Episode 78: Non-surgical treatments post weight loss

With Semalgutide and weight loss medications becoming all the rage, people all around us are losing weight at a fast rate, and with rapid weight loss comes skin laxity. In this episode, Dr. Franco, Nurse Sarah, PA Gilbert, and Aesthetician Andrea talk about non-surgical procedures that patients can have done to tighten loose skin and help them achieve the look they want when they are at their goal weight. Patients can get RF micro needling done to tighten loose skin, filler to create a snatched, youthful, full face, and neurotoxin to prevent and help with wrinkles and fine lines. Listen to this episode to learn how to achieve the body of your dreams after weight loss through nonsurgical treatments.


Welcome back to Plastic Surgeon Untold, greatest podcast in the world, as voted by us. We’ve got a special topic today, you know, with all the weight loss and the Semaglutides exploding. The question is what do you do once you’ve hit that goal weight because while it’s absolutely fabulous from an overall fitness, wellness, longevity, just living your best life, sometimes we can get a little bit of loose skin when we’ve stretched it out a little bit. Sometimes when we’re not 18 or 20, our skin doesn’t bounce back quite as much as we’d hoped. But there, don’t worry, your overall health is the most important, we can help you with the rest. So we’re going to talk a little bit about some non-surgical ways to kind of tighten up that neck, contra that jawline, just making you look on the outside as good as you feel on the inside. But before we get to the good stuff, let’s just run around the room, catch up with our celebrity crew here and see what’s going on. So Andrea, what’s been new with you in the SA and how’s school and everything else going?

Great. I am so excited, this upcoming week we’re actually having an influencer coming in on Thursday for Vivace, so I’m super excited. Ooh, that must be because you guys are so famous. *laughs* Exactly that. Sarah, what’s going on with you. Um, same, still in school, going strong, staying busy. Y’all are keeping me busy in the office, which I love, love seeing all my beautiful patients. And I’m excited about this topic because as you all know, I lost quite a bit of weight on the skinny shot, almost 30 pounds. So little do y’all know I’m about to put myself on your schedule for all these treatments that we’re about to talk about. So stay tuned for my own before and afters.

Gilbert, what about what about you, what’s going on?

Oh, just living the dream. Still splitting my time between San Antonio and Austin which I love. I love going down San Antonio scene. Seeing all of my San Antonio patients. I love being in Austin. Obviously, cause that’s that’s home for me. But yeah, it’s just been it’s been an exciting ride. Well, let’s jump into it. Let’s talk about it. Because I think this is something that sometimes people get super excited. But as you start to lose some of that, you know, and, and we see in a lot of places you can look great from like the neck down and you’ve lost a lot of this weight. But even sometimes tummy a little bit, you get a little bit of skin laxity. And for a lot of people, it’s just a little something but you feel great. You look fabulous, you know in terms of how you feel, but you want to just kind of either accentuate that, kind of that neck a little bit, accentuate that jawline, maybe maybe lift those cheekbones a little bit, what are some options that we can do to start kind of tighten up that skin get you to a good spot, especially as most of us who are pretty younger, are not really neck, facelift candidates at this point, we don’t need that way too much.

But what are other options?

The Vivace RF Microneedling.

Talk to us a little bit about microneedling. I know that’s a hot topic.

Yeah. So it’s one of the comfortable, most comfortable RF microneedling treatments on the market. It’s really amazing from what I’ve seen with my patients, it’s very little downtime. They’re pretty much like bread after the treatment. But as soon as we do the mask that comes with it. It’s like super light pink, and they’re like, yeah, the next day, I’m totally fine. So it’s really nice, because with spring and summer coming up and with people wanting to vacation, it’s really hard to tell them no swimming, no doing all the fun things, you know, have a few days of downtime. So with this, you’re really only looking at one to two days of downtime.

And who’s a good candidate? Like what what would be somebody who needs this? Who’s gonna benefit from Vivace and RF Microneedling?

Pretty much anyone who has any skin laxity issues. So for a lot of our patients who are on the skinny shot, we’ve been you know, seeing a lot of them come in and really wanting to focus like on the submental area, or the stomach, pretty much anywhere where they’re having a little bit of that loose skin. And this can treat anywhere like the the neck, the jowls, I mean, can you go, can you even do some some cheeks, brows with this area?

Yeah, full face. And then and then for the treatment itself, is this something that I’m one and done? Is this something that I need to do every six months? How does that work?

Yes, so typically, we recommend about three treatments at four weeks apart.

And when should I do this in terms of my overall journey? So, should I wait till I get to my goal weight once I start seeing some skin laxity? Should I start doing this? When’s the best timing for me?

Probably when you’re at your goal weight, because we can see significant improvement and then as you continue to lose weight and kind of lose, you know that skin can get a little saggy again, so probably when you’re at your goal weight.

Okay, and then can this be combined with other stuff? So, if I was doing some RF microneedling and then, you know, also wanted to chisel my jawline or do something like that, because when we lose weight, unfortunately, we lose in the places we do and don’t want to do, so it’s great for getting rid of that visceral fat, other stuff. But if you’re like me, my face is the first place that I lose fat. My tummy tends to be the last, but I’m trying to get there. Can we combine this with other and if we do, what what should be the order?

Probably lose the weight first and then come and see me.

No no no, but I’ve already lost the weight.

Oh I’m sorry.

Should I do filler, should I do RF microneedling, does it matter? Can I do whatever? What’s the…

I would I would probably say do the the RF microneedling first, followed by the filler and then the toxin at the end. If that is something that you’re planning on doing all in one day, then that’s the order I would probably recommend just from, from a safety standpoint in terms of making sure that the micro needling doesn’t affect the products that we’re using for these injectables.

But if I got fillers, you know, a month ago, doing my RF microneedling or something that’s not gonna change anything I can do?

Not that long. Yeah no.

I have in in Austin, we have Morpheus, which is another brand of RF microneedling that we love. So we can definitely treat you at both locations with that. I have a lot of patients that do both of those treatments, so filler, and Morpheus in Austin. I tell them like, if I could pick your treatment plan for you, in my ideal world, we would do your Morpheus first. We would wait and do your filler on another day, just because there is some inflammation. So you know, if you’re from out of town, and we need to like talk about doing it in the same day then we can talk about that, but you will have some inflammation and when we’re talking about chiseling the jaw or lifting the cheeks, I want to see your face, you know, essentially at its most lax state. So I’d like you to wait at least two weeks afterwards. But definitely, we can either do your series of three and then do your filler if you’re willing to wait. But if you’re like me and you want your jawline, hurry, to hurry up and look great, then we can talk about spacing this out for you. I want you to wait at least a couple weeks after your filler, before your next RF microneedling. And then you should be good.

I could see a lot of people wanting to do like a jawline filler right away, because that’s something that people see instantly. But with RF microneedling, correct me if I’m wrong, but you’ll see a, probably a little change with some of the inflammation, get back to baseline, but then take several weeks to start seeing some of that that skin tightening, that collagen building and so forth.

Yes, correct. Especially with the laxity you know, I do want to highlight, I love these treatments, I recommend them to almost everyone because you’re gonna get other benefits, pore size, you know, reduction, fine lines and wrinkles, overall skin texture, I love it for all of these things. So you’ll start to see some of those other benefits quicker, but specifically for skin laxity, I do feel like you need the series of three, you know, each treatment that you do is gonna get a little bit better.

And then, like the procedure itself, if we’re talking about RF microneedling, is this something I can drive myself to the office? Do I need somebody to drive me home? Am I asleep for this? Do I just do numbing cream? How does this typically work?

No, you can come in. We have multiple options to make you comfortable. We have Pro-Nox, numbing cream, and Pro-Nox wears off like in five minutes. So yeah, you can come in.

And Pro-Nox is the, is that the laughing gas stuff from the dentists? Yes, it is. Okay. So that one, I can just kind of stuck on a thing. Get into my little happy place, and then you do your magic. And then when it’s done, I just hang out for about 20 minutes. Yes. Awesome. And then you said numbing cream is something that we typically do.

Yes. And we numb you for about, for me, I numb for 30 minutes, and then we get started. And the treatment itself takes about 30 minutes. So you’re looking at an hour in the office.

So, 30 minutes of treatment time for my whole face and neck?

Yes, I can get it done pretty fast. I’m a professional. *laughs* Okay. Yeah.

I mean, I like efficient, especially if you’re trying to do this and then and then you were saying most people can, will have a little bit of redness. But if I wanted to go back to work the next day, can I? Most certainly yes.

You can even go back to work the same day as long as you don’t mind looking a little red and inflamed. Safety wise, there’s no issue there. Just know you are going to look a little red, a little bit inflamed. I agree with Andrea, even with Morpheus, a lot of my patients next day, very minimal redness, maybe some really mild like pinprick red marks for a couple of days. But we’ll send you home with some products that are safe for you to use that’s going to help with that inflammation, help you heal up quicker, go back to work, avoid exercise for at least 24 hours. But other than that, same with makeup, at least 24 hours, so no makeup if you’re gonna go back to work, but other than that you’re good.

And then our… Vivace, Morpheus, they’re good for other areas besides just the face. And I know that we do a lot of blood and leg stuff because you know, when you lose weight, sometimes you can get a little bit of that skin laxity and obviously we’re not talking about this being a replacement for you know a BBL or a thigh lift or those type of things. But if you just got a little bit of laxity around the knees, close to your thighs, those type of things. These are great options for that as well. Correct?

Correct. Absolutely. Yeah, I love Morpheus or Vivace in the body. Um, I’ve seen a ton of patients, like you said, for the knees, the abdomen, even the arms. Um, I feel like it’s kind of a forgotten area, but that’s something that’s picked up recently. I feel like women especially and I started to notice it on myself after my weight loss. And just as we age and our skin loses that collagen, we’re forcing the skin to wake up, make that new collagen, so everything can kind of tighten and look a little bit better. So, don’t forget about your arms.

And this is something though, that you know, you’ll do your series, but most people are probably going to do some RF Microneedling at least at least once a year, correct, because unfortunately, it took turns back the clock at a time but it doesn’t doesn’t stop them.

Yeah, that’s my favorite saying. It turns, it’s, we’re going to move you backwards on the time clock of aging, but we’re not going to stop you from aging. So I, everybody’s a little different. And of course, it depends on your budget, I recommend at least one maintenance treatment a year. If it’s been longer, you may need to repeat the whole series of three. And also depends on your sun exposure and your skincare and all of that.

Can we touch base on that for just a minute, because I think people sometimes sabotage themselves unintentionally, in terms of, I mean, there’s so many cost effective things you can can do to keep you in a good spot. And maybe we can touch base on some of those. What are some nuggets to kind of keep your skin looking good if you if you have if you’re, if you could go back to when you were like 12?

Okay, that was like three years ago,

Oh my gosh.

Kidding. For sure a retinol, that’s like the number one thing you need. As far as like doing your Vivace or Morpheus treatments, you want a good skincare product to maintain the skin because a lot of people will purchase a round of treatments and invest and they kind of just don’t do anything. And it’s like, no, you want to use some really great products to maintain your investment. So it’s super important.

What about a something to hydrate your skin? Is that important?

Oh, yes. So here we glow moisturizer, I love that. Sunscreen, sunscreen is super important.

I feel like sunscreen is the forgotten one. I mean, it can be super cheap, that you should start, the idea of getting like your good sunburn that we get in the summer that, those days are gone. That is by the wayside. Gilbert used to be in dermatology and maybe he can touch base. But I mean, sunscreen is something that you should do for yourself, you should do for your kids, you should do for any your loved ones, get them started as young as they possibly can, because it’s, preventing the damage when you’re a little baby kid is so much better than waiting till your till your older because that damage builds up over time.

Allow me to put my DERM hat on. But yeah, you’re right. Absolutely right. You know, the, the skin cancers that we see in in adult patients are not due to the sun that they’ve gotten in the last two, three years. It’s actually sun exposure that they’ve they’ve gotten over the like last 20 years. And it just takes time for all that UV radiation to affect the cells in a way that it creates these, these cancerous cells. So yeah, sunscreen was going to be my my suggestion, in terms of what else you can do to help make this investment more worth your while because there’s really no reason why you shouldn’t be using some some sort of some sort of sun protection.

And just limiting sun exposure, probably wear your hats, if you’re going to be out, you know, your APS hat. You know, if you don’t have one, hit us up. But just limit, I try to be really good about wearing my hat if I am at the beach and put on my sunscreen.

And I think we’ve talked about in the past like you know, where are you going to go after your semaglutide, how long are you going to take this, I think it’s super, super important once you reach that goal way to really try and maintain that and, and definitely the you know, one of the goals with the semaglutide, which has been super unique is that people tend to only have about a 5% rebound once they’ve stopped it. I think you want to stay pretty vigilant about keeping, maintaining that healthy lifestyle because unfortunately, as we age, our body just doesn’t bounce back like we used to. And so if you do do some of these these great techniques like the RF microneedling, like the Vivace, Morpheus, but you gain weight, lose it, you can backtrack a little bit, because the older we get, unfortunately, the less our skin bounces back, we don’t want to keep testing our luck and really putting pressure on on Sarah and Andrea to to get our skin just tightened right because then you may have to see myself or Dr. Weinfeld or Dr. Arredondo for for our neck left, other things. So trying to keep you from from having to undergo those type of things.

And then timing in terms of this, you know, because I think it’s also super important, if you’re losing some weight, making sure you’re getting to a good spot because I think Andrea alluded to a little bit, if you try and do some of these treatments, and you still lose a lot of weight, you may feel like you’re not getting a benefit. And I honestly have mixed mixed feelings just a little bit because you just have to know because some of the benefit of treating some of that before you you lose a ton is that you don’t get to a really bad spot. Because I think it’s been harder to do, sometimes I think it’s nice to kind of treat stuff as you’re losing, so that you never get to a spot where you have so much loose skin. But I think you have to be super upfront with patients like, hey, look, you’re losing weight as fast as I’m treating it. So if you’re doing that, you may just end up being kind of at a baseline, but the goal is that we’re trying to keep you from having a lot of extra loose skin. So I think there are ways to do it if people just don’t want to wait till they have a ton of loose skin to to do these treatments, just being super upfront that like hey, you know, if you’re losing a lot of weight, and we’re doing these, we may just be holding the line, you know, but I think that’s reasonable and some may be attractive to a lot of people.

Absolutely. Yeah, same thing with like acne. You know, if you’re here for acne scars, and I’m treating you and you’re still breaking out, you’re creating new scars. So it’s kind of the same approach.

And no question if you’re treating for acne, definitely should be on a regimen to treat that if you’re doing some of those things. Just since we’re on a, I know it’s a little off topic, but since we’re talking about RF microneedling, what are some other great treatments for it because a lot of times, people will kind of combine the…. also it can treat what other things?

Stretch marks. Those are like my new favorite. So a lot of the smaller ones go away, the larger ones do fade. Obviously, with any treatment or cream out there, you can’t really fully get rid of it unless it’s surgery. But yeah, so stretch marks is a great area.

Even in surgery, we can’t completely get rid of all your stretch marks. Yea, not all of them. No question, I think there’s ways to make it better. There’s also some lasers… some redness, the stretch marks are fresh. I think there’s a lot of options for that. Also, for our surgery patients that aren’t microneedling, SkinPen are great options for treating these scars, correct? Yes, correct.

And I’ve seen really amazing results just with one treatment alone. My patient the other day said her massage therapist even noticed as well. So it was really nice to hear.

Super incredible. And a friend of mine in in Philadelphia was the, one of the ones who pioneered the study on this, but our whole paradigm shifted about how we treat and manage these scars. We used to wait until they were fully mature. And he had published a paper recently about treating these at six weeks when those scars are still developing and kind of makes sense, you know, as they, we were, also surgeons tend to be a little bit babies, we don’t want to mess with them. We want everything to heal well. But but being aggressive about it, you know, right after the surgery tends to give the best results. And I think somebody mentioned it earlier, being proactive, you know, prevention of these and waiting, not waiting until they turn into thick scars is probably going to give you the best outcome. Looking back it makes sense now, but we’re also a little a little hesitant to try new things.


What other tricks, pearls do you guys have for treating people that have some skin laxity, trying to improve their overall facial contour or other areas after, you know, kind of some some post weight loss with with semaglutides.

I’ll tell you something I’m excited to do myself is Sculptra in the face. I feel like you know, especially if you know you’re a little more mature, your skin can get a little thinner. And when you lose weight, it can make you look a little hollow. So I still definitely love your typical hyaluronic acid fillers to sculpt you know, accentuate your cheekbones, your jaw, jawline, and all of that. But I love the natural result of some sculpture. And I know Gilbert can tell us more about that.

Here’s here’s a bold prediction before Gilbert jumps into this. 2024 Sculptra will be in a massive explosion and probably be the number one filler in 2024. Because by then, people will be a year out from the semaglutides which are exploding, people are gonna lose weight, it gives people a natural fill, it improves their overall skin texture stuff. So, you know, two years from now we’ll go back. I believe you… And be like Franco called it.

I’m in support. Yeah.

No doubt Sculptra is is, it, in a class all of its own, you know, it’s it’s, it’s a totally different product than what we are used to using with the hyaluronic acid fillers. It’s Poly L Lactic Acid, PLLA, which basically is kind of like an absorbable suture type material that surgeons use when they’re in surgery. It’s very similar to that. And so essentially, what it does is when when it’s injected into the tissue, it stimulates collagen production. And then over a period of time, it kind of dissolves, because of those, those little molecules of that absorbable suture. So you don’t have any like product left in the tissue. But it’s already been doing the work because it’s stimulating the collagen production. And so it’s called a bio stimulatory and no doubt, I think it’s going to it’s going to play a huge role in in, you know, a lot of these patients. Because, as you mentioned, the face is one of the areas where people tend to lose weight first, or at least it’s more noticeable. And so there’s going to be some hollowing of the of the submalar area, the cheek area, the temples, and some of those things can sometimes actually make a patient look older than what they really are. It really can age them. So no doubt it’s going to help kind of maybe bring some volume back a little bit more in a bio stimulatory kind of way, more naturally in a sense, with using these types of products.

Without making you look wide. I feel like when we talk about adding like filler to the cheeks and the jawline, and even Sculptra. A lot a lot of my patients ask like, is this gonna make me look wide? And I’m like, no, we’re actually contouring and it makes you look thinner. But with Sculptra, I feel like it’s going to be a supernatural volume, just makes you your skin look youthful, right? Younger. So yeah.

Now if I was getting filler for the first time, would you recommend Sculptra?

I think it depends on what your goals are. And based on the assessment that I would make of of your face. If you did have some hollowing in the cheeks, I would probably I would probably suggest it. If you had some hollowing in the temples, I would probably suggest it. It can also even be used in the nasal labial folds, so that’s another good area. And it’s going to have that benefit of helping your skin look better too because of that natural collagen production. So you’re gonna get like a little healthy glow to your skin in addition to the volume.

Okay, but what happens if I already look better? Okay.

And I think people forget there’s there’s no one product that that’s fast, and people are like, oh, I want I want whatever filter is best. And it’s like, well, depends what we’re treating and what your needs in and so forth. I mean, the really great thing is that we have so many options now to treat people. But I think this is this has has some unique properties. And also too, for a lot of our patients that Sculptra, unlike some of the other fillers, you’ll get a little bit of filler right away just because of the diluted volume out, but then it goes away. And after a week, it looks like nothing happened. And slowly over the next six to eight weeks, you start to see some of that volume returning. And so people are wanting to be a little bit subtle, more natural, don’t want you know, too much of a sudden change. Definitely a good option for some of that. So I think super, super exciting some of these things to come.

Yeah, one other thing, my friend Dr. Shino Bay, he, he has this theory that I think he’s in the process of doing some some clinical studies on, but he has this theory that sculpture can actually help strengthen facial bone because as you know, as we age, we lose some of that that bone mass, some of that, like density of the bone. And so he believes that when sculpture is injected onto the periosteum, which is that layer just above the bone, it actually helps stimulate a little bit of bone production or osteo, osteoclasts and helps kind of maintain the integrity of the bone so that as we age, we we maintain our youthful look for a longer period of time.

Because most people don’t realize you actually get some structural bone changes, we think about in like our hips and other stuff, you know, where we have osteoporosis, bone atrophy stuff, but you actually get some of that in the face too. If you actually follow like, you know, bone structures over the course of you know, 40, 50, 60 years, you actually get some some structural changes, which is is interesting and probably underappreciated by most people. Yeah. What other last little nuggets, would you guys like to leave people with.. you know, kind of some skin rejuvenation tightening after after weight loss?

I’ll start um, I would just say like, in general, everything that we do, I feel like you’ve got to be open to a combination approach. I love RF Microneedling for some skin tightening. Obviously, I love filler for some contouring and replacing lost volume, Sculptra for again, natural volume skin improvement. But just get with your provider, we’ll give you tons of ideas and options, the order to do them in, but in general, the combination approach is going to give you the best result.

Awesome. Gilbert? You know, I think for those patients that maybe are not quite ready to do something more invasive, like like a full tummy tuck or something like that, this is a good alternative. Because it’s minimally invasive. The results are very, very good. Obviously, nothing is going to compare to surgery, right? But for those individuals that are maybe a little hesitant or nervous about doing a procedure, like like a full tummy tuck, this is a good alternative provided that you know the amount of skin laxity is appropriate for the type of of treatment that an RF microneedling device can provide. Andrea?

Yeah, I just want to, I agree with Sarah with the combination approach, but some financing options, we do have Klara now which I have used in the past, so I love it. And then our Rewards app. It’s awesome. Every time you check in, you accumulate rewards and so you might get a discount on Sculptra or Vivace or Morpheus, so yeah. Yeah.

Yeah. You get $25 for just downloading the app. Yeah. Well, I appreciate you guys because I think this is gonna be a topic that we have to talk about more and more as is as I think this this whole wellness is is just changing and super exciting for a lot of us, but appreciate all of you listening to greatest podcast in the world, Plastic Surgery Untold. Don’t forget, you can download and load us anywhere you get your favorite podcast. iTunes, iHeart, Pandora, Spotify, you can also watch us on Youtube. But we’ll see you guys, thank you for you longtime viewers, sometime DMers. We’ll see you guys bye. Bye. Great. Awesome. Thank you. We cranked out so much stuff today.