Episode 16: Taboo Topics In Plastic Surgery – Financing, Care Credit Credit/ Alpheon and Recovery

Dr. Franco: Welcome back, team, to “Plastic Surgery Untold.” I’m Dr. Johnny Franco, board-certified plastic surgeon, also known as Austin Plastic Surgeon. I have my celebrity crew here joining us again for our cast today. Today, we’re going to be talking about the patient experience and how people go about scheduling and obstacles to that. Because I think we’ve talked a lot about different procedures but some of the questions we get from patients, “sounds great but how do I get there? How do I do that?” And I think, kind of, being mainly prepared about the process and how to go about it. I think we’ll relieve a lot of anxiety and also other people will be better prepared to do that. But before we jump into that, let’s get a little update from everybody and see what’s going on in their lives. And we’ll let Gilberto be a beautiful man again. He was on timeout for an episode but he’s back. He’s back in full-go, so he’s doing a little [crosstalk 00:00:52.091].
Travis: The shark is in the house.
Dr. Franco: Well, what’s going on with all of you? Anybody got some updates, life, things going on in their life?
Travis: Gilberto, you got anything?
Gilberto: Well, nothing too, you know, out of this world but, you know, with everything that’s been going on recently, kind of, been staying in a little more, not really going out much. However, I did go out to the movies last night and feeling as guilty as I did for having left Johnny out from previous outings, I gave him a quick little text, invited him out to join us at a movie, but he rebuked me.
Travis: Oh.
Dr. Franco: Yeah. I was lame-o. I had to stay home. I worked on the scripts for today. You know, I had to bring it home and be full-go. You know, one of us maybe just takes the podcast a little…
Travis: Mr. Responsible.
Dr. Franco: Yeah, maybe one of us just takes the podcast a little bit more seriously than the other. Boom, boom, boom.
Gilberto: No good deed goes unpunished.
Travis: Right? Yeah, yeah.
Gilberto: We’ve been home because of the whole Corona thing. We’re just, you know, not because we’re afraid of necessarily contracting it ourselves, but we don’t want to be the reason that anything gets spread, right? So we’ve just been trying to take a little bit of a time out and hang out around the house, get some house projects done. But, that has led to infinite amounts of Netflixing and we just…
Dr. Franco: What’s your favorite Netflix then?
Gilberto: We just watched and finished and we binged it, “Love Is Blind.” Have you all seen that?
Dr. Franco: No.
Gilberto: Last night…
Travis: Wait, what?
Gilberto: Actually, all day yesterday and Friday night.
Travis: This surprises me.
Dr. Franco: You guys had your little man-date or what?
Gilberto: No, no, no.
Travis: This was separate. It’s separate.
Gilberto: This was separate.
Travis: Ironic.
Gilberto: And Mary was like, “Let’s try this show out.” I keep getting, you know, DMs. So @yourtrainingtherapist, my wife, shameless wife plug number is 792. She got some messages from her followers that said, “Hey, you guys have to watch this show.” It’s like “The Bachelor” on steroids except these people don’t get to see each other before they commit to each other for the rest of their lives. So they’re in these little pods. They talk, they have dates, and then they decide whether or not they’re gonna get engaged.
Lindsey: So you can have like…
Gilberto: Sight unseen and they try to figure out is love truly blind. Show goes off the the rails…
Dr. Franco: So does it work or no?
Gilberto: I’m not going to tell you.
Travis: You’ve got to watch it.
Gilberto: You’ve got to watch.
Dr. Franco: Called “Love Is Blind”?
Gilberto: “Love Is Blind”. It’s definitely right up your alley.
Travis: I will say I am not a huge reality fan…
Gilberto: You got sucked in?
Travis: …reality TV show fan. And I got talked into it. I like came up with all kinds of excuses to try and not to watch it. Like, can I do work while we’re watching it? Can I, you know…like, how many episodes is this? It was actually really entertaining.
Gilberto: It is funny, I, of course, was pushing the brace. The whole time I was like, “Mary, we’re not going to watch this. We’re not going to watch this.” We start watching it, like 20 minutes in, I’m like, “Oh, that is ridiculous. We’ve got to see what happens next.” And she’s like, “Wait, now who wants to watch it?”
Dr. Franco: It’s just the trainwreck that you can’t stop watching.
Gilberto: Oh, 1,000%, yes.
Dr. Franco: Lindsey, are you a reality TV fan or…?
Lindsey: Just a little bit.
Dr. Franco: What’s your poison?
Travis: What’s your guilty pleasure?
Dr. Franco: Yeah.
Lindsey: Oh. Gosh, I haven’t watched any reality TV in a while but… No, I have nothing right now. I’m like not…
Travis: Well, not [crosstalk 00:03:59.697]?
Dr. Franco: So you’re a reality TV fan but you don’t have any…? Okay.
Lindsey: But I’m not currently watching anything, yeah.
Dr. Franco: That makes sense.
Lindsey: But I’m not watching anything.
Dr. Franco: That makes sense. Good, good. Okay.
Lindsey: No, thanks.
Travis: That’s fair.
Dr. Franco: But you have a little one so you probably Disney+ a lot.
Lindsey: Oh, yeah.
Dr. Franco: Well, what’s the hot child show right now?
Lindsey: She’s obsessed with “Star Wars.”
Dr. Franco: Oh, really?
Travis: Yeah. Yeah, that’s right up your alley.
Dr. Franco: I love a little “Star Wars.”
Gilberto: There you go.
Dr. Franco: Is “The Mandalorian” kid-appropriate? Did she watch that or no?
Lindsey: Yeah, no, it’s not kid appropriate.
Dr. Franco: Would she watch it anyway?
Lindsey: We watched one or two episodes and it was like, “Ooh, not appropriate.” And so she does the eye covers when we say it’s not kid-appropriate.
Travis: Like this way?
Lindsey: Like this, yeah, over the eyes. And so…
Dr. Franco: But I feel like baby Yoda…
Lindsey: So now we’re like, “Oh, my gosh…”
Dr. Franco: …baby Yoda is like a…
Travis: Steals the show.
Dr. Franco: …a childlike, you know, [inaudible 00:04:44].
Lindsey: And we pre-ordered all of the baby Yoda items. So I’m like, “Yep.”
Dr. Franco: Kind of, an interesting ploy by them, right? You know? Much bigger hit than Jar Jar Binks for those of you that want to…
Travis: Oh, yeah.
Lindsey: Oh, my gosh.
Dr. Franco: …want to bring back that nightmare from “Star Wars.”
Travis: Who?
Dr. Franco: Exactly. Who just mysteriously had a huge role in Episode 1 and then just faded into the dust for the followings. I know we’re geeking out seriously here.
Travis: Nerd alert.
Dr. Franco: For those of you that are listening, I appreciate you guys bearing with us for a minute. Just hashing back some nightmares of Episode 1 through 3, but yeah. I love me some baby Yoda. That was a hit.
Travis: Oh, yeah.
Dr. Franco: Anything else going on that we should touch base on before we jump into this?
Lindsey: I’m giving away our puppy.
Dr. Franco: Oh, you guys are? Why?
Lindsey: No, I’m not really giving it away but I would like to. That little tiny thing is…
Dr. Franco: I don’t think that people know.
Lindsey: So I have a puppy. My daughter has one. It is a Morkie and she will tell you it is a Morkie and his name is Howdy [SP].
Dr. Franco: Howdy is an interesting choice for a name.
Travis: Yeah.
Lindsey: Yeah, she picked it. Or Elsa…
Gilberto: Is that like a “Toy Story” reference or something?
Lindsey: …from “Frozen”. Mm-mm.
Dr. Franco: So the dog changes names depending on the day?
Lindsey: Yeah. It’s either Elsa or Howdy. That’s what I would say.
Dr. Franco: Okay. That can be confusing.
Travis: But probably not confusing at all for that poor dog.
Lindsey: It is, yeah. So it is…
Dr. Franco: Especially if it’s a small puppy.
Lindsey: …4 pounds and he is a little terror.
Dr. Franco: Okay, good. Good. Sounds a lot like Gilberto. But…
Gilberto: Not entirely inaccurate.
Dr. Franco: Let’s get into a little bit of the topic here today. Yeah, tell me about the patient process. And so I think we talk about the surgeries itself but let’s maybe walk through what patients have to do to get into this and then some of the big roadblocks. And maybe my goal of today is what can patients do to start looking forward to some of these things and figure out how they can avoid some of these problems and obstacles. Because I think, no question, and Travis can probably attest to this, the better prepared people come in, the better they tend to do after the surgery.
Travis: On the backend, for sure.
Dr. Franco: So the more we can do to, kind of, help them be prepared I think would be helpful.
Lindsey: Absolutely. Definitely, you know, gosh, being prepared it leads to, like you said, a better recovery too because you don’t have all of these other problems that they’re…
Dr. Franco: Maybe we’ll start from the very beginning. So a lot of times people will call, send an email, whatever to get scheduled. When they initially get scheduled, then it goes to…because it’s typically because of life’s schedule and surgeons, unfortunately, make life a little difficult in terms of scheduling because we’re typically only in the office, you know, maybe two days a week, one and a half days a week depending on people’s particular schedules and then getting into the office. Because we’re in surgery the other days. And not really…
Gilberto: Wait, you’re not just hanging out on your yacht?
Dr. Franco: It’s a little weird. It’s a little weird, but yeah. But the other things to think about is, so from the time they get scheduled and then we’ll do a couple of things. So the front desk, obviously, and whoever takes the calls tries to answer some information. Typically, they may or may not actually reach you. You’re the patient care coordinator, so for people who haven’t listened, you know, we’ll get into it a second about what that is, but and then we actually do something called a pre-consult call. Can you explain what that is?
Lindsey: Yeah. So the pre-consult call is my…basically, the most important call before they meet you. So I go over all of the information with them, health history a little bit, what their goals are, financing, pricing, recovery. You know, so basically all of the questions that they have that are not for you.
Dr. Franco: I mean, most of the time we describe this as like a mini-consult, and the idea is giving them information so that when they come see me, it’s not the first shock. And I feel like it helps become better prepared because they’ve already… It’s like any conversation, questions lead to more questions. And so the more you can, kind of, touch base on some of these things, it lets them look at their life and figure out like, “Oh, okay,” and then when they come in, some of this stuff’s been more thought out. And then if they still have questions, we can dig deeper. And I feel like it makes that first superficial consult a little bit less, kind of, overbearing.
Lindsey: Exactly. Especially if you’re coming in for a breast augmentation consultation and you have more excess breast tissue and you’re actually needing a lift. It’s just that recovery is so much different than the regular breast aug.
Dr. Franco: And not even just the… The pre-consult stuff, I feel like not only just talks about which surgery but more life in general. And I think that’s what sometimes people forget. And I feel like that’s the true benefit of this is a lot of times people don’t even realize basic stuff that I’m sure you guys cover in terms of, “I need somebody to take care of me.” “Oh, really? Well, let me start thinking about that.”
Gilberto: “I can’t just drive myself home?”
Lindsey: “Oh, I can’t drive home?” Yeah, exactly.
Dr. Franco: It’s a super common one that we hear. I think in terms of, you know, needing lab’s clearances, other things they may need. And I think that’s an easy ball for them to get rolling because even if they won’t have it done before they see us, they can be like: “Oh, well, let me start scheduling an appointment to see my primary healthcare provider. Oh, I have this. Let me move up that appointment.” And I think there’s a lot of little things they can do to get the ball rolling to make stuff better.
Gilberto: I think it’s very analogous to, kind of, our pre-anesthesia screening and then when I see patients for my anesthesia, you know, consult day of, before I put somebody to sleep for a procedure, if they have had a thorough preanesthesia screening and they’ve gone through everything for them to expect afterwards and preop and everything, it makes my time with that patient much more productive. And it fast tracks that, that entire process. And I think you guys have the exact same setup, but in the surgery world, right? So she’s helping to facilitate, you know, questions the patients have about the process, about payment, about scheduling, and it frees you up to think about, “Hey, let’s really talk about the nuts and bolts of the procedure. This is what we’re going to tailor to fit your specific needs for the procedure and for your surgery,” and allows you to be more productive with that time with the patient.
Dr. Franco: No question, and then it’s just, outside of our 18-year-old breast augs, most have a lot of life. And I feel like even now, as busy as the 18-year-olds, they have a lot of life going on. And so it’s just, there’s a lot of moving parts and the better prepared you can be, the better that’s going to be. So let’s just keep marching down the line here. Because, so initial appointment and then there’s pre-call and I can’t stress how big of a benefit it is. And patients who come in who complete that always give us the feedback, they’re like, “Wow, that was super helpful and I felt like I got more out of this consultation,” because, you know, some of the superficial questions were answered. And which leads to…
Lindsey: That’s the goal.
Gilberto: Deeper.
Dr. Franco: …deeper questions.
Lindsey: That’s the goal.
Dr. Franco: Definitely the goal and makes it feel like… I feel like some of that anxiety has gone because they’re not so nervous about it. So then we actually get to the consultation and so, you know, people are filling out paperwork, there’s a lot going on that day. And then when they meet us, we’ll actually talk about everything. So we see you, we examine you, and do this. And nowadays, this may be in the office or this may actually be online and we’ve talked previously about virtual online appointments, consultations, follow-up stuff. And so I think there, they don’t realize how many people they get involved with. And so sometimes a PA like yourself, Gilberto, a nurse, other staff who help. And then because we do the actual consultation. You may spend, 20, 30, 45 minutes with me depending on the specific situation and what we’re doing. And then you go back down to our PCC, i.e. like Lindsey who will actually type up a quote going through a lot of information and logistic stuff. And just because of the human nature of it, people tend to blank when they’re in the actual consultation with me. So I’m sure you get a lot more questions when they go down to see you.
Lindsey: Oh, absolutely. It’s the deer in the headlights. They have their long list and it goes out the window. So I definitely get more questions afterwards as well.
Dr. Franco: And I think that’s what’s weird, if you can make a connection ahead of time, it makes that whole process a little bit easier. I, kind of, love doing our social media stuff because I feel like the first time they meet us, it’s not so nerve-racking because they already know us. They already know about this. I don’t know how you’ve seen it in your practice with injectables but for our surgery stuff, with us being online and doing a lot of these things, people feel like they already have a good idea of what we’re going to do, and it gives them a little bit better idea of what questions to ask.
Gilberto: Yeah, I think you do it on a whole other level. You know, you are posting multiple stories on your Instagram account about your surgeries, going through the procedure, explaining it step-by-step. You know, you’re doing it on a whole other level that’s really impressive. You know, in my practice, we’ll do some stuff with social media on occasion, especially when we have like a big event, like a Botox day event or I like Fall Aesthetics day event or something like that. And we’ll, kind of, put our goofy hat on and, you know, do little dances and, you know, stuff like that. But in terms of like educating, you know, the masses and really, kind of, helping them get to understand what they should expect, I think you’re doing everything, you know, the right way.
Dr. Franco: We try to. I mean, and we’ve now tried to incorporate that into the anesthesia because that becomes a big part of this. And we get a lot of anesthesia questions. And so something we’re trying to work on a little bit better and some of the things we talk about in those visits is this whole ERAS protocol that you actually helped me design. And you’ve been a little stingy with sharing this but you’re actually giving a talk at the Austin Society of Plastic Surgeons coming up soon.
Gilberto: I am, yeah. We’re going to talk about Enhanced Recovery after Surgery. That’s what ERAS stands for. It’s basically how can we increase or expedite a patient’s recovery from surgery through good fluid management, carbohydrate loading preoperatively, decreasing narcotics intraoperatively and postoperatively, and using other non-narcotic analgesics or pain-relieving medications during and postoperatively? So it’s been awesome. We’ve seen a huge decrease in nausea. Patients are more active postoperatively. Those are all things that help with gut motility, and decrease in constipation, and decrease in vomiting. So yeah, it’s been fantastic.
Dr. Franco: Can we talk a little bit about a topic that I feel like is a question we get all the time?
Gilberto: Yeah.
Dr. Franco: And not a sexy topic and I feel like nobody wants to talk about it, but pricing, financing, those type of things. And, you know, it’s out there. I feel like it’s a black box of plastic surgery. We’ve tried post pricing on our Instagram to help people because I feel like a lot of people, they just want to know and then they want to figure it out. And this is something where I think with Lindsey and other practices, patient care coordinators can help with giving you some ideas of pricing. And I think that’s why we’re talking to them and them giving you ranges helps, kind of, figure some of this stuff out. And some people like to do stuff on credit cards, some people just want to pay cash. Some people want to finance and do other issues and so maybe you can discuss a little bit of options that people have and how some of these pre-calls can talk about how they can look into this so when they come the day of, they can ask more specific questions.
Lindsey: Absolutely. So I do get the…I mean, “What does this procedure cost?” all the time. And that way, I try to give them that range as much as I can prior to that.
Dr. Franco: So people understand ranges is because we don’t know exactly what they might need.
Lindsey: Exactly.
Dr. Franco: And we can give you the price for a breast aug with gummy bear implants. But especially when you start talking about mommy makeover, lipo, depends on the number of areas, depends on, you know, whether we’re doing fat transfer. So it’s nothing we’re purposely trying to be vague, but it’s sometimes hard over the phone until we actually do the consultation to know exactly what you need.
Gilberto: It’s not a one size fits all, right? It’s not.
Dr. Franco: And the length of the procedure effects because for those of you that don’t know, celebrity anesthesia is expensive. You know, that pony ain’t free.
Gilberto: I can’t stay shopping at Central Market for nothing.
Dr. Franco: No, so trying to make that. And so the length of the surgery varies. Price, you know, and other things as well.
Lindsey: Absolutely. And so one of the… So going over the breast aug, for example, you know, typically your $5,550 for a breast augmentation with the gummy bear implants, giving them that price in advance, then that way they can figure out, “Okay, well, am I going to put it on my credit card? Am I going to finance? Do they have financing options?” Which we do. So we offer ALPHAEON and CareCredit. They are two different financing options.
Dr. Franco: And what do people have to do to get into them? What’s the benefit of them? Do they do anything special for cosmetic procedures? I think for you, it’s secondhand, but most people may not know what those are.
Lindsey: So I will be more than happy to email or send a link so then that way… But honestly, it takes about five minutes. You can go online and apply. But it is, it’s every practice is different. So your practice, Austin Plastic Surgeon, excuse me, offers 6 months and 12 months with 0% interest.
Dr. Franco: Through these programs.
Lindsey: Through these, yeah.
Dr. Franco: Just so you guys don’t really confuse, so CareCredit and ALPHAEON are actually two financing systems that are made specifically for cosmetic surgeons. You can use them for other things but that’s what they were built for. That’s what they’re made. And they’re made in terms of a couple of things to make the process easy for patients. And so that’s why they tend to have shorter terms and other things like that because, the idea is that we don’t want people getting in over the head but we want to make this easy for people. And so, you know, there’s a couple of different ways to do it. And a lot of people break this up. They may do some of it. A lot of people just like to take advantage of the zero-interest and do this over some payments. Some people want to get points on their cards so they can show off their new body on a beach vacation. That’s okay too. We just want to give you options and help guide you through this.
Lindsey: And that’s one of the, well, questions is, “Well, what do you think I should do?” I’m like, “Okay, well, one, I’m not a nurse,” as previous episodes. And then, “I’m not a financial advisor.” So whatever makes most sense to their family and whatever’s going to benefit them financially, so yeah. Earning points on their credit card or a 0% interest through one of our options.
Dr. Franco: And I think that that’s our job is just to make recommendations and put opportunities out there and to help guide people a little bit in terms of, here are some options for you and then that way, people can look into what’s best for them.
Travis: When you guys released that processing pricing for a breast aug, when she said the $5,550, what does that include? Is that all-inclusive? Or is that just for the implants? Or is that just for the surgery? Or what does it…?
Lindsey: One implant.
Dr. Franco: And I think that this is what’s super important is that it varies from practice to practice. And I think that’s an incredible point is, does that include…And, you know, typically most people, when they give you a price for breast augs it include the surgery, the implants, but the part that sometimes is a little vague is does that include the surgery center? Does that include the anesthesia? Some practices do it differently. In our practice, we take care of everything. So when we give prices, that includes everything outside of labs, other, you know, things that you may need at home in terms of, you know, snacks, other stuff.
Lindsey: Prescriptions.
Dr. Franco: Prescriptions, that’s a good one. You know, but we try to keep those reasonable too in terms of that. But it includes the surgery center, the anesthesia, our visits, office visits, follow-ups, those types of things, garments are included in that. So I think that’s a phenomenal question, something to make sure with whichever provider, you know, you’re using, that you’re very clear about that. And we’re write something up. In our new app, people can reference it on their phone and [crosstalk 00:20:35.568]…
Travis: That’s awesome.
Dr. Franco: …so they have access to it for later use. So I think it’s super important to ask those questions for sure.
Gilberto: And I think it’s important for patients to understand that, that there is difference in practice so that they can compare apples to apples. You know, you don’t want to say, “Oh, man, well, this guy is only charging $2,000.” Well, he’s probably not charging for anesthesia, and the facility fee, and all that stuff. So as a patient, it behooves you to know exactly what you’re paying for.
Dr. Franco: And there’s no right or wrong answer. So I’m not trying to cast stones for practices that have surgery centers or other things bill them directly. We just have so many patients from out of town that we’re trying to make stuff as easy as possible for them. And so that’s why we do it. Again, you know, different strokes for different folks, so things work differently for different offices. And I wouldn’t let one way or another be a deterrence, but I’d definitely know what you’re getting into.
Gilberto: Absolutely, yeah.
Dr. Franco: I think that this is something we’re really having a good relationship with the patient care coordinator because honestly, if you ask most of these questions to the doctor in terms of how to apply, how to do some of these things, they’re not going to know. And this is where, you know, utilizing and doing some of that first consultation, making some time, so that mini pre-consult is super important because they can actually make this process very easy and walkthrough. So then you know the answers to what should I do because you can already see what you have on your credit card. You can see what you would do on CareCredit. You can see what you would be approved for. And that helps too because then when you’re talking with the PCC, and again, I feel like I’m talking about stuff that was voodoo to talk to or taboo to talk about, you know, previously but it’s important. You know, I mean, for most of us, i.e. except for 1%ers celebrity anesthesia here at Whole Foods, you know, what we can do or can’t do, you know, in terms of a budget is important. And there’s lots of times like I’m looking at stuff, you know, I want this suit, I want these shoes, I want this, I want that, but, you know, what fits into our budget too? And sometimes when people come in and say, “Hey, this is my budget, what’s going to be the biggest bang for my buck?” That’s not an unreasonable question. And if you work with the PCC ahead of time like, “Hey, look, here’s my CareCredit. Here’s my credit card. Here’s what I can afford.” Then after we, kind of, know like, “Okay, well, if you’re asking me what one procedure is going to make the biggest difference for you, here’s what it is.” And I think that there’s good ways to do this that isn’t derailing us because it’s great to have a wish list. And sometimes it’s just like we talk about for lip fillers, sometimes it’s a process, and figuring out that process in an organized fashion.
Gilberto: Absolutely.
Lindsey: That’s what I definitely try to, you know, help them do prior. That way, they have again, their time with you in the room is just that, just honestly like what they’re trying to…with their consult.
Dr. Franco: And if we already have, kind of, worked through some of these ahead of time with you, then it’s more worthwhile in here because then it’s not trying to come back and have a reconsult and other stuff, which we’re happy to do but everybody’s time is precious. And so, you know, it’s hard to get off from work especially if you’re trying to have a surgery and you’re going to ask for more time. And then keep asking. It’s sometimes a little bit difficult.
So I want to keep moving along the process because there’s a lot of stuff. So after the quote, after people figure out the financing stuff and then they pick a date. I think one, most people don’t realize that it takes a little bit longer to have surgery than you think. It’s pretty rare that we see somebody on Monday and have surgery on Tuesday. You know, most people are scheduled out, you know, two months or so in advance and talk about…because once they pick a date, that’s just the beginning between your relationship. Because you actually set up a couple of other appointments for them.
Lindsey: Absolutely. So once they choose their surgery date, I work backward. So you have your surgery date and then you have your postop afterwards, so meeting with Doctor Franco, the day or two after. And then even working backwards from there. So scheduling their preop. So that’s when they’re gonna hopefully, so we could… Sarah or nurse Sarah or one of our MAs to go over labs, clearances, EKGs, which is about three weeks prior to their surgery. And then even there, you know, we still meet with them and I still chat with them and go over the deposits and, you know.
Dr. Franco: Exactly. Because it’s all about doing as much stuff ahead of time. And so because we actually get everything over to the surgery center. I know your team does has a nurse call as well ahead of time to prescreen patients, getting all these labs that you’re talking about ahead of time because we want to make this as smooth and safe as possible for people. And we do the things early, so that way, if there is an issue…You and I talk all the time and I’ll say, “Hey, a patient has X. This is what we’ve done. Do you guys need anything else?” In the conversation that just to make stuff as smooth and safe for patients.
Lindsey: And the goal is to give them, the patient, as much information right then that they need and not to overwhelm them. So I know that right now listening to this, it might be, “Okay, what do I have to do next? What’s the next step?” But, “I’ll walk you through it.” So I will give you, you know, “This is due at this time. This is this appointment. This is what you need.” And not to give them too much too quickly.
Dr. Franco: And I think once people have that roadmap, I think that’s what’s super important because they’re going to have time off work figuring out those type of things. I know I’ve said it a couple of times but it’s so important, the better off you are in terms of preparing, the better you’re going to do for your surgery and that’s figuring out who’s going to help you get in those labs, doing those things. So once they get a date, we do what’s called a preop, and this is where we review their labs, review sizing, make sure that we have a good plan because again, even though we’ve spent so much time with the pre-call, with the actual visit, you know, there are still questions at that preop and going over more specifics. And again, talking about some of the ERAS and the anesthesia stuff ahead of time and doing those things.
Lindsey: And that’s a great… I get a lot of questions of I’ve…from patient saying, “I have a really low pain tolerance. Like, I do not do well on anesthesia. Or I get a scratch and I cry.” And so I’m like, “Okay, well this is exactly what Dr. Franco does, it’s the ERAS,” and I, kind of, walk them through what medications are taken even beforehand so they know that we’re not just giving them narcotics and saying, “Good luck.”
Dr. Franco: Because we take this very seriously. And for people that didn’t listen to some of our prior episodes, you actually, by you I mean Celebrity Anesthesia, she helped us install this program in our practice and that’s what you’re giving a talk about to other plastic surgeons throughout Austin Texas is how can they better incorporate this because the old days of just giving people narcotics… We’ve taken the narcotic crisis in America very, very seriously and so, you know, I think sometimes, and this would be, my behind-the-bovie statement would be, I don’t think people realize it’s a struggle for us as providers because we really want you to be comfortable. We want to take care of you, you know, but we also want to do our part to make sure that we’re not just giving you narcotics endlessly. And so it’s a really, really tough battle for us because we want to judge [SP] your pain, but we want you to be comfortable, but we also want to move you in the right direction. We talk about it all the time.
Travis: We do, and I think we have patients of all different forms and fashions, right? We have patients that are narcotic-naïve or surgery-naïve, never had anything done ever, surgery that was elective or not. And we have also had patients that are, you know, chronic pain patients and they’re followed by a pain specialist. And they are on methadone or they are on other narcotics because of low back pain or whatever. And we actually, and not to get ahead of ourselves with behind the bovie, but we talk about that. Johnny will call me and we’ll have a chat and say, “Hey, Patient X, it’s coming up in two weeks. They’re followed by a pain guide. This is the pain specialist.” I will either reach out to the pain specialist and see what they’re on, and we’ll tailor the anesthetic, and we’ll tailor their perioperative plan around that.
Dr. Franco: I think it’s super important. And it’s one of those things that’s hard for us because it’s not something that we can measure like a temperature or a blood count level. And a lot of this we try to get questions, during surgery, I think it’s a little bit easier because you do measure their heart rate and other stuff that are indicative of whether they’re having pain or not. But after that period, we’re dependent on people’s statements and how they’re feeling. And I think one of the things that we’ve gotten away from, and not that I grudge too much but for a while, there was, you know, the fifth vital sign was pain. And it came from a good point. We were trying to get…
Travis: Yeah, it came from a good place, for sure.
Dr. Franco: …trying to take care of patients but, you know, you’re going to have some discomfort. We do everything we can to minimize it. There’s lots of modalities that we do but, you know, trying to get you mentally prepared for that I think is super important.
Travis: Absolutely.
Dr. Franco: So once we get through the surgery, the other thing that I know you do in the process with them is scheduling some of the follow-up appointments because the thing that people forget is we get really excited about the surgery but it’s the time after. And so, you know, in terms of helping people with time off work. You know, a lot of people need forms filled out in terms of, you know, what they can or can’t do and depending on whether you have a desk job or a job like ours that, you know, is definitely a little bit more labor-intensive, maybe not for Gilberto who is just more of a finesse guy. But for you and I that do the heavy lifting, you know, we have to really be on top of this.
Lindsey: Do I fill out my own familiar paperwork to have four or five weeks off from work when I have mine?
Dr. Franco: That won’t be signed. That will be denied by HR. So I think that’s super important, something that you work a lot with people because I think everyone doesn’t realize how much they work. And we talked about this in one of our other episodes, you know, with behind-the-scenes of you and nurse Sarah’s how much of this paperwork and this stuff goes through and you tend to be the main contact. I might be the one who signs it but you guys actually fill out a lot of this, get stuff prepared, you know, working with different jobs because some people just want a note from our office, some people have specific paperwork. And I get it, every institution has its own policies, but it’s impossible for us to just, right off the bat, understand what everybody needs. And I promise, we’re working hard to help get to what people need.
Lindsey: Kind of like what you said there before too, it’s not one-size-fits-all. Every patient’s different.
Travis: Absolutely.
Lindsey: Literally, you come up with a surgery plan and customize it for every single patient. So, when someone calls for a mommy makeover, it’s not, okay, what does that look like to you? It’s not mommy makeover package A, everyone gets the same thing.
Dr. Franco: I think that’s a great point and it’s a great point in terms of recovery too. Like, sometimes we’ll take time off and we’ll sign something and then sometimes it alters. Sometimes people are feeling good and they want to go back sooner. Some people need a little bit more time. It is what it is.
Lindsey: Everybody’s different.
Dr. Franco: And we try to help people. Give us, if there was a few take-home points here that you tell people in terms of scheduling and preparing for their surgery, what would you say? Maybe three, like, key factors that you would say that makes the process smooth for them.
Lindsey: It would, honestly, talk to your employer. You know, you do not have to tell them that you’re having, you know, a breast augmentation or you’re having, you know…”I’m getting a larger booty.” You know, you don’t have to say that to them because of HIPPA, but make sure you’re getting that time off because it’s going to make that much…my and your life, that much easier especially when you’re picking a surgery date. You can really narrow it down.
Dr. Franco: It also makes it easier to know, “Hey, this is the amount of time I have off. This is when…” The more if they can bring paperwork that they need us to help fill out. It helps because it doesn’t make a delay on them where they’re stressing the last minute trying to get time off because then it’s being faxed. And it didn’t get to fax…It goes into the abyss of this e-fax which I still don’t completely understand.
Lindsey: You know, for time we talked… You can’t take five days off of work and go back and be okay. So if that’s all you have allotted, it’s, “Okay, well, let’s find another time where you can take additional time off from work.” Because if not, I mean, you’re not going to have…It’s going to be a hard recovery. And that’s not even humanly possible.
Dr. Franco: And I think that point of hard recovery is, you know, not everything is a hard recovery but everything needs some help. And I think figuring out who’s going to help you.
Lindsey: That’s the second step, yeah.
Dr. Franco: I think the point you’re definitely getting to here is that you’ve got to plan accordingly. People who plan accordingly do well. And I know we’ve said that already a couple of times but it’s that important.
Travis: I mean, that’s the biggest take-home, huge, great support system and having a plan in place preoperatively, in day of, and then postoperatively.
Dr. Franco: You know, because I think people don’t realize, and we’ll wrap this up because we weren’t hitting the timeclock again but, you know, there’s a couple of big decisions in life. You know, and I tell everybody there’s the big three, so, you know, marriage is one, buying a home is another one, and I’d put plastic surgery because it’s a big transformation. You can probably speak to this more than I can, but most people say that they’ve been thinking about this for years. We had someone the other day who came in and said, “I’ve been following you on Instagram for two years and been thinking about this. And now the time is right.” So it’s a big decision for them.
Lindsey: Oh, absolutely. It’s a huge… You know, for most patients, it’s a huge investment and they’re honestly thinking about just like you said, who’s taking care of them, how are they going to do it? And they’ve been thinking about this for years.
Dr. Franco: Let’s do a little…wrap this up a little bit in terms of this. I think it’s a great conversation. I think it’s something that we need to talk to more about. And definitely, if there’s more questions people have about this, feel free to DM us at Austin Plastic Surgeon on Instagram and we’ll be happy to incorporate this into some future cast because I think it’s something that nobody talks about and people have tons of questions about it. And one of the goals that we’ve been trying to do with our Instagram and with this podcast is take away this black box of plastic surgery, where, like, you don’t know what you’re coming into.
Gilberto: It’s too taboo.
Dr. Franco: It’s too taboo and nobody wants to talk about it. And I think you’ve done a great job with the anesthesia. I feel like you’ve opened up some of this injectables of what people can and can’t do. And now this whole, kind of, scheduling, financing, other stuff, we want to be as transparent as possible and help people through that journey. But fact or fiction, would you say that financing is the biggest obstacle people have?
Lindsey: Half [inaudible 00:34:32], I mean, fact though. Absolutely, it is financing and recovery.
Dr. Franco: Because I would think financing or recovery would be my two biggest because I think people just don’t think about them until the time, and makes it hard. And I think both of those, planning ahead of time makes sense, and that’s why, you know, we’ve tried to… And Tarah, our social media person has really helped with this in posting prices after procedures so people can start to plan. Because we never want people to do something that’s going to get them into logistics trouble and that comes with either of those.
Can we jump to a little Behind the Bovie? I feel like we’ve hit in a couple of these. Any more nuggets? I think we talked about, you know, how much goes behind the scenes of doing some of this. I feel like we hit up at least three of these during this. Any more tips behind the scenes that people don’t realize in terms of scheduling that you’d like to share with people?
Lindsey: Just give me a call so I can go over some things with you or just at least give me a call back or, you know, speak to me, myself directly because I promise the whole process will be a whole lot smoother.
Dr. Franco: It’s like anything, the more information you have… What’s the old NBC thing? The more you know, the better you are. I know I’ve butchered that, so sorry, NBC.
Gilberto: I mean, I just want to say I feel like I learned a lot, especially in preparation for this calf surgery that I’m going to be having some time in…
Dr. Franco: We talked about that. And word on the street is that you haven’t done your pre-consult call.
Travis: We’re not talking about baby cows, right?
Lindsey: Right, I don’t have pictures yet either.
Travis: You’re talking about a full-on calf implant.
Gilberto: Well, I mean, that’s what we talked about in a couple of episodes ago, right?
Dr. Franco: Summer’s coming, you’ve got to look good in your shorts, man.
Gilberto: Yeah.
Lindsey: And I still don’t have pictures.
Dr. Franco: Because you were the big hit of last year’s pool party, the terry cloth shirt. People did say, you know, “He’s got a good chest but those legs…” like, you know.
Gilberto: Chicken legs?
Dr. Franco: That was the rumbling we heard and so…
Travis: Fact or fiction, there may be a pool party this year?
Dr. Franco: That would be fact. Timing has been a little bit, because don’t want to over-inundate stuff because I feel like we typically do this at the end of June, early July, but I feel like our grand opening party is going to be in June. So maybe we’ll do a little grand opening at the beginning of the summer, close out the summer with a big blast. Still details in the works, but stay tuned at Austin Plastic Surgeon for details. Can we do a quote of the day? Does somebody got a quote to close this day out?
Gilberto: I’ve got one.
Dr. Franco: Oh, you just randomly have one. Well, great. Thank you, Gilberto.
Gilberto: Well, I wasn’t even prepared.
Dr. Franco: No, but I just happen to have these memorized.
Gilberto: I’ll pick one of these.
Travis: I happen to have one, I mean.
Gilberto: So I like this one. I don’t know how well it applies to the topic today but I really like this one quote by…
Dr. Franco: Sure, sure. It’s your show, Gilberto. It’s your show, you do whatever you want to do.
Gilberto: …by Benjamin Franklin. It says, “Tell me and I forget, teach me and I remember, involve me and I learn.”
Travis: Oh, I like that.
Dr. Franco: Damn. What have you learned today?
Gilberto: I learned a lot about scheduling, surgery consult…
Lindsey: Calf implants.
Gilberto: …and I learned something about calf implants.
Dr. Franco: So I mean, it’s perfect. You’ll start applying to some ALPHAEON, get preapproved for your calf implants…
Gilberto: Some CareCredit or…yeah.
Dr. Franco: …and be ready to go, and then know that you’re going to get an anesthesia call and boom, I love that. But I think that’s what we’re trying to do with these podcasts. Our Instagram has involved people so they feel a part of this. So I understand because I truly feel like when people come in and they watched us, they’ve done these things. They have a better understanding because they feel like they’re already a part of our team and they know what the process is. They understand like, “Oh, I see what you did to my belly. I understand why I need three weeks, because you lifted my skin up. You tightened my muscles.” It makes sense. And so for me, when I understand a process, like, it makes more sense. When you just tell me to do something I have no understanding, the chances of me doing that are zero.
Gilberto: Totally.
Lindsey: And on that note, if you cannot stomach watching some patients, say, “I just can’t watch the surgeries,” just turn the volume all the way up and, you know, turn the phone over and just listen to it because if that’s the procedure that you’re getting, at least you can hear exactly what you’re doing. Same thing, it’s going to make it go by so much quicker or so much better.
Dr. Franco: That was my experience when I went to watch “The Invisible Man”. For those of you that follow us on Instagram, I talked about this a little bit. One, it’s not a Marvel, like, superhero show. Two, I should’ve watched the previews. It goes to our point of doing research ahead of time. I know it’s important in plastic surgery, but it’s also important in picking a movie. I do not do well with scary movies. And then it was more basic…I went with two dudes. And the whole time I’m like pulling my hat, and they’re like, “What’s the matter dude? What’s going on?” I was like, “I’ve got something up my eye. I’m just really tired, you know?”
Gilberto: “I’ve got to go to the bathroom again.”
Dr. Franco: And they’re like, “Yeah, you’ve gone out like six times.” Just you got anything for the concessions. “They’re delivered to the seats, dude.” I was like, “Yeah, but it’s cold by the time it gets here.”
Travis: “Johnny, why is your seat all wet? What’s going on?”
Gilberto: It’s such a good thing you didn’t join us last night then.
Lindsey: What did you see?
Gilberto: We went to go see that new movie, “The Hunt.”
Dr. Franco: [crosstalk 00:39:28.507]
Lindsey: Oh no, see, I want to see that.
Dr. Franco: No, I’m out.
Travis: Game over.
Woman: Just don’t [crosstalk 00:39:32.540].
Dr. Franco: So, do your research when you’re thinking about watching a movie. That’s my take-home message from behind the bovie.
Travis: Yeah, watch the previews.
Dr. Franco: Well, I’d like to thank everybody for joining us today. I appreciate Lindsey being here and demystifying the process here. I’d like to thank all of our listeners. Again, I appreciate you guys listening. I appreciate you all telling somebody. Feel free to download us, iTunes, iHeartRadio, Spotify, Pandora, wherever you get your podcast from. I’d like to thank our producer Donald, but since his pointed us his watch 12 times, I’m not going to. Thanks for listening to the number 1 Podcast in America voted by us, boom, thank you. See you guys.
Gilberto: See ya.
Lindsey: Thank you.

About The Author

Dr. Johnny Franco
Episode 12: Luscious Lovable Lips!AquaGold – Feeding the Collagen Craze!!!


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