Dr. Franco: Welcome back to Plastic Surgery Untold, I’m Dr. Johnny Franco, also known as Austin Plastic Surgeon. I have the privilege of having our celebrity cast joining us today. We have some familiar faces, we have the anchor, Celebrity Anesthesia
Travis:What’s up you guys?
Dr. Franco:By popular demand and by really default because Austin’s Most Beautiful Man, G-Berto is not here. We’ve got producer Donald who’s somehow found his way into a chair. I think he arm-wrestled Fernando over it and used a little leverage there to take the spot.
Donald:Had to readjust the camera. It was a little low.
Dr. Franco:And then I guess the man who doesn’t have a microphone. So, you know, take it for what it is. And then we got Dr. Chang, who we’ve been able to somehow convince and steal him for a third episode. So I appreciate you letting us take up all your time.
Dr. Chang:Glad to be here.
Dr. Franco:I think this has been pretty phenomenal for us. First couple episodes back into the studio, I’d like to give a little shout out to Permanent Records here. They’ve been pretty phenomenal in terms of… You see we’ve got some different backgrounds if you follow us on YouTube. If you’re just listening, I hope you can appreciate how great the sound is.
But we’re actually in two different rooms. We got desks separated by well over six feet, and so phenomenal setup, so I appreciate them. So shout out to Permanent Records and Grant who’s made this possible for us. So thank you to them.
Donald:You know, you just destroyed the magic of the whole setup, right?
Dr. Franco:Did I?
Donald:Because now people know we’re in separate areas.
Travis:But that’s important. Because, I mean, just to re-emphasize Grant and then him, I mean, it was masks-in when we walked in.
Travis:Masks up until we were in our own little room, and then we’re all separated. They’re adhering to social distancing. I love it.
Dr. Franco:And this is just a little lesson on perseverance. I mean, Plastic Surgeon Untold us has persevered, we Zoomed it, we’ve came here, we wore our masks, we found a way. The studio here has found a way to make the magic happen. So you’re welcome, Donald, you’re welcome for giving a shout out to first appearance here. And on that note, while Donald is being Debbie Downer here. Today, we’re gonna talk about a little something that’s not a Debbie Downer.
We’re talking about the modern mommy makeover. And so I think this is really something interesting that we’ve talked about in our office recently, in terms of how the mommy makeover has changed. It’s not something new.
But what we’ve changed recently over the last couple years that has really, I think, changed how mommy makeovers are seen, done, and performed, and really what the benefit has been. But before we jump into that magic, can we get caught up on what’s going on in everybody’s life here? Maybe we’ll start with, as usual, the anchor, Celebrity Anesthesia.
Travis:Oh, man, what’s new? We did… We have been quarantining and we’ve been social distancing appropriately. But the other day, my wife wanted to get out and do something that we hadn’t done in a little while. So we selected a Tesla to test drive, and we test drove the new Model Y and it was great. Social distancing appropriate, it was perfect.
You make a time, slot appointment online. We got there. The guy, you know, six feet away, everybody was in masks, they wiped down the car and everything before they got us in. He gave us a little tutorial and then said, “Go ahead and take it for a spin.” And it was very cool. We do not own a Tesla at this point, but it was very appealing. After driving it for a little while, I don’t know, I get it now. I definitely get it.
Dr. Franco:I think K. Chang has three Teslas.
Travis:Oh, my. gosh.
Dr. Franco:Maybe he can lend you one.
Dr. Chang:Yeah, I’d be happy to let you drive anytime. And hey, actually I’ve got a referral code too if you end up going to buy.
Travis:Little back scratching here. All right.
Dr. Franco:And correct me if I’m wrong, Celebrity, but you also came to an Emsculpt Bus event sometime over this and you and your wife made an M scope challenge where you…
Travis:You had to bring this up.
Dr. Franco:…you got crushed. Is that… Or should I save that for a fact or fiction?
Travis:Oh, God. We can talk about it now. So yeah, the Emsculpt device you have in the office that tones and helps build muscle, I’d never tried it before. My wife has tried it, @yourtrendytherapist.
Dr. Franco:Oh, so she had an unfair advantage.
Dr. Franco:Sorry, I ruined your plug. Go ahead. Say it.
Travis:No, no, it’s @yourtrendytherapist, Instagram, YouTube. All that good stuff. Follow along with all of our shenanigans. That was shameless plug number 397, for those of you keeping track.
Dr. Franco:And we don’t get paid.
Travis:That’s right. So we hopped on the bus. We both put on a different Emsculpt device. And we’re separated by, you know, a little partition, and they started turning hers up and I could only tolerate up to 80%. And I felt like I was doing a full setup every time it was contracting. And she’s sitting there rocking 100% no big deal and I’m over there crying on the other table. Not my proudest moment.
Dr. Franco:Yeah, there’s clips of it on Instagram, we may have to bring it back when he put out this podcast. Hey, Donald catch us up a little bit. I mean, you’ve been around. You’ve been behind the scenes. Somehow got on the scene. So what’s going on with you? What’s new?
Donald:Yeah, I’m sneaking around here and there. I’ve been pretty busy in the gaming space. So outside of working with you guys and having a whole bunch of fun doing the podcasts, I’ve been doing some speaking in the gaming industry on diversity and inclusion and having a lot of fun with that.
Finished up one of the biggest talks of my personal career, which is doing a talk at GDC, which is the Game Developers Conference. I don’t wanna get too nerdy into it, but it was a lot of fun.
Dr. Franco:But they can check you out at @tallgamer.
Donald:@tallgamer everywhere. So I’m @tallgamer on Instagram, @tallgamer on Twitter. And so yeah, definitely follow along.
Travis:What was the GDC talk about?
Donald:So the GDC talk this time was about managing mental health of your employees. So outside of doing production for this show, I also do production for a game studio. And, you know, production is just like herding cats, which is like herding Johnny.
But so, you know, we were like just talking about, you know, everybody’s going through the whole pandemic and everybody’s mental health is definitely being affected by this. And so we were talking about different strategies on helping your team out and helping people through hard times.
Dr. Franco:Yeah, Don, there’s a whole side of you I never knew. Moving on to Kevin Chang on that point. Dr. Chang, what about you, what’s going on with you?
Dr. Chang:It’s good timing. Speaking of mental health. So things are going well. As mentioned in prior episodes, I recently had a baby and just kinda learning how all that is working. My wife is recovering well, and actually had her first day out kind of by herself the other day, which was really helpful for her mental health.
And I would say yeah, things are, you know, I’m back to work, kind of getting back into the swing of things. I took my first walk with the baby and my puppy the other day, which was actually really nice. And that was something that I was doing for my mental health as well. But yeah, that’s life right now.
Dr. Franco:Have you been able to take the baby in any of your Teslas yet or?
Dr. Chang:So not yet. Very soon, I think very soon. The baby seat, of course, right now is in my wife’s car. But at some point, we might switch that up a little bit.
Dr. Franco:My favorite was when you had two matching Teslas. Exactly identical Teslas, one S version, one not. And it was like whether this was a speed day or regular day.
Dr. Chang:That’s right.
Dr. Franco:That was absolutely priceless.
Dr. Chang:That might be a little fact or fiction.
Dr. Franco:The rest of us just trying to live the Kevin Chang life. Other than that, it sounds like everybody’s rocking and rolling and kinda getting some stuff going.
Travis:Johnny, we touched on mental health. What have you been doing for your mental health?
Dr. Franco:I mean, besides just, you know, dominating the plastic surgery world, that’s kind of been it. No, in all sincerity, we’ve been trying to get into our new office. I would say it’s definitely been mentally challenging for me. We’ve actually been living out of a temporary office. So shout out to Dr. Levaik[SP] who’s let us be an unwanted guest in his office and let us take it over two days a week.
So I can’t thank him enough for that and then hopefully our new office will be soon. We’ll talk about it. We’ll do some new clips about it. We’re close but I’ll tell you just trying to push through getting the new office done, working out of a temporary office, an admin office. A shout out to my team who I’m sure it’s been a struggle for them as well as every day is a new adventure. So we’ve been trucking.
Travis:Dr. Franco, like that unwanted college roommate that just hangs out on the couch for a couple of weeks. No, not paying rent, no doing dishes, you’re just Dr. Levaik’s unwanted college roommate right now.
Dr. Franco:You know, just walking around, you know, in your boxers and some shoes and just hanging out, you know, leaving your stuff all over the place, TV too loud. It’s us. Well, let’s jump into a little bit of what I call the modern mommy makeover. And so I think this has been really interesting because mommy makeover in of itself is not new. It’s been something that we’ve talked about before on this show. But I just wanna kinda talk about how it’s evolved.
And before I jump too far, can we talk just a little bit about mommy makeover and not that anybody’s lovely wives here would ever need that because they’re gorgeous to begin with and don’t need any help from me. But I think people get confused. Mommy makeover is a collection, typically a breast procedure, and then some type of body sculpting in terms of tummy tuck most commonly, but sometimes combination of lipo.
And then the modern mommy makeover starts to include some fat transfer because what we’ve seen is that in the past, we’ve always been able to tighten, we’ve been able to remove fat, we’ve been able to remove skin. And now with fat transfer, we’re able even to do some addition. And I tell people, it’s always the subtraction, the addition, that equals the sum of this fabulous figure.
And so it’s really this three-dimensional body sculpting that we can do now that makes our patients look absolutely fabulous coming and going, because, you know, we can adjust some of the hip dips, we can adjust some of the overall shape and most people just wanna look good in their clothes. And so it’s not like trying to give them something crazy but just addressing all of their needs in a new way.
Donald:So I got a question for you, Johnny. So…
Dr. Franco:Yeah, please.
Donald:…you just listed a bunch of different procedures for the mommy makeover, like, can you… Like is there a limit to how much…like you were talking about a breast operation, lipo, tummy tuck, maybe a BBL. Like, how many different things can you get done at once?
Dr. Franco:It really varies. It’s basically a time thing. So there’s only a certain amount of time that we ever wanna spend on one surgery. And some of this goes to if you’ve listened to some of our prior podcasts about where we do our surgeries, I only go to two surgery centers, typically have a very small team that works with me on a very consistent basis.
Travis:Hey, it’s not nice to call me small.
Dr. Franco:I said small, not short. And Travis can attest to this. I mean, you know, and we’re very efficient. We can do a lot of things in a very safe, very efficient manner because you cut out the waste of time, of people not knowing what the next step is. And so everything from positioning changes to just rocking and rolling right off the bat.
And so I think that’s a great question Donald, and there’s some things we’ll get into in terms of why we don’t want the surgeries to be too long, and things that we need to do, but no question, tailoring it, being efficient in the time we have. And sometimes we do have to break up surgeries because there’s a limit to what we can do in one setting. Maybe Travis or Kevin can talk to you a little bit about that of why we try and shorten our surgeries a little bit.
Travis:Sure, yeah. I mean, anything that really goes over six or seven hours, we really start to question and critique. That is from a patient safety perspective. Really, we shouldn’t be doing outpatient surgery, where they go home, same day, a couple of hours after the procedure, after you just had an eight-hour general anesthetic. Some things, you know… Everything is shades of gray, there are no hard black and whites in surgery for the most part.
So these are the things that, you know, Dr. Franco, and I will talk about or he’ll talk to, you know, other anesthesia providers or other internists around town and say, “Hey, what do you think about this?” “Hey, maybe instead of an eight-hour case, let’s make that two four hour cases done at separate times, you know, with a couple of months in between.”
Dr. Franco:Yeah, I think it’s a great point and Dr. Chang and I were talking in between sessions here about DVT, blood clots, and some of the things that we do to decrease the risk of that. And honestly, there’s some new medications that have made this easier. And maybe if, since Donald brought it up, if you don’t mind talking about it, we’ve started using a new medication called Xarelto that’s been I think, used in the hospital a lot longer.
In the old days, we used to have patients giving themselves shots after surgery to prevent DVT, blood clots, but some of these new medications don’t have to have levels tested, tend to be much more reliable, and much easier for patients.
Dr. Chang:Yeah, that’s right. So again, I think a lot of this is you’re kinda focusing on the blood clot issue. It’s really both before and after surgery, most mostly the after surgery piece. But you’re right. So there is a newer class of medications. They’ve actually been out for quite a few years now. I’m actually thinking back exactly the year that they came out. It’s been a few years already.
Travis:Five, ten years?
Dr. Chang:Yeah, it’s been a while. So, but we still kinda call them the DOACs or the NOACs. The Direct Oral Anticoagulants, and you’re absolutely correct. They have been in many ways very revolutionary as far as blood clot prevention or DVT or VTE prophylaxis goes. Kind of back in the day and for decades, the standard for blood clot stuff was gonna be either Coumadin or something like a Heparin or a Lovenox. Lovenox is a low molecular weight heparin.
And Heparin and Lovenox are both injections that basically go in the belly. And that’s challenging, right? So some people can do that. And we can teach them to do that. But if you could take your pick between an injection in the belly versus a pill that you take, I think most people are gonna pick the pill, right?
Donald:We’re gonna go with the pill.
Dr. Chang:Yeah and you mentioned the other really great point about Xarelto. And the other ones in that class is that some of these other medications like Coumadin, you have to get regular blood tests and it’s very challenging. We call that, basically monitoring for something called a therapeutic window, which is that your range for that blood test in the case of Coumadin, the INR has to be within a very specific range.
Otherwise, it’s either underdosed so it’s overdosed, neither of which are good. The nice thing about Xarelto and some of these other medications is that once you start taking them, they pretty much take effect. And they’re therapeutic almost right away. And you don’t have to do that regular blood test monitoring. So it’s kind of a nice thing.
Dr. Franco:And I don’t want people to get the wrong idea that we’re solely dependent on medications to help this…you know, Travis can speak to this in terms of the nursing education that our patients get from both myself and from the nurses after the surgery, but we get everybody up and moving the night of the surgery, that’s something that’s become common practice in the hospital as well as early ambulation. The old days of being in bed for a week recovering from the surgery have gone by…
Dr. Franco:…gone by the wayside a long time ago. And so getting people up and moving. In my practice, we even send people home with decompression device that people typically in the old days used to only get during surgery. Again, technology’s gotten better. So they come with a tiny little baby battery pack. So you can actually go home with them wrapped around your legs, when you’re in bed, when you’re in the recliner, you have the compression device that you would have inside a hospital.
In the old days, you have this big old bulky machine that just wasn’t practical. And as technology has gotten better, this is become easier and safer for patients. So I think there’s a lot of things we do to make it safe. And to your point, Donald, I think all these things get weighed into what procedures can be combined or not combined. I think some of it is weighing…for patients, it’s hard to take three weeks off or a month off work to do something and then say three months later, “Hey, I need another month off work to to do some more procedures.” So definitely trying to figure out a system that’s safe, but also practical for patients as well. Oh, go ahead.
Travis:Yeah, I was just gonna say I completely agree with that. And I think you do a great job of making…and the other plastic surgeons that I work with. Everybody typically does a really good job of trying to balance the patient satisfaction and fitting things into their schedule. Also with making sure that it can be done as safely as possible.
Dr. Franco:And there’s a lot of times, we have a patient coming up who’d had a history of blood clots, she, you know, if you refer to some of our other episodes, she’d got seen by our hematologist, made sure she got a clearance, we had a plan together, we’ve decided that, you know, shorter is better than longer. So, you know, already has a plan to have multiple procedures done so that we can break this up and make it as safe as possible for her.
So, you know, this is where I think really, you know, finding a plastic surgeon, a team that’s gonna work with you to do whatever is safest and best for you. And so in some of that, you know, may not be what you had hoped and wanted. But, you know, hopefully, you’ll see that they have your best interests at heart, you know, that they’re gonna do this over a period of time for you.
Travis:And another thing I think Johnny that you try to do with patients is help them prioritize. You know, if they want a tummy tuck, and a breast surgery, and implants, and they may not, you know, it may not be financially savvy for them to have all of that done at one time or maybe they can’t, you know, for whatever reason, they can only have one of those, you sit down and you help them decide, you know, what’s gonna be the best bang for my buck at this point. And then what can wait another six months until we’re back.
Dr. Franco:I think that’s a phenomenal point. Because, you know, sometimes it’s a safety thing, sometimes it’s the practicality part. And so we definitely have people that come in, and this is where some of our patient care coordinators will help as well. Because a lot of times people won’t be comfortable talking money to yourself or to me, but, you know, to maybe our patient care coordinator, they can say, “Hey, you know, this is my budget, this is what I’m worried about.”
And so then that information can be relayed to me, and it can be like, “Hey, this is what I think is gonna be the biggest bang for your buck.” “This is what I think is really gonna help you.” And then we can find a good plan. Because we want them to be super happy, you know, after the procedure and making sure we’re doing something that’s gonna make a nice difference for them after all this hard work.
Other things to think about and this is one of the things that we’ve talked about and I’d be interested to see your thoughts, Travis, is, you get to see a lot of plastic surgeons, is kind of this modernization of this mommy makeover because it used to be we just pull people as tight as we can, make them as skinny as we can but now we’ve done a lot more things in terms of some of the new, highly cohesive implants, we’ve done things in terms of some of the special measures that we’ve talked about for the breast augmentations and internal bras. And then as you see in my practice, we do a lot of fat transfer, which I think a little bit can go a long way for people.
Travis:And don’t forget some of the skin tightening devices like the J plasma.
Travis:And a couple of other things that I’ve seen other surgeons use. And I think that, you know, that only helps to round out that result.
Dr. Franco:I think that’s an incredible point of one that I didn’t even think about when we were talking about this episode but no question, the skin tightening has been a huge difference for people and you’ve seen use it even after tummy tucks and mommy makeovers to refine the results. Because sometimes you can only pull the skin so much. But if people have stretch marks, other things like that that we can’t control, there’s devices now. J plasma Renuvion is one that I commonly use.
I know other surgeons at the surgery center use BodyTite, which is another phenomenal machine. So there’s options out there and like everything, they have a little bit of plus or minuses depending on what you’re specifically trying to achieve. But that’s a great point, Celebrity. Wow, boom.
Dr. Chang:So I’m kinda curious, as someone who is not normally involved in this space directly. And maybe a little birdie gave me this idea. So basically, everything that you’re describing sounds very interesting and it sounds like there are just so many options to be considering and going and kinda the thought process to go through.
But I’m kinda curious just to hear a little bit from you, like, you know, it sounds like a lot of this is basically some blend of art and some blend of science. And like, how do you kind of approach that with your folks, with your patients?
Dr. Franco:I think this is we’re really spending time with people ahead of time. And we typically visit with people at least twice before their surgery. And in my office, we actually have a pre-consult with our coordinator who does a lot of this, that basically talks to patients and helps them organize questions because sometimes it’s really hard the first time. And I have found that that’s been super helpful, because at least that way, they’ve kinda gone over some common questions, ideas.
My coordinator will help push them to get before and after pictures that they like, kind of wish goals, those type of things, because then I get an idea of what their goal is, and then from my perspective, I can be like, “Hey, here are the steps we need to do to get there.” Or sometimes say, “Hey, look, you know, I can’t achieve some of these things, but this is what I can.”
Because ultimately, we’re just trying to make people the best version of themselves and enhance what they already have. So I think those things are super, super important to spending some time with patients and going over those goals.
Dr. Chang:And, just, by the way, as another provider, I definitely commend you for taking those steps and having that type of communication being very transparent about what is realistic versus what’s not. I think, ultimately, the more informed that people can be about whatever they’re getting into, the better chance of success and the more sort of satisfied they will be with the results.
Donald:Yeah, that was…
Dr. Franco:And sometimes it’s hard, because, you know, it’s like anything you’re… As those of you that know that we’ve been trying to do a building, you know, I kinda felt it on the flip side, because when the architects, project managers were like, trying to describe stuff I… You know, I’m sure like, just like patients, they’re like, “Well, show me what I’m gonna look like,” and it’s impossible.
You know, they can do some renderings, some stuff, but there’s some leap of faith in-between the patient and myself like there was between me and the architect, project managers of what this is ultimately gonna look like. And so it definitely gave me a new perspective on that category for sure.
Donald:I was gonna bring up with you, Johnny that I’ve seen you several times talk about, oh, I think the term you call it is like a skinny BBL where you have a patient, so we’re speaking about, you know, fat transfer.
Dr. Franco:You’re talking for a friend?
Dr. Franco:Just asking for a friend?
Donald:Yeah, just asking for a friend. But no…
Dr. Franco:Yes, we do male skinny BBLs, Donald. Thank you for your friend.
Donald:You completely threw me off on that. I love it. But no. So like, you know, I know that you have patients that are typically are well, just more on the thinner side. So like when were just talking about fat transfer and 3D sculpting with the mommy makeover. Like, I guess those types of conversations will come up if they don’t have a lot of body fat or…
Dr. Franco:Exactly, because this is something we’ve got to decide what their goals are. Because we’ll do something called targeted fat transfer. So if there’s a limited amount of fat, just like anything, if there’s a limited amount of resources, where are those resources gonna be best used, and basically, we’re doing that with the fat is figuring out, okay, we only have this many CCs.
What bothers you the most? This is what I think is gonna make the biggest difference. And then that’s how we get to an idea of what we’re gonna do. And this becomes, again, a point to if we’re doing some skin tightening devices, if we’re doing a tummy tuck, if we’re doing different things, sometimes we can make a lot out of very little in terms of fat, if somebody is really skinny.
Sometimes we do a combination of implants and fat transfer. There’s a lot of options out there with some of the new devices and toys that we have available to us as Celebrity well pointed out.
Donald:Right on. Okay.
Dr. Franco:And I think Celebrity gets an interesting perspective because he probably gets to see on a regular basis probably about six or seven different well-known plastic surgeons here around Austin, Texas, would you say that’s fair?
Travis:Yeah, I would say somewhere probably between 7 and 10 a week. Different guys that I’m either working with or…
Dr. Franco:And gals.
Travis:And galsthat I’m working with and involved with from a surgery perspective. The one thing that I did wanna touch on Dr. Chang and Dr. Franco were both kind of talking about earlier is just taking that extra two or three minutes, and really diving deep on what is concerning to that patient. And I think I cannot, you know, emphasize that enough.
That goes such a long way for patients and just giving them… Most patients want to learn and are willing to learn. And some people just gloss over things. And, you know, for me from an anesthesia perspective, I get all the time, “Oh, my gosh, I hope I don’t wake up like I did in the middle of my colonoscopy.” And I just stop and I’m like, “Wait, one sec.”
Donald:But that must have been a surprise.
Travis:When you have your colonoscopy you probably had MAC or monitored anesthesia care, which is just deep sedation, you did not have a general anesthetic with a breathing tube down in your windpipe. And those are two completely different anesthetics.
And sometimes anesthesia providers, I feel like do a disservice to patients by not sitting down with those patients in a minute or two explaining the difference of that monitored anesthesia care and that deep sedation and a general anesthetic, which is what they’re gonna be getting from me at the surgery center if they’re having a BBL or a mommy makeover.
So I like to take that two seconds out of my day, stop it right there, squash that bug, listen to the patient’s concerns, and then educate them and redirect them to where they feel much more comfortable.
Dr. Franco:Because I think information becomes a double-edged sword here a little bit. And you hear it all the time, Celebrity, and I’m sure K. Chang, you hear this in the hospital too. Because there’s so much information out there. It’s sometimes really hard for patients because, I mean, even we as physicians look at different articles, different stuff out there, and then trying to decide where does this go? And how does this information value or unvalue?
Is it a good article, a good research study that we should incorporate into our practice? Which is its own challenging, and a subject for another day. But there’s so much information out there that it’s good that patients are educating themselves. But there’s no… The internet is the wild, wild west of information. And there’s a lot of stuff out there that may not be true, or may be misleading, or taken out of context. And so then that’s where we have to help.
Because I definitely have people that come and say, “Hey, I saw you do this, the J plasma, the Renuvion. I wanna do this,” and then it’s our job to say, “Hey, I like it. I don’t think it’s a good option for you. Because X, Y, and Z.” Or, “Hey, I’m glad you brought that up. I think you could benefit from it.” And so no question, I think it’s a good idea for patients to do their research, to bring these questions in. I honestly tell them. write stuff down. Because the day becomes busy when you come in and you’re nervous, especially with COVID, unfortunately, we limit how many people you can bring with you into the office, you may not have a ton of support in the office. We do allow people to FaceTime or call in with a significant other or whoever they would like if they would like to. So people are welcome to do that. But having a list of questions keeps you organized, also lets you ask all the things that you want.
So if you have questions, concerns, you can bring those up ahead of time, so we can address them and make sure you get into a good spot because there are so many great things in plastic surgery that we can do now. But, you know, you also don’t wanna get lost in the weeds doing a 16-hour surgery with a bunch of nonsense that isn’t gonna make you better, isn’t gonna be safe.
I tell people, “It’s one thing if you’re in the hospital in K. Chang’s setting and you have cancer, and you need a 12-hour surgery to get the cancer out to do reconstruction to be functional and so forth.” Like there’s risk to go with that. But the end justifies it. And so in our elective world, it’s pretty rare that that’s justified to do. And it’s something you deal with all the time, Celebrity.
Travis:Yeah. Again, completely agree with that. And the one thing I did wanna touch on, you mentioned fat transfer a few minutes ago. And that kinda being the new side of this mommy makeover that you’re seeing.
And I just wanted you to elaborate on that because I have… I thought that that is fascinating. And probably over the past six months, we’ve done a lot more fat transfer on these patients that are coming in for breast aug, tummy tuck. And then we’re doing a little bit of lipo and then we’re putting it in some targeted areas.
Dr. Franco:Yeah, and it’s interesting, because if you recall, I just moved to Austin, probably four, not even five years ago, and when I first came, fat transfer was not a huge thing here in Central Texas. And I mean, you can tell me if I’m wrong, Celebrity, you see a lot of people but you probably don’t have very many plastic surgeons that don’t have at least some fat transfer incorporated somewhere in their practice at this point.
Dr. Franco:And I think it’s just so many patients now, we’re taking this fat out we’re doing lipo. It’s like well, where can I put this to good use? And obviously, I do a lot of body contouring. So hips, butt, breast tend to be areas that I do a lot of fat transfer. But some of our facial plastic colleagues, some of our patients that do facelifts and other procedures to that extent also do a ton of fat grafting to the lips, to the cheeks, to the face to rejuvenate.
And, you know, I see most of my colleagues doing facelifts. I know when I do a facelift, I’ll incorporate some fat transfer because it gives some of that softened look. You know, nobody comes in with a picture when they were in a convertible going 90 miles an hour and say, “I look so great. I had to come in and see you, you know?” And so this overly tight look, you know, has gone by the wayside from the old days. And so it’s turning back the clock.
And we now know that aging isn’t just, you know, skin laxity. It’s volume loss. And I think in the mommy makeover and facelifts and other things, for a long period of time, we weren’t addressing that volume loss. And this is some of the thing with mommy makeovers that I think people take for granted is, it’s not just because of time, age, kid,s a lot of people have had weight changes. And so while that’s been great in some areas, it has negatively affected them in other body parts.
Donald:So I got a question for you, Travis. Like, as Johnny’s procedures change and evolve over time, especially with, you know, now we’re doing more fat transfers inside the mommy makeover. From the anesthesia world, are you seeing…are you having to do new things to address him like doing those types of things to patients or anything like that?
Travis:I don’t think that what he’s doing particularly is affecting, you know, my level of, you know, how much anesthesia I have to give somebody or their pain levels or whatever. I mean, obviously, when we…as we do extra procedures, or as we make extra incisions, or go to different body parts, you’re now talking about pain in another area, a new wound that we’re creating, a surgical wound that we’re creating.
And yes, those things do need to be addressed pain-wise on my end, but I think the whole thing, like Johnny approaches his practice is, how can I get better at doing something that I already do? I already do, or provide good anesthesia. But…
Dr. Franco:I would argue that you provide great anesthesia.
Travis:Thanks man. I’m gonna blush on camera right here. But I think the anesthesia is the easy part, it’s tailoring and maximizing the efficacy of that anesthetic, reducing nausea on those patients, trying to get them, you know, as lucid as possible postoperatively. So they’re able to get up and walk around and be mobile, to decrease their chance of blood clots and having pulmonary function issues postoperatively and pneumonia.
So it’s just everything that I can do to tailor and enhance every anesthetic that I possibly can. And there are new things that we’re incorporating all the time, like new drugs, new techniques, that kind of stuff, try to block as many patients as possibly can, we use a lot of local… We’ve touched on Exparel several times in here, which is a long-acting local anesthetic that Dr. Franco puts in between some of the muscle layers, that just anything we can do like that, to increase patient satisfaction and reduce pain scores post-op.
Dr. Franco:And to your point earlier, you know, we haven’t just grown in technology in terms of, you know, body-tightening devices and other treatments. We’ve also added technology that has made the surgeries more efficient and safer. And so that’s how we’ve been able to add some of these procedures, and not necessarily add any time to the surgery. One of them is we have a fat injector, that’s actually a machine that has a pressure sensor on it, that we can control the rate of the fat transfer, has larger cannulas to avoid intramuscular injections. You know, and that has decreased the time of fat injection and actually increased the safety. So decreased time, increased safety, which I think is a huge win from both my standpoint and yours and our patients’.
Travis:Completely, and you alluded to having, you know, a pretty regular team with very regular personnel that goes a long way too. I don’t know if you’ve ever watched surgery, or if anybody has actually gotten to go into an operating room with a team that’s worked together several times.
But it’s almost like a ballet or we’re, you know, a composer that’s just directing an entire orchestra. I mean, it’s just it works seamlessly. We don’t have to talk to do anything. We know what’s coming next. Everybody’s anticipating the next move. It makes things happen much faster and in a much smoother and more predictable manner.
Donald:Kinda like this podcast.
Dr. Franco:Like this. podcast.
Dr. Franco:I think somebody described Celebrity’s anesthesia techniques much like a well-orchestrated symphony in one of the prior episodes. We’ll have to go back and fact check that.
Travis:We’ll check the tapes.
Dr. Franco:Kevin, any other stuff, the concerns about some of these surgeries, other things from a medical standpoint, because we’ve talked previously about cardiac workups, pre-op workups especially on some of these, because typically, if we’re talking mommy makeover, you know, it’s all ages, people have kids at different ages, but a lot of times where somebody may be more in their 40s or 50s is not uncommon. And then at that point, we need to do stuff, sometimes EKGs to check their heart, if we’re doing a breast op, mammograms and so forth.
Dr. Chang:Yeah, no, I think you’ve hit on most of them. I think all the same things that you’ve talked to would be things that we would be concerned for, and looking out for, as medical providers. You know, I think just backing up just a half step to going into these sessions and spending the extra time right to do the question and answers, making sure people are asking the questions that they need to. Writing down questions even ahead of time.
That’s all terrific. And something that I definitely try to do in my practice as well. For the pre-op management and post-op management, I totally agree. You know, there’s gonna be… We will tailor the perioperative, the pre-op testing, and so forth the workup if you will, to what is happening with that patient, and to what they’re about to get. So you brought up examples of EKGs and mammograms, you know, sometimes there might be an X-ray or something else, blood tests and so forth.
Sometimes it might be a stress test. It just depends on kind of what’s happening with the situation. And then, you know, Travis kind of mentioned this, too, I absolutely agree. I mean, the whole post-op period of this is equally as important. So we definitely want to be mobilizing people. We want to prevent those blood clots.
We wanna get them moving better, get their lung function going, prevent that post-op pneumonia, and so forth. All these things do lead to not only better outcomes, but they lead to just in general, I think, people feeling better. And it leads to better satisfaction, better results. Probably better wound healing as well, in the long run. So absolutely. I think these are all really important topics.
Dr. Franco:I think to your post-op, you know, one of the things people ask like what can I do to prepare, and I tell them, “Figure out your post-op care will help you prepare,” because who’s gonna take care of you after the surgery, enough time off work, because especially if you’re doing one of these mommy makeovers with multiple procedures, you need some time to recover. And if you’re doing too much too soon, you’re setting yourself up for problems.
And also you wanna make sure that you have someone that’s gonna be very positive in your life helping you recover because the first week or two is gonna be a little bit of a process. And so you need some of that help. And I think that’s one of the biggest things you can do is making sure you’re preparing for that after portion.
And then the other thing I tell people as Celebrity brought it up with all the new devices out there is I think, just like information, there can be almost product overload in terms of the amount of things out there, make sure that you have a real comprehensive plan before you just start spending money on stuff. Because there may be a better order to do them. There may be things that are worthwhile or not depending on what your overall picture is.
And this is why I think wherever you choose to do your plastic surgery, your provider kinda be up front with them like, “Hey, here’s my overall goals. Here’s my overall things,” because I have a lot of patients that see a dermatologist that’s doing a lot of things but we kinda wanna coordinate what we’re doing because, you know, if we’re about to do a facelift, we may wanna adjust the timing of some laser resurfacing skin stuff before you do it.
And so maybe we wanna do some stuff to hydrate the skin ahead of time and then once it’s healed then you can do some laser resurfacing but those are just some simple examples. So making sure you’re coordinating all of your care so that we get a good result and there’s no surprises that are gonna sabotage yourself.
Other take-homes for our kind of modern mommy makeover and all the stuff out there. I feel like we fit on some really good topics in terms of the body tightening, the fat transfer, the three dimensional transformations, which I think is really new for people, I think some male skinny BBLs for a friend for Donald, I think all those things are super, super helpful. Other questions, Donald, that you have for a friend?
Donald:No, man. He’s set now. He’ll put in the order later.
Dr. Franco:And, Celebrity, other thoughts you have about things that people should know or think about? We’ve talked about a lot of really good stuff today I feel like.
Travis:No, I think especially for those, the mommy makeover procedures, they typically are a little bit longer in length, they typically do require, as much as we try to reduce narcotics, they do require sometimes a little bit of pain medication, which is not a bad thing. It’s something that when it’s warranted, it needs to be given. So sometimes nausea accompanies that. So really just doing everything I can to make sure I have every antiemetic or every anti-nausea medication on board for those patients.
You and I talk at length about these things pre-op. So most of your patients are given something to take orally pre-op, we give a bunch of antiemetics during the procedure. I also give a lot of fluids IV in young healthy patients that can tolerate them. So, you know, just doing everything we can to make sure that perioperative environment and post-operative environment for them is as comfortable as possible.
Dr. Franco:K. Chang, any last thought, concerns, comments?
Dr. Chang:Sure, maybe just take just like 30 seconds to talk about post-op pain management just really quickly. So I think you hit a great point there, Travis. And this is something that I personally struggle with just a tiny bit. Because it’s like we in healthcare, we sometimes swing one way or the other, depending on what is happening at the time. And opioid specifically is one of those topics, at least in my view. I think absolutely at some point, there was a question.
There were appropriate questions that needed to be looked at for sure. But then I think sometimes…then we start looking and then we start getting interventions, and then we swing way the other way, and sometimes we might undertreat pain and that’s really not the right answer either. So, as in a lot of things in life, it’s all about being judicious and finding that right balance. When there’s an appropriate situation to use opioids, absolutely.
Clearly, we wanna be transparent about that, if that’s appropriate and necessary. And it’s always the conversation. It’s never one of these things where we just say, “No, you’re just… you’re gonna get this and that’s what you get.” It’s not like that.
But certainly, if it’s appropriate, we wanna be transparent about that. And we wanna make it a conversation. So all that is just to say that, yes, sometimes it might be a recommendation, it’s okay, we will take other things into account if we’re making that recommendation. But ultimately, it’s really just to help you have the best care at that moment in time.
Dr. Franco:I think so the perspective too is that, you know, it’s unlikely that we’re gonna be able to ever get you a pain score of zero after a mommy makeover right after and so, you know, having a good mindset in terms of this, we want you to be comfortable but we aren’t gonna be able to 100% especially stuff like pressure and some of these other sensations are very, very difficult.
And so then and the problem too, is if we oversedate you, overmedicate you then it’s harder for people to get up walking, moving. And then the more medications you get, the more side effects you get. So it’s trying to find a really good balance and that’s why we try to mix up different medications and easier so we can get you off the pain medications as soon as possible.
I think either Dr. Chang or Celebrity mentioned, you know, the sooner you can get off those things, the more you can start to just feel normal, feel good about yourself, feel alive. Because some of them do sedate you. Some of them can make you feel a little foggy.
People are worried, especially now that they have the ability to work from home, when can they start. I typically tell people if you’re on a lot of narcotics or other medications that have those type of side effects to be very, very cautious, and it could be recommended against making any important decisions because you might put yourself in a very precarious position.
Dr. Chang:Yeah, totally agreeing. And I think that conversation around realistic feasible pain goals is key to that conversation. Yeah, go ahead.
Travis:I used to do more OB or obstetric anesthesia, epidurals, spinals, that kind of stuff. And when that was a bigger part of my practice, I would always have that, you know, pre-epidural consultation with the laboring woman, go in the room and say, “Look, my goal is to get you, if you are at a 10 out of 10 pain, my goal is to get you somewhere in the 6 or 7 range. If you’re having an 8 out of 10 pain, I’m gonna try to get you into that 4 or 5 range.
The fact that we’re gonna get you down to a zero is not gonna happen. You have discomfort and you have something telling your body that you’re in pain for a reason because you have something going on. So we’re gonna try to reduce that and get you to a comfortable level. Comfortable does not mean zero.” And that was always something that I had to reiterate to those patients.
I carry that to my surgical patients too and I let them know. “Look, afterwards it’s gonna feel like you had something done. We cannot get you feeling like you just walked in before the surgery, but we want you to be in a comfortable, manageable position when you leave the surgery center.”
Dr. Franco:I’m glad you guys brought this up. I think this was an incredible topic and hopefully Donald will pass this on to his friend that there’s a limit to the amount of pain control that we can do. Can we do a little fact or fiction with Donald?
Donald:Oh boy, here we go.
Dr. Franco:And hopefully you can answer for you and your friend, but…
Donald:Oh, here we go.
Dr. Franco:…talk to me a little bit, fact or fiction, even though you’re not on the camera you’re always here.
Donald:Always here .
Dr. Franco:Fact or fiction, I have to help you start your computer.
Donald:That is very much a lie. No, you are not the most technical. ..
Dr. Franco:Fact or fiction that I’m like the assistant producer because you make me get coffee and so forth before the podcast for you.
Donald:You order the coffee before I get to the shop. That’s on you.
Dr. Franco:Well done. I’m glad you got a little airtime. It’s nice for people to know the man behind the myth here. Can we do a little up behind the bovie? Celebrity, you wanna give us a little something behind the surgery, behind the bovie that that people might not know? You know, this is my favorite segment.
Travis:I know.. I’m trying to think of something besides, you know, something we haven’t talked about before. One of the aspects of the liposuction that you do is tumescent fluid. And the tumescent fluid, the nurses or anesthesia, or, you know, the pharmacy, depending on where you’re at makes up a bag of…it’s either normal sealing or lactated ringers, and it’s infused with epinephrine to reduce blood loss during a liposuction.
And it’s also infused with Lidocaine, which is a local anesthetic that helps bathe all the nerves in that area that we put the tumescent in to reduce pain and discomfort during the liposuction. So when you actually do the liposuction, the aspirate or the liposuction stuff that comes out, ends up being much less bloody, and much more concentrated in fat.
Dr. Franco:I think that’s a phenomenal point. And people listening might say, “Well, if I’m asleep, what difference does it make?” But this goes to the whole point of people being able to go home the same day because the less narcotics you have to give during surgery, the less time to recover, the less sick they’re gonna feel, you know, the better they’re gonna feel overall, because we’re working as a team to decrease that narcotic need.
Travis:Absolutely. And I think I can’t speak enough to how much that epinephrine helps reduce blood loss in liposuction cases, especially when you’re doing upwards of, you know, four or five liters on some of these cases, which is a lot of lipo, but a safe amount when you’re adding epinephrine and reducing the amount of blood loss.
Dr. Franco:The statistics are pretty crazy. So to do lipo, without any of this tumescent epinephrine, the aspirate could be as high as 30% blood loss in that aspirate. With the tumescent, if you do standard wet or super wet, or a true tumescent, talk for another day, but in terms of those amounts, you can actually get it under 1%. So under 1% is actually really low in terms of this and your overall blood volume.
And people sometimes worry about what’s coming out, but it’s all that tumescent fluid that we’ve put in. And then I tell people, you know, it’s just like, if you ever do any baking or anything like that, just a couple drops of food color will give it a red tent. So it’s mostly the tumescent fluid that we injected with just a few drops of blood, which makes it look red that sometimes people have drainage after lipo.
Dr. Franco:That was a good one. That was a good one, Celebrity.
Dr. Franco:Talk to me. So it’s gonna be hard to follow with the quote of the day and we’ll get Donald’s take on your quote afterwards, just so he can be listening and not thinking about…
Dr. Franco:…you know, his friend’s procedure.
Travis:We’ve been talking about innovation today with the mommy makeover and anesthesia and perioperative care and all that good stuff.
Dr. Franco:We’ve dropped some knowledge.
Travis:We have, man. This has been a banger. There is a quote from Thomas Edison that says, “There’s a way to do it better, find it.” I like that. Because I think that shows that there’s always room for constant improvement. And there’s always room to grow and get better. Even at what you’re an expert in.
Donald:You came with that quote with some authority. I like that.
Dr. Franco:I mean, I would say that our modern mommy makeover is that, right? So we said, “Hey, here’s what we’re doing. Here’s the shortcomings. Instead of throwing that fat away, how can we make these results better?” And I don’t think people realize that we take a lot of before and afters and some we put on the website and stuff. I don’t think they realize how much, you know, us as plastic surgeons just look at them and say, “Hey, what do I like? What don’t I like? What could I make better in this?”
And so that’s pretty interesting, I think from this podcast, you know, part of the reason we’re back in the studio here is the Zoom stuff was fine. It was great to be able to incorporate some colleagues from around the country but I just felt like we could do better and Grant here at Permanent Records has helped us and even though Donald didn’t like me giving a shout out to another producer, you know, we’re fine. Let Donald be a hater. I’m gonna give it a little credit where credit’s due.
Dr. Franco:Kevin Chang, thoughts? I mean, you’ve seen this in medicine probably more often than not. How things can keep improving.
Dr. Chang:Oh, yeah, absolutely. No, I’m 100%. But I think that’s part of what makes our jobs interesting. There’s always room for growth, there’s always things changing, there’s always new information, new research being done. And so it is interesting that we, you know, sometimes do kinda get situated in our habits.
But I think, everything you’re describing is a great example of how things do and can evolve and do evolve, and you kinda just adapt your practice to incorporate those things. So that’s kind of… I think that is maybe getting a little tiny bit philosophical here, but that’s part of life too, right? And it’s like we wanna continue to learn from past experiences and continue to do things better.
Donald:That’s why they call it a medical practice.
Dr. Franco:Boom. Mic dropped down. Donald’s mic dropped there, I’d like to thank everybody for listening, I’d like to thank our celebrity cast for joining us and rocking out to an incredible episode here talking about the evolution and kinda modernization of plastic surgery and especially the mommy makeover.
So thank you, everyone, for listening to Plastic Surgery Untold. As always, you can download us on iTunes, iHeart, or wherever you get your favorite podcasts. So Plastic Surgeon Untold, the greatest podcast in the world as voted by us. Thanks for joining. We’ll see you guys soon.
Dr. Chang:Thank you. Bye-bye.
Travis:See you guys.