Episode 8: Dermal Fillers (Re-Volumization and Finishing Touches)

Special Guest: Megan Parken

Dr. Franco: Welcome to “Plastic Surgery Untold.” I’m Dr. Johhny Franco, board-certified plastic surgeon. Also known as austinplasticsurgeon. I’m joined by my incredible co-hosts, @celebrityanesthesia, Travis Osborne.

Travis: Thank you, sir.

Dr. Franco: Megan Parken, and one G-Berto Saenz, who is actually doing us the great honor of hosting Episode 8. Can you let us know what Episode 8 is today?

Gilberto: Yes, I can. Thank you for the introduction, Dr. Franco. Episode 8 is Dermal Fillers (Re-Volumization and Finishing Touches).

Dr. Franco: If you noticed, I let him say the title because it was a little complicated for me. But…

Megan: He said it perfectly, by the way.

Dr. Franco: He did say it perfectly.

Travis: Over-under, how many takes was that?

Dr. Franco: Well, we did six. And then, I decided that we were just gonna restructure this a little bit and let G-Berto take it. So I appreciate you guys bearing with us. But before we let G-Berto take over the microphone as he usually does, let’s catch up a little bit about what’s been going on. Anything new and exciting? Celebrity?

Travis: Not too much.

Dr. Franco: Do you mind if I just call you “Celebrity”?

Travis: No. My name has just been shortened to Travis Celebrity Husband, Celebrity Anesthesia, Celebrity. Soon, it’s just gonna be C. Yeah. We’re actually headed to Long Beach, California, here in two weeks. And we’re gonna be going to a Long Beach reggae festival out there. So, I’m gonna be doing that for the weekend. And then, doing LA for a day or two and then heading back.

Dr. Franco: Wow. You gotta lot of positive stuff going on.

Travis: Yeah. Yeah.

Dr. Franco: I’m just glad that you…
Travis. Good vibes only.

Dr. Franco: I’m glad that you would take this time in the one or two days that you’re in Austin, Texas to help film with us. And so…

Travis: Gotta make time for you guys.

Dr. Franco: …I appreciate it greatly. Megan, what about you?

Megan: Well, as of very recently, the San Francisco 49ers are going to the Super Bowl. So I’m going to Miami. I’m actually hosting an event. Well, I’m, kind of, doing some stuff. I was asked to host part of it. But it’s put on by Shaq. And it’s a bunch of different DJs and stuff. And it’s, like, a pre-party for the Super Bowl.

Travis: That’s cool.

Megan: And so it’s in Miami. And I don’t really know what to expect, but we’ll see.

Dr. Franco: That’s pretty impressive.

Travis: That’s awesome.

Dr. Franco: Since you know Shaq personally, you probably know a lot more about this than I do. But he’s actually a pretty incredible businessman. And he has his Shaq-Or-Treat. Have any of you heard about this?

Megan: So this is called Shaq’s Fun House. And apparently, he does it, like, every year. And it’s all…

Travis: He is also a DJ.

Megan: Okay. I think that’s what it’s gonna be because it’s, like, Diddy, Diplo, Carnage. Like a bunch of DJs and then, maybe, he’s gonna DJ.

Dr. Franco: I’m gonna nod my head like I know all of them. Yeah, that’s right. But he actually does a retreat where he does… It’s all his businesses.

Travis: Yeah.

Dr. Franco: So every brand that he supports…

Megan: Oh, cool.

Dr. Franco: …anybody that sponsors him, if you wanna be a part of his brand team, you have to come to the strategic meeting…

Travis: That’s pretty cool.

Dr. Franco:…which is pretty interesting. And I have talked to a few people, who say that it’s actually a very well-oiled run machine which, obviously, he is still doing [inaudible 00:02:48].

Megan: Right. Yeah, to rival G-Berto saying about the gloves, have you ever seen the photo of him and if you haven’t looked this up? He’s holding a Krispy Kreme doughnut. So we all know, like, what that looks like, you know, whatever…

Travis: Yeah.

Megan: …in his hand.

Dr. Franco: I don’t. And it’s off my diet.

Megan: You don’t want to eat, okay.

Megan: The average size of a doughnut is probably like this. He’s holding it in his hand and it literally looks, like, a miniature doughnut.

Travis: It looks like one of those, sort of, mini…

Megan: It’s a very weird photo. You should look it up.

Travis: That’s hilarious.

Megan: Shaq with a doughnut. And it’s interesting.

Dr. Franco: I’m…

Travis: Just a shout out to Shaq too. We were both LSU grads.

Megan: Oh, wow.

Travis: LSU just won a very big game a couple of weeks ago.

Megan: Joe Burrow.

Travis: Sorry, just… And Joe Burrow, baby.

Gilberto: Yeah.

Dr. Franco: I’m surprised it took this many episodes for you to bring this up.

Travis: Dude, I had to get it in somehow.

Dr. Franco: I mean, I was wondering how many weeks we’re gonna go. We were almost past a month. So I thought that we weren’t there, but not quite.

Travis: I had to. Finally, you got a way to work it in the Shaq. That was perfect.

Dr. Franco: I’m a little jealous. I don’t know if you know this. But I actually spent about four years in Miami.

Megan: Really?

Dr. Franco: Yeah. You need any recommendations, you need any, you know, personal concierge or anything, you let me know. I’ll talk to my peeps.

Megan: The last time I went to South Beach, I was there with a fake ID. So, now, I’m actually there of age.

Dr. Franco: Oh, so, last year it was rough. And this year, it’s gonna be a lot more fun.

Travis: I knew that was coming.

Dr. Franco: That’s that. No, I’m excited for you, Megan. I’m excited. You take that card in there. You go, girl. G-Berto, what’s going on with you before you take over and let the world know how to get a little bit of filler?

Gilberto: Actually, I’ll be honest. Not a whole lot. I just work a lot. And so I don’t have any cool trips planned like my counterparts here. I’m not as popular, as impressive as they are.

Travis: But those might be on the horizon?

Gilberto: Maybe. Maybe.

Dr. Franco: I’m gonna… Can we go back a few episodes? I wish the producer, Donald, right now could replay because…

Travis: [vocalization].

Dr. Franco: …because pre-ex-girlfriend, I felt like G-Berto was always doing something. I mean…

Travis: Oh, yeah.

Dr. Franco: …that he was like…

Megan: But that’s when you’re single. Yeah. That’s like, yeah.

Dr. Franco: Oh, so single Megan is in Miami and…

Megan: Well, you’re with [inaudible 00:04:35]? I mean, yeah, with the wife.

Dr. Franco: And a single Megan is in Miami, and taken G-Bergo is in Austin Netflixing and chilling. Is that what you’re saying?

Megan: I guess so. Yeah.

Dr. Franco: Okay, cool. Cool.

Travis: Fair enough.

Dr. Franco: So that’s interesting. So things still going well on the home front or where are you guys at?

Gilberto: Yeah, no. Things are good.

Dr. Franco: Did you guys get a puppy yet or…?

Gilberto: She has a dog. So I think that’s taken care of.

Dr. Franco: Okay.

Gilberto: Yeah.

Dr. Franco: But is it your guys’ dog yet?

Gilberto: No, it’s her dog.

Dr. Franco: Okay. Okay. I’m just checking [crosstalk 00:05:03]

Gilberto: But it’s her dog…

Megan: He did not adopt the dog yet.

Gilberto: …that she’s had since it was a puppy, I think since she was in college.

Dr. Franco: Okay.

Travis: Before we get too far, one tiny surprise for this episode.

Dr. Franco: What?

Travis: Yeah, Mary was actually…

Dr. Franco: I feel, like, you like to drop the little nuggets.

Travis: I like to… a little nugget here and there. Mary, actually… I was… Because you had me working on a Saturday. You people out there know. This guy never sleeps and never stops working. And because of that, sometimes, I never stop working. So in between…

Dr. Franco: Misery loves company.

Travis: Yeah, that’s right. In between travel, Mary actually actually went to New Orleans to see her family and stuff. I was supposed to go, but then I got to hang out with you all day in the operating room doing cases.

Dr. Franco: You’re welcome.

Travis: While she was there, she got you a little present.

Travis: What?

Dr. Franco: And not that I’m keeping count. But this is actually the second gift by one Celebrity Husband, zero from Megan Parken, and zero from G-Berto. But we’re not keeping count. We’re not keeping count.

Gilberto: I feel like my presence here is the gift.

Dr. Franco: I’m not keeping count.

Travis: Technically, Celebrity wife got this, so…

Dr. Franco: Let’s see.

Travis: She got it…

Dr. Franco: Do you know about Your Trendy Therapist?

Travis: Yes. Oh, Your Trendy Therapist, @yourtrendytherapist. A shameless wife blog right there.

Dr. Franco: Those of you’ve been listening, you can’t see, but this is a little Baby Yoda.

Megan: Oh, wow.

Dr. Franco: This is a little baby Yoda. I mean, if I didn’t have an incredible lovely lady sliding into the DM, now I am. I mean, you can’t turn down this little… Thank you.

Travis: Do you want to hear the funniest part of this story?

Dr. Franco: I do. This is pretty incredible.

Travis: Mary tells me, and she was like, “Oh my gosh, I am by this sidewalk artist. And they’ve got all this art on display. It’s really cool. And I think a lot of it’s, like, “Star Wars.” Mary’s never seen “Star Wars” in her entire life. So she’s like, “The guy from all the memes, like, the little baby… the little baby, the green guy.”

Megan: It’s a little baby green thing.

Travis: I was like, “Send me a picture.” She sends me a picture. I’m like, “Get it right now. You gotta get that. That’s money.”

Gilberto: That’s awesome.

Travis: From the girl that’s never seen “Star Wars”…

Dr. Franco: Baby Yoda.

Travis: …that’s a Baby Yoda.

Dr. Franco: Baby Yoda. I thank you.

Travis: You’re welcome, man.

Dr. Franco: Your Trendy Therapist, thank you. I appreciate it. Well, let’s jump into this a little bit. G-Berto, tell us a little bit… number one, I think most of our listeners are probably wondering what fillers are just to get this going.

Gilberto: Yeah, so, excuse me. So fillers are a product that we use to help re-volumize or put back or replace volume, I guess, I could say a little bit better.

Dr. Franco: Re-Voluminization.

Gilberto: Re-Voluminization, yeah, due to natural aging or in some cases because of just aesthetic, you know, preference.

Dr. Franco: Can you give us some common names that people might know of fillers?

Gilberto: Sure.

Dr. Franco: And if they’ve got this, so they know that they’ve had it?

Gilberto: Yeah. So brand names, there’s a few that you might be familiar with like Restylane, Juvederm. Radiesse is another one.

Dr. Franco: Voluma?

Gilberto: Voluma. So…

Dr. Franco: Would Botox be a filler?

Gilberto: No. Actually, it’s not. Botox is actually a neuromodulator, a neurotoxin. So very, very different in its application and its benefits.

Dr. Franco: Okay. If somebody doesn’t know about Botox, can they refer to Episode 2?

Gilberto: They certainly can.

Dr. Franco: Okay.

Gilberto: Yeah, we talk a lot about Botox in Episode 2. And there’s a lot of different types of fillers too. The most common one is is one called hyaluronic acid. And that’s something that our body naturally produces. So, essentially, we’re using something to replenish lost volume that our body already makes. Aside from that, there’s also a different filler that uses a calcium base. It’s calcium hydroxyapatite, which is Radiesse. And then, we also use collagen, although collagen has, kind of, fallen a little bit out of favor. It’s not used as much as hyaluronic acid anymore.

Dr. Franco: I’ll be honest. I don’t think I’ve ever done a collagen filler in my last nine years of practice.

Gilberto: I trained on it when I first started, but I never used it.

Dr. Franco: G-Bert is a little older than I’m. But that [crosstalk 00:09:03]

Travis: But that was the typewriter clicking in the background, right?

Gilberto: Yeah, exactly.

Dr. Franco: But who would be a good candidate for fillers? Like, would somebody who’s Megan’s age, who just became legal in Miami, be a filler candidate or is it mostly my mom? Who gets it?

Gilberto: Well, that’s the beauty of it.

Dr. Franco: Travis?

Gilberto: I think you could… Yeah, I mean, it is applicable to, you know, different age ranges and, you know, both men and women. I think it’s just based on what the patient’s goal is. If they’re trying to, you know, replace some of the lost volume through aging, then, obviously, that’s going to be someone who’s a little older. But someone as young as Megan, they may want something to just, kind of, create a little bit more fullness or a little bit more projection in certain areas, like the lips, for example, or jawline or something.

Megan: And I think…

Dr. Franco: Do you feel, like, Megan’s lips are flat?

Megan: No.

Gilberto: No, not at all.

Megan: I think something interesting to be said too, like, you can also build upon fillers. So just coming in to get one syringe isn’t necessarily… like, it can be subtle on some people that maybe don’t have any other filler already. But, like, to get a really dramatic look, like, sometimes that is a process of layering and…

Gilberto: Exactly.

Megan: …getting more syringes and…

Gilberto: Kind of, staggering…

Megan: Right.

Gilberto: …the procedures. And, you know, I’ll kind of talk about this a little bit later. But one of the things that a lot of patients may not know is that one syringe of filler does not go very far.

Megan: Right.

Gilberto: I mean, one syringe of a filler is typically in most cases about one ml or one CC. If you think about that, that’s, like, one-fifth of a teaspoon. That’s not a lot.

Megan: I’ve actually seen a graphic that they had on… it was on a MedSpa’s page. And it was showing, like, in a spoon, like, the actual amount of filler. And it was interesting because it was, kind of, debunking when people are saying, like, “Oh, this person has so much filler in their face.” And it was showing how much it actually is, kind of, so you’re eye could visualize exactly because it’s hard to just hear that and think, “Well, what does that really mean?”

Travis: Yeah.

Dr. Franco: And this goes to some of the myths that people think, like, “Oh, I’m gonna get one syringe of filler. I’m gonna look so overfilled.” No, that doesn’t happen by accident. You didn’t just fall on 12 syringes of filler. And all of a sudden, your face blew up. No, that didn’t happen by accident. And so people tend to get into this. And so, it’s actually quite the opposite where people are sometimes disappointed with the results they get from one syringe of filler. Like, in someone super young, like Megan, one or two syringes can make a really nice difference because it’s very targeted, whether it’s lifts, whether it’s jaw, whether it’s something small. But someone for, like, your mom or my mom, who’s a little bit mature and so forth, one syringe of filler is not gonna go very far, especially if you’re trying to lift the cheeks or you’re trying to restore volume that they’ve lost over the last 60 or 70 years.

Gilberto: Right, exactly. It’s just one of those things where, I think, we talk about this a lot. You have to set expectations for your patient and, you know, really talk to them about what their goals are. And, you know, if their goals are, “I want to just, kind of, soften up my look a little bit, not look, you know, quite so tired. Maybe look a little bit more refreshed,” you know, those are all, kind of, like little terms or keywords that, kind of, clue you in, like, “Okay, this is what this patient wants. And this is what I think we can do for them.” And then just having that conversation.

Travis: I think that speaks to you as a seasoned provider that encounters those kind of words all the time. And you’re able to see through that, you know.

Gilberto: Yeah.

Travis: You can get to what those patients actually want, like, “What does a more refreshed look? I always look tired.” What does that actually mean?” Does that mean that they have some undereye, you know, bags? Does that mean, you know, they’re lacking volume in certain places? That’s pretty cool that you’re able to see through that.

Megan: Right.

Dr. Franco: What would you say is the best filler out there?

Gilberto: Wow.

Travis: On the spot.

Gilberto: Yeah.

Travis: Fire round.

Gilberto: I mean, I think the honest answer is that there is no one best because it really depends on the person. It depends on the individual and what their needs are.

Megan: And do fillers in different areas of your face last different times, like,…

Gilberto: Absolutely.

Megan: …to dissolve and everything?

Gilberto: Yeah. Absolutely. So there are some fillers, most hyaluronic acid fillers, HA fillers, which most people are probably more familiar with, are going to last, depending on the person, depending on how quickly they metabolize the product, you know, break it down in their body, anywhere between, I say… I tell my patients 9 to 12 months.

Megan: Okay.

Gilberto: Some may be fast metabolizers because of their lifestyle. They may break it down, like, in six months. You know, some maybe, you know, a little bit slower to metabolize it, so they may even get a little bit more than a year from that product.

Megan: So it is possibly something…if you start out doing it and you really like the way it looks, it is something you need to keep up with to keep that look.

Gilberto: 100%.

Megan: Okay.

Gilberto: I try to get my patients to come in for little touch-ups, you know, every nine months to a year, so just before the product actually wears off completely because it’s so much easier to touch things up than it is to try to get them back to full correction.

Megan: Interesting.

Dr. Franco: I think you hit on a ton of good points there. If we can, kind of, recap some of these…

Gilberto: Sure, yeah. Yeah.

Dr. Franco: Because I think to her point, the one area where I see people if they don’t have the right expectations disappointed in terms of time of filler, it’s lips.

Megan: Oh, yeah.

Dr. Franco: I think product and lips go fast. And a lot of products will say, you know, on their box, they last six to nine months, or up to a year. I typically quote people unless they’re doing something a little bit stronger off-label like a Voluma or something in lips, I typically tell people five to six months even because talking, eating, moving, I think in the lips things go faster no matter what.

Megan: Yeah.

Gilberto: Yeah.

Dr. Franco: And so, whatever people normally get, if you’re getting it in the lips, I think, you need to decrease a month or two.

Megan: Right. And not to make lofty claims, but you guys can probably speak to this for just the sheer volume of people coming in, I would say in the last three to four years, like, the lips have really been a big thing that I think has, kind of, brought filler to the forefront. Like, a lot of people now are very familiar with getting your lips filled. Like, it’s, kind of, a common thing that you hear all the time, which I don’t know, 10 years ago, people talked about it as much.

Gilberto: Thank you, Kardashians.

Megan: Right. Mm-hmm. Mm-hmm.

Dr. Franco: I think the lips are huge. I think we, as injectors, have gotten better about injecting lips too, which I think is brought up because I think in the old days, it was just, “Let’s pump some volume in there. Let’s make them look big.” And then we realized at some point recently that just too big sausages on your lips didn’t look that great.

Megan: Right.

Dr. Franco: And now, there’s all sorts of…

Travis: You got to have some shape.

Dr. Franco: You got to have a little shape. And there’s some cool things you do that I’ve seen where you do some things to get a little bit of a lip flip to give them a nice cupid’s bow. Maybe, do you mind sharing a few little nuggets with the world?

Gilberto: Sure. No, I mean, I can’t say that that I created this technique. You know, I’ve picked up little things from different people that I’ve worked with. Different people that I’ve, you know, admired, you know, their work. Different injectors that are huge in… you know, in the social media, you know, realm or arena. And it’s all about placement of the product, you know. Where you want the product to really have most of its focus. And again, depending on what the patient wants, if the patient wants more projection, then, you know, you’re going to put a little bit more filler in certain areas. If they want a little bit more just, kind of, like, Dr. Franco alluded to, a little lip flip, you know, just, kind of, turn the lip out a bit, there is a different technique for doing that. You know, maybe, it just involves, maybe, going into a different depth of the lip so that you can get, you know, that desired effect.

Dr. Franco: And I think you touched on a point that a lot of people miss in that, you know, the product is the product. And some people will say, “Oh, I saw this on Groupon. I saw something else.” And I’m sure you see ads on social media all the time.

Megan: Right.

Dr. Franco: And it’s not the product that necessarily changes, but you also got to be careful what product because when you come to a board-certified plastic surgeon, dermatologist, you know, a physician assistant, a nurse practitioner, any one of these accredited practices, you know, you’re getting a legitimate product.

Gilberto: Right.

Megan: Well, isn’t that also just, like, back in the ’90s people injected silicone into their lips?

Dr. Franco: This hasn’t gone away.

Travis: Oh, yeah. Yeah.

Megan: People still do that?

Travis: Oh, yeah.

Dr. Franco: You still see it.

Megan: Oh, I thought you weren’t… I thought you couldn’t do that anymore.

Dr. Franco: You’re not supposed to.

Travis: Yeah.

Megan: Oh, okay.

Dr. Franco: And it’s not just silicone. It’s biopolymer. There’s all sorts of stuff that people inject illegally. And so, like, most things in life, if it sounds too good to be true, It probably is.

Gilberto: Well, I guess [inaudible 00:17:00].

Dr. Franco: If stuff’s too cheap to be legit, it probably is. You got to be careful because some of these things are really hard to fix. Oh, go ahead.

Travis: I have a question about that actually, about just regular filler, in general. You guys are both perfect injectors, of course. But if you do make a mistake, can you fix it?

Dr. Franco: This is why the hyaluronic acid fillers have become so popular. If you got your lips done, you just hate it, you want to come in, there’s an enzyme we can actually inject that makes it dissolve pretty much instantaneous. Within the next 24 to 48 hours it’s pretty much gone. But you’ll see a difference instantly. So it’s, kind of, a nice safety blanket. And I’ll tell you, most people are worried about it. It’s pretty rare that somebody comes in and actually gets their stuff dissolved.

Gilberto: Right.

Megan: Unless, maybe, they were coming from a different injector and saying, “I need you to start over and fix this because…” Is there a limit to, if someone got them injected and, like, for example, the shape was off and they wanted something different can you go in and correct someone else’s work or is that harder to do? I feel like…

Dr. Franco: Yes and no. I think sometimes you can correct some stuff. There is the occasional person who… I’ll say exactly to your point like, “We just need a clean start.”

Megan: Yeah, we’ll just start over. Yeah.

Dr. Franco: And, typically,] if I inject people and dissolve stuff, I say, “Take a two-week break. Let that all the swelling, all the inflammation stuff go down.”

Gilberto: Let it settle down, yeah.

Dr. Franco: But how long do you make people wait?

Gilberto: No. I think that’s a good time frame, two weeks, maybe a month at the most. But I think that’s, kind of, like, stretching it out a little far.

Dr. Franco: Just to, kind of, see where the dust settles, like, can we touch base on…? Lips have gotten a lot of glory. In my practice, jaw is the new lips.

Gilberto: Yeah.

Dr. Franco: That has become super popular.

Gilberto: I’ve seen that.

Dr. Franco: You know, and one of the things… I think the reason why is I’m going to blame the selfie. You know, we look at our neck. We look at our face. And I think accentuating that jawline. And this is another area where just you don’t need a ton of product but some very, like, strategically-placed product can make a big difference for people.

Megan: A big thing. I think about that too. I’m really interested in actually doing the jaw. And I think what it is, is for taking photos.

Dr. Franco: We’ve been trying to talk to Megan to get in for about a month now. But she can’t work us in between her Miami trips, LA, Dallas.

Gilberto: The Super Bowl, yeah.

Megan: And most people have, like, a good side where they, kind of, want to angle their face. And I think that comes down to…

Dr. Franco: What’s your good side?

Megan: I think it’s this side, but…

Dr. Franco: And you let me sit on this side of the table?

Megan: So what I’m saying is, I think…

Dr. Franco: Wow, I feel privileged. Well, thank you, Megan.

Megan: I think most people’s faces aren’t completely symmetrical. So, maybe, you know, restoring a little bit of that volume on, if you think this side of your jaw is less strong, then, maybe, you’d have two good sides. I don’t know. That’s my thought, at least.

Dr. Franco: We would double the world’s selfies. We would double the world’s selfies. You know, this is one of the reasons I love plastic surgery. And I would love to get your thoughts is, this is one of the illusions you can make because if you think about it, you add product to make the face look smaller.

Gilberto: Yeah.

Megan: It’s weird to think about that.

Gilberto: Yeah.

Dr. Franco: And pretty interesting.

Gilberto: Yeah.

Megan: Because I feel, like, when people think of cheek, they’re thinking, “Oh, I’m gonna have, like, bigger cheeks.” But no, it chisels you as if you… in the makeup world, this is called contouring. You take a darker shadow to enhance that. But if you do a little bit of filler, you then naturally have a shadow casted on your face because you have volume coming in.

Gilberto: And I think you just hit on, like, one of the most important things when it comes to fillers. It’s all about the shadows. Like, it’s all about, you know, creating or making those shadows disappear.

Dr. Franco: I love it. I think… And this is where, you know, again, going to the right provider or somebody that’s gonna help walk you through this, and be, like, “Hey, what can we do with this?” Because they’ll straight up say, “Hey, you can’t do that,” or, “This is going to help. This isn’t.” And I think that’s where the difference becomes of just buying, you know, syringes of filler on Groupon versus coming to see somebody who’s gonna walk you through the process.

Megan: And, obviously, from a woman’s perspective, are men big on filler? Do men come in and get filler done or is it…” Yeah.

Gilberto: I wouldn’t say it’s a big part of my practice, but I do have, you know, a handful of men that come in, jawline is pretty.

Megan: Yeah, that’s a good point.

Dr. Franco: Jawline, Botox?

Gilberto: Yeah, Botox.

Dr. Franco: Cheek filler stuff. It’s funny because some of the filler patients that we get are actually people who are extremely fit, extremely thin because, like, most things in life, you know, we don’t lose weight in the areas we want to get rid of and places that we do want to come down. So we have a lot of personal trainers. We’ve talked on previous episodes, losing a lot of weight is overall great for your health. But unfortunately, sometimes things drop. Some things don’t feel the way we should. And so, you’d be surprised how many health fitness people get a little touch up here or there to get them into a good spot.

Megan: I even think, like, the non-surgical nose jobs, I’ve been seeing that with filler. That’s crazy, the difference that that can make.

Gilberto: Yeah.

Dr. Franco: I love that.

Megan: It’s amazing.

Dr. Franco: I love it.

Gilberto: I do too.

Dr. Franco: It makes a big difference for people.

Megan: The before and afters are, like, wow.

Gilberto: Yeah, it’s very impressive.

Travis: [inaudible 00:21:37].

Dr. Franco: Can we talk a little bit, and we touched on it, just basically a little bit about filler safety? And I’m not trying to scare people away, but I think you got to be smart about where you get it and what you do. So one is making sure that you’re getting a legit product injected.

Gilberto: Right.

Dr. Franco: Two, that you get it done somewhere where if you have a problem, you don’t like something, you can find them.

Travis: I think that’s the biggest deal, right? If people are going to be injecting stuff, they need to know how to deal with the consequences because, with everything, you know, I’m never going to give an anesthetic that I cannot reverse or manage myself. So to think that there are people out there injecting people, and if they get an intravascular injection or if they do something like that, they can’t solve it. They’ve got to punt to somebody else. That to me is crazy.

Gilberto: And that’s probably one of the most rare, but one of the most dangerous adverse events of fillers.

Dr. Franco: Can you explain a little bit what intravascular infection is because I actually saw one recently from another practice…

Gilberto: Oh, wow.

Dr. Franco: …that came to us to treat afterwards because they had gotten injected somewhere. That facility didn’t know exactly what to do for the person, and fortunately, at least, got them over to us to help with it. And so, can you explain what it is?

Gilberto: Sure.

Dr. Franco: And what you guys do for it because I think this is super important to recognize early.

Gilberto: Yeah. So one of the things with filler is that, you know, we’re injecting product into, you know, the face, for the most part, almost blindly. I mean, you have to have some, you know, a good understanding of, you know, human anatomy to know where the major vessels are. But sometimes you might, you know, come across a tiny little vessel that you weren’t expecting to be there. So an intravascular injection is when you get product into a blood vessel. And that leads to something called an intravascular occlusion or blockage, essentially, which then can stop blood flow to, you know, the appropriate areas. And depending on, you know, which vessel you hit, you can get yourself into some really, really big trouble. I mean, I’ve heard of cases… I can’t say that I’ve personally ever experienced any or seen any, but I’ve heard of cases where, you know, patients can lose their lips. They can lose their vision because they got a vascular occlusion in a vessel that’s close to the eye. So, I mean, it’s dangerous and…

Dr. Franco: But not to scare people. I mean, this is extraordinarily rare.

Gilberto: Yeah, like, I said, it’s rare.

Dr. Franco: And it’s even more rare, you know, by people who are doing this with some thought and skill to this. But it can happen to anybody.

Gilberto: It could.

Dr. Franco: The other thing is, when treated timely, people actually tend to do well, especially for skin stuff.

Gilberto: Oh, yeah.

Dr. Franco: You know, and lips, nose, those type of things. And you actually treat them by…

Gilberto: Dissolving it.

Dr. Franco: …dissolving it. But time is of the essence because…

Gilberto: Yeah, it has to be within a certain time frame.

Dr. Franco: …the longer you wait, the less benefit you’re gonna get. But this the same enzyme that we inject if people don’t like the way they look, we can actually use to treat this. And we actually flood that area and can get this. There’s a lot of other tricks that we won’t get into. But the take-home message is, if there’s a problem, if something doesn’t feel right, if something doesn’t look right, you need to call your physician, your injector immediately because this is not something you want to just wait on and hope it gets better.

Gilberto: Right.

Megan: Right.

Gilberto: Yeah.

Dr. Franco: Other questions, anything that we can answer about fillers to clear up, take this home?

Megan: So for pain and stuff, like, is there anything you can do when you’re getting injected? Like, people that are worried about being numb and all that, kind of, stuff.

Dr. Franco: Oh, yeah. That’s a good one.

Gilberto: That’s an excellent question. So depending on the areas being treated, I will always offer patients, you know, some topical numbing.

Megan: Right.

Gilberto: And, maybe, Travis can, kind of, piggyback on that. But, you know, we have a compounded topical numbing cream that we use in the office. And we apply to an area that’s going to be treated for… I usually do about 20 to 30 minutes before treatment just to give the patient as much comfort as possible. I’ve also done something called a block where, you know, we inject lidocaine or a numbing agent into a specific area to numb out certain nerves…

Megan: Right.

Gilberto: …so that we can make the injection process a lot more comfortable for the patient. And then sometimes just distracting the patient with, like, a little vibratory tool in an area that’s… it’s called the T-bar. And it’s just, kind of, it distracts the patient from the injections.

Dr. Franco: I have so much to say.

Gilberto: I know.

Megan: Our producer started laughing, so I started laughing.

Gilberto: I feel, like, I walked right into that.

Travis: You definitely did.

Dr. Franco: We have really found the ProNox to be super, super helpful for…

Travis: Yeah, that’s cool.

Dr. Franco: …our lipid injections. And that’s a nitrous oxide. And that just helps, kind of, relax, get rid of some of the anxiety. So that in combination with the numbing cream has been big for us, especially our lips.

Travis: Yeah, it produces super mild sedation but it also gives you some analgesic effects or some pain-reducing effects. But you breathe it off super quickly, too. It’s, like, the fastest on and off gas anesthesia that is available.

Dr. Franco: And they now have a…

Megan: So you can drive after and everything?

Travis: Oh, yeah.

Megan: Oh, wow.

Dr. Franco: You gotta wait 20 minutes.

Travis: You got to wait. I mean,…

Megan: Okay, yeah. But like…

Travis: You can’t just, like, run out the door. [vocalization]

Megan: Right. Okay.

Dr. Franco: Can we do a little segment, maybe, we’ll do a little clip next time you guys come? We’ll have everybody try it and just, kind of… And then, I’ll ask you all your deepest… Maybe, we’ll do fact or fiction with the products here…

Gilberto: With the products.

Dr. Franco: …next time.

Travis: That seems dangerous. But all right, let’s do it.

Dr. Franco: So leading into this… And anything you want to talk about fillers to take this home before we do a little fact or fiction? I know that there’s so many questions we didn’t get to.

Travis: I was gonna ask you one thing. If I want to get this done, when do I get… how… If I have a wedding to go to, and I want it done before the wedding, how far out do I need to have this done?

Dr. Franco: Oh, that’s a good one.

Megan: Yeah, that’s a really good question.

Gilberto: That’s a great question.

Gilberto: So the beauty about filler as opposed to Botox, like, we talked about in Episode 2, is that the results are almost instant. Like, you will see them right away. Now, the only thing that I would caution you on is, you know, sometimes you can get a little bit of bruising from some of these procedures. And so…

Travis: Can we just talk about bruising for injectables, in general, just for one second?

Gilberto: Yeah.

Travis: That doesn’t mean you’re a bad injector, whether you went to someone bad if you get some bruising.

Dr. Franco: What?

Gilberto: No.

Travis: You are entering a needle into an area that is completely blind. And even though everything looks completely normal and totally right in an anatomy book, that’s not how it is underneath people’s faces.

Gilberto: No. Not at all.

Dr. Franco: It is why I typically push people… I say the same, two weeks before… fillers before a big event because I tell them, “If you’re going to a wedding, you’re doing something, if you have a big old bruise, you’re gonna be unhappy about it.”

Gilberto: Yeah.

Dr. Franco: And it’s Murphy’s Law. You may have come and seen G-Berto a thousand times and never got a bruise. If you got your first big Tinder date that night, that’s not the time to do it because you’re going to get a bruise. You know, if you’re someone who bruises all the time, if you’re on some blood thinners, doing arnica, bromelain, those type of things tend to help. My dad used to be on aspirin and Plavix. We would start him on. And that’s when I became a true believer. When he started that ahead of time, the difference was actually pretty amazing. And being able to see somebody, I think it was super helpful in terms of that.

Gilberto: Yeah.

Travis: Sorry to get us off the track…

Gilberto: No, no.

Travis: .. but how fast is that? Do you see results?

Gilberto: With the…?

Travis: With filler.

Gilberto: With?

Travis: And so, if I’m doing it ahead of time, am I going to see later that night or is it gonna take six weeks to kick in?

Gilberto: Yeah, it’s almost instant. Like, you can pretty much, you know, see an instant result. There might be some associated swelling. So, sometimes, things can look a little bit fuller than what the final product is going look like.

Megan: Right.

Gilberto: So I always tell patients, you know, give it a few days for the swelling to go down. You can certainly ice the area. And that’s going to help, kind of, speed that process up.

Dr. Franco: And sometimes the people feel a little uneven. There’s a little lump bump. It’s hard to tell if that’s truly product. Most of the time, that’s a little deep bruise, a little swelling…

Gilberto: Swelling.

Dr. Franco: …a little something that’s gonna go away.

Gilberto: Yeah, exactly.

Dr. Franco: And I’m also a little hesitant to chase stuff too quickly because then if you start injecting stuff, once you don’t know in that area, you chase your tail.

Gilberto: Right.

Dr. Franco: Because, then, when the swelling goes down, now you got a new lump somewhere else and it’s just…

Gilberto: Exactly.

Dr. Franco: Let the dust settle sometimes.

Gilberto: Yeah.

Dr. Franco: And it’s hard for all of us, but let the dust settle a little bit.

Gilberto: Yeah. Yeah.

Dr. Franco: Any other questions, Megan, before we get G-Berto off the hook? And, I know, there’s a lot of things we didn’t get to, like, choosing a provider and some of those we’ve talked to a little bit in the past. But if you guys don’t mind, I think we should do a whole segment on how do you pick, you know, your injectable provider. I think that’s a good one.

Travis: I totally agree.

Megan: And I think we should also poll our viewers for some questions because I know, for me at least, injectables and fillers that’s, like, the number one thing I get asked about. So I’m sure there are a lot of questions that people have…

Gilberto: Yeah, that’ll be fun.

Megan: …that you could answer next time.

Travis: Yeah, absolutely.

Megan: And we could have, you know, kind of, down.

Travis: Or an ask me anything section.

Dr. Franco: Oh, I like that. Maybe, we’ll get producer, Donald, on that. We’ll poll a little ask me anything and make an episode. Maybe, like, every 15th episode will be an ask me anything. We could poll some. And just so you guys know, we’re working on some live events. We’ll let you guys know when that happens. So it would be great to get people out and then just hit us up on the fly. So, basically, you guys can fact or fiction the entire team here, which seems like a great segue to our favorite segment here, a little fact or fiction.

Gilberto: [inaudible 00:30:35].

Dr. Franco: I felt, like, I got left out and not able to ask any questions last time. So we’ll go around and get stuff started a little bit. We’ll start. Boom, boom, boom, Celebrity. Celebrity, fact or fiction? You drive a pink Vespa.

Travis: It’s red and white. It’s not pink. But that is fact. And it’s not a Vespa. It’s a Ruckus.

Dr. Franco: Fact or fiction? Mary does all the driving, and you sit in the backseat?

Travis: That is fiction. That is fiction. She actually rides behind me.

Dr. Franco: Fact or fiction? You guys have been stopped before on the Vespa because somebody pulled up and recognized Mary.

Travis: That has not happened yet. People probably have. But people can barely contain their laughter sometimes when they see us. They… it looks pretty… it’s very dumb and dumber-esque. We look pretty ridiculous on a tiny little Vespa, yeah.

Dr. Franco: Okay. Okay. I like this. G-Berto, fact or fiction? That you’ve lost your title as Austin’s most eligible bachelor?

Gilberto: I don’t know. I don’t how to answer that.

Dr. Franco: Or is this is a question, maybe, we should ask Megan? Fact or fiction, G-Berto has lost his title as the most eligible bachelor?

Megan: I think, he said fact.

Gilberto: Yeah, I mean…

Megan: Yeah.

Gilberto: I’m…

Megan: As of now, yes.

Gilberto: Yeah, I am involved.

Megan: Yes.

Dr. Franco: So you’re out?

Travis: He’s committed.

Dr. Franco: So you’re out?

Gilberto: Yeah.

Dr. Franco: Okay.

Travis: You heard it first right here, folks.

Dr. Franco: Because the last time, it was still, like, “We’re just getting to know each other. We’re just talking a little bit.” You gave us a little bit of a Megan-esque answer where you avoided the question, you slid around, and we weren’t sure what was going.

Gilberto: Oh, It’s because it’s still in development, you know.

Megan: Okay.

Travis: It’s new. It’s evolving.

Megan: Right.

Gilberto: Yeah, it’s very fluid.

Travis: I like it.

Dr. Franco: Okay.

Gilberto: Yeah.

Dr. Franco: Okay. Okay. Megan, fact or fiction? I feel, like, I can’t even ask Megan these questions. We’re gonna let Megan off the hook this time. Can we do our quote of the day?

Travis: Sure. Let’s do it.

Dr. Franco: Are you doing it? I thought G-Berto was gonna get to do the quote today.

Travis: I think I got past this one again.

Gilberto: I thought… No. I mean, I can do it. I don’t …

Travis: Read it. I want to hear it [inaudible 00:32:49].

Gilberto: Well, I don’t know that I have it on my notes.

Travis: Well, allow me.

Gilberto: I appreciate it. Thank you, sir. Okay, quote of the day by none other than one Mario Andretti. “If everything seems under control, you’re just not going fast enough.”

Dr. Franco: Whoo, I like that.

Gilberto: Yeah.

Dr. Franco: That sounds a lot like Megan’s dating life right now.

Megan: I was just about to say, “I don’t like that quote.”

Travis: Really?

Megan: No.

Dr. Franco: No?

Gilberto: No? No, I like it.

Dr. Franco: It hits too close to home or what?

Megan: I mean, I got to think about it for a minute.

Dr. Franco: Because that could be your life in Miami here.

Travis: For me, I think it means that if everything feels too under control, you’re playing it too safe. You’ve got to be pushing the envelope a little bit.

Megan: Okay.

Travis: I feel like that’s how I always try to live. Like, how can I be growing in some aspect of my life, whether it’s work, whether it’s with friends, whether it’s trying a new activity, whether it’s trying a new sport, something like that, like, constantly trying to grow and evolve and do something that keeps you out of your comfort zone?

Dr. Franco: I agree.

Gilberto: [inaudible 00:33:57]

Dr. Franco: I think when people are afraid to fail, you’re never going to reach your goals. You got to push yourself. You got to pick yourself up. You got to dust yourself off sometimes. And so…

Travis: I totally agree.

Dr. Franco: …if you’ve never failed, you ain’t trying hard enough. You’re not pushing yourself enough. So, I 100% agree. I like it. I like it.

Gilberto: Yeah, I agree. I like it, too.

Travis: Megan, still a hater?

Megan: I just think sometimes when you’re doing things the right way, things are nicely under control. You know, like, when it said, like, out of control, I feel like, I don’t know. There’s something to be said for things being in control because you made them in control, not because you’re not doing anything, you know.

Dr. Franco: That’s an interesting perspective.

Travis: That is an interesting perspective. I was thinking about…

Megan: I’m always here to bring the female perspective, so…

Travis: I like it. I was thinking more about taking risks and doing stuff that keeps you out of your comfort zone.

Megan: And that’s the cool thing. You can interpret it…

Travis: I like that.

Megan: …however you see fit.

Travis: That’s why I love quotes. Everybody’s got a unique take on it.

Dr. Franco: Well, I appreciate it. Gilbert, I want to thank you for running this episode…

Gilberto: Thank you.

Dr. Franco: …and filling us in a little bit about fillers. I liked it, loved it. I feel like I learned some stuff. So, I appreciate that. As always, thank you to producer, Donald, who I don’t think scolded us a single time this episode. So that was a major, major win in the end. Guys, stay tuned. We got more episodes coming. We got some live on location episodes coming soon. And I’m not gonna quite tell you yet. But in a not too distant future, we might even have a little road trip. So, just a little nugget to hold on. We’ll give you some more details about that. But I appreciate you guys listening to “Plastic Surgery Untold,” the number one podcast in America voted by Megan Parken. Thank you, Megan, appreciate it.

About The Author

Dr. Johnny Franco
Episode 7: Social Media – Has it Changed the Perception of BeautyEpisode 9: Secondary Breast Surgery: How do we Rebuild?


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