AGING - It appears to be in your bones.

Another in a series of blog postings by Fort Myers Board Certified Plastic Surgeon Dr. Robert J. Brueck MD FACS of Fort Myers and Cape Coral, Florida. For more information about cosmetic surgery procedures available in fort Myers, visit Dr. Breuck's web site, Beauty-by-Brueck.com

Aging is something I deal with every day.

Women come in and say my friend Brenda is 10 years older than me, but she looks younger than me. Why is that?

There are so many factors such as sun exposure, genes and the list goes on. For some it's simple, wrinkles and loose skin. But now we can add a new player in the game of facial aging: your facial skeleton.

Researchers at the University of Rochester studied the facial skeleton of 3 age groups. Included were young (20-40's), middle age (41-64) and older (65 and up -I say more mature).

One finding was that the orbit, which contains our eyes, widens and lengthens as we age. The length and height of the mandible decreases with age.

These changes occur sooner in women than in men. That may help to explain in part why men seem to "age better."

It also helps explain why I "volumize" the soft tissue of my patients filler with their own fat and stem cells.

Please visit the website of Dr. Robert J. Brueck MD FACS at Beauty-by-Brueck.com for more information on matters of aging and cosmetic surgery.

NOSE-WORTHY HISTORY REMEMBERED

Another in Dr. Robert j. Brueck MD FACS's series of blogs on subjects of medicine, health, cosmetic surgery and youthful appearance. Dr. Brueck posts more about these subjects on his plastic surgery web site at Beauty-by-Brueck

Plastic surgery is a sub-specialty that has evolved over the centuries.

During the great World War much progress was made in the development of plastic surgery as a recognized surgical sub-specialty. A rare book dealing with plastic surgery was recently purchased at an auction in England.

The book was published in 1597 and was entitled "De Curtorium Chirurgia Per Inritionem." It was written by Gaspare Tagliacozzi, who was a professor of surgery and anatomy at Bologna University.

One of the diagrams in the book shows a patient with a flap from their upper inner arm attached to their nose.

This attachment of the patient's nose to their upper arm had to remain in place for about 3 weeks. Then the flap was separated and inset in the nose to reconstruct it. A true classic!

By the way, if you are looking for something special and unusual for that special person in your life, it was sold at auction for about $17,000.00

This fore-runner to modern rhinoplasty, more commonly known as "nose jobs", has evolved into countless procedures that have made life more enjoyable for individuals with unattractively shaped noses. As one of the most prominent features on a face, a beautiful, aesthetically proportioned nose can be an asset in life.

Happy New Year.

Dr. Brueck on Tumy Tucks and Mommy Makeovers

As part of his continuing appearances on The American Health Journal appearing locally on WINK-TV, Channel 5, Fort Myers, Dr. Brueck talks about Mommy Makeovers and Tummy Tucks in this appearance. You also find more information about the subject at Dr. Brueck's web site, Beauty-by-Brueck.com

Thank you for viewing.

If you have any additional questions on this subject, you may find answers on Dr. Brueck's web site's Frequently Asked Questions. Or you may contact Dr. Brueck directly at 239-939-5233.

Stem Cells: What does the Future Hold?

Dr. Robert J. Brueck, MD FACS regularly blogs about matters of health, medicine and cosmetic surgery. Learn more about Dr. Brueck at Beauty-by-Brueck.com

"Bright, promising, exciting, cutting edge", are terms that we can use to describe what lies beyond the horizon in stem cell therapy.

There is much to be learned from stem cells derived from bone marrow and something most of us all have, stem cells derived from fat. Many of you have read one of previous blogs about my own encounter with stem cells.

As you know I had them injected into my severely arthritic left ankle about 4 months ago. The results, in my opinion, are nothing short of fantastic. It is still a little sore but going up and down the stairs is no longer cause for me to grimace in pain.

So where are we? Where do we go from here? There is no question that stem cells have applications across the whole spectrum of medical conditions/problems i.e. cardiovascular, arthritis, burn therapy, reconstructive surgery, breast augmentation, diabetes, strokes and the list goes on. The list is endless.

Plastic surgeons are heavily involved in stem cell research.

Stem cells are plury potent cells so they can differentiate down different cell lines. They may become bone cells, heart muscle cells, whatever. They are cells looking for an identity.

When they put my stem cells in my ankle once they “got home” they were surrounded by old bone and cartilage cells so they said why not become bone or cartilage cells.

There are still many mysteries to unravel.

What causes a cell to differentiate down a particular path? What turns it on? How can we control it?

There are some preliminary studies that show fat-derived stem cells may be stimulated to produce insulin. These are exciting advances.

Some researchers in Finland were able to direct fat derived stem cells to become and produce bone tissue. Plastic surgeons are on the forefront of this exciting new field of research.

The U.S. Department of Defense is funding research to see what influence stem cells may have on scars produced in war times. Also, how stem cells can be used to treat soft tissue injuries or defects created from war injuries, such as on the face.

Another exciting avenue of research concerns the use of stem cells as “carriers of drugs”. In essence the stem cells would be fitted with a certain drug and delivered to a part of the body where this drug is needed to treat a particular medical condition.

What causes a stem cell to become a bone cell? Or a heart muscle cell? Some researchers believe that a stem cell has a built-in DNA program (also, cells have DNA) and will manifest this program depending upon the neighborhood you put it in. For example: When I had stem cells put into my ankle the stem cells looked around and saw other bone and cartilage cells and decided to join the crowd.

Some researchers believe it’s not the DNA program in the cells but the “the environment” that it is put in. How a stem cell differentiates is based on outside factors in its new environment i.e. the environment will send signals to the stem cell to cause it to differentiate down a particular line.

Another area of research involves developing a scaffold to allow the stem cells to do their work.

The scaffold is like the steel girders of a building where the framework is and the stem cells are walls and the windows, etc. The idea is that you create a compatible scaffold, populate it with stem cells and let them grow over time – the scaffold dissolves or breaks down over time and we have a new organ.

Many questions remain to be answered.

For example: When we do stem cell facelifts we are not concentrating the stem cells i.e. it is a mixture of fat and stem cells. What would happen if we only injected concentrated stem cells and no fat? These are questions yet to be answered.

The use of autologous fat grafting has been around for years and years and in that fat there are stem cells as well. These fat grafts have been used mainly in facial rejuvenation. In my practice I employ fat/stem cell grafts more and more because one of the signs of aging is the loss of volume in our face. Also the sun damage created to the skin causes it to thin and loose its elasticity and sag. It’s a borrow-from-Peter-to-pay-Paul scenario.

We are not seeing autologous i.e. "your own” fat grafts to breast augmentation. You can use fat in the reconstruction of defects in the chest wall following breast cancer surgery. Dr. Scott Spear, who is chairman of the plastic surgery department at Georgetown University, uses fat in some of his breast reconstructions. He is ambivalent about it.

In some patients, fat grafting works well and in others it doesn’t.

There are no guarantees in life. Dr. Spear also said there is very experimental work that says fat grafting to the breasts may potentiate the growth of cancer cells. He said, “that doesn’t mean it’s happening but it would be naive to assume it’s not”.

The use of fat grafting in irradiated skin holds a lot of promise. Dr. Sydney Coleman of New York is one of the pioneers in fat grafting. He has had excellent results in using fat grafting for irradiated wounds. He also has used fat grafts/stem cells in treating scars, particularly scars that are depressed.

Dr. Gino Rigotti of Verona, Italy has been using fat grafts to irradiated skin. “Before we injected fat I believe the damage caused by irradiation was irreversible - that we would need to excise everything irradiated and replace it with a skin flap, but after using fat we have seen a transformation to normal tissue with normal sensation”.

Dr. Curry, a plastic surgeon in Miami, has even used autologous fat to treat Dupuytren’s contracture. He cuts the contracting bands and once that is complete he injects fat into the area and which prevents the bands from reconnecting. This transplanted fat along with the release of the contracting ligaments has given him outstanding results.

Exciting as the horizon is many questions remain to be answered.

What are the areas of the body are the best sites from which to harvest fat? How do we prepare the fat? What do we add to the fat to enhance its take? How do we control the differentiation of fat cells? These are just some of the many questions we need to have answered.

The journey has begun and the future indeed is bright.

Dr. Robert J. Brueck regularly blogs about matters of health, beauty and cosmetic surgery. In this message he comments on a recently received testimonial.

I have often written about the effect of cosmetic surgery on how a person feels about himself or herself. I think it is important to keep that in mind because it is all too easy to disparage cosmetic surgery as an act of selfish indulgence. Yet, no one would speak that way about emotional therapy, would they?

I know from experience that 99% of the people who come to me for free consultation want to improve their appearance in order to overcome a lack of confidence, whether it is the way they look, the way they feel with friends, their ability to compete at work.

It is one of the most rewarding parts of what I do to hear from people for whom cosmetic surgery has been life-changing.

The other day, I received this poem from a patient. It says more eloquently than I can what cosmetic surgery is about. Please read it.

"Dr. Brueck:

I'm sure you receive so many gestures of saying "thank you" everyday.
A card, a smile, a homemade cake, each patient in own special way.

In my prior life, its words I'd use to express how a client would feel.
Trying to do it about myself makes it seem a little surreal.

My friends would ask if I was ok. I looked so stressed and tired
I couldn't explain the life I lead needs a sign that says, "Stress Required".

I can walk miles; eat just right, value life as I was taught to do.
But no matter how I tried, that stressed look kept bulging through.

The first time I came to see you, I had no idea I would find.
A very kind and generous man, who would help me, leave all that behind.

Thank you seems so silly, no short and not very clear.
But you have given me the gift. I don't shun at the lady in the mirror."
- J.T.

Incidentally, this letter and others, including videos, are posted to the testimonial page on my web site as well. Please visit when you have a chance. Thank you.

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.

PHYSICAL MARVEL - On human growth hormone by Dr. Brueck, plastic surgeon

We have Marvel comic book heroes. They surround us each and every day. We are very familiar with them since they have been popularized in movies of late.

In real life many of us strive to be that “Marvel specimen”. Many people have resorted to the miracle drug; HUMAN GROWTH HORMONE.

Many of my patients have asked me about it in the past and I did some research on it but for some reason I never pulled the trigger. I guess I decided to age sans growth hormone.

They do say sometimes that aging can be graceful and beautiful, I don’t know why but for some people that seems to be the case.

A recent study done at Johns Hopkins University showed that growth hormone levels did NOT affect the life span positively or negatively.

The lead researcher in this study was Dr. Roberto Salvatori, in the department of endocrinology. He found that even people with severely DEFICIENT levels of growth hormone appeared to live as long as people with normal levels.

There was a similar study done at Stanford University in 2007 that encompassed 220 healthy individuals. They found no evidence that growth hormone levels positive or minus promoted anti aging.

I guess we have to be a little more cautious when we sit down at the breakfast table and have an extra bowl of the breakfast of champions.

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When it comes to aging, plastic surgery can't turn back the clock. But it can turn back the clock "face". You don't have to look any older than you feel. Let's talk about it. Call me at 239-939-5233 or check out my web site at www.Beauty-by-Brueck.com

DO PLASTIC SURGEONS HAVE COSMETIC SURGERY? Dr. Brueck comments.

This is really a great question to ask and many times when patients come in to see me I have been asked this question, "Have you had plastic surgery”?

I will wait until the end of this discussion to “tell all”.

A recent survey was sent to 2,635 randomly selected plastic surgeons and of those 276 responded. 62% of respondents had at least one minimally invasive procedure, which could be Botox, fillers, things of that sort.

Females were more likely to have more procedures done than their male counter parts. One third of respondents had at least one cosmetic surgery procedure performed. The most common procedure was liposuction of the trunk and the abdomen.

So there you have it. Yes, we do have cosmetic surgery. As far as I’m concerned, I am also in that group, I have had cosmetic surgery done and about 20 years ago I had liposuction done to my abdomen and flanks, which many people refer to as "love handles."

I guess that gives new meaning to the expression, "Been there. Done that."

I hope you all have a wonderful, happy, healthy and prosperous New Year. Take care and God Bless.

If the spirit moves you to find out more about plastic surgery and how it might be right for you, check out my web site at http://www.Beauty-by-Brueck.com.

As a past user, I can recommend it.