BOTOX: A New Treatment for Depression?

Getting a wrinkle-free look is enough cause for enjoyment, but Botox® cosmetic may be going deeper.

A study conducted by Georgetown University seems to have found a fix for depression. In an analysis of 74 people, all who had been diagnosed with depression, Botox® was administered to half (while the other half received a placebo) over a span of six weeks. With the injections given between their brows, each of the participants was asked how they felt post-administration. Those who received Botox® reported a better mood by 50%.

What is it about a Botox® injection that can lighten the mood or damper negative thoughts? Let’s take a look:

How Botox® can affect you:

  1. Stops the contraction of muscles that cause wrinkles
    1. When Botox® is injected, muscles that normally form those worry lines, crow’s feet, and frown lines are relaxed. Brain stimulation from these muscles is consequently relaxed.
  2. Reduces fine lines for 3-6 months after administration
    1. Not only will you have a significant wrinkle reduction for this period of time, but you will also notice your facial expressions have changed – less frowning leads to more happiness.
  3. May cause light bruising that will go away in a matter of hours
    1. There’s extremely minimal downtime with Botox®. If you’re heading back to work, to a big event, or social gathering, there’s no need to worry about your appearance.
  4. Brightens your face by combating lines around the eyes, mouth, and forehead
    1. With wrinkles and fine lines diminished, you’ll appear younger, more vibrant, and happier.

With all of this, essentially, if you aren’t able to see your frown lines, you are happier. Less visible wrinkles, little risk, and a brighter complexion for up to half a year can really contribute to a more positive demeanor.  Even with this positive finding, we must understand that this is a preliminary study and it may well not prove helpful for all forms of depression.  Stay Well

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The Causes and Treatment of Breast Asymmetry (Uneven Breasts)

The condition of breast asymmetry or uneven breasts is much more common than most people think.  As a Plastic and Reconstructive breast surgeon in Wisconsin, I would guess that approximately 65% of the women that I have examined have some form of breast asymmetry.  Breast asymmetry is defined as a difference of form, position or volume of the breast and in most cases the difference between the breasts is about ½ cup but occasionally may be a 1 to 2 cup size difference.  It is also interesting to note that this condition can cause some rather significant psychological problems, as noted in a recent study by the American Society of Plastic Surgeons.  The causes are unknown but I feel the four main reasons that we see this condition are:

  • First, would be a hereditary cause, where this is passed down from generation to generation.
  • Second breast feeding on one breast more than the other can cause differences in size.
  • Third and thankfully less common is the presence of a breast mass.
  • Fourth, a deformity of the Chest wall may also contribute to displacement of the breast leading to the perception of asymmetry

The treatment for uneven breasts is dependent upon the severity of the condition.  Listed below are the three most common conditions and their recommended treatment.

  • Mild Asymmetry with no evidence of breast sagging …. A small augmentation (breast implant) of the smaller breast would usually be sufficient.
  • Larger breasts with some evidence of breast sagging on the larger side….. A breast lift of the larger breast.
  • Much larger breasted female with a significant asymmetry…. A breast reduction on the larger side.

The procedure for the treatment of breast asymmetry is:

  • Usually done under a general anesthetic in our office
  • The surgery takes about 2 hours to perform
  • A return to normal activity takes about 2 weeks, depending on the type of procedure done
  • This is usually considered as a cosmetic procedure and is therefore not covered by insurance.

Patient presented with significant breast asymmetry. Underwent

Bilateral Breast Lift.. Post-operative photograph at 4 months


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6 Steps to Speed Insurance Coverage for Breast Reduction

The process of seeking prior authorization for Breast Reduction can be very frustrating because many insurance carriers have developed more rigid guidelines prior to approval.  I have performed over 2,300 breast reduction cases, and my staff and I have developed a protocol that we have found very helpful in 1. Reducing the time for approval and 2. Increasing the percentage of those patients that have received approval for Breast Reduction. Below is our step-by-step approach to seeking prior insurance authorization:

  1. Seek your consultation with a surgeon that is board-certified by the American Society of Plastic Surgeons who has performed a high volume of breast reduction cases and is familiar with the process of insurance authorization.
  2. Have all of your documentation including: your insurance information, all of your symptoms, any input from you primary care physician regarding your symptoms, any conservative measures that you have employed to reduce your symptoms, and, if you are older than 40, the results of your most recent mammogram, forwarded to your Plastic Surgeon prior to your consultation.
  3. Document your symptoms well. The most common findings  associated with enlarged breasts are:
    1. Bra strap irritation
    2. Upper and lower back problems
    3. Neck strain
    4. Chest wall heaviness
    5. Rashes beneath the breasts
    6. A decrease in overall activity levels because of the above
    7. Overall difficulties during your employment because of your breast size
  4. Provide a complete list of the conservative measures that you have employed over the past year to improve your symptoms:
    1. Physical therapy: massage, heat treatments for the back
    2. Chiropractic care
    3. Medication for back soreness: Tylenol, muscle relaxers
    4. Special support garments employed
    5. Documentation from your primary care physician regarding your symptoms
  5. Match a reasonable weight relative to your height 
  6. During your consultation your physician will review all of your documentation, perform a detailed examination, and forward a letter including your photographs to your insurance carrier.

If the above guidelines have been met, we see coverage within 2-6 weeks.  If there has been inadequate documentation provided, the approval process may require 4 to 8 weeks.   Depending on the insurance carrier and the physical examination findings, our approval rate over a 30 year period has been 70 to 85%. For more information on the breast reduction procedure, the recovery, and before and after photographs, please visit us at

Good luck!

5 Tips to Help Avoid Breast Sagging

Breast sagging is, unfortunately, a certainty in your lifetime. As you get older there is a loss of skin elasticity because of the normal reduction of the connective tissue layer beneath the skin. You may notice:

  • A loss of fullness on the upper portion of your breasts
  • You feel a push-up bra is a necessity
  • You feel going bra-less is not an option
  • You feel your nipples have fallen into a lower position.

These unwanted changes in your breast shape are usually caused by:

  • Breast enlargement during pregnancy
  • Weight fluctuations
  • Hereditary factors (your mom may have had saggy breasts – “Thanks, Mom…”)
  • Natural aging
  • Anything over a D-cup bra

The Myths of Reducing Breast Sagging

There are, unfortunately, several myths that have been promoted as being able to improve or reduce the chance of breast sagging.  In my estimation these factors are untrue.

  • Certain exercises can reduce breast sagging and help avoid it.
  • Push up bras can slow and reduce the occurrence of sagging.
  • Breast feeding can enhance the risk of breast sagging. A recent study by the American Society of Plastic Surgeons has determined that this is not the case. I feel breast feeding will usually reduce the degree of breast sagging because of breast size reduction during nursing. This puts less stress on the skin of the breast which ultimately leads to less stretching and less sagging.

Ways to Minimize Breast Sagging

While sagging is inevitable in most women, you can take these steps to at least minimize it:

  1. Good skin quality through a Healthy Diet. The average adult should consume 2-3 portions of protein per day. This can consist of meat, milk, fish, eggs, soy, beans or nuts.
  2. Avoid Smoking: Smoking weakens and ages the skin and will also reduce that very important collagen layer.
  3. Avoid putting on or losing weight too quickly. Crash diets can result in a sudden loss of breast volume, resulting in a deflated breast skin envelope.
  4. Don’t Skip the Sunscreen: Exposing your face to UV rays without the protection of a protective coating of sunscreen can cause premature wrinkles and a decrease of the collagen layer. It has the same effect on breast skin which will increase the chance of breast sagging.
  5. Take Care of your Skin: It is highly recommended that you regularly use a non-oily moisturizer that won’t clog your pores and a stem cell serum to boost your breast skin’s collagen layer. We have formulated this two product regimen and have found it works best in our patient population.breast lift eau claire, breast lift wisconsin, breast lift cost, breast sagging, breast lift before and after, breast lift recovery, breast reduction, nipple reduction eau claire, breast reduction wisconsin

Breast sagging is inevitable but the process can be slowed and the overall extent can be reduced.  Hope these tips prove helpful.  Don’t forget prevention and maintenance are the key to success.  Stay Well.


Joseph Rucker M.D. F.A.C.S





Avoid That Mid-Summer Skin Meltdown


Well those of us living in the upper mid-west will begin to experience our much awaited hot and sticky, summer season.  It’s easy to let the heat get the best of us. Here in the upper mid-west, sun, 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.  Living here we are more prone to develop more sun damage because of

  • Our propensity to enjoy our outside Wisconsin summer activities
  • Excessive Sunshine
  • High Humidity and Heat
  • High percentage of our local residents having fair skin which is more prone to sun damage


This article was published in Arizona Sports & Lifestyle Magazine for their Summer 2016 issue. 

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All of these factors contribute to skin damage which we see as the early appearance of fine line wrinkles, irregular pigmentation, uneven skin tone and a dull skin color. So to help avoid these damaging factors without sitting inside in front of your air conditioner for the rest of the summer, try a few of these tips to better manage the heat, the humidity, and the sun so you can get outside and enjoy your active lifestyle.

  • Hydrate, hydrate, hydrate. We all know water is essential in the heat of summer and Dr. Joseph Rucker recommends eight glasses a day, and even more in warmer weather. Seem like a lot? Try breaking it up to one glass every hour, or liven up your water by adding a lemon or lime which will also help cleanse your system of impurities, improve digestion and stimulate the liver. Don’t forget other great sources of water such as watermelon, berries and other water-rich fruit!
  • Tone, baby, tone. A travel-sized container of your favorite toner might be your new best friend this summer. Misting your skin throughout the day will allow the toner to absorb excess oil and keep you looking fresh- even on the most sweltering days! We highly recommend the ENZA natural toner because of it less irritating effects.
  • Sunscreen to start your day. The best way to protect your skin against sun damage is to wear a broad spectrum sunscreen anytime you are exposed to UV rays. To prevent your-sunscreen from sweating off during outdoor workouts, first apply a light moisturizer which contains a natural anti-inflammatory component.   Also, remember SPF does not stand for the strength of the sun-block it refers to the theoretical amount of time you can stay in the sun without getting sunburned.  We strongly suggest that you double up on the application in those areas that are more exposed such as back of neck, cheeks and your nose and head gear and also UV-protective clothing is highly recommended.
  • Color your palate. What better time than summer to eat colorfully! Stop by you’re the local farmers market for an array of fresh, local vegetables to add to your cooking. Look for foods with Vitamin C, such as bell peppers, fresh herbs, leafy greens, broccoli, sprouts and strawberries, or try applying it directly to your skin in a topical form, such as a Vitamin C Serum. Vitamin C is an excellent way to fight off free radicals and team up with your SPF to stand up to UV rays.
  • Wine Night! Red wine is rich in antioxidants and loaded with other benefits! Dr. Rucker agrees, “The flavonoids found in red wine can help your body fight against skin cancer.” So kick back, relax, and enjoy the benefits of your favorite red wines. Note! It is important to drink in moderation (1-2 glasses) and to follow up with plenty of water to stay hydrated!


Try these tips and allow yourself to enjoy the longer days, warm weather, and fun summer activities while you still can. Don’t let the heat and humidity stand in the way of you and your much anticipated upper mid-west summer!

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6 Things To Consider Before Scheduling your Breast Augmentation

The Optimal Age for Improving your appearance can be rewarding at any age provided you have no underlying health conditions that impact the safety of surgery. However, there are some advantages to considering this procedures during a particular age range.  For breast augmentation, anytime between the ages of 21-45 is ideal.

  • Prior to having children you would want the implant under the muscle where it won’t interfere  with your ability to breast feed.
  • After Children, you might require a combination of an augmentation and a breast lift because of the toll pregnancy, nursing and gravity takes on your body.


  1. Recovery after Breast Augmentation: Planning Weddings, reunions, vacations and other special events are the perfect catalyst to want to look your best. Keep in mind, the physical and emotional aspects of recovery vary from person to person. Below are some general guide lines for recovery:
  • 7 day: light lifting (5 lbs.)                                     breast augmentation recovery, cost,breast augmentation eau claire, breast augmentation, wisconsin, breast augmentation photographs, breast augmentation costs, breast augmentation before and after, breast implants, gummy bear implants
  • 10 days: resumption of office work
  • 2 weeks: lifting 15-20 lbs
  • 3 weeks: Light upper body workouts
  • 4-6 weeks: resumption of normal routine

      2. How Much Pain Should I Expect After Breast Augmentation: Most patients rate the pain associated with breast augmentation between a 5 to 7 on a scale of 1 to 10. In the nearly  1,000 augmentations that I have performed,  patients rate their pain between a 2-5. I attribute this lower pain level to the use of an oral muscle relaxer which his patients start the day before surgery and then continue for 2 weeks after.

     3. Implant Size: Sizing options are determined by a patient’s height, weight and shoulder width, but truthfully most decide on a full C cup with upper pole fullness. Some general recommendations relative to the patient’s height are as follows:

  • 4’ll” – 5’4″    340-370cc    (C to C+ cup)
  • 5’4″  – 5’8″     370-420cc   (C+ to small D cup)
  • 5’8″ and above   400-480cc  (small D to mid D cup)

         Simulation of the Breast Enlargement: Relative to the above findings it is helpful to place different sized implants into the patient’s bra and the size enhancement is then noted by the patient. I have my patients that a selfie of each size so that, if she desires, her significant other can review the various enhancement choices.

     4. Breast Implant Types: The latest breast implants are superior to those of the past. Both saline and silicone can deliver beautiful, natural results and each has distinct advantages and disadvantages. In my opinion the high tension gel Silicone implants offer a more natural feel and appearance and have less of a tendency to show the rippling effect which is most commonly associated with the Saline implant.


      5.When the Best Time of the year is for Breast Augmentation:  although this procedure can be done during any season, trends in plastic surgery suggest that spring and early summer seem to be the most popular times.  Spring procedures are popular because patients are looking forward to looking their best during the upcoming summer months or they may be looking forward to feeling more comfortable while walking on a warm sandy beach during their spring vacation.

       6.What is the fee for Breast Augmentation? The average cost for breast augmentation in the United States ranges from $4,000 to $10,000.  When looking at fees make sure that the fee includes all of the following:   

    • The cost  of the implants ($1,000-$1,500)
    • Anesthesia fee: ($600-$800)
    • Facility fee: ($800-$1,200)
    • My  fee can be accessed at

*Is Your Doctor Board Certified by the American Board of Plastic Surgeons and is she or he A member of The American Society of Plastic Surgeons. 

More info:


Double Chin…None Surgical Removal

If you’re bothered by moderate to severe submental fullness, sometimes referred to as “double chin,” there is a non-surgical alternative now available.  Kybella is a FDA approved treatment procedure that contours and improves the appearance of submental fullness. Basically, when this naturally occurring solution is injected, it causes the target fat cells in the neck to shrink in size as they release their fatty content into the body.

What Health Care Professional should perform this Procedure?

A highly trained and experienced professional should be chosen to perform this procedure because of the slightly higher risk for complications, a need for a familiarity with the anatomy of the neck and most importantly the experience of being able to carefully select the ideal candidate.   As stipulated by the FDA, this procedure should be performed by a licensed health care professional.

The Procedure and the Recovery:

The procedure is done in an office setting.  The area to be treated is carefully marked so as to avoid the treatment of undesired areas. The technique involves a series of precisely placed injections using a very small needle. The procedure takes about 15 to 20 minutes to perform and most patients describe the pain level on a scale of 1-10 as a 3.  A topical numbing cream can be applied to the skin prior to starting the procedure, and lidocaine numbing injections can also be used.  Patients rate the discomfort level as similar to BOTOX injections.  Most patients relate a mild burning and stinging sensation which can be reduced with the immediate placement of a cold compress on the treated area.  There is an inflammatory component immediately after the injection, and there will be some swelling and some tenderness for a few days because the body is cleaning up the released fatty deposits. 2 to 3 treatment sessions are usually required and they are spaced about one month apart. You can expect to see results after several weeks. In studies, over 65% of patient’s reports improvement in the appearance of the double chin

How long do results last?

Results theoretically last forever because the fat cells that are dissolved are destroyed and no longer able to store excess fat. Since Kybella is a brand new product, we still don’t have long term results to know exactly how well the results will last. There have been good results over the past 3 to 4 years during the clinical trials showing that the results do hold up well long term. The average cost is typically in the range of $1200 to $1500 per treatment session.



Joseph W. Rucker M.D. F.A.C.S      715-833-2116      800-456-8222

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