The Perfect Lip Pout – Nurse Sarah and G- Berto Debate Live From Austin Texas!
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 the great pleasure of being joined by our incredible team here of co-hosts. And I think you’ve met everybody, but we’ll go around the table and introduce everybody. Today, we’re gonna be talking about the perfect lip pout and so we’ll have a little G-Berto, Nurse Sarah off here and I think they’re gonna lead a little bit of the discussion and the debate. And we may even have a surprise quiz for them, but who knows what will come in. But we’ll start to my right here, we’ve got Celebrity Anesthesia.
Travis: What’s up, guys?
Dr. Franco: Also known as Travis Osborne. Nurse Sarah.
Sarah: Hello. Hello.
Dr. Franco: Katie Jay.
Katie: Hello, everyone.
Dr. Franco: Our incredible aesthetician. And then to my left, beautiful man, G-Berto.
G-Berto: Buenos dias, everybody.
Dr. Franco: Damn, look at him.
Katie: I love it.
Dr. Franco: [crostalk 00:00:55.081] You’ve already been one-upped.
Katie: Oh, he brought the heat.
Dr. Franco: Not that we’re keeping score, but score 1-0, G-Berto on the intro.
Katie: To the ding ding ding.
Sarah: Okay, fine. I lost that.
Dr. Franco: So not that we’ll have a grand total at the end of the day, but we will. Hello, let’s catch up a little bit. I knew with the COVID-19 and everything else going on life’s been a little crazy I’m sure for everybody. Catch us up. What’s been going on in your life?
Travis: Not too much has changed. Mary is getting a little bit better with her knee. I know you guys have been following along. People have been reaching out and asking, which has been super nice. She’s doing better with the pain stuff that she had going. I hear in a week or two she should be off crutches completely, which will be cool. But because we weren’t doing a whole lot of social interacting before that, social isolation hasn’t been too bad with the Coronavirus. So, not a huge change at our house, but been trying to not go out to huge events and big things, but not that there’s much of that going on right now at all.
Dr. Franco: I’ll tell you, this was my weekend off and I think for most people to understand that the people in this room are not gonna have some really bad effects from this, but we could be carriers, we could distribute this.
Travis: For sure.
Dr. Franco: I’m so afraid of being locked down into quarantine that it was my weekend off and I avoid large crowd areas because I don’t wanna be part of the problem.
Dr. Franco: And so I think just being responsible.
Travis: I think it’s a social responsibility at this point.
Dr. Franco: Can we digress for a little bit about social responsibility? This is just a personal plug. You guys don’t need 16 months’ worth of toilet paper stocked at your house. There’s a little social responsibility. You don’t have to get both armfuls full of cleaning supplies. I promise, this is gonna come to an end, it’s gonna get better. Get what you need, but be a good neighbor, please.
Travis: Real quick story on this. The other day…we get groceries like normal people, like for maybe a week or two at a time.
Dr. Franco: No, no, no. For a week at a time?
Travis: A week at a time. And I went to Central Market because like normal people, we had eaten through most of our groceries.
Dr. Franco: Normal people don’t do all their shopping at Central Market or whole foods, but for the one-percenters out there, please continue so we can leave the celebrity anesthesia [inaudible 00:03:04]. Please continue. For those of us at Walmart, let me know how the one-percenters do. Thank you. [crosstalk 00:03:12.940] I do a little fiesta, but no. Please continue so I can have dreams and aspirations with the anesthesia world.
Travis: I knew I was gonna get flack for that. Anyway, so I went to Central Market the other day and we are looking for sponsors, by the way. If Central Market wants to reach out [inaudible 00:03:27]
Sarah: That’s how he does this.
Travis: So, we’re at whole foods, we’re not gonna discriminate. Anyway, so I went there to just get a couple of things. We needed milk, groceries, eggs, blah, blah, blah, whatever. And I walk in and I’m talking with my mom on the phone on my way in, and HEB is a big chain in Texas and Central Market is kind of their whole foods version of it. So, I’m walking in and I’m talking to my mom. She’s like, “Hey, the other day I went out and I was trying to find stuff. It looked like the end of the world. There’s nothing on the shelves.” I was like, I doubt Central Market is gonna be like that. It’s like whole foods, very boutiquey. So, I walk in, the entire produce section, all they had was pineapples. The entire place is like salads, vegetables, anything, all gone. I call Mary and I was like, “Hey, so that list that you gave me, we’re getting like three things on it. There is nothing here.” I just thought it was absolutely hilarious. Everybody does not need to buy greens and spinach for the next six months. Please leave a couple on the shelves just so that I can make a salad.
Dr. Franco: They don’t even keep for like two weeks.
Travis: I know, right?
Sarah: Oh, you know what? Pineapple is one of the things they should have gotten. That’s bromelain, it’s healing. It’s really good for you and actually…
Dr. Franco: Yeah. You don’t want bruising after your lip. You gotta be on that.
Sarah: You don’t want bruising after your lips. So, actually, go get that pineapple. Actually, that’s the plug.
Travis: The best part of that entire shopping experience, I’m ready to check out, there’s a guy behind me…I don’t know…50, 60 years old and he coughs and I swear the lady behind him looked at him like, “Oh, my God. We’re gonna die. We’re all gonna die.” And I just see this panic over this lady’s face and the guy was coughing. Normal people cough, it was not a COVID-19 cough. And he just coughs and she was like, uh-uh, next line. She moves her cart over and goes to the next line. I was like, oh man, we’re living in a new interesting time for sure.
Dr. Franco: What’s going on in your life, G-Berto. I feel like we haven’t gotten an update. Nothing? I do love that every time I reach out to G-Berto he’s like, “Oh, I’m at this party. I can’t go tomorrow because I have this thing.” I was like, “Oh, I guess my invite got lost in the mail. It must be a problem with the mail and my phone.”
G-Berto: Yeah. I kind of picked up on that a little bit.
Dr. Franco: Okay. So, tell us about the parties that Celebrity Anesthesia and I didn’t get invited to.
G-Berto: So, most recently my girlfriend just celebrated her 30th birthday and so we had a big party for her.
Dr. Franco: And tell the audience how old are you?
G-Berto: Age is just a number.
Katie: You’re 33. You’re 33 and you’re 33.
G-Berto: I’m 30 plus.
Katie: You’re 30 plus.
Sarah: Okay. That’s a good way to put it.
Dr. Franco: Okay. That’s good. Women like older men. You’re still good.
G-Berto: But I didn’t plan the party.
Dr. Franco: But I still think she falls in that half-your-age -plus-seven, doesn’t she? I mean it’s right on the fence. Close maybe.
G-Berto: No, I think we’re good. This is a solid half-age-plus-seven.
Dr. Franco: Okay.
G-Berto: So, I didn’t plan the party itself, it was like a dinner out and then gathering. It was her, one of her best friends and she got all her high school friends together. I think I got lucky to get invited into this thing.
Dr. Franco: Well, somebody had to pay for the party. Yeah.
G-Berto: I didn’t see it that way.
Dr. Franco: It sounds so different when you say it like that.
G-Berto: That’s a little more hurtful.
Sarah: I feel so awkward about this conversation.
Katie: He just had a whole epiphany, when you look at his face.
Sarah: I just felt so bad. I just saw his face and I felt so bad for a moment.
G-Berto: That’s a little more hurtful, John.
Dr. Franco: Well, if I got an invite, i’d probably speak [inaudible 00:06:53]. But [inaudible 00:06:54], lesson learned.
G-Berto: I did plan some stuff for her on my own at home.
Sarah: You’re sweet. That’s sweet.
G-Berto: Like the morning of, I got up a little extra early and blew up some balloons and put up some banners and just decorated my condo for her so that she could wake up to this really festive.
Sarah: Okay. Hold on.
Dr. Franco: I feel like it’s these little nuggets that make you Austin’s most eligible bachelor. I hope that some of you ladies are trying to slide into this DM because, G-Berto, damn, you’re not just a beautiful man, you’re an incredible man. Damn.
Sarah: I’m gonna slide right on into those DMs.
Travis: I’m gonna have to up my game at the house.
Dr. Franco: I hope Mary at Your Trendy Therapist is watching this so that the bar has been set so high for Travis that he’ll be sleeping on my couch after Mary’s birthday. So at Your Trendy Therapist, please take notes, set the bar very high for Travis.
Sarah: That set the bar so high for the world right now I feel like.
G-Berto: It was a special birthday.
Dr. Franco: That 30. Gosh, life is half over. Boom.
G-Berto: I didn’t get to plan the dinner, so I figured let me do something a little nice for her.
Dr. Franco: You’re an incredible man.
Sarah: You really are.
Dr. Franco: Anything with our lovely ladies here? Anything new and exciting going on in your lives?
Katie: Yeah. Well, you know what? Everything is exciting when you’re in our life. No, I had a great time this weekend. I did keep it chill, but there were some fun house parties. People were doing like, “Hey, if you wanna come over, I’ve got hand sanitizer, we’ll play games inside and it will be a fun night.” And that was fun. So, I did that. But I’m kind of boring compared to what just happened with his whole thing. Yeah.
Sarah: Yeah. I have some friends in from out of town, we’re just going on a little Austin food tour.
Dr. Franco: Is this the out-of-town boyfriend?
Sarah: No, this is one of my best friends.
Dr. Franco: Is this is a different man?
Travis: This is the in-town boyfriend.
Sarah: No. I have an in-town boyfriend. The out-of-town boyfriend is still out of town. this is one of the 20-year-besties.
Travis: I’m kidding.
Dr. Franco: Because don’t you typically say this, “As long as they’re out of town, you can an in-town,” is that what you say?
Katie: In theory, that’s the idea, but…
Dr. Franco: Do you wanna give him a shout out so he can listen? So he can tag in?
Sarah: No. This is getting out of hand.
Dr. Franco: He can hear the in and out of town?
Travis: You said Austin food tour. Where’d y’all go?
Sarah: So, obviously, Torchy’s, The Grove is by my house. I actually like their brunch option. They do a good $15 champagne bottle with all the flavors if you’re looking for something good.
Travis: There you go. A little plug for The Grove.
Sarah: Also, the Fairmont Hotel, I did whoop it up at brunch yesterday. The Fairmont was very quiet, but I will tell you what, that’s the best brunch I’ve ever had my entire life.
Dr. Franco: Really?
Sarah: I’m gonna…
Travis: All possible sponsors by the way.
Sarah: Honest, I’m not joking. They give you. There’s rooms upon rooms of food and you’re just like, “This cannot be.” All the dessert I’ve ever seen and all the things, and then they give you a sheet of paper and they’re like, “You can order one of all of these if you want.” And I did. I ordered one of everything. They keep just bringing it to like a Brazilian steakhouse and you just keep getting all this stuff and then you can still go into the room and get all the things. It was maybe the best brunch of my life, but there was a band playing. I ate like a princess. It was a great day.
Dr. Franco: One plus is as much as your reservation is in Austin the last week or two. So, I’m not gonna complain, but because pretty sure Donald is tapping his watch again, for those of you that listened to the last episode, let’s get into a little bit of a lip craze here. And so I know that we’ve talked about lip augmentation in general, but we got such positive feedback, we got so many questions. And nurse Sarah says that this is her specialty. So, and those of you that follow us on Instagram probably agree. We’re gonna talk a little bit about what the perfect lip shape is, but just so that we know who to listen to, whether Sarah or G-Berto, can we start off with a little quiz here?
Travis: Is this a lip off? Our first official lip off?
Dr. Franco: Maybe a little lip off. First official lip off. So, let’s do a little lip history to make this fair. One point to the answer, first in. Travis will be the official generator if you raise your hand first.
Sarah: Can I get a 2 for 1 special [inaudible 00:11:02]?
Dr. Franco: What was the first lip filler ever used?
G-Berto: We’re talking about type or brand or if you know the answer?
Sarah: Throw out on the answer.
Dr. Franco: Nobody? You guys are…
G-Berto: I will just say injectable fat.
Sarah: I think it was fat, injectable fat.
Dr. Franco: Boom, boom, boom, fat was the number one.
Dr. Franco: Question number two.
Travis: Score is now 2-0, G-Berto.
Dr. Franco: What was the first manmade lip filler?
Dr. Franco: Minus point. For the steal.
Sarah: Hyaluronic acid.
Dr. Franco: Hyaluronic acid is actually a very recent filler. Paraffin was the very first.
Sarah: I did not know that.
Dr. Franco: 1906 was the first time it was used and described.
G-Berta: I did not know that.
Dr. Franco: It was epic failure. So, please don’t for it.
Sarah: There was no more.
Dr. Franco: Question number three. What was the next filler described after paraffin that people used for a pair of about 20 years and now it’s only illegally done in the United States?
Dr. Franco: Silicon. Boom, boom, boom. We’ll give you each a point.
G-Berto: Yeah. That was a tie.
Dr. Franco: Last question. What filler was used before hyaluronic acid and what is the huge benefit of why we use hyaluronic acid and not the filler that it replaced?
G-Bertp: Well, the huge benefit is that it’s reversible.
Dr. Franco: That’s a good one. There’s another one. Well, what was the filler? Part one, what was the filler before hyaluronic acid that was commonly used worldwide?
G-Berto: I’m gonna say collagen again.
Dr. Franco: Okay.
G-Berto: Bovine, bovine collagen.
Dr. Franco: Bovine collagen. And what was the huge problem with it?
Travis: So, you had to do what?
Katie: It’s a test.
G-Berto: Yeah, yeah, yeah.
Dr. Franco: Nurse Sarah, you’ve been awfully quite. What’s going on?
Sarah: I’m learning my facts.
Dr. Franco: So, with bovine collagen, the problem was that people had to be tested ahead of time. And so it was, in this day and age, we were talking on our previous episode about online and this uberization of plastic surgery, and here, in the past, with the collagen stuff, people could have reactions to it. And so they had to come in weeks before and get tested and then do it. Now with hyaluronic acid, this has been a natural occurring product in your body. People can come in, get it done the same day. There’s no testing. I think one of you mentioned that it’s reversible, which is a huge, huge plus. So, if people have something, if they don’t like, they can reverse it. But I think both of you can attest that the times that you actually reverse an injectable is extraordinarily rare, extraordinarily rare. But to the last point and the reason for the history stuff is, is be careful what you’re getting injected. There’s a few very quality products out there done by quality providers, there’s a lot of cheaper stuff done in hotels and other things and literally done in hotels and other back-alley type stuff. Be careful what you get injected. The reason silicon and these things have problems is they looked good initially because they cause this intense inflammation. The problem is they’re not reversible, they don’t dissolve, they don’t go away. If you have a problem, it’s a bad problem and it’s very, very difficult to see. I saw a lot more of this when I was in Miami than I do here, but you definitely see a little bit.
G-Berto: I’ve even heard of cosmetics being done like on cruise ships and stuff.
Dr. Franco: This is true.
Katie: Really? Interesting.
Dr. Franco: This is true. The laws in terms of who can do injectables in a cruise ship that gets into international waters is very, very interesting. And so maybe a topic for another day because I actually know the man who started the company that did the cruise ship stuff.
Dr. Franco: He was actually part of my practice in Miami.
Dr. Franco: And so topic for another day, but a good topic.
Travis: More history here on “Plastic Surgery Untold.”
Katie: I liked it.
Sarah: I liked it.
Dr. Franco: And so I hope you guys just…the reason I want to bring in a little history is I don’t think people realize…we take lip augmentation and fillers for granted. I don’t think people realize the evolution, how complex, how hard this is, and how much has gone into development and where we’re at. We’re leaps and bounds from the old days of trying to melt paraffin and put in these steel syringes to fill up lips, which is an epic disaster. And so now we have these quality hyaluronic acids. They’re reversible, they’re shaped in different volumes, different size. So, Sarah, maybe kick us off a little bit. This was your choice to do the ideal lip. So, talk to us about the ideal lips because I feel like I have the ideal lips naturally, but you may disagree. So, let’s go.
Sarah: I think a lot of people would actually agree with you. In the office, you get eye-balled a lot for those lips.
Dr. Franco: Damn. So, are you saying that maybe I’m the most beautiful man and not G-Berto? Because that’s what it sounds like.
Sarah: We could do a vote. We could do a vote, a side by side.
Travis: He is not gonna be able to walk out of this room, his head will always be stuck on the board. Do not keep this up.
G-Berto: If there’s anyone who I would gladly pass that crown onto would be you, John.
Dr. Franco: I’m gonna say that to gossip Greg. He is not gonna be happy with you.
Travis: Beautiful man. He’s the most eligible bachelor. It’s two different crowns.
Katie: Yes. That is. That is two different categories.
Travis: He ain’t gone for the triple crown yet.
G-Berto: I only have one head. It’s too many crowns. I don’t know.
Dr. Franco: Talk to us a little bit about that.
Sarah: I think lips is a super popular, obviously, procedure. Probably, the most popular thing we do in the office outside of Botox, Xeomin, jawline’s kind of creeping up for top of the line there too as well, I’d say.
Dr. Franco: You can refer to episode 11?
Dr. Franco: Jaws and your lips?
Dr. Franco: But continue please.
Sarah: But yeah. I think everybody is, for the most part, a really good candidate for lip filler one reason or the other, whether they’re trying to work on some fix of some asymmetry, whether they just want a little bit more volume, or whether you’re like Katie and I and like five, six syringes and that really nice pout. So, I think everybody can benefit from it one reason or the other, but I think going into it, if you’re coming in the office for lips for the first time especially, is a really, really good quality consultation because the perfect pout and perfect lip to everyone is completely different I think.
Dr. Franco: And I think this is where the paradigm has changed. I think when lip filler started coming, we didn’t have the fine products and stuff that we have now and the tiny little syringes, we just added volume. And now I would…and I’d love to hear your guys’ thoughts on this, I feel like there’s been a real paradigm change in terms of trying to shape the lip and not just volumize the lip. Thoughts about that?
G-Berto: So, I think 100% that’s kind of shifted. I think before even maybe two or three years ago, the craze was let’s get these lips as big as possible. And I think we have social media to thank for that.
Dr. Franco: You’re welcome.
G-Berto: Maybe maybe one or two Kardashians for that.
G-Berto: But I couldn’t agree more in that I think now it’s more about being a little bit more subtle, a little more natural, but giving the lip that ideal shape.
Dr. Franco: What are some things that you look at in terms of ideal shape? What are stuff that you try to create? Stuff you talk about? Stuff that may be you look at when you’re doing these consultations because there’s things that you can improve, things you can’t, things that take time.
Sarah: So, essentially when I go into a consultation, I look at a few things first. Initially, have they had filler before at all, and what type of filler have they had? I think that plays a part into how you can shape the lip going forward. And just knowing what products they’ve had in place. But as far as the actual consultation itself, I think to focus on the Cupid’s bow, any asymmetries that they have, and then the actual how large they want their lips to be, I think are the three points that I hit on most. Initially, fixing asymmetry, sometimes I will tell people let’s fix asymmetry first, get you balanced and then come back and then we can work on a little bit changing of the shape or volume and things like that. So, I think just addressing how they see it versus how you see it and coming up with a really good game plan.
Dr. Franco: Good. Can we talk a little bit about size and lip flip, and the theme vermilion show. And so when I talk about vermilion show, the other term I like to use is “red show” because a lot of times one of the biggest things that I get from patients is they want more red show. They want that luscious lip and the lips just tend to hide and disappear. And so I think, and I don’t wanna take credit for this because I actually listened to somebody else talk a couple of years ago about how it takes time to stretch out the lips. And can you guys touch on that? Because I think people have to realize they can’t come and say, “Here’s a million bucks. I’ll do whatever fillers I want.” But there’s still a limit to where you can get people in one setting.
Sarah: For sure. I typically don’t do more than a syringe at a setting. What about you?
G-Berto: Yeah. Typically, not more than a syringe just because it can be pretty overwhelming for the patient and initially to go from not having that much volume at all to having a lot of volume. And oftentimes they’ll call and say, “Look, I don’t know if I really like this.” And I tell them, I just reassure them even before they leave the day that we do the procedure, I’m like, “This is gonna swell and it’s gonna look a lot bigger than what it’s gonna end up looking like at least for a couple of days.” The more you ice the lips, the faster you’re gonna see that swelling go down. And then that gives them a better understanding of what kind of expectations they should have.
Dr. Franco: Because I feel like if you try to just overfill, they get this very hard fake appearance. Part of it is stretching that skin. And if you look back at other plastic surgery procedures like breast reconstruction, there’s a reason that we use tissue expanders to shape. The biggest thing was always expanding that lower pull. You could just stick a huge implant in, but it’d be really tight. And I feel like some of that we kind of for some reason just ignore it in the lips. It’s basically stretching that lower portion of the lips to get that to roll on out. We now also incorporate some Botox and other things to do this.
Sarah: Yeah. And I think, to your point, another really great benefit of doing the tinting on the top to get the lip flip is that you don’t have to put in a whole syringe of filler on the top. If you strategically can place that and get that lip to flip up and get a little bit more red show, they get the bigger appearance without the duck lip. Right?
Dr. Franco: Can we talk about a few specific technique stuff? Because I feel like you see these on Instagram, you hear about them, and I think for people like Celebrity Anesthesia and myself who have naturally perfect lips, these words are foreign to us a little bit. But let’s talk about the lip flip because I know we hear about it. Can you guys maybe tell me in each of your practices what that exactly means and how you do it?
G-Berto: In my practice?
Dr. Franco: Can you share your little nuggets with us? Is that okay?
Dr. Franco: You don’t mind sharing with the world?
G-Berto: No, yes.
Dr. Franco: Okay.
G-Berto: I’m all about educating the masses.
Dr. Franco: Damn. Thank you. For those of you just listening, I’m taking notes right now.
G-Berto: In my practice, the lip flip is utilizing Botox right at the vermilion border to help relax that orbicularis oris muscle so that the lip can give that little outward curvature showing a little bit more of the red. In some cases, you can even help minimize the appearance of some of those vertical lip lines that people get that they may not like. Quite honestly, I was doing that long before I was doing the lip flip Botox approach. I was getting patients to come in asking me to help them with their vertical lip lines from either just extensive sun damage or maybe there were once smokers or maybe they drank out of straws a lot throughout their lifetime. But it’s that puckering movement that the orbicularis oris muscle makes that creates a lot of those lip lines and exposure to sun radiation.
Dr. Franco: I love the Botox or the vertical lines around the mouth. I think you gotta be careful because it can change people’s smiles or they can feel a little funky. But I think it gives people a nice natural look and settles those down. Sarah, lip flip to you.
Sarah: I agree. Same thing. And a lot of people, myself specifically, I liked it because I have smaller teeth. So, I think that’s kinda where the consult comes into play. Sometimes it’s not that somebody wants these gigantic lips, they just want to have a little bit less show of their gum line and things like that. So, I think all of that is a really good benefit.
Dr. Franco: How about lip tenting? Do you guys do that and can you explain what that is? Because I think people online used to think I was saying tenting, like we’re painting people’s lips. It kind of looks like that because they got more red show, but what are we really doing with that?
Sarah: So, we go in through the top…and I don’t know how many injections you do. Typically, anywhere between four and five on each side, put the needle in and then we just pull back a little bit to just provide a little pillar almost to help that lip stand up.
G-Berto: So, for me, it’s patient dependent. And some of that may even go into the patient’s age, their ethnic background because all those things are things that I feel are important to take into account when you’re trying to…
Dr. Franco: How long are your consultations? Two, three hours?
G-Berto: No. I’ll consult with a patient maybe about for 15, 20 minutes just talking about the procedure itself and then I’ll inject after that. But I do tend to block out at least 45 minutes to an hour for a filler, which… And for me, that’s what works. I don’t know. But to Sarah’s point, I think it just depends. I really don’t keep count in terms of how many supporting pillars I inject through the vermillion border when I’m doing this lip tenting procedure, but I will say that it is something that I have adopted into my practice a little bit more recently because I think it’s what patients are looking for.
Dr. Franco: I think it can be super powerful. They are basically like struts or columns, they’re basically supporting the lip to rotate it and keep it out. And this is where I think doing specific techniques like this is gonna help stretch the lip in the proper shape. And this is where again, just blasting the lips isn’t gonna help stretch in the right direction. And it’s just like, again, if you look back at other procedures, putting your tissue expanders down at the bottom, special expanders that are made specifically to stretch the lower pull. That’s what you’re doing, you’re trying to stretch the red show, you’re not trying to make them overly duck and get stuff up high and get this to sit into a good spot. I think that it’s super. And you even do a cool technique where you lay people down. Is that correct so you get a better angle at this?
G-Berto: What I do is I lean them back and I actually inject from above them so that I can have a little bit better control of my syringe and see exactly how things are developing. But throughout this whole process, I’m kind of going around, sitting them up again, taking a look, making sure that everything is as it should be. Kind of similar to what you do with your breast augmentation patients.
Dr. Franco: Yeah. Sitting them up, checking, re-evaluating, and then proceeding. What about this whole keyhole pout? I know that that’s something that’s…
G-Berto: Super popular.
Dr. Franco: …super popular, that caught fire. I’ve seen all sorts of crazy things and if you guys do this then, then it’s not crazy, it’s cool. In terms of doing stuff like dental floss and things like that for the shaping, I honestly don’t do that. I think if you’re really precise reinjecting your filler, I don’t think you need that. I guess if you’re just blasting stuff in then you can use some barriers to try and overly create stuff.
G-Berto: I don’t know how effective that is. I think it’s like trendy and you see a lot of it on social media, but I don’t know that it actually does a whole lot. I think if you just, like you said, perfectly place the filler in the pillows of the lower lip, then you can create that keyhole pout without having to use any kind of props. You know what I’m saying?
Dr. Franco: I feel like it gives a false sense of where the lifts are gonna be because you’re creating a false indentation that looks great for the two seconds on Instagram, but long-term, I don’t think it changes anything.
Sarah: I agree. It’s not something that I… People will do it with the dental floss in between the bottom tooth so you just pull it down.
G-Berto: I’ve seen a ribbon.
Sarah: Yeah. And again, I think that a really good consultation of what the patient is looking for…they may not want this big keyhole, they may want them to be even, or they may already have it if you just inject in other areas. Once you get the filler where you need it to be to improve other things, it’s just naturally there.
Dr. Franco: And what is really the keyhole for Celebrity Anesthesia who’s watching us here, and being a little bit quiet and I think he does wanna talk about this.
Travis: He asked me if he could get a keyhole pout.
G-Berto: I did. I did.
Sarah: Let’s see, let’s see. Put your lips together. Nope. You don’t have it,
Travis: Next time.
Sarah: No. I want people relax their mouth. They just have a small little tiny…
Sarah: …opening in between the two lips and it’s a subtle, sexy, more look to the lip.
Dr. Franco: And again, goes to breaking up the lips of not just having an upper and lower sausage across the lip stuff. Travis, go ahead.
Travis: I think that Sarah has touched on it a couple of times and G-Berto has too, but this is the importance of that consultation. You’re actually trying to figure out, okay, yeah, they come in and they say they want their lips done, but why do they want their lips done? Is it because they don’t want a bunch of their gum showing when they smile? Maybe the lips aren’t the issue. Maybe you could fill in some Botox around that area or maybe you’re more concerned with a lip flip instead of actually…or some tenting like you talked about earlier, instead of just blasting and filling and getting these two big sausages. So, I totally agree. I think that’s really the take-home point with this stuff. It’s finding out what is the goal of that patient.
Sarah: And I think when you sit and have these consults and you’re really literally listening to what they’re saying, stuff dawns on them that they didn’t even realize. “Oh, I didn’t even recognize that,” or, “I didn’t look at it that way.” And so I think you can really fine tune things. And let’s face it, in the face, any small change is a big difference.
G-Berto: One of the things that I do too is as I’m consulting with them, I’m observing their facial features, their animation and stuff so I can see, “Okay, look, this is going on. Maybe they’re not aware of it, let me bring it up to their…I’m gonna bring it to their attention so that we can maybe have a conversation about that too.”
Dr. Franco: I think that’s a great little nugget.
Sarah: For sure. Dr. Franco does that all the time. He’s preached that to me a whole lot, especially with Botox and animation and things like that. But as far as the lip goes, they may not notice that they hold their mouth a certain way until you point it out to them. And I think it’s really good to bring those things up upfront because then, afterwards, they may look at it and think, “Oh, did you fill this improperly and that’s why this is happening?” But it’s nice to acknowledge that they had it before. Yeah.
Dr. Franco: Go ahead.
Katie: I was just gonna say, just because I also work on the face and I look at it all the time…and so as I’m working with my clients, they’re gonna ask a lot of questions. Important to also know what lip filler can and cannot do. I’ll get a lot of people asking about texture. They’ll be like, “I don’t like what’s going on here.” So, they think that if they get their lips filled, it’s gonna help this right here.
Travis: And for those of us that aren’t watching, can you talk about where you’re pointing to?
Katie: This right here where the lines go down.
Travvis: The marionette lines?
Katie: I can’t make that face right now very well because I’ve got a little Botox helping me. But I’ll get people asking like texturally around their lips, like, “Oh, I feel like I’ve got texture and so I think if I get my lips done this will help.” Or they’ll say, “I don’t like these lines right here coming down the marionette line.” And then they’ll say, “Okay. If I get my lips done.” No. That’s not going to help that area. And I think it’s important to know that texturally when you get your lips done, nothing around your mouth is actually going to change the lines, the wrinkles. We can do a little bit, but we can’t over botox that area, we can’t fill your lips and then all of that disappears. So, there’s a combination of treatments that have to happen and I think that’s important for people to know as well.
Dr. Franco: I think that’s for the face in general. That’s an incredible point because we get it from everything from facelifts and so forth. You don’t wanna pull the face so tight. That’s not gonna change the skin texture. I tell everybody you wouldn’t buy a Ferrari and not get an oil change.
Dr. Franco: So, doing some good skincare, the sunscreen, other things can make a big difference.
Dr. Franco: Can we go back to…we we’re talking about the history in terms of what…fillers? There’s a lot of really great products out there, a lot of different hyaluronic acid fillers, but can you guys maybe tell me how you use these different products depending on the appearance that people want? Because I think there’s some cool things now that we have available to us that maybe we didn’t four or five years ago, how you can use different products and not one filler is perfect for everyone.
Sarah: I think it depends on what the client wants. Do they want something soft and subtle? Do they want something that stands up a little bit stronger? Have they had previous filler? Are we layering this on top of another product that’s in there? So, Gilbert, do you have any?
G-Berto: I think that there’s a lot of different products out there that do a lot of different things. And ultimately, it’s like you said, just listening to what they’re trying to achieve, but at the same time, I think it’s our responsibility to make sure that we guide them to make the right decisions because what they think they want may not necessarily be what is in their best interest, at least not initially. And just coaching them about that and explaining, “Look, this filler is a really robust filler, it’s a very viscous filler. It’s going to make your lips really, really large.” Or “This filler is a little bit softer, you may not get the exact same look that your friend got just because she got the same one.”
Dr. Franco: You guys are being really PC. Can we help people a little bit out there? Because we’re not tied to anybody. So, what fillers? Somebody is coming in and it’s their first time. “I want something super subtle. I’m a little nervous, I wanna dip my toe.” Well, from each of you guys, what filler would you recommend, first-timer, wants something subtle or something very natural?
Sarah: Currently right now, I would use Versa. It’s a really good product that we’ve brought into the office not that long ago. People have been loving it. It produces a lot less swelling in that first 24 to 48-hour period. And I think once it settles in, it gives the volume that people are looking for, but in a softer way. It doesn’t stand up as much as some of the other fillers. So, Versa, I really like.
Dr. Franco: G?
G-Berto: Someone who’s never had a filler before is like filler-naive or at least lip filler naive, I would probably do something like Juvederm Ultra or maybe like a Restylane-L. It’s just a little bit softer. Restylane Silk is also a really good one. The problem with silk is that it’s very lipophilic so it attracts a lot of water and sometimes causes more swelling initially. And that can sometimes make the patients a little uneasy.
Dr. Franco: Good and bad, right? Because some people like the swelling and the fullness and I feel like this is why a lot of people wanna be bigger later is because they liked that fullness, same thing we get with breast augs. And it’s a little funny with the Versa. It’s actually been kind of cool and people skip a little bit of that first initial huge thing and they almost think it didn’t work because they jumped right into that nice spot. And they still get some swelling, but not to the same point. But I think you bring up a great point. The Juvederm family has a large amount of products, the Juvederm, the Ultra, Ultra plus. And so I think that gives you a little bit of room to play with how much fullness you want or not. And you guys can…I get criticized for this sometimes. I’ll even sometimes, for someone who wants some big old luscious lips…the thing people hate about lips is having to redo their lips. I’ve even done some Voluma in some lips and it lasts a little bit longer, it’s a little bit stronger, a little bit firmer, but gives them more volume and doing some of that. So, I don’t know how you guys feel about that. Other people like to just layer to…I think Sarah had said this where maybe do a Versa, do another one in a month or so before the other one wears off. And so there’s different ways to get to those points. And the reason I was pushing you guys for real product stuff is that I feel like a lot of people listen to our cast and are actually looking for real direction so we can help them. I know both you guys are speakers for different companies and different things and when we’re giving speeches at meetings and stuff, we gotta be careful with product names, but whatever we want here, it’s our show.
Dr. Franco: It’s our show.
G-Berto: To add to that, I think, like you said, Ultra, Ultra plus, those are really great products for lips. I actually also use a lot of Restylane Refyne or Restylane Defyne because of the technology that they use in their product, which allows for a little bit more mobility and stretching of the product, especially in areas where there’s a lot of animation like the mouth or around the mouth. So, I like that too. And it’s a little more robust than some of the ones that I mentioned earlier, like the Juvederm or Juvederm Ultra or Silk, for that matter obviously.
Dr. Franco: And there’s a little bit of spectrum, and you guys can correct me if I’m wrong, because the Versa, Juvederm Ultra, Ultra plus are in the six to nine-month range. The Rfyne Defyne is more in the a year to a year and a half range and then the Voluma is in that year and a half to two-year range. And then my other thought about that is that any product in the lips tends to go a little bit faster. Would you guys agree with that?
Sarah: I agree. Yeah. Just the talking, the movement, the eating, the chewing, you’re constantly massaging that product.
G-Berto: All that just starts to break down the product a little bit faster or metabolize because the body will metabolize a little bit faster.
Sarah: To that point, another question I get, and I’m sure you get it often too, is, when can I come back for a second syringe? So, someone that’s new to it or someone that’s had it previously before your office, if they’re looking to go bigger, they always ask, “Can I come back next week?” And I think that’s a good topic to talk on that, “No, probably next week or two weeks even isn’t a good idea.” I tell them, “Wait. And if you’re really trying to get volume, at least a month just to let everything settle and then we can see kind of where you end up.” Is that what you tell your…?
G-Berto: I tell them, “Come whenever you want, girl.”
Dr. Franco: Wait, are we at the club or are we at the office? Because that was a little seductive there.
Travis: No, I think a month. I think a month.
Katie: Yeah, a month is good.
Travis: I did have a question. I know we’ve touched on it in previous podcasts, but when do people come in to get their lips done if they have something to do afterwards or an event coming up? If you’re getting married in a month, is that okay to get your lips done before or what…two weeks? What’s my time frame?
Sarah: I think a month is good.
Katie: A month is good.
Travis: Yeah. So, it depends on the event I guess, but I think a month would be the safest. But I’d say at least two weeks because that gives you time to allow some of that swelling to go down, any bruising is gonna dissipate by then too.
Dr. Franco: And we always get the kiss of death where people say, “Oh, I’ve come and I’ve gotten my lips done by you 16 times, I’ve never gotten a bruise.”
Katie: Yeah, and then that’s the day…
Dr. Franco: You have just just sealed your fate right there.
Katie: Yes, yes, yes.
Travis: For some of that is because I’m the most lip-naive or lip injected and lip injectable naive at the stable, obviously.
Dr. Franco: At Your Trendy Therapist is not Botox disport nice.
Travis: She is not Botox.
Dr. Franco: Not to call her out in front of thousands.
Travis: At Your Trendy Therapist, shameless life plug, number 684. But what are the risks associated to having your lips injected? I don’t know.
Dr. Franco: That’s a great question. There’s risks for everything.
Sarah: Everything in the face.
Dr. Franco: Bruising and swelling is a given, so I wouldn’t even count that as risk because that’s a given. You’re gonna get it to some degree. There’s some things like arnica, bromelain that you can do ahead of time that helps. I truly believe in it. My dad used to be on aspirin, plavix. And when we do fillers, if you did it before, the bruising was dramatically. So, I’ve seen it firsthand.
Sarah: Yeah. So, there’s something called arnica, but you can take in a pill form and, or the gel. CVS, Walgreens sells it for seven bucks.
Sarah: You can go there, get it. I tell everybody, when you brush your teeth in the morning, when you brush them at night, apply a little bit of gel. In two, three days, that bruise is gone. So…
Dr. Franco: I would say the biggest infections, one, you could get, knock on wood, I’ve never actually seen a lip infection. I think it’s just so vascular here that the body tolerates it well. Something we do worry about, and this isn’t just true for lips, but there’s something called intravascular injections. I think, again, because the lips are so vascular, again, knock on wood, I’ve never seen a really bad lip something because there’s so many collaterals. But something to be worried about, people in intense pain, if they had things, we have a protocol in our office if somebody wants to get a suspected injection that we treat. So, I think that’s the biggest thing. And again, going to a provider who, one will recognize it, two, if you do have a problem, and this is true for any procedure, is gonna help take care of you. I’m sure you guys have a protocol in your office as well.
G-Berto: We do. We have a protocol in place. And oftentimes, if you do have an intravascular occlusion or injection like you said, oftentimes you can see it like almost immediately. There’s gonna be a discoloration to the lip. The patient may not necessarily experience pain right then and there, but you’re gonna start to see a color change to the tissue. And that’s your first clue is like, “Okay. We gotta do something here to reverse this, start flooding the area with hyaluronidase or hylenex. Yeah.
Dr. Franco: And there’s a couple of different brands out there. So…
Travis: Which is what for people?
G-Berto: So, it’s an enzyme that basically reverses or breaks down that hyaluronic acid that is being injected into the lips. And you could use that too if I decided to come in and I didn’t like the look.
Dr. Franco: Absolutely. I bit off more than I can chew.
G-Berto: As long as it’s a hyalurinc acid filler that was used, then yes. You can certainly come in and reverse that.
Sarah: It’s actually pretty amazing to watch it. It dissolves it within moments, few minutes really. It really does that.
Dr. Franco: The one problem with it is it’s a little harder to control because we’ve had people come in and be like, “Hey, I just didn’t like this little spot, this little that.” I tell people, “Look, it’s an all or none something. If it bothers you enough where you want your lips completely gone, that’s cool. We’ll do it.” But to say, “Hey, I just want it like 3% less.”
Sarah: [inaudible 00:40:15]. It’s not happening.
G-Berto: It does not work that way.
Sarah: It’s not worth it.
Dr. Franco: And to the point, I think you guys mentioned it a little bit earlier is, once you do something like this, you have to give it time before you can come back. I tell people at a minimum two weeks because it doesn’t make sense for that enzyme to be lingering, injecting, and then it’s gonna be counterproductive. Same thing about if you need to do either a touch up or revise or you’re coming for a second. The problem is if you come back too soon, you don’t know if that’s swollen, if that’s real, if it’s what, and you end up chasing your tail and that’s counterproductive.
Sarah: Yeah. And there was no way for us to tell you exactly how your lips are gonna swell. So, sometimes one day post-injection people think that they’re drastically uneven and this and that. And a lot of times if you give it the two weeks and it settles down, you’ll see that we’re very calculated as far as how much we’re putting on each side and things like that.
Sarah: Just ride the wave.
Dr. Franco: Can we do a little key points from each of you for lip shaping, lip augmentation? Because I wanna ask you guys one more question after that.
G-Berto: I would say, listen to your patient just really see what they’re trying to achieve and replicate that as closely as possible.
Sarah: I agree. Yeah. To me it’s more of like an art. I really have a passion for this and I think it’s amazing to be able to either…whether it’s just aesthetically somebody just likes the larger, more plush lip, or if you’re actually doing a correction of a gum line of an asymmetry that in 20 minutes you can turn around and they look in the mirror and they love it. And that’s just a great thing. So…
Dr. Franco: I agree with your passion. My passion is torturing Celebrity Anesthesia and G-Berto, which is the sole purpose of having this podcast…
Katie: Instant satisfaction. I love it.
Travis: I know we give him plenty of material.
Dr. Franco: And I know this is hopefully, if [unintelligible 00:42:05] allows will be a topic for a completely different podcast itself. But since we have you both on here, maybe just a quick little summary. I think there’s so many people out there doing injectables. And right now we have a plastic surgeon, a PA, a nurse, and then even a CRNA here in too. Is there a benefit from one person versus the other? Is there some guidance that you should give for people in terms of doing this?
Dr. Franco: Or locations where people get it because you can get it a derm office that which G-Berto works out, a plastic surgery office where we’re at. Just some thoughts about those things.
Sarah: Previously before ever working in aesthetics, I think the biggest thing outside of word of mouth that I focused on was before and after photos. Look at as many before and after photos you can as the injector that you’re looking to go see, see their results. Keep in mind though that some of them are directed by the patient of a certain look that they want. So, I think being able to see that your injector can tailor that look to different people is important.
G-Berto: Doing your research on who you’re gonna go see and to Sarah’s point, they have before and after photos on their company’s website or social media or something like that or even just referrals. So, asking other patients that have been to that particular injector.
Dr. Franco: Okay. You both are too nice. I’d be like, “Plastic surgery’s king.” You go only to a plastic surgeon. Both of you guys playing nice in the sandbox.
G-Berto: No, but there’s a lot of really great injectors out there though.
Dr. Franco: I think there’s a lot of great injectors, but I do think it’s important to make sure that the person doing your injecting…and I’ll be the bad guy, I’ll say this. I think you should know who you’re seeing. I think it should be a credentialed person. Whether it’s a nurse, whether it’s a PA, it should be someone that’s in a system. They can be taken care of because we unfortunately have seen it where people have gotten injected, had a problem and there’s no one to be found to take care of them. So, this happens if you’re having a party at some hotel.
Dr. Franco: Surprise, surprise. If you’re at the super eight and you’re having a party and you’re gonna injected and you have a problem a week later, guess what? You can’t find anybody.
Travis: With that question though, I think you should be going to someone who knows how to manage complications if they were to arise.
Katie: Right, adverse reactions.
Dr. Franco: And this becomes the whole practice where there’s somebody there in terms of this, because like in our office, even if I’m out of town, there’s somebody there. There’s a physician who’s out of town that I’m covering for the week and that’s responsible on their part. They’re like, “Hey, if my patients have a problem, there’s somebody else.” And there’s obviously people that do it for me. And so I think whether it’s a nurse, whether it’s a PA, that they’re in a system that they have a process. We touched on it a little bit earlier. There is a system in both of our offices, we have a printed out protocol. If somebody has a problem, this is what we do. And I think it’s easy to see on Groupon, “Oh, here’s Botox for 3 cents a syringe,” or whatever it is. It doesn’t make sense because some of it is like life insurance. You’re paying for something you hope you never need.
Sarah: Right. Absolutely.
Dr. Franco: We have this and we’ll do another topic, but we’ll talk about this from an anesthesia standpoint. They’re paying for your service and an expertise that they hopefully will never need to experience.
Travis: Absolutely. Totally agree. Not somebody that’s in rural Miami in the middle of…in a back alley and they’re pushing meds that they don’t understand, they’re doing it themselves or at some dentist that’s pushing drugs and then doing a breast aug under…that’s not ideal.
Dr. Franco: Because like for surgeons, when they have you, they have you for the entire time. You were there. You’re not going to six different rooms, you’re not popping in and out. “Call me if you guys have a problem.” They don’t understand I think sometimes how much goes into this and it’s for the…all the stuff that we talked about on other episodes about preparation and stuff that goes into this. So, not to belabor, but I think of all the stuff that we’ve talked about today, there’s definitely some beauty stuff, making sure you go to the right person. We can talk about it another day, but I don’t think people realize how much training, time, effort that beautiful G-Berto and just Sarah have put into into training and doing lips and those type of things. So, super, super important. But let’s get into some fun part here, maybe a little fact or fiction.
G-Berto: Let’s do it.
Dr. Franco: Fact or fiction? I feel like… I’m just…
Katie: He looks worried.
Travis: G-Berto just started sweating.
Katie: He just go so scared. his facial expressions today are amazing.
Dr. Franco: Some of it I got ahead of myself. Fact or fiction? You’ve had multiple parties that you’ve forgotten to invite your best friend to.
G-Berto: I’m gonna say fact, but it’s not because I forgot, it’s because they weren’t my necessarily parties to be able to invite you to.
Dr. Franco: You didn’t get a plus one?
G-Berto: I had my plus one.
Katie: So, it’s…
Travis: Ooh, and that is not you anymore, man. That is not you.
Katie: Sips tea.
Dr. Franco: I mean, I’m not gonna say it. I’m not gonna say this. There’s a dagger here, but we’ll just rotate this seat for those of you that are just listening I’ll look at Sarah and he who shall not be named to the left of me.
Sarah: Can we make him just G-Berto then and the beautiful Sarah? We just [inaudible 00:47:08].
Dr. Franco: Bam. Just like that. Just like that.
G-Berto: I see how you are, just jump on that little…
Katie: Beautiful Sarah.
Dr. Franco: Fact or fiction, Sarah? Lips is your favorite procedure.
Sarah: Correct. Yeah. Fact, for now. Yeah. Cheeks are coming in second for me, actually. I’ve really enjoyed cheeks recently, but lips are my go-to.
Dr. Franco: Okay, cool. Can we do, because as you guys who listen religiously appreciate it, number one, but two behind the bovey, can you both give me a little something that people don’t know about lip augmentation? A little behind the scenes action that people wouldn’t know?
Dr. Franco: Just Gilbert, anything you can answer this?
Sarah: Just Gilbert, do you have a…?
G-Berto: Something that we kind of talked on or touched on in the past is, you know, I will sometimes offer different options of anesthetic to help ease the discomfort of lip injections from topical numbing to dental blocks to just numb the…basically, the whole area and a lot patients seem to like that. I know you guys offer ProNox at your practice.
Dr. Franco: We do. It’s a nitrous gas that helps us just release some of this, help the lips go a little bit numb. Sarah, a little behind the bovey?
Sarah: In relation to lip injections, I think that aftercare is important. Just setting the patient up for what to expect, having the right tools in their toolbox for the few days afterwards, post injection.
Dr. Franco: I thought of one that you mentioned earlier and didn’t mention now, the subtle watching people. I think that’s one that people don’t realize that you’re doing the entire time, so that helps with some of the pussing, the animation, the other stuff. And I think most people don’t realize that. I thought that was a golden nugget that one of you guys mentioned. And a really, really good one.
Travis: Beautiful G-berto was the one that…
Dr. Franco: You mean just G-Berto?
Travis: Just G-Berto.
Dr. Franco: Can we do a quote of the day? I don’t even know who to look to. Just G-berto or Celebrity Anaesthesia?
Travis: I’ve got one for the day I feel is… [inaudible 00:49:04].
Dr. Franco: No. Let’s go to Celebrity Anaesthesia because G-Berto is dead to me.
Travis: …pretty topical with the Coronavirus and everything going around. There’s a lot of fear and panic. Marie Currie said, “Nothing in life is to be feared, it is only to be understood.” Now is the time to understand more so that we may fear less.
Katie: Love it.
Sarah: That’s great.
Travis: And it’s super important because there is a wealth of information out there. Obviously, you got to figure out where source is and where that’s coming from, but we need to be learning as much as we can about this virus, about the spread, about the disease process and how we can decrease the risk of contaminating others, putting the at-risk population at higher risk. And if we can do those things, we’ll be able to control this and move forward.
Dr. Franco: I also think that this is gonna be a learning experience for all of us. I think we talked about it…and those of you who didn’t listen to…on our virtual online appointment podcast about how…taking what we learned from this to move medicine forward. The world has become a very small place. So, this idea that things are gonna be isolated in a certain country or a certain town, those days are long gone. And if you don’t know that, you are living under a rock and the world is only gonna get smaller. So, I think there’s so many things we’re going to learn coming forward. For all of us in this room who are super young, this is not gonna be the last crisis in our lifetime that we face and so I think [crosstalk 00:50:26.000].
G-Berto: it’s historic times that we’re living in right now.
Sarah: It is historic. But, you know, was beautiful even about this whole thing…and I like to just see the positive and everything…is how united I feel like the world is right now. I think we’re all going through the same thing. We’re all kind of experiencing some of the same things. And so it brings people together. And I think really, if we can focus on that and being positive and helping each other and loving each other through it and being sensitive, that’s the most important thing that we can do and really use this time to grow, you know, as a nation.
Dr. Franco: Can you send that message to producer Donald who had three carts of toilet paper. He was being the horror that you saw in Walmart. Listen to his…
Sarah: Let me tell you all, I’ll go to his house for some toilet paper when I run out, that’s what’s going to happen.
Dr. Franco: I want to thank all of you for for being on the podcast. I thought today was really pretty incredible to kind of do some myths about about lips. And I want to take this time to ask all the people listening, if you enjoy this, if you’re watching on YouTube, tell a friend about it. Make sure you guys know you can download this on on iTunes. Yeah, we’re now on iHeartRadio. That’s what I’m talking about. You’re welcome. You can also listen on Spotify, Pandora. So wherever you get your favorite podcast downloads, Plastic Surgery Untold. Thank you, guys. Number one podcast as voted by G-Berto, just Gilberto’s mom. Thank you.