Episode 72: Avéli

This week Plastic Surgery Untold dives deep into a treatment for something most women have. What immediately comes to mind? Did you guess cellulite? Sometimes even the best diets and intensive exercise routines just don’t do the trick when you want to get rid of those pesky dimples. Dr. Johnny Franco, Nurse Sarah Mack, Nurse Sarah Viebrock, and the CEO of Revelle Aesthetics, Caro Van Hove go into great detail about a minimally invasive treatment for cellulite. Avéli is a one-time cellulite treatment for the buttocks, thighs, and outer thighs. Avéli uses a light guided, handheld device manually operated by an expertly trained provider. With this device, the provider is able to target and release the bands that cause the cellulite dimples. Listen in to this week’s episode to hear more about what this incredible treatment can do for your cellulite!
Dr. Johnny Franco: All right! Welcome, team to Plastic Surgery Untold, greatest podcast in the world, as voted by us. Today we’re going to talk cellulite, I know that we’ve talked about this before but there’s some new exciting treatments out there, and overall, always evolving frontier, so this is super exciting. We also have a special guest that we’re going to get to in just a moment, but before we get to our special guest let’s talk to the lovely Sarahs, see what’s going on with their life and then we’ll get into the nitty-gritty here. Sarah, number one.

Dr. Johnny Franco: All right welcome team to Plastic Surgeon Untold, greatest podcast in the world as voted by us. Today we’re gonna talk cellulite. I know that we’ve talked about this before, but there’s some new exciting treatments out there. And overall, always evolving frontier. So, this is super exciting. We also have a special guest that we’re going to get to in just a moment. But before we get to our special guests, let’s talk to the lovely Sarah, see what’s going on with their life. And then we’ll get into the nitty gritty here, Sarah number one.

Sarah Mack: Well…

Dr. Johnny Franco: I was just wondering who was going to answer when I said that. (Chuckles)

Sarah Mack: Well, we came prepared. We figured that we would mention something newer in both of our lives in relation to cellulite, which is that we were very, very lucky and blessed to speak for a national sales meeting for Avéli recently.

Sarah Viebrock: It was super fun you’ll actually zoom this in, so we were in Austin, ya’ll were – remind me where you were?

Sarah Mack: Chicago.

Sarah Viebrock: Chicago, so we got to speak about why we love cellulite, how we, you know…

Dr. Johnny Franco: You love cellulite?

Sarah Viebrock: Well, we love cellulite treatments, yeah.

Dr. Johnny Franco: Okay. (Chuckles)

Caro Van Hove: Yeah, good correction.

Sarah Viebrock: Yeah, we love cellulite because…

Sarah Mack: …we know how to treat it, that’s why.

Sarah Viebrock: …and it brings us lots of amazing patients, so but yeah, and what’s been successful for us and why we love Avéli, it’s been super fun.

Dr. Johnny Franco: What else is going on? Anything else personally, anything?

Sarah Mack: Um, well we started school (Chuckles) so we are bonding.

Dr. Johnny Franco: You don’t want to share that with the world?

Sarah Viebrock: Well, we were saving it, but we’ll bring it up now thanks for, you know, ruining the surprise, go ahead.

Sarah Mack: So, we both started FNP School, five weeks ago, we just finished our first class yesterday, and…

Dr. Johnny Franco: I heard you both got an A?

Sarah Viebrock: We did.

Sarah Mack: We are straight A students. (Chuckles)

Caro Van Hove: Oh, of course.

Sarah Viebrock: We’re about to start Advanced pathophysiology, so stay tuned we’ll see if we still have an A in December. (Chuckles)

Sarah Mack: Exactly.

Dr. Johnny Franco: We may have to get Dr. Weinfeld to tutor to you guys.

Sarah Mack: Yeah, please, Dr. Weinfeld.

Sarah Viebrock: Yeah, please, we need help. (Chuckles) Can I phone a friend?

Dr. Johnny Franco: I mean we’re so lucky to have Caro come join us, who’s the CEO President of Revelle Aesthetics, which has Avéli, our new cellulite treatment. We’re going to get into exactly what this is, which is super cool because it’s taken some of the things that have been there in the past and basically taken it to another level in terms of precision, I think, and being able to be very, very consistent which has been a chronic issue with cellulite treatment and why a lot of people are frustrated. And I was hesitant about treating cellulite because I think most people who’ve had cellulite issues have been frustrated by treatments that haven’t worked in the past.

But before we get into it, tell us a little bit about you, a little bit about the company, how you got involved? And thank you for taking time out to come join us.

Caro Van Hove: You’re so welcome and thanks so much for having me. So, I’m Caro, short for Caroline, I’m the proud CEO of Revelle Aesthetics a company that was founded to really solve for that really complicated issue, right? That most of us women have, which is cellulites. So, I joined the company right when it essentially came to light, so the device was born out of a med tech incubator out of San Francisco Silicon Valley. They’re a group of Engineers who had been really studying the issue of cellulite and trying to figure out why is nothing working, what makes it so complicated to treat? And so, they had really been working in stealth mode for numerous years, really studying the underlying anatomy, which is the complicated part, and they made a couple of really awesome discoveries and then started to work on various different devices and so came up with a winning concept. And at that point in time, they knew they were sitting on something really special that might actually start changing the standards to treat cellulite.

And so, then I was lucky enough to find my way to that incubator, I had been working in Aesthetics for many, many years so I started at a company called Allergan, so the makers of Botox and –

Dr. Johnny Franco: None of our listeners have ever heard of it. (Chuckles)

Caro Van Hove: Yeah, yeah, nobody.

Sarah Viebrock: Sorry, what is that?

Caro Van Hove: …but, all joking set aside, back in the day when I was introduced to Allergan, Botox was a small little sort of biologic and people didn’t quite get it yet. It hadn’t been launched for aesthetic purposes…

Dr. Johnny Franco: But you’re like 29, I don’t even know how that’s (Chuckles) that’s possible.

Sarah Viebrock: How is that possible?

Caro Van Hove: Yeah, I spent my whole childhood there. So anyway, so that was sort of my step into Medical Aesthetics. And obviously as women, you get very passionate about this field very fast and I had the good fortune of sort of really being at the brink of kind of the launch of botox cosmetic and then we acquired dermal fillers and so on, and so I ended up staying in the field for 20 years.

I also spent quite a bit of my career in plastic surgery, so in 2000s — 2008 I believe, one of the kind of tasks that was put — landed on my desk was to help bring silicone breast implants back into the United States. So anyway, so I’ve had a lot of great experiences, and so when this opportunity to try and solve for cellulitis came to me, I just I was very fast to jump on it, and here we are.

Dr. Johnny Franco: I think — and if you don’t mind maybe we’ll back up just a touch because you hit on a few concepts, you know, and a lot of women have cellulite, I think a lot of people blame themselves, a lot of people think that, you know, that they have control over their cellulite, and maybe we have a tiny little bit of control over some of this with diet, exercise those things, but there is a lot of factors that we have zero control over in terms of genetics, hormones those things that predispose it.

And sort of like when we talk about breast asymmetry that over 90 of women have – some — this is true for cellulite, more people than not have this, the vast majority of women have some cellulite and so I think people beat themselves up about it and it’s actually something that the majority of women have at least to some degree.

Caro Van Hove: Yeah, I think that’s absolutely true, and, you know, I mean to Sarahs, you know, we talk about this all the time, you know, ask any girlfriends do you have cellulite yes or no? Very rarely will you find somebody who says I don’t have it, right? Because that’s true, nine out of ten of us have cellulites, and the complicated part of cellulite is that it can be triggered by so many things. It doesn’t really have anything to do with kind of weight gain or just aging alone, it can be anything, hormonal genetics, you name it, and it just kind of happens post-puberty. And so, it is unlike a little bit of a wrinkle that can be charming, occasionally, right? There’s nothing charming about cellulites (Chuckles) and in fact a lot of studies show that. It’s quite embarrassing and so women do so much, right? We do creams, we do exercise and we all just want it to look a little better to have some smoother skin.

And so, we did quite a bit of research to kind of understand how does it make a woman feel, right? To have cellulite, you know, something that seems so — is it significant but in fact it’s quite emotional for women because they’re embarrassed, you know, it really restricts what we wear, you know, many of us wouldn’t be too comfortable wearing really tight pants or light-colored pants because that would show kind of the irregularities on the skin so, you know, the data showed it’s quite restrictive and quite honestly personally I felt that way too.

Dr. Johnny Franco: And is our service probably can attest to, fashion is not help this, because I feel like bikinis have gotten smaller, I feel like leggings have become an everyday thing, so I mean the ability to hide and do some of this has become more and more challenging with some of the fashion wear.

Sarah Mack: Yeah, I totally agree.

Dr. Johnny Franco: Because you both are fashion forward?

Sarah Mack: Absolutely, we like the little bikinis and the…

(Voice overlap)

Sarah Viebrock: I learned all my fashion tips from Sarah.

Sarah Mack: You’re welcome.

Sarah Viebrock: But I couldn’t agree more. I feel like we see so many patients in the office that when we’re talking about cellulite, they almost feel like they have to apologize. They’re like, I should be working out harder, I should be doing more, you know, and we’re the first ones to point out to them that, like actually you probably, if you were dieting perfectly and you were working out every day you would still have this and I’m sure we’ll get into why, but it’s super common more common than most people think.

Dr. Johnny Franco: And in our next episode, we’re talking about these full like luxury legs, you know, total body comprehensive treatment that we’re starting to embrace more. We’re going to talk about this because it’s become a big part of our fat transfer, Brazilian butt lift, the boom, boom booty stuff, because it’s been such a process, and it’s such a genetic thing that people have at an early age. I think that there’s even truly some underlying, you know, restrictive projection factors to this because if you look at, you know, the shape of the butt, you know, it correlates with the amount of cellulite stuff that — and most people have had this since they were very, very young and so I think, you know, to really get people an aesthetic result they’re going to love, you know, you really have to take all these factors into account. And so, while some people may say, hey I’m not worried about the cellulite I’m worried about the overall shape of my buttock, I think the days of considering all these things in isolation is fading fast and you’re never going to get the result aesthetic goal that you want if you’re only thinking these — about these in isolation, and this is a concept and dream that you and I share.

Caro Van Hove: Yes, a shared dream. And I think that’s true, right? I think, a couple of things, I think it’s true that body is really the new face, right? Because 20 years ago when we launched Botox cosmetics, you know, people were really looking for a solution for kind of wrinkles and volume loss in the face, but now that that’s pretty well taken care of, right? With all the things you do so well, you know, we use our toxins, we use our dermal fillers, skin care energy-based devices you name it. And I think if you then descend below the neck, you know, kind of enhancement of the breast area is also pretty well covered today and then if you go down towards kind of the midline, you know, I think again tummy tucks and abdominoplasties that’s also really great techniques for it.

But below the waist, it’s sort of still a big puzzle and women kind of have to go on a scavenger hunt to figure out what do I actually not like below the waist because it’s complicated, you know, it’s not just cellulite, we also have kind of what we call like adiposities or extra fats in certain areas and then there’s kind of the skin quality that also gives over time, and I think those are three distinct kind of areas that we need to think about.

Dr. Johnny Franco: And that’s something that we’re going to go into depth about in our next episode because I think it’s funny because we’ll have people that come into the office, and there’s two folds. One, there’s treatments that just don’t work and we’ve all seen the infomercials of home remedies other things, you’d be surprised what people tell us they’ve tried to treat cellulite, people come in frustrated. I think it makes it hard for us because, you know, now when there are some good quality treatments out there people are always skeptical for sure because they’ve been burned so many times. Some people literally been burned because they’ve been doing treatments that don’t make any sense or result on something that that’s not helpful and walking through.

Before we jump too much into this — can we talk a little bit specifically about what Avéli is and how the treatment goes? Because I think we’ve helped people in suspense a little bit and what’s unique and different about it. Because there’s some treatments that were similar but there’s definitely a big leap forward in terms of precision and I think, you know, just being reproducible by the providers.

Sarah Viebrock: That, and I want to make sure we remind people what cellulite truly is and why – why

(Voice overlap)

Dr. Johnny Franco: Oh, let’s start there, that’s an even better place to start. Thank you, Sarah. That’s why we need you. Yay!

Sarah Viebrock: I figured we could start there (Chuckles) and then go into Avéli. So, we talk about this all the time, cellulitis, those dimples that you see on the skin. Sarah and I are, you know, all the time going over with our patients what is skin laxity versus cellulite and we can discuss with you in office because most of us have a combination of both and we’ll get into that. But the cellulite is actually caused by these fibrous bands that are pulling the skin down, right? And some of those we need them, they’re structural, they support the skin, they hold the booty up, they hold up the legs, but some of them are super tight and they’re actually pulling the skin down. So, whether you work out, add more fat, have less fat, you know, eat right, the bands are still going to be there, so if you don’t treat the bands, you’re still going to have the cellulite.

Sarah Mack: Yeah, absolutely. And what I think I found that I love about Avéli is that it is pretty superficial as we go into the skin, and so it isn’t anything that’s deep that’s, you know, a significant thing with the treatment of Avéli, I feel like it’s pretty well reproducible, right? When we go in to do the treatment, and so we know that we’re actually treating the true cause.

Dr. Johnny Franco: Can you guys explain what Avéli, is because I think once you kind of walk people through it they’re going to understand why you’re talking about, why it’s consistent, why it’s superficial, why you can make sure that you’ve actually cut these bands? Because this technology and they sound like little changes but they’ve actually been big changes that have made stuff more consistent and easier for us.

Sarah Viebrock: Go ahead. (Chuckles)

Caro Van Hove: Yeah, so I think that it’s a great explanation of cellulite, right? So for many, you know, decades now people have been trying to figure out what are all the factors involved in causing sort of these irregularities kind of on the surface of the skin that we call kind of dimples or depressions. And we know that the skin thins, right? Over time, and we also know that the fat cells generally become larger, and then you’ve got these bands. A

And so generally in the past the reason why so many cellulite treatments have disappointed is that people have tried to go after these little bands from the outside in, really sort of trying to approach it kind of more superficially. But when we started to look at the problem of cellulite, what became clear is that these bands are actually really complicated webs it’s almost like a cluster, you know –

Sarah Viebrock: Right, it’s not just one little band. Yeah, that’s a great point.

Caro Van Hove: Right, it’s not just one little band that’s sort of easy to kind of release and ease that tension. And so our engineers discovered that, wow, they’re really complicated kind of webs and they also differ kind of from area to area, so the bands underneath kind of a depression or a dimple in your buttock is different than in your thighs. And so that made them think like how should we effectively try to release them, if you will, if we don’t really know kind of what it looks like underneath the skin?

So that came then to the evolution kind of in thinking like what if we could come up with like a little device that could help the provider kind of and with expert hands to really kind of go underneath that skin very superficially guide them to kind of the dimple and then give them away to first test where are these bands, are these the right bands, and then release them.

But the most beautiful thing that they also wanted to do was, let’s take out any guesswork, so can we create a device that when we give them the opportunity to first feel and see where these bands are and then release them, can we allow them to actually verify that that release is complete and that we’re getting all the bands that are pulling down the skin before you move on to the next dimple? And that sort of led to discovery of Avéli, which is our device, and if you’re wondering what the heck that name is about? It really stands for kind of advanced and verifiable, so it really is all about advancing kind of the standards in cellulites, and verifiable is to say for the first time it’s not about guessing anymore whether or not you’re treating it, you’re really attacking the problem from the inside out and in expert hands give people the tools to really do the job well before you move on to the next impression.

Dr. Johnny Franco: I think you guys hit on so many important stuffs like I think it’s only recently that we’ve really understood more of this complex web underneath, and I think super underappreciated, even aside from cellulite, this fibrous septae stuff is why, you know, even liposuction in these different areas can be super, super challenging if people aren’t super cautious because it’s just a different attachment. On the flip side, you know, in the past sometimes people have just tried to carbon release all these attachments and that can lead to serious problems, because some of these bands are there for a reason in terms of structural support, and so like anything in life too much is can cause problems and can lead to some skin laxity issues, some contoured deformities, seromas like just space because you need some of those structures and the idea is that you’re only releasing the bands that are causing a problem and not overdoing it, the light guided is super easy.

And it’s funny when simple concepts are applied because I think when things are too complex, they become very hard and when you take something super simple and make a very manageable way, now it lets people, you know, it’s even in, as a sports fan, you know, people play fast when it’s simple, and so something like this that’s designed, and its uniqueness and kind of coolness is in its simplicity of application unless the provider focuses on what areas need to be treated and releasing those and not worried about this complex device that needs yeah 5 000 assistance in six thousand cords, so I think that is some of the real uniqueness of it.

Caro Van Hove: Yeah, and I think that’s, you know, what was nice is the way the device was sort of designed was it actually was created by people who knew nothing about aesthetics, it was hardcore engineers that really looked at kind of these problems and tried to kind of decomplex them if you will and sort of look for the beauty in the simplicity.

And so I think today what that has translated to is we now have — truly kind of our mission is to set a new standard in cellulite with Avéli and, you know, in the right hands what that means is it’s a one-time procedure, if you have it done in the right place, you know, it should be a one-time procedure, and it’s, you know, it’s kind of the — the amount of time it takes varies on the number of depressions or dimples that need to be treated but generally, we’d like to say, you know, it’s in about an hour, and it’s under local anesthesia so no general anesthesia, so we just numb the pathway, right? That we’re going to kind of tunnel and do the procedure through. And we can treat depressions in both the buttocks as well as in the thighs, so that’s kind of clinically what we can do.

Dr. Johnny Franco: I’d love to hear your guys’ impressions because I think one of the things that have been surprising for me is, one, how efficient the procedures become and then how well patients have tolerated because if you just think about this like, you know, from a just pure, you know, mechanical thing, oh I have this rod being stuck in my butt, like this does not seem comfortable, and that has not been our experience.

Sarah Viebrock: Yeah, go ahead.

Sarah Mack: I just treated somebody two days ago who actually asked if their friend could come in the room and I think this is kind of a unique, interesting story. So, she was in there while we were doing the treatment which was fine, and afterward she couldn’t believe how comfortable her friend was during the treatment, she was just sitting there chatting, doing emails, you know, talking, so getting — being able to see an outside perspective and just see how comfortable the patient truly was during the treatment was pretty nice.

Dr. Johnny Franco: Is it true that the patient was helping you swipe through your Tinder pages because you had to clear out a lot (Chuckles) or is that fact or fiction?

Sarah Mack: No, we were actually just discussing future surgeries but –

Dr. Johnny Franco: Oh. (Chuckles)

Sarah Mack: Nothing like that. But, you know, Sarah and I like to take it as a really great time since we’re doing them before the BBLs to sit and answer any questions the patient may have, and they’re super comfortable during the treatment they get to ask us all about recovery and things like that for when they come to see you, so I think it’s really manageable, it’s super comfortable, and it’s a great opportunity to just educate the patient even more.

Dr. Johnny Franco: And that’s something we’re going to cover in our next episode is combinations because Avéli can be done as a standalone I just don’t like cellulite treatment, it can also be done and probably going to become more and more in combination because as Caro alluded earlier, there’s a lot of things that cause us to not like the way that our butt, legs, lower extremities look and so this is obviously treating one of the larger problems but doesn’t treat all the things that we may dislike, and I think that’s where having an experienced provider is super, super important to be super clear. Because we’ll stand you in front of the mirror and for good or bad and be like, hey, here’s the spots that are going to improve, here’s the ones that aren’t, you know, and so sometimes, you know, you mentioned it does a one-time treatment to the treat the true cellulite, but sometimes people need other treatments to help with other issues going on. And so, we try to be super upfront and clear about what we can do and come with an overall plan for you.

Sarah Viebrock: Yeah, that’s what I was going to say, as we talked about earlier. Most people have a combination of skin laxity and cellulite, and we have treatment options for that so we’ll go into detail at the — in the next episode. But we won’t, you know, tell you, we can treat this, and then you’re stuck with the laxity, you know, we’ll give you some options, give you some treatment plans, but also, we’re going to be super honest and upfront about what is going to improve and what is not because we want you to be happy and if you’re happy then we’re happy.

Dr. Johnny Franco: Because I’ve seen you guys tell people like, hey, these are the dimples that I know I’m going to make better if that’s going to make you happy, this is a great treatment for you. If that’s not what’s bothering you and this isn’t the issue, then let’s talk about something else. And, you know, we’d rather, you’d be a little disappointed in the consultation room before you spend a bunch of time, effort, and money than afterward.

So, you know, and that’s one of the beauties about this being able to be done when you’re awake and so forth because you’re literally part of the process with us, you know, we’ll talk about it, we’ll mark you, we’ll send you in front of the mirror again in these fancy little paper panties that you will love and then be like, you know, and then you can say, hey, yeah. And then it’s a chance for you to say, hey, what about these? And we can say, yep, that’s one, give me a tutor no, that one’s not because of X, Y, and Z, and we’ll walk you through that.

Sarah Mack: Yeah, absolutely. We do that — I think our biggest thing is just really honing in on the assessment process like you’re talking about. We make sure the patient is involved, they’re the one that looks at their booty every day, we don’t, so we’ll mark them initially with what we see and then walking them to the mirror and saying where — is there another spot that you see every day that’s bothering you?

Sarah Viebrock: Sometimes they see stuff that we don’t see or it’s different lighting and that’s why, you know, making it a conversation with the patient is so important, and then we all know what to expect, too.

Sarah Mack: Yeah.

Dr. Johnny Franco: And has that been your experience that a — because to me it seems like the longest and hardest part, is this marking, is this discussion, it seems like an hour is about what it’s taken, you guys obviously there’s a little variation if somebody has five dimples versus 30, you know, it’s going to take a little bit more, more time in terms of that.

Sarah Viebrock: Totally depends on the number of depressions, but yeah, around an hour, mark you, take photos, and then we have you late — you know, take a look, make sure you’re happy and then we’ll get started with the actual treatment, which Sarah mentioned, you know, you’re totally awake, we numb you with some tumescent fluid, local anesthesia, and we almost get kind of annoying throughout the whole procedure because we ask you a million times, you’re doing good, you’re doing good? Because if you have any spot that gets a little uncomfortable, we can add some extra numbing.

Sarah Mack: That’s something I think we also found is taking the time to really be sure that they’re numb before you start the procedure, so we’ll double, triple check even and then the procedure itself goes super smooth after that as long as they’re comfortable ahead of time.

Sarah Viebrock: And then we can offer laughing gas if they want it to, you know, not a requirement but an option just to help you kind of relax.

Dr. Johnny Franco: And what about from a recovery standpoint, what does that look like for people? Because I think the biggest thing is a lot of people like I just can’t do downtime, those type of things, and then is there may be a better time of year or not to do this or is all the time booty time? (Chuckles)

Sarah Viebrock: I mean, we can technically treat all the time but for sure, you know, the fall, winter, spring is perfect time to take care of these dimples before we get back to our next hot girl summer. But recovery is minimal, you’re going to drain that fluid that we’re injecting a couple hours, you know, most of our patients have found they’re totally done draining by the next morning, so do the treatment in the afternoon, we’ll send you home with a little goodie bag, which I’ll let Sarah go into in a second, but we’ll give you everything that you need for that recovery process, we’ll tell you exactly what to expect, you’re going to drain for about 12 hours, we like you to avoid exercise for probably about 48 hours. But it’s a pretty minimal downtime procedure, there’s not even any stitches, we close up the little insertion site with Steri-strips, and then um just to be safe we have you stay out of any like hot tubs, lakes, pools for a couple weeks, but other than that, you know, very minimal. And then you want to tell them about our little goodie bags?

Sarah Mack: Yeah, so we put together a nice little goodie bag at the office, they go home with a pair of compression shorts just to help with any swelling and bruising, they also go home with topical and oral arnica, we have them take that just to prevent or help reduce bruising that they may have which we noticed is significantly less…

Sarah Viebrock: It’s pretty minimal.

Sarah Mack: …compared to other treatments so that’s really been nice. And then Avéli provided us with a really awesome aftercare sheet, it talks about day one to two, three to seven, and then it goes even into 30 days, 90 days what to expect, we send that home with them and kind of review it just so they know about possible things that could come up and how to deal with them.

Dr. Johnny Franco: Do — are most people able to drive themselves home, do they have to bring somebody with them or?

Sarah Mack: No, they can drive themselves. Outside of the Pro-Nox, which wears off in a few minutes there’s nothing else that would inhibit them from driving. And by the time — if they do use the Pro-Nox during the treatment, once we’re done with the treatment it takes us another 15, 20, even 30 minutes to, you know, do the Steri-strips, go over post-care and all of that, and they’re perfectly ready to drive home.

Dr. Johnny Franco: Can people go back to work the next day?

Sarah Viebrock: For sure, yeah, back to work the next day, like I said to be safe we have you avoid, you know, working out 24 to 48 hours but we don’t make you take any time off, head back to work the next day and get back to your normal routine.

Dr. Johnny Franco: And what do you think is a realistic time zone, like if you’re really trying to squeeze this in before, you know, a big bikini party pool, you know, you know, party boat barge that type of thing, what’s a safe amount of time? Because I know bruising is definitely less but, you know, I always tell people it’s — you can’t jinx us it’s like when somebody comes in for Botox and fillers and says, Sarah you never bruised me, you’re like, okay, you just guaranteed you going to get (Chuckles) the biggest bruise of your life. What’s realistic for people if they’re trying to plan this in terms of recovery time, when they’re going to start seeing results bruising being gone?

Sarah Viebrock: I would say –

Dr. Johnny Franco: Not for any our procrastinators out there. (Chuckles)

Sarah Viebrock: At minimum we want you to do this a month before any sort of event. I would like — to be safe I’d always like you to maybe even do six weeks if you could, but just to be safe, like Dr. Franco is saying, everybody heals at a different pace. I would say, you know, most people are looking really good after a couple weeks but just to see your final results let everything smooth out, let all the swelling go away, let any bruising that you did get, you know, resolve — would you agree about four weeks?

Sarah Mack: Yeah, four to six weeks.

Sarah Viebrock: Yeah.

Sarah Mack: And — I think yeah, that’s another great time we can talk about on the next episode to go in with a secondary treatment if they need it, I think it would definitely need to give them four to six weeks to see how well Avéli did.

Dr. Johnny Franco: It’s been — it’s actually been super interesting to me just someone who does BBLs, other cellular treatment like how little bruising the majority of the patients have had? Everybody’s obviously is a little bit, you know, different and — but there’s some patients we’ve had that they have like one tiny little spot which to me is almost amazing that you can have so many, I think some of that has to do with the great job you guys do ahead of time, because there’s some hidden nuggets and some of the stuff you do in terms of pre-treatment and getting them numb, some other stuff for another time maybe for us to go into that actually decreases some of that and we’re happy to share with that if you want to slide into our DMs, we’re happy to talk to people offline of some of that medical care that we do stuff, but I think it’s super interesting in terms of that.

Also, too, I think, you know, being — we’ve talked about this in our scar management, being good partners. If you go out and you go to the gym that evening or you do something, you know, very strenuous it’s getting your heart rate blood, that’s not helping your bruising, that’s not helping your swelling, that’s not helping your cause, so the better you can be about following instructions, the quicker better you’re going to do.

Caro Van Hove: Yeah, and that’s I think it’s absolutely right, I think it is minimally invasive but you have to be a good patient, and I think just apply some good judgment and what we’ve also said kind of, you know, you might feel some soreness and then just take some Tylenol sort of that’s kind of recommended, but, you know, by and large it’s really well tolerated and we’re seeing rapid and really nice results with minimal downtime so.

Dr. Johnny Franco: We’ve talked a lot about buttock, but this actually can treat some of the thighs, too, can we talk a little bit about thighs before we wrap up, because I think thighs is one of these that really drives a lot of people crazy because, you know, buttock is great for, you know, you’re at the pool, you’re the party barge, those type of things, but thighs especially with shorts and things like that is something that are exposed for a lot of women a lot of the time.

Caro Van Hove: In fact, you know, when we started our studies, it was really kind of touching to hear all these women that were enrolling in our study just sort of saying, can you do something for my thighs because I haven’t worn shorts in 20 years, you know, and really…

Dr. Johnny Franco: And in Texas that’s tough.

Caro Van Hove: Yeah. (Chuckles)

Sarah Mack: Yes, we hear it a lot though, I agree, all of our people say the same thing.

Caro Van Hove: Yeah, right? I mean it’s so visible, right? Your buttock, you know, you can kind of cover that up, but thighs is really restrictive if you really don’t want to show off your thighs. And so we always say that, you know, oftentimes cellulite is a misnomer in and of itself, people don’t really know what exactly are we talking about is it laxity, is it kind of a dimple area?

And so we can treat with Avéli, we can really treat kind of any sort of skin depression, if you will, so long as what we say it has edges kind of defined edges, and if, you know, if patients come and see you, they’re in perfect hands because you do your assessment beautifully.

But we can treat very effectively the thigh areas, so the sides of the thigh, the back of the thigh, but going back to kind of what we’ll talk about next is generally in the thigh areas there’s lots of other stuff going on, too, and that’s where you really need to go to experts like you guys to really kind of help make that determination. But if you’ve got some dimples on the sides of the thighs or the back of the thighs, we can treat those beautifully also.

Dr. Johnny Franco: And I guess one take home, I would say from the thigh stuff is don’t let your body keep you from wearing what you want to do. I feel like we’re way too hard on ourselves –

Caro Van Hove: Yeah, it’s very true.

Dr. Johnny Franco: — it’s never as bad as you think it is, I promise.

Sarah Viebrock: Yeah, no, I love that point.

Caro Van Hove: Very true. But, you know, one kind of thing that was so important to us, so the company that makes Avéli is called Revelle, and so we decided to land on that name because it’s kind of the blend of reveal and elle in French her, so reveal her, because for us it was all about sort of…

Sarah Viebrock: I love that.

Caro Van Hove: You know, our mission is — we’re all in the business of helping women reveal their true selves, right? So help them feel confident and comfortable in their own skin, and that was it was all about, and so going after cellulite was really appropriate for us and obviously for the company, so.

Dr. Johnny Franco: What are some other little nuggets of insider tips you would like to tell people about cellulite and, specifically Avéli treatments?

Sarah Mack: One thing that I really think is awesome is that it’s light-guided, the device that we use itself, so it helps for precision. So if, you know, if you’re somebody that’s worried that, you know, other treatments have failed before and things like that I think it allows the provider to exactly, you know, know within a certain region that we’re treating the specific area and I think that’s really awesome.

Sarah Viebrock: And like we touched on earlier, actually verify it, I like to call it my cellulite magic wand. But essentially, you know, treat the dimple and then go back and verify that the dimple is truly gone, because as, you know, when you — when you stand up you can see the cellulite easily, when you lay down for the treatment it looks like you don’t have any cellulite, so that’s why the marking is so important and then being able to recreate the dimple with the Avéli device before you release the bands and make sure that you’re truly treating within where you marked, right? Because, like we talked about earlier, you don’t want to release too much or you can run into issues, you don’t want to treat areas outside because then your dimple will still be there, so just the precision and being able to verify, like Sarah said and the fact that typically it’s should just be a one-time treatment is just so awesome, and it’s been really great.

Sarah Mack: Yeah, I think it gives you a ton of confidence as a provider that, you know, what you’re doing is going to be effective, and it’s really exciting to see those patients back and see how great their results are.

Dr. Johnny Franco: and I think the other thing we touched on it was, you know, it can be done as a standalone treatment or in combination because a lot of people are doing other things, whether it’s butt implants, BBLs, fat transfers, we’ll help you walk through the timing because there is a window before and after just because obviously, we want you to heal, we want you to do well in terms of this and so we’ll guide you through that.

Definitely, you know, if you’re getting different treatments at different facilities, definitely be upfront with them because we’re happy to talk to your other providers and those type of things, but we want to make sure everybody’s working towards your aesthetic goals.

Sarah Mack: Absolutely.

Sarah Viebrock: And if you already had a BBL in the past, it’s not too late we can treat you after as long as you’ve been, you know, healed long enough, so just — those of our patients that we didn’t have this in the past and they still want to go back and treat that cellulite we can see you too.

Dr. Johnny Franco: And we’ve seen patients who have BBLs done in other practices, out of the country, you know, and have come and been like — and this is where it goes to like, you know, I think a misconception because the BBL adds volume definitely can do a lot of great lipo sculpting shaping stuff, but sometimes when people are looking at — I think the idea of BBLs or Brazilian butt lift is creating this just only this big old massive booty has faded by the wayside and now it’s more of this overall shape from your waist to your butt and, you know, part of shaping the butt is contouring it. Because we get so many people now that want — they’re like, I want to improve the shape I don’t necessarily want this intense volume, and so I think sometimes people say this and it’s our job to help kind of work them through like how do we improve this overall shape and sometimes it’s multiple treatments including something like this.

Caro Van Hove: And I think that’s a good point, right? I think that what — maybe it’s also important to stress is that treating the body requires a lot of finessing, you know, and I think that therefore you really, it’s not just about finding good products it’s also about going to people that have really amazing techniques like you guys. You guys are excellent in your craft and because you study it so well anatomically and you really think very carefully about how all these pieces of the puzzle fit. But at the end of the day, it wouldn’t matter how good Avéli is, your technique has to be superb and so now you see all these cool technologies that are super targeted in what they do but they still come with a really kind of detailed kind of playbook, right? And so I think going to, you know, practices that really have this technique down is very important because they’re complicated problems that really need a very sharp eye.

Dr. Johnny Franco: And it’s interesting because your company has taken an approach where you’ve selected a few providers around the country to start, and the idea is that, like hey, you know, we’re going to start with people who have really, you know, focused on this type of the body, on buttock stuff, on these type of treatment stuff, and then slowly evolve and roll this out to more and more practices as you kind of partner with practices to develop best practices and making sure that — because obviously it doesn’t do the patient — you guys or us, any benefit if people aren’t getting the results they want and so, you know, we’re fortunate to have the Sarahs that are helping kind of make sure all these things in terms of the goodie bags, the evaluation stuff are getting people to a goal.

Caro Van Hove: Yeah, I think it’s an excellent point, so because there has been so much failure in cellulite, right? I remember when the engineering team, I was introduced to them, and they said we have the Holy Grail in cellulite, and they were kind of joking and I was almost rolling my eyes, right? (Chuckles) I was like, sure you do. (Chuckles) You know, and — but I think we knew once we discovered kind of really how neat our technology was and that it could actually for the first time do the job well, we also recognize that we would be bringing this product to market when there had been nothing but failure, and a lot of skepticism, and a lot of cynicism, because we’ve all tried the lotions and potions (Chuckles) that promise everything, and we may have also tried other treatments in aesthetic practices that didn’t do the job after thousands and thousands of dollars.

So for us, it was very important that we would really kind of, you know, earn our clinical stripes and really prove our worth from the start and we’re only as good as our last case, so we really wanted to go to physician practices that really were meticulous, that were really detail-oriented and that would really be good partners and learning how to do the procedure very well with a lot of detail and a lot of patience. And so I think that’s been kind of our formula for success, and we’re so — it’s such a privilege working with you all and I can’t wait for more patients to come and see you because I think your work is excellent, so.

Dr. Johnny Franco: Thank you!

Sarah Viebrock: Thank you!
Sarah Mack: Thank you! We really appreciate that. Thank you for coming to see us.

Caro Van Hove: Oh, you bet.

Dr. Johnny Franco: Do you guys want to do a little behind the Bovie? Any other little nuggets? I feel like we’ve shared so many nuggets.

Sarah Viebrock: I know, gosh.

Sarah Mack: We shared so many.

Dr. Johnny Franco: Maybe a quote of the day?

Sarah Viebrock: Sure.

Dr. Johnny Franco: You had a great one last time, so no pressure.

Sarah Viebrock: I have one more.

Dr. Johnny Franco: Okay.

Sarah Viebrock: Lucky for you. (Chuckles) I think –

Dr. Johnny Franco: And the listeners.

Sarah Viebrock: That’s right. I think it’s perfect because of — I didn’t know the meaning behind Revelle, but this kind of is a play on that, so this is from Coco Chanel, “Beauty begins…

Dr. Johnny Franco: That’s interesting, that’s who you chose? (Chuckles)

Sarah Viebrock: “Beauty begins the moment you decide to be yourself.” So…

Caro Van Hove: Oh, love that.

Sarah Viebrock: I think, you know, treating cellulite and getting, you know, a play on confidence, we talked about that last time, just helps you kind of play more into who you are, not being afraid to wear whatever you want and stuff like that so.

Sarah Mack: Yeah, I think that’s perfect.

Dr. Johnny Franco: I love it. I just want to thank you for coming to see us again –

Caro Van Hove: Oh, thank you.

Dr. Johnny Franco: — and hopefully, you’re going to stay, we got another episode coming up soon so we’ll catch all you guys in just a few minutes. Thank you, guys, for coming out on your Sunday, I appreciate you all. Don’t forget, you can download Plastic Surgery Untold wherever you get your favorite podcast, iTunes, iHeart, Spotify. And if you want to see us, you can watch us on YouTube as well. So I’ll catch you guys soon we’ll see a little bit, alright, bye.

Caro Van Hove: Bye.

Sarah Viebrock: Bye.

Sarah Mack: Bye guys.