Episode 65: Hyper Dilute (HD) Radiesse

Listen up Team, I hope you’re ready for this week’s episode! The Plastic Surgery Untold crew is about to blow your mind with another fact filled episode. This week we are talking about Hyperdilute Radiesse, also known as HD Radiesse. But you may be saying to yourself, “What is HD Radiesse? Is it any different than the Radiesse we’ve all heard of before?” The short answer is yes… and no.

At its core it is still the same Radiesse you may be familiar with, but in its hyper dilute state it is quite different. Listen as we explain what HD Radiesse actually is, discuss the differences between the two, the many added benefits and treatment options that hyper dilute Radiesse opens up. The PSU crew will cover all the new and innovative uses for Radiesse that would not be feasible in its pure form.

This episode is chock full of, as Dr Franco would say, little nuggets of great information. You will not want to miss it!


Dr. Johnny Franco:  All right team, welcome back to Plastic Surgery Untold greatest podcast in the world, as voted by us.  We had a little line change here, if you will, for those of you play hockey, boom, boom, switch it out.  So, we got our lovely ladies of Austin plastic surgeon join us today.  Not all of them, but some of them some of our key members, if you will.  But before we get to the good stuff, and we talk a little bit about hyper dilute radius, which is a – interesting hot topic for sure in the injectable world.  Let’s catch up.  Let’s see, we haven’t done podcast a long time.  Maybe ladies first, Christine, what’s going on in your world?  What’s going on?


Christine Bell:  So, I am turning 40 next weekend.


Dr. Johnny Franco:  Oh, what are you doing, the big four is here? Can we talk about this on…


Christine Bell:  We can.  I’m having a party on the river, going to…


Dr. Johnny Franco:  Oh.


Christine Bell: …going tubing and rented a boat for Sunday and I got plans on the water.


Dr. Johnny Franco:  Yeah.


Christine Bell:  Hopefully it doesn’t rain on a Memorial Day weekend?


Dr. Johnny Franco:  Yeah.  Yeah.


Christine Bell:  But yeah.


Dr. Johnny Franco:  I feel like you and I need to check our mail.


Travis Osbourne:  Yeah.


Dr. Johnny Franco:  Because I haven’t seen an invite, but it must – must – must be in there. Well, check my mail as soon as I get home.  Boom.  Boom.  Boom.


Christine Bell:  I’ll see it.


Dr. Johnny Franco:  Excited.  Use your sunscreen, be safe.


Christine Bell:  Yes, of course.  Of course.


Travis Osbourne:  Happy birthday by the way.


Christine Bell:  Thank you.  Thank you.  


Sarah Mack:  You don’t look anywhere 40.


Christine Bell:  I appreciate it.  I just had a really good peel last week.  I think I peeled all my wrinkles away.


Sarah Mack:  Yeah.


Christine Bell:  So yeah, thanks guys.


Dr. Johnny Franco:  Well, next session, we’ll have to hear about this.


Christine Bell:  Yeah, yeah.


Dr. Johnny Franco:  Yeah, yeah, yeah. 


Christine Bell:  I’ll let you know,


Dr. Johnny Franco:  Boom.  Boom.  Boom.  Sarah, what’s going on with you?


Sarah Mack:  Something new. I just went to Florida a few weeks ago.  Got to see my family and my brother has a newborn baby. So, I’m an aunt.


Dr. Johnny Franco:  Congratulations.


Travis Osbourne:  Sorry, we have to pause.  This mike is a little bit soft, so just to adjust it.  So, we’re good to start off with you, just introduced them and then go back into that.


Dr. Johnny Franco:  Okay.


Travis Osbourne:  Sorry.


Sarah Mack:  Should we get closer?


Travis Osbourne:  Yeah, I think just bring it in a little closer.


Sarah Mack:  Got it.  Hello, hello. How do I sound?  Hello.  How do I sound?


Travis Osbourne:  Much better.


Sarah Mack:  Much better.  Okay. Ready.


Travis Osbourne:  So, you can just start again with him asking.


Dr. Johnny Franco:  Okay.


Sarah Mack:  Okay.


Dr. Johnny Franco:  Nurse Sarah, what about you?  What’s been going on in your life?  Catch us up a little bit.


Sarah Mack:  So, I recently went to Florida to see my family, mom, dad and brother there and my brother had a newborn baby. So, I am now an aunt.  Miss Riley Ray is her name.


Dr. Johnny Franco:  Congratulations.


Travis Osbourne:  Congratulations.


Sarah Mack:  Thank you.


Dr. Johnny Franco:  She sounded like you’ve kicked off bikini season already.


Sarah Mack:  Yeah, I have. You’ve seen a couple posts?


Dr. Johnny Franco:  Yeah.  Yeah.


Sarah Mack:  I’ve been wrapping the Austin plastic surgeon bikini.


Dr. Johnny Franco:  We did get our new bikinis in, so, that’s exciting.  More to come.  But…


Travis Osbourne:  My Speedo hadn’t come in the mail yet.


Sarah Mack:  We need to get that.


Dr. Johnny Franco:  Well, that was – we’re saving that little thing for the end of the episode, but you know.  And anything new in the injectable world for you?


Sarah Mack:  I know we have a couple of meetings coming up with some new products potentially to look at.  So I’m excited about that.  I think there’s a longer lasting neurotoxin we’ve all been chatting about and anxiously awaiting, and maybe some more stuff for cellulite.


Dr. Johnny Franco:  Yeah.  Some exciting stuff coming up.  And then you were in San Diego as well?


Sarah Mack:  I was.  Absolutely loved.  It was great.  Got to see so many new devices.  Learn tons of trips, and sorry, trips…


Dr. Johnny Franco:  Trips and tips?


Sarah Mack:  Lalala, can we stop?


Dr. Johnny Franco:  But if you – just keep going.


Sarah Mack:  Keep going, okay, learned a bunch of new tips and tricks for Med Spa, growing the Med Spa, retaining customers, all that fun stuff, to bring our patients the best experience. So, super exciting.


Dr. Johnny Franco:  Okay, awesome.  Gi, what’s going on you?


Gilberto “G-Berto” Saenz III:  You alluded to it a couple episodes ago, but we’re getting ready to open up our second location.  So been helping get that up and ready, in terms of getting the space ready and getting it all set up with furniture, and there’s a little construction going on with the space.  So, trying to help move things along, and just really excited about that.


Dr. Johnny Franco:  Yeah, there was just some fun little tweaks.  We’re trying to do to make the office super-efficient. So, we’re homestretch.


Gilberto “G-Berto” Saenz III:  Yeah.


Dr. Johnny Franco:  I mean, we’re literally like countdown days away.


Gilberto “G-Berto” Saenz III:  Yeah.


Dr. Johnny Franco:  So, we’re so close.


Gilberto “G-Berto” Saenz III:  Yeah.


Dr. Johnny Franco:  So, close.


Gilberto “G-Berto” Saenz III:  Super excited.


Dr. Johnny Franco:  We’re not quite there yet.


Gilberto “G-Berto” Saenz III:  Yeah.


Dr. Johnny Franco:  T-VO, what about you?


Travis Osborne:  So, it’s officially boat season in Austin.  We’ve gotten to go out and wakesurf a couple of times with – with a couple of our buddies, and then we went…


Dr. Johnny Franco:  Oh, you are invited for the boat.  Must have been next to Christine’s…


Travis Osborne:  …it must be sent in the mail.


Christine Bell:  Lost in the mail. 


Travis Osborne:  That mail carrier. 


Christine Bell:  Right.


Travis Osborne:  We got to get on that guy. 


Gilberto “G-Berto” Saenz III:  We need buddies with boats.


Dr. Johnny Franco:  I know.  I know.  Interesting.  Thank you T-VO.


Travis Osborne:  So we actually just went up to Dallas two weekends ago and saw a concert with some friends, hung out.  It was nice to kind of unplug for a long weekend.  So, that was nice.


Dr. Johnny Franco:  Awesome.  Well, let’s jump into it.  Let’s have a little fun here.  Let’s talk about it.  Gi, this was your topic.  Take it away.  What’s going on.


Gilberto “G-Berto” Saenz III:  So, I thought it would be interesting to discuss hyperdilute radiesse.  I think most of our audience or at least I would like to think most of our audience may be familiar with radius as it stands, but for those that aren’t.  Radiesse is the type of filler that we have in our practice, and it’s a little different than some of the other fillers that we typically use, and that this one is a calcium-based filler. It’s called calcium hydroxy apatite, and so it works a little bit differently.  The technology is a little bit different but in in its pure form, it functions very similar to that as our HA fillers. But today we’re talking about hyperdilute radiesse, which is basically taking, taking the radius product and blending it down with either some bacteria static saline or lidocaine for patient comfort and using it in its bio stimulatory effect.  Meaning that it stimulates the body to produce more collagen, and in that sense, helps with an array of different things, but can help with skin tightening, can help with the appearance of the skin, giving it a little bit more of a natural glow, but also has filling effects like the radiesse would in its pure form.


Dr. Johnny Franco:  It’s interesting.  I mean, this is such an exciting topic that you choke Nurse Sarah Viebrock off.  Hopefully, she’s coming back, but I think she just got so excited about this topic that she choked on her own excitement. So, we hope that she’s okay.  Please send your cards and well wishes to her.  But you actually – they can’t send it to you because you actually have a new Instagram.  Is this being this correct?  What’s going on with this?  Did they see this?  Is it – Does this looks like a new Bumble or new Tinder?  What’s going on?


Sarah Mack:  No.  My new Instagram, I just did an injector pay.


Dr. Johnny Franco:  Okay.  Can you catch me up on this?  I just –  I don’t even know I found out from the ground? Boom.


Sarah Mack:  Yes. Oh, I started just storing all of my amazing before and afters on there, so that I could keep track of it.


Dr. Johnny Franco:  But can you tell people what it is, or do we have to keep guessing?


Sarah Mack:  The injector Austin is the name that I chose, which was surprisingly available.  So that’s my new IG handle.


Gilberto “G-Berto” Saenz III:  Awesome.


Dr. Johnny Franco:  Boom.  Boom.  Boom.  We’re excited about that.  Yeah – tell us a little bit more.  So hyper dilute, this is super cool and I feel like this is kind of our past episodes have alluded a little bit to this.  It’s – radiesse in and of itself is not a new product, but kind of expanding our use – our kind of understanding of the capability of the products is what is relatively new here.


Gilberto “G-Berto” Saenz III:  Yeah.  So just to kind of take it back a little bit, radiesse in its pure form has been around for quite a while.  I remember using it in my practice back in like 2006, seven, around there.


Travis Osbourne:  Gosh.  Were you not solo practicing on them.


Dr. Johnny Franco:  Before podcasts were even a thing.


Gilberto “G-Berto” Saenz III:  Yeah, before podcast even a thing.  


Dr. Johnny Franco:  That’s interesting.  Wow.


Gilberto “G-Berto” Saenz III:  And back then we used to use it to do just regular dermal filling like we do with HA fillers. So, essentially nasal labial folds or smile lines, marionette lines, which are the lines that run from the corner of the mouth down to the chin, and that’s where we were pretty much placing it at that time. As we know, things have kind of evolved and changed and the placement of this product has kind of moved around a little bit on the face, from cheeks to jawline, backs of the hands, things of that nature. But hyperdilute radiesse is a little bit more of a newer concept. So, essentially, what we’re doing is we’re like I mentioned, blending down the product and using it in areas where maybe the skin might be a little bit thinner or a little bit crapier, and we’re trying to give it a little bit more definition a little bit more structure, trying to for lack of a better word, thicken the tissue to improve the appearance of it. So, some of the areas that we’re using this hyperdilute radiesse is in the neck, as well as the chest or what we commonly call the decolletage area for some of those fine lines and wrinkles. It’s also being used quite a bit in elbows and knees for the skin that kind of thins out a little bit in those areas. It’s kind of hard to treat with other treatment modalities.  I find that this is a really, really great option for those areas, especially because their areas of motion.


Dr. Johnny Franco:  Let’s back up a little bit before we go because I want to go into each of these. You cover a ton of topics there and let’s dive into each of those a little bit more, but just so people who knew, you know, because radiesse has actually expanded a little bit because I think you alluded to it was most commonly used in the cheeks previously. Actually, just recently, it actually got its indication last summer but really kind of launched you know, from a marketing standpoint and indication for jawline, which is always been one of my favorite areas for radiesse, and I think some of the things that make it unique is it is a calcium which is different than some of the HA fillers.


Gilberto “G-Berto” Saenz III:  Yeah, that’s right.


Dr. Johnny Franco:  That maybe we can get Sarah to comment in once she comes back from her break.  Have you choking her up?  And I see what Gilbert did here, right?  You put a little something or coffee.  Sarah’s out. 


Gilberto “G-Berto” Saenz III:  I’m going to dominate this episode.


Dr. Johnny Franco:  This is…


Gilberto “G-Berto” Saenz III:  This is all mine.


Dr. Johnny Franco:  This is episode Gi you know. 


Gilberto “G-Berto” Saenz III:  Yeah.


Dr. Johnny Franco:  Gi, talking about the calcium.  It’s – but…


Gilberto “G-Berto” Saenz III:  It’s really the effect that I have on women.


Dr. Johnny Franco:  Ohh…


Sarah Mack:  Ohh.


Dr. Johnny Franco:  So many things I want to say, but I want us to be able to stay on the air. But you know, I think it is a little bit thicker, a little bit stronger, which is some of the reason that it’s an interesting product to use to restructure some of that bone to be able to lift some of that, and I think you know, and you talked about spending some time with Shinobi and talking about this biostimulatory.  And I think this is definitely a new wave of aesthetics and we’ll jump into Christine here in a second but I think trying to do some regenerative medicine that people – people love this especially in Austin where you know, we want to be natural.  We want to do some of these things is how do we improve our – most of us want to age gracefully.  We don’t want to look like somebody else.  We don’t want to look overly fake but we – you know, if you eat right, you take care yourself, you do want to get into a good spot with some of that.


Gilberto “G-Berto” Saenz III:  Maintaining your – your natural appearance but like you said doing it at your own pace.


Dr. Johnny Franco:  Let’s jump into because one of the areas that I love this and I think it’s so exciting for us the decolletage if you will the neck area.  Maybe you and Christine can kind of talk about how do you know what’s a good spot for because some of it is laser which we’re gonna get into in another spot.  Some of its may be a, you know, skin treatments whether we’re talking about if RF microneedling, maybe it’s talking about being on a good moisturizer, but at some point, there’s only so much topical stuff you can do and then you transition over to filling and kind of softening these.  Because I think this is a hidden area that we all look at the face, other stuff, but this decolletage is the giveaway.  Decolletage and hands are the two giveaways of people really.


Gilberto “G-Berto” Saenz III:  Yeah.


Sarah Mack:  Sure.  Yeah.


Gilberto “G-Berto” Saenz III:  Because you can – you can certainly have someone who’s been lifted and had a facelift and neck lift and, you know, they don’t look their age, but you know, they – their – their neck and decolletage area can age them if you have a discerning eye, you can take a look, and see that in patient with a perfect facelift and they look like they’re, you know, 38 years old, and then you see their neck and I’m like, “Wait a second, are you are you 60 something?”


Dr. Johnny Franco:  Or they go to shake your hands.  You know, and that looks really aged. And so, maybe – can we start with maybe the least invasive and then to see…


Gilberto “G-Berto” Saenz III:  Sure.


Dr. Johnny Franco:  …That way we know like who would be a good candidate for the hybrid because I think that’s sometimes hard for patients. So, when somebody comes in with concerns of neck, decolletage area, how would you start like the most mild, like what – what are some treatments and then when do you refer them to nurse Sarah, Gilbert for maybe some hyper dilute treatment, and then we can get into the treatment itself?


Sarah Mack:  Yeah.  I think like y’all were saying the neck and decolletage and the hands are the most neglected area where…


Dr. Johnny Franco:  Don’t judge me for not saying that right but I’m doing my best.


Sarah Mack:  Decolletage.  But I think people forget to put sunscreen there.  They forget to bring their products down in that area. So, a lot of people like you guys are saying age on the chest and the hands in their face stays youthful.  So, something I like to ask my patients “What bothers you?”  And they come in for the console so I can kind of get on their page about, is it spots, is it wrinkles, is it laxity?  So since we’ve had the Morpheus in the office, that seems to be, you know, the heavy…


Dr. Johnny Franco:  To those who don’t know Morpheus is?


Sarah Mack:   Radiofrequency with micro needling.


Dr. Johnny Franco:  Okay.


Sarah Mack:   So, super effective for all of these issues, skin laxity, texture, tone, and then we also have blue mecca for the spot.  So, I love doing combo treatments for that.  I think, you know looking at the patient’s age, like you said skin laxity, crapiness, you know, if it’s, you know, we can do three treatments with Morpheus to try to help with that but if there’s just so much laxity that they need volume, Morpheus say it’s not going to give you volume.  So maybe a couple of treatments Morpheus and then attack it with some filler.  That’s kind of new to me.  The filler and the decolletage, this – I think this past week was the first time I had kind of heard of that treatment. So, it’s underutilized treatment, and I know we’ve talked about it and I think sometimes we get so fixated on the face and other stuff we forget about this other area.  So, help me understand a little bit because Gilbert and Sarah, you guys maybe jump in here and help me but because if somebody just one, I think they should be on a good moisturizer no matter what.  I think they should be on a good sunscreen no matter what.  We agree there?


Gilberto “G-Berto” Saenz III:  Yes.


Sarah Mack:  Yes.  Absolutely.


Dr. Johnny Franco:  Unanimous.  Okay.  And so, once we get past that, then it’s deciding whether the spot or whether it’s the kind of texture.  So, tell me that hybrid dilute is going to treat specifically what?  Some of the skin laxity?  Yes or no.


Gilberto “G-Berto” Saenz III:  So it might help a little bit in the sense that it’s going to stimulate collagen and that collagen is going to help support the tissue.  I can’t tell you that it’s going to lift the skin.  It’s not going to – it’s not going to like give you like a – like a lifting effect so to speak but it will help with the appearance of the skin laxity to some degree.


Dr. Johnny Franco:  Because it also fills in that skin, so it is going to help with the appearance, right?  Because some of those wrinkles, some of the crapiness is going to get stressed Just a little bit, right?


Travis Osbourne:  Right.  And like I mentioned earlier, so it’s blended in or blended down with either a bacteriostatic saline or some lidocaine. So, you’re gonna have a little bit of expansion from all that fluid. But as the fluid gets absorbed by the body, then the calcium hydroxyapatite, the radiesse product itself starts to do its work. So, it starts stimulating that collagen production, which in turn over time is going to give you more of that long lasting smoothness to the to the decolletage area to the neck area. But it is kind of like this, you get benefits in the short-term and the long-term because of that, because of the way it works.  What would you say is like a timeframe that patients can expect that…


Dr. Johnny Franco:  Ooh.  Good question.


Travis Osbourne:  …you know, for that neck and, and chest and upper chest area.


Gilberto “G-Berto” Saenz III:  …So you know, the recommendation…


Travis Osbourne:  Notice, I had to say upper chest, décolletage, decolletage.


Sarah Mack:  Yeah, you did.


Gilberto “G-Berto” Saenz III:  They’re interchangeable so.


Travis Osbourne:  Okay.  Perfect.


Gilberto “G-Berto” Saenz III:  So currently, the recommendation that I have for my patients is doing these treatments in series.  So, usually doing a series of like two to three treatments separated by about four to six weeks apart from each other.  And then after that, you can expect to have these results last anywhere from, you know, 15 to 24-ish months.  You know, it can last up to two years in the right conditions, if you take care of your skin, use your sunscreen, things like that, right?  But as far as like seeing the results in the short-term, like I said, I think you’re going to see some benefit in in almost the immediate short-term because of that expansion of the tissue from all the fluid that is used in this blended product.  So…


Dr. Johnny Franco:  So, Sarah, would you say that this is almost like an area that needs like a two-pronged approach? Because it sounds like you’re treating both sides of the skin?  Is that fair to say?


Sarah Mack:  Yeah, that’s actually exactly the point I was gonna make.  You read my mind.  I think it’s super important.  I’m glad we have Christine down the office because her and I pass a lot of people back and forth, right?  It’s not necessarily filler and toxin only, we have to take care of the skin too. So, I think some sort of resurfacing, peeling, things like that, in combination with the dilute radiesse is a great combination to it to take care of the skin, and then give it some support and volume back.


Christine Bell:  Yeah.  And we have specific products for the neck and decolletage, and even for the hands.  I mean, some filler on the hands with some Blue Mecca to get rid of the sunspots.  And then, you know, good hydrating moisturizing sunscreen for the hands really changes – I mean, you can tell night and day just doing that, you know, over the course of a couple of weeks will change the way someone’s hands’ look.


Sarah Mack:  So yeah, I think it’s really important to educate the patients, you know, because I think in the world of aesthetics, a lot of people know neurotoxin and filler, they don’t know what else is out there.


Gilberto “G-Berto” Saenz III:  For sure.


Sarah Mack:  And so, when you refer them, you know, to both of us, and she can do the skincare side, I can do the filler and toxin side, and then we can send you home with some maintenance products.


Christine Bell:  Yes.


Sarah Mack:  People’s results are so much better over long-term. Would you agree?


Dr. Johnny Franco:  Yeah.


Sarah Mack:  Yeah.


Dr. Johnny Franco:  And this is what the benefit of having such a diverse team and trying to add members that have different specialties is, you know, I feel like if a hammer is all you have, that’s all people get.  And I feel like, you know, the nice thing about having so many different people so many different, you know, we’ll call them toys, you guys can call them medical devices in the office is that we can really give people what they need, and not just what we have.  And so, I think that’s super exciting.  Do you do – Sarah and Gilbert, do you want to walk us through what the actual process is if somebody comes in for like a hyper dilute treatment of this area?  And then we’ll kind of walk through some of the other areas because there’s – you touched on a bunch, and there’s a few more that they – that are a little interesting, too, that I hope we’ll get to.


Gilberto “G-Berto” Saenz III:  Yeah, I had some others in mind but you cut me off. 


Dr. Johnny Franco:  Okay.  Yeah, well, I don’t want to give people everything at once, because then they’ll turn us off because they’re like “I’ve heard everything,” and then what do we do for the next 30 minutes?


Gilberto “G-Berto” Saenz III:  Okay, that’s cool.


Dr. Johnny Franco:  Which one of you wants to talk a little bit about what the actual treatment would be like?


Sarah Mack:  Yeah, so for the neck and décolletage, we actually – there’s multiple ways to do lots of fillers, right?  You can do them just, you know, primarily in the neck area with cannulas what I’ve been taught.  I’m guessing you feel the same way. So, we’ll do little pilot holes, usually three on each side of the neck, and then we just go in with the cannula after we’ve diluted down the radiesse and we fan that area in, massage it for a few minutes afterwards. And that’s it.  It’s pretty painless, pretty seamless. Um, there’s just a little bit of pressure noted as we move around with the cannula, but people tend to tolerate it really, really well.


Dr. Johnny Franco:  But so, for the most part, it would be similar to any other injectable that they would come in, get some numbing cream probably in the office at most for an hour or so unless they’re doing other treatments…


Sarah Mack:  Yeah.


Dr. Johnny Franco:  …at the same time.  Maybe some bruising that you would expect because it sounds like you are covering an area that most likely, especially with 100 degrees would be unlikely to be covered with clothes.


Sarah Mack:  Yes, definitely bruising.  You know those patients that are specifically worried about it, some people just bruise worse than others.  We can start them on like Arnica tablets a few days before their procedure.  You know we have them avoid any NSAIDs ibuprofen, fish oil, things like that, alcohol before the procedure, and then we also recommend Arnica gel topically afterwards.


Dr. Johnny Franco:  And then just for people’s planning before we jump into the other areas, it sounds like there’s some immediate benefit but if you’re really trying to look good in this area for something long-term, this is maybe something that you’ll need multiple treatments and really need to look at as a long-term treatment that’s going to help you over the long term, right.  So you get some quick and some long?


Gilberto “G-Berto” Saenz III:  Correct, and that was one of the points I wanted to allude to,


Dr. Johnny Franco:  Yeah.


Gilberto “G-Berto” Saenz III:  Is that there is that short term, you know, almost instant gratification from the – like the actual feeling effect, right?


Dr. Johnny Franco:  Yeah.  


Gilberto “G-Berto” Saenz III:  But then there’s also that long-term, slower onset, delayed onset kind of benefit from all that collagen production.  So, you know, if you’re looking at, you know, the long term and trying to, you know, figure out, “Well, how long is it going to take for me to get to the final product?”  You know, you probably want to plan if you know, these sessions about a month apart from each other.  And like I said, I recommend about two to three treatments, you know, in series.  And so you’re looking at, you know, a process, right?  But, you know, if you’re – if you’re, let’s say, you know, planning for an event that’s coming up in a matter of a few weeks, you’re still going to have some of that – some of that, you know, nice smoothing effect from the immediate impact that the filler has on the tissue. So, you know, it’s, again, the short-term and the long-term that you got to look at.


Dr. Johnny Franco:  One last question before we jump into the other areas.  If I’m trying to decide on like the order of treatments, should – I think we can all agree moisturizer and sunscreen should be number one, should get started, there’s no reason not to start that today.  Agree.


Gilberto “G-Berto” Saenz III:  Right.  Agree.


Sarah Mack:  Yes.


Dr. Johnny Franco:  But after that, I guess is this where you guys would help guide me is what I do first and filler, the hyperdilute radiesse versus like the little Meca laser versus Morpheus with the RF microneedling?  How do I decide which is the best course of action?  Is this person dependent?  Is there a set order no matter what?  How do I know?


Gilberto “G-Berto” Saenz III:  I think is person-dependent.


Dr. Johnny Franco:  Okay.


Sarah Mack:  Agree.


Christine Bell:  Yeah.


Gilberto “G-Berto” Saenz III:  I know you guys want to jump in on that.


Sarah Mack: I think it’s person-dependent for sure. Um, speaking of the neck, like a lot of people, you know, we have our older clients with thinner skin, they just want full on rejuvenation.  I’ve had a couple girls I’ve treated recently that are in their mid-30s, that just kind of went – are starting to notice these neckless lines, and they want to only get rid of those.  So, I think it’s totally tailored per patient.


Gilberto “G-Berto” Saenz III:  Yeah.


Dr. Johnny Franco:  And I guess depends on what bothers them the most is where you would start.


Christine Bell:  That’s what I was gonna say.  I always ask them what bothers them, because what I see may not bother them at all, you know.  So, it may not be the spots, or it may only be the spots and not the lines, you know.  So, I think that’s important finding out what they want to fix.  Their timeline is super…


Dr. Johnny Franco:  I want everything fixed.


Christine Bell:  …right. Morpheus.  Yeah.  Yeah.


Gilberto “G-Berto” Saenz III:  One thing I always tell my patients are the analogy I like to use is like, “Look, you’re the pilot, I’m the navigator, you ultimately decide what we do.  I’m just going to guide you along the way.”  And so, I can make these – these recommendations, these – these suggestions as far as what we should do, but ultimately, it’s your decision as to what you want to do and in what order.


Dr. Johnny Franco:  I don’t want to let T-VO to be the pilot.


Travis Osbourne:  You are the facial rejuvenation Sherpa.  They see what you are man.


Dr. Johnny Franco:  He just keeps tracking into that.


Travis Osbourne:  I do all the heavy lifting. They throw all the stuff on your back and you just start climbing.


Dr. Johnny Franco:  Well, I know I could show up earlier because I wanted to dive into this because I think it’s just such a – underutilized treatment area that that’s such a telltale sign but now that we’ve – I feel like have a good foothold of that.  What are some other areas that this hyperdiluted radiesse is used very commonly from either of you, maybe one each.


Sarah Mack:  I like the hands.  I think we’ve seen really, really good results there, and that’s a place that’s totally neglected.  I feel like when they come to the med spa, they’re talking face, face, face and then you see these little sweet ladies with their little wrinkly hands and we can do quite a bit with one syringe per side.  I feel like they get a really good result without needing like 10 treatments.


Dr. Johnny Franco:  And this is one of the things I do like about radiesse is you get a little bit more product for the thing, and I know it’s only an extra half cc but when you think of most syringes or a cc you know, you’re getting you know actually you know a lot more product. And so, goes a little bit further, so I think that’s – that’s kind of a nice little nugget but I definitely feel hands are underutilized and definitely a telltale sign of people’s age, especially most of us are age or older we grew up.  We got our first good sunburns, we did this, we didn’t do full body sunscreen and things back in the day.  I mean I did it.  I got my first sunburn and that was it, you know.


Sarah Mack:  No, all of my patients like my age and older, we all talk and laugh about like the betadine with baby oil and…


Dr. Johnny Franco:  Why do you go that far?


Sarah Mack:  We did in reflective light, right?  To try and get as dark as you possibly can who needed the sunscreen and now, we’re all paying for it.


Dr. Johnny Franco:  Gilbert, any more nuggets about the hands before we jump into some other ones?  I like this.  One person picks an area.  The other person tells us how we treat it.  I like this.


Gilberto “G-Berto” Saenz III:  So, you want me to explain the treatment?


Dr. Johnny Franco:  Oh sure. Seems like a great plan.  Okay, thank you Gilbert.


Gilberto “G-Berto” Saenz III:  So, hands I don’t necessarily dilute or blend down the radiesse.  I think – I think just pure product is perfectly acceptable.


Dr. Johnny Franco:  Okay.


Gilberto “G-Berto” Saenz III:  …with the hands.  So, that’s going to be more of a traditional like injectable treatment that most patients are familiar with.  And in all honesty, the procedure for the patient from their perspective doesn’t really change much at all.  It’s all on the back end, we’re actually doing, you know, the chemistry behind it all and blending down the product with either of these documents like lidocaine or the bacteriostatic saline, but to the patient is all going to be the same.  In terms of the actual treatment, there’s a couple of points in the hand that are, I guess preferred, trying to avoid obviously any like blood vessels, but trying to get in between, like the joint spaces, and then using either like a cannula like Sarah mentioned, or just a long needle, making a little in insertion point, and then just kind of getting under the skin, but over the fascia. And as long as you’re in that plane, you’re pretty good as far as avoiding any blood vessels and minimizing your risk for bruising because that is one of the things that can happen when you’re using filler in the hands.  If you hit a vessel, it’s gonna bruise pretty good.  It’ll go away, but it’s gonna take a couple of weeks, a week and a half.


Dr. Johnny Franco:  This is one of the things I love about the art of – of medicine, you know, is an add on, like Sarah likes to do some of the hyper dilute for the hands, sounds like you don’t like to dilute it at all.  I actually like to be somewhere in the middle and I wouldn’t say it’s – we’re using some of these terms. So, there’s like dilute, hyper dilute, and that just depends on somewhat that does is it changes the viscosity, how we move stuff, and I’m in the middle.  I do like to soften it up a little bit because I feel like I can smooth it out. But it’s super interesting that here’s three different ways to do it by three different providers and everybody gets a great result and it sort of goes in the context of how we’re doing this.  So, I think that’s what’s super, super cool about this, and why it’s nice to because I’ve learned different things because we obviously don’t necessarily treat patients together all the time. Occasionally, we have mutual patients and we get to do some fun stuff together but not as often as I think we would all love.


Gilberto “G-Berto” Saenz III:  Yeah.


Dr. Johnny Franco:  And then even on top of that, I think hands are still another area where you can treat some sunspots.  You can treat some other little veins, some other things that are more of a superficial treatment.


Christine Bell:  Absolutely. The Lumecca is great for the sunspots.  It also stimulates a little bit of collagen every time you do it.  So anti-aging for that.  You’re going to have some coffee grounds, a little speckling happens for a week or two but those just flake right off, and I love that combination, the filler with the with the Lumecca, and I think you could do them maybe a few weeks apart.  I don’t think they would…


Gilberto “G-Berto” Saenz III:  I think two weeks apart is acceptable.


Sarah Mack:  Yeah.


Dr. Johnny Franco:  We’re talking about – about – about radiesse for the hands but there’s also some other products that you can use in the hands and we won’t – do you guys each one to name one other that you like in the hands if there is?  If not, we’ll – we’ll keep moving.


Gilberto “G-Berto” Saenz III:  Like HA fillers?


Dr. Johnny Franco:  Anything you like.


Gilberto “G-Berto” Saenz III:  Yeah.


Dr. Johnny Franco:  What do you like?  What else besides radiesse? Or is that the only one you like?


Gilberto “G-Berto” Saenz III:  No.  No.  Galderma lyft is really good for the hands.


Dr. Johnny Franco:  Okay.


Gilberto “G-Berto” Saenz III:  And it’s indicated for that area too. So, that’s another really great product.


Dr. Johnny Franco:  Sarah, any other?


Sarah Mack:  I agree with him, lyft.


Dr. Johnny Franco:  Okay.  Is Voluma, that one, okay?


Gilberto “G-Berto” Saenz III:  I’ve never done it in the hands.  So be honest.  You know, it could be used.  No reason why it couldn’t.


Dr. Johnny Franco:  I have used some of Voluma stuff and I’ve done the same where I’ve diluted it out a little bit, just so it’s not so thick.  In that way, a little bit of smooth, but there’s a lot and there’s some other newer product stuff.  And so again, you know, it can be tailored to each person.  Some of it just depends on, you know, the provider specific, and there’s pros and cons like we’ve talked about for each of these.  I think it’s super cool. Gilbert, what other areas do you like too hyper dilute?


Gilberto “G-Berto” Saenz III:  For the BBL King, where else.


Dr. Johnny Franco:  Yeah.


Gilberto “G-Berto” Saenz III:  The booty.


Dr. Johnny Franco:  Yeah, we definitely do a treatment called a tweak treatment.  You know, so this is an area where we’ve – we’ve put a decent amount of filler. So, number one, I want to be super clear with people like when we do a tweak treatment, we named it tweak treatment, because that’s what it is.  It’s a small tweak.  It’s not a replacement for a BBL, it’s not going to give you the same look as a BBL. Typically, like us for people who have some small, little dead, some little spots they want to tweak, i.e., the tweak treatment, and then the idea between this hyper-dilute is that it gives us some volume, spreads over this area.  I like it because people know what they’re getting.  I also like sculpture, which was probably the first one that got proper eyes for using for body filling and stimulating you know, in the buttock and stuff like that.  With sculpture, I’ve had people that are absolutely phenomenal responders and people who haven’t responded quite as great. You know, it’s it was a little hard when people are spending a significant amount of resources and a little bit of unpredictability.  And so, I feel like with the radiesse, the nice thing in the hyper-dilute is that you know that you’re at least getting some minimum volume, even if they’re not a great responder to the stimulatory properties.


Gilberto “G-Berto” Saenz III:  Yeah.  Yeah.  I agree.


Dr. Johnny Franco:  Sarah – Gilbert, any thoughts on you guys have heard the butt, hips stuff?  I know you guys do that procedure as well.  Experienced thoughts about that?


Gilberto “G-Berto” Saenz III:  So more recently, some experience with not necessarily full-on tweak treatments like you do in the office, but doing small little pocketed areas where maybe a patient who was treated with our cellulite reducing product quo didn’t have the ultimate result that they were looking for and have still small little indentations going back in and kind of filling those indentations out with some of this hyper-dilute radiesse has been really, really good.  So, you know, I think that – that’s worked out really, really well.


Dr. Johnny Franco:  I think we’re going to do more of that.  Because I think the idea that you have this dead for 50 years, and just because you release a band that is going to magically, like come all the way to the surface and be perfectly smooth, just even from a – a, you know, physiologic standpoint seems flawed.


Gilberto “G-Berto” Saenz III:  Yeah.  Yeah.  But I’ve had some really great results with that.  And so, that’s – that’s really exciting.  I’m looking at looking forward to doing some more of that.  What are your thoughts on…


Dr. Johnny Franco:  Just because I don’t want to, I think this is such a cool thing, and I’ve seen some nice results are really good.  I mean, do you see a path forward where, you know, maybe we start packaging some of this stuff like the quo and filler, especially these people who have really deep because I mean, like for us, we want people to be super happy.  We want to be realistic.  We also want to figure out a clear path forward for them of what it’s going to take to get them to that endpoint.


Gilberto “G-Berto” Saenz III:  No, no, no doubt.  I think that it’s, it’s something that you can certainly – most certainly get amazing results with quo alone. But it would be – it would behoove us to at least discuss with the patient that there may be a possibility that we have to combine it with some radiesse in the future.


Dr. Johnny Franco:  And I think that’s one of the things is we’ve played with quo and some of the new side achievements is who’s a better candidate for releasing bands, who need some filling, and I think there’s a large portion that need both.


Gilberto “G-Berto” Saenz III:  Yeah.  Yeah.  I agree.


Dr. Johnny Franco:  I cut you off, continue.


Gilberto “G-Berto” Saenz III:  Oh, no.  So still staying on the topic of the “but” but what are – what are your thoughts on, you know, these – I see these like liquid BBLS with – with radiesse?  You know, I understand that, you know, it’s not going to be anywhere near the same as like actually having a true BBL from the BBL king, but what are your thoughts on it?  And just in general, like, do you feel like there’s a place for it?  Do you feel like…


Dr. Johnny Franco:  I think there is a place for it.  I think that you got to be very, very, very clear with patients of what’s achievable. Because if you think about it, even with these tweak treatments, and even if we’re doing something like, you know, 15, 20 syringes, if you think about that, that’s still, you know, 30, 40 ccs of product, right?  Depending on how well we’re doing.  Compared to a BBL, there’s 1,000 ccs of product, i.e., your fat. And so, you know, being super clear about what – what you can get from this, because in the end, we want to help you achieve your goals.  We want you to be super happy.  And so, we want to make sure that we’re being super clear about what we’re going to be able to achieve with this.  And in my experience, I think people were trying to look for an overall huge volume change, tend to be disappointed.  I think people that have very discreet stuff that they want to enhance for the buck tend to do very, very well.  And I think you guys see that in your facial fillers, right?  Someone says, “Oh, I just don’t like the way my overall face looks.”  You guys will push them and be like, “Okay, like, I get that one, you’re not as bad as you think you are, you actually look pretty good.” But two, like, pick one or two things specifically.  And that’s what I’ll say about the buttons that really bother us so we can focus on those because then it becomes hard.


Gilberto “G-Berto” Saenz III:  Yeah.  Not to mention the fact that, you know, with a true BBL surgery, those results are going to be much more long lasting than, you know, any product that you inject into the butt.


Dr. Johnny Franco:  And just a public service announcement here.  Be very, very careful what you put in your butt.  Okay.  because I know some of these products can be expensive when you start doing a lot of them but the expense of getting some illegal substance or some substance that you don’t even know in your butt, you know, when you’re talking about your health, your life, those type of things is much more expensive than any BBL product stuff.  So, you know, I don’t wanna go on tangent, just be careful know what you’re getting injected.  Know who’s injected, you know.


Gilberto “G-Berto” Saenz III:  Yeah.  Know your injector for sure.


Christine Bell:  Yeah.


Sarah Mack: A really great patient, just kind of speaking of the cellulite treatment, as well as the radiesse that I found that I’ve seen a lot of is with doing the quo. People kind of confused cellulite with laxity, right?  So, I’ve had a few like little maybe like 30- to 40-year-old ladies come in and they just have a few dimples. They’re worried about what they’re complaining of like kind of along the outer side of the butt some laxity, and they think the quo can treat that but really, they just need volume. So, I think that would be like a perfect person for you know, 10s or hundreds of radiesse. So, just treat that laxity on the outside and then use the quo for the center of the butt. 


Dr. Johnny Franco:  I like that just, almost being laxity is also one that worries me a little bit.  Remember, unfortunately, time keeps marching on.  We’re going to make it better, but we’re not going to stop the aging process. I think there’s some things that will help work with you.  I always tell people that I’m not casting stones in my glass house here but you know, yow, yow, dieting and going up and down doesn’t help the situation. So, there’s things that if you’re going to make this investment, make sure that we’re doing a good job to take care of that investment for as long as it can last. What other areas?  Because I mean, we could talk about butt stuff all day. But the essence of time, what are some others because you named a few other ones that I think are super cool, and – and


Gilberto “G-Berto” Saenz III:  Yeah.


Dr. Johnny Franco:  Maybe a little hidden nuggets for hyper dilute treatments.


Gilberto “G-Berto” Saenz III:  So, I mentioned elbows and knees.


Dr. Johnny Franco:  Ooh, yeah.  Can we talk about that.


Gilberto “G-Berto” Saenz III:  Yeah, I think that’s an area that sometimes either gets overlooked, or you know, the patients just aren’t aware that there are options for them.  And I think that as we mature, as we get older, you know, just time and gravity play its role on our body, and we start to see some skin laxity and sagginess in these areas, in particular, and then the fact that there are areas of motion doesn’t necessarily help the situation, but we can restore some of that, you know, fullness and some of that, you know, skin turgor by doing treatments with hybridoma radius.


Dr. Johnny Franco:  I love this, because those are areas that surgically, I don’t really have a lot of great options to offer people.  Travis, you see a lot of plastic surgeons, but that’s probably not an area you see very many treatments of just because crossing joints is something that most of us try to avoid.


Travis Osbourne:  Yep, leave that for the orthopods.


Gilberto “G-Berto” Saenz III:  Scarring isn’t great.


Travis Osbourne:  Yeah.


Dr. Johnny Franco:  The scar is not great.  We worry about contractures and limiting range of motion.  And even with that, I mean, you made it – the point, it’s the range of motion. So, if we take out too much scan or do something, you know, we can have the – do consequence of limiting some of that, which can be hard to recover from.


Gilberto “G-Berto” Saenz III:  Yeah.  Yeah.


Dr. Johnny Franco:  And they’re not areas that we can hide scars, all that well, for.


Travis Osbourne:  Yeah.


Gilberto “G-Berto” Saenz III:  Right.


Sarah Mack:  There are areas we can treat with Morpheus and body firm. Yeah.


Dr. Johnny Franco:  Let’s talk a little bit about that because I do think there are areas that gotta get it again.


Sarah Mack:  Yeah.


Dr. Johnny Franco:  I know being — home, but the biggest vain for your butt, getting on a good moisturizer.  And then let’s talk about – you’re talking about a little RF microneedling possibly?


Christine Bell:  Yeah.  Yeah, for the skin laxity of on the knees and the elbows, it’s really big, and then pairing it with body firm, which has peptides and skin firming, antioxidants and things in it that using that at home for your maintenance treatment, of course, and then getting some filler after that.  I mean, again, combo treatments, you know, we’re addressing all the issues. So…


Sarah Mack:  I feel you get to ask that a lot.  I’ve been with you for a while now, and I feel like every time people say, “What can I do about this,” you get asked about knees all the time.


Dr. Johnny Franco:  We do people ask us about lipo, but I’m like, “You already have loose skin, and then if we turn around, and we’ll try and live or do this, you’re gonna have more loose skin, you know.  And honestly, a really hard area even for us to do Renuvion or some of these things that, you know, we’re trying to put a cannula down the leg and stuff.  And I was getting a little nervous about that, because I want to make sure you’re coming out better than you went in.  And so, sometimes when we mess with these areas, it’s a slippery slope.  So.


Sarah Mack:  Yeah.  It’s great to just resurface everything.


Dr. Johnny Franco:  And realistically, like for the people listening, like how many, because we talked about that you need a few more syringes than then you would think, like, realistically to treat like, a single knee, a single elbow or the neck area, how many syringes of product does a typical person need?  I know, it varies but a lot of product – a little product as little go along ways, where are we at with that?


Gilberto “G-Berto” Saenz III:  So as far as I know, what I – you know, discuss with colleagues and staff, you know, it basically boils down to like one syringe per site.  And then it just depends on how much you – you diluted or how much you blend it down, like how much extra volume you’re using.  Because certain areas are going to require more volume to diluted – dilute the radiesse than other areas. So, for example, and I’m just throwing numbers arbitrarily off the top of my head, but let’s say, you know, for your neck and decolletage area, you do, you know, one syringe of a radiesse, but you have to dilute it like, you know, two or three times.  That’s going to be, you know, four and a half to six ccs of product.  Something like the – the elbows and the knees may be one – one syringe of a radiesse, but maybe only one diluted just one time. So, then they’re getting like three ccs of product.  And it just depends on the area that you’re – that you’re treating. But most of most of the documentation research, you know, that’s out there, you know, pretty much states one syringe per, per extremity, really, and it’s just a matter of how much you blend it down.


Dr. Johnny Franco:  Any – any other areas or topics of hyper diluted, we’re running short on time that you guys would like to talk about – bring up before you summarize some stuff.


Gilberto “G-Berto” Saenz III:  I’ve heard the abdomen being – being treated with hyper dilute radius.  I’ve never done it but I’ve – I’ve heard of the pers – people that are really, really like slim that maybe have some skin laxity that are like, like ultra-marathoners or something, you know.


Dr. Johnny Franco:  I’ve done some of that hyper dilute Sculptra, even a product called renouveau, which is a process fat.  So, I’ve done it for two things on the, belly one, sometimes right around the belly button.  They may not be a tummy tuck candidate, but they got a little bit at loose skin after pregnancy or sometimes other things just to see a fill that up a little bit.  I definitely think this is in that category where you need more product than you think, and once is just probably not going to be enough.  Also, to not that this ever happens, but you know, sometimes people have a little bit of unevenness from lipo.  And so, even if done a little bit, just to try and smooth some of that out a little bit, and I think it helps break up. Because sometimes it’s – it’s the skin scars down to the underlying structure.  So sometimes trying to free that up, add some buffer to let this kind of rehydrate nice and smooth has been helpful.  So, those are the two things in the abdomen where it’s been helpful for me.


Gilberto “G-Berto” Saenz III:  And everyone’s different just to kind of piggyback on what I was saying about number of syringes, like just because, you know, most people need one doesn’t necessarily mean everybody’s going to require one.


Dr. Johnny Franco:  Correct.


Gilberto “G-Berto” Saenz III:  So, you know, I think it’s just – it’s patient-dependent.


Dr. Johnny Franco:  And sort of like – like you guys do with facial fillers, right?  The more mature you are, probably the little bit more product you’re gonna need, and depending on where you’re at with stuff and you may not get all the way there the first day.


Gilberto “G-Berto” Saenz III:  Right.  And if you pair it with like a Morpheus microneedling with radiofrequency, you may not need, you know, as much product. Because you’re – you’re inducing collagen from the surface by creating that controlled trauma and sending in that energy, where maybe that you know, helps kind of tighten up the skin a little bit.  And then if you come back and treat with hyper dilute radiesse underneath the surface of skin, you may not require as much.  So, it’s all dependent.


Dr. Johnny Franco:  So, any other hyper dilute radiesse or just radiesse in general, comments you might have?


Sarah Mack:  I do think that sometimes BBL patients don’t keep as much but I know we briefly mentioned like the tweak treatment, but I feel like we do those a lot of times for people that just want more results. But sometimes that doesn’t take in certain areas just by their own body makeup.  You know, you do as best you can during a BBL.  Sometimes they have just little spots that they want tweak that’s not worth taking them to surgery.  And so, I think I’ve seen – we’ve done two or three syringes in one area, just to round something out a little bit more and they’re super happy.


Dr. Johnny Franco:  Yeah, I do think it definitely I can – and we can play with it and we – you know, hyper dilute is one specific but sometimes we can play with that, you know, depending on where we want to go and do and those type of things.


Sarah Mack:  It’s a great difference.


Dr. Johnny Franco:  Christy, tell us about the two-prom.


Christine Bell:  Well, let’s go – well, I just wanted to share my personal experience.  Two things, Sarah recently injected me with radiesse and that was my first time, getting it in my cheeks and a little in my chin, and it feels different.


Dr. Johnny Franco:  Your chin is a good one.


Christine Bell:  Yeah, it makes such a difference in my profile.  And then I’m used to having you know, Juvederm products in my face. So, this one feel different.  It feels like it’s staying in place really well.  I don’t know if this is a thing but sometimes, I feel like tingling in my cheeks and I like to think that’s the collagen stimulating and awakening stuff up.  I’ll just be sitting there like single feeling but um, I also in the past, a DERM I worked with had my ear lobes injected with filler.  I don’t know if that’s a common thing but I’ve worn heavy earrings all my life in high school and everything and I had saw my grandma’s earlobes at one point in my life and kind of freaked out because they were – they were very droopy, and I’m like, “Oh no, is that going to happen?  And so, I’ve had filler put in there and it made a difference.  “It kind of – yes, like made it filler and I could wear my heavy earrings and they weren’t, you know, so just kind of an odd experience that I had that people like you said may not think of that area, but…


Dr. Johnny Franco:  Even helping earrings stay in a better place because sometimes when they get the openings get loose and the skin gets soft, they kind of turn in weird ways, and so, kind of like gets it just love to.


Christine Bell:  I actually have one that hung lower than the other which I probably had all my life but they – yeah even that out with the filler too.


Dr. Johnny Franco:  The – we’ll come back to it and it was funny because offline we had talked about – talking about, you know, how people know which way to go between jawline filler Chin filler, chin implant lipo you know renewing on if the next steps are made for a future episode, we’ll talk about that because I do think they’re super powerful, but I think sometimes people don’t know which treatment is best and maybe we can help outline that for people. So, we’ll put that on our list.  Future conversation for us for sure.  Anything else summarize, hyper dilute, anything that you guys would like to talk before we jump into a little behind the Bovie segment.


Gilberto “G-Berto” Saenz III:  The only thing I would say is as far as like – like, because I don’t think we really talked about, you know, any kind of like anesthesia where Travis would normally jump in.


Dr. Johnny Franco:  I’m trying to minimize this time. 


Gilberto “G-Berto” Saenz III:  No screen time for us.  Glad to be here.


Travis Osbourne:  But like – like any other filler, it’s mostly just local topical, you know, anesthetic.  We have products in our office that we offer our patients but for most patients I don’t think that’s necessary with this product.


Dr. Johnny Franco:  And you know, Travis, you correct me if I’m wrong, but typically like extremities like arms, knees, stuff are gonna be less sensitive than like a face or so.


Travis Osbourne:  Yeah.  Yeah, definitely.  And speaking of, I’ve recent experience, I came in and Nurse Sarah injected me with some Dysport, and I mean, it’s really not a – it’s not an unpleasant experience at all.  You feel a couple little pokes when – when you’re first getting the needle introduced. But you know, it’s a very, very small needle gauge.  It’s a – it’s a fresh needle, so it’s not dull and you guys use the same types of needles when you’re doing these fillers, outside of when you’re using a cannula.  But, you know, everybody here is awesome as far as an injector goes.  So, it’s – you get what – you get what you pay for.


Sarah Mack:  Yeah, I think that’s a good point too.  I change out needles a lot.  I’m sure you do.  Every couple, you know, areas that we’re treating will change the needle often that makes it a lot more comfortable.


Travis Osbourne:  Absolutely.


Dr. Johnny Franco:  What’s a little behind the Bovee nugget that you guys would like to share with our listeners?


Travis Osbourne:  I got one.


Dr. Johnny Franco:  Yeah, please?


Travis Osbourne:  No.


Dr. Johnny Franco:  Okay.


Sarah Mack:  I have one. Can I say mine first?


Dr. Johnny Franco:  Okay.


Sarah Mack:  So, one point that I think is important to make about radiesse is that it is not dissolved with Hylenex. So, certain areas that we place it, we just like to really inform the patient like, “Hey, you know, if this is something you’re on the fence about, we just need to talk a little bit more about it.” It’s not like a regular HA that we can go in and dissolve, you know, a week later if they’re not happy with it. So…


Gilberto “G-Berto” Saenz III:  That’s what I was gonna say is that, on the horizon, is a product that actually combines the main ingredient in radiesse which is this calcium hydroxyapatite. With HA, and it’s going to be a combination filler of both HA and CA.


Dr. Johnny Franco:  That’s gonna be exciting.


Gilberto “G-Berto” Saenz III:  That’d be really exciting to see, you know, because you’ll be getting, at least in my mind that, you know, my theory is you’ll be getting the – in the immediate feeling effects of the HA, with the delayed, you know, stimulatory effect of – of the collage – Collagen production. Yeah, it’s cool.


Dr. Johnny Franco:  It’s amazing how many things are out there and in the horizon.


Gilberto “G-Berto” Saenz III:  Yeah.


Dr. Johnny Franco:  Should we do a little quote of the day?


Sarah Mack:  Hmm.


Travis Osbourne:  Yeah.


Dr. Johnny Franco:  I actually came up with one.


Dr. Johnny Franco:  Oh, it’s a quote by you.


Sarah Mack:  Like you created.


Travis Osbourne:  Quote by me.  I actually posted the other day on – on Instagram, past couple weeks with work had been crazy and going kind of 1,000 miles an hour, and I realized that I needed to, like, slow things down and go back to a place of control and what I can control, which is only my mindset and my reaction to things.  So…


Dr. Johnny Franco:  Can we fact check this two afterwards to make sure that this is really not…


Sarah Mack:  I saw this on Instagram.


Dr. Johnny Franco:  Oh, you know, what it is.


Sarah Mack:  I liked it.  Yeah.


Travis Osbourne:  Three little things.  Focus.  These are like new focus points for me.  So, solutions over problems, opportunities over setbacks and gratitude over frustration.  I think if we’re focusing on seeing solutions, rather than seeing what the problems are or identifying problems, it’s going to put us in a better mindset and make it so that we can approach things with a, “Hey, let’s make a positive change,” within that’s, you know, applicable to patients too.  “Hey, instead of, Oh, I’ve got this turkey neck going on.  Oh, I’ve got this skin I don’t like”, “Okay, well, what are some solutions that I think those fillers do a great with, you know, the dilute filler, like we just talked about and everything.” Those are solutions to that issue.  Opportunities over setbacks.  So, you know, for us, it’s – it’s seeing setbacks as opportunities to improve things.  Opportunities to get better in those areas. And then on gratitude, over frustration.  It’s easy to get frustrated, but then you’ve got to realize, right now you’re being frustrated by something that 10 years ago, you were dreaming about. So, just having that perspective and seeing that, “Hey, I’m – I’m lucky to be frustrated by the current things that are going on my life,” like that is you got to – we just got to be happy about where we’re at and where we’re going.


Dr. Johnny Franco:  I feel lucky to have you as my life partner.


Travis Osbourne:  Oh, wouldn’t have chosen anybody else.


Dr. Johnny Franco:  I actually went on your Instagram when, you know, Mary tried to claim that, you know, you were hurt to her.  She was your shining light.  I said no, I’m his shining light.  So, her and I are nonspeaking terms right now.  I think that’s an incredible quote for everything going on in the world and the craziness over the last two or three years.  I think it’s easy to get caught in the “Woe is me.” Freight train for sure, and so, you know, as hard as things have been I think a lot of people have had some – some great success.  So, try not to not to forget about those things.


Travis Osbourne:  There’s always something to be grateful for.


Sarah Mack:  Absolutely.


Dr. Johnny Franco:  Gi, you want to summarize, take us home, close us out for the day. 


Gilberto “G-Berto” Saenz III:  Yeah. So, in summary, you know, this – this product has been around for quite a while, but we are finding new ways to utilize it, and I think the – the horizon or I should – let me rephrase that.  I think the future is bright in terms of, you know, aesthetic medicine and.


Dr. Johnny Franco:  Way to take Travis’s quote.  Thank you.


Gilberto “G-Berto” Saenz III:  And I’m really looking forward to seeing what – what else comes around.  I mean, I think there’s just you know, there’s just so much opportunities, not setbacks in – in – in aesthetic medicine.


Dr. Johnny Franco:  We’ll close this out.


Gilberto “G-Berto” Saenz III:  I’ll do that.  Thank you all for joining us on Plastic Surgery Untold, the greatest podcast in the world as voted by us.  Stay tuned for our next episode where we’ll be talking a little bit about Lumecca, which you may have heard about a little bit on this episode. We’ll dive into it a little bit deeper in the next episodes, so stay tuned, and we’ll see you then.


Travis Osbourne:  Boom.  Boom.  Boom.