.

They want to feel good, look youthful and sexy and regain their self-confidence. They realize that having a positive self-image can also improve their relationships with loved ones.

Mrs. M, now 38, didn’t like her shape after pregnancy. “I lost fullness up top, I had badly stretched skin and nothing was where it was supposed to be, even though I was doing endless sit-ups,” she said. “ I just wanted my body back.”
A Mommy Makeover is a combination of plastic surgery procedures that may include a breast reduction or breast lift (with or without breast implants), a tummy tuck and liposuction. These procedures lift and tighten slackened skin and reduce the unwanted, hard to remove pregnancy fat.

Before

After

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Breast Reduction

This procedure has been helpful for women with large pendulous breasts who have medical problems caused by the excess weight of the breasts, which can often occur after pregnancy. These problems can include:
• Back and neck pain
• Skin irritation beneath the breast
• Skeletal deformities
• Bra strap irritation
• Breathing problems
• Occasional tingling sensation in the hands

The goals of breast reduction are to:
• Make your breasts look balanced when you are wearing a bra
• Regain your younger breast contour
• Reduce the size of the nipple areola to fit the smaller breast size
• Reduce the overall breast size to reduce the associated symptoms and to make the breast proportional to the rest of the body
Breast reduction is performed in a hospital under general anesthetic. Care is taken to make the breasts symmetrical and to preserve sensation to the nipple, as well as, hopefully, the ability to breast feed. Both of these goals are addressed by leaving the nipple areola attached to a pedicle of breast tissue. Through this pedicle run the nerves and vessels that help preserve sensation and a good blood supply to the nipple areola.
All incisions are closed under limited tension, resulting in a smaller breast and areola and a lifted breast contour. We have found that if symptoms are well documented, most of these procedures can usually be covered by insurance. Please visit my website, www.ruckermd.com, to view before and after pictures of breast reduction patients.

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Breast Lift
You’ve nurtured your children, now, your body could use a little help getting back to normal. Stretched and sagging breasts are common after child rearing. The breast lift (mastopexy) has become one of the most requested procedures in plastic surgery, with approximately 100,000 breast lift procedures performed in the U.S. in 2007.

Over time, a woman’s breasts lose their youthful shape and fullness. These changes may be the result of pregnancy, breast-feeding, weight fluctuations, aging and the natural effects of gravity. Heredity can also contribute to breast sagging. Many women are born with poor skin elasticity resulting in a loss of breast firmness.

A breast lift raises and firms the breast by removing excess skin and tightening the surrounding breast to reshape and support the new breast. The nipple areola may become enlarged over time. A breast lift will reduce the areola to place it in better proportion with the newly shaped breast. The goals of the breast lift are to improve a female breast that:
• Sags or is pendulous, but is proportionate with the body frame
• Has lost firmness and skin elasticity
• Has a flatter elongated shape
• Has a nipple and areola that point downward
As with breast reduction, we do not detach the nipple areola complex during a breast lift, in an effort to maintain nipple sensation later. It has been my experience that most patients want to be a “perky ‘C’ cup” after a breast lift. This is an outpatient procedure when performed by itself.

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Liposuction 

After pregnancy, unwanted, fat deposits on the hips, thighs, abdomen and buttocks can be extremely difficult to remove, even with an exercise and dietary program. Liposuction can be performed on any part of the body to remove fat deposits and sculpt a more pleasing contour. This procedure is best for someone of normal weight with good skin tone. Several areas can be reduced at the same time. Because the fat cells are permanently removed, the bulge cannot come back in that place. Your new figure should be a motivation to exercise and be mindful of a healthy diet. Liposuction is usually performed on an outpatient basis under general anesthesia, taking approximately 1-3 hours. Body contouring procedures are considered cosmetic and not covered by insurance.

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Tummy Tuck (Abdominoplasty)

The human body is more like plastic than rubber. Childbirth may leave you with loose abdominal skin and stretched abdominal muscles. The tummy tuck (abdominoplasty) procedure helps to flatten your abdomen by removing excess skin and fatty tissue. Tummy tuck should not be confused with liposuction, although your surgeon may elect to perform liposuction to improve the overall results.
Tummy tuck is the recommended treatment for sagging or projecting lower abdominal wall tissues. Good candidates are women who have muscles and skin stretched by multiple pregnancies, and men and women, who, after massive weight loss, still have excessive fat deposits or loose skin in the abdominal area. The procedure is usually done as an outpatient under a general anesthetic and will take 1-2 hours. 


There are several options for tummy tuck.

Your surgeon will examine you and then discuss your desired results and the anticipated outcome for each.
Complete abdominoplasty. The incision is made in the lower abdominal wall area, from hipbone to hipbone. Excess tissues beneath the umbilicus (belly button) are removed and the scar is hidden beneath the panty line.
Belt abdominoplasty is usually for patients who have lost a considerable amount of weight. The laxity of the skin and fatty tissues occurs on the abdomen and around to the back requiring a circumferential excision of these tissues to get the best result.
Partial or mini abdominoplasty is often performed on patients whose fat deposits are located in a small area beneath the belly button. This procedure can be done in the office with IV sedation.

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What are the risks of having multiple procedures?

Several studies have found that the combined Mommy Makeover procedure was not significantly more risky for the patient than a single procedure would be. It is important to stress that these procedures are best performed by Board Certified plastic surgeons at a fully-equipped surgical facility. I believe that the best way to avoid complications is to select my patients carefully. We try to avoid performing these procedures on patients with any significant medical problems that may compromise their recovery.

The benefits to the patient of performing multiple, carefully selected procedures as opposed to several separate procedures are:
1. A reduced overall time under anesthetic
2. Downtime for recoveries can be combined, especially when time away from work and other responsibilities is an issue
3. Reduced cost for combined use of surgical facilities, 
anesthesia, and medical staff.