Wednesday, May 30, 2012

Incision choice in breast augmentation

Breast augmentation has rebounded in popularity to the top of the charts due to readily available silicone implants.  

Breast augmentation can be done through several incision types, inframammary, periareolar (around the nipple), axillary or armpit and periumbilical.  

Does the choice of incision impact the incidence of significant capsular contraction (remember EVERYONE gets a capsular)?  A recent study of 197 primary breast augs revealed a lower incidence of significant capsular contracture with the inframammary approach.  The rate of capsular contracture with the axillary incision was 13 times greater. It was five times greater with the periareolar.  The degree of significant capsular contraction rates is pretty much the same whether saline or silicone is used.

I insist that patients consult with me before going forward with any breast augmentation procedure. There are man considerations to discuss an agree on. I invite you to get a primer on breast augmentation at my Fort Myers plastic surgeon website.

Saturday, May 26, 2012

Why do we brag.

I guess we all have universal needs and wants.  We all want to feel loved and needed.  

Researchers recently revealed that when we brag about ourselves it triggers the same pleasure center in our brain like food and money.  Self disclosure or bragging was extra rewarding.  

I guess that explains why we all need a little self-indulgent kick once in a while. 

That may also explain some of he popularity of Facebook, almost a million members. You can find me on Facebook at Surgeon or at my Fort Myers plastic surgery website, Beauty-by-Brueck

Wednesday, May 23, 2012


Innovation is the cornerstone of progress in most human endeavors and plastic surgery is no exception.  Some of the advances I have seen in 30 years as a Fort Myers and Cape coral plastic surgeon are truly remarkable – I sometimes have to pause and catch my breath.

One area of new research and innovation has to do with the field of stem cells, autologous fat and PRP or platelet rich plasma.  There are recent trends that have received much hype and notoriety but I think it is important to not oversell something before we enough about it.

As we speak, studies and research are being conducted to unlock new avenues of clinical application of stem cells and platelet rich plasma.  The possibilities are only limited by the collective geniuses of hundreds of scientists world wide working to unlock the hidden secrets of stem cells and PRP.

For years, stem cells were a hot political issue and to some extent that persists today but to a lesser degree because of new discoveries in stem cell research.   We were led to believe the only stem cells available for research were embryonic, but we know now that the “pooch” around our stomachs – mine included – contain millions of stem cells.  It really is not necessary to go out and harvest embryos or fetuses.

Basically a stem cell is a pluri potent cell, ie. a cell looking for a neighborhood to hang out in or grow up in.  If you put a cell in say an ankle joint – the stem cell looks around and hopefully will differentiate say into a bone or cartilage cell.  I have had stem cells injected into my arthritic left ankle three times with what I consider good results.  Is my ankle like it was before my injury – no!  Is it less painful – yes.  So, many questions remain to be answered.  One of these newer trends in cosmetic surgery is to augment the face with a patient's own fat stem cells and PRP.

I would say about 30% of the time or more, I recommend patients get autologous fat to build up their facial structures.  As we age we loose volume – our skin thins – it sags – we lose collagen and elastic fibers.  Finally one day we wake up – look in the mirror and decide the time has come to do something – time to go see Dr. Brueck about some cosmetic surgery in Fort Myers, Florida.

The fat/stem cells are usually harvested from the patients abdomen.  We recommend combining the fat/stem cells with the patients own PRP.  This combination of fat/stem cells – alone or with PRP is then injected into a patient's face to build it up and replenish what was lost due to aging.

Sunday, May 20, 2012

What is PRP?

We hear so much about PRP – What is PRP?

This three-letter name stands for "Platelet Rich Plasma."

How do we get PRP?

The process is very simple.  We draw off about 60-70 cc’s of the patients’ own blood.  We then spin it down for several minutes.  This gives us the red cells in the bottom of the centrifuge tube and the top half containing plasma, platelets, ie. the platelet rich plasma.  

We recently had a new development which allows us to get super concentrated platelet rich plasma.  After the initial spinning down – we draw off the plasma – minus the red cells.  We then spin it down a second time for several minutes giving us pure or more concentrated PRP which we then mix with the patients own fat and stem cells.  It is this combination that we inject into the patients face to augment it.  This would be in lieu of say Juvederm, Restylane or Sculptra.  The best part is it is cheaper – lasts longer and it is your own tissue.

What makes platelets so special?

Platelets are very special and have a very prominent role in healing wounds.  Part of their magic centers around them containing x-granules.  These are small packets contained within the platelets that have several growth factors, ie. protein with growth factors that are released when the platelets are activated.  These factors increase in growth of blood vessels, new collagen and a whole host of other cellular functions to heal and rejuvenate our skin.  The proteins contained in these granules influence many aspects of wound healing. 

What’s on the horizon?

More and more people want simple – easy – no downtime procedures to enhance their facial appearance.  That helps to explain the explosive growth in Botox and fillers.  Millions of these procedures are done every year and their popularity is growing.  People want something easy – quick with no downtime.

This may be the "miracle" they are hoping for.

Why Starbucks makes "bucks"

Several months ago, I posted my thoughts and some findings about coffee consumption and health. Now, the New England Journal of Medicine chimes in with the findings of a massive (400,000 subjects) study of coffee drinkers.  The article is excerpted below.

"Association of Coffee Drinking with Total and Cause-Specific Mortality

Neal D. Freedman, Ph.D., Yikyung Park, Sc.D., Christian C. Abnet, Ph.D., Albert R. Hollenbeck, Ph.D., and Rashmi Sinha, Ph.D.
N Engl J Med 2012; 366:1891-1904 May 17, 2012


Coffee is one of the most widely consumed beverages, but the association between coffee consumption and the risk of death remains unclear.


We examined the association of coffee drinking with subsequent total and cause-specific mortality among 229,119 men and 173,141 women in the National Institutes of Health–AARP Diet and Health Study who were 50 to 71 years of age at baseline. Participants with cancer, heart disease, and stroke were excluded..."  

"Inverse associations were observed for deaths due to heart disease, respiratory disease, stroke, injuries and accidents, diabetes, and infections, but not for deaths due to cancer. Results were similar in subgroups, including persons who had never smoked and persons who reported very good to excellent health at baseline.


In this large prospective study, coffee consumption was inversely associated with total and cause-specific mortality. Whether this was a causal or associational finding cannot be determined from our data. (Funded by the Intramural Research Program of the National Institutes of Health, National Cancer Institute, Division of Cancer Epidemiology and Genetics.)
Supported by the Intramural Research Program of the National Institutes of Health, National Cancer Institute, Division of Cancer Epidemiology and Genetics.

So, if you love coffee and have been worried about it's affect on your health, this should be reassuring. Perhaps we should offer a cup of coffee when you come to visit my Fort Myers plastic surgery center.

Thursday, May 17, 2012

Do you sweat too much? Read this.

Several million people suffer from hyperhidrosis, or excessive sweating.  It is estimated that 2-3% of population has hyperhidrosis.  People with hyperhidrosis often sweat even when it’s cool outside.  It runs in families and many people choose to live with it since, no permanent effective treatment existed until now.  There are several conditions that can cause excessive sweating such as menopause, hyperthyroidism.  This is termed secondary hyperhidrosis. 

The main symptoms are excessive underarm perspiration.  It can effect the palms and soles of the feet.  Most people with excessive sweating have had to alter their lifestyles, and their clothing because it causes many embarrassing moments not to mention permanent stains to blouses, shirts and other articles of clothing.

Available Treatments:

This is the front line of therapy for most people.  Usually the deodorant consists of 10-20% aluminum chloride hexahydrate.  This can be irritating to your skin and expensive.  It can also cause damage to your clothing. 

Some people have tried anti-cholinergics such as robinul but these are not very popular due to side effects such as dry mouth, dizziness and difficulty urinating.

This is an FDA approved procedure that utilizes electric current to temporarily shut down sweat glands.  This is effective for hands and feet.  It takes 10-20 minutes per session and several sessions are needed.

The FDA has approved Botox for underarm sweating.  About 70-100 units are divided equally between the patient’s armpits and injected.  At a cost of $10-$12.00 per unit the expense is considerable.  The Botox may last 3-6, months but again is only temporary.

Endoscopic Thoracic Sympathectomy (ETS)- 
This transects the nerve that is responsible for stimulating your sweat glands.  This is usually not too effective for excessive armpit sweating.  It’s good if someone has excessive palms, sole or facial sweating.

Other surgical rx’s-
Sometimes one can use special suction cannula to remove the sweat glands or use a special surgical shaver which will “shave” away the glands.  These are surgical procedures; often require anesthesia and a more prolonged recovery.

This can be a very disabling and devastating condition.  It causes extreme embarrassment.  Many people alter their types of clothing- the colors they wear.  They limit their arms or shoulder movement so as to not reveal their wet armpits.  It can affect careers where people need to manipulate equipment with their hands, like a surgeon.  Then there is a risk of dehydration.  I had one patient who would drive to work with her armpit hanging out the car window to “keep them dry.”


Late last year, miraDry was approved by the FDA to correct permanently excessive axillary or armpit sweating.  It is NOT used to treat excessive hand or foot sweating.

The procedure is done under local anesthesia as an out-patient.  In Fort Myers, FL, this will be either in the licensed surgery center of Dr. Robert J. Brueck MD, who is the only Southwest Florida surgeon licensed to perform the procedure, or at Fort Myers' All-Inclusive Medi-Spa, by staff trained to perform the procedure.  The area of skin with excessive sweating is determined and infiltrated with local anesthetic, similar to the way Novacaine is administered when having a tooth filled. The miraDry procedure is then performed.  The treatment of both armpits takes around 40 to 45 minutes.  The miraDry machine delivers electro-magnetic energy to the armpit area to eliminate the eccrine or sweat glands.  Once eliminated, these glands DO NOT regenerate.

What will it feel like?  There are no incisions.  Once the local is injected, we wait 5-10 minutes for it to take effect.  This totally eliminates any pain or discomfort.

What do I do after the treatment?  It’s simple, we usually put some ice packs under the patient’s arms and they are discharged home.  The most important thing the first day or two is ice to minimize the swelling.  Usually a simple Motrin or Advil is all that is needed for controlling minimal pain.  You can shower the next day and go to work.

What are the results?   Most patients will experience an immediate reduction in their underarm sweating.  In one clinical trial patients experienced an 86% reduction.

How many treatments do I need?  You will need 2 treatments separated by about 3 months to maximize your results.  On rare occasions a person may need a 3rd treatment.

How long does it last?  The decrease in sweating is permanent.  Once the eccrine sweat glands are destroyed by the electromagnetic waves, they do NOT regenerate.

Is it harmful to de-activate under arm sweat glands?  The sweat glands in the under arm area represent only 2% of the total number so there are NO more bad side effects.

Who can have mira-dry?   Patients should be 18 years or older. If you have excessive sweating, this is made to order.

Dr. Brueck, a Board Certified Fort Myers plastic surgeon, advises that this article is for informational purposes only and should not regarded as medical advice. 

(c) 2012 Dr. Robert J. Brueck MD

Wednesday, May 2, 2012


What is this?  Once again we are utilizing the patients own tissues.  

We draw off 60-70 cc’s of a patients blood and spin it down twice to get super concentrated PRP with all of those growth enhancing proteins. 

We apply an anesthetic cream to the patients face - sometimes use a little ice which is numbing as well.  While the cream is working we draw the blood and get our concentrated PRP.  After working and prepping the face, we spray the activated PRP onto a small area of the patients face, say the forehead.  We have a micro-dermal roller with very tiny needle points 1 mm in depth and make literally thousands of small openings in the patients skin to allow all of these goodies, ie. growth factors, to sink in.  We roll – massage – roll – massage. 

We then move to another area, say the left cheek, and repeat this process until the entire face is done.  Once completed we cover the patients face with a collagen mask for 15-25 minutes.  It’s removed and the patient goes home – they don’t shower or wash their face that night.  Up in the morning – shower – and back to normal routine with a new healthy glow to their face.

As a plastic surgeon in Fort Myers-Naples, I do not want to oversell this procedure, but UNDERSELL it.  This is NOT  a facelift, but it is a good way to restore your skin to a more normal healthy appearance. 

I recommend a patient receives 2-4 of these treatments separated by 4-8 weeks.  It is also helpful if a patient is on a good skin care program such as Nia-24 or Obagi.  Some patients may need a peel to soften wrinkles – fat to fill in hollows or depressions - but the key is that the combination of all of the above can go along to help rejuvenate a patients facial appearance.  Again, it is NOT a facelift.  Also remember whenever a non-surgical procedure is done on someone – there may be a tremendous variation in one patient's response compared to another.  It’s another alternative – another choice – outpatient – non surgical – minimal downtime.  It is not a panacea, but surely a step in the right direction.