Episode 24: Where Should I Have My Surgery? Does the Surgery Center matter?

Dr. Franco: All right team, welcome back to Plastic Surgery Untold, and we’re doing our very first ever little mini-series. And so today we’re actually gonna talk about where should you have your plastic surgery done?

And so for those who don’t know, I’m Dr. Johnny Franco also known as Austin Plastic Surgeon. We have our celebrity crew with us here for Plastic Surgery Untold. We’ve got the anchor Celebrity Anesthesia.

Travis: What’s up, guys.

Dr. Franco: And then we had such a great time with our cohost, one Dr. Chang and one Fernando Rodriguez that we invited them back and mostly just didn’t let them leave and we’re gonna have them on again today.

Fernando: Hello. Hello. Hello.

Dr. Chang: Wow, great to be here.

Dr. Franco: And I thought that this would be a perfect chance since we’ve kept Dr. Chang hostage here, to talk about where people have their plastic surgery and because there’s a lot of different options and there’s pluses and minuses to everything and just a question we get all the time in the office. Before we jump into that, I was gonna go around the horn here and catch up to see what’s going on with everybody. Celebrity, you want to kick us off?

Travis: What’s new with me. I almost died yesterday on a run.

Dr. Franco: Wow.

Travis: Yeah, that was exciting. I have a…

Dr. Franco: Was this a shirt or shirtless run?

Travis: It was the shirtless run of course. Come on now.

Dr. Franco: For the ladies of Austin, where do you normally run?

Travis: Normally Town Lake, but I am married. The ring will be on when you see me running out there so stay back. No, I decided to run town Lake yesterday and I woke up and was like, you know what, I’m gonna run a half. So I set my sights on 13.1 and that was the first time I hit the wall.

I was like 11 miles into the run and I just could not go any further. So I gutted out like another half a mile and I was right by my car, thank God. Got to my car and just started chugging. I had this, you know, sports mixed drink and I was just crushing it. I bet I drank the whole thing in like three seconds, but I felt pretty bad for the next couple hours after that.

Dr. Franco: Okay. No, but just so the people of the world know, you’re training for a marathon that you’re not actually signed up for.

Travis: That’s exactly right.

Dr. Franco: Okay, good.

Travis: As soon as a Corona started and COVID hit and quarantine happened, I needed something to do besides going to the gym. So I started running and I was training for a half marathon and every half marathon that I’ve tried to sign up for has ended up getting canceled or pushed so now I’m just training to train.

Dr. Franco: Okay. Fernando Rodriguez also known as The Captain. You are single and please let us know what’s going on in your world so the ladies can reach you.

Fernando: And so not a whole lot. Still sheltering in place, working from home but not a whole lot. Try to stay active with our friends and families and reaching out to all my former dance partners and seeing what they have been up to and checking in and make sure that they’re still all doing well.

Dr. Franco: Because you are an avid country-western dancer, and word around Austin is that you were once, before your back injuries, rated as one of the top 10 dancers in Austin. Is that correct?

Fernando: That’s incorrect. I was not in the top 10. The reason I’m not in the top 10 it’s because I’ve never competed professionally or at the local amateur level in order so that I will not be rated, but I am considered to be indeed 11th percentile of the dancers here in Austin.

Dr. Franco: So this is something that maybe if Celebrity would agree to we could go off-site one of these days and confirm this 11th percentile.

Fernando: We’ll see what we can do.

Travis: I’m all about that. I don’t know how to country or western so I’m always down to learn. You think you could teach me? I have two left feet.

Fernando: If we have good female dance partners, I can teach anybody how to country-western dance.

Travis: There we go. I’ll bring my wife.

Fernando: The problem is having good female dance partners.

Dr. Franco: If you’re really one of Austin’s best, why are you dependent on the partner? Like you should be the lead. Am I misunderstanding? I thought that the male…

Fernando: I do lead but I’m not going to dance with another male.

Dr. Franco: I thought the male figure was the lead dancer. So you’re more of the follower. Is that what you’re saying, you need a strong woman to lead you?

Fernando: That’s incorrect. I need a strong woman to teach Travis how to be a strong lead.

Dr. Franco: I misunderstood.

Fernando: You did misunderstand.

Travis: I’ll get the wifey involved. We’ll have to link up and all go do a little country-western.

Fernando: The problem is going to be finding the venue because all the dance venues right now are technically supposed to be shut down. If they’re open, they’re probably not open legally.

Travis: If Franco’s office is anywhere close to being finished, before all the furniture gets in, I’ll bring a boom box, so we could do it.

Fernando: There you go.

Dr. Franco: We do have some wood floors, so this is gonna be phenomenal.

Travis: Where are we coming along with the office?

Dr. Franco: Oh, that’s a great question. I mean, if you want to see a grown man cry, I mean, please continue with these questions.

Fernando: I wanna see a grown man cry.

Dr. Franco: We’re right on pace. We’re a good two and a half months behind schedule.

Travis: Perfect.

Dr. Fernando: So, you know, boom, boom, boom. Still no office. I appreciate all of the people who are listening that have been scheduled. One, sorry, it’s so hard to get in. Two, appreciate everyone who’s gone to different locations to see us. Three, if you see a grown man cry, that’s me.

Fernando: [inaudible 00:05:14].

Dr. Franco: But hopefully by the end of the month, we’ll be in. We’re actually close. I think floors are going to be done today. I think, hopefully ceilings going in tomorrow. So we’re making some progress but surely can’t come soon enough.

Travis: That’s awesome.

Dr. Franco: Dr. Chang, you? Anything new and exciting in your life besides the new baby?

Dr. Chang: Yeah. Yeah, that’s mainly it. I’m sure most people can relate to this, but it’s basically for me at this point, it’s work baby care, and house care, and that’s mainly it. Baby’s basically on a Q2 hour schedule. He eats, pees, poops and sleeps and like that’s, you know, diaper change in between.

Dr. Franco: It’s like a dream life. Somebody feeds you, changes your diapers and you just hang out. It’s phenomenal.

Fernando: We should all be babies again.

Dr. Franco: Well, let’s jump into it a little bit. One of the questions I always get is where’s my surgery going to be performed? Is it in your office? Is it a hospital? And it’s actually from my practice personally, it’s sort of the in-between. We don’t do any of the surgeries in our office. And we’ll circle back to this. We do do some local procedures, some small procedures in the office, but most of the general anesthesia cases, the tummy tucks, the buttock augmentation, the breast augs are done at one of two surgery centers and in one where those of you that listen I perform with Celebrity Anesthesia.

But there’s plus and minuses and I think people get sometimes can get confused because there are so many options in terms of where people can have surgery. Do you want to tell us Travis, a little bit about your surgery center, which is a Quad A certified surgery center and kind of what that means? And then we’ll, we’ll maybe circle around to Kevin and talk a little bit about hospital surgeries and what really goes on there and then we can kind of talk about why we do stuff in certain places and not.

Travis: Sure. The surgery center that I work at is a Quad A surgery center or certified surgery center. You can either be JCAHO certified or Quad A certified. If you’re neither of those, probably would not have surgery there. Just make sure that, you know, as a patient, you understand who the credentialing body is that’s certified that surgery center because that ensures that those surgery centers are upheld to a certain standard of care for patient safety moving forward with cases.

Dr. Franco: And just so people know, to be a Quad A certified or Jcaho certified, basically what happens is, and correct me if I’m wrong because you’re more intimately involved with that process than I am is that there’s actually an organization that comes in and they physically come into the surgery center, they walk through everything, they have a checklist. So making sure that you guys have certain things, that the people who are providing care there have certain things. I know I have to turn in my hospital records, my stuff yearly to you guys to be re-credentialed. So they check the physicians that are coming, what they’re doing, the anesthesia providers, etc.

Travis: That’s exactly right. There is a probably a hundred, two hundred-page binder that has all the requirements to maintain that certification throughout the year. Whether it’s the temperature of the operating rooms, the humidity level of the operating rooms, the medications and the equipment that’s in the crash cart and emergency supplies, emergency power, all of these things have to be accounted for. And this outside governing body comes in and inspects once a year or twice a year to let you know if they’re recertifying you and if you have held that same level of standards and you’ve met those standards to maintain that certification.

Dr. Franco: And you guys even have to turn in like chart reviews and stuff that you have to do periodically throughout the year to make sure there’s no trends going in the wrong direction, you know, infections, hospitalizations, anything like that, that there would be a red flag and so they… And I’m not sure exactly on the process and you can correct me, but they do randomly check so many charts every month that you guys have to submit to them and they verify all of these things just to make sure that everything is still in the right direction even in-between visits.

Travis: That is exactly right. And these governing bodies or these associations are to protect the public. So the people that are having the surgery there, the patients that are having the surgery, these entities are designed whether it’s Jcaho or Quad ASF, they’re designed to make sure that these standards are being upheld and met so that when they come in or the general population comes in to have a procedure done, they know that the temperature has been the right range throughout the entire year, that we have all the right meds and drugs in the right places and that we’re accounting for everything appropriately.

Dr. Franco: And this is, I think people get confused because typically a Quad A or outpatient surgery centers, and outpatient surgery centers in general whether they’re Jcaho or Quad A, tend to be a system where they’re doing less acuity or to Dr. Chang’s, if you listened to some of our previous episodes, talked about how we risk stratify. So typically people done at the outpatient surgery centers are all considered low-risk patients.

And the idea is that we’re keeping sick patients or people who need extra care at the hospital and patients who, you know, can be done in a more efficient manner. And from, you know, a plastic surgery, I think it makes it more cost reasonable for patients. I think for the healthcare system, it makes it more reasonable for us to be able to provide healthcare to a greater number of people because the hospital and Dr. Chang can maybe jump in and talk about this, stuff done in the hospital, you know, is usually set up for more, either things that need more higher level of care or more individuals involved, and that comes with additional costs and needs.

Dr. Chang: Yeah. Yeah. You raise an interesting point and I think it’s worth highlighting that a little bit. So absolutely, there is definitely growing recognition out there that as a country really we are spending quite a significant amount of resources in health care in general. So definitely there has been for many years now, a very big push to be judicious if you will, with our healthcare resource utilization.

So to your point, I would definitely agree that surgeries and procedures performed in the hospital are definitely more geared to and more amenable towards those that are a higher acuity. So meaning that if there is just higher chances of complications, higher chances of things that may…you know, adverse events and those kinds of things. If for example, that we think or speculate that there may, might be a need for higher specialty level of care, for example, those are all reasons that might kind of guide you towards a hospital setting, but really anything I would say short of that we probably should be thinking carefully through, is it appropriate to do this in a quote little lower level of care?

And I don’t say that to mean that you’re not getting as good of care in a different setting, that’s not what I mean by lower level of care, but really it’s the acuity piece of that.

Travis: Sure. And I think, to point out, most of our patients that we’re doing, especially aesthetic patients and at the surgery center, ambulatory surgery wise, when they come in and they have a procedure done after general anesthesia, I mean, once we get them into the recovery area, they’re staying, you know, one maybe at most two hours after their procedure before they are discharged from the facility.

Fernando: And Dr. Franco, do your patients get to choose whether they go to a surgical center or to a hospital? How does that work? How do you specifically say, “You should go here, or you should go there.”?

Dr. Franco: They do have a say in it, but it becomes a little bit complicated because typically if someone has enough medical issues that I think it’s not safe for them to be done at an outpatient surgery center, then you really have to wonder whether this is a good plastic surgery procedure at all. Because then you’re getting to Dr. Chang’s point about, you know, acuity and so forth like that. So that’s something we need to have a really serious discussion about.

The other thing that I think people have to realize in terms of their overall care and the procedure going well is most surgeons operate at certain facilities and they’re there routinely. And when they’re there routinely, they have a good relationship with the anesthesia, with the surgical tech, with the nurses, that facility has all the things that they need to perform the surgery efficiently, safely, and to the best of their abilities.

And so for me, you know, probably something like 98% of my surgeries are performed at one of two surgery centers where I pretty much have the same team all the time. So they know exactly what I need, we communicate well, there’s a really good system. They have all the equipment and instruments that I need, and so it becomes very specialized in terms of making sure that their care is perfect.

And the nice thing on the flip side about doing it at so many surgery centers is at these outpatient surgery centers, one, they’re made where everybody there knows that the patients are coming in, they’re going home the same day so there’s a mindset and a very efficient flow that makes it a very good experience for our patients in a very safe way.

I think two, it also…we don’t typically bring any patients that have chronic infections, bad infections, those type of things into the outpatient surgery center, which also helps avoid the spread of some of these hospital resistant bugs, bacteria stuff that we worry about at a hospital setting, where people are being treated from the ICU and other things.

We don’t have any of that in the outpatient surgery so for those of us that are doing like breast augmentations, fat transfers, you know, the avoidance of infections, complications is huge. And so I think that’s a huge, huge benefit that those type of needs are not treated in the outpatient surgery center and so the risk of bringing some of those resistant bacteria in is extraordinarily low.

Travis: I agree. And I also think during this time in particular with COVID, we’re not doing any known COVID patients at the surgery center and all of our patients right now are being preoperatively tested for COVID. So the way that that differs from a hospital is, well, if you do have COVID and you need an appendectomy, you’ve got to have it done at the hospital whether you’re positive for COVID or not. So we’re eliminating or trying our best to absolutely eliminate that risk of doing or performing surgery on COVID positive patients in our surgery center.

Dr. Franco: And I think something, and you and Kevin and Fernando can jump in and because I know Fernando has probably had about 16 surgeries between his calf implants, pec implants and jaw augmentation. But, you know, where you have your surgery is dependent, but it’s also sometimes confusing because an outpatient surgery center can be either privately owned, it can be owned by the hospital or hospital system. And a lot of times those will be in medical arts buildings because of that purpose that you alluded to there, Travis, is that you’re trying to be away from the big house, but typically close by if you needed stuff, but you’re trying to limit the flow.

And in a hospital, obviously, the hospital’s there to take care of the community so the doors are always open. At the outpatient surgery center, they can control a little bit more of the flow in terms of people coming through and so forth like that. So it’s a very secure and great setup even if it’s not in a true hospital. A lot of times it’s in a medical arts or professional type building.

Travis: Absolutely. Yeah, I agree with that. The place that I work currently does not have affiliation with any hospital, it’s privately owned, but we have an agreement and you have to, if you’re a Quad A facility, you have to have agreement with a hospital that you can transfer patients out to. And those surgeons that bring cases to the surgery center have to have admitting privileges at a hospital in case something happens, in case there is an emergency and the level of care, like Kevin was alluding to, needs to be escalated. Now we can take somebody to where they can receive higher acuity of care and they can be brought to a hospital that has an ICU or a tele unit or a place that they can be monitored appropriately.

Dr. Franco: And those who didn’t listen to our previous episode, listen to it because that’s why we take a thousand steps in the preoperative step to avoid that type of stuff. But to Fernando’s statement and in previous episodes, he’s like a good boy scout. You just always gotta be prepared. The more prepared you are, the less likely that stuff is to happen.

Fernando: And my experience with surgical centers is that each one of them have I received high-quality care in each one of them, it’s just been different in each one of them. I’ve had to stay overnight, which I know that Dr. Franco’s patients generally do not spend the night at the places. So that’s one of the things to definitely consider. And one of them at the hospital it was very hard for my mom who came to watch over me to stay there and they didn’t have a place for her to, you know, be able to sleep overnight to watch over me. I demand a lot of attention when I’m sick.

Dr. Franco: Oh, I know

Fernando: But at the other surgical centers, the other places that I’ve been to, they did have facilities so that she could sleep during the night and, you know, be attentive to my personal need. Not just my medical needs from the professional staff. So that’s also one of the things you need to consider is if you need that kind of care or if you don’t, oftentimes, you know, you want somebody there that can tolerate you when you’re sick.

Dr. Franco: That’s a good point, Fernando. And unfortunately, some of that has changed because surgery centers and hospitals, and Kevin can probably speak more to the hospitals than I can, but I know at our surgery center and this has been a big change for the nursing and for families is that unfortunately we really limit who can come up during the surgery.

Basically at this point, it’s a curbside check-in when it’s time to come in, you come in and just the patient straight in. You actually spend very little time in pre-op, not like the old days where they bring everybody in at 6:00 in the morning and you sit there until your surgery at 2:00. It’s closer to the time, you get seen by the preop nurse, by the surgeon and then you go back pretty quickly, but you can’t have people waiting with you in the preoperative pack. You just eliminate that overall flow. And I think that’s been hard for people. Dr. Chang, in the hospital?

Dr. Chang: Yeah, absolutely. I mean, certainly, these past few months have been interesting. It’s changed the way that we’ve done things, it’s changed the way…that process and everything. I’m sure this is similar for many places, but our visitor policy has changed a couple of times but I think the important thing to remember there is of course that as a society if you will, are kind of figuring out what is the best way and safest way to handle all this to prevent transmission of COVID as we’re talking about, that we obviously will continue to adjust and adapt to make it both safe as well as palatable.

And like, in the case of Fernando, I mean, his story is spot on. That’s reflective of what many people are going through. Clearly we want to have the right support system in place for these folks too.

Dr. Franco: And that’s something, you know, to Fernando’s point about bringing up ahead of time. You can ask your plastic surgeon ahead of time so they can tell you what the facility is able to or not to do. And then I would encourage patients to bear with us as Dr. Chang said. Unfortunately, protocols have changed. The more we learn, the more we know. We’re trying to do our best to make it a good system for you, but also protect you and others because we really want to make sure that people are safe especially during that preoperative surgery and then postoperative time because, you know, that’s a time where we got to really make sure that you’re being taken care of.

Travis, I want to circle back around because, you know, a lot of times I get questions about office-based surgery, office-based procedures. And I think it really depends on the procedure and the term “office-based surgery” I think sometimes can be misleading because people use it in very different terms. And I know you guys do provide some services at office-based surgeries and so forth, and just because somebody’s based out of their office doesn’t mean that they don’t have proper certifications and accreditations, a lot of people do. And so it’s just questions you need to ask.

Travis: Yeah. That’s the other thing. I just think patients need to be informed and they need to be asking those questions. “Is your office-based setup certified? Have you had it checked out by the Texas medical board?” That kind of stuff. And I think those are all fair questions and if a patient isn’t asking those questions, I mean, you know, then they’re not demanding that high-quality care that is going to be guaranteed or at least that minimum standards are gonna be met by having something that is followed up by some type of entity like Quad ASF, or Jcaho or Texas Medical Board.

Dr. Franco: And I think those are good because, you know, questions people should ask is where am I having my surgery? What level of accreditation? Who’s doing my anesthesia? I think those are all super reasonable questions. I think there’s the flip side, you know, like we will do in our office little scar revisions, procedures like that, that don’t need that acuity and again goes to a resource and cost perspective for people.

And I think this is where discussing with your surgeon, what you’re having done and where it can be done. And sometimes we just talk with patients, “Look, this is strictly under local, it’s a little scar revision, I think you’ll do fine here.” We’ll do those in the office if people need more anesthesia sedation, those types of things. Some of that is limited depending on the accreditation of the facility.

Travis: And that’s one thing I was going to point out. There are certain levels of sedation certificates that you can get, or permits, for certain offices and those offices if they’re not outfitted with certain protective equipment, will not be given that designation. So for example, if a place is allowed to have conscious sedation, there are because of the Texas Medical Board rules, there are certain guidelines that they have to follow, meaning that they may have to have suction in the room and available. They may have to have a smoke evacuator in the room. They may have to have a grounded power line in that room to reduce the chance of, you know, an electrical event or whatever.

So there are certain things that are put in place for patient protection that need to be followed by those facilities. So it is important to ask those questions because if they’re not being followed, then you should be asking, “Okay, well then where are we gonna do my procedure?”

Dr. Franco: And I think this has been super helpful, and I don’t want to belabor the point of the different types of surgery centers and so forth, but I wanted to at least get some of that information out there as this is questions I hear all the time. Fernando, any other questions for Celebrity, Dr. Chang or myself in terms of surgery centers, hospitals, those types of things?

Fernando: Not at this time.

Dr. Franco: Thank you, Capitan. Celebrity, any take-home points on the facilities?

Travis: No, I just think know where having surgery, know who their accrediting body is, and know who’s going to be there to do your anesthesia. I mean, obviously, I’m biased from that perspective, but if you’re going to have a BBL in the back of some office and they tell you that they’re doing general anesthesia and it’s not an accredited location, and there’s not an anesthesia machine and they’re not doing things that they need to be doing, that’s not okay. You’re not being done on the up and up at that point. So you do need to be mindful of that and just make sure that you protect yourself.

Dr. Franco: Dr. Chang.

Dr. Chang: Yeah, no, no, no. I think that’s all great. As a non-surgeon, right, myself, if I were going to be thinking through the safety of my patients getting some surgery done, of course, I’d be thinking about all these things as well. We would want to make sure that the facilities, the process, the people, are all on point and as Travis mentioned, kind of at least meeting minimum standards. Of course, we want to go beyond that if we can, but the minimum standards are there for a reason and that’s really to help protect you.

Travis: Absolutely.

Dr. Franco: And I think to take home, last thing is the things Fernando brought up is make sure you discuss with your plastic surgeon because typically that’s who you’re going to see several weeks before the procedure and their office staff can help with this in terms of changes made to the surgery center even if you’ve had surgery or had friends that have had surgery.

Unfortunately, even if it was just six months ago, the protocols have probably changed. Even if you’ve had someone who’s had surgery two months ago at the same center, the protocols may have changed since then. And so, and I think it just helps you kind of have a good expectation. So if you have family and friends maybe they know like, hey, we don’t need to get everybody up at 5 to come to the surgery center because they ain’t gonna let them in any way.

And so I think some of those things just so you can be mentally prepared and have a good idea of what you can and can’t do and plan accordingly in terms of all those things, which just makes life a little bit easier.

Travis: That’s a great point.

Fernando: Agreed.

Dr. Franco: Can we do a little fact or fiction here?

Travis: Let’s hit it.

Dr. Franco: I mean, I felt like I jumped the horn a little bit. We’ve already discussed that it’s fiction that Fernando’s one of Austin’s greatest country dancers so I’m glad we got that out of the way to start the show. Fernando, fact or fiction, you have followed me around the country.

Fernando: That’s actually almost fact, but it could be a little bit of fiction, but I have lived in several locations.

Travis: That’s interesting.

Fernando: I haven’t followed him around. We just happened to coincidentally be in the same city twice.

Dr. Franco: So but coincidentally, I came to Austin, you were here. I left for St. Louis, you shortly came to St. Louis after that.

Fernando: It was not shortly.

Dr. Franco: I came back to Austin, you came back to Austin. Boom, boom, boom. And shortly after I arrived, you come.

Fernando: Incorrect. Austin has always been my home base for the last close to 25 years now. I had a hiatus where I took a traveling job that was based out of St. Louis for a little while and then I had a couple of traveling jobs throughout the country for about three years. So then I finally made my way back to Austin and then you moved from Miami to Austin because I remember taking delivery of your car at my house.

Dr. Franco: Oh, that makes more sense. I’m glad we clarified that because the restraining order was about to expire, and I didn’t know whether to renew or not.

Fernando: So granted I have visited you in a lot of places that you’ve been, but I have not been following you around the country.

Dr. Franco: Can we do a little section called Behind the Bovie, which as you guys know is one of my favorite. And Celebrity, if you don’t mind, I’ll take this one.

Travis: Absolutely.

Dr. Franco: One of the things about some of these different accreditations and depending on which one it is Jcaho, Quad A. I know with Quad A, even a lot of former surgeons actually participate in this accreditation because they’re part of the body and it means so much to them that you actually have surgeons that come through and evaluate, which I think is actually pretty incredible because you have someone who’s intimately been involved with a process that’s helping evaluate these other surgery centers to make sure that they’re doing their public service, you know, deed to help make sure that the safety of individuals is kept.

Travis: Absolutely.

Dr. Franco: And I thought that was pretty cool because it’s not just, you know, some random person off the street who has no medical knowledge that’s doing some of these accreditations.

I mean, the teams that do it and anyone who’s been part of a Jcaho accreditation knows that it’s a very, very, very serious deal and process. This isn’t a five-minute process by any means. And so and the centers spend a long time preparing, which again is all in the name of patient safety.

It’ll be interesting to see how some of those Jcaho, Quad A regulations change based on the whole COVID system and PPE and everything. There’s already been some changes, which is a talk for another day. I’ve been long-winded and our mini-series has turned into a moderate series, but Celebrity again, because for those of you that don’t know, Gilberto, Austin’s most beautiful man has been replaced by Fernando El Capitan. Someone recently actually confused you two didn’t they, Fernando, and thought you were Gilberto, Austin’s most beautiful, man.

Fernando: I think so. I don’t remember exactly what the circumstances was, but it was an excellent compliment. Gilberto is a very handsome man.

Dr. Franco: What does that make you in the running for Austin’s most beautiful man if they think you guys look alike?

Travis: There we go.

Fernando: I think it does. Maybe, maybe not.

Dr. Franco: So for those of you ladies that are listening to the podcast, feel free to check us out on YouTube and get a glimpse at Austin’s, you know, possible new, most beautiful man. But on that note to Celebrity, we got a little quote of the day possibly.

Travis: Absolutely. This one pertains to choices because we were talking about where your choices to have surgery were and this is a John C. Maxwell quote, “Life is a matter of choices and every choice you make makes you.”

Fernando: Wow.

Dr. Franco: Fernando Capitan, what does that mean to you?

Fernando: That we have the power to change our lives based on the choices that we make.

Dr. Franco: Does that include the beard that you’ve grown out?

Fernando: It does. Yeah, it does.

Travis: I’ve got Teen Wolf in here sitting next to me.

Fernando: I like it. I’ve been told I look like the father in “Teen Wolf.” My niece is like the older father in “Teen Wolf.” I’m like, “Thanks. I love it.”

Dr. Franco: Well, I appreciate our crew today. I appreciate our guests stepping in and filling in and two celebrity guests to fill up for one Austin’s most beautiful man. So hopefully Gilberto feels better soon and is back on track with us.

I think today was super important. Questions we get in our office all the time and hopefully, we cleared it up a little bit for people. And so I really appreciate everybody listening to Plastic Surgery Untold, the greatest podcast in the world as voted by us. You can download us anywhere where you get your favorite podcasts, iTunes, iHeartRadio, Spotify, and you can check us out on YouTube. So thanks, guys. We’ll see you later. Bye.

Fernando: Good to see you.

Travis: See you.