Episode 76: The Skinny Shot

The skinny shot has been one of the hottest treatments in plastic surgery to date. The skinny shot is Semaglutide, the generic name for the medication found in Ozempic, Wegovy, and Mounjaro; it has recently been used as a weight-loss medication that curbs your appetite leading to a decrease in calorie intake. The results have been amazing. Dr. Franco has lost over 45 pounds in just 3 months. At Austin Plastic Surgeon, we use a  compound version of the medication; thus, it does not take from the supply needed for diabetic patients. The shot is great for patients trying to reach their ideal weight in preparation for surgery or who want to live their fit and fabulous lives! Listen to Nurse Sarah, PA Gilbert, and Dr. Franco discuss this amazing medication and how it can set you up for long-term success.


Welcome back to Plastic Surgery Untold, greatest podcast in the world, as voted by us. I’m fortunate enough to have our lovely and super gorgeous staff here and team. So we got Gilbert and Nurse Sarah. So maybe we’ll go around the room, check in and see how they’re doing. And, and then we’re going to talk about one of my favorite topics, something that I’m super passionate about. We’ll be sharing our story, but the semaglutide, the weight loss injections, this has been a, just an incredible innovation and change in in people’s life and our practice, and in my life personally, before we get to all that, I get too emotional. Let’s check in with everybody and see what’s going on. Ladies first, Nurse Sarah? ….I said negative ghostrider.

You tricked him. Yeah. Um, hey, guys, welcome back. Happy New Year, I’m excited to be back on the podcast. Um, lots of new things. I’m in a new house, I just got back from vacation in the Virgin Islands, which was awesome. So you posted some thirst traps? If I mean, you know, call it what you will. But I was just actually showing off my skinny shot results. So we’ll get into that a little bit later. But I too have loved the skinny shot. And back in back in school. So lots of fun, exciting things, because you’re like, halfway there, a quarter of the way there, maybe a quarter. Yeah, you’re making moves, making moves. We’re moving forward, for sure.

Yeah. Gilbert, what’s going on with you?

You know, things in San Antonio are picking up, we’re starting to get a little busier there. I also just got back from a trip not too long ago, I went to London for a conference. It’s a it’s a it was a complications management conference, which, which I think is super important in the world of aesthetics, because, you know, it’s, it’s very easy to, you know, inject stuff into the face. But you know, if something happens, you need to know how to how to manage it, how to take care of it. So I felt that it was my, my responsibility as a provider to, you know, be up to date with, you know, all these different treatments and managements of of anything, should anything ever occur, you know, because preparation is always the best, best solution.

Yeah, no, no question. It’s great, hopefully share some nuggets with us maybe on a future episode. But super cool. But let’s jump into it. Because I think the the semaglutide. And then there’s the, is the generic name for it. But there’s Ozempic, Mounjaro, Wegovy. There’s a bunch of terms out there for some of these new weight loss medications. And maybe Sarah can can kick us off a little bit and, and then we’ll share a little bit of our personal journey. But why don’t you answer some of the most common questions because this has been such a hot topic. This has been something that’s been personal to both of us as we’ve been on this journey. And we’ve been trying to share as much of our journey with all of you as possible. But let’s get into it. Sarah, talk to us a little bit about what semaglutide is, how it works, and what’s going on.

Yeah, honestly, I tell everybody, when they asked me about it in the office, that it’s been the easiest way I’ve ever lost weight. But it’s a once a week injection that we do, goes right into the fatty tissue, we do it, you do it yourself, you do it right under your abdomen. And essentially, it tricks your brain to help you think that you’re not hungry. So honestly, I, you know, you and I talk about this a lot, we’re not, we should be eating probably a little healthier than we are. But we’re honestly eating the same things that we always were just much, much, much smaller portions, probably more like the portions we should have been eating. So it makes it super easy for somebody who’s super busy. Because you can just eat the same thing. You know, if you’re going out with your friends, you can eat whatever they’re eating, you just are not tempted to eat a lot. I honestly am not tempted to eat sweets at all. So once a week, do your shot, kicks in pretty quickly, I’d say within a couple hours. And then you take it, I mean, you just take it from there.

I think the semaglutides are super unique. And unlike other weight loss drugs, they have a few unique properties. And so one is it does affect the receptors in your brain that that causes you to be hungry, so decreases your appetite, decreases your cravings. It also does something called delayed gastric emptying. So it makes, and that’s a little bit of transit but helps kind of jumpstart you, where you know your stomach feels a little fuller, when it’s full like that, causes you to release something called glucagon. So it tells your body that you’re full, the idea is that you’re staying full longer, so you’re not feeling hungry throughout the day.

For me personally, it’s helped me decrease snacking throughout, you know, I eat a more reasonable portion. I think most of us, you know, here in America, like our portions sometimes get a little out of control. And we think we’re hungry. We think we need we need more and that that hasn’t. So I think that’s what’s super unique. I also, you know, super cool in the terms of semaglutide. So, it’s just helped wellness in a different fashion than a lot of other medications. You know, we’ve, phentermine and some of these other drugs that have been out there, they still probably have a place but you know, those were tend to be transient, they affected the heart, some other stuff that we didn’t love where the semaglutides don’t do that at all. Maybe Gilbert talk to us other you know, in terms of other unique properties of the semaglutide.

Yeah, so the interesting thing about it is it it basically communicates with the hormones in the brain and in the in the body, like you said, to delay gastric emptying to help curb your cravings, help curb your appetite a little bit. And so essentially what’s happening is you’re going into this like caloric deficit, because you’re not eating as much as you used to eat, you’re not eating as often. And as everybody knows, if you burn more calories than you take in, you’re going to lose weight. Right? I think you touched on this briefly is one of the questions I get a lot is, is this a stimulant? Is it like phentermine, that’s going to going to stimulate your central nervous system, make your heart race, things like that? And it is absolutely not anything related to a stimulant, which is, which is really nice for a lot of people. Because, you know, some people have cardiac issues, high blood pressure, stuff like that, that they can’t take those those stimulant type medications for weight loss. So I think this is a good way to kind of circumvent that.

I get that question a lot. Does it burn fat? Like, is it doing something specific to burn the fat for you, and you’re truly losing the weight just from calorie deficit, right? Like, all these things are helping you do that. But that’s how you want to lose weight in a healthy way anyways, so this just helps you to do it, it makes it super easy.

So some of the common questions we get for this are one, you know, am I gonna have to be on this medication forever? What would you say to that?

I tell them that it’s dependent on the individual and their goals. Because, you know, everyone has a different goal in mind, I do tell them that, on average, patients that were on the medication for at least six months, last anywhere between 15 to 20% of their body fat, or approximately 25 to 35 pounds. But some people have greater goals than that. And so it may require them to stay on the medication for a longer period of time. But I tried to ask my patients to commit to at least a six month course of the treatment, not only for them to reach that goal, but it was it was also studied, and found that only about 5% of those patients that that did at least six months, rebounded and gained some weight back once they got off the medication.

I think that study was was was huge, because that’s different than any other medication, they looked at over 1000 patients, if the study went 72 weeks, and so the idea was half the patients were on the medication for five months, the other half finished out the whole 72 weeks, they measured everybody at 72 weeks, people only had a 5% rebound after five months, kind of rule of fives there. And the idea is that these medications cause you to truly make lifestyle changes, which is different than anything else out there.

And I think that that’s where that’s where the difference comes in, in maintaining the weight off is because, you know, what is it, what do they say, it takes 40 days to create a habit or something like that. And so, you know, not only are patients using the medication to help lose weight, but we’re also encouraging them to live a healthier lifestyle, we’re encouraging them to exercise more, we’re encouraging them to, to eat better. And if you do that over and over and over again, it becomes a new lifestyle for you. And so essentially, you create this maintenance of your weight loss because you’ve made a change in your life.

And then I’m gonna hit you guys with a bunch of rapid fire questions that we get all the time about this in terms of stuff. How does the process work? Do I have to come in every week, once a month, three months, how does that work?

We typically see you at least once a month, however, we are exploring some options. If you live a little farther away, we have a you know, an option to do possibly a three month, you know period of time for you. So you don’t have to come as often. But we’ll send you with at least a month of medication. So we’ll show you how to do the first shot. And then you do the next three yourself at home or have your significant other do it for you. And then we do want to check in with you at least once a month. So even if we send you with a couple months supply, we’ll typically do a virtual or something because we adjust the dose to make sure that you’re on a good dose for you, that you’re still losing or you’re maintaining depending on where you’re at.

Well most people who are going to be on the three months supply are people who are already at a steady state because you’re getting to a steady state, because we do see people every month and we do adjust your dose to to the side effects, which we’ll get to in just a minute.

Perfect. And I think it’s important to track progress, really, because I mean, how else are you going to know whether the medication is working for you or not? So I think that’s where the follow ups are so important,

Because it is a medication. And so we want to take this seriously, we want to make sure you’re getting to to a good spot, we want to make sure that it’s working for you. And just like anything that’s new, sometimes it takes a little titration. So you basically come in, start you at the lowest dose, we keep ramping it up till we get you to a spot where you’re getting the results that you want, but also minimizing the side effects. And and when people talk about side effects or downsides, what what should people know about?

So I’ll tell you, I don’t even like to call them side effects because okay, because I think that they’re more like a response to the medication or how the medication makes you feel. Not a true side effect. Making me feel excited right now. Yeah, in the sense that most of us know right or are familiar with. So I tell them that, you know, these are like like symptoms or responses to the medication. And I think we can all agree that the probably the most common one is a sense of nausea, right? And the way I explain it to patients, at least cause I’ve been on the medication myself as well, I haven’t had the drastic results that you guys have had. Cause you already look so good.

But.. you’re a married woman.

It’s the red jacket. But for me, it was more a sense of nausea like I just over ate, like I stepped away from the Thanksgiving table. And I just wanted to lay down on the couch and watch football, you know, not not nodulating.

Not everyone gets a sense of watching football, but it is a possible side effect, the football side effect.

Yeah, so football response. But nausea, like like a sense of overheating. There are some people that will experience some nausea to the point where they feel like they want to vomit. There are some individuals that may experience some vomiting, diarrhea, constipation is, is a possibility because of that delayed gastric emptying, that delay in digestion. Some people experience some headaches, some people experience some hunger pains, I’m sorry, not hunger pains, abdominal cramps, or abdominal pain.

But most of those other ones are very rare, very, very rare, very rare that somebody truly vomits digesting if you’re an appropriate dose, and you’re treated for the appropriate reason, and that’s why we evaluate everybody. There are some anti-nausea medications we can do. But again, those are are super rare that people need those type of things.

And I think that that’s why it’s so important for us to titrate slowly, because I get a question a lot like, well, do I have to start on the lowest dose? And the answer to that is yes, because we don’t know how you’re going to respond. You know, I’ve seen I’ve seen both ends of the spectrum where, you know, someone starts on the lowest dose, they don’t have zero symptoms, and then someone starts on the lowest dose, and they’re throwing up for three days straight, you know.

And throwing up for three days straight is very, very, very rare, very rare. So I don’t want to Gilbert to give you guys the wrong idea here. Because most people tolerate it very well and can have a few things the first few days, but no question, we want you on the lowest dose possible to get you to the effect and that’s true for any medi medication in terms of this. What other fun facts, should should people know about the semaglutides.

Honestly, just that it’s a journey, it’s not going to be a miracle drug, although. I mean, it kind of is. I kind of think it is, but um, you know, we want to work with you, like Gilbert mentioned, we want you to create a healthy lifestyle, once you start feeling good, you start incorporating those things that you know we should be doing anyways, like you have been, you know, incorporating the gym into your routine, probably just, you know, if you hit a plateau, work with your provider, so that we can adjust it. Just communicate with us and we can get you the best results possible.

And remember, everybody’s weight loss is going to be different, because everybody’s starting point is different, you know, and so, you know, just to share a little bit of our own personal journeys, I’ve lost about 45 pounds in three months, you know, and so, but I had a BMI of 38. And so you know, people who have a much higher BMI are going to lose more weight, because they have more to lose, you know, for me, you know, I lost more weight than Sarah. Also, my percentage of weight loss was higher than Sarah’s as well. Mine was over 17%. Her’s was only 16%. 16.4%. Not that anyone’s counting, but, but you know, it remember If your BMI is much lower, you know, some people don’t need to lose that much weight. And that’s why we want to make sure that we’re titrating you and getting you into a good spot. Other things that I think is super unique is when we first started the program, we really thought about it as people who were preparing for surgery and those type of things. But it’s amazing. It’s been for people preparing for surgery, people after their surgery, and we’ll get into that in a minute. And then really kind of anybody that just wants to live a healthier lifestyle.

Yeah, and if you’re ready, I’ll share a little bit of my journey too. So I lost about 28 pounds in a little under three months. And I’ve kind of plateaued there, I want to lose maybe another four or five more just to be in a really good spot. And then, like we’ve talked about, I’m kind of, I’ve actually already titrated down a little bit on my dose, and I’m getting kind of at a maintenance dose and I plan to stay on it, like we said for about five or six months at least. But if you don’t know, I had surgery with Dr. Franco about a year ago. And you know, tummy tuck, lipo, breast aug, all the things. It looks awesome and still does. So thank you. But, um, after my surgery, and if y’all have had surgery, you know, this, like, you feel super thin, so you can be like I can eat whatever I want. And that’s totally not true. So I gained about 15 pounds, ended up losing, like I said, almost 30. So I even lost a little more than before the surgery. And I can tell you that I feel like my results just got way better and better. So highly recommend, even if you’ve already had surgery, and you just have a little more weight you want to lose. Your results are only going to get better.

And let’s talk about that. Because there’s the you know, we obviously want you to be in the best shape possible prior to surgery. So a lot of times we’ll help people because in the past people come in with maybe above our BMI cut off, would say hey, lose some weight, come on back, and they’d be frustrated because they’re like, hey, I’ve been trying, you know, that’s why I’m here. And so now we can actually help people get to a great spot. We want you to be in that ideal spot before your surgery. If you plateau, something then then maybe we’re ready. And then even people after the surgery because there’s people who come in, and maybe they’ve put on a little weight. But sometimes it’s not areas that we can treat with plastic surgery, we talk a lot about the visceral or internal fat stuff, you know, diet and exercise, the only thing that can help and it’s funny because we’ve had people either have had surgery with us or other, one of the other great plastic surgeons in Austin, around Texas. And I’d be like, hey, why don’t we try this this weight loss program first and see if you really need it, rather than spending another $10, $15,000 for a surgery that that you probably don’t even need, because it’s not going to address the areas that that are concerning you. So that’s been really cool, because in the past, there weren’t a lot to do for patients that had some of these issues. Because we all put fat in different areas, we can’t really control where we put this fat. And so it’s nice to be able to treat all the different areas now.

Yeah, I totally agree. If you look at my before and afters of my weight loss, you can see like, obviously, with the muscle plication, and the tummy tuck, I was, my abdomen was pretty flat, but like the whole thing was a little bit round. So definitely, I think there was some internal fat, and also just the changes in my face. And like other areas that we didn’t treat, my arms, you know, because typically, when you lose weight, you lose it everywhere, at least a little bit. So, again, I’ve been super happy with the results.

Here’s another common question I get is, I’ve been on Mounjaro, Ozempic, it’s either become too expensive, or I can’t get it. Can I switch to the generic semaglutide? Is that an option?

Absolutely. And the transition is pretty seamless, as a matter of fact. So, you know, based on the dose that they were on for their previous medication, we just kind of set them up with what would be equivalent to that and just make this transition, you know, from one to the other.

So if they bring their their current dose or old box of what they had in the past, or their old prescription, we take care of everything for them?

Make it super easy. Yeah, awesome. Another question that I get is, if I’m doing this semaglutide, you know, am I taking away from the supply for diabetics or other people that need Ozempic or Mounjaro? Is that true?

That’s a great question. I think it comes up quite a bit. So our source of the medication comes from a compounding pharmacy. So we’re not, we’re not utilizing medication that is created by the the manufacturers, the companies that that got this medication FDA approved. So, so in essence, that that medication is still available for those patients that need it, we’re getting something from our our pharmacy, which is a compounding pharmacy, that makes the medication for us specifically.

And so I mean in common assets, it’s actually protecting some of that supply, so that people are are using the medications for what they’re actually actually for, in terms of that. Right. Another common question I get is, is, is the compounded semaglutide, you know, as efficacious as like an Ozempic, or Wegovy in terms of some of these medications?

I would have to say, absolutely, I mean, it, they have to use the exact same ingredient, the exact same ratios, exact same compound. So it’s really no different. The only thing that, that I will say is just a little variant to to the medication that we have in our office is that in, in my understanding of it is due to patents that are held by these companies that make the medication. It can’t be exactly the same, so the compounding pharmacy adds a little bit of B12 to our medication, which the way I explain it to patients is it’s kind of just like a little extra energy boost to your to your medication.

So I think you know, not to bore people with with kind of some some history about this stuff, is that semaglutides have actually been around for a long, long time. And so they’re actually a very simple molecule, which is super cool. And the the idea is that, you know, you can’t make anything that’s exactly the same as others. So, you know, a lot of the other drugs have either other additives, other things in them. And so, you know, it’s definitely a little bit different than that, the active ingredient, you know, and this, this is sort of like toxins, right? So the active ingredient of the toxin is similar in the different companies, the semaglutide is the same, you know, the semaglutide itself, you know, is the same in these, but I do think, you know, and I agree and disagree, I think from a compound pharmacy, it can definitely be as efficacious, I think, you know, we take a lot of care and pride of which compound pharmacies we use. And I think like almost anything in the world, you got to be careful if it’s too good to be true. We use American compound pharmacies, we use the pharmacies that we were already getting some of our other medications from, our numbing cream, those type of things. So I do think we have to be a little careful of where you get these from. I’ve already seen some advertisements from out of the country, from other stuff, I think then not saying that they’re not good, but it’s sometimes they don’t have some of the same regulations that we have here in the, in the United States, which are holding a lot of these pharmacies to a very, very strict standard in terms of sterility, you know, reproducibility, in terms of those things. So I think they can be, I think you got to be a little careful, if it’s too good to be true, maybe ask a few more questions. Is that fair? Yeah. I think cause and that’s why we’ve been so selective about who we get these medications from. What what other common questions do you guys get?

Um, I feel like we’ve covered or how quickly I would say, you know, a lot of people ask how quickly am I going to lose weight? And again, I feel like that’s very, like a very personal thing. It totally depends on if you, you know, like if you’re working with so you know, the last stubborn 5 to 10 pounds, it’s gonna take longer, and that’s kind of where I’m at, now I’ve got like, just five to seven more pounds that I want to lose, it’s definitely taking longer, if you have 15 to 40 or more pounds, it tends to come off faster. Again, that’s why we titrate the dose so everybody’s a little different for me, and for you, you know, it was, it’s exciting the first couple weeks, because you definitely start to see a few pounds come off. Be better than me. Don’t obsessively weigh yourself every day, because then you can drive yourself crazy, because it does take time.

And I always tell people, you know, people’s weight loss is going to change because if you’re just dependent on this medication, you’re not making any other changes in your life, like I was telling you, you should use this as, this is a booster, this is an adjunct, this is like a, you know, your, your motivation to do this, this is going to help jumpstart you in terms of that, but you know, you got to be committed to make some other overall lifestyle changes and the more changes you make towards a wellness and healthy lifestyle, the more results you’re going to see, the better you’re going to, quicker you’re going to get there, the longer you’re gonna be over longevity, and also to and and you know, I’ve almost have I’ll be honest, even though we use the term Skinny Shot, I have a little bit of mixed feelings about it. Because it’s not about being skinny, it’s about being in a very healthy wellness area stuff. Because all of us have a different body frame, I got thick thighs, I’m okay with that, you know, and it’s just, it’s just getting you to a spot where you’re super healthy, and my family and I’ll tell you, you know, diabetes, hypertension, those things run run in my family, my, my dad personally was going to, had retired, he had to put a six months notice in at his job, and then and then was going to move here to be our practice manager and, and then actually had a massive heart attack his last week of work, you know, at the age of 68. So, you know, super, super young. And so for me, if I didn’t make some lifestyle change something, you know, it wasn’t gonna go well, in terms of, you know, just overall, you know, lifestyle and wellness. So, I think for a lot of people, it’s just helping them make moves. And a lot of people like myself have have tried things, the problem with some of the other diets out there is you can lose weight quickly, but it’s hard to sustain and and that’s what’s been super exciting about this. And it’s been in some of the articles like in New England Journal of Medicine that have argued that some of these new medications will, you know, replace bariatric surgery, sorry to any bariatric surgeons out there. It’s still still TBD, to see if that’s true. I think there’s gonna be some places for that. I also think that, you know, super interesting in terms of how this changes the longevity of decreasing the rate of diabetes, hypertension in America, and I think those are going to be crazy, crazy changes over the next 15 to 20 years, right? Because a lot of stuff happens over over time. You know, there was also an article that argued that that the semaglutides, you know, if you took, really like Ozempic, Mounjaro, those generic, that it will be the number one most prescribed medication in America in 2023. That is super crazy exciting.

I believe it honestly, I believe it. It’s not just about being skinny, like you said, I mean, I have more energy, you feel more confident. Overall, I feel like like you’ve said, it’s a general wellness that we’re aiming for. So I couldn’t agree more.

Who’s a good candidate for this? Because I think we get it a lot of times so I mean, maybe I’ll rapid fire some things that you, men or women, both. For men, can we just talk about it because I feel like women get all the love on the show. And so when you talk about men, because men sometimes come in for lipo, and a lot of men tend to carry their their fat intra-abdominally. And not that we don’t want to do lipo and stuff in men, you know, but it’s sometimes the intra abdominal, the visceral fat, what people used to call a beer belly, but honestly, it can be a breakfast taco belly, it can be a brisket belly, it can be a cheesecake belly, it can be anything, but it’s that intra abdominal fat that we just surgically can’t do anything about.

You can’t access it right. At least not with our, for our purposes.

So So I think a lot of men have done this, a lot of our patients have brought their significant others because I think just like like my family, they see what happens to other family members. And they’re just trying to get them to a healthy style. They love their ones. And it’s, I’ll tell you personally, and I know I keep bringing this up, but I’m super passionate about this, for my little brother, you know, I had him get started on this, you know, because I was like, if you don’t do anything for yourself for Christmas, like let’s, let’s take you, let’s get you started because, you know, I think this is important, this is going to make a change for you. And he started over the holidays and he’s down 20 pounds in just less than a month. You know, he was a higher BMI sort of, sort of like myself, so again, don’t want to give people false expectations. But if you’re in that higher 38 to 40 BMI range, you know, people do tend to lose it a little faster at the beginning at least. Other kind of rapid fire questions stuff is what is a weight that you’d have to be or BMI that that you would really consider this.

So, I would say for our surgical patients, anyone who has greater, has a BMI greater than 30 would be an excellent candidate. Because you know, for the sake of their safety in surgery, we want to make sure that that BMI is under under 30.

Just because that’s such a good point. One of the reasons we don’t do this, just to try and like, you know, make it difficult for people. It’s been shown that the lower that BMI, the less chance of complications, wound healing, DVT, blood clots, all those type of things. So there’s a reason that we’re doing this, and it’s your safety, along with you just having a better aesthetic results. Great point.

Yeah, thank you. I think for you know, the average person that’s just trying to get healthier, look better. You know, it’s again, it’s going to be dependent on on them and their goals. But, you know, anyone that that is considered overweight by the BMI scale is certainly a good candidate. And that varies because you know, if you know, the BMI scale, it takes into account your weight plus your height. And so there’s this whole graph that you look at, and, you know, some people are considered normal weight, some are considered underweight, overweight, and then obese. And so for, I think, I think for like, you know, just average people that want to look better, feel better, be healthier, if they fall into that overweight category.

And remember, we use BMI as a general rule. That’s why we’ll see in the office, there’s definitely some people that carry a lot of visceral weight that that may not be some of our muscular people may may be in an overweight, but they actually are super fit and don’t need it. So we use that as a general guide. But we’ll actually see you in person, we’ll take a look at you, we’ll hear you and just just depends a little bit on that some of that gray area. Just a general rule of thumb. Yeah. Awesome.

What other common questions do do you all get? What do you think Gaby? I feel like we’ve covered the main ones.

I think some other common questions that I get is what happens if I miss a dose? You know, do I have to start all over? Set me back and honestly, I’ve forgotten on, I do mine every Friday, sometimes I forget. It’ll be Saturday, Sunday, just do it, you’ll start to get a little bit of your appetite back. That becomes less and less. So I think that that’s a common one.

I’ll tell you, I forgot to do my dose before I left for St. Thomas. And I was on a pretty high dose. And I actually was talking with Catherine, our PA because she had been doing my taking care of my dosing for me about decreasing before the vacation anyways, because I’m not gonna lie, I wanted to be able to enjoy more food and frozen drinks than probably the shot would let me enjoy. So I ended up, I truly did forget, I didn’t do it on purpose. So I went the whole week, because I was gone seven days in a few you know, a few days before that came back. I still felt it through at least half of that next week. So I don’t that’s not something I recommend. But if you forget, just give us a call because I probably, you know I went longer than we’d recommend. And I ended up decreasing just a little bit, jumped right back in with no problems. So it’s totally adjustable. And I’m the same way, I’ve kind of adjusted the day I take it, if we have an event coming up or I want to do it on Thursday instead of Friday. So I love that it’s a little flexible.

I don’t plan my shot around Sarah’s events, but I try to remember the same day but no question people can do that. I do think you know, no question when you change your dose, if you go up and we bump you up, sometimes you can get a little bit more of different effects from it in terms of that. The other question is can I still eat and do everything that I want. I’ll tell you that the two times I’ve had some some some kind of upset tummy or a little bit more nausea has been Texas Monthly barbecue, which was great. Wasn’t great afterwards, and then going to visit my brother in in DC because his wife made a ton of cheesecake, sides, stuffing so I do think you got to be a little cautious of overdoing it at the beginning. Fizzy soda stuff, things like that, were, made me feel a little bit full, sort of like Gilbert was saying earlier and, but but honestly a lot of those get a little bit better with with some time, which I guess is good and bad upon you to cut some of those things out. If you’re watching us on YouTube… on now. So, sorry about that.

I’ll say that I get the question quite a bit too is can I kind of have any alcohol while I’m on this medication? And the short answer is is yes, you can, it’s not going to affect you in any negative way, but you have to remember that alcohol has nothing but like empty calories, right, and so you’re taking in these calories that have no nutritional benefit for you. So you might be kind of just delaying some of your progress basically, but from a from a safety standpoint, it doesn’t it doesn’t limit you from drinking or anything like that.

Other than, than you do feel full faster just like anything else, so you know if you’re a beer drinker and you know you can definitely get have that overly full thing but but not even just beer but any any just a large amount of fluids can make you feel a little bit full faster. I think that’s the only other thing but but honestly not bad because I I’ve definitely I wasn’t a big alcohol drinker but definitely decreased pretty dramatically because I just feel full so fast.

Yeah, I’ll say that I probably don’t even, you know, drink as often as I used to since I’ve been on the medication which which is good.

And I think that some of the things that the semaglutide has helped because most of us don’t just sit down and be like, Oh, I’m gonna eat four plates, right? Most of us, it’s all these empty calories that add up throughout the day, whether it’s, you know, the fabulous patients that bring us Tiffs Treats, whether it’s, you know, a bag of potato chips, because you’ve been running, but you know, whether it’s a glass of wine before, you know, with dinner or before bed stuff, but you add up all four or five of those throughout the period of the day, and there’s just been some sneaky calories that really didn’t make you any healthier. And you know, but definitely have added over the course of time.

Yeah, yeah, I feel like it really, really helps with cravings. Like when we’ve gotten like Tiffs Treats in the office. Now honestly, I’m not even tempted like where, obviously it smells great and looks great. But, and I won’t say it works that great for everything, but definitely significantly decreases cravings, which I think helps with alcohol. And one other thing that I noticed, and especially for like those of us that are busy running around, whatever, which is almost all of us, I’m sure, I got nausea typically if I needed to eat, like I had gone too long without eating. So that’s one other thing I like to point out, like, sometimes you got to make sure that you are eating enough, because I did notice if I wasn’t eating enough, I didn’t have enough energy. So just make sure you don’t get too busy and you’re not eating, we still want you to make sure that you’re getting enough calories in. If you’re feeling nauseous and it’s been a long time since you’ve eaten, just try eating a little something and I tell my patients try to get some stuff with high protein.

Yes, just because if you’re not eating a lot, we definitely want you to get enough protein. And one last thing on that topic is something else I personally struggled with was getting enough water because we talked about liquids make you feel full. And that can definitely affect constipation and other things like that. So just try to stay super hydrated, try to stay on top of your protein, so that you don’t run into some of these other side effects or medication responses as Gilbert referred to them as.

I think the last thing I would I would share about the the semaglutide program in our practice is we actually are in the process and over the next couple of weeks adding an internal medicine doctor to our practice, because I think there’s a lot that goes into wellness. And I think this is going to be absolutely fabulous. And we just want to keep improving this so that we can help people reach their, their fitness journey, whatever that that may be individually for them. And I think there’s a lot of things that contribute to this, I think, you know, portion control and appropriate doubt, calorie intake is one portion of it, but it’s not the only one and we’re also working on on adding some fitness and we’ve worked with a few fitness trainers and stuff and then as a nutritionist, so more things to come. So I’m super excited about that over the course of the year. Any any last take home messages for our longtime viewers, sometime DMers.

All I’d like to say is that as as a whole, I think, you know, sometimes patients think of plastic surgery as being truly just aesthetic, and maybe in some in some way or another, rather superficial, but I think we’re taking it to a different level in the sense that we’re we’re not only taking care of what people see on the outside, but how they feel on the inside to when when we’re talking about, you know, these semaglutide weight loss programs, some of these other wellness programs that we’re hoping to incorporate pretty soon, so I think that that sets us apart from a lot of different plastic surgery groups in Austin and you know, across the country, that we care enough to take care of our patients as a whole.

Sarah, I couldn’t agree more. For me personally, it’s been a game changer. I couldn’t speak highly enough about it. If y’all have any questions, you can actually now book appointments online. So go to our website, go to our link on our Instagram, we have, you know, that link posted lots of places, but you can book weight loss consultations right online if you are interested.

Well, I appreciate you guys coming in and giving up your Sunday to share our passion, the semaglutides, which I think is is going to only continue to evolve and and keep helping more and more people, so for all of you longtime listeners, sometime DMers, Plastic Surgery Untold, you can download us wherever you get your favorite podcasts: iHeart iTunes, Pandora, Spotify, and many more. Also, if you’d like to see our shining faces, feel free to watch us on YouTube. And we’ll see you guys soon. Thanks, guys. Bye. That was good. Great. And this one.