Episode 73 Luxury Legs

Dr. Johnny Franco: Our team, welcome back to plastic surgeon untold greatest podcast in the world as voted by us. We’re continuing our cellulite talk, doing little luxury legs, if you will. We still have the fabulous Sarah, and our special guest Caro who flew all the way in for us. So we appreciate you.

Caro Van Hove: Thanks for having me.

Dr. Johnny Franco: Let’s go around the room a little bit, catch up, whatever what’s going on with everybody’s life, and then we’ll jump into a little bit of what luxury legs really means in terms of this total body transformation here. So, Sarahs

Sarah Viebrock: Yeah. I can go first. I know we mentioned in the last episode Sarah and I are back in school. We’re getting our nurse practitioner, which is super exciting, but y’all be thinking about us because we are starting Advanced Pathophysiology tomorrow. So…

Sarah Mack: Please, prayers are accepted.

Sarah Viebrock: Yeah. We will be…

Sarah Mack: …phoning friends.

Sarah Viebrock: Yeah. We’re sending all of our free time studying…

Sarah Mack: That’s right.

Sarah Viebrock: …but that’s so that we can be better providers to take care of all of you.

Sarah Mack: Absolutely. I love it. I’m excited.

Caro Van Hove: Even better, you say.

Sarah Mack: Ahuh. We have four fabulous surgeons we’re going to be calling…

Sarah Viebrock: That’s right.

Sarah Mack: at 1 am, crying.

Sarah Viebrock: Can you please explain this to me?

Sarah Mack: Yeah.

Sarah Viebrock: So, yeah.

Dr. Johnny Franco: You can catch me up because you and I have talked about this – this idea of – of this entire, like lower extremity, and I think you say all the time, you know, the – the lower extremity, the lower body is the new face in terms of just as overall rejuvenation of the – of the legs…

Caro Van Hove: Yeah.

Dr. Johnny Franco: …but as an entire subunit and not just, you know, trying cellulite temple stuff.

Caro Van Hove: Yeah.

Dr. Johnny Franco: Talk to us a little bit about this because you’re super passionate about it.

Caro Van Hove: Yeah, I’m very passionate about it because, like, all of you, I’ve been in sort of – I’ve had the good fortune of being in the medical aesthetics field for a long time. So, since the days of the early days of Botox Cosmetic, and so if you date back to the year 2000, when Botox first came out, right, it was all about facial rejuvenation. You know, and I think that now, medical aesthetics has become more normalized and we really kind of make it part of kind of our well-being and self-care regimens, and so on, we’re all living better, longer lives now, right?

We take better care of ourselves. We take our vitamins. We go to the gym. And so, it’s only normal that kind of, we do a scan of the whole body and think about what are the areas that are just not fitting well with how we feel. And so, the lower body, I think, is a big part of that. So, you know – and unfortunately, it’s also the area where, you know, it’s been a bit of a mystery, kind of what happens in the lower body, right? Because oftentimes, when you ask a woman, you know, and I have this conversation with my girlfriends all the time, “Tell me what you don’t like, you know, in the lower body.”

It’s hard to describe because many women feel like it’s everything. And, you know, it’s because we’ve worked – we work out so hard, we do our squats and our lunges, and it’s just the area that is just very hard to kind of, you know, make us – look as good as you want it to. And I think that has to do with the fact that we all – talk about it in terms of like, we have the trifecta, which is you’ve got a bit of extra fat, generally, that’s hard to kind of exercise away, then you have cellulite, right? These pesky dimples that start to appear.

Then we also have just the quality of our skin. And so, that’s sort of why a lot of women are very frustrated about it, and I feel so passionate because the company that I have the privilege of running has come up with a really great cellulite technology and we are extremely proud and passionate about it, because I think it actually does the job of treating cellulite very well but it is only one piece of the problem. You know, we don’t solve for the skin quality or the laxity. We don’t solve for the extra fat.

So, I think that kind of is opening up the whole world of what should lower body rejuvenation look like and I – that’s why I think patients coming to you all are just so blessed because you have such a toolbox and it’s such a big focus for your practice and you’re so deeply kind of looking at these issues that I think it’s going to open up new solutions.

Dr. Johnny Franco: And I think it’s – some of the issues and concerns and stuff is one this is a challenging place to treat.

Caro Van Hove: Yeah.

Dr. Johnny Franco: And I think you know a lot of patients are hesitant just like we’re talking about cellulite is that there’s been a lot of new, you know, lotions and potions that just really never have panned out so people are skeptical, people, you know, are hesitant to invest a lot of time and effort into this because they don’t wanna be disappointed again.

Caro Van Hove: Yeah.

Dr. Johnny Franco: They don’t want to get their hopes up and be done.

Caro Van Hove: Yeah.

Dr. Johnny Franco: And the other part of this is there’s so many factors. So, you know, cellulite gets a lot of the hype, and the thoughts and those type of things. But you know, it’s not the only issue you know. Most of us that aren’t, you know, 18, 19, 20, we got our first good sunburns of the summer and then continue to, you know…

Caro Van Hove: Yeah.

Dr. Johnny Franco: …just kind of go on live, and we now realize how bad that was for our skin. You know, their skin laxity, which, you know, we have some limited – very limited control over. A lot of it has to do with genetics and life and those type of things. And then – so, there are so many factors that play into this. And in the past, there just weren’t a lot of great treatments, and I think one of the big turns, there’s been some of the technology that has come a bard recently that has really made a big difference for that. And so, I think that’s where this is a…

Caro Van Hove: Yeah.

Dr. Johnny Franco: …it’s really nice to be on the frontier…

Caro Van Hove: Yeah.

Dr. Johnny Franco: …and working with companies like – like yours to be able to treat this whole holistic approach. And that’s where we came up with this, living your luxury legs lifestyle because that is a big change in terms of people being able to, you know, wear what they want to do, live their lifestyle, the way they want to, and address some of these concerns that they feel like just really limit what they want to do, what they want to wear. So, maybe we can kind of dive into how we evaluate this, what we look at, and maybe one of the Sarahs can kind of take us through that evaluation and then we can go through how we treat each one of these, because I think that’s one of the concepts you’re trying to change.

I feel like, unfortunately, a lot of practices just because of, if you’re not passionate about this concept, you know, one, it’s a super high investment because a lot of these different devices, treatments are lasers, skin tightening devices, stuff that can be very costly. And so, a lot of practices, medical aesthetic businesses only have one or two, and if you go, that’s what you’re gonna get.

Caro Van Hove: Yeah.

Dr. Johnny Franco: In this way, you can really take a holistic approach, evaluate their needs, figure out a concept. Because there is some timing, some treatments that are better done at the beginning, and vice versa, like that.

Caro Van Hove: Yeah.

Dr. Johnny Franco: And so, that you start from the beginning, get a roadmap to your aesthetic goals, and then kind of keep marching along.

Sarah Viebrock: Yeah, I feel like that’s what I was gonna say, even in the last year, what has become available has changed a lot, and now, you know, for our patients at Austin Plastic Surgeon, Sarah and I are super lucky to be able to say, “Okay, first of all, you know, let’s do an assessment. Let’s stand in front of the mirror together, point out, and literally show me what bothers you. Because then I can tell you if it’s something or any of us can tell you if it’s something that we can help or not, you know…”

Caro Van Hove: Hmm.

Sarah Viebrock: …and then we tell them all the time, “Give us a year. You know, give – you know, I wish I could fix all of this in one appointment.”

Caro Van Hove: Yeah.

Sarah Viebrock: But if you really want to, you know, like Dr. Franco has kind of coined this term, have your luxury legs and like get, you know, to the goal that we’re all hoping for, we’ll give you an outline, like I can tell you, this is cellulite, this is skin laxity. You know, if you want a little more volume, maybe we’ll have you talk to Dr. Franco about fat transfer. If you are not interested in surgery, then we can even talk about doing some filler and stuff like that. But typically, you know, just one of these treatments is not going to get you to where you want to be. So we’ll outline a whole treatment plan for you for the next year or so to really get you to where you want to be. So you’re stuck with us for a little bit, but we also are, you know, super lucky to be able to offer lots of options for you.

Sarah Mack: Yeah.

Dr. Johnny Franco: And we, even in our own work, we recently hired a coordinator that’s going to help do your – your cellulite coordination, you know, in terms of this because I think just like you know, for surgeries, mommy makeovers, these transformations, you have someone that’s helping you through this process, because it can be super complex. There can be a lot of appointments, those type of things.

Caro Van Hove: Yeah.

Dr. Johnny Franco: It’s nice to have a point person that can help make sure that everything is organized for you and so forth. And so, that’s a big change in our practice because we understand the complexity, the time, the effort, and so, that you have someone that’s going to make sure that, you know, they help guide you through all this because I know these areas are super busy, I text them all the time, and then it may or may not get a response, but you know, because they’re responding to all of you guys, so…

Sarah Viebrock: And they also can go over financing options because you talked about how it can get kind of pricey.

Sarah Mack: Hmm.

Sarah Viebrock: So, we’re excited to be able to not only lay out your appointments nice and organized, but also go over options to finance that for you.

Sarah Mack: For sure.

Caro Van Hove: Yeah.

Sarah Mack: We want to talk a little bit about the options that we do have.

Dr. Johnny Franco: Yeah, let – and do you mind if we talk about them in order, so – you know, because one of the big ones and I think one that very frequently people mistake for cellulite, is skin laxity. So maybe let’s start at skin laxity. What we can do for that and then kind of keep marking down, and then we’ll do cellulite, and then do some depressions which not all depressions are caused by cellulite, which is sometimes I think confuses people and gets misnamed and then – and then we can jump into some of the surgical treatments because there is just sometimes laxity, volume deficient that need more than we can do with – with non-invasive or minimally invasive treatments.

Sarah Mack: So as far as laxity goes, you know one of the newest devices that we have at Austin Plastic Surgeon is Morpheus eight, which we have really been loving. We have the face handpiece as well as the body. And recently went to a really big conference with them and learned a bunch of new awesome settings and tips for our patients in regards to that, which is just good old-fashioned RF microneedling on steroids through Morpheus. It can treat at several different settings and depths in the body. So it actually goes all the way down to seven millimeters, which they coined as a surgical depth to get the ultimate skin tightening. They also offer a handpiece on the Morpheus eight which I think is awesome and something we hadn’t brought up yet which is just textural changes to the skin. So we can actually resurface the fine lines and wrinkles as well.

Sarah Viebrock: Yeah. With the resurfacing tip. So if we need to tighten with, you know, tighten loose skin, we go a little bit deeper, even can do a little bit of fat remodeling, and then like Sarah said, we can actually use a separate tip called our resurfacing tip, only a half millimeter depth to really target the outer layer of the skin and give you that smooth appearance.

Dr. Johnny Franco: Because the result like in term of skin laxity is that even if you release dimples, even if you restore – you know, if you’re trying to just do volume, and we’re talking about this in the face, you know, if somebody needs a facelift or need some type of tightening, they need it because you can do a ton to the underlying structures, but if you try to overly fill people or – or you release these bands causing cellulite, but you got a lot of skin laxity.

Sarah Viebrock: Right.

Dr. Johnny Franco: Then you’re – you’re not gonna see the benefit of it because you’ve released that, but part of the you know, the reason that you know people look good, you know, with the cellulite, you know, release of these bands is because the skin pops back, like a trampoline back into place. If there’s no trampoline effect, you know, that skin still just gonna kind of hang there and no question. We don’t want to overly promise if you’ve got – you know, if you’ve lost 150 pounds and you got a lot of saggy skin stuff, Morpheus, you know, RF microneedling probably is not going to be your option.

There are other options in terms of surgery and skin tightening like renovation body type that do some skin tiny tightening under the skin so we can be a little bit more aggressive. And then the next step up is doing some type of body lift, circumferential lift, a surgical butt lift, if you will, where we actually remove some skin, do some reshaping in terms of that. And that’s why we really want to guide you through the whole process because depending on where we’re at, we don’t want you to spend a ton of money on fillers or other things if we know that you need a surgical treatment in terms of this.

Caro Van Hove: Yeah.

Dr. Johnny Franco: And then we can kind of get you to a good spot. So, it’s not you don’t wait till after you’ve paid a lot of money for treatments and decide “Oh, well, you really needed a surgery or you needed X, Y, & Z.”

Caro Van Hove: Yeah. Yeah.

Sarah Mack: I think assessing the patients, you know, when we do talk about skin laxity, how much do they truly have? Is it something that we can treat with dilute radiesse or Sculptra and give them you know, 30, 50 ccs of volume that’s going to help kind of airbrush and soften the laxity that we see or do they have to go like full on fat transfer?

Sarah Viebrock: And I like what you said about starting with the skin laxity because you know, we’re kind of creating a bit of a controlled injury, which as it heals, helps with collagen stimulation. The skin itself is going to have been more – you know, have more elastin, more collagen, so then when we go back and treat the cellulite, we have a much better chance of that skin bouncing back, like you said.

Sarah Mack: Hmm.

Dr. Johnny Franco: And then and – as well will guide you because I love renuvion, body Tite, these radiofrequency energies that can go under the skin, so they’re a little bit more aggressive than like a Morpheus would be. Body Tite is the – the equivalent of that, but again, goes under the skin and, and applies that energy, but still to a point, you know, and it’s one of the areas of technology that I think is only going to continue to improve over the next few years and make these treatments even better as we kind of develop new settings, modes and stuff for some of these – these energies. Remember, it’s always the fine balance between tightening skin without causing any – true injuries to the skin…

Caro Van Hove: Right.

Dr. Johnny Franco: …here you’re going to have some permanent effects. It’s a controlled injury, if you if you will.

Sarah Viebrock: Exactly. Exactly.
Dr. Johnny Franco: If we keep mark, any other comments about skin. Skin laxity is a tough one, we could spend a whole episode on this, but just want people to understand it’s one part of the evaluation process. There are different treatments depending on how aggressive or not we need to or want to be.

Caro Van Hove: Yeah. I think just what’s so exciting is just the education alone that women can get right from these kinds of conversations. Because for so long, you know, women wonder what’s all going on there. I don’t like any of it, but they can’t really explain it. And so, it’s so exciting that now they can go into consult with you all and you can just kind of like dissected properly, right?

Sarah Viebrock: Hmm.

Caro Van Hove: And I don’t think that we should be afraid of this whole kind of treatment plan. Because essentially, that’s what happens, you know, with the face too, right? We started with Botox, and then went on to dermal fillers, and then you know, we also know that you have to take care of the skin itself. So, skincare products became much more important and now we’re talking about skin resurfacing and so energy-based devices. And I think that, you know, the education will start to click, I think, you know, similar to the way it’s happened kind of in the face. And so, this is very exciting.

I think for women to finally know, it’s not your fault, whatever you’re doing, you know, these are kind of issues that all women have. It’s not just you that the majority of us have these kind of little complex kind of areas. And now, there are really specialized practices like you all that are really coming up with a treatment plan that, you know, even over, you know, a course of time is really going to really meaningfully, you know make it better, so.

Dr. Johnny Franco: And then as we kind of keep moving down, so, you know, once people are in a good spot and we have good control of the skin laxity or if we’re doing in conjunction than treating actual cellulite because that still is a – is a thing for sure that they can cause people on the buttock and thighs. And so, you know, we have a couple of different treatments we offer depending on people’s specific needs. I think the two biggest ones on the market right now, are Aveli, obviously, and then QWO which was the first FDA approved injectable. And I think even our own practice, we’ve really kind of honed in who we like to treat with what and kind of how we go through that program. Do you guys want to talk a little bit about cellulite management for people as part of this holistic approach?

Sarah Viebrock: For sure. Yeah. And if you missed our last episode, we dove into detail about what cellulite is. But remember, just treating skin laxity isn’t going to fix these dimples because they’re really caused by those – like web of fibrous bands, essentially, you know, not just one band, which Caro was pointed out so eloquently for us. But, you know, we have some patients that maybe if they have just a few dimples, you know, they prefer an injectable over a minimally invasive treatment, we could treat them with quo, knowing they’ll have to come back a few times. We also have those patients that have deeper depressions, quite a few of them, really need a quick treatment, maybe they’re in from out of town, obviously is definitely the better option for some of those because, you know, we can do one and done treatment, and we’re able to treat – would you agree a little bit more at once?

Sarah Mack: I agree. Yeah.

Dr. Johnny Franco: I – for sure. I think when people have the deeper advanced stuff, I think for us, we have a lot of people from out of town, it’s hard to do multiple treatment stuff. So I think that’s super, super helpful. It’s I think nice and kind of reassuring, when people have some of these really deep bands that you make sure you release some of those.

Sarah Viebrock: Right.

Dr. Johnny Franco: Because I think I think that can be super challenging in terms of this. I think it’s also nice in a lot of our patients who are coming in for but augmentation, stuff that you know that you can treat this pretty effectively ahead of time. Sometimes, you know if people are enough that any of us are procrastinators, but if we’re waiting until right before a surgical treatment to try and do some of this, that can be super, super challenging for people, and it’s nice to be able to do one and done. I think sometimes too, just in the busy life that we all live now…

Caro Van Hove: Yeah.

Dr. Johnny Franco: …we’re just talking about your travels…

Caro Van Hove: Yeah.

Dr. Johnny Franco: …and everything else that they carried us around the world, you know. Sometimes your opportunity to do a treatment, do something, maybe a very limited window.

Caro Van Hove: Yeah.

Dr. Johnny Franco: And so, the more that you can do, obviously safely in one setting, and one time, I think can be super attractive to people.

Caro Van Hove: Yeah. I – that’s exactly also one of the – you know, when you’re – when – when you are on this side of the table, where you’re thinking about what products, you know, when you raise kind of areas of concern and say it’s really kind of an unsolved area, there are many companies that will really dig deep into those problems and try to figure out solutions. I think you just raised a very good point, which is we do have to accept that while medical aesthetics is becoming really a normal consideration as part of self-care, we do live a bit busier life than ever.

I think that, you know, whatever you do, it has to be practical. So, you know, that was one of sort of the – the big standards that we wanted to meet with our product Aveli for cellulites, we wanted to really set a new standard and treated very effectively. So, it would be worth paying for. It would be reproducible for you, something super reliable, but we also wanted it to be easily incorporated into a busy woman’s life. And so, that’s why a one-time treatment that would allow you to really verify your work and make sure that the dimple, that tension on the skin would truly be resolved, and a one-time treatment is really important to us. And I think that we’ve done that as well.

Dr. Johnny Franco: And it’s been interesting for us even from a surgery procedure standpoint, because during – during the COVID time when people were working from home and doing some of those, people have a lot more flexibility in their schedule.

Caro Van Hove: Yeah.

Dr. Johnny Franco: I’ll tell you; we’ve already seen a lot of people who all of a sudden, their job may be like, “Hey, you’re working at home and on short notice,” and they’ve been like, “Hey, you have to come back into the office by this date.” And it is changed how we’ve seen this and I think some of it we had forgotten before so many people were working home remotely in different areas. So, I think definitely time is and being efficient with that time is – is – is the thing again.

Caro Van Hove: The other thing that I love about sort of, you know, Austin Plastic Surgeon is like, I think that we all have to embrace and I think you’re seeing that sort of acceptance more and more so, at one point is when we are all becoming very educated in the field of medical aesthetics, right? We’d like to do our homework. A lot of people dial into this podcast just to understand and learn.

Every area of the body at some point, there’s a whole spectrum of treatments you can consider. But similar to – for example, with the face at one point, you know, whether it’s age-related or the acceleration of your aging process, which is very personal to each – each individual, you know, you might come to the conclusion that, you know, you don’t want to keep doing all these fillers, you know, or you have to, you know, essentially go in for your filler treatments too often now because your face may be ages a little bit more, and then kind of maybe kind of a mini lift or a mini facelift is a better option for you.

I think that’s sort of something that we see more and more also that women are starting to understand it’s a whole spectrum. And surgery was a really scary thing, you know, 20 years ago with lots of downtime and sort of lots of scarring potential and incisions but that’s not the case anymore. So, techniques and surgery have become so progressive that I think the downtime and the recovery are just really much more easily manageable, you know.

Dr. Johnny Franco: And then can we keep moving in because there’s the true cellulite dimples but then there’s also, you know, and I call them, you know, depressions or contour deformities. And so, you know, I think sometimes two people are confused that it’s a true cellulite but sometimes there’s other things that cause depressions, and it can be volume loss, even, you know, intramuscular injections that didn’t get in, steroid shots, other things trauma, sometimes we follow the…

Caro Van Hove: Tissue trauma.

Dr. Johnny Franco: And you lose some – some fat over time stuff and get some depression things. So, there are some other things that cause the butt not to have the shape that we want. That’s not just true cellulite, and that’s part of, you know, during the evaluation and why we asked you a bunch of questions, especially if something looks a little bit off because we’re trying to get to the actual source of this. And it’s, it’s funny, you know, I was on a panel one time about cellulite, and I – very prominent dermatologists tell me she had a friend that she had treated with everything under the sun for cellulite and they were talking at one point, she’s like, “Yeah, it’s just, you know, frustrating how this hasn’t gotten better with all these cellulite treatment stuff.” The friend – and she’s – talked to her a million times about, and goes, “Oh, well, I’ve had this since I fell,” and she’s like, “Wait, what?”

It was, it was interesting because there’s someone that she had a great relationship with, had talked about this, and for some reason, just had never brought up that the depression, you know, came after our trauma, which we would all treat very differently. And so, you know, bear with us when we’re asking you 1,000 questions because we’re trying to figure out what’s actually going on, especially if something looks a little atypical to us, we’re probably gonna ask even a few more questions, because it really does alter how we treat you.

Then we can get into some of these. “I also tell people look, you know, if you’ve had cellulite for, you know, 30, 40 years, and you got some depressions, the idea that we can just cut this band, and that your skin’s just going to magically pop up and be perfectly baby bottoms smooth at that point,” doesn’t seem super realistic to me. And so, this is where a lot of times, we can release these bands, and then come back and do some smoothing techniques in terms of doing some fill, because like the Sarahs mentioned, some of the off-the-shelf fillers are fabulous but there’s a limit to how much you can do for most of us in a practicality standpoint, from a sheer cost volume type thing, but when you’re treating a few residual spots, definitely in becomes much more worthwhile.

I also think if you’re trying to – and this is why we try to walk you through the order, if you’re trying to treat some of these cellulite spots with just filler and you haven’t released the cause, one, I think it’s always gonna be a limit to how much you can pop these up, because you’re always fighting a battle type here. I think you’re also not going to get as much out of the product as you hope, want, think, and so I think just trying to stepwise this.

Sarah Mack: Yeah. We did a couple combo patients recently that I can think of…

Sarah Viebrock: Yeah.

Sarah Mack: …that we did Aveli first and then waited about four to six weeks, brought them back and then did what we call a tweak treatment with radiesse too, just kind of smooth everything out and the results have been really, really nice so far.

Sarah Viebrock: Yeah, for sure. And like you said, just going back and doing some perfecting, so we’re not adding like BBL type of volume, we’re just perfecting any of those stubborn demos that were left. And also, if we’re using something like radiesse, we’re getting a little bit of collagen stimulation as well, which is just going to help smooth, add a touch of volume but not a lot, and kind of the icing on the cake.

Dr. Johnny Franco: What are some other fillers did you guys do? We talked about dilute radius, is there other stuff you guys like to use in the leg buttocks to help us in volume replacement?

Sarah Mack: Yeah, the sculpture is another one that we love. Again, like you said, costs can get a little pricey if we’re talking large volume, but for small volumes, the sculpture is great for stimulating collagen as well. It’s something that we premix in office and have you pre-pay for and then come in and you know, the appointments for this type of stuff, is usually only just about an hour or two like Aveli. So, it’s nothing that’s long and drawn out. It’s something that we can really specifically target areas that are bothering you and treat effectively.

Caro Van Hove: And something on a sculpture that’s important to point out is you’re going to have some immediate volume from the saline and everything but then that volume is going to initially go away until that college information builds back up, right. So, we try to be super realistic, so you’re not like “Wait, what happened, it’s gone.” It’ll come back…

Sarah Mack: Yeah.

Caro Van Hove: You’ve gotta give this stuff some time.

Sarah Mack: …give this stuff some time.

Caro Van Hove: …but something for you to know for sure.

Dr. Johnny Franco: And then other things to just think about is, you know, we’re talking before we started on air here is that, you know, there’s some people that just need a more aggressive, more treatment in terms of surgery, if you have a ton of volume that are trying to replace in terms of shaping, then we look at a Brazilian butt lift, fat transfer, possibly but implants. We also even talked about, if you’re looking at the legs and a lot of skin laxity, then we can even talk about a thigh lift and those type of things.

Because if you’re someone who’s lost, you know, 150 pounds and you have a lot of skin laxity, you know, none of these treatments are going to get you to where you want to be and then I’m not saying that we make not come back and treat some say light spots to do a little bit of fine icing on the cake. But you know, we’re really got to get you to a good spot where those treatments are gonna make a difference for you and, and that’s where making sure that like we’re making steps in the appropriate manner because if we do a thigh lift and we get rid of that majority of the skin and then you just got a little bit around the knees, maybe a little bit, you know, right on the outer hip stuff that we want to tweak, then that becomes a reasonable thing to manage.

If you’re trying to tighten an entire leg after 150-pound weight loss, that’s gonna be super challenging and probably set you up for, you know, disappointment if we’re not doing the appropriately aggressive treatment to begin with.

Caro Van Hove: Yeah.

Sarah Viebrock: Yeah, for sure, just talk to your provider and we can kind of point you in the right direction and set realistic expectations.

Dr. Johnny Franco: Go ahead.

Sarah Mack: Something else I wanted to mention that you just made me think of, you had had a patient that had fallen and had like a kind of indentation to their buttocks. Do you remember who I’m talking about? We went in with radiesse, but we also found that part of the issue is that because of where the divot was, we noticed there was a larger bulge of fat above that divot. And so, that’s where we can bring in eon, which is our touchless, fat reduction laser to kind of just shave down that area. And, you know, through doing consults with you, that’s not necessarily a spot that you’d want to go in and lipo. So, it’s nice to have those little treatments as well, that we can kind of help contour the butt without doing surgery.

Sarah Viebrock: Yeah.

Dr. Johnny Franco: And contouring the butt and legs is a concept that’s only going to continue to – to evolve. I don’t think that the fascination with button legs is going to go away. I think the idea that you just want this massive out-of-control button is probably going to be for, you know, select few individual stuff. But I think the idea to have a nice, perky shape, you know, to your butt and legs, that is not going away, especially now with fashion trends. Can we jump into a little bit of specific combination treatments because we’ve got to talk about all the different things?

You know, one of the interesting ideas, and we’ve started a new package called the boom boom booty, which is a pretreatment for cellulite and then the fat transfer. And this stemmed from a study we had done with a cellulite treatment and we’re actually presenting it at this year’s American Society of Plastic Surgeons, where we pre-treated people for cellulite and then did a BBL. It was interesting because the satisfaction rate in those patients is over 90%. I mean, anyone who’s looked at Amazon reviews, over 90% is high…

Sarah Mack: Yeah.

Sarah Viebrock: It’s good.

Dr. Johnny Franco: …to keep everybody happy. And so – you know, I think it really just goes to the idea that Caro was talking earlier about this holistic approach and people really, really wanting, you know, a better overall shape. It just shows you that, you know, the satisfaction rate is higher in these combination treatments, rather than…

Caro Van Hove: Yeah.
Dr. Johnny Franco: …each one of these alone, and not just by little by a lot…

Caro Van Hove: Yeah.

Dr. Johnny Franco: …which is super impressive and super exciting, probably why we were invited to talk at this international meeting.

Sarah Viebrock: Super exciting. I’m excited for you. I can’t wait to hear about it.

Dr. Johnny Franco: Hold back your excitement.

Sarah Viebrock: I’m so excited.

Dr. Johnny Franco: Sarah will help you with your studies. So, she’s not really surprised. She already knows. And then some of the other stuff in terms of packages that we’re trying to work on, because I do think there’s so many people, you know, you see these round two BBLs, you know, we’re also working on some called, you know, BBL retouches. Because I think there’s a lot of things that you could go. I – I see a day where we have these luxury leg packages where we do you know, some pre-treatments for cellulite.

We do our fat transfer, and then as part of that package, we also have some of the Morpheus — to help with some of the fine texture and skin just like you look at a facelift, right? The idea that you’re going to pull a face so tight, that you’re not going to have any fine lines and wrinkles just doesn’t make sense. Nobody gets out of their convertible and goes, I was going 100 miles an hour, my skin looked fabulous, you know. So the idea that you need to do…

Caro Van Hove: Right.

Dr. Johnny Franco: …some – some volume, you need to do some fine line skin – skin tightening, that’s true for the buttock and legs as well. And so, the idea would be they’d be pre-treated for their cellulite, they would do their lipo sculpting, their fat transfer, you know, and all the things that we do with the fat transfer in terms of like the lip on the bottom or the butt, the little sweetheart, the Victoria’s Secret to shape it. And then, once that heals, we’ll do some – some final touching skin resurfacing with Morpheus.

Then the final touch would be doing like a tweet treatment or a little bit of filler to kind of fill out some of these icing on the cake spots. Because, you know, it’s really a lot of steps and it’s amazing how, you know, this whole journey can really come together, and it’s some of the stuff we’re trying to work with people and – and get a better package for this.

Caro Van Hove: Yeah.

Dr. Johnny Franco: And I think that’s exciting because that’s going to be the next frontier.

Caro Van Hove: Yeah. I totally agree with that. And I think that we as women, most of us are not the most patient right? But I think you all have studied this now so much and you’re collecting – you’ve tried many different combinations, and I think your before and afters are really starting to document kind of what that improvement can look like if you are patient, and if you just follow good guidance, and if you go to experts like you guys that can really kind of dissect all the – the little areas, and I think that should make a lot of women very excited.

Dr. Johnny Franco: And people always ask about recovery, you know. We’ve touched on it a little bit but you know for people who didn’t listen to our other episodes, shame on them number one. Two, do you want to – you want to give them a quick little background like recovery for treatment for Morpheus for like a tweet treatment just so they have a good idea. I’ll tell you, you know, recovering for a BBL, you know, fat transfer buttock. I typically tell people – you know, most people will be back to work in about a week and a half or so can’t – can’t sit on your butt for about six weeks. Really, got a plan, you know about a good two months till you really feel like you’re yourself, you know, you still have a little bruising, swelling and all that shape to take place. So, a little bit of a surgery recovery to CliffNotes. What about for you guys?

Sarah Viebrock: Yeah, so for Aveli, you know, in like you said we’ve kind of gone into detail in some previous episodes, but just to sum it all up, it’s a minimally invasive procedure. You will leak some of that numbing fluid that we talked about for the first couple of hours after the procedure but we’ll send you home with some pads and some compression shorts, you can head back to work the next day, we have you avoid working out or anything that’s going to get your heart rate up high for the next couple of days. Send you home with some Arnica but the bruising is minimal compared to some other treatments.

Sarah Mack: Yeah.

Sarah Viebrock: So, really minimally invasive. Downtime, we’re talking a couple of days. Still, we have you do it about four weeks or so before any sort of like, you know, fashion show if you’re going to be in a bikini or anything like that, but really pretty quick turnaround.

Sarah Mack: Yeah.

Sarah Viebrock: Are you gonna touch on Morpheus’s recovery?

Sarah Mack: Yeah. So, Morpheus recovery, we – we do the treatment in the office, again takes about an hour. So, you’re a little red and pink when you leave. Typically, we’ve noticed within about 48 hours that the redness is – is subsiding. And then we obviously asked you to stay out of the sun for about two weeks, that’s the biggest part of any kind of Morpheus and laser treatments and stuff like that. But overall, not very minimal downtime, people can take Tylenol if there’s any discomfort afterwards. You and I actually just had it ourselves on our face…

Sarah Viebrock: Yeah.

Sarah Mack: …a couple of weeks ago, and I was surprised at the downtime. By the next day, we pretty much looked like we didn’t have anything done.

Sarah Viebrock: Some dryness and that same on the body, and that’s one thing I want to make sure we touch on is even if we’re doing all of these treatments, we still want you to take care of the skin.

Sarah Mack: Yeah.

Sarah Viebrock: So, we’ll recommend some products for you while you’re healing and two, just long-term to keep it moisturized, help with cell turnover, help with collagen production, all of that, but we want to protect the investment, right? So, make sure you’re taking care of your skin product.

Sarah Mack: Yeah, revision body firm is one of the products that we have. That’s really great, just to help kind of a little bit of that textural issue and laxity, just to maintain what you already did.

Sarah Viebrock: Yeah.

Dr. Johnny Franco: Because I think people forget, you know, sometimes we can do all these great things…

Sarah Mack: Yeah.

Dr. Johnny Franco: …but if you don’t maintain it take care of this. I mean, you can really backtrack.

Sarah Viebrock: Right.

Dr. Johnny Franco: And so, it’s still gotta be good about sun exposure…

Sarah Viebrock: SPF. SPF.

Dr. Johnny Franco: SPF stuff. I think yo-yo dieting stretches and skin, so forth like that, especially if you’re treating skin laxity…

Sarah Viebrock: Yeah.

Sarah Mack: Yup.

Dr. Johnny Franco: …and they’re not casting stones, and the worst about yo-yo dieting, but as the older we get, the less our skin bounces back from some of these things.

Sarah Viebrock: Yeah.

Sarah Mack: Yeah.

Dr. Johnny Franco: So really, really don’t want to test and see how – how much your skin’s gonna bounce back after weight loss. So, the more you can maintain, the longer results are going to last because that’s a very common question. How long is this going to last? And part of it, we can tell you in terms of the treatment, but part of it depends on how much you help us take care of this.

Caro Van Hove: Yeah.

Sarah Mack: I’d say that’s the number one question we get is how – when do I have to redo this? When and how long is this gonna last me?

Dr. Johnny Franco: The nice thing and I know you guys are – are having some more approvals coming out soon in terms of the length of the treatment for Aveli, I’ll tell you conceptually, once you cut those bands, they’re gone but that doesn’t – doesn’t prevent, you know, overall aging of the skin doesn’t prevent laxity of just normal aging, especially if we’re having changes in weights and other things like this.

Caro Van Hove: Hormone changes.

Dr. Johnny Franco: Hormone changes, also doesn’t change, you know, if you’ve continued to get sun exposure and changing the texture and those type of things. So, that’s why we bring up so many of these other things that seem very, very minute. It’s funny, because I once had a patient be like, you know, they want to do some stuff for their skin and they’re like, “What can I do? I was like, well, you can use a sunscreen, moisturizer and stop smoking”. “Okay, I don’t want to do any of those. But what else can I do?” And it’s like, “Here’s like the cheapest, easiest things, and honestly, if you quit smoking, you probably paid for all the other things.” But it’s just funny sometimes how, you know, we can be really, really hard on our bodies, and be a little bit self-destructing in terms of making good progress.

Caro Van Hove: Yeah. Yeah. In on Aveli, we – we did a year-long study and so excitingly too, we submitted that data to the FDA, which is the governing body that really reviews all these drugs and devices and clears them okay for release in the US, and we just got our long-term indication. So, that means that Aveli actually is now approved or cleared for the long-term reduction of cellulite.

Sarah Viebrock: That’s great.

Caro Van Hove: So, we know that it is a long-term result, which is great. Having said that, just because you treat your satellites in one area, it doesn’t mean that you’ll be saved from cellulite and other areas you know, and I think that’s an important consideration, so.

Sarah Viebrock: For sure.

Dr. Johnny Franco: Sarah brought up a good point about because we do know hormones play a role and as we age.

Caro Van Hove: Yeah.

Dr. Johnny Franco: Unfortunately, hormones kind of change and then play some of that. And so, there are lots of lots of factors.

Caro Van Hove: Yeah.

Dr. Johnny Franco: What other kind of full luxury legs package stuff would you guys like to touch on before we let people go and let Caro catch her flight because she was nice enough to fly and participate perhaps.

Caro Van Hove: I love sharing all of this too. It’s like sitting here all of us, obviously the head of rebel, but also as a woman, I think it’s amazing.

Sarah Mack: Yeah, I think that – that’s why we’re here, you know, Sarah, and I just have a background in the hospital life for 10 years and I think being able, like you said to, you know, provide confidence and…

Sarah Viebrock: Yeah.

Sarah Mack: …empowerment to women and making them feel comfortable is something super awesome. And I think luxury legs is gonna help even more with that.

Sarah Viebrock: Yeah. I think just remembering it’s a process, right? So we’re gonna give you lots of different options based in it’s – you know, it’s not a one size fits all. So come in and see us so we can really do that assessment to figure out what’s right for you. We’ll build a package for you, and what makes the most sense, you know, give you the order that you need. Like we said, give us a little bit of time to do all the treatments because we can’t do them all the same day, for sure. But you know, we really want this to be a partnership, work together with you to get you to where you want to be.

Sarah Mack: Absolutely. Yeah.

Dr. Johnny Franco: I think that’s the biggest thing. It’s a process and being really upfront about what bothers you the most, where we can get you, and get all those things put together for you, and then – and then figure out a timeline in terms of this. Also, you know, if you’ve had issues, if you’ve had other stuff, I think that the new technology, the new things out there, is going to be a game changer, and it’s only going to get better and better because there’s a few other fillers, some other bio stimulatory stuff on the horizon that are coming out over the next year or two on the market as well. So, that’s exciting. Yeah.

Caro Van Hove: And I think that you know, what’s – what’s – what’s I think so revealing about this conversation is that it’s – it’s so wonderful for women to hear you all talk about this and to know that you don’t have to just accept it. You don’t have to be so deflated and defeated, you know, by all the lower body, you know, concerns. And so, I think that we will be very understanding that it’s a process but it’s just exciting to get started somewhere. And I think you know, you guys a center of excellence and kind of lower body now I think is – is really the great place to go, so.

Dr. Johnny Franco: Well. I’m super excited and thankful to have you join us.

Caro Van Hove: Yeah. Absolutely.

Sarah Viebrock: Thank you so much.

Caro Van Hove: Appreciate it.

Dr. Johnny Franco. Appreciative to have Sarah here as always. Do you guys want to do a quote or…

Sarah Mack: I have one?

Sarah Viebrock: Okay.

Dr. Johnny Franco. Yeah, let’s hear it.

Sarah Mack: Okay. So, this is by Dale Carnegie, and it says discouragement and failure are two of the surest stepping stones to success. And I think that’s really great and applicable to what we’re talking about today because so many people are frustrated with cellulite…

Sarah Viebrock: Yeah.

Sarah Mack: Frustrated with changes in the lower body.

Sarah Viebrock: They try and stop in the past.

Sarah Mack: And it just doesn’t work and I think by having those failures, we’ve now figured out what is actually working.

Sarah Viebrock: Yay.

Dr. Johnny Franco. And we’re going to work with – with them because Sarah has brought it up and I know I’ve repeated this a couple times, but definitely a process, definitely have to be patient, but we’ll work with you to get to a good spot and make sure that you’re you know, bikini ready for next summer. So, that’ll be super exciting. So, I want to thank everyone for coming out.

Caro Van Hove: Thank you.

Dr. Johnny Franco. Super excited. Don’t forget you can listen to us anywhere you get your favorite podcast, ITunes, I heart Spotify, Pandora, or if you’d love to – like to see our lovely faces, you can check us out on YouTube as well. We’ll see you guys thanks for joining.

Sarah Mack: Bye guys.

Sarah Viebrock: Bye.

Caro Van Hove: Bye.