Plastic surgeons have never been able to change patients’ lives as dramatically as they can today by combining aesthetic and well-being treatments. Drs. Bharti and Kortesis chat with Austin plastic surgeon Dr. Johnny Franco about the ‘Skinny Shot’ and the best modalities to combine with it to make patients healthy and happy.

It’s easy to love the simplicity of semaglutide, but when you lose weight drastically, you’ll start to get loose, lax skin. For a complete treatment that makes you look and feel great, it’s best to address skin laxity simultaneously with biostimulators like Sculptra, energy modalities like RF microneedling, and skin tightening treatments like Renuvion.

This episode was recorded live at The Aesthetic Meeting 2023.

Follow Dr. Johnny Franco on Instagram

Transcript

Speaker 1 (00:03):
You’re listening to Dr. Bill Kortesis and Dr. Gaurav Bharti on It’s Complicated. The podcast that uncomplicates the mental and physical aspects of life and the aesthetic surgery to help anyone committed to achieving their personal best.

(00:15):
It’s Incredible.

Dr. Franco (00:19):
70 pounds.

Dr. Bharti (00:21):
70 pounds. What a impact and change. You somehow, I think, are more energetic than you were before when you were your 70, which is virtually impossible.

Dr. Franco (00:33):
I didn’t even realize how outta shape I was. Like, honestly, when I first started getting back in the gym, I was fucking walking on the treadmill, like at a speed of one, you know, and, and then slowly kind of built up and built up and, you know, it just happens so slowly over time. And the same thing our patients tell us, like, just don’t know what happened. You know? It wasn’t like, yeah, I just started binge eating. Just kind of grew and then we’re in scrubs and weren’t wearing in and

Dr. Bharti (00:52):
And you’re following your passion. You were just, you’re, you know, developing an incredible practice and you neglect yourself.

Dr. Franco (00:57):
Yeah. And then you look up and you’re like, fuck, I don’t even know where I’m at. Yeah.

Dr. Kortesis (00:59):
Walk me through this 70 pound weight loss.

Dr. Bharti (01:01):
Yeah. When did this, when did this start?

Dr. Franco (01:03):
Yeah. No, this was, was pretty incredible. So I’ll back up into the story and kind of get started. I’ve, uh, honestly, I’d had a physician join us and it’s almost funny cuz like you guys, you know, we always welcome people to our practice to come check things out. And someone came to visit us and you almost learn as much from the people visiting you always as, as you teach them. And, and so I was, it was a RENUVION and somebody was, uh, learning about some, some body tightening stuff, which I think we’re gonna get to in a minute, but, you know, we’re just talking offline stuff. And he is like, Hey, you know, I’ve been, uh, thinking about starting this weight loss stuff. And so he had talked about some of these new semaglutide medications that were coming out. So I was like, oh, let me do a little research in this, kind of see it. I, I personally honestly made the move when I had bought this new suit for my birthday, went to feed my little Winston Frenchie, tore my pants. I was like, fuck, I, I gotta change something.

Dr. Bharti (01:45):
Bill splits his,

Dr. Franco (01:47):
I was like,

Dr. Bharti (01:47):
Bill, bill splits his pants, all the fucking time, he orders three’s pants for each suit.

Dr. Franco (01:50):
<laugh>. I just couldn’t do it. But at that point, I started myself on the shots, uh, in October. And then I saw such a dramatic change right away that I brought, brought it onto our practice. And honestly, when we first started it in our practice, it was just gonna be for pre-op patients. Because like, as you guys, it’s almost frustrating for the patients. It’s frustrating for, for us when we bring patients on and then you can’t even, you know, it’s like, Hey, you gotta lose 30, 40 pounds. It’s not safe to do your surgery. We’re not gonna get a great result. And so that’s where we started. But then they came on and he was like, oh, can my husband try this? Can my significant another get on this? And so then we expanded it in our, in our practice. And honestly, it’s absolutely exploded in terms of our practice, but it’s led to something that we were talking offline about this weight loss revolution and, and what do we do now that we have, you know, 2 million prescriptions of Wegovy, you know, flowing around in the United States now.

Dr. Bharti (02:38):
It’s incredible, you know, I will, I will have to say though, I remember, um, watching you through this and, and we stay connected, you know, texting, but we stay connected on social. Yeah. And, you know, I tech, I, I hit, hit up, hit you up and I was like, I think it’s time for us to bring this into our practice. And so, um, we have done the same thing, and I will tell you, and we, we try to do it in a very responsible way. So maybe we can speak to that at some other point. But regardless, we’ve done it. We’ve been very cautious, very careful about who and, and, and what, and how we do this and make sure we have a fundamental program of more than just giving them a shot and also helping them with lifestyle adjustments, modification, weaning them to whatever maintenance dose is appropriate for them. But my god, I mean, massive adoption and we’ve had just incredible change on, on people. And so many of, like, the team and the staff have wanted to do it. Joe Hunstead, our, our business partner is doing it. And he’s, I mean,

Dr. Kortesis (03:29):
We’re, we’re at this meeting, it’s one of in hot topics and how many people raise their hand and say they’re on the medication. It was an overwhelming.

Dr. Bharti (03:36):
It was incredible.

Dr. Franco (03:37):
It was like 80 percent of the people.

Dr. Bharti (03:39):
And you’re seeing people that like, you know well, and you’re like, oh my God, you look, you know, like a different person. But look healthy. I mean, you look good. And so I think that’s remarkable. But I think you hit on a great point. All right, so some people are swinging 70 pounds, some people are swinging 20 pounds. That, that leads to some dramatic change, um, for patients. I mean, diffusely all over their, their body and, and I think brings about a new issue that we’re gonna have to, you know, plan for and help that patient through so that they want to actually stay where they are. Because sometimes there can be this opposite shift where like, oh my God, I don’t like this. I’m gonna go back.

Dr. Arredondo (04:16):
Well, the skin changes after you lose that much weight. You know, you get those massive, they become massive weight loss patients, so they look prematurely aged, theirs jowls are hanging, they’ve got neck skin hanging, they’ve got extra skin on their stomach, their butt’s loose and saggy. So gotta do all these things to try to address that. Just to get them back into that good shape that they want. Cuz now they feel great, but they don’t feel like they look great. So like, I gotta get, they want to finish that piece of the puzzle.

Dr. Kortesis (04:42):
I, I don’t think it’s just the weight loss, it’s the speed of that weight loss that, that plays a part in this and that combo that really changes things. So what do you do to address to these patients? What are you, what are you letting them know and, and, and what are the steps that they can take as they’re losing the weight?

Dr. Franco (04:59):
Yeah. No question. I mean, this whole ozempic face and body, you know, is, is is something there. And, and weight loss patients, like you said, isn’t new to us in terms of this cuz we’ve treat ’em for a long time. But it’s the number of people that are coming in with this. And also a unique population because I think you’re seeing a lot younger patients, you’re also seeing a lot more of those patients in the 20 to 40 pounds. Cuz in the past it was a pretty straightforward, it was a multiple stages, big surgeries, lot of skin. But in the 20 to 40, I think they have a lot of great options in terms of this. And, I, let me even just start with what I’ve done for myself personally and then we can kind of keep rolling from from there. I’ve honestly started a couple things and some of these programs we’ve rolled out into our, our practice cuz uh, they’ve helped me. But we started a program called Skinny Sculptura. So again trying to get people like you mentioned earlier and and offline about what can you do proactively before, cuz now we have control of this. So when they’re coming through our office and you’re being responsible about it, you don’t have to wait till they have a problem. We can address a lot of these as they’re going along the process.

Dr. Bharti (05:54):
Because patients hate surprises. We all hate surprises.

Dr. Franco (05:56):
Right. And if we can mitigate some of that skin laxity, some of those things as they’re going. So I’ve personally started, uh, Skinny Sculptura which is just one vial, you know, periodically to reproduce some of that collagen.

(06:06):
When did you start it?

(06:07):
I started about three months into it. So before my skin completely came down, we’ve we’re exploring a concept called structural sandwich of this collagen. So I did at the exact same time, RF micro kneeling of my skin and then the, the sculptura underneath to see if you can’t sandwich that skin from below and above in terms of building some of that collagen stuff. I’ll be honest, I’ve even done a little bit of jawline filler just to try and kind of pull that skin out a little bit. Uh, you know, so that’s what I’ve done personally. Uh, Dr. Arredondo here is hopefully gonna do a little my elevate for me, uh, for my birthday in October. Uh, just to, to finish off some of that.

Dr. Bharti (06:38):
Charge him twice.

Dr. Arredondo (06:39):
Oh, it’ll be a premium.

Dr. Franco (06:40):
Oh. Oh I’m gonna be a pain in the butt. He better get his money’s worth from this. <laugh>

Dr. Bharti (06:43):
<laugh>. Um, you know, that’s, but that’s interesting. I didn’t mean to Oh no, go ahead. Is um, we have available a lot of technology that can be used to combat some of the issues that we are, uh, dealing with where you have the exacerbation or hastening of, you know, aging, ie. skin laxity and I using energy-based platforms I think can help. But what you hit on is really important is that you have to approach things multi modally. Sometimes the simple as shit is the most valuable. ie just at least some sort of skincare, and hydration. But then the next thing is gonna be like an energy modality. Whether that be, you know, RF needling or super light CO2 laser resurfacing. But biostimulators are incredible, they’re getting, finally getting the attention that they deserve I think now and, and multiple sessions. And there are different kinds, you know, you mentioned Sculptra, Radius is a great bio stimulator. Yep. And, and I think there’s gonna be some, there’s some newer ones coming from our industry partners that are gonna be I think even more robust. Um, and then there’s, you know, injectable fat that’s really valuable. You guys use any Renuva?

Dr. Franco (07:44):
We use some Renuva and then, and then we also even use, you know, underneath skin tightening, uh uh, whether you use RENU Vion or body Tite, I think those are gonna become so prevalent cuz you guys do a ton of body contouring and I think, you know, the amount of people are gonna be able to get away with liposuction and not, you know, do this is gonna decrease and decrease uh uh cuz these 20, 30 pounds are gonna have a little bit of that laxity and not get the result they want if you don’t combine something.

Dr. Bharti (08:07):
And you know, and sometimes these are the standalone ones where we, you know, a lot of, I know you love Renu Vion, we love Renu Vion also. And it’s, it’s almost with every single lipo case that we do. But there’s certain instances where we’re, I think we’re gonna have just real, just isolated Renu Vion treatment where you, you might go in there pre tunnel a little bit, but you’re really not suctioning.

Dr. Arredondo (08:23):
Right. Just to get that skin to re-drape. Let that structural change happen.

Dr. Franco (08:27):
Sean’s doing a lot of these in the office. Because again, some of these people who just have a little bit of neck or arm stuff, which are, are primary is cuz the skin’s so thin, it’s actually amazing. Some of these energy devices and maybe Sean can lead to it about how quick and easy some of those are. And you don’t even need general anesthesia.

Dr. Arredondo (08:41):
Oh yeah. It’s fantastic. I just tend to over tumes a little bit. So just, you know, two to 400 ccs in the neck so it gets pretty full. They tolerate it fine. Most of the people, I’m doing a little bit of liposuction, but I feel like it’s important to really, like you said, just really loosen up that tissue, allow that to drape back and it’s been born because I’m just new in practice so when I don’t have or time booked, what can I do instead? I’ve got the procedure room right there and we’ve done a lot of arms, necks, thighs. And then adding the RENUVION I think is a game changer for those because Mike’s,

Dr. Kortesis (09:13):
You bring up a really good point, right? The stuff that we’re doing in the face you can also do in the body, right? Yes. It’s not just isolate the one part of the body you end up doing it in multiple areas and can be done simultaneously. You can do the neck and the body all at the same time under local anesthesia.

Dr. Bharti (09:27):
Mm-hmm. <affirmative> and, and here is an interesting thing and that this is a, I love what you said about the face. Historically patients, and it’s a little, this is a little bit of a tangent but I’ll bring it back, is that, you know, patients would

Dr. Kortesis (09:36):
Shocking, G’s going on a tangent.

Dr. Bharti (09:36):
No patients would, al patients always would invest heavily on their face when it comes to skin products, sunblock, et cetera. Cuz that’s what’s the highly most highly visible thing. If you’re able to do and pledge that same attention to the rest of the body. You know, you start spreading and taking care of the face in a way that you take, take care of your dece the same way the extremities, et cetera. So a lot of those, those things can be um, uh, cross pollinated or extremely important and I think need to be done. But this combination of energy and so in the face we’re adding, using energy, using bios, simulator, using resurfacing, all of those things can be used anywhere on the body. Obviously the settings are different, right? Because the, the, the, the behavior and the um, the dermal thickness et cetera.

(10:16):
The pilosebaceous units are very different. But I think that’s really interesting that you can do these things practically anywhere. But at the end of the day, I mean at, call it what it is, if there’s a tremendous amount of excess, if there’s la if there’s real laxity then we can always go the surgical route. But I think what we can do with technology is we can downgrade what we, what would needed to be or historically have been done. Like for example, you know, someone loses 20 pounds or 30 minutes, they don’t wanna have a circumferential body lift and incision all the way around. Nothing’s wrong with that surgery.

Dr. Kortesis (10:44):
You bring up a really good point. G is like what, I mean how often can you do these technologies? Right? Is this a one and done kind of thing or are we doing repeated treatments? Cuz that’s what our listeners really want to know.

Dr. Franco (10:54):
And especially cuz we’re seeing such a young group of patients. So, you know, these people are gonna need multiple treatments and you hate to be so invasive on a, on a 25, 27 year old. Because I think again, this is the unique population that we’re seeing with the Ozempic face in, in body.

Dr. Kortesis (11:08):
People want minimally invasive stuff. And that’s why I think this Ozempic craze is happening. It’s like this is a simple solution to a problem that we have ongoing in this country and they can, it, it works and it works really, really well. And so they want the next portion of that, which is what we’re talking about now. And they want this simple, minimally invasive way to approach it.

Dr. Bharti (11:28):
Yeah. And and even more important, like for us is our intent, and I know it is yours too, it’s like when we, when we take care of a patient, we have no interest in doing a procedure and them disappearing. We have no interest in them just being coming to you for their weight loss. We want to, we actually are almost like we, we are their provider and we have to take care of all aspects of their care. And I think we are, we are becoming more of, of their general generalists. Like we are addressing a lot of their other needs and, and generalized wellbeing and wellness. Cuz you all know, and I think we all believe how important your aesthetic wellbeing is to your overall wellbeing and that now we’re, we’re finally combining, you know, you know, everybody’s adding this small bit into their practice, but I think what we’re all it’s unmasking is that this is a little bit of peace. This is that catalyst, but the lifestyle improvement, the nutrition, et cetera, and then all the modalities that we have now not only are making people look better, they’re feeling better and they’re having a better lifestyle. And now we’re moving into longevity, which is which really important.

Dr. Franco (12:30):
And, and for the first time in all the things that we, we brag about that we can do, we’re changing the, their lifespan. We’re changing their quality of life at the end of that lifespan. But the things that we’re doing right now, we’ve never had the opportunity to change people’s lives the way we do right now in terms of, of this, you know, from an aesthetic standpoint, I’ll tell you, me personally, I haven’t been excited about shopping, coming ready for this meeting. You know, I, I went and bought three new suits and I was super excited about this because you’re right, it changes your whole outlook about stuff because you’re like, there’s nothing worse than going shopping and being like, damn, I’m not upgrading a size. I can still fit into this. And they’re like, <laugh>, you know, that, that’s heartbreaking. And so to be able to be, you know, comfortable in your own skin, I think is priceless.

Dr. Bharti (13:10):
It is priceless. And I think the other thing too is I think we’re making sure, and I think there the verdict is still that, but we wanna make sure that we have sustainability and stability for, for these patients from a standpoint, and I, and I think I’d love to hear you speak on this, but it’s very important for us when we decided to embark on this addition into the practice, is that it has to be something that’s long-term sustainable. And that’s the thing that people can stick with. What you don’t want is just to have this undulating pattern. I would say that that is actually probably the worst thing from a aesthetic in the skin laxity standpoint. If you have swing, I think that’s really when you have the most difficult case to address, where you have swing up, swing down, swing up, swing down, swing up, swing down. Because you go through this cycle of stretching and, and deflating.

Dr. Franco (13:50):
And, and no question that’s something that, that we do. And, and Sean probably sees the most weight loss patients in our practice, but it’s, you know, we see them monthly. It’s guiding them. We turn down a lot of patients because they come in and they just wanna lose 10 pounds before a wedding or between something and have no real plans for a lifestyle change. Those are not good candidates for us because we’re not doing them any favors. That’s not what this drug is designed for. You know, we do a lot of education like you guys do in terms of lifestyle cause we tell this is just one tool to help you get there. But this is, the standalone is not the answer in terms of this.

Dr. Arredondo (14:19):
Right. We call it the skinny shot, but really it’s not about making people just skinny. This is about changing the fundamental way they interact with life, their relationship with food to a healthy relationship. We’re not trying to make people skinny. We’re trying to make them healthy and happy. And this makes it so easy to do cause people just respond so well to it.

Dr. Franco (14:37):
I, I, I think this is super exciting. I know that you guys got a couple more talks you gotta get to, so we won’t keep you honestly, but can’t thank you guys enough for taking a little time to be on our show, so super appreciate it.

Dr. Kortesis (14:46):
You for having us. Thanks guys.

Speaker 1 (14:50):
Links to learn more about anything mentioned on today’s show are available in the show notes. To learn more about Dr. Bill Kortesis and Dr. Gaurav Bharti, and the entire team of HKB Cosmetic Surgery, just go to hkb surgery.com or follow HKB on Instagram at hkb cosmetic surgery. Subscribe to our newsletter for key takeaways from each episode, links to any resources we discuss and promo codes or giveaways from HKB and our partners. If this show has helped you in any way, if you learn something, write a review on Apple Podcast and share the podcast with a friend. Take a screenshot of this podcast episode with your phone and show it at your consultation or appointment or mention the promo code PODCAST to receive $25 off any service or product of $50 or more. It’s complicated. It’s a production of The Axis, t h e a x i s.io.