Dr. Rucker in Arizona Sports and Lifestyle

This article was published in Arizona Sports and Lifestyle for their November / December 2013 issue. 

Skincare By The Numbers: What’s Your Skin Code? 
While skin, hair and eye color are general classifications that cannot be disputed, do they tell the whole story? What about age? Lifestyle? Environment?  Are we to believe that identical twins—one living in Vermont and one in Phoenix have the same skincare needs based solely on genetics?

Here in the southwest, sun, dry heat, and the lure of outdoor activities create the perfect storm for exacerbating skin conditions and premature aging. It is never too early or too late to give your skin the care that it needs and deserves. Let’s explore what causes skin damage and how to avoid loss of collagen, inadequate moisture and chronic inflammation.

Collagen. For youthful looking skin.
Think of collagen as a tightly woven net that provides our skin its underlying structure; it is vital for giving skin elasticity and strength. Our bodies produce collagen, but as we age production decreases. Because our skin cells are inherently sensitive and fragile, if we are not vigilant about protecting the collagen we have, we may experience permanent damage. Over time, consistent exposure to elements harmful to skin cells will destroy both collagen and elastin.

What you can do:  

• Use serums containing Vitamin C, peptides, and antioxidants.
• Always use sunscreen with UVA/UVB protection and reapply often.
• Pay attention to diet: up the Omega 3 rich foods, beans, dark fruits and vegetables, green tea. 
• Avoid sun exposure, smoking, and topical collagen – which cannot penetrate the skin. 
• Use a stem cell serum to help reverse damage and help prevent further aging.

Moisture. Dry skin plus desert heat equals a lethal combination.
The southwest is renowned for its dry environment, and as we age skin has trouble retaining moisture. So when you combine inherited dry skin with the desert heat you have a lethal combination, which can result in fine lines, wrinkles, and loss of elasticity.

What you can do:

• Try products with hyaluronic acid to smooth and plump skin.  
• Ask your doctor about injectable dermal fillers that will hydrate from the inside, out.
• Use a humidifier at night and moisturize right after showering.
• Treat yourself to oxygen-based facials or a hydrating mask. 
• Wash with a hydrating cleanser to remove chemical and biologic irritants without reducing the skin’s moisture content.

Inflammation. The age accelerator.
Sunburns are actually an acute form of inflammation, which can destroy healthy tissue and compromise new tissue. Sun exposure also destroys elastin and collagen. When natural antioxidants are exhausted, free radicals are released and inflammation is triggered. This results in crepy skin and wrinkles.

What you can do:

• Add antioxidants to your diet; such as berries and nuts. 
• Stay hydrated by drinking plenty of water throughout the day. 
• Limit sugar intake at all costs, which breaks down collagen.
• Avoid sun and wind exposure as much as possible.

So where do you start if you live in our southwestern zip code? Focus on making skin healthy rather than just alleviating symptoms. It takes more than one product or a single serving dose treatment at your doctor office to make a dramatic improvement to your skin and fight the signs of aging. The effects of aging are not one-sided, so neither should your anti-aging plan. It is never too early to start your anti-aging regimen and avoid harsh Arizona elements if you can.

Visit Dr. Rucker’s website at www.enza.com and www.ruckermd.com to learn more about his customized skincare suite for the Arizona lifestyle.

Check out pages 74 and 75 of Arizona Sports and Lifestyle for the article.

FIVE WAYS TO KEEP YOU “SKIN-SANE” THIS WINTER

No matter how hard we try to avoid it, the dreaded winter weather is on its way here. It’s time to start taking out winter coats, mittens and boots out from winter storage. But don’t stop there- it’s also time to rejuvenate what’s under those winter layers – your skin.  It’s no secret that the combination of dry air and holiday stress can prove to be a nightmare for your skin, so as with any other season, you will have to adjust your daily routine accordingly to keep your skin fresh and renewed.  Keep your “skin-sane” with our top five tips this winter.

1. Balance. Using a moisturizing toner will balance your skin’s pH levels to a normal level of between 4.5 – 6. This allows the rest of your products to work more effectively and penetrate deeper. Using Enza Essential’s Saturation Toner will increase the hydration for dry, weathered skin. And, bonus! This toner also helps prevent early signs of aging, including fine lines and wrinkles.
2. Be strong. With the holiday baking and sweets about, it seems impossible to resist sugar. But did you know that excess sugar can age you? When your body processes sugar, it turns into glucose which can destroy collagen and your skin’s elasticity, which is a big factor in aging skin. You may want to pass on that extra chocolate chip cookie, for your skin’s sake.
3. Out with the old. Winter is the perfect time to get rid of old items you don’t need any more, right? It’s an even better time to get rid of dead skin and bacteria left on your face with a gentle, oatmeal-based exfoliator. Exfoliating two to three times each week will help avoid acne scarring and irritation. We suggest the Saturation Aloe Scrub, a hydrating exfoliator that nourishes and provides extra moisture.
4. Watch out! We know its cold, but extreme heat from the blow dryer, sink water, or shower can break capillaries, cause irritation and end up drying out your skin even more. Use lukewarm water to keep your skin calm.
5. Drench and hydrate. Don’t forget to use deep-hydrating creams and facials to ensure your skin is receiving enough moisture during this harsh, dry season. The best time to apply a moisturizer is just after getting out of the shower while your skin is still moist. For your body, we recommend using the Shea Body Butter by Enza Essentials, rich with antioxidants and vitamins A and E to protect every inch of skin. For the face, try the Saturation Herbal Crème.

Now after changing your closet from your summer dresses to winter jackets, it’s time to start changing into your winter skin care routine. With these five easy tips, you can keep your skin happy all winter long.

For more skin solutions, visit our website at www.enza.com or www.ruckermd.com or schedule an appointment at the Enza Medispa by calling 1-800-456-8222.

BEATING THE CLOCK

They say growing old is better than the alternative, but aging certainly is not for the faint of heart. By the late 30s to early 40s, fine lines and wrinkles begin to appear. Changes in skin texture, volume and appearance, pigmentation problems, broken capillaries and dullness become more pronounced with every birthday. We cannot stop the hands of time, but knowing the factors involved with aging can lead to an understanding of what we can and cannot influence when striving to look our best.

First, the basics – the skin has three layers: the epidermis, the dermis and a deeper subcutaneous tier. The epidermis is the outer layer and its role is protection. This layer loses lips (fat-like substances), making the skin dry. In your 30s it will shed itself every two months. The dermis is the skins inside layer, responsible for texture and elasticity. This is the home of collagen and elastic fibers that break down over time. The subcutaneous inner layer is composed of fat and connective tissue and allows us to maintain constant body temperature.

Intrinsic Aging: Changes that happen within the body.

• Fine lines and wrinkles
• Thin and transparent skin
• Loss of subcutaneous layer attachment to bone, resulting in sagging and folds
• Thinning of underlying fat, leading to hollowed cheeks and eye sockets and loss of firmness on the hands and neck
• Drying of the skin
• Gray hair and hair loss 

Extrinsic Aging: Skin changes due to external factors:

• Sun exposure, resulting in age spots, loss of elasticity, fine lines and wrinkles
• Facial expressions: Repetitive facial movements actually lead to wrinkles, often referred to as “character lines”
• Gravity: Our skin gradually ceases to “snap back” due to gravity
• Sleeping positions: Resting your face on the pillow in the same way every night can contribute to the development of facial folds
• Smoking: People who smoke regularly are more likely to develop wrinkled, leathery skin, especially wrinkles around the mouth.

Prevention + Treatments: We cannot stop the aging process, but we don’t have to surrender quietly. Signs of aging can be corrected with fillers, lasers or ultrasound. Pharmaceutical-grade skincare products can further repair damaged skin. 

• Avoid deliberate tanning, including use of indoor tanning devices. 
• Apply sunscreen year-round. Sunscreen should be broad spectrum (offers UVA and UVB protection) and have a Sun Protection Factor (SPF) of 30 or higher. Using an effective sunscreen, such as Enza Essentials Advanced Protection SPF 30, on a daily basis will make a big impact on the skin and help prevent future damage. 
• Consult with Dr. Rucker and his staff. We have developed a skin treatment program that has been used by over 1,000 patients. Let us discuss personal options that will fit your lifestyle and priorities.
• Tri-Peptide Cell Activator: Dr. Rucker’s exclusive wrinkle-reduction serum formulated with Resveratrol, Tripeptide-3, and Swiss apple stem cells, clinically proven to reduce signs of aging. 

For more information, please contact our staff at 800-456-8222 or email us at info@ruckermd.com. Check out our website at www.ruckermd.com.

When Insurance Covers Breast Reduction

No matter the reason a woman decides to have plastic breast surgery, this decision may cause her stress: physically, emotionally and financially. Her stress can be lessened if she is presented with the right information, such as the symptoms that hint towards surgery, how she may obtain insurance coverage and what she can expect going through surgery. With these pieces of information, a woman can be comforted by knowing what to expect through her breast reduction.

When To Get A Breast Reduction
A woman inquiring about functional breast surgery has the best chance to have her surgery covered by insurance.  This woman will have large breasts that have caused her discomfort. Symptoms may include:

• Chest wall heaviness
• Neck strain
• Bra strap irritation
• Upper or lower back pain
• Poor posture
• Tingling or numbness of the fingers

These symptoms will make it difficult for a woman to be active in sports, make her want to wear clothing that will conceal her size and will have worsening symptoms during child bearing years. Typically, these women begin as a D cup or higher and wish to be reduced to a C cup or smaller.

How To Obtain Insurance Coverage
For a woman to be covered under insurance, it is essential for her provide the following information to her insurance carrier:

• The estimate describing the amount of reduction from the procedure (most patients will go from a D or DD cup to a C cup)
• A detailed list of the symptoms present and their duration
• Any records of a non-successful conservative treatment period 
• Documentation regarding her condition and any attempts to reduce symptoms from her primary care doctor 

Anticipating The Surgery
After a patient goes through surgery, she can expect the following, as part of the plastic breast surgery procedure:

• Overnight stay in the hospital
• Pain level roughly between 2 and 5 on a scale of 1 to 10
• A return to work within around two to four weeks (dependent upon the patients type of employment)
• Partial or full return of nipple sensation and ability to breast feed in 90% of patients
• The breast shape lifted, as well as reduced

During my 30 years as a plastic surgeon the breast reduction procedure has been by far the most appreciated by my patients.  I attribute this to the fact that they not only feel better with the reduction of symptoms, but they also have an improved appearance. The most frequent statement that we hear after the procedure is, "I should have done this years ago."

To set up a consultation, call our office at 715-833-2116 and visit our website at www.ruckermd.com. Our staff is happy to assist you with any questions.

REGISTER NOW FOR THE IDEAL BODY SEMINAR.

Join us for The Ideal Body seminar and learn how to achieve yours! The free seminar will be next Tuesday, November 19th at the Clairon Hotel in Eau Claire, Wisconsin from 6:00 - 8:00 p.m. 

Tighten, tone, and reduce body fat with inside secrets and breakthrough treatments from board-certified plastic surgeon, Dr. Joseph Rucker and the Enza Medispa. 

Register now by emailing us at info@ruckermd.com or calling us at (715)833-2116.

TREATMENT OPTIONS FOR DARKENED ACNE SCARS

For some individuals, the healing of acne scars can turn into a whole new skin issue -- darkened acne scars. Acne inflammation can lead to a deposit of pigment in response to the skin’s healing process which may result in hyper-pigmented areas of the skin to be revealed through the skin. To address this issue, the treatment is two-fold.

1. The use of broad band Light (BBL), also called an IPL laser, reduces the present pigmentation and reduces the chance of future pigmentation problems.

2. Over time, the pigmentation problem may recur. In such cases, I recommend using a maintenance topical, skin bleaching cream such as hydroquinone.

These treatments will effectively lessen the effects of acne scars. However, in order to obtain the best results, always wear sun protection as excessive unprotected sun exposure will allow for hyper-pigmentation to worsen.

Call us at the Rucker MD Plastic Surgery Clinic for a consultation at 800.456.8222 and visit our website at www.ruckermd.com. Our staff is happy to help.

THE ADVANTAGES OF THE RUCKER MD IN-HOUSE SURGERY SUITE AND RECOVERY CENTER.

Avoid expensive hospital facility charges. You can save money just by scheduling your surgery at the Rucker MD Plastic Surgery Clinic since you don't have to cover the hospital facility charges.

Rest assured. Your surgery will have a full staff of Dr. Rucker, an Anesthesiologist, two surgical technicians, nurse, and recovery nurse at your side.

Enjoy extra privacy.You can trust our small staff and know that your appointment will be secret. Our back door entrance and exit make it easy for a discreet visit with us.

30+ years of experience. Plastic surgery is no small deal. Trust your body in the hands of a board-certified plastic surgeon with over 40 years of experience.

Call us for a consultation at 800.456.8222 and visit our website at www.ruckermd.com.

Doctor, do I need a breast lift with my augmentation? And what is the difference between silicone and saline?

It’s hard to give the best answer without the benefit of an examination, however, there are three general complaints you may have that will indicate whether you need a breast lift with your breast augmentation.
Three good indicators are:

• You feel you have lost fullness on the upper portion of your breasts
• You feel a push-up bra is a necessity
• You feel going braless is not an option

Before.

After.

A good at-home test to decide whether a lift is right for you is to place your index finger beneath the fold of your breast and point upwards toward your nipple.  If your finger tip protrudes over the upper portion of your areola or above it, then a lift is probably needed, however, a detailed examination by your plastic surgeon is recommended.

If a lift is needed, but not done with your augmentation, your breast sagging may appear more pronounced after your breast augmentation procedure. In my experience, 75% of my patients that opted for a breast lift also chose a breast augmentation. A breast augmentation and breast lift combination may be the best option for you if your goals include any of the following:

• Regaining a "perky”  look
• Improving your cleavage
• Being  able to go braless

Your next decision may be choosing between a saline versus a silicone implant. I personally believe that current saline and traditional gel-filled implants will be obsolete in the near future.  I use the Sientra  “Gummy Bear” implant.  The benefits of this new implant option include a natural feel, less complications in the event of rupture and a probable less chance of scarring around implant. See video for more details. Choose wisely.

“Some people think that women with perky, well-formed breasts are stupid. Actually, it’s quite the opposite. Women with perky breasts make men stupid.”

To schedule a consultation, call us at 800.456.8222 and visit our website www.ruckermd.com 

5 FACELIFT FACTORS TO CONSIDER.

1. Sunken Eyes. Gravity begins to pull the fat under the eyes down, which results in a sunken appearance. Typically a blepharoplasty is addressed at the time of the facelift.

2. Loss of Volume. A loss of fat in the face results in droopiness. Volume can be restored through injectibles, fillers, fat, or a combination during or after your facelift.

3. Wrinkly Skin. Various factors over time can cause the skin to age and wrinkle. Think sun exposure, pollution and free-radical damage.

4. Deep Folds in Skin. This is due to the bone density changing over time. Excess skin is removed and remaining skin is pulled back.

5. A Saggy Jawline. As time goes on, bones become less dense and gravity begins to wear on the skin. Eventually, only surgery can correct and tighten the jawline.

For the full article, check out our latest issue of Profiles magazine. To schedule a consultation with Dr. Rucker, call the office at 715.833.2116. Our staff is always happy to assist!

TYPES OF FACELIFTS

Lower (Standard)
Tightens the lower face’s underlying structures that slacken with age. Also trims excess skin, smoothing it to eliminate facial creases, and giving a visual lift to the bottom third of the face.

Mid-Facelift
As people age, the cheeks and eyelids tend to sag. This procedure restores a youthful, rested look to the lower eyelids and cheeks.

The Mini “Weekend” 
Performed quickly with a shorter recovery period, the procedure enhances key facial areas. However, the “weekend facelift” is a minor surgical procedure. Results are much less impressive than a standard facelift.

Thread Facelift
A less invasive approach that has come under criticism for not producing the results as promoted. I do not offer this technique because of the questionable level of improvement.

For the full article, check out the latest issue of Profiles. To schedule a consultation with Dr. Rucker, call the office at 715.833.2116. Our staff is always happy to assist!

PROFILES IS OUT.

The Fall/Winter issue of Profiles is out! Pick your complimentary copy up at the Rucker MD Plastic Surgery Clinic, the Enza Medispa or grab one of these upcoming newspapers:

• Leader Telegram: Saturday, October 5th.
• Pioneer Press: Wednesday, October 9th.

This issue's topics include:

• Functional vs. Cosmetic Rhinoplasty
• 5 Facelift Factors to Consider.
• Dr. Rucker in Arizona Sports and Lifestyle Magazine.
• Your 5 Minute "Anywhere Workout" by Lori Heck.
• Do you need a Facelift?

For your free copy, email us at info@ruckermd.com or call the office at 715.833.2116. Our staff is always happy to assist!

The Top 5 Nose Complaints. Sound Familiar?

While we can often disguise protruding ears with different hairstyles and soften the appearance of our eyes with makeup, the nose is the most noticeable facial feature and is more difficult to hide or disguise. In the 500+ Rhinoplasty procedures that I have performed, I have employed a highly focused individualized approach which avoids the dreaded “operated on” or “done” appearance.

FUNCTIONAL nasal problems usually arise from an injury and result in a disfigurement of the nasal shape with complaints of obstructed nasal breathing.
     Most functional Rhinoplasty candidates  have sustained an injury to the nose that has resulted in a possible nasal fracture and/or displacement of the internal partition of the nose, which separates one nostril from the other. The most common concerns - difficultly breathing through the nose and severe headaches.
     The nose may appear disfigured, often identified by a hump at the mid-portion of the bridge. An internal examination may confirm that there is, in fact, a deviation of the nasal partition resulting in a partial blockage of nasal airflow. We then would develop an operative plan to restore the displaced nasal structures to their original position, and to rearrange the displaced nasal partition in an effort to restore normal nasal airflow. The reconstruction of a functional nasal problem is usually covered by one’s insurance.

COSMETIC nasal problems include the above complaints of “my nose is too large”, “I hate my hump” or “the tip is too large”. These are characterized as cosmetic because their improvements do not affect the function of the nose and the ultimate goal is to produce a better appearance of the nose. I refer to this type as an “aesthetic” Rhinoplasty. It is important to understand that the shape of the nose is dictated by the bone and cartilage framework beneath the skin.  It is therefore the goal of the cosmetic nasal surgeon to reshape the framework beneath the skin to reduce the size and shape of the nose, without producing a result that looks “done”.
     In the case of an aesthetic Rhinoplasty, I feel the most important aspect of the initial consultation is to determine whether the results of the procedure can realistically meet the patient’s expectations.  Difficulties can arise when a patient states, “I want my nose to look exactly like this,” and presents a photo of a celebrity.  This type of result is often not realistic, firstly, due to other facial features contributing to the nasal appearance, and secondly, because the nasal framework may not allow a specific result. However, certain characteristics of someone else’s nose may be incorporated into each individualized Rhinoplasty. A detailed examination of the candidate is performed and an operative plan to address the patient’s concerns is formulated. Because this is a purely cosmetic procedure, it is not covered by insurance.

The Nasal (Rhinoplasty) Procedure:  Both functional and cosmetic procedures are done under a general anesthetic and on an outpatient basis.  Each procedure takes about two hours to perform. Most patients rate the pain on a scale of 1 to 10 as a 4 to 6.  There is a dressing in place for 6 to 7 days, and upon its removal the patient’s result is noted with a moderate amount of swelling.  Patients typically feel comfortable being in public after Rhinoplasty in seven to eight days.

To set up a consultation, call Dr. Rucker’s office at 715.833.2116. Our staff is always happy to assist!

MINNESOTA BREAST CANCER AWARENESS ASSOCIATION ANNUAL CONFERENCE

Dr. Joseph Rucker, has been selected to be a keynote speaker at the 12th Annual BCAA Education Conference in Minneapolis, MN on October 12th. 

He will be speaking on "Staying Abreast: Innovations in Plastic Surgery".

Tickets are available for purchase at www.bcaamn.org.

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The Future of Breast Augmentation.

Silicone or saline? That is the question that many women on the market for a breast augmentation face. When weighing the options, there have always been strong arguments for both sides. Thanks to new technology, the future of breast augmentation is here with a new implant that has the best of both worlds.

Up until five years ago, the salt water filled implant (saline) has been the preferred implant. The standard silicone implant has since returned to favor, but there has always been that lingering doubt of what happens if it leaks. 

Saline Implant Benefits:

• Non-toxic in the event of leakage since it is filled with salt water.
• Size can be varied by merely adding more fluid to enlarge it.

Saline Implant Drawbacks:

• Does not feel natural.
• Tends to reveal itself more by producing ridges on the breast.
• Higher chance of leakage.

Over the past five years, many of my patients have chosen the silicone-filled implant because it does feel much more natural, and it tends to not show the ridges beneath the skin that the saline implant does. Nonetheless, it still causes some concerns if there was leakage, and the silicone was to leak into the breast tissue.

Currently, I feel the saline-filled implant and the standard silicone gel filled implants will be obsolete within the next two years. This is due to the current availability of the revolutionary high tension, gel implant – AKA the “Gummy Bear” implant. The term is coined from the fact that when cut in half, the breast implants are able to retain their shape with no leakage, similar to the popular gummy bear candies.

The benefits of the “Gummy Bear” implant are so pronounced that it has become my implant of choice.

"Gummy Bear" Implant BENEFITS: 

• Smaller chance of a leakage of gel into the body if a rupture is to occur.

• Natural feel, similar to the gel-filled implant.

• Multiple shapes and sizes offered.

• Cost is very comparable to the standard gel-filled implant.

• Some studies suggest that there may be less of a chance of scarring around the Sientra “Gummy Bear” implant.

With these suggestions and information in mind, it is important to remember that a consult with your plastic surgeon is highly recommended to determine your personalized needs. For more information or to set up an appointment, please call 715.833.1068 and speak to our patient coordinator.

It's here! PROFILES Summer 2013!

Check out the latest issue of PROFILES magazine to read up on:

• The Future of Breast Augmentation by Joseph Rucker, MD, FACS
• Benefits of Stem Cells in your Skin Care Regimen
• Menopause & You by Donna Schoenfelder, MD
• Help! I have ACNE SCARRING
• Group Workouts You Will LOVE by Lori Heck, ASPIRE Personal Training
• Feed Your Skin! by Tammy Schofield, MS, RD
• The Enza Medispa summer specials!

Mastectomy and Immediate Single-Staged Skin-Sparing Breast Reconstruction

A Breast Cancer diagnosis is devastating and the idea of a mastectomy is often just as difficult to accept. While your primary goal is to rid your body of cancer, it can be hard to imagine ever getting back to feeling “whole” again. Part of a complete recovery is restoring confidence in how you look and feel.

Dr. Joseph Rucker performs the new skin-sparing, single-stage mastectomy and immediate reconstruction which preserves, in some cases, the nipple and areola as well as the breast skin. 

The benefits of this technique are:

• One surgical procedure for both the mastectomy and reconstruction.
• One recovery.
• Patient's skin envelope is preserved.
• Usually only one overnight hospital stay required.
• No increased risk of recurrence.
• Better cosmetic result after reconstruction.

The Procedure: On the surface, your natural breasts are preserved. Inside, your tissue is completely replaced with an implant. This state of the art procedure involves the cooperation of a cancer surgeon and Dr. Rucker acting as a team, along with your oncologist. 

Until now, mastectomies involved flaps, expanders, tattoos and scars. Skin and nipple-sparing mastectomy offers an option that is less severe and more cosmetic. By retaining the shell of your natural breasts and using an implant, the results often resemble a breast augmentation rather than a reconstruction.

Insurance Coverage: Single or double mastectomy? A federal law was passed in 1998 requiring all health insurance companies to cover reconstruction of the breast on which mastectomy has been performed. Additionally, it covers surgery and reconstruction of the other breast to produce a symmetrical appearance.  Because of this, women with a higher risk of developing breast cancer, and who formerly might have considered a single mastectomy now elect to have both breasts removed and reconstructed.

Risk of Recurrence: Skin-sparing mastectomy has been advocated as an oncologically safe approach for the management of patients with early-stage breast cancer that minimizes deformity and improves cosmesis through preservation of the skin envelope of the breast. Extensive research has been done regarding this procedure when compared with mastectomies that remove all the tissue, skin and nipples. The result? The new skin and nipple-sparing mastectomy in no way contributes to recurrence. In addition, careful review of scientific research over 20 years found no proven link between breast implants and auto immune or other systemic diseases, nor do they inhibit future cancer detection.

Candidates for Procedure: Many, but not all, patients are candidates for a skin-sparing mastectomy. Your choices may be limited by your pathology or prior surgeries. However, this new option has made women with the BRAC gene and those at high risk for breast cancer consider a skin and nipple-sparing mastectomy prophylactically - removing the tissue as a potential target. Others considering lumpectomy, which can be disfiguring, can now confidently opt for removal of all tissue while preserving and enhancing their natural breasts. These patients leave the hospital not only with their shape and contour intact, but the gift of peace of mind, knowing that all of the breast tissue has been removed.

Philosophy: Dr. Joseph Rucker, a board certified plastic surgeon with advanced training in breast reconstruction techniques, approaches reconstruction no differently than an elective cosmetic procedure. His keen aesthetic sense makes his goal to leave every woman looking even better than before their unfortunate diagnosis. Working closely with a cancer surgeon and your oncologist, Dr. Rucker will help determine if you are a candidate, considering your individual treatment plan and overall health.  

To view a short video on this subject go to: http://www.youtube.com/watch?v=zUXv2RWny6A.

40 year old female with advanced premalignant breast disease and also with a strong family history for Breast Cancer. She requested bilateral mastectomies and immediate single-stage bilateral breast reconstruction.

1 month after bilateral skin and nipple-sparing mastectomies and immediate reconstruction.

Doctor, What Size and Type of Implant would you Recommend?

When choosing a breast implant, there are two major factors one must consider (1) what size implant is best for me and (2) what type of implant should I choose. The following information is meant to guide you in making an educated decision

IMPLANT SIZE: While there is no specific chart that will display exactly what size implant should be used, most surgeons will have a general suggestion for each of their patients. The surgeon must make a determination based on the cup size that the patient desires as well as the body size of the patient. Generally I offer the suggestions listed below:

• Small statured women (<5'3") with an A cup requesting a C cup. My implant range suggestions are between 280cc to 380cc
• Medium statured women (>5'3") with an A cup requesting a C+ cup size. My implant range suggestion is between 380cc and 480cc
• Large statured women (>5'8") with an A cup requesting a C+ cup to a D cup. My implant range is between 480cc and 540cc

IMPLANT TYPE: When it comes to implant type, I personally think the saline filled implant and the standard silicone gel filled implants will be obsolete within the next two years. This is due to the many benefits of the revolutionary Sientra "Gummy Bear" Implant. The benefits of the Sientra implant are so pronounced that it has become my implant of choice due to the following reasons:

• There is a smaller chance of a leakage of gel into the body if a rupture is to occur
• Has a natural feel similar to the gel filled implant
• There are multiple shapes and sizes offered
• The cost is very comparable to the standard gel filled implant
• Some studies suggest that there may be less of a chance of scarring around the Sientra implant

With these suggestions and information in mind, it is important to remember that a consult with your plastic surgeon is highly recommended to determine your personalized needs. For more information or to set up an appointment for a consultation with Dr. Rucker, please call our offices: 715-832-1774. All inquiries are welcome and can be answered by an experienced Rucker MD staff. 

Why Trust a Plastic Surgeon with your Skincare Needs? Dr. Rucker is about to tell you!

How to easily treat Marionette Lines

Marionette lines are long, vertical lines that start at the corners of the mouth and extend downwards towards the chin. They are visible on a person's face as landmarks for general expression. However, for some, these lines deepen or turn downward and may create a cosmetic concern. To improve these lines, I would recommend a filler introduced in the following manner: 

1. A direct placement of the filler of your choice in two planes beneath your marionette lines will diminish the problem

2. I would also place a small amount of filler on the underside of the upper lip near the corner. This will roll the lip up nicely to produce more of a smile while also reducing the deepened marionette lines. 

3. This is a 5 minute procedure with minimal to no downtime. 

Six Tips to Minimizing Dark Under-Eye Circles

Dark circles can be blamed on multiple factors including heredity, hormone levels, sun exposure, stress, aging, a lack of sleep and most commonly- allergies. An important thing to note about dark under-eye circles is that here is no perfect way to prevent them, only minimize them once they are visible. However, contrary to what you may think, dark circles cannot be remedied by skin lighteners because the darkness is not caused by skin discoloration, rather a shadowing of the skin.

In order to relieve the darkness around the eyes, there are various methods you can use to minimize the appearance of them.

• Using powerful peptides such as Enza Essential's Eyebright Anti-Puffiness Gelee will cool and sooth the appearance of puffy bags while increasing cell turnover, leaving you with a brighter, more youthful appearance.
• Dermal Fillers can be used in order to plump the area around and under your eyes which reduces the intensity of shadowing. 
• Because allergies are the number one cause of dark circles, it is important that you have identified what you are allergic to and have proper allergy medication to minimize any potential reactions.
• Wearing sunscreen, particularly an SPF 30 or greater, will help to minimize unprotected sun exposure and the effects of aging from the sun. 
• Applying ice packs or cucumbers directly on the dark circles at nighttime will sooth and minimize the dark circles caused by puffiness.
• Lastly, the Pelleve Wrinkle Reduction System is a treatment that will help to tighten and brighten your face while also increasing collagen production that will work against the skin's natural aging process.

Although there is no way to completely prevent dark circles from appearing, there are multiple ways to reduce the shadowing that occurs. By using the methods listed above, you can successfully mask those embarrassing signs of aging, lack of sleep and stress before anyone has time to notice them. 

Winter Skin Care

The combination of dry air and holiday stress can prove to be a nightmare for your skin. As with any other season, you will have to adjust your daily routine accordingly to keep your skin fresh and renewed. The following are tips to help you rejuvenate your skin and look your best for the winter season.

• Don't Skip the Toner- Applying toner will normalize the skin's pH level, misting your skin throughout the day will allow the toner to absorb excess oil and keep you looking fresh.
• Curb Your Cravings- Be sure to limit sugar intake. When your body processes sugar, it turns into glucose which can destroy collagen and your skin's elasticity. Eating fiber-rich foods can help ward off hunger and your sweet tooth.
• Exfoliate Twice a Week- Dead skin and bacteria left on your face can irritate your acne and leave scarring. Be sure to slough it off with a gentle exfoliator.
• Watch the Blow Dryer- The extreme heat and extended use of a blow dryer facing your neck can break capillaries and over time, leave them permanently broken. 
• Use Lukewarm Water- When rinsing your cleanser, avoid water that is too hot or too cold. Your skin is very sensitive and not being careful with temperature could cause irritation and break capillaries. That means shower water temperature can also be damaging if it is too hot. 
• Use an Oatmeal Based Scrub- Abrasive scrubs and exfoliants are too harsh on your skin during winter. Milder, oatmeal-based facial scrubs can unplug the oily pores. 
• Avoid products that use mineral oil or petroleum- Mineral oil and petroleum, both derived from fossil fuel, may dog your pores and prevent your body from flushing out toxins through your skin, leading to breakouts. Be sure to check the ingredients on all your skin care products and cosmetics. 
• Drench and Hydrate- With dehydrated and cracked skin, be sure to add moisture with deep-hydrating creams and facials. Also, don't forget to stay hydrated yourself. Be sure to drink at least 8 glasses of water per day to maintain a radiant complexion. 

By following these tips you will ensure your skin stays healthy and protected through the cold, snowy weather. You can do it- keep your skin you love, even in the harshest winter months. 

Pellevé®: A Breakthrough in Anti-Aging

It’s an inevitable evil, and it happens to us all: with each increasing year come new wrinkles. We’ve tried it all- creams, medications, even surgeries in hopes of minimizing wrinkles and reducing age. However, Rucker M.D., Enza Medispa has taken initiative and began using a new procedure in their offices: the Pellevé® Wrinkle Reduction System. Here we look to introduce and explain this new procedure and why it is important to the Rucker M.D., Enza Medispa and its patients.

What is Pellevé®?

Pellevé® is a unique wrinkle reduction system with various benefits including minimizing wrinkles, tightening and smoothing the face, and creating a younger, brighter complexion. Pellevé® does this through a non-invasive and nonsurgical treatment.

How is Pellevé® different from other wrinkle remedies?

Dr. Joseph Rucker M.D. describes what he sees as the top three benefits of Pellevé® that no other wrinkle reduction treatment can offer:

1.   An appreciable wrinkle reduction

2.  A painless procedure

3.  No downtime

What can I expect to experience while undergoing the procedure?

Rucker M.D., Enza Medispa patient feedback will tell that the Pellevé® experience is calming and enjoyable. “It feels like a warm facial, and when it gets too hot for me, they move on. It’s never too uncomfortable. It’s relaxing; I even dozed off a few times.”

How long until I start to see the effects of Pellevé®?

Immediately- Rucker M.D. Patients have expressed their surprise at how quickly they could feel the treatment working on them. “It was immediate and the results were amazing. I loved the tightness and I loved the fullness.” “My face had this healthy glow; [it] felt tighter and firmer. I noticed around my eyes right away that the crow’s feet weren’t noticeable.” And when combined with Enza Essential’s topical wrinkle reduction serum, the Tri-Peptide Cell Activator, your immediate results will be enhanced.  

With your immediate results, you may notice a slight depletion of tightness a few days following treatment. This is normal. With time and follow-up treatments, you will begin to feel a permanent re-tightening of the skin.

What are the side effects?

One of the benefits of Pellevé® is that there are very few side effects to this procedure. As mentioned earlier, it is a non-invasive treatment, meaning no downtime is necessary. You will be able to go out in the sun, apply make-up, and get back to your daily routine immediately following treatment. Some patients may experience mild swelling and redness; however this typically goes away within 2 to 24 hours.

Is it effective?

Dr. Joseph Rucker, M.D. stands by his efforts to ensure patient comfort and satisfaction by incorporating Pellevé® into his practice. Pellevé® successfully passed all of his following criteria:

1.   Research shows its benefits

2. A waiting period to review the long term effectiveness of the technology

3.   My own personal use of the technology

For more information or to set up an appointment for a Pellevé® treatment, please call our offices: 715-832-1774. All inquires are welcome and can be answered by an experienced Rucker M.D. staff.