Episode 28: Injectable Treatments You Have Never Heard of, But Should Have!

Dr. Franco: Welcome to “Plastic Surgery Untold.” I’m Dr. Johnny Franco also known as Austin Plastic Surgeon, and I got our celebrity cast here for another exciting episode. Today, it’s going to be “Injectable Treatments You’ve Never Heard of But Should Have.” This episode was actually created by one Gilberto Saenz, Austin’s most beautiful man. So, Gilberto, thanks for joining us today.

Gilberto: Thank you, Dr. Franco. It’s a pleasure as always.

Dr. Franco: You seem a little excited and anxious for your episode. Well, as you guest produce occasionally. We also got the rest of our infamous crew here, one Celebrity Anesthesia.

Travis: What’s up, you guys?

Dr. Franco: For those of you watching it at home, yes, he does have a shirt on so you can let your children watch. And then we’ve got a rare appearance by one producer, Donald. As you can tell, you know, we weren’t able to find anybody else so he stepped in. And, you know, it’s a tough line up to get on here with us, but somehow, Donald found his way in.

Donald: That’s right.

Dr. Franco: So, boom, boom.

Donald: That’s right.

Dr. Franco: Here we are.

Donald: That’s right.

Dr. Franco: Let’s catch up before we get into to Gilberto’s episode here. Let’s catch up with everybody and see what’s going on. Donald is the new man on the show. What’s been going on? It’s been probably about two years since we had you on the show. Anything new and exciting in your life?

Donald: Yeah, man. It’s been really busy so I’ve been pretty busy speaking about diversity and equality in the video-game space. So this month alone, I’ve got four talks that I’m giving. I just finished up a talk at UT, University of Texas. Hook ’em. And, yeah.

Dr. Franco: Oh, I thought here in Austin, you were talking about UT, University of Tennessee. I’m glad you clarified, I was confused there for a minute. But for all of our worldwide listeners, they appreciate that.

Donald: Exactly, exactly.

Dr. Franco: Okay, good. Thank you.

Donald: But, yeah, no, that’s been the busy part of my last couple of months. So that’s what I’ve been up to, man. It’s fun.

Dr. Franco: And it’s nice because I know you had a big part by South by Southwest, and then that stuff got canceled but it seems like, maybe, you’re supplementing that with some, not exactly the same stuff you were going to do, but in a more empowering way now.

Donald: Yeah. Actually, as a matter of fact, I had about five talks lined up at South by, and then, so I’ve been able to piece together some of that, you know, throughout the year. And then at the end of September, I should be in Helsinki, but, unfortunately, good old coronavirus is preventing that so I’ll have to do the talk via Zoom. So…

Dr. Franco: So just, kind of, interesting that Donald had five talks, and he’s close enough with them that he calls it the South by and yet none of us got platinum wristbands from him. So, you know, it’s interesting. That’s all I’m going to say, it’s going to be interesting when Botox comes around and be like, “Sorry, corona. You know?”

Donald: Oh, okay, I see how it is, I see how it is.

Dr. Franco: Celebrity, what’s going on with you? I feel like you haven’t traveled the world lately. I feel like I’ve been traveling more than you have and that makes it feel awkward in here.

Travis: Funny you should mention that. Next week, we’re actually headed to Rosemary Beach which is just past a couple…maybe 15 minutes past Destin, Florida and go hang out for a week. That should be fun. Taking the dogs with us.

Dr. Franco: You’re taking another vacation? That’s interesting. Wow, okay.

Travis: You just got done saying, I haven’t taken one in like three weeks.

Dr. Franco: For those of you that are looking for a career path, you can either do plastic surgery where you work day and night, you know, and you’re just working yourself to the bone or you can be a CRNA and you could work three weeks a year. So, I mean, I feel like you can do whatever you like, there’re some career options. But boom, boom, boom, yeah. Okay, cool.

Travis: Hey, everybody has got choices, man, everybody has got choices.

Dr. Franco: No, you’re doing well.

Travis: No, we’re excited. We’re actually going to pop in and see Mary’s parents in New Orleans. That’s my wife. Her family is still in New Orleans where she’s from. You can follow her at @yourtrendytherapist.

Dr. Franco: That’s an early plug.

Travis: I know, man. That was…

Donald: That was your plug.

Travis: Yup. Thank you. Thank you. It’s seamless, almost. No, we’re going to hang out and see them for a little bit. You know, every time we go back to New Orleans, I’ve got like three or four spots we have to eat. It’s like the second we pull into town, we’ve got a couple of…got to get the Po-Boy, got to get some good Italian food. It’s good stuff.

Dr. Franco: Okay. I like it. And then, Gilberto, what’s new in your life? What should Austin know about Gilberto?

Gilberto: Well, something that I actually shared with you not too long ago and I haven’t had a chance to share with the rest of the team.

Dr. Franco: I’m like a vault. I’m like a vault so I [inaudible 00:04:15] with anybody.

Gilberto: Yeah. Earlier this summer, I submitted some tapes for an audition for a position within the podcast group of my professional society, the Society of Dermatology and Physician Assistants. And I got news last week that they like my audition tapes and they asked me to join their team.

Travis: That’s awesome.

Dr. Franco: Dude, congratulations.

Donald: Whoa, whoa, whoa, wait a minute.

Dr. Franco: I’m glad that you still have time for us, just little lonely souls in Austin, Texas.

Donald: I know, man. That’s what I [crosstalk 00:04:45]…

Dr. Franco: So the other question is, does Gilberto need the celebrity title and we have to strip this and just make Travis, like, you know, Average Anesthesia?

Travis: Dude, I’ve had so much…

Dr. Franco: That is a great name for you, Average Anesthesia. That should be your new hashtag. Who wants Average Anesthesia? Pick me.

Travis: Come on down and get it. Oh, man, I’m getting killed here. That’s like my fourth time having chest pain in three episodes. This is terrible.

Dr. Franco: Well, congratulations. I mean, that’s a huge honor because I know they take people from all over the country and they only pick a couple of people.

Gilberto: Yeah, they only selected two people to join the team. I think I’m joining a team of two others so it’s going to be a team of four, is my understanding. I’m still trying to get all the details. But, actually, I wanted to thank you for, you know, giving me, you know, the opportunity to do this, and Donald for helping me put the clips together. I genuinely appreciate that.

Donald: I’m glad it worked out.

Gilberto: Yeah. Thank you. You know, I owe it all to you guys.

Dr. Franco: You know that that makes you greater than a one percenter. You’re like a point one percenter in this world now.

Donald: Are you even going to have time for us little people anymore?

Gilberto: Oh, yeah, absolutely.

Donald: We lifted him up and then he’s forgetting about us.

Gilberto: No, no, no. No, no, no, no, no, no. Actually, it’s a voluntary position so I think we only film episodes around the time of our, like, annual conferences and stuff. So I don’t think it’s going to interfere with plastic surgery, I’m told. I’m not going to let it.

Travis: They’re not going to make you do quotes, are they?

Gilberto: I’m sorry?

Travis: I said, they’re not going to make you do quotes, are they?

Gilberto: I’m going to bring it on.

Travis: Are you?

Gilberto: No.

Dr. Franco: Don’t let Average Anesthesia talk to you like that, you’re a celebrity, dude.

Travis: We are not starting that hashtag.

Gilberto: I feel like I’m creeping up to, like, Joe Rogan status? You know, I’m multiple podcasts.

Dr. Franco: Because, no, you’re on multiple things, you’re just making things happen. I want to be like you when I grow up, dude. I’m just a lonely worker bee, dude. Well, let’s do this. If you don’t mind, let’s get this show started. Gilberto is not off the hook in, you know, just so you guys know, we’re going to split Fact or Fiction up among people, mostly Gilberto.

Gilberto: Oh great.

Donald: That’s what I’m talking about.

Dr. Franco: Yeah, yeah. And he already knows what’s coming so he better be ready. For those of you that listened to episode 27, you should. Uh, Gilberto avoided the question like 16 times so we’ll see if there’s any updates to that as well. So, boom, boom, boom. If you don’t know, pause this one, go to episode 27, then come back. This episode has actually started off really, really strong, there some good golden nuggets here so far. So…

So we’re going to talk about injectables. Gilberto actually came up with this idea when we’re flying to El Paso to visit my mom for her birthday. Big baller status. For those of you, again, that didn’t listen to episode 27, big baller style to fly with Gilberto where everybody recognizes him so that was, kind of, cool.

Gilberto: Exclusivity has its perks, John.

Dr. Franco: That’s what you kept saying. That’s what you kept saying. When you told the flight attendant, “Follow me.” And she’s like, “Oh, wow, you have 126,000 followers.” And he goes, “I ask everyone that I meet to follow me.”

Gilberto: I think you’re confusing me with you.

Dr. Franco: But talk to us a little bit, what’s going on today? We’re talking about some injectables. People know a tiny bit about the standard Botox. Lip fillers, we’ve talked about, jawline. But there’s some other golden nuggets that we’ve never touched on.

Gilberto: Yeah. No, there’s so many different areas where we can actually treat with Botox and filler and make a huge impact on a patient’s, you know, image and their self-confidence, their, you know, perspective on things. So I, kind of, wanted to, like, put together a little episode where we can talk about some things that, you know, some people may not know about that are treatable with, you know, either Botox or fillers.

Dr. Franco: Where do you want to start us? Let’s kick this off, let’s get the show going.

Gilberto: So one of the things that I know you like to do, that you really enjoy doing, and it’s one of the procedures that I really enjoy doing as well, I just don’t do as often as you do is a liquid rhinoplasty where we actually use filler to recontour the shape of the nose. And so it’s essentially, kind of, like, you know, creating a new shape of the nose without the patient go through any kind of surgical procedure.

Dr. Franco: I love this little hidden nugget because it’s one that I feel like people forget about. I think nose is one of these that’s a really big decision in people’s lives to undergo a rhinoplasty and especially for a certain type of nasal reconstruction, right?

Gilberto: Right.

Dr. Franco: This isn’t going to affect people’s airway passages, this isn’t going to open up airways, this isn’t going to treat a deviated septum. But people would just want the illusion of a sleeker, thinner nose. If you want to hide, you know, from your profile, especially in this day of social media, Instagram, YouTube, Snapchat, TikTok. Did I miss any? LinkedIn, I guess.

Donald: Facebook?

Dr. Franco: Facebook. Oh, I’m too young for Facebook, dude.

Gilberto: TikTok?

Travis: Okay, Boomer.

Dr. Franco: We’re different ages here. But so can you mail me a letter. But so, you know, it’s really cool because you can just smooth out the top of that nose and just enhance stuff. I think you’ve got to be a little careful in terms of how much you can change from tip. I think you’ve, also, that’s an area you’ve got to be careful in terms of intravascular injections.

Gilberto: Absolutely.

Dr. Franco: So being right on the periosteum or bone depending on what part of the nose you’re treating. But I love it. Thoughts you have?

Gilberto: No. I think you, you know, like, hit the nail on the head. You know, you’ve got to be really careful about, you know, those little blood vessels that, kind of, run along the side of the nose and make sure that, you know, you’re basically laying the product down on the bone itself. But, yeah, there’s so many different things you can do with a liquid rhinoplasty from, you know, kind of, correcting a little dorsal nasal hump or bump, to, you know, it’s something called a saddle deformity where it creates… The nose, kind of, has this congenital, kind of, like, little, shape to it that makes it look like a saddle which is where it gets its name. And you can just, kind of, fill these areas in to, kind of, make everything a little more even and more aesthetically pleasing.

Dr. Franco: The other thing I love for liquid rhinoplasties is just when people, maybe, have already had a rhinoplasty and they’re either waiting to do a revision or it’s so minor that they really don’t want to go into a surgery again and then doing that. Because some of those little things, you can smooth out and people do great. The other great thing I love about injecting noses with fillers is, I’ll typically do a product like Voluma, which, you know, is supposed to last about a year and a half to two years. I think, in the nose, you really get pretty close to that two years because there’s not a lot of motion, there’s not a lot of action there. And so, in general, the product tends to sit pretty well, unlike on lips where we’re constantly talking, moving, eating, drinking, you know, and the product gets, kind of, massaged out. That’s not true with the nose and so a treatment can actually last patients a long time.

Donald: I was going to ask about that. Like, so as far as, you know, because when we do talk lips, it’s like, you know, every month, or two, or whatnot, you’re going back in for a new treatment.

Dr. Franco: Where are you getting your lips done that you’re going in and every month?

Gilberto: Come see me, Donald.

Donald: First off, natural. But…

Dr. Franco: Oh, okay. You’re talking for a friend again.

Donald: Yeah, yeah, yeah. But the one question that I do have is, when it comes to recovery versus, like, a normal rhinoplasty, versus an injectable, what are we looking at?

Dr. Franco: That’s a great question and that’s the beauty of it. I mean, we have a lot of patients that will come in, do it on their lunch break, go back to work, and then they’re looking good. I definitely wouldn’t do it the day before a wedding or a photo shoot because you can get a little bit swollen. With the nose, a little swelling can linger for a couple of days. You know, you don’t want to go do upside down yoga or something that’s going to enhance that swelling. But, you know, either than a small bruise or a little swelling, people feel fine. They, they look good right away, and that’s really one of the benefits of it. I do tell people who are looking for a more dramatic change, “One, there’s a limit to how much we can do with filler. Two, sometimes if people have a large deformity or defect that we’re trying to correct many multiple sessions or more than one syringe.” And so that’s something we can talk about at the console.

Gilberto: Yeah, I agree. I agree with that.

Dr. Franco: Do you do other products besides Voluma for the nose? What do you like to do? What’s your go-to for some of that?

Gilberto: So I’ll use a number of different Juvéderm products. I’ll be honest, I haven’t used Voluma in the nose. I’d be interested to try it. But I usually use something that’s maybe a little thinner like Juvéderm Ultra or Ultra XC. I really, really, like, Restylane Refyne for that area. I think it’s got a lot of really great properties to it where you get the fullness and the product, kind of, like a Voluma but it’s still, kind of, soft, you know? It’s not a very firm…

Dr. Franco: Sort of, like our Gummy Bear Implants.

Gilberto: Yeah.

Dr. Franco: It’s a fullness without firmness.

Gilberto: Yeah. I like that.

Dr. Franco: That’s incredible. But for me injectables stand point.

Gilberto: Yeah, yeah.

Dr. Franco: That’s such an…

Gilberto: So those are a couple of the ones that I more commonly use. But there’s like a number of different, really great, you know, filler products out there and some new ones coming out too.

Dr. Franco: And I think that’s where, you know, having a good provider that you trust can really help guide you a little bit because it depends on the length of time that people want. Some people are like, “Hey, it’s hard for me to come back. I want something that’s going to last two years. I’ll see you guys, you know, in a couple of years.” Other people are like, “Hey, look, I’m really nervous about it. I don’t want to spend a ton of money. Let’s start with something a little shorter-acting, make sure I love it and then go from there.” Not one month short-acting like Donald is getting for his lips, but, you know, something that helps us a little bit.

Gilberto: Right. Yeah.

Donald: Nice. Got me thinking about my lips.

Dr. Franco: No. I mean, you’ve got great lips. You’re a good-looking man, Donald. You’re a good-looking man. I mean, not Austin’s most beautiful man good looking but good looking.

Donald: I’m getting there.

Dr. Franco: Okay. Okay. That’s cool. I mean, you know, Average Anesthesia is not going to let you take his spot. But what else about the nose should people know? Because a couple of things that I always tell people is, the tip is really hard. You know, we can do some subtle tips but that’s where people get themselves into trouble thinking that they can do too much with a tip with filler.

Donald: Yeah. I think that the tip is a bit of a challenge because, you know, most people like that little, like, everted nasal tip that comes up and sometimes it’s hard to get that with just filler alone, I think. I mean, what’s your experience with it?

Dr. Franco: Yeah. I think trying to get an upturn with the nose is hard. I think the things that people tend to see and do really well with liquid rhinoplasty is, from the profile, hiding that dorsal hump, smoothing that out. I definitely think you can give people the illusion of a thinner sleeker nose. I think you can, if people have some curvature or crooked nature to their nose, I think you can give the illusion of straitening that out. I think you can, you know, enhance the overall, like, rate X [SP] or the apex, the nasal bridge just to make that a little bit fit into the face a little smoother. So those are the areas that I tend to see, you know, people do well with the liquid rhinoplasty.

Gilberto: Best results. Yeah.

Travis: Have either of you guys, have you all used any threading procedures with the tip or with the bridge in the nose?

Dr. Franco: I have not done any threading for the nose and I would be a little cautious about that.

Gilberto: Yeah. I personally haven’t either.

Travis: I’ve seen a little bit on Instagram and around, you know, on social media. I didn’t know what you all take on that was.

Dr. Franco: You know, I’ll tell you, I’ve been a little hesitant with the threading. And I’m not saying that it’s good or bad. For those people that don’t know, threading was on the market and it was on the market about 10, 15 years ago and then got taken off. They changed what the threading is actually used. They had used non-absorbable sutures previously. People had some problems with erosion because, basically, it’s like a barb suture. If anyone has watched our tummy tucks and other things, it’s that special suture that holds and locks. So, basically, you can use this to grab some of the tissue and just subtly bunch it up. So you can do some slight changes that’s based on the strength of the suture itself. And the idea is that you’re getting it, holding it, and then before it erodes or does anything through the skin, which was the problems in its predecessor is that, that suture will dissolve over the next, you know, six months to a year. So I think there’s some optimism there, but, obviously, you know, when you’ve seen the bad side of some things, it’s some caution too. That’s my two cents.

Travis: No, I like it. That’s why I’m here. I’m here to learn.

Dr. Franco: G?

Gilberto: Honestly, I don’t have enough experience with threading. I do remember it from about 10, 15 years ago, and then it, kind of, just fell off the face of the earth, I didn’t know why. I wasn’t in cosmetics at the time. I would think, 15 years ago I was probably still doing family medicine.

Travis: You were what, 15 years old?

Gilberto: If only. If only.

Dr. Franco: Let’s talk about some other things that people can do with injectables that people forget. What are the ones you brought up? And just, kind of, starting to work, maybe, from the top down so that we don’t skip around too much is temples. Temples are a phenomenal one that I feel like people forget about. Especially when you’re a little bit older or if you’re very, very, very thin, our temples can hollow out and just gives us a little bit of an overly thin, sometimes, unhealthy appearance and it’s a really cool one that just adds a little bit of volume to the face. By adding some volume to the upper portion of the phase, it can actually make our cheeks and lower of the face look slimmer because of this whole perception. And, again, the…

Gilberto: The everted triangle?

Dr. Franco: Yeah. The little plastic surgery magic where we add volume that actually makes you look thinner which is super cool.

Gilberto: Yeah. I like that a lot. I think it’s a great procedure. I’ve done sculptra for temples before. That’s great because it’s, kind of, like a slower onset of action. You know, you see, like, the fullness almost immediately. But then as the product, kind of, gets absorbed, you, kind of, lose a little bit. But over a series of treatments, you see this fullness, kind of, return as a sculptra, kind of, takes its shape. But I’ve also done a hyaluronic acid fillers in the temples too.

Dr. Franco: Before we jump to this, do you want to let people know what sculptra is? Because it’s cool. Because it’s in its own category outside of the hyaluronic acids that we most commonly use.

Gilberto: Yeah. So, essentially sculptra is like a suture product that is mixed with a saline. And, essentially, what it does is, when you inject it into the area, it promotes collagen formation and more fullness. And the body will naturally absorb the water but the product is left behind, and that’s what creates this process where, you know, we start to see the fullness over an extended period of time. Some people, kind of, get turned off by it because they see the effects of it immediately and they like that. But then as the saline gets absorbed by the body, they start to lose a little bit of it and they think that, you know, the product didn’t work. But in reality, it’s actually doing a much better job of, probably, giving you more longevity than like a hyaluronic acid filler which will wear off after about 6, 12 months, 18 months, depending on which product you’re using.

Dr. Franco: That what’s really cool about the sculptras, is that, you know, for people who, and it’s the plus/minus, right?

Gilberto: Right.

Dr. Franco: Because people who want something like, “Hey, I want my own collagen because it’s basically what it’s doing is stimulating you to make your own collagen. Versus a hyaluronic acid which are still extremely safe, you know, and very good products. You know, but some people like that, that, “Hey, I’m stimulating my own collagen.” And some people are like, “I just want results right now, I don’t want to wait for anything.” And I think it’s just something that we have to talk to our patients about what they’re trying to achieve.

Donald: Is that collagen that’s generated, is that permanent collagen, or is that something that the body will fall back into a routine of not producing collagen at that spot?

Dr. Franco: It’s a little bit of both, unfortunately. Because remember, you always have constant collagen turnover. And, unfortunately, as we age, we lose collagens, you know? And so the idea is that people typically get a year and a half, two and a half years as a typical result with the sculptra. Also, we’ve got to remember too, because it’s stimulating your body to make collagen, and I’d love to hear your experience in this, I’ve seen people who are really great responders and people who don’t respond quite as well. And that’s the only frustrating thing for me sometimes is, it’s not quite as predictable. A syringe of Voluma, a syringe of Juvéderm is going to be 1cc of Juvéderm or Voluma, where sculptra, it can be a little different depending on each person.

Gilberto: Yeah. Or it may require multiple treatments versus one syringe of filler like a Voluma or something like that, where you’re going to see the results right then and there. You know, with sculptra, like I alluded to earlier, it’s something that takes place over time. Like, the results that you’re going to get, they’re going to take place over like four to six months, so…

Dr. Franco: No, I agree. So, kind of, know what you want. But the nice thing is, it’s slow onsets so people don’t see a drastic difference and then that lasts over a period of time. So good question, Donald. Thank you. Good question. Average Anesthesia has not asked any good questions.

Donald: Yeah, he is just sitting over there. I don’t know what’s wrong with him.

Dr. Franco: Another great one that we’ve talked about is the brow lift.

Gilberto: Yeah.

Dr. Franco: We’ve talked about this a little bit at Botox, but sometimes people don’t really have any lines they want to treat but you just want to get that brow up just a little bit and improve that overall shape. I think that’s a great golden nugget for Botox because some people are trying to use it to open their eyes rather than to get rid of wrinkles.

Gilberto: I do a lot of the lateral brow lift with a little Botox there. And like you said, it just, kind of, you know, relaxes the muscle, opens up the eye a little bit, makes people look a little bit more refreshed and youthful. And they love it. You know, it lasts, with Botox, you know, about three to four months on average. But it’s such an easy procedure and the results are phenomenal.

Dr. Franco: One of the cool things we were talking about recently in terms of brow lift is even doing a little filler out of the lateral portion of the brow just to, kind of, kick that little lateral brow up just a little bit. And, again, that’s another neat one where a little bit of product goes a long way.

Gilberto: Yeah, yeah. I remember you told me about that last week when we were traveling, how you use a little bit of filler there. I’ve got to say, I personally have not yet tried filler in the lateral brow but I’d be interested to try.

Dr. Franco: Cool. Maybe Average Anesthesia will take a little filler in his brow, give him a little opening [crosstalk 00:22:52] shape, you know.

Travis: I don’t know, man.

Donald: Did you get your Botox?

Travis: I never got my Botox. That’s something we need to talk about.

Dr. Franco: Why can’t we do that? Can we set up a day we’ll do a little video, we’ll, you know, clip it into one of these, do a little Average Anesthesia Botox?

Donald: We’ve got to do the shopping one.

Travis: We do.

Donald: The Botox one.

Travis: We do. I did do a half M scoped little…

Donald: Yeah. Do we want to bring that up?

Dr. Franco: Wasn’t that the one where Mary destroyed you or no?

Donald: Crush is the word.

Travis: She did better than I did with the M scope. But I will say I could tell a difference. And I don’t know if this is just totally placebo. But I feel like I could tell a difference in my abs from the 10 minutes I spent on M scope.

Donald: You know, what’s interesting? Since you never wear a shirt on Instagram, I could see the difference. Like, I was just like, “Like, like.”

Dr. Franco: Like, “Damn, all this is whoa.” That got double tapped.

Travis: Oh, man. I’m getting murdered on this episode.

Dr. Franco: I read something once where, I guess, when they were first creating the whole like button, they want to call it the awesome button. And then that got thrown out by, was it Zuckerberg? And then ended up being just the like button. And so that was, kinds of, interesting how stuff happens but kind of cool. Let’s keep marching down into, what about a little under-eye filler. I feel like we haven’t talked about that. That’s another golden one.

Gilberto: Yeah. One of my favorite procedures. It’s just so much fun to, like, see the drastic change that you can make in somebody’s appearance just by putting a little bit of filler right in that under eye tear trough area.

Dr. Franco: What’s your filler of choice for that area?

Gilberto: For me, my filler of choice is Restylane-L. Just plain Restylane. I think it’s such a great product. It gives you the volume that you need but it’s also rather thin so, you know, it doesn’t make the under eye look overfilled, it just makes it look really, really natural. Plus, if, for whatever reason, you know, someone doesn’t like it, it’s super easy to just dissolve that product and, you know, just, kind of, start from scratch.

Travis: That’s cool. What’s your typical age range on patients getting that under-eye filler?

Gilberto: It varies for me. I mean, because there are so many different variables. Like some people come in because they are a little older and they want that more youthful look. But, I mean, it’s also kind of, like, for some people, it’s, kind of, like an ethnic thing where, you know, they just have a little bit of, you know, a darker under-eye kind of situation going on. And if you can put a little bit of filler there, you can, sometimes, camouflage that a little bit because you’re separating the tissue from some of those blood vessels that create some of that discoloration. So you’re putting a little bit of space there in between the tissue and the blood vessels and so, you know, I see patients from all different age groups. But, I think, probably, the youngest patient I’ve treated for under eye was, maybe, like 28, 29.

Travis: Wow.

Donald: Is that to fight the bags under the eyes?

Dr. Franco: It is. And, sometimes, people just have it congenitally because I’ve seen people where their mom has it, the daughter has it, the son has it. And so, you know, there’s a fascial wall that holds those bags back and they weaken as we age. But some people, I think, just have a weak fascial wall to begin with, that leads to some of that herniation. But, basically, what you’re seeing is you’re seeing the fat pads which are different than the other fat pads like we get in our belly and other stuff. These tend to be pretty stable in terms of size but the wall weakens and softens. But so what you can do is, surgically, either take them out or you can camouflage them. And what you’re trying to do is hide that peak, valley, and then peak which shows off those bags, gives those dark circles, and try and just smooth and camouflage.

Gilberto: Yeah, yeah.

Travis: You guys are blowing my mind today.

Donald: Yeah. I didn’t know about the brow lift. I didn’t know that you could do an injectable to lift the brow. I thought that was always surgery.

Dr. Franco: You want to lift your brow and get your lips done for over a month?

Donald: No. But I’ll tell you what, I’m thinking about the eye stuff. The under-eye stuff because I’ve got a little bit of bag, actually but I wear the glasses to hide it.

Dr. Franco: You’ve been a hardworking man so you…

Donald: I am, yeah. Editing stuff, and [crosstalk 00:27:03]…

Gilberto: I don’t know about you, Dr. Franco, but I like to use this technique where we use a little cannula where I’ll make like a little insertion point out here, like, on the malar cheek, and then I’ll just, kind of, guide the cannula underneath the eye. And it minimizes bruising, it’s a little more comfortable for the patient in my opinion, and the result is, in my opinion, probably even better than just going straight in with a needle.

Dr. Franco: I haven’t, but it’s something that we’ve talked about in our office, is incorporating the cannulas for under-eye fillers so it’s something I definitely, definitely want to do and will do soon.

Gilberto: Let me know, I’d be happy to, kind of, come by the office and work with you on that.

Donald: You’ve got to teach him.

Dr. Franco: I would love it. I would love it. I would love One Most Beautiful Man to come in and help us do a little cannula step stuff. So…

Travis: I’ll let you guys practice on me.

Dr. Franco: Let’s do it.

Donald: Practice on him first and then come to me.

Dr. Franco: We’ll bring Celebrity in and we’ll go from Average Anesthesia to Celebrity Anesthesia. We’ll Botox, a little under-eye fill, boom, boom, boom. You’re welcome. Just to keep stuff moving a little bit, yeah, other Botox tricks that we do, and we talked about this, another kind of sleepers is something called the masseter muscle. So sometimes, you know, people get it because they’re always, like, biting down and it helps with headaches and other things. Some people, it’s just to slim that face a little bit.

Gilberto: Yeah. I get that a lot, especially, with, you know, the advent of social media, and photos, and wish photos, and such. I have a lot of patients come in and ask me to get, you know, some Botox done in their masseter s just so when they can, kind of, get a little bit of a slimmer elongated face for their social media photos.

Dr. Franco: I mean, we can’t all have the chisel jaw that Celebrity Anesthesia has. But for those of us that don’t, there’s ways to get there.

Gilberto: Yeah, absolutely.

Dr. Franco: Damn, that’s a good-looking man.

Travis: I did have a question. Do you guys do anything with the neck and Botox?

Together: Yeah.

Dr. Franco: I mean, that’s another great one. If people just have a little bit of platysma bands, that’s a good one to, kind of, a cheater before people need a neck lift or something to that aspect. So that’s a good one just to soften and get the neck back up a little bit.

Gilberto: Yeah. There’s a term that’s, kind of, become pretty common, vernacular is tech neck. You know, where we start to see, you know, these, like, horizontal lines across our neck because we’re constantly looking down at our devices and stuff. And that’s something that a lot of people are coming in to get treated just to, kind of, soften those lines up because they’re, kind of, like, lines in your forehead or in your brow. You know, if you move those muscles often enough, you’re going to get those lines, kind of, set in. So, Botox, kind of, helps soften that up amongst other things like diluted filler too.

Travis: Are you using a diluted Botox when you’re doing the neck like that or are you just using a regular concentration?

Gilberto: I usually just use a regular concentration. I just feel like if you dilute it too much, then you have the potential for the Botox to, kind of, spread and you may get it in areas where you don’t necessarily want it and that might make it uncomfortable for the patient or just, kind of, like a different sensation.

Travis: Sure.

Dr. Franco: I think you do have to be cautious about the amount. I think the level at which, you know, being more superficial in the neck, I think, is super important. You know, you’ve got to know what you’re doing. You can’t be super deep or else people are going to have problems. So no question like with the muscle bands. I’ll grab them, lift them up in air, and then inject them. With the next, same thing, make sure you pinch the skin, get it up, and, you know. So there’s definitely some safety things, to your point, to make sure that we’re in a good spot for that.

Gilberto: Yeah.

Dr. Franco: You touched about doing a little bit of dilute filler for the neck. That’s, kind of, a hot topic.

Gilberto: Yeah, that’s pretty popular too. I personally don’t do it but I have colleagues that do that I’ve seen, and it’s a pretty impressive stuff where they dilute, like, Radiesse or, you know, another HA filler. And they’ll just, kind of, do, like, these little micro injections along that horizontal line and just, kind of, really smooth it out. And it’s really impressive the results that we end up getting out of that. But I am really interested in, you know, finding, you know, a good candidate to do that on.

Dr. Franco: Cool. No, no. I think the neck with this day of Zoom, and webinars, and everything else has just become more, and more, and more, and more popular. Can we talk about a few little, like, really cool, interesting stuff? Like, and I did one the other day and you had brought it up, ear lobes. Earlobes is another one because, you know, some of us probably don’t deal with this as much. But if the ear opening gets a little big and the ears are a little thin, the ear rings won’t sit perfectly. And so, you know, fill in the ear lobes and, kind of, holding that volume in let’s things sit a little bit better. Just, kind of, doesn’t give you some floppy ear lobes. So that was a great little nugget by you.

Gilberto: I love that one. Especially for, you know, women that have been wearing really heavy earrings most of their life, that just, kind of, pulls down on the ear and, you know, that gravity is just, kind of, stretching that ear lobe out. You put a little bit of HA filler in there and you can just, kind of, reshape it and give it, you know, a little bit of volume and, you know, you’ve got a youthful looking ear lobe again. And not only that, but it’s going to help support that heavy earing again and make it a little easier for that patient.

Travis: That’s cool.

Dr. Franco: You know, one that I’ve heard about but I’ve never done it and I was wondering if you’ve done is, I’ve heard about people getting their feet injected because they feel like their heels are uncomfortable and they’ll get, like, the pads of their feet injected. Have you ever done that?

Gilberto: I haven’t. No. You know, there was a time when I would do, like, Botox for excessive sweating or hyperhidrosis, like, under the arms and on the hands. And it can be done on the feet also, but I’ve just never done this. It just seems like it’d be such a painful, you know, procedure. Patients are willing to do it because, you know, in this example, you know, they sweat excessively on their feet. They’re going to see some drastic improvement from having Botox done on their feet and so they’re willing to do it. And I haven’t done it for, you know, either that or what you’re mentioning.

Dr. Franco: Okay. Just a man with a foot fetish. I thought if there was someone who have done it, it would have been you. So… No, but I’m glad you’ve cured the world of sweaty feet with Botox too.

Gilberto: No, I haven’t. That’s what I’m saying.

Dr. Franco: No, that’s great. I appreciate that.

Gilberto: I haven’t, that’s what I’m saying.

Dr. Franco: No. Thank you. Thank you. The gyms in Austin, thank you.

Travis: I do have a question about one other spot for filler, back of the hands?

Gilberto: Oh yeah. That’s a good, yeah.

Dr. Franco: That’s become an increasingly popular one because back in the hands shows your age. No question, it shows your age.

Gilberto: Yeah, back of your hands and neck.

Donald: I like how Dr. Franco looked at his hand.

Dr. Franco: I’ve got some great looking hands. I could have been like a hand model.

Travis: Could have been a hand model? Oh, my God. QBC, where you at?

Dr. Franco: I don’t know if that’s possible for us to zoom in on that, but that looks good. For those of you just listening, these are some great looking hands. They’re soft, they’re smooth.

Travis: Baby hands, right?

Dr. Franco: Yeah. No, but strong. They’re very strong. These were farm hands. Gilberto got the chance to see orchard that I grew up, you know, picking pecans with these bare hands. And I think I feel like that helped my fine motor movements, you know, just finesse.

Gilberto: Picking up tiny little pecans?

Dr. Franco: Yeah, just one after another. Millions over time. Millions.

Donald: Oh, my God.

Travis: It’s getting deep in here.

Dr. Franco: What other cool little Botox or filler nuggets would you like to share with us?

Gilberto: Décolleté. I think that’s a big area. I get a lot of requests for that too. That’s the area on the chest that gets exposed. Mostly women coming in asking for a little Botox on the chest because the chest is exposed in a lot of women’s blouses. They’re either, like, kind of low cut or V cut so it gets a lot of sun exposure. And as we know, sun is what, kind of, triggers a lot of, you know, premature aging. And so women will start to see these vertical lines, kind of, form on the chest there. And so if we do a little bit of Botox on the chest, you can relax those lines and they really love it. They think it’s a great result.

Donald: So if you’re running around downtown Austin shirtless on Instagram, would you suggest that?

Gilberto: I mean, it depends on whether you get a lot of sun on your chest.

Dr. Franco: Interesting.

Gilberto: I mean, if you’re running around shirtless, I would imagine so.

Travis: Man, I’m going to need like nine things done when I’m in the office.

Dr. Franco: Well, we can’t have Average Anesthesia walking around. You know, we’ve got to be nothing but the best.

Travis: That’s right.

Dr. Franco: I think it’s kind of cool because, and this is where, I think, having a really good provider is going to help in terms of this, because there’s a lot of really cool things you can do but also things that’s a waste of money. There’s products that shouldn’t be injected in certain areas and then different safety stuff about what can be done safely or not. We’ve talked about a few of these in terms of, you know, the level of what you inject around the neck. I think, you know, especially for the masseter, knowing, you know, where the right space is and also realistic about what change that’s going to be. I think the under eyes, the nose, those are both great ones. But, again, using cannulas being on bone. There’s definitely a few nuggets that really make this safe for patients.

Gilberto: Yeah, absolutely. I think it’s just, and like you said, it’s a matter of, you know, going to your provider, you know, asking questions, making sure that your provider is comfortable with doing these procedures. Because a lot of the stuff we’re talking about, they’re advanced injection procedures. They’re not for someone who is, you know, just, kind of, starting out doing injectables. You want to go to someone who has been doing it for a while that, you know, knows their way around the anatomy of the body, the face, the neck, the chest so that you have the best outcome possible. Because as Travis has said many times before, what we’re here for is to educate the patient and make sure that they stay safe.

Donald: Yeah. I was also wanting to point out that I liked the fact that there are so many options other than going under the knife for these little areas around the body. It’s like, I think a lot of the times, people will think that, “Hey, if I want my nose changed in any way, I’ve got to go under the knife.” And as we’ve explained today, it’s not the only option.

Gilberto: Right.

Dr. Franco: It’s not the only option but we’ve seen the flip side too, where people will just, you know, spend so much money on fillers, Botox and never get the result that they’re hoping for. So I think this is where, you know, having somebody you trust that can guide you and say, “Hey, look, this is what we can get with Botox and fillers. You know, if you want more, then that’s facelift.” There’s even patients who are come in for a facelift or whatever and I’m like, “Hey, what you’re looking for, I can’t do.” And so I think no matter what the procedure is being very clear about what we can and can’t do.

Gilberto: Yeah, knowing your limitations is huge.

Travis: One hundred percent.

Dr. Franco: Celebrity, what about, you know, in terms of anesthesia, I think we’ve talked about this on previous injectable episodes. But, you know, there’s a couple of things that we do. We do numbing cream for most people, Pro-Nox has been something. We honestly took it out of our system during this whole COVID, there’s now some specialty filters that you can put on it that are, of course, on back order but as soon as we can get those in our hands, we’ll start offering that again so there are some options. But any thoughts about anesthesia during these injectable procedures?

Travis: I mean, you guys use such, such small needles, and then with the local anesthetic cream that you guys put on for patients prior to having any injections, honestly, it’s not bad. I’ve had some of the local cream on my head before I had a couple of PRP injections in my scalp and I couldn’t feel it at all.

Dr. Franco: Yeah. I think some of the new numbing creams, I think the Pro-Nox, I think some of the nitrous oxide gas stuff, I think so many things have made a lot better. Most of the products themselves don’t mix with [inaudible 00:38:26] in it. If they don’t, we have the ability to add it.

Gilberto: Yeah. And one thing that I think we haven’t really talked about is ice. I mean, ice is a great numbing agent. You know, we use that a lot and that’s really inexpensive.

Dr. Franco: I agree. And to your point about ice, and swelling, and bruising stuff, you know, a couple of take-homes just so people don’t forget if they didn’t listen to our other 18 episodes about injectables is, you know, one, the day before a wedding, a photo shoot, you know, your first date, whatever, it’s not the time to come in and get injectables or try something exotic. So, you know, because with Botox, it could take up to two weeks to really see the full effect. And, honestly, people look better at two months than they do two weeks. If you have some deep lines, it takes time for all of that to smooth out. If you’re getting fillers, last thing you want us to be a little swollen, maybe you get a little bruise. And I have people come in all the time and say, “Oh, well, you never bruised me.” I was like, “Well, you’ve just jinxed us both and I guarantee you’re going to get bruised now.” But, you know, don’t do that to yourself the day before a wedding or the day before this. You know, especially when you do something new, give yourself time. You know, that way, if you get a bruise, you get something, do a little Arnica and you’ll be good. So plan ahead. Also with a lot of providers and COVID and everything else, you know, I know in our office we’ve limited the flow through the office so sometimes a little harder to get into your favorite injector. So being a little careful that you plan ahead of time and you’re not left out.

Gilberto: Yeah. Yeah.

Dr. Franco: Other take-home points for people to think about ahead of time?

Gilberto: I know I think we talked about a lot of different things. You know, again, I can’t, you know, emphasize this enough. It’s really a matter of, like, setting expectations with your patient, talking to the patient, you know, what are their goals, you know, what is it that they’re trying to achieve? And, really, I think if you can develop a good rapport with them, you’re going to have a patient for life.

Dr. Franco: Donald, any take-home messages or thoughts, questions, concerns for your friend with the one-month lip fillers?

Donald: No. Like I said before, my big thing is, I just want people to know that there are many different options that they have other than just going under the knife and, you know, having these proper conversations with your injector and your provider to explore all your options before you make that decision.

Dr. Franco: Average Anesthesia, anything?

Travis: No. I mean, I think you guys hit the nail on the head and covered, kind of, everything with injectables. Really cool. Learned about some new techniques today that I did not know about. And, you know, some of the things that you can do, like you said, with a liquid rhinoplasty, with doing a brow lift, with a little bit of Botox. I mean, that’s cool stuff and, maybe, great candidates for that are people that are, you know, may need a brow lift in a couple of years, a surgical brow lift but this may buy them a little bit extra time. And that’s, like you all were saying, talk to your provider, get a game plan together, and have those conversations where you can actually hash out a realistic expectation.

Dr. Franco: I sure hope Mary is not listening to this episode or it’s going to cost you a lot of money.

Travis: Oh, I know. I know. Story of my life.

Dr. Franco: Can we do a little Fact or Fiction?

Travis: Let’s do it.

Gilberto: I don’t know. Can we?

Dr. Franco: And there’s really just one big question. You know, I just want to clarify this for all the ladies in America, Fact or Fiction, Gilberto is back on the market.

Donald: Uh-oh.

Dr. Franco: Because I feel like this is a big one.

Donald: Uh-oh.

Gilberto: That’s fact.

Together: Oh.

Dr. Franco: Wow.

Travis: You heard it here, folks.

Dr. Franco: Wow, wow, wow.

Donald: You’ve got to pop the collar when you, “It’s a fact.”

Dr. Franco: Oh, yeah. Yeah. Don was talking big over there. He raised his seat.

Travis: Yeah.

Donald: I had to, yeah. You guys, you guys made me look short on this [inaudible 00:42:03].

Dr. Franco: But I guess the question is always like, what do you do? So do you take a little time to get yourself, you know, back and a little hiatus, you know, or do you jump right back on the way? Because every time we’re together, I feel like people are just throwing themselves at you. We were on the plane and somebody is like, “I recognize you.” And it’s just, I feel like it has to be hard being Austin’s most beautiful man.

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

Donald: People watch this episode so that they can see you blush.

Travis: Oh yeah.

Gilberto: I mean, I think I’m as red as my jacket if not more. Honestly, I don’t know how to answer. I mean, it’s something that I think I’m going to ease into.

Dr. Franco: Okay.

Gilberto: Yeah.

Dr. Franco: Okay. Because a lady friend of yours recently compared you to a Piranha, didn’t she, or bull or something like this? Is that fact or fiction?

Gilberto: I think the quote is wrong, and…

Travis: Enlighten us.

Gilberto: I think it was more along the lines of a one-eyed-three-legged pussy cat.

Donald: What?

Dr. Franco: I don’t even understand why they would say that about you.

Gilberto: I don’t either.

Dr. Franco: But this is a family show so we won’t go into this. On that note, Gilberto, I’ll let you off the hook. What’s a little behind the [inaudible 00:43:25] nugget that you would share for all of our fans and your fans out there about injectables that they should know?

Gilberto: I just think that there’s, like, there’s so many different innovative ways that injectables and Botox can be used and we’re just coming up with new things, you know, as time progresses. You know, not just new techniques but new products, you know, that are coming to market, you know, that are going to be longer-lasting Botox or shorter-lasting Botox for someone who just needs something for, like, an event that’s going, like, have quick onset but it’ll also wear off quickly. So it’s an expanding world in aesthetics and injectables and I’m really excited to see what the future holds.

Dr. Franco: Yeah. You talked about a few products coming out and we’re not going to let the cat out of the bag yet, so, I think. But some new stuff coming out soon that I think will make some nice differences. I think sometimes too, you know, people come in all the times like, “Oh, I want lip fillers. I want this.” Sometimes just, you know, I try to get people to express, “What bothers you?” Because, sometimes, we can help guide them with some of these other tricks that they may not even know about, and they would be more helpful if we know what really concerns them so I think that’s a good point. What about quote of the day? Can we get a quote of the day? I feel like we’ve struggled a little bit recently, for those of you that have been listening.

Gilberto: I feel like I should hand the reigns over to Celebrity Anesthesia.

Travis: Oh, no, no, no. No. I’m going to give you a shout of redemption right here.

Dr. Franco: Average Anesthesia forgot that he does the quote of the day so we had to audible Average Anesthesia. That’s, kind of, cool.

Donald: Do I need to step up in one? What’s this?

Dr. Franco: Anesthesia, are we were going to get a quote of the day or?

Travis: I’m just going to let Gilberto redeem himself. Last two, were not up to his normal level.

Dr. Franco: Wow. Wow. Okay.

Gilberto: All right. Well, let me see if I can redeem myself.

Travis: Here we go.

Gilberto: How about, this is from Babe Ruth.

Dr. Franco: Okay.

Gilberto: Babe Ruth said, “Never let the fear of striking out keep you from playing the game.”

Dr. Franco: I like that.

Travis: I like that.

Dr. Franco: I like that one.

Travis: I like that.

Dr. Franco: You came on back strong.

Gilberto: Is that redemption?

Travis: That is redemption.

Gilberto: Is that redemption?

Dr. Franco: Yeah, yeah.

Donald: Heavy.

Dr. Franco: It’s interesting. I think we were talking on the plane when we were flying that, you know, I’ve been listening to Phil Knight’s book, you know, him talking about how he created Nike and so forth. He struck out a lot, a lot. And so it’s amazing, you know, but you know you’ve got to get back up.

Gilberto: Yeah.

Dr. Franco: You’ve got to just get back up. I mean, just because you got nicknamed Average Anesthesia one day doesn’t mean you can’t earn back Celebrity. So we’ll see, got to just work hard for it. Donald, thoughts about striking out?

Donald: Don’t do it.

Dr. Franco: Tuesday and Friday?

Donald: Tuesday and Friday, what? I don’t know.

Dr. Franco: Celebrity?

Travis: I mean, I think that couldn’t be more timely for Gilberto back on the market.

Donald: That’s true.

Travis: No fear striking out baby.

Gilberto: Yeah. All right.

Travis: Full speed ahead.

Dr. Franco: I don’t think Gilberto struck out, but, you know, we’ll agree to disagree so who knows, who knows? Well, I want to thank everybody for coming on. Producer Donald, I’m glad that you worked us into your schedule. Gilberto, thank you for taking the lead on this cast.

Gilberto: Yeah. This was fun. Thank you.

Dr. Franco: The fans wanted it. They said they wanted more G, we got it. Average Anesthesia got a new nickname which I couldn’t be more happy about. So boom, boom, boom. I love it.

Guys, don’t forget, you can follow us on Instagram at Plastic Surgery Untold, you can see us on YouTube, Austin Plastic Surgeon, or you can download us on iTunes or wherever you get your favorite podcasts. Greatest podcasts in the world as voted by us, Plastic Surgery Untold. Thank you, guys. Bye, see you.

Donald: Before we go.

Dr. Franco: Oh, wait. Oh, wait, wait.

Travis: But there’s more?

Dr. Franco: That’s how we close every day but I guess not.

Donald: Yeah, I’ve got to break in. What’s on the next episode?

Dr. Franco: Oh, I don’t know yet. I don’t know. I usually write the script about 20 minutes before the show. But, you know, if you want to, and today we finish so I don’t know. I don’t know. Do the people want to hit us up on Instagram, maybe DM us, maybe give us some shouts of what they want to do? Why, do you have a topic?

Donald: Well, no. Actually, I was following the notes for today’s script.

Dr. Franco: Yeah.

Donald: We were supposed to plug the next episode.

Dr. Franco: Oh, yeah. But I don’t have one.

Donald: See that’s…

Travis: Maybe we can reach out to our fans and ask them to give us some ideas, some suggestions.

Dr. Franco: Yeah. You can DM us. Let’s go through our Instagram handle. So, Tall Gamer.

Donald: Tall Gamer, T-A-L-L G-A-M-E-R.

Dr. Franco: Oh, people don’t know how to spell tall?

Donald: You know what, you know what? You know, I’m not insulting our audience.

Dr. Franco: That was a tough one. Okay. That was a tough handle, I’m glad you clarified that. G?

Gilberto: Austin Aesthetic PA.

Dr. Franco: Boom. Okay. And, Celebrity?

Travis: Celebrity Anesthesia.

Dr. Franco: Okay. You don’t want to spell that one out?

Travis: I figured I’m going to give the listeners the benefited of the doubt.

Dr. Franco: And then Austin Plastic Surgeon. So can I close it out or anything else, Donald?

Donald: Sure, sure. Run it.

Dr. Franco: Oh, oh, oh, oh. Oh, now it’s my show.

Travis: Now it’s your show.

Donald: Take it back.

Dr. Franco: Thank you. Thank you, Donald, for letting me take it back. Download us greatest podcast as voted by us. Maybe not Donald but by everyone else on the crew. Download us on iHeart or wherever you get your rated podcasts. For reals, we’ll see you guys. Thanks for joining us. Bye.

Travis: See you guys.

Gilberto: Thanks, guys.

Donald: Peace.

About The Author

Dr. Johnny Franco
Episode 27: Local Lipo – Fact or Hype?Episode 29: Breast Reconstruction – The Art of Plastic Surgery


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