Saturday, May 29, 2010

Here comes the summer...and the sun. Thoughts on skin cancer from Dr. Robert J. Brueck MD, Fort Myers plastic surgeon.

Dr. Robert J. Brueck MD, a Board Certified plastic surgeon, frequently blogs on subjects of health, skin and developments in plastic surgery. This time, he comments on melanoma.

Memorial Day Weekend signals the start of summer,
when we all tend to spend more time in the sun and the sun is closer to the Northern Hemisphere.

For years we have known about the cause-effect relationship with basal cell carcinoma and squamous cell carcinoma and the sun.

Some researchers, though, were not convinced that UV radiation had a similar cause and effect relationship with melanomas.

Now, a new study published in Nature (December 2009) confirms the role of the sun in the development of melanomas. Researchers at Wellcome Trust Sanger Institute in Hinxton UK mapped the complete genome of a patient with melanoma; in other words these were the genes of the melanoma from that particular patient.

The researchers found thousands of mutations in the patient’s genome, all of which were caused by radiation. There were in excess of 33,000 mutations mapped. They compared the genome of normal skin and melanoma. These abnormal mutations occur over many years but our bodies are programmed to repair the damage done to the DNA caused by the inciting effect of the sun.

In the end, the failure of our body’s ability to repair the damaged DNA or the gene, results in melanoma.

Be cautious, be alert and get a checkup. Melanoma is lethal because it is the one form of skin cancer that has the ability to metastasize not only through the lymphatic, but the blood stream as well.

There is no doubt that an ounce of prevention is worth a pound of cure and that ounce should be an SPF of 30 to 35.

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From time to time, Dr. Robert Brueck, Board Certified plastic surgeon practicing in Fort Myers, FL , comments on matters of health, appearance, plastic surgery and whatever else occurs to him in a moment of reflection

I know this has nothing to do with plastic surgery, but I am always trying to provide my patients with helpful and timely information that may benefit them and/or their families.

When I was a young man growing up, the choices for jobs were very limited, you were either an engineer, lawyer, doctor or banker. If you were a woman you became a nurse, a secretary, a teacher or a bank teller. But the landscape has dramatically changed over the last 20 to 30 years.

The job opportunities for young people today are enormous and at times overwhelming. So how do we counsel our young teens and adults as to what direction to go? What does the future hold for jobs?

I was reading an article in the Wall Street Journal today that was entitled, "What Will Be The Hot Jobs Of 2018?". It mentions a tremendous book on future job data and prospects put out by our labor department (our tax dollars working for us).

The latest biannual compilation was published last month and is entitled “Occupational Outlook Handbook.”

In this compilation they forecast demand and pay for over 300 jobs in 45 categories. So this may provide a clue for those searching and looking for an answer to where will I be in 5, 10, 20 years.

Good luck. I am hopeful this will provide you with valuable insight and information to what lies ahead.

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Wednesday, May 26, 2010


Dr. Robert J. Brueck MD frequently blogs about interesting information and news about advances in health, medicine and cosmetic surgery. He has recently completed the first facelifts in Florida using stem cell therapy. Here is some of the background. Also view the video in the adjacent posting.

I recently had my own encounter with stem cells. The mere mention of the word stem cells can evoke outrage over the political-ethical football this has become. But with recent advances, this may end and should once and for all.

As a young college student I played varsity soccer. Early one season I suffered a severe left ankle sprain. In these days, before MRI’s and arthroscopy, etc., the protocol was simple, we used crutches and elevation.

So it is now 40 years later I have severe degenerative arthritis in my left ankle. For awhile I controlled it with Celebrex. Had this been my hip or knee I would be on the table getting a new hip or knee. Total ankle reconstruction is not perfected and has many risks. Ankle fusion would be a last resort so I decided to go with the PRP (protein rich plasma) and stem cell route.

The whole process is simple in theory. We inject something from our body and heal another part of our body. The big question is “what is a stem cell?” A stem cell is a pluri-potent cell essence. A stem cell and has the intrinsic ability to differentiate to become a cartilage cell, a bone cell, a muscle cell.

Everyone has stem cells. We have them when we are born. Basically there are two types, embryos, which are ones that are creating all the controversy and adult stromal derived stem cells.

Throughout out our life our bodies produce stem cells which become skin or blood muscle cells. Through research we know that garden variety fat is a great source of stem cells. It has been estimated that 20 units of fat, a couple of ounces, contain about 25 million stem cells.

Who doesn’t have a few extra ounces of fat hanging around? In many cases, it truly is "hanging around".

Stem cells are found also in the brain, bone marrow, skin, etc. When I went to the east coast to have my stem cell injection, I spoke with Dr. Purita who did the injection.

They harvested my stem cells from my fat and then mixed it with my own PRP (protein rich plasma) and some growth hormone. Dr. Purita has done over 2000 of these and said “Bob, it works”. Obviously not 100% but the results have been exceptional.

Last week I saw Dr. Ron Gardner an orthopedic doctor here. He gave me another injection of PRP. My ankle is so much better. It feels better than ever but what is more encouraging is that I have not been on my daily dose of Celebrex for over 6 weeks.

With my success, I wondered how I might use this to help my patients. Many of my patients have severe sun damage to their skin. They try make-up, creams, light peels, lasers, high end prescriptions and not always with the best results.

I thought, why not take their stem cells and inject them into the face and try to “regenerate” their skin from the inside out. The cells were harvested, mixed with PRP and some growth hormone. With the patient comfortably sedated we injected fat into some areas plus stem cells, PRP, and growth hormone to the entire face. We injected just below the skin layer.

One of the patients I did Friday came back to work Monday. She really looked great and had minimal discomfort. So did the other two patients I did.

Be sure to watch the video.

I am excited about the prospects and am eager to learn more about this whole process. What is so great is that it’s “your own tissue”, how great is that? There is more to come.

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Thursday, May 20, 2010

Plastic Surgery Patient Consent Forms now online

Dr. Robert J. Brueck MD FACS, a Board Certified Plastic Surgeon practicing in Fort Myers, Florida, frequently posts news about his practice, his web site and the latest news in health and plastic surgery here.

As of now, Informed Consent Forms for Dr. Brueck's patients are online. They are linked in my web site at Beauty-by-Brueck, as Portable Document Format (PDF) documents. This means they can be printed on any computer-connected printer so patients may read them, digest all the important information they contain and sign them before leaving for scheduled surgeries.

"I strongly recommend that patients take advantage of this new benefit. So much time can be saved by preparation and understanding before arrival for the surgery at my office. By doing so, you allow me and my staff to process your paperwork faster and expedite your surgery. No one wants to spend unnecessary time sitting in the reception room filling out forms that they could have handled in advance."

To locate the forms on Dr. Brueck's web site either click on the Frequently asked Questions page for the applicable procedure. You will find another link on each of those pages that will access the appropriate Informed Consent Form.

Alternatively, you can click on the Patent Forms link on Dr. Brueck's home page. This will give you a list of links to the various Informed Consent Form PDFs.

"I hope you find this as convenient as it is intended to be. If you have any questions about the forms, you may call me or my aesthetic coordinator, Judy, at 239-939-5233. We will be happy to answer any questions or concerns."

Thank you for your attention again.

The Latest Plastic Surgery Stats, reported by Dr. Robert Brueck MD

Dr. Robert J. Brueck MD FACS, Fort Myers Board Certified Plastic Surgeon, regularly reports on news and events of interest in the fields of health and cosmetic surgery.

Cosmetic surgery statistics for 2009 were recently released.

I have to say there were no major surprises. The total number of cosmetic procedures surgical and non-surgical was down 3% compared to 2008. The number of surgical procedures went down a whopping 17%.

This is what one would expect with the current state of the economy. Nonsurgical procedures such as Dysport, lasers, etc, 8,491,861 in 2008 was up slightly to 8,522,139 in 2009.

What heads the list? The top five surgical procedures are:

  1. Breast augmentation

  2. Liposuction

  3. Eyelid surgery

  4. Rhinoplasty

  5. Tummy tuck

What were the top 5 non-surgical procedures?

  1. Botox-Dysport

  2. Fillers

  3. Laser hair removal

  4. Micro-dermabrasion

  5. Chemical peels

The total number of cosmetic procedures by men were just over 9% of the total, so men need to catch up with the ladies a little bit in this group.

The age group having the highest number of procedures was 35 to 50. This cohort was 44% of the total.

So what was America’s total bill for all of this?

It was a paltry $10.5 billion. I say that with tongue in cheek only because our society has moved to thinking "a billion dollars here, a hundred billion dollars there" and pretty soon, we're talking real money. Many people don’t seem to blink an eyelash.

It is a tremendous amount of money. With all of this runaway spending in our government, why not offer everyone free cosmetic surgery?

It truly is a misnomer. We seem to think free healthcare, free food, free cosmetic surgery, free unemployment and the truth and reality is that it is NOT free; someone is paying for it.

One of my biggest complaints or irritations is the tremendous waste fraud and greed that has permeated into our culture and particularly our federal government.

It seems that we have adopted an attitude of "it’s all about me". I think we can all pray that better days lie ahead.

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Wednesday, May 19, 2010

Plastic Surgeon Dr. Brueck comments on Fat.

Dr. Robert J. Brueck regularly blogs on interesting developments
in the field of health and cosmetic surgery.

Fat is an interesting word.

It can mean the substance that all of us eat in our normal daily diet such as steak, potato chips, French fries; you name it we eat it.

Or it can be used to describe you or me. Are we fat?

I think that every one of us, including me, has dieted at one time or another. It is hard to find that individual who “never grows around the mid section”. My roommate at medical school was one of those individuals. No matter how many banana splits Steve ate his weight never changed.

I recently read an article in the Wall Street Journal discussing being “fat”.

It seems that recent research shows that people who are 10 to 15 pounds overweight are NOT necessarily at an increased risk to die from cancer or heart disease. For example people in their 70’s who were a little plump had a longer life span over a 10 year time frame. Boy, I would fit right in right now.

Also, it seems a few extra pounds can help your bones fight off osteoporosis. Also a little extra weight can make a person’s face “appear younger”.

I now probably volumize the face. Many of the face lifts that I perform, I remove fat from the abdominal section, prepare it and then inject into the face in order to create a fuller more youthful look. I probably do this 20% to 30% or more of the time when I am doing a face lift.

I believe the fuller look is a more youthful look.

But then again having a few extra pounds means that you are cultivating stem cells for future use. Perhaps stem cell face lifts will be the thing of the future.

In the end it is not about having a few extra pounds. It is about what you eat and getting a moderate amount of exercise every week. So let the pounds fall where they may, enjoy, go at it and peace to all!!

Monday, May 10, 2010

HOW BOTOX REDUCES WRINKLES from Ft. Myers plastic surgeon, Dr. Brueck

Another in the series of blog messages from Dr. Robert J. Brueck MD, Board Certified Plastic Surgeon practicing in Fort Myers, Florida. This report contains information about Botox injections.

When patients come in and inquire about Botox-Dysport, many of them have misconceptions or have been misinformed regarding the subject.

I tell patients that the injection of the substance causes paralysis of the particular muscle group, which helps eliminate the development of frown lines so many people have between their eyebrows or around their eyes.

Botox does NOT reverse aging or rejuvenate skin. It merely prevents repetitive frowning that causes the wrinkles to become deeper and more pronounced as time goes on.

A recent study done by Dr. Roger Dailey-a professor at Ohio State University, found that after 2 years of treatment with these agents patients could cut the cost and the frequency of the injections that they would normally require.

In his study of 50 women, ages 30 to 50, he found that if the women received injections every 4 months for 2 years the injections could be delayed for up to 6 months and still receive the same results. This would then result in a decrease in the frequency and amount of Botox required.

So there you have it, a nice study that may help you and your planning.

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Saturday, May 8, 2010

How susceptible to skin cancer are you? Fort Myers Plastic Surgeon comments

Dr. Robert Brueck periodically reports on news from the medical field,
particularly in reference to matters of skin health. This report focuses on the risks of skin cancer.

Here in Southwest Florida, we have lots of sun all year around, which puts us at special risk for skin cancer.

But summer could be considered "skin cancer season".

In the summer it is particularly hot and our skin becomes more susceptible to the damaging rays of the sun.

As you may know, there are three types of skin cancer: basal cell, squamous cell and, of course, melanoma.

The one that we need to be particularly diligent about is melanoma.

I recently read an article by Dr. Darrell Rigel, a clinical professor of dermatology at NYU.

He has co-developed a model of six factors that independently predict an individual’s melanoma risks.

These include:
  1. History of blistering sunburn as a teenager

  2. Outdoor jobs for 3 or more years as a teen

  3. Red or blond hair

  4. Marked freckling on the upper back

  5. Family history of melanoma

  6. History of actinic keratosis or pre cancers such as dysplastic nevi

With two 2 or more of these risk factors, a person has a lifetime risk of melanoma that is five to 10 times that of the general population as a whole.

I think it is important that we are aware of these risk factors. If we have some of them, it would be prudent and wise to go to the dermatologist or a plastic surgeon to be evaluated.

I hope you will all get your SPF35 on and enjoy your time in the summer sun.

Thursday, May 6, 2010


Dr. Robert J. Brueck MD FACS reports periodically on subjects related to health, healing and plastic surgery. In this message, he hints at the possibilities for stem cell therapy in plastic surgery, based on his recent experience with it concerning his arthritic ankle.

As many of you already know, I recently went to the east coast of Florida to receive “stem cell” therapy to my severely arthritic left ankle.

Recently, I have been doing some reading and investigating into stem cells. Basically, there are two types of stem cells, embryonic and adult-derived. Embryonic stem cells are ones that come from fetuses and have been at the center of debate between conservatives and liberals for decades. Adult-derived stem cells come from your own body fat so being a little plump around the mid section may not be so bad after all - you can tell your friends and family you are stem cell planting for the future.

I traveled to Boca Raton on a Thursday evening because my appointment was at 9am on Friday and I didn’t want to be caught in traffic on Alligator Alley, or have the Alley be closed due to an accident. I really felt good and didn’t have much trouble sleeping. As usual, I got up at the crack of dawn. Linda and I put on the trusty GPS and off we went. You know me, if my appointment is at 9am, I will be there at 8am. Once we arrived at our destination we had to park and decide which building we were going to, floor, suite, etc. etc. Since we were early there really wasn’t any problem.

We went up to the waiting room and it was filled with people walking on crutches, people with canes, people wearing casts, just what one would expect. After giving them my insurance card, driver’s license and other required documentation, I returned to the lobby and was waiting for my name to be called. After about 20 minutes I was called back to an exam room and an X-ray was then taken of my left ankle.

Soon thereafter Mr. Jim Vandenbosch came into the room. He is a “clinical ortho biological specialist” working with Dr. Joe Purita, he went over the procedure with me and told me what to expect. I was not NPO so I assumed it was going to be under local. Indeed, it was, so I was able to eat breakfast.

Dr. Purita came in. He is an orthopedic specialist and is actually going to be doing the procedure. He has been doing protein rich plasma and stem cell transplants for several years and now has performed in excess of 2000. He looked at the X-ray and told me I had severe arthritis. I told him the pain in my ankle speaks to the arthritic nature of my ankle.

Basically, a stem cell is what we call a plur-poten cell, in other words it has the ability to differentiate down different cell lines depending upon the “neighborhood” it is in.

The stem cell is placed in an arthritic joint and the hope is that the stem cell will eventually form a new cartilage or bone cell and help restore and heal the involved arthritic joint.

Jim came in and prepped me and the donor site for obtaining the stem cells. It was my right posterior flank. The area was prepped and local was applied to the area, after several minutes Dr. Purita came in and made a small incision and obtained about 10cc’s of fat from the area.

The fat was allowed to separate and the fat was then transferred along with protein rich plasma and a small amount of growth hormone into a sterile syringe which was eventually going to be injected into my joint.

Protein rich plasma is derived from your own blood. They obtain about 20cc’s of blood and then spin it down separating the cells from the serum. Once this is completed, they obtain the buffy code which is in the middle and contains all of the platelets and growth factors.

This is all mixed together.

Then I went downstairs to the fluoro room. I was placed on the table and the fluoro unit was turned down to delineate my left ankle joint.

Over the course of 10 minutes, Dr. Purita injected the mixture into my ankle. At that point, I was done and he gave me instructions, and Linda and I were off to the races. We decided to stop and get a bit of lunch before we began the trek home to Ft. Myers.

That weekend I stayed home, put my leg up, packed it in ice and I was back to work on Monday. I will give you an update since it will take 4 to 6 weeks for this to start showing an effect.

In about 3 weeks, I will be going to Dr. Ron Gardner in Ft. Myers for more protein rich plasma injections to the joint in order to stimulate their growth. So far so good and we are hoping for a successful outcome that will help me avoid an ankle operation.

Is there a role for stem cell therapy in plastic surgery? At the rate, research and technology are proceeding, there well could be.

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