Cosmetic Surgeon vs. Plastic Surgeon: What is the difference?

The term Plastic Surgery can be confusing for most people.  One must understand that the word Plastic is derived from the Greek word Plastikos.  The term is actually a verb which means to mold or shape. Plastic Surgery is a field that is composed of two main sub-specialties including reconstructive plastic surgery, which involves the restoration of body function that has been damaged by trauma, disease or birth defect, and aesthetic (cosmetic) surgery, which is a reshaping of the body to improve appearance only.  Therefore reconstructive Plastic Surgery is often covered by insurance and cosmetic plastic surgery is not.

Training: Now in order to fully understand the difference between a Cosmetic Surgeon and a Board Certified Plastic Surgeon we should look at the training required for each. A physician referring to themselves as a cosmetic surgeon might belong to any medical specialty including dermatology, gynecology or a family practice and they then decide that they would like to perform cosmetic procedures.  The training can be anywhere from a one year of training to a series of short weekend courses.  

The training for a board-certified plastic surgeon is much more extensive.  Following a completion of medical school, a board-certified plastic surgeon serves first a surgical residency for at least 3 years and sometimes five years.  During this residency they are trained in all aspects of surgery followed by a 3 year residency which is focused on plastic surgery training. This process can take 6 to 9 years and many further their training in fellowships including hand, micro-vascular pediatric and cosmetic surgery. Therefore the amount of and the wide scope of training is the key differentiator between a Plastic Surgeon and a cosmetic surgeon.

Board certification is another major difference between a cosmetic surgeon and a Plastic Surgeon. 
Cosmetic surgeons who claim to be board-certified may have received their certificate from the American Board of Cosmetic Surgery, this board is not recognized by the American Board of Medical Specialties. Alternatively, they may be certified by their specialty board which may not even be a surgical specialty, such as internal medicine. Cosmetic surgeons referring to themselves as board-certified can be misleading if you don’t know the right questions to ask.

It is always important to confirm that a plastic surgeon has been certified by the American Board of Plastic Surgery (ABPS) – the only Board recognized by the American Board of Medical Specialties (ABMS) to certify doctors in the specialty of Plastic Surgery. Only ABPS diplomates can call themselves a Plastic Surgeon. In Canada, a patient should look for certification by the Royal College of Physicians and Surgeons of Canada (RCSC). International plastic surgeons should be board-certified in their country of origin.

In conclusion, if you are considering any type of aesthetic/cosmetic procedure, it is prudent to be aware of the education and training of the surgeon you’re considering for your procedure. You can verify the credentials of a doctor by checking with your state medical board or verify you are seeing a board-certified plastic surgeon whose practice focuses on aesthetic surgery by visiting  to select a Surgeon. Choose Well.

Joseph W. Rucker M.D. 


3 Ways to Keep Cosmetic Surgery Fees Low without Going to Mexico

  1. Select a Board Certified P.S. When considering cosmetic surgery, probably the most important factor would be to select a surgeon that is board certified and a member of the American Society of Plastic Surgery. It ensures that he or she has been intensively trained in performing these cosmetic procedures and is able to manage any complications that may occur. This is important because there may be a higher complication rate with non-board certified surgeons which can ultimately lead to higher costs and the possibility of a more difficult recovery period.
  2. Having Multiple Procedures at the same time: I strongly advise my patients that are interested in having more than one cosmetic procedure to have them done at the same time for several reasons:
    1. Most surgeons routinely decrease the second procedure by at least 30%
    2. Having the procedures at the same time also produces one recovery episode and one time off work resulting in a significant savings in fees.
  3. Does Your Surgeon have an In-Office Operating Room?: A great many cosmetic surgery procedures are done in a hospital setting and this can lead to increased fees. First there is the cost for the hospital room, then the anesthetic cost is also included. If the surgeon has an accredited operating room in his or her office, the overall cost can be significantly reduced by avoiding these additional hospital and anesthesia charges.

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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