Episode 34: Is Zoom Neck a Thing?

Franco: Welcome back to “Plastic Surgery Untold.” I’m Dr. Johnny Franco, also known as Austin Plastic Surgeon, and today we’re talking neck. And so the world of Zoom, social media, FaceTime, has just really changed how we look at ourselves. And I think everybody, you know, is their own worst critics. So today we’re gonna talk about necks, kind of jawline. What we can do to just make this look, you know, Zoom ready, if you will, for those of us working from home, webinars, etc. But before we get into all the good stuff here, let’s catch up with what our celebrity cast is doing. So, we’ve got the anchor, Celebrity Anesthesia. What’s new in your world? I know you’re making some big moves around Austin.

Travis: Making some big moves. We should close in our house next week, which is very exciting. But beyond that, it is Thanksgiving next week. So, we’re excited. We’re actually gonna go down to just outside of Houston, go see my grandmother and the rest of my family. A little socially distant Thanksgiving celebration. I know with the COVID cases kind of ramping up, and not to get political or anything, but we’re gonna go by, stop and grab some lunch, and say hey to everybody, and keep our distance, and head back home.

Franco: Okay, sounds good. G-Berto, what’s going on in your life? Fact or fiction, starting early since you don’t wanna share any good nuggets with us, is it fact or fiction that you are the king of slipping into friend zone? True or not? I wish this was a live call-in show because then we can have people call in and be like, “Yes, G-Berto is the king of falling into the friend zone.” Because at one point, we had a great debate whether you were a lion or… What is it? A three-legged, one-eyed pussy cat?

Gilberto: I believe that’s what it was. My memory doesn’t serve quite as correct as it should.

Franco: It’s still unclear which category you fall in.

Gilberto: I guess it’s gonna remain a mystery, John.

Franco: And then, what would you say is the greatest trait or feature you have that slides you into friend zone so quickly? If you had to pick one trait.

Travis: He’s a nice guy, man.

Gilberto: If I had to pick one? Only one?

Franco: Only one. Only one.

Fernando: The top one, Gilbert, the top one.

Gilberto: I’m a good listener, John.

Fernando: Oh, okay. Because I definitely need some tips on how to get into the friend zone because there are some girls that I just need to keep in the friend zone. It’s so hard.

Travis: You have problems with that?

Fernando: I do.

Franco: Is it just women or just friends in general that you’re having a hard time connecting with? Because as your friend, I feel like you could take some tips.

Fernando: Thanks, John. Thanks.

Franco: Well, Capitan, what’s going on in your life? Talk to us a little bit.

Fernando: Well, with the holidays just right around the corner, I got a lot of Christmas shopping to do online and getting that stuff shipped.

Franco: Well, if you don’t have any friends, this is gonna be pretty quick.

Fernando: But I do have a very large family, Dr. Franco. Very large family. And many god children in my life. So, they range from the ages of 5 to 30, so the gift range has to be just, you know, age-appropriate, as you like to say.

Franco: Okay.

Travis: You looking to adopt?

Fernando: Well…

Travis: I’m only 32, dude.

Fernando: Yeah, but you have to be Catholic and I have to confirm you in our faith.

Travis: Oh, that’s fair. My wife’s Catholic.

Fernando: Close enough.

Franco: Boom, boom, boom. There we go.

Travis: All right, boom. There we go, let’s ponder off.

Gilberto: Mary gets a gift.

Travis: @yourtrendytherapist, give her a follow.

Franco: Well, as you guys know, I got a new, little puppy, a little Winston. If you guys aren’t following us at Austin Plastic Surgeon, he’s got his own little highlights reel. Finally got his shots, so if you’re out at the dog park, say hi. Winston’s super friendly, and so gotta get him to get some little energy out. I’ve tried taking the role of letting him be a free Frenchy in my house.

Fernando: How’s that going for you?

Travis: Free-range Frenchy?

Fernando: Bad idea?

Franco: Yeah, I think he thinks that his name is either Bad or No, at this point. So, it’s been interesting, to say the least. It’s a learning curve for sure.

Gilberto: It’s a good thing you have hardwood floors.

Franco: A good thing I got hardwood floors.

Fernando: And I would like to point out, Dr. Franco, congratulations on being a third-time winner of the Austin’s Best of the Best in 2020.

Travis: All right.

Fernando: Even through COVID, you managed to still shine above all the other plastic surgeons here in Austin. So congratulations on that.

Franco: Well, I’d like to thank all of our listeners, everybody that…all three people that download our podcast. I appreciate you guys voting for us because in all sincerity, without everyone who voted, everyone who supported us, wouldn’t have happened. So, sincere thank you to all of you.

Fernando: And you have strong competition out there, so kudos to you.

Franco: We definitely do. There’s an incredible amount of talented plastic surgeons in the greater Austin area, if you will. Cool. Well, let’s jump into it. Let’s talk about necks. I think we alluded to it in the intro, probably one of the hottest areas of plastic surgery because of the video chat, you know, Premium Snapchat, fans only. All of these things have made the neck explode because we’re all looking at ourselves so much on these different platforms, you know. And we always tend to be a little bit of a hard critic on ourselves. How can we improve this just a little bit? Because most people don’t wanna change themselves. They just wanna tighten and refresh, do a little something. And for some of us, the quarantine 15 was real, and unfortunately, you know, face is an area where a lot of us tend to put on a little bit of weight and do some of those things. So maybe, G-Berto, kick us off. Talk a little bit about neck, how you address this, what we can or can’t do. Is there anything we can do before the holiday? Is the hope over for the year? You know, better luck 2021. Or where we at?

Gilberto: So I think like you were saying, you know, with the advent of social media, Zoom meetings, TikToks…

Franco: Do you do a lot of education on TikTok?

Gilberto: No, but a lot of people are on it. And during COVID, everyone jumped on TikTok, you know, everyone was on there.

Franco: Is TikTok still a thing?

Gilberto: I thought it was. It’s pretty popular. Yeah.

Travis: The kids are saying that.

Franco: Last TikTok you did?

Gilberto: I haven’t done any.

Franco: Travis? Celebrity?

Travis: Got nothing, man.

Franco: Fernando?

Fernando: No, no.

Travis: I’ve maybe been in the background on one or two of my wife’s. That’s it.

Franco: Okay, cool. Sounds good.

Gilberto: I take it back. There is one out there with me in it, but…

Travis: Oh, we’re gonna have to get our hands on that.

Gilberto: Is this is a paid account or can we get it for free?

Gilberto: No. I didn’t film it. One of my nurses filmed it.

Franco: Is this one of the girls you slipped into friend mode with?

Gilberto: No, no. This is one of my old co-workers.

Franco: Okay, cool.

Gilberto: I’ll show it to you. It’s funny. It’s good.

Franco: Awesome. Good. Can we talk about necks?

Gilberto: Yeah, let’s talk about necks.

Franco: Okay, good.

Gilberto: So with all these different social media platforms, Zoom meetings, a lot of people have kind of just focused a little bit more on their appearance and how they are perceived among their peers. And there’s a term that’s been kind of thrown around. I think we’ve used it before in a previous podcast, called tech neck. And that’s kind of like this appearance of what we look like online, our perception of what we look like online because of technology or because of our devices, the things that we’re looking at constantly. We have our head down, looking at, you know, screens, either our phones or iPads, you know, different tablets and stuff, and because of that, we start to see these, like, lines form across our neck, that kind of age us essentially. So I think there’s a lot of interest in trying to rejuvenate the neck and trying to, you know, make ourselves look our very best, give the world the best version of ourselves, you know. So there’s a lot of different things that we can do with that. And some of the, like, most common things that are available are things like Kybella. Kybella is a procedure, a treatment that we perform in our practice. I think you perform it in your practice as well. And essentially, Kybella is a solution, it’s deoxycholic acid, and we inject it into the submental fat pad, or the little area just underneath the chin that kinda creates that double chin or, turkey neck kinda chin.

Travis: It is the season.

Gilberto: Right? I thought it was appropriate.

Franco: And when we’re talking about necks, to kind of put in perspective, can you break this down a little bit for us? Because with the initial evaluation, how do we know who’s a good candidate for what? Because it sounds like you’re starting off with the kinda non-invasive, quick-fix stuff in terms of this. Because in my practice, it’s almost a difficult nature with necks because there’s a slippery slope. It’s whether it’s an excess adipose fat issue, volume issue of the neck that’s making it bulge, or a skin issue. And the same thing that we struggle with with tummy tucks, lipo, you know, whether it’s a skin issue or fat issue.

Gilberto: Yeah. In some cases, it’s both, you know. In some cases, the patient may have excess fat in that fat pad, and they may have skin laxity depending on how they take care of themselves, it’s also age-dependent in some cases.

Gilberto: Do you have some good rules of thumb? Because age, skin, you know, there’s definitely people who are 40 going on 70, there’s people who are 70 going on 40, vice versa. And so, you know, age isn’t… Like people say, it’s only a number.

Gilberto: Yeah.

Franco: You know, it’s a guide, but there’s lots of factors. How do you go about who’s a good candidate for Kybella? Because I don’t want 8 million… I mean, I do want 8 million people rushing to your office to see you because you’re fabulous, but we wanna make sure they’re going there for the right reasons. How does somebody know whether they’re a good candidate for Kybella or if they need something else before they…

Gilberto: I think that’s where we come in. I think we’re the ones that are supposed to be making that decision as far as what’s the best approach to treat these problem areas. But I will say that skin laxity is not gonna be corrected by Kybella. Kybella is gonna help more with that submental fullness, like that little pooch or pouch, you know, just underneath the chin, that we can kind of dissolve the fat that’s right in that area and help, in essence, kind of create a little bit more of a sleeker profile, a little bit more defined jawline. But it’s not gonna do anything for skin laxity. That’s something that’s gonna require maybe surgical intervention or other maybe non-invasive treatment modalities that help kinda tighten the skin. But yeah, a patient may have the impression that they’re a good candidate for Kybella, but ultimately, it’s gonna be the provider that makes the decision on what the best course of action is.

Franco: Can we go through the process a little bit because I feel like Kybella is one of these that got just this massive amount of hype when it came out, and people were so excited about it. And there was definitely some people who were left disappointed. I think it’s a great product, in the right position. And this is where it’s our job to make sure that you’re the right candidate for it. Can you guide me a little bit in terms of what you tell patients? And hopefully, we can get Fernando to jump in here in just a minute, not to give away the beauty secrets to the stars, but maybe he can give us a little personal insider expose about the true inside treatment of Kybella?

Fernando: Of course.

Franco: Okay. But before we get to that, kind of what you tell people in terms of expectations, timeline, and when to and not do it. And maybe we can argue about this if we disagree. I hope we disagree so badly.

Gilberto: I hope we disagree too, John. So, I’ll have patients come in, and the first thing I’ll do is I’ll hand them a mirror. We know what they’re coming in for, we’ve scheduled them for a consult for Kybella. So we know that they’re coming in for that. I’ll hand them a mirror, you know, I’ll ask them to show me what are the areas that concern them, what they would like to improve upon, get a little bit of background on their situation. I’ll also take some photos. I love getting photos of my patients so that I can have something to show them because what we see is not the same thing that everyone else sees. Like you said earlier, sometimes we’re our own worst critics. And so, you know, getting photos and being able to, you know, see and talk about these trouble spots with the patient looking at their own photos I think is paramount importance because it really just puts things in perspective, it puts everyone on the same page, and it’s much easier to have a conversation about what expectations can be met.

Franco: And in terms of expectations, just so people understand, with Kybella, that’s not something they’re gonna see an immediate result. This isn’t like a filler, you know, like if you’re doing somebody’s Juvederm lips or something, you know, right away they see the result, boom, looks great. “Yeah, I love my lips.” And maybe a little swollen. But Kybella’s actually the opposite.

Gilberto: Quite opposite. As a matter of fact, things actually get quite swollen, pretty swollen over the following 7 to 10 days, sometimes up to 2 weeks. Because of the way the product is taking effect, the way it’s working, it essentially emulsifies the fat. And by doing that, it creates, like, an inflammatory response in the submental area, in the lower neck area, or below the chin, I should say. And so you create a lot of swelling and a lot of inflammation, and it almost kinda gives you like this full, I hate to use the word, but bullfrog look because it really just causes that neck tissue to get so swollen. I’ve had it done myself, so I can speak on that. But it feels kind of slushy. You know, you shake your head, and it just feels like there’s fluid in there shaking around. So it’s actually a process that takes a lot of consideration with regards to, you know, are you gonna be around your peers? Do you have presentations that are coming up? Family events where you may not want to be quite so swollen, and take that into consideration when you’re planning these treatments. But over that period of time as that inflammation kinda starts to subside, we do start to see a reduction in that submental fullness.

Franco: And just so people understand. I typically tell people, six to eight weeks to see the full effect of Kybella. And again, I don’t want people to think that this is a magic bullet. You know, one or two vials of Kybella is not a replacement for a liposuction, neck lift, those type of things. Because I typically will tell my patients that we’re in the range of… Typically, for most people that are good candidates for this, we’ll do something like three vials at the first setting, two months later, do another three vials, and then maybe two or three vials at a third setting, depending on where they’re trying to get to, where our results are. So, it’s a process and then it does take significant amount of treatments to get you where you want. I do think it works, but I wanna be real about the difference it can make and the time it’s gonna take to get there.

Gilberto: Absolutely. And there’s different ways to do this. Sounds like you take a pretty aggressive approach right from the beginning, doing two to three vials. I have some patients that maybe don’t wanna…

Franco: I ain’t playing no games. Let’s go. Let’s do it. Let’s get the show started. Let’s roll.

Gilberto: Johnny’s favorite line is, “Go big or go home.”

Franco: Exactly. You’re welcome. You’re welcome.

Gilberto: But then I have some patients that maybe don’t want such a drastic, you know, amount of swelling. So we kind of space things out even further still and use less product with the understanding that they will eventually get to that endpoint that they’re looking for or as close to as possible, but in a more subtle way so that they don’t have so much swelling or so much inflammation, and they can kind of carry on throughout their normal days without much interruption.

Dr. Francoe: So you treat Kybella very, very, very similar to your dating life. Very, very, very, slow, and steady.

Gilberto: It’s a long game, John.

Gilberto: Okay. Good. Just want to make sure that everybody understands.

Travis: Yeah, the Kybella friend zone.

Gilberto: It’s the long game. It’s the long game.

Franco: So 10 years from now, they might be able to see, you know, the nice chiseled jaw and stuff they… I like it. I like where you’re going here.

Gilberto: Not 10 years, but maybe like 6 months.

Franco: Fernando, as a man of beauty yourself that takes a lot of pride in your personal hygiene and self-care, can you talk to me? Before you grew out the man beard and caveman look, you know, you had a chiseled jaw and you had done some Kybella. So tell me a little bit about your experience and how this chiseled…that beautiful face of yours? Because someone actually confused you for G-Berto recently.

Fernando: Oh, really?

Franco: You were there.

Fernando: Oh, I was?

Franco: You forgot?

Fernando: Well, okay.

Franco: Well, good. I’m glad you saw the comment.

Travis: It was a memorable experience.

Franco: Remember we talked about, if she confused you for G-Berto, then maybe you are Austin’s most beautiful man.

Fernando: Well, that may be true too.

Gilberto: That’s debatable.

Fernando: But to Johnny’s point, I guess, it about a year ago, I got pleasantly plumped is the term that I like to use. And my face is naturally chubby, but it got way too round. So I had the little double chin going. And I know you can’t see right now because I grew out my COVID beard. Once I get out and released from my COVID imprisonment, I will take it off. The disappointing part for me was I did not realize how painful it was gonna be just to get the injection done, to begin with. And then the fact that it took like 6 to 8 weeks, maybe even 10 weeks, for me to actually see a noticeable reduction on it was the disappointing part of it. So, yeah, going on a date the next day was not the best idea because my expectation was that they’ll do it overnight, it’ll go down, and then I’ll be fine on my date the next night. She’s like, “Are you having some kind of allergic reaction? Because you are really, really chubby today, Fernando.”

Franco: There are so many things I wanna tackle there.

Travis: I got around 10 things.

Franco: Fact of fiction, was there really a date the next day, or is this for dramatic effect?

Fernando: There really was a date the next day, but we could call it dramatic effect as well.

Travis: I got a couple things here. Number one, did she know…

Franco: Celebrity is like, “Wait, wait. I gotta put a stop to this.”

Travis: We gotta unpack a few of these things. Number one, did she also know it was a date? Number two…

Fernando: Oh, man.

Travis: …pain is very… I am very familiar with pain being subjective during anesthesia.

Franco: If you start off the dinner with, “These will be separate checks.”

Travis: That’s not a date. But I am very familiar with patients having very different meanings of the word pain. I like to give everybody my Wong-Baker scale. If anybody’s familiar with the 0 to 10 pain rating scale, I do my own, 0 is no pain at all, 10 is actually being mauled by a bear or burning alive. I try to set them up. You know, 10, it’s the worst pain imaginable. I don’t wanna say patients are a little dramatic sometimes, but sometimes people will say it’s a 10 out of 10, when they’re getting a Kybella injection.

Franco: And just to put this in perspective, Fernando got EMSculpt and only got up to 20%.

Travis: Oh, come on, really?

Franco: So I just wanna put this in perspective for everybody out there that’s done a little EMSculpt, okay?

Fernando: Yeah. And to Travis’s point, on his scale, I would say the pain was only like a one and a half, maybe a two.

Franco: You just said it was unbearable, and now it’s a one?

Fernando: I did not say it was unbearable. I just said I was surprised by how much it…

Travis: Do you guys see what I have to deal with all the time?

Fernando: But it felt more like a bee sting more than one time.

Franco: What’s the old saying? Men are from moon, Fernando is from Venus? Or what’s the old saying? Something like this?

Fernando: So it felt like multiple bee stings in one area, is what it was.

Franco: Bee stings?

Fernando: Yeah.

Franco: Have you ever been stung by a bee? I wanna be stung by a bee.

Fernando: I actually have been stung by a bee. And it felt like I got stung by a bee, like, you know, 20 times.

Travis: Unbelievable.

Franco: I promise to everyone listening, it’s not like being stung by a bee 40 times. I promise you.

Gilberto: So to give you…

Travis: Thank you.

Gilberto: …the real experience of what to expect, it is not bee stings, I promise you. Here’s what I will say…

Travis: Kybella’s stock is plummeting in the background right now.

Gilberto: Kybella is a very tolerable treatment. It doesn’t even require any topical numbing. You can use a little bit of ice to kind of ease a little bit of that initial injection stick, and that’s pretty much it. You’re really not gonna feel anything. That’s the God honest truth from someone who’s had it done and who performs it.

Travis: Thank you. Thank you.

Franco: And for those of you that are listening, this will be Fernando’s last episode. So, Fernando, I appreciate you being on the show as we continue. And so, now that we’ve beat down Kybella as much as possible, can we continue to some other ways to treat the neck because it’s not the only option.

Gilberto: No, no. There is so many different options. And it’s also dependent on what you’re trying to achieve. I alluded earlier to the neck lines across the neck or the tech neck lines. Some of those are due to, you know, wrinkling of the skin or just the skin kind of naturally aging. Some of it is due to mechanics of how we position our head. And some of those things can be addressed with either Botox to kinda help relax some of those lines. We talked about that in the past, where we inject Botox into the platysmal bands.

Franco: I think that’s a great nugget. Not to bypass it because I think Botox to the little platysmal bands, is a great nugget that a lot of people forget about. Because they don’t need a full lift, they don’t need some of those things and some of those bands because, again, muscles contract and shorten, so they [inaudible 00:21:16.138]. If you can relax that, it actually lets that skin come up a little bit. Especially patients that have thin skin, those type of things, I think it can smooth it out just a little bit and buy people time before having to do, you know, a neck lift or some other procedure.

Gilberto: Yeah. Another thing that has become pretty popular is this Hyperdilute Radiesse.

Franco: Yeah. You did one of these recently. I was watching you on Instagram. So talk to us a little bit because I think that’s another nugget that people don’t know a lot about.

Gilberto: So Radiesse or calcium hydroxyapatite is a filler product, but this particular procedure is basically diluted with sterile saline and maybe a little bit of lidocaine…

Franco: Because we love our patients.

Gilberto: …for pain relief. Exactly.

Franco: Because I don’t want it to be like 40 bee stings, much like Fernando had to endure.

Gilberto: Definitely don’t want that.

Travis: Ten out of 10.

Franco: Being mauled by a bear.

Gilberto: Burning alive.

Fernando: You sabotaged me.

Gilberto: Basically, we dilute the Radiesse down, basically like a one to four ratio with saline and a little bit of lidocaine, and then we inject it subdermally or just underneath the surface of the skin into these areas, like the neck, for example. And the purpose of that, is that it helps stimulate collagen production. So for patients that have more aging skin and a little bit more, like…not true skin laxity, but just aging skin or like that crepey look to the skin that a lot of people don’t like, what this does is it essentially stimulates collagen production to help kind of give the skin a bit of more of a youthful appearance. It takes a couple weeks for that to kind of kick in. And this is usually done over a series of treatments. But you can really rejuvenate the appearance of the skin on the neck with this Hyperdilute Radiesse. It’s pretty impressive stuff.

Franco: That’s a pretty impressive nugget.

Travis: On those patients, are you doing at the base of the neck, or is that kinda in the middle of the neck, around that crichothyroid cartilage? Where are you depositing most of that?

Gilberto: So there is a couple different deposit sites that can be used. You know, the training that I had recently showed us four different port sites. So basically, one up high kind of just below the jawline, one a little bit lower, closer to the clavical, and then the same thing on the opposite side of the neck. And the way I trained to do it was with a cannula, which is like a blunt tip needle. And so we basically make a little insertion point with a sharp needle to allow the cannula to enter into the skin. Similar to what Dr. Franco would use in doing liposuction, but instead of pulling stuff out, we’re pushing product in.

Travis: And much, much, much smaller.

Gilberto: And much, much smaller. This is essentially the size of almost like an insulin needle, but long. It’s about an inch and a half long, and it goes just underneath the surface of the skin, and we’re basically just pushing this product underneath the surface of the skin to stimulate that collagen.

Franco: That’s pretty cool. It’s just amazing how many new things come out because treating that skin texture can be really, really difficult. I think, you know, one thing before we jump into kinda surgical and a little bit more invasive methods of treating some of the next stuff, is just keep in mind, if your head’s all the way flexed down, and you’ve got your phone on your lap and you’re trying to look at it, you’re gonna have some loose skin, you’re gonna have a neck bulge. So, you gotta put in perspective of how you’re seeing yourself and what can… Because even when we do face lifts, if your chin is touching your chest, you’re gonna have some skin because you gotta have some range of motion of that neck. So, being real about where we can get this.

Travis: And if your chin is touching your neck and you’ve had a facelift, they pulled you too tight if you don’t have any skin laxity. If you don’t see any type of wrinkle or bulge, yeah, that was not done properly.

Franco: That chin will come up eventually. Just give it a little time. Stretch it out little by little.

Travis: Yeah.

Gilberto: And to Travis’s point earlier about, you know, being around certain length, like structures and stuff, this is just underneath the surface of the skin. So we’re not really getting deep into the tissue or anything. So it’s a very, in my opinion, very safe procedure.

Franco: I feel like everything you do is safe, G-Berto.

Gilberto: I try to keep my patients safe, John.

Franco: A priority.

Travis: Love it.

Franco: You know, some of the other things that we do, there are some mechanical devices, like Ulthera, that do some deeper skin tightening, which I think is a good option. And some radiofrequency energy, because there’s some energy-based devices that do help with skin tightening because the Kybella, liposuction, which we have talked about a lot in the past, you can actually lipo the neck and do some fat reduction similar to Kybella. You know, still gotta make sure that you got a good skin envelope so that the results are gonna be good. I think liposuction versus Kybella, too different. You know, if somebody’s having a surgical procedure kinda makes sense to do the liposuction while you’re there. The benefit of the Kybella is that you’re avoiding any type of surgical procedure. If people tend to have a significantly more amount of fatty tissue, then I tend to push them to more of the liposuction. If it’s just a tiny little something, then I think Kybella is a great option. There are some people that just don’t wanna undergo surgery. And that’s super reasonable, as long as we’re on the same page about it. But Ulthera is a radiofrequency energy device. J-Plasma Renuvion, which is a device I love, is another radiofrequency energy that, again, helps with skin tightening. To the point we’ve made many times, these devices are not a replacement for neck lifts, skin excision surgeries. I know you do some of the devices in your practice, G-Berto. And I think it’s almost hard to give people realistic expectations of what we can or can’t get with some of these devices. They’re not a surgical replacement yet. The day may come, but we’re not there yet. But some of them do help.

Dr. Gilbeto: Yeah. We have CoolSculpting in our practice and Ultherapy,

Franco: Talk about those, Ulthera and Coolsculpting, because Coolscultping used to just be for the love handles, belly, but expanded a little bit.

Gilberto: Yeah. So essentially, it’s a device that freezes the fat and creates what they call lipolysis, or basically, like, destroys the fat cell through cold temperature, and then the body’s lymphatic system kinda just moves it out of the area. And so, you’re right, it used to be just for love handles or around the abdomen, but they’ve come up with these different adapters that can be used, like, for the arms or, like, under the neck and chin area. It’s pretty impressive. For being minimally invasive, you know, the results can be pretty impressive. That’s one option.

Franco: Again, still this is where you need a provider to guide you because, you know, even with CoolSculpting or these, Coolsculpting is more of a still fat reduction, Ulthera, J-Plasma, are more of a skin tightening. And sometimes people need both, sometimes people need one direction or the other.

Gilberto: Right. And again, it depends on what they’re coming in for, how they present, and such. But yeah, you’re right. And then Ulthera or Ultherapy is ultrasound that is used to help tighten up the skin. And so, again, minimally invasive. It’s a energy device that we have in the office. Has a little adapter that kind of goes over the treatment area, the ultrasound energy is sent into the tissue, and basically, similar to what we talked about with Radiesse, where it stimulates collagen, it’s doing the same thing, but in a different way. And so it’s using this ultrasound energy to essentially stimulate that collagen production, tighten up the skin, and helps kinda create a little bit more of that, again, defined jawline, that slimmer profile. And it’s a good option for someone who’s maybe not quite ready to go down a surgical option.

Fernando: And to your point, Gilberto, how painful is this since I’m worried more about the pain factor of beauty than the time factor of it? Would you say that the CoolSculpting is painful?

Gilberto: So, it’s a little uncomfortable, but I wouldn’t say it’s painful.

Fernando: Okay.

Gilberto: In relation to Travis’…

Franco: You are a word wizard, G-Berto. You are a word wizard.

Fernando: Some days. Not every day.

Franco: Well, Fernando’s like, “This is my last podcast, I am taking shots left, right.”

Gilberto: Peace out y’all. No. In relation to Travis’ guide of pain scale, I would… I’ll be honest, I haven’t personally had CoolSculpting done on myself, but what I have heard anecdotally, is that it’s probably somewhere like a three or a four. So it’s very tolerable.

Franco: And for those that haven’t, catch us up. Like Kybella, is CoolSculpting, Ulthera day procedures, go back to work same day, next day? What’s going on there? Just for people planning.

Dr. Gliberto: So most of these are done in the office. The patient can very easily go back to work the exact same day if they choose to. I would probably encourage them to plan on maybe staying home for the rest of the day, just so that they can kind of feel it out, especially if it’s their first time. After that, if they tolerated the treatment well that first time around, you know, maybe next time they feel comfortable enough, they can go back to work. Because, again, like I mentioned before, a lot of these things are done in series. It’s not just a one and done. You’re not gonna get, like, the magic outcome from just one treatment. Some of these require, you know, a series of treatments to be done. And they’re usually done about four to six weeks apart from each other.

Franco: I feel like I would have a hard time going back to work after being stung by 40 bees. Just seems like it would be difficult.

Gilberto: I feel like you’d end up in the ER if you were stung by 40 bees.

Franco: Not on a date, you know. I mean, if we’re just looking at the facts, if you’re able to go on a date that night, you probably weren’t mauled by a bear, right? Celebrity, would you disagree?

Travis: That’s why I had to pop in a little BS factor [inaudible 00:30:43.128].

Gilberto: It was starting to get [inaudible 00:30:45.385].

Travis: Had to reign in that pain rating.

Fernando: And, of course, if you’re the last patient of the day, it always works out better because you don’t have to technically go back to work.

Gilberto: Exactly. Yes, exactly.

Franco: And just to kind of round it out. Then there are surgical treatments for the neck, you know.

Travis: Sure.

Franco: And the nice thing about a lot of these other treatments you’ve talked about, there tends to be pretty minimal bruising, swelling, other stuff. So those hide pretty well. Any procedure, you can always get some bruising, something, so I never tell anybody, you know, if you got wedding pictures, if you got a big family reunion, if you got, you know, your interview for your dream job, don’t do this the day before. Don’t sabotage yourself. But in general, for normal day to day stuff, you can always say, “Oops, my Zoom camera’s not working.” People tend to do pretty well. On the flip side, neck lift, neck lipo, you are gonna get bruising, you are gonna get swelling, so just think about it. Be smart about it because you don’t wanna do this before, again, another big event because unlike, you know, a tummy tuck, body lipo, where you can wear clothes, hide it, it’s a little hard to hide your face and neck. So make sure you take that into account. People typically don’t have a lot of pain, so people tend to do pretty well with those surgical procedures. The neck lipo, much like the neck injections, tend to be [inaudible 00:31:56.190] incisions hitting right at the ear lobe or right under the chin. So you can remove that fat. The J-Plasma Renuvion is done through those same ports, to do some skin tightening underneath. If we do a neck lift, that tends to be kind of the ultimate skin removal procedure and is often done with a facelift, but not necessarily. But the neck lift itself, you know, does tend to… There’s all, sorts of, different techniques, just like tummy tuck, breast aug, but different ways, but for most of them, undermining a good portion of that skin. A lot of people do something in terms of tightening the muscles for the neck, getting rid of the platysmal bands that we’re Botoxing because a lot of times you see the edges of that muscle. And it’s basically doing the corset for the neck so that you can get that neck up and high and tight, and then redrape the skin over it because…

Travis: Almost like an abdominoplasty for your neck.

Franco: Boom.

Travis: If you refer to our last episode.

Franco: Super snatched neck, if you will.

Travis: That’s right. That’s right.

Franco: You know that may have to be our new thing because I think most surgeons would agree. And this is where some of the problem with some of the threads and other stuff. Anything that’s just based on a suture pulling… And, Celebrity, you see everybody else’s technique.

Travis: Sure.

Franco: Pretty rare that you see any of the plastic surgeons at our center just grab the skin, pull without undermining, without freeing up, without doing something, and just try and pull something tight and hold it with sutures because, in general, that doesn’t last.

Travis: Nope. You’re exactly right. Almost nobody’s doing that. You know, I think there may be a time and place for threads, but most of the guys that I work with do not advocate that practice. And they really think that if you want a big change, you need to have some surgical alteration, skin removal, muscle tightening. Something bigger needs to be done if that’s really the look that you’re going for long term.

Franco: And that’s something that, because it’s your face, you gotta plan to give yourself a little bit of time off because you wanna heal well. You want those incisions to heal well. I know I have gone over this over and over again. Neck lift, facelift, these things, smoking is a deal-breaker for me and my practice. Just because, you know, you have some skin loss or something in your face, it’s a disaster for both of us, and, again, for your own protection. Gotta be crazy about that. That’s something that studies have shown, face and neck lift, hypertension, high blood pressure, definitely puts you at a higher risk for a bleed after surgery. That’s been well documented.

Travis: Yes, yeah, absolutely. And that’s one thing, you know, with facelift patients in general, my biggest focus is blood pressure control on those patients, what do they look like preoperatively, what is their hypertension, or antihypertensive regimen look like? What meds are they on? And then those cases can be done. Most of the time we do them under general anesthesia. Completely asleep. But one thing that’s very nice about the face and the neck, it is super easy to get a great block and to get that area completely numb. I know we had Dr. [inaudible 00:34:44.762] on a couple episodes ago that was talking about some in-office procedures that you can do, as far as neck lift. Some people do their face lifts completely under local anesthesia as well. So, there can be a time and place for those as well.

Fernando: And out of curiosity, how many of these procedures can actually be done in-office, or do you actually have to go to a surgical center to get them done?

Travis: I think that varies on, you know, number one, what does the patient look like, and what are their comorbidities and whatnot. And then also, you know, look at does that surgeon want it done under local anesthetic or do they want it done under general? You should never have general in an office that’s not outfitted for general anesthesia and doesn’t have those protocols in place. If you are in an office setting that is used to doing local anesthetic cases, they still have to have all their emergency airway equipment and all that stuff, just in case.

Franco: And to the point just of this podcast right now, right? You know, you had two people, two beautiful men that had this procedure, I think there’s a couple nuggets there. One, like we’re talking about, two men that had plastic surgery, which is a topic for another day. But, you know, it’s much, much more common than it ever was before. Second, two people had the exact same procedure, and they would describe the pain discomfort completely different. And so, to your point earlier about everybody’s perception of pain is a little bit different. We’re not gonna say that one is stronger, more tough, maybe a little bit more.

Gilberto: Maybe a little more masculine.

Franco: Nope, nope, we’re not gonna say that.

Travis: We’re not gonna say that, though.

Franco: Not gonna draw any conclusions to that effect. None at all. But, you know, definitely different experiences. And so, in general, most of the non-invasive stuff that G-Berto, Austin’s most beautiful man had talked about, are able to be done in the office. I know a lot of people with Ulthera and other treatments like that in the office either do like Pro-Nox, some nitrous oxide stuff to relax people, some people do a combination of Aleve, Celebrex, maybe even, like, a Valium and some other things to help with that, which would determine whether they can go home or not. And definitely not comparing that to anesthesia, but there’s kind of a spectrum of what people can and can’t do. And then to the surgical, no question. You know, a lot of times it’s some combination of this, but depends a little bit on patient’s anxiety levels, comfort, and then the surgeon or provider in general.

Travis: You know, I know that sometimes people will have anesthesia for another procedure that they’re having. Maybe they’re having some lipo of their abdomen or whatever, and while we’re there, maybe they have around of Kybella injection under general anesthesia in certain areas or, you know, whatever facial aesthetics injection they need to have done, sometimes we just wrap it in, and the surgeon’s able to do that while the patient’s completely asleep.

Franco: G-Berto, we’re down the homestretch here. Any take-home messages, points that you’d like to leave all your fans with?

Gilberto: I think it’s just really important, like we’ve talked about so many times in the past, just to have a good, open conversation with the provider who’s gonna be performing any of these procedures, whether they’re surgical or just minimally invasive so that everyone is on the same page. I know I probably sound like a broken record saying this over and over again, but it boils down to making sure that everyone’s on the same page so that expectations are properly met.

Franco: And then, how about a little bit Behind the Bovie nugget from you.

Gilberto: Ooh, okay. Let’s see.

Franco: Not that we’re doing a Bovie when you’re doing injectables.

Gilberto: No, no. No Bovies with injectables. So Kybella, which we talked about a little bit earlier, was released or FDA approved, I should say, for treatment of submental fat, but what some people may not know, is that it’s actually being used in some other areas, too, for little stubborn spots. Like the bra strap little roll that some women may get, you know, that little trouble spot on the abdomen, where maybe you can’t necessarily get that little pooch of fat to kind of tighten up and you’re not quite ready to do lipo or anything like that. So it’s actually being used for a lot of different areas to treat some of these, like, little trouble spots, too.

Franco: I actually love it for the little banana roll underneath the butt because you gotta be careful about messing the fold of the butt up. But that’s one spot where I actually love the Kybella. So, that’s a good one. That’s a good one.

Gilberto: Yeah.

Franco: Can we get a quote of the day? Celebrity, can you take us home?

Travis: I would, but G-Berto had a couple lined up for today he was excited about.

Franco: Okay. No, good.

Travis: This is his episode. I’m letting him dominate.

Franco: I feel like G-Berto’s carrying this episode.

Travis: Absolutely.

Franco: He’s gotta balance out Fernando’s Debby Downer-ness. Thank you, Fernando.

Fernando: You’re welcome.

Gilberto: Let’s see. I’ve got a few, but this one kind of… I really like this one.

Franco: Okay, please.

Travis: It’s about bee stings.

Franco: I’m on pins and needles.

Gilberto: Are you?

Franco: Did you guys ever decide on what Fowler meant? Fowler position? Did anybody research this since our last podcast?

Travis: I didn’t. Does it have something to do with… Actually, I don’t know.

Gilberto: My best guess is maybe it’s having something to do with, like, a respiratory distress of some sort.

Franco: Treatment of appendicitis.

Gilberto: Interesting.

Travis: Really?

Franco: Yup, yup.

Travis: I didn’t know that.

Franco: So that everything falls into that posterior gutter.

Gilberto: Interesting.

Travis: Oh.

Franco: You’re welcome.

Travis: All right.

Gilberto: I like it.

Franco: Yeah, thank you. You’re welcome.

Fernando: [inaudible 00:40:11.385] knowledge every time.

Gilberto: So this is one that I shared with Travis earlier this morning and he really liked it. It’s by RuPaul.

Franco: Oh, you guys are having group meetings without me?

Travis: We are.

Gilberto: Yeah, you guys, go, go. Take it away. Take it away, Capitan.

Gilberto: You were a hard-working man this morning. You were at the hospital early in the morning.

Franco: Working hard, you know, day in and day out.

Gilberto: This one’s actually by RuPaul. It says, “The biggest obstacle I ever faced was my own limited perception of myself.”

Franco: Oh, wow. Gold star, G-Berto. I feel like this year…

Travis: Crush it.

Franco: …pandemic, everything else, you know, quarantine, that stuff, I feel like people have been their own worst critics. I think people have gotten into their own head. I think depression is real. I think something in terms of this effect of isolation has really kind of made people think the worst of themselves. I don’t think we realize how much we depend on outside comments. So, maybe to everyone listening, say something nice to somebody today.

Gilberto: Be kind to one another, guys.

Franco: Say it. Yeah.

Travis: Totally agree with that. I also think, reach out to some friends. If you haven’t talked to ’em in a little while, give ’em a call. Give ’em a cold call. “Hey, what’s up? How have you been?” And just chat with everybody, trying to make everybody feel like they’re still connected even though we are living very separate and kinda isolated lives at this point.

Franco: But you’re not saying to midnight text…

Travis: No, no, no, no

Franco: …an ex and say WYD?

Travis: No, no, no.

Franco: Okay. Just clarifying.

Travis: Especially for friend zone, like G-Berto over here.

Fernando: So no 2:00 text messages?

Franco: Nothing after 10:00 during the week, nothing after midnight on the weekends…

Fernando: Okay.

Franco: …is the standard rule. Thank you, guys.

Travis: Oh, Franco’s rules to live by.

Franco: Nope, just trying to keep things PC. You’re welcome.

Fernando: And how about 8:00 in the morning or 10:00 in the morning?

Franco: No, no. I think during the week, you can start at 6 a.m, I think on the weekends 7:30.

Fernando: Okay. Because that’s the time I got my text this morning. It was like 7:00.

Franco: Yeah, you’re welcome. Thank you.

Fernando: Yeah, thank you.

Franco: This was business.

Franco: Well, I’d like to thank everybody for listening to Fernando’s last episode on “Plastic Surgery Untold.”

Gilberto: It’s been nice having you, Fernando.

Fernando: It’s been a good run. I loved it while I was here.

Franco: Greatest podcast in the world, as voted by us. Stay tuned. More episodes to come. Please download us wherever you get your favorite podcast, iTunes, iHeart, Pandora, Spotify. So a lot of outlets. And we’re also available on YouTube, so feel free to look us up on YouTube, Austin Plastic Surgeon. Thanks, guys. We’ll see you later.

Travis: See ya.

Fernando: Have a good one.

About The Author

Dr. Johnny Franco
Episode 33: Tummy Tuck – Hot Girl Summer Coming Soon!Episode 35: Facial Feminization Surgery


Hava a question. Submit it here.


(512) 559-1376


Mon-Fri 8am – 5pm