Episode 71: Scar Management- What can I do?

After the nervous anticipation of what the surgical results are going to look like, what is the next most important thing that most patients think and worry about? That’s right! Their scars! Current research has shown us that attacking surgical scars early in recovery actually provides the best results with regard to the appearance of those scars. Historically we believed we needed to wait for 3, 4, or even 6 months before we could do anything to address post-surgical scars. Now we know that by hitting the scars with specific, scientifically researched treatments such as Radio Frequency Microneedling, Microneedling, and Intense Pulsed Light, we can see greater results in the appearance of the scar as well as faster recovery. Listen to the incredible team of providers from Austin Plastic Surgeon as they discuss these findings and what exactly it takes to get those scars looking “oh so fine!”

Dr. Johnny Franco: All right, welcome team back to Plastic Surgery Untold, the greatest podcast in the world, as voted by us. We’re actually continuing our Med spa/post-surgical care routine here on this episode, so before we get too much into our first episode of the day, let’s meet our celebrity crew here. We’ll go around the room with everybody’s favorite nurse Sarah one of the Sarahs, we got half the Sarah’s here today with us. (Chuckles) Go ahead, Sarah catch us up, what’s going on?

Sarah Viebrock: That’s right, guys. Well, it’s been a busy weekend, we’re actually trying to sell our house, which if you’ve ever sold a house with young kids, you know, that is like…

Dr. Johnny Franco: You’re like Travis, you’re trying to put a plug to sell your own house on our podcast. (Chuckles) We need to charge Sarah like a marketing fee, but continue.

Sarah Viebrock: …Yeah, if anybody is looking for a home in Dripping Springs, but no, also, you know, my…

Dr. Johnny Franco: Please check on the link for her home address. (Chuckles)

Sarah Viebrock: No, no, no. But yeah, a busy weekend celebrating my five-year-old’s birthday party, a little bowling, little arcade games so…

Dr. Johnny Franco: Oh, that sounds fun.

Sarah Viebrock: Yes, it was fun for the adults, the kids, busy weekend, but yeah, good — happy to be here.

Dr. Johnny Franco: Yay! Andrea what’s going down in San Antonio? She’s joining us remotely, if you will.

Andrea Benavides: Yeah, so…

Dr. Johnny Franco: We did ensure that she’s wearing pants we made a requirement for zoom. (Chuckles)

Andrea Benavides: Yeah, sorry. I take gifts if you want to see. (Chuckles) No, I’m kidding. I — nothing much, I’m moving myself too in two weeks so I’m just kind of slowly gathering some boxes up and, you know, that way I can be prepared, but yeah, everything’s good. We had our grand opening, the gala, so that was really fun to experience, I haven’t really done events like that so it was very cool to be a part of.

Dr. Johnny Franco: Yay! Christine, what’s going on?

Christine Bell: It’s been a busy two weeks. I just moved from an apartment to a house…

Dr. Johnny Franco: Everybody’s moving what’s going on, I feel left out right now.

Sarah Viebrock: Yeah, wow.

Christine Bell: Needs some changes in my life. (Chuckles)

Dr. Johnny Franco: Okay.

Christine Bell: But yeah, school started for the kids the same week I was moving, I was super stressed out and the gala, the opening house, so yeah, I feel like this week we can breathe a little. And work’s going great. October is going to be a year since I’ve been here and I wanted to…

Dr. Johnny Franco: Wow!

Christine Bell: …thank you Dr. Franco…

Dr. Johnny Franco: Yay!

Christine Bell: …it’s amazing.

Sarah Viebrock: Yay!

Christine Bell: I love the team, I love working here, it’ one of the best jobs I’ve ever had so I’m looking forward to the following year to come.

Dr. Johnny Franco: Awesome! Well, let’s jump into a little bit today, we’re talking about scar management because I think this is one of the biggest roadblocks in terms of people having procedures done, especially when we start talking about breast lifts, tummy tucks, facelifts, neck lifts those type of things. And then I think some people may be wondering, you know, why are most of our surgeons not here so no question our surgeons do the absolute best they can in terms of fancy sutures on the inside, some glue on the outside, but I think people don’t realize how many things you can do after the surgery to make those incisions as good as possible.

And so, you know, I really like to just start kind of going down and maybe we can kind of go in a time order in terms of from like right after the surgery, kind of over the course of a year because people don’t realize those scars get better for a year but the more you can be on it from the beginning, the better you are. It’s really, really hard to go back later and try and treat these if you just didn’t do anything for the first six to nine months. Go ahead. Yes, nurse.

Sarah Viebrock: I was going to say no I couldn’t agree more with that study that you sent us that showed if you start treatment early, and we’ll get into the different treatment options, that you actually have collagen induction therapy, there is that right? So, you know, while the scar is healing, it helps to stimulate collagen, and I know you, you know, Christine, you could probably tell us more about this, but it sounded super cool to me. So, you know, I think we’re hesitant. I know when I had my tummy tuck scar, we started treating it with IPL, we’ll get into that in a little bit, and I was hesitant because it was still fresh so you kind of are afraid to touch it, you know, but it actually really helped, it help to get the redness out quickly so I couldn’t agree more, let’s start early around six-ish weeks would you agree?

Dr. Johnny Franco: Yeah. But before we get into the actual treatments, let me, let me just touch base on a couple of things because there are the things we can’t control in terms of people’s genetics and some of those and then also some of the things we do in surgery to get you to a good spot and then I’ll let our incredible Med Spa team take over and kind of walk you through the scar management journey and all the cool things that we have and things that we really try and partner with you to do to get the best result possible.

So, number one, you know, what we do in surgery? So, I think a lot of it has to do with tension so really trying to create things that are going to heal well, not making things overly tight, you hear us talk about this all the time. Everybody wants to be super tight, super snatch, but there is a limit so that people heal really, really well. I think some of the new sutures out there really help a lot too in terms of dissolving but not being reactive to the skin to not create more scar tissue than we need.

One of the things that people tend to forget or they see on our Instagram and they think that like we use this special Dermabond or glue and that that’s the only thing holding the incisions together, it’s not, there’s usually three or four layers, because surgically if we can take all the tension off the skin so that’s why you see us a lot of times put a lot of sutures and maybe I need to do a better job showing you guys really doing some deep stuff so that the final layers should just be kissing the edges together.

The glue that you see us put on Instagram and Snapchat, TikTok, wherever you watch us we appreciate it, it just really is a dressing because it’s been shown that if you can stop some of that micro movement, right? Our body is made to heal, to survive, it’s not made necessarily to look good, so if it sees any movement, any breaks or holes in the dam it’s going to try and put scar tissue to plug that hole.

So, this is why, you know, we tell people to be cautious about overdoing it, you know, being too active because if you’re pulling a lot of force on that incision right away, your body is going to think, oh, this isn’t strong enough I need to make more scar tissue thus those breaks. There becomes a very open window in terms of collagen remodeling, and this is where some of our timing and thought process about scars has changed and we’re going to jump into that of why we’re microneedling at a certain time, because if you think about it right? Scar tissue starts to peak at six weeks, so this is the time to hit it and do it well, but if you go too early you can definitely put a lot of strain on that, widen scars, have problems with wound healing and, you know, wound that doesn’t heal well is not going to have scars that we love.

So maybe we can jump into some of the basic stuff and easiest things in terms of silicone treatments. Does somebody want to talk about the silicone sheets, creams and even the silicone balls that I’ve loved for tummy tucks, because that’s been a game changer for us?

Sarah Viebrock: Yeah, yeah, I can jump on that. You know, if you didn’t know Dr. Franco did a tummy tuck for me back in January, which thank you very much, love it.

Dr. Johnny Franco: Yay! Hot girl summer.

Sarah Viebrock: That’s right, that’s right. Hot girl rest of my life but (Chuckles) so…

Christine Bell: I’m next.

Dr. Johnny Franco: You’re welcome, Dusty. (Chuckles)

Sarah Viebrock: That’s right, shout out to the hubby. But we love the silicone products, we have a couple of different brands that we offer in the office, but I found for a longer scar, you know, when we’re talking tummy tuck, breast lift and the silicone strips work really, really well, but the most important thing is that you wear it all the time. So if you’re using a silicone strip and we highly recommend, you know, getting one of the brands that we recommend so, you know, it’s medical grade silicone, something reliable, but wear it all day. So, you put it on, you know, after you take a shower, wear it all day, next day when you’re going to shower, take it off, rinse it in the water, let it dry, so about 23 hours a day you got to keep it on.

If you don’t want to do the strips or if you have smaller scars, they definitely have silicone cream or gel, which is also another great option but you gotta do it twice a day every day or it’s not going to work, right? So, if you just kind of do it spot therapy, not going to make a huge difference, but definitely, those are one of the most basic ways you can keep the scar soft, help it to heal nice and smooth, and start to lighten.

Dr. Johnny Franco: And we kind of start with that because we’re kind of working down in terms of a time, so we had the surgery, we have the glue, the glue typically peels off at about two to three weeks, everybody’s a little bit different, that’s when you want to get started on the silicone sheeting or cream. And like Sarah pointed out, you know, got to do it all the time, if you’re doing it sporadically, it’s kind of like workouts, it’s not going to help, so got to be super consistent.

We have people that do it, you know, once a week and they’re like I don’t think it’s benefiting me so nope it’s not. (Chuckles)

Sarah Viebrock: Kind of a waste your money at that point.

Dr. Johnny Franco: And, you know, we do have some products in the office that we love, honestly, we like them because they’re a good balance of a good quality product for a good price. There’s definitely some other silicone-stripped materials out there some of them are very, very, very expensive. And so, you know, definitely welcome to do those things but we’re trying to help you find — we know overall it’s — these aren’t a cheap endeavor and so trying to find you something that’s quality that works really well but it’s also super reasonable in terms of budget and lifestyle and those type of things, because all ultimately being able to work together is going to get you good result.

Can we talk a little bit about the belly button silicone ball, because this has been one of my favorite finds over the last like year.

Sarah Viebrock: Absolutely! And I, I wish I think we found it like a couple of months or a month or so after my tummy tuck, I can’t remember, but I actually wish I would have gotten it sooner but I’m, you know, my belly button turned out great. But (Chuckles) it’s a little silicone sphere, I think we actually did a video demonstrating it that you can find on our Instagram. But essentially, it’s going to help to shape — keep the belly button’s shape, helps to treat the scar of the belly button. You literally pop it right in the belly button and it comes with a little — I tried to wear it without the tape it’s going to fall out guys. (Chuckles) But you use the little tape that comes in the package to try to keep it on there, keep it in place but, you know, helps with healing so it doesn’t scar down. Would you agree Dr. Franco?

Dr. Johnny Franco: Oh, yeah.

Sarah Viebrock: Just kind of helps to keep it open, and again, you know, the little — if y’all seen Dr. Franco, he does like these tiny little sutures around the belly button very impressive but helps to treat that scar line around the belly button as well.

Dr. Johnny Franco: And the cool thing about this is when it helps keep that nice shape of the belly button so it doesn’t shrink down to that pressure of the ball because some of the pressure with the silicone is what’s been shown to help.

And then, you know, three, we worry so much about the belly button because besides probably a couple of special loved ones, very few people are going to see you completely naked, but the belly button, we want to get you into one of our fancy two-piece bikinis and so this is an area that a lot of people are going to see, and so being really aggressive with the belly button because I feel like a bad belly button is the telltale sign of a tummy tuck. And so, if you watch our Instagram, the belly button is what we start and end with because I think it’s super, super important, so getting it’s set right from the beginning, saving it at the end, making sure it all comes together just perfectly.

And so, if this is the focal point of your tummy tuck, why not go the extra mile and take care of it.

Sarah Viebrock: Yeah, I couldn’t agree more.

Dr. Johnny Franco: Any other comments on the silicone treatments that you guys have? I think being consistent is the number one most important thing. How do you guys feel, because I know we get a lot of people – oh, go ahead.

Sarah Viebrock: I was going to say one more thing on that though, is wait until you get the clearance from your doctor, your nurse because we did have some people that started the strips too early, so definitely wait like he said for the glue to be totally gone, you want to make sure that incision is totally closed. But once you get the all-clear go ahead and get started, but don’t jump-start it like a week and after surgery, please.

Dr. Johnny Franco: And the issue really just if you start too early when you have the glue on there is if you’re doing the sheets, it’s just a waste of money, with the glue seal in it it’s not really going anywhere and so just, you know, it doesn’t help that much in terms of some of this.

Sarah Viebrock: Yeah.

Dr. Johnny Franco: Can we jump into — so that’s step one, that one’s super easy that’s a really, really cheap treatment thing so there’s no reason for somebody not to do one of these.

But let’s jump into step two, so this has gotten us where we’ve started it at the second week of after surgery, so now we’re at about a month to six weeks after surgery, we can start looking at other things. Obviously, you got to get the clearance from your surgeon that you’re in a good spot but a friend of mine recently published an article talking about microneedling with scars, and this is where some of this whole modern approach to scar management has really transitioned. We talked about at six weeks is when scars really hit their peak and so this is the time to attack them.

And so can we talk a little bit — number one for listeners that maybe aren’t all-the-time listeners, shame on you guys, but if you just joined us we still welcome you. You know, can we number one talk about microneedling so they know what we’re talking about, and the difference between like a SkinPen like a microneedling with and without radio frequency energy? And then we’ll get into the different scars and what we do and the different types of RF microneedling? I know it’s a lot (Chuckles) but we got two fabulous estheticians to help walk us through that.

Christine Bell: Yeah. I wanted to just jump in and I know Andrea has worked with dermatologists before, but we’ve seen a lot of different scars not just acne scars, we’ve seen surgery scars and for a long time, you know, at least in my world 10 years ago all we had was microdermabrasion and peels, SkinPen wasn’t a thing so — and those treatments weren’t always consistent, you’re kind of crossing your fingers hoping you smooth it out or something like that. So microneedling SkinPen has kind of changed…

Dr. Johnny Franco: And that’s a great point that these treatments aren’t new to the world like microdermabrasion, they just weren’t in a process that was super-efficient that was super reliable. The technology has basically taken these concepts that have been around for decades but made them in a more manageable, more consistent, more user-friendly, more patient-friendly application system.

Christine Bell: Yes, and hopefully we come up with the first and best protocol for scars (Chuckles) because it’s a struggle, it really is. SkinPen has been great for acne scars and I’ve definitely I’ve seen it work on, you know, some keloid scars, some hypertrophic scars and — where were we going with that — SkinPen and the difference between…

Sarah Viebrock: Yeah, with and without radio frequency.

Christine Bell: Yes, so with SkinPen, were essentially creating a wound to the skin, right? And then the healing process, new elastin and new collagen is being formed. We can brighten the scar too, depending on what we use while it’s healing.

And then with the Morpheus8 and the Vivace, this is microneedling but the depth is a little deeper, it’s a stamping motion versus a dragging motion, and when we’re stamping that microneedling into the skin we’re delivering heat which is radio frequency and that helps to tighten the skin and also create more collagen and elastin.

So, I think if the scars are on the body, we may need to go a little deeper and use a little more aggressively than the SkinPen. But the SkinPen’s been amazing, for even just small little lipo scars on the back, you know, sometimes we can get away with just SkinPen with that, you know.

Dr. Johnny Franco: And I think that that’s super interesting because, you know, to some people, you may think why are we doing, you know, creating injuries when I’m trying to recover for an injury, right? So, you add the bigger traumatic injury of the surgery, and so now what you’re trying to do is get that really thick scar tissue the form because we were trying to plug this huge hole in the dam and now trying to get it to be a much less or something so it remodels in a softer area in a softer way so that it heals. You’re trying to stimulate some of the collagen because not all collagen is created equal, there’s different types and there’s different thickness so I think this is super, super cool.

Can we go into a little bit Vivace, Morpheus, what is RF microneedling Andrea and tell us a little bit about the unique stuff of Vivace that you guys have in San Antonio?

Andrea Benavides: Yeah. So, I really love it, I love the concept of, you know, I can do it pretty quickly. I know we have different options to make the patient comfortable, but what I really love about adding, you know, microneedling with radio frequency is if someone wants a little bit of extra tightening, you know, when — if they have that scar say for example on their abdomen and they just want a little bit of extra tightening in the abdomen area that’s something that we can also utilize as well. So not only that it’s for the scar, but they want some extra tightening on their abdomen, you know, that radio frequency energy can help tighten some — maybe a little bit of loose skin or, you know, creating extra firmness in that area.

Sarah Viebrock: Yeah, good combo.

Dr. Johnny Franco: And I love the Vivace and I think this is one of the spots where because it’s actually known as the most comfortable RF microneedling device on the market. And while you may still be a little bit numb which is also a great reason to do this at about six weeks because most people are still a little numb at their scar, I also think something like this that’s super comfortable that doesn’t — because here’s an area where you’re trying to get right into the depth of the scar, not necessarily different depths and stuff so I think, you know, it’s a great, great, great treatment for that. And it’s funny because there’s so many modalities out there but we can really tailor it, and sort of like Christine was alluding to like an inframammary fold breast augmentation, microneedling with the SkinPen is going to be perfect, you know.

If we’re talking about around the facelift, around the ear, some of those things, SkinPens most likely going to be your treatment unless we’re trying to do some adjuncts to some neck tightening or something else, depending on what specific treatment you had. But, you know, if we’re looking at a tummy tuck, thigh lift, or brachioplasty, I think the combination of an RF microneedling is the best of both worlds in an area where you can really make some improvement.

Andrea Benavides: Yeah, yeah, and really like to add to the SkinPen, you know, we’re talking about remodeling, you know, the scar, you know, because I think it goes through four different phases from what I’ve read, but in that remodeling phase that’s when all that collagen, you know, is being, you know, put down.

And so in my mind, you know, six weeks post-op I feel like, you know, it’s a better option to start treating versus a year because the whole concept of, you know, microneedling, as we discussed is to stimulate collagen, you know, CIT, collagen induction therapy so –

Dr. Johnny Franco: Oh, that’s fancy. (Chuckles)

Andrea Benavides: …in a year, you know, when treating so late, I feel like those fibroblasts that make up of that collagen are kind of asleep and say you wake them up essentially with the treatment, and so you’re probably looking at maybe six to eight treatments versus the three treatments right away, you know, at six weeks.

So I think that’s also like important, you know, when you’re speaking to your patient about, you know, treating at six weeks versus six months to a year because, you know, waking up that collagen can be a little bit more, you know, leading to more treatments as to three.

Sarah Viebrock: That’s a good point.

Dr. Johnny Franco: And I think this is interesting because people are asking what is this treatment. So we’re starting at six weeks and then I think she’s alluded to it that we’ll do three treatments four weeks apart and so — and Christine can jump more into it. But kind of this treatment, obviously you want to make sure you get the clearance from your specific surgeon, provider that everything’s on track, everybody’s a little bit different, some people heal a little faster, some people need a little bit more TLC, either way, we’re going to work with you and make sure you get to a good spot.

The nice thing is about our team is they all communicate so, you know, if you don’t know whether you’re cleared or ready for it, your provider will take care of it and find out for you and then that way we can make sure, you know, they’ll help guide you which is a better treatment in terms of the SkinPen, the Vivace, the Morpheus and so you don’t have to do any of that leg work, we’ll help you with it, and that’s some of these holistic total body transformation that we’re trying to do for people.

Tell them a little bit — do you mind walking them through like how a true like SkinPen microneedling, Morpheus treatment like actually goes, like what would they expect during that treatment?

Christine Bell: Yeah. So, I think – oh, how the treatment will go?

Dr. Johnny Franco: Yeah.

Christine Bell: I think determining the type of scar and where it is is super important. The color of the scar, whether it’s red or brown or, you know, doesn’t have any pigment to it –

Dr. Johnny Franco: And we’re going to get into that in just a minute.

Christine Bell: Yes, yes. And then that helps determine which device we’re going to use. So yes, we have lots of tools in our toolbox like Dr. Franco says, and SkinPen — SkinPen so we numb, you know, I like to numb my patients for 20, 30 minutes, we have really good numbing cream so I think an hour is kind of overkill, but 30 minutes is usually good.

The Pro-Nox is laughing gas that makes our patients super comfortable, they kind of forget what’s going on for a moment so the SkinPen can be done in — I mean it’s fairly quick, would you say like 30 minutes Andrea? For, you know, facial scars, most scars, I think we could do the entire treatment in an hour. I like to put cold gauze just to kind of calm the skin down and, you know, we try to make it as soothing as we can. I’ve, you know, we’ve both been doing SkinPen for a long time, we’ve never had anybody get up in the middle of the treatment and want to stop, (Chuckles) so it’s comfortable.

Dr. Johnny Franco: And it’s going to be even more comfortable right after surgery like this because anyone who’s had her tummy tuck knows that your tummy still tends to be pretty numb during this initial period and that’s another benefit of jumping on this right away, but I think Christine’s point is that the experience is actually pretty seamless. You come in, you get evaluated, there’s already a treatment plan in place, get your numbing, get — figure out where we’re going, exactly which device we’re doing and then let you sit for a little bit so you can get into your happy zone –

Christine Bell: And Zen out.

Dr. Johnny Franco: — and then the treatment itself depending on the size of the scar incision, you know, takes anywhere from 15 to 30 minutes depending on the specific area and length.

Christine Bell: Yeah, it’s quick. And then we’re trying to come up with, you know, packages and products to give the patient to take care of the scar at home whether it’s the silicone scar treatments or, you know, me and — Andrea and I just went to a training with a skincare line that we carry that has some really great ingredients for dark scars, so we’re excited to try that out. And then, you know, if we’ve got to throw an IPL treatment in there in between the SkinPens or wait after the three treatments and you’ve got a little pigment, I know we were kind of experimenting on CeraVe’s tummy tuck scar and it looks a little lighter, right?

Sarah Viebrock: Mm-hm, even after just one.

Christine Bell: We just did one treatment so – yeah. And what you can expect with that we — we don’t numb for IPL, you feel a little rubber band snap, a little heat but it’s super quick, and then usually immediately or within 24 hours, the dark pigment should get darker. It’s one of those treatments that’s going to look worse before it gets better, so a little bit of flaking over the few days and then that pigment just kind of comes off and it looks lighter.

Dr. Johnny Franco: Let’s back up so we don’t confuse people. So separate treatment from microneedling is Lumeca or an IPL, and so that treats what?

Christine Bell: Pigments, reds and drowns, vascular and — yeah pigment.

Dr. Johnny Franco: And red is for anyone who’s had a surgery, are super, super common, facelift, tummy tucks, mastopexy and all that stuff.

And this is interesting because some of the natural history is everybody has some of those reds, those go away over time in most people, especially in our face, especially some of these areas. Most of us don’t want to wait a year, a year and a half for these to go away, so there’s a little bit of ways to kind of cheat and get it moving in the right direction a little faster.

Christine Bell: And so, IPL is just another device that we have if we need to use that, that would work perfect. And IPL — Andrea doesn’t that stimulates collagen as well, right? A little bit of anti-aging with that so…

Andrea Benavides: Yeah, yeah, the heat from the treatment does help stimulate some collagen.

Dr. Johnny Franco: And talk to us a little bit about when would people typically do that? So obviously you got to be cleared from your surgeon that you’re in a good spot, you know, when would somebody normally start treating some of the reds if they want to get this out as soon as possible?

Christine Bell: Andrea? (Chuckles) You want to take that one? If we’re doing SkinPen treatments, I don’t know if we want to complete the SkinPen treatments and then maybe do some IPL so we know what’s working.

Dr. Johnny Franco: That’s what I would do is, I think you want to — it’s always the fine balance of being overly aggressive with the skin at one time, you want to give stuff a chance to heal. I think some of it depends too, a little bit on what bothers people the most, I think sometimes, you know, the color like if in a perfect world if it’s on the face and we’re just worried about the reds because they stand out, I think I probably would jump to a Lumeca, IPL right away just because it’s going to be a little less noticeable.

If we’re talking about like a brachioplasty, a tummy tuck, a mastopexy where we’re just trying to do the best we can in terms of a long-term management, I would jump right into the microneedling because I think there is a window that makes the biggest difference for people. And once that’s done, then we can get rid of the colors and also honestly, you know, you shouldn’t be showing off your tummy tuck scar in the first six weeks because you shouldn’t be at the pool, (Chuckles) you should be giving this a chance to heal.

Andrea Benavides: Yes. I would say, four weeks apart, typically between laser and microneedling, pretty much anything anesthetics four weeks apart.

Dr. Johnny Franco: And what about downtime recovery? So, if I came in and I got, you know, microneedling for my calf implants, what — would I have to take a week off? What happens, what’s my recovery from there?

Christine Bell: I usually tell people you’re red like a sunburn for 24 hours so the skin is going to look angry, it’s going to be warm, you know, how you take care of it at home is super important and we usually give the patients instructions how to do that, but a week I think is, is — I don’t think that’s necessary. The skin may get dry and you might have to moisturize a couple times, but I mean I know if it’s in an area showing, yeah, redness maybe the little prick marks for a week, maybe.

Dr. Johnny Franco: But Andrea, but can I go to dinner that night? Can I go back out? Can I go back to work? What about those type of things, because that’s what’s important to most of our people.

Andrea Benavides: Yes, I — you can go eat, you can go to work I just wouldn’t work out that day of, go swimming –

Andrea Benavides: Oh, you’re messing up my routine. (Chuckles)

Andrea Benavides: Sorry. But yeah, so no vigorous activity just for about 24 hours, but if you want to go to like shopping right after you totally can.

Sarah Viebrock: Overall really minimal downtime treatments. But one thing that you do have to be careful of is sun exposure, you don’t want to reverse what we just did, right? So we’ll tell you to be crazy about SPF with any scar, whether you’re treating it or not, if you sunburn it it’s going to look worse, right? I know Christine hammers that into our head all the time.

Christine Bell: Yes. And one of the silicone products that we have has an SPF 30 in it.

Sarah Viebrock: Yep, yep. Absolutely.

Dr. Johnny Franco: And that’s why we helped tailor you to which treatment because there’s things on the face that sometimes the creams with the sunscreen are a little bit more practical than trying to put some strips on. I think for like a mastopexy, tummy tuck, thighs lift, you know, the strips just tend to be a little bit more practical in terms of a cost because the cream only goes so far, so I think there’s different ways and we’ll help walk you through that.

Andrea, thoughts?

Andrea Benavides: Yeah, you know, just protect your investment, I mean you spent a lot of money already on your body, and if you’re looking to spend money on your scars, you know, it’s really important that you take at home care, you know, to protect it because, you know, you can only — we could only do so much and, you know, you know as a patient you want to protect that and make sure you have like, you know, the best treatment possible.

Dr. Johnny Franco: And I think that goes for all of it, right? because the moisturizer, the massaging, those type of things, there’s so many things to make your overall results so much better. And we always talk about, you wouldn’t buy a new car and not get an oil change, it just doesn’t make sense, and you’re going to, you know, not really value that over a long period of time. Because everything that we do turns the clock back, reverses stuff, but it doesn’t stop the aging process, you know, really kind of how long your results last is depending on how we work together whether it’s managing your scars, whether it’s taking care of your skin — not yo-yo dieting which I’m not casting stones because I go up and down like a roller coaster ride, but it’s definitely something that you want to take care of.

What about if you – because we’re running out of time here, what about a few things like you hear a lot of people talk about vitamin E, Mederma, other stuff? I worry that there’s a lot of expensive stuff out there and I just don’t know how well some of them work. I have some thoughts, but I want to see if you guys had some thoughts on some of these things.

Andrea Benavides: Um, for me it’s really, you know, I was reading up on some ingredients last night, you know, with different scar products like, especially over the counter, and obviously, I don’t know them to the T, but there’s a lot, and silage, when I was looking last night it literally just says silicone. So, I think, you know, doing your research on some products and trying to avoid any type of irritation or a possible allergic reaction that you may not know of, I’d rather go with a product that has literally one ingredient than go with another product that has like five or six.

Dr. Johnny Franco: I love the allergy thing because we see this all the time, I feel like people get stuff, and it’s harder than you think if you don’t buy a medical-grade product to get something that doesn’t have a ton of ingredients other, fragrances, fufu stuff, and the skin all bets are off after a procedure it’s so sensitive, and we see so many rashes and stuff from people who got something that’s well-intentioned but just really irritated the skin, and now in terms of trying to — on top of trying to heal you’ve got a rash all over and so it can be super frustrating and challenging, so no question being super careful what you purchase.

Sarah Viebrock: I would say overall, just like rely on your providers, we’re going to try to guide you the best we can, you know. We even give you different — there’s different price range options, you know, we don’t say you have to buy the most expensive one, but definitely, we’ll try to guide you as best you can. If your scars are bothering you we’re going to give you a whole treatment plan to try to get rid of them as fast as we can, but definitely, I would say, if you can, I would rely on whatever your esthetician, nurse, or surgeon is recommending.

Dr. Johnny Franco: Perfect.

Christine Bell: Yeah, I agree. Most of the products we have are – yeah, no fragrance, no Parabens, they’re very medical grade, they’re clean. You know, I came from Aveda, so I’m all about plant medicine and holistic. I love aloe, I know that’s crazy to hear from, you know, somebody who loves medical grade stuff, but aloe and vitamin E, I don’t think there’s anything wrong with those, those go way back, I mean, they’re good for healing, they provide a little bit of moisture and aloe is just a great healing plant, but yes, we have products, we’re again doing some experimenting and testing with this — you want to say the word the transition acid, I can’t say it.

Andrea Benavides: Oh, yes, I had literally – yeah, so I’ve been saying it wrong but tranexamic acid. So that — it’s really not only great, you know, for suppressing melanocytes within scar, but it’s actually really great for melasma, but we already talked about that in the last podcast. (Chuckles)

Sarah Viebrock: So, if you missed it, go back.

Christine Bell: So yeah, we’re constantly trying to find the best product for these particular treatments. We hear scars all day long in the office, the facial patients that come after tummy tucks, and the consults before we even do surgery it’s a question so it just comes up, and we really want to zone in on the products that we carry, we know they’re good stuff and provide the best for our patients without breaking the bank like you said.

Dr. Johnny Franco: It’s funny because TXA is a really, really old drug that has come back, and it’s funny because it’s not only for some of the stuff that you guys have talked about, but even in surgery, there’s a few new frontiers for it, so super interesting you have some old stuff that’s kind of circled back in terms of this. I know Dr. Weinfeld uses in a lot of his surgeries, there are some studies ongoing right now for it in combination with liposuction and some things like that, so definitely some more stuff to come, and we’re a part of some of these studies so that’s super cool and exciting for that, even with cellulite treatment, which is coming up in our next episode conveniently. Thank you, Andrea, for the plug and the lead in.

Any last thoughts before we wrap this up because I think this has been super, super helpful and we’re actually in our office creating this nice info packet so that we can walk you through and everybody can have that information even beforehand, that way you get everything lined up, set and we can be a good partner with you. Any take-home messages, anything we missed?

Sarah Viebrock: I don’t think so. I think y’all killed it, yeah. Just if you have questions, ask.

Dr. Johnny Franco: You killed the episode, not anyone, just so, just so, we’re cleared, I don’t want Sarah to confuse (Chuckles) anybody, thank you.

Sarah Viebrock: Wow, okay. (Chuckles) But yeah, we will give you as much info as you can, ask any of us we’re happy to answer any of your questions.

Dr. Johnny Franco: Can we do a little — not to put anybody on the spot here, but I’m sure they read the script ahead of time so they’re not on the spot, but we do a little episode, a little segment called behind the Bovie so something about scar management that maybe they didn’t — that people didn’t know about that you guys want to share? Anybody got a little nugget they want to share, anybody?

Sarah Viebrock: Genetics play a huge role in it. Maybe they didn’t think like some people, you know, I feel like we see this in the office all the time like why I see these beautiful scars online, why does my scar look like this? Like genetics plays a huge role in it and it may be nothing that you can control that we can control so I feel like that’s a huge thing.

Christine Bell: Right, correct.

Dr. Johnny Franco: I think that’s a great one. And so, if you’ve had problems with healing, with scarring, there are all sorts of genetic factor stuff, definitely make sure you talk to your surgeon about that if you’ve had scars. And remember, not all scars are created equally. There’s a difference between a surgical scar made, you know, with a plan versus you fell off your bicycle as a little kid and got, you know, kind of an avulsion injury type stuff. So, you know, they are predictors in a sense, but also, you know, one doesn’t necessarily equal the other, so — but definitely genetics play a huge role, talk to your provider because we’ll ask you a thousand questions to kind of figure out where this came from, but also something good to keep in mind, and sometimes we’ll start with small procedures before we do something big if we have real concerns.

And there’s also, we didn’t get into it, it’s beyond this, but there are also some treatments if people develop keloids hypertrophic scars that maybe we need to dive into another day, but maybe we’ll bring in the professor, Dr. Weinfeld, for that one.

Sarah Viebrock: (Chuckles) That’s a great idea. But we at least – we do have some options for y’all.

Andrea Benavides: Yeah. I will say for keloiders, if you’re someone that knows that you keloid, I know in dermatology we saw a lot of that and people waited until it got really bad before they, you know, decided to move forward with treatment. So, I would say, you know, if, you know, you’re a keteloider get on it as fast as you can. That way you can kind of, you know, take care of that as soon as possible before it gets essentially worse.

Dr. Johnny Franco: You mean, it’s like the regimens that we developed for them?

Andrea Benavides: Yes.

Dr. Johnny Franco: Thank you for plugging us, Andre. I appreciate you. Thank you! Do we get a quote of the day, I know T-Bone is not here today, but nurse Sarah said she may do a little something even though T-Bone and G-Berto are gone.

Sarah Viebrock: Yeah, yeah, I have one, y’all may think it’s cheesy, but I feel like a lot of what we do at Austin Plastic Surgeon and just in aesthetics, in general, is building confidence, right? And that’s why a lot of us come to do these surgeries and stuff like that, so according to Sabrina Carpenter, “Confidence is the most beautiful thing you can possess.”

Dr. Johnny Franco: Wow, you crushed it. (Chuckles) We don’t need G-Berto and T-Bone anymore. I love that. I think this goes in all sorts of stuff because you see people that just — and it’s funny because Sarah sees patients with me, and I say all the time was like we see a lot of naked people, and I tell our patients so often I’m like, you’re way too hard on yourself, you look fabulous and, you know, you got to be confident about what you do and how you look and how you carry yourself, so I love that.

Sarah Viebrock: Well, and there’s nothing like when they come back, and they’re like so confident to show it off, and they’re sending us their selfies like that truly is beautiful when you’re like just proud of how you look and how you feel so yeah, I love it too.

Dr. Johnny Franco: Yay! Just to summarize, you know, there’s a whole process for scar management, got to be patient, let us be good partners with you, be good partners with us we need your help. So, you know, following your instructions, giving this a good chance to heal, trusting in the surgical process and then letting us help guide you with silicone treatment, with the microneedling, with some of the laser treatments that way we get you to a fabulous spot so boom, boom, boom, thanks guys. Appreciate all of you for coming in today. Appreciate our team for coming in on a Sunday morning to film this and share their knowledge with all of you. So Plastic Surgery Untold, the greatest podcast in the world, as voted by us. You can get us anywhere you listen to your favorite podcast, iTunes, Spotify, Pandora, iHeart Radio, and we’ll see you guys soon bye.

Sarah Viebrock: Bye.

Christine Bell: Bye.