Eva Sheie (00:03):
The purpose of this podcast is simple. We want you to get to know your doctor before meeting them in person because you're making a life-changing decision and time is scarce. The more you can learn about who your doctor is before you meet them, the better that first meeting will be. There is no substitute for an in-person appointment, but we hope this comes close. I'm your host, Eva Shea, and you're listening to Meet the Doctor. Welcome back to Meet the Doctor. My guest is Johnny Franco today. I have known him for a while actually. I've known you since you were in Miami.

Dr, Franco (00:43):
Yeah, yeah. Since I was just starting out as a little fellow,

Eva Sheie (00:47):
But now you are the Austin Plastic Surgeon. So talk to me a little bit about where you got started and how you ended up in Miami and then subsequently Austin.

Dr, Franco (01:00):
Yeah, it was definitely a little bit of a roundabout trip. So I actually grew up in New Mexico, so just kind of right at the border of Texas in New Mexico. So I think deep in my heart, I always wanted to come back to kind of the Southwest area. Then ended up in Wisconsin for my undergrad. And then during undergrad I actually did a summer internship at UTMB down in Galveston. I'll get back to why that's important. And then did medical school in Galveston after that fellowship and then did my residency in St. Louis. But while I was doing some of my medical school rotations, I actually got to spend one of my years here in Austin. Loved the city. I almost hoped to come back at some point and then did some, I brought a fellowships. I went to Taiwan, I went to Belgium, did aesthetic fellowship in Miami and stayed there for about three or four years and then finally had a chance to come back to Austin, which was always my hope and dream.

(01:45):
So jumped on that. I actually worked for a big dermatology group and even before was all the rage. Right after I got there, they started being bought out by a private equity group. Me being their first plastic surgeon, I don't think really fit their model per se, so they were kind of like, you can stay, you can go. So decided to start my own practice. If it hadn't been for that kind of push in the direction, I probably wouldn't be here now. So starting this little 800 square foot pink office that you probably remember back in the day and then slowly grown. And so now we have three offices just open to surgery center and up to almost 70 employees now.

Eva Sheie (02:18):
So no more surgery center or are you still going back and forth a little?

Dr, Franco (02:22):
Nope. So we do everything in our own surgery center, quad, a certified, two full operating rooms. We have an outside anesthesia group that comes and runs that. And so it's been fabulous because we've been able to hire a bunch of people. They're super passionate. They love it, part of our team. So it's been just I think an incredible experience for our patients. Definitely made my life a lot easier. Everyone is the same mission, same goal, and then consistency, which has been huge. Well,

Eva Sheie (02:47):
One thing that is very true about you, which is obvious and what you just said to us is that you never stop moving. You're always moving 9,000 miles an hour. What's different about your life that lets you move that fast that is unique to you? I don't think everybody's quite like that.

Dr, Franco (03:06):
I don't know what's definitely unique. I think there's a couple things though. It's one of our nurses pointed out, she's like, once you get your mind stuck on something for good or bad, you become fixated on it and you're going to keep going until you achieve that item, whatever it is. And so I think I do get very goal centered and work towards that. I think some of it was overall just growing up from a personality stuff. I grew up in a small pecan orchard out in New Mexico, and so even when we weren't working, going to school doing other things, we were always working on the pecan orchard. It was the way my dad was. He retired as vice president at University of Nebraska and even on his off days, he'd be working on the pecan orchard. So I think there was always kind of this tone setting that I grew up with of always being busy. So I think that's kind of rolled over into my personality as well.

Eva Sheie (03:55):
Okay. Did you live in Nebraska or

Dr, Franco (03:58):
Did he moved out there later? So I grew up in New Mexico and then he went out there afterwards and then kind of came back and forth from the pecan orchard when we were in New Mexico, he was at New Mexico State.

Eva Sheie (04:11):
Yeah, it's rare to grow up in New Mexico. You just don't hear New Mexico very often, but you're like the one person I know that's from New Mexico, but you also said Wisconsin in there. I didn't remember that. You had gone to undergrad in Wisconsin. Was that at Madison or somewhere else?

Dr, Franco (04:27):
It was called Beloit College. So a little school in between Madison and Chicago, little school, about 2000 kids.

Eva Sheie (04:34):
So now I have a new Dr. Franco fund fact. I went to a small school in Minnesota, and I do know about Beloit and I have heard of it.

Dr, Franco (04:43):
I'll tell you a couple of things that have been super unique about our practice and I think that I've been super fortunate is one of the first partner plastic surgeons I brought was Dr. Adam Weinfeld. I think it's one of the things that's helped us to be super successful is our personalities are probably a little bit exactly different. I think like you had mentioned earlier, I'm a little bit emotional, fireball, excitable, which I think is great for social media, great for kind of rallying the troops in our office. But he's very analytical. He's very step by step, and I think the combination of that has been fabulous for our practice to have the yin and yang to keep us on the straight and narrow. And then we've subsequently acted Dr. Aradondo, who's a super young and eager plastic surgeon, then just added our first internal medicine doctor, which honestly has been a little bit of a pivot in our practice. I think as much like most plastic surgeons in terms of wanting to grow our med spa, grow some things, but it was almost slow to do it. And then I think we made a seismic change when we changed how we viewed the med spa changed, how we market, change how we involved those providers. I think that's been a huge, huge change.

Eva Sheie (05:51):
Another fun fact about you that I love is that you're a twin, identical, right?

Dr, Franco (05:55):
And we even have twin names, Johnny and Jimmy, if I jumped off and he jumped on, you wouldn't be able to tell the difference sound exactly the same. We look identical, especially with a hat and headphones like this, zero chance.

Eva Sheie (06:07):
But he doesn't live in Austin, does he?

Dr, Franco (06:09):
Nope. He lives in Boston. It was funny, probably about six, nine months ago, he had someone come up and talked to him and was talking to him about surgery and other things, and my brother's like, I know who you think I am.

Eva Sheie (06:23):
That's awesome. Okay, so you and I have kind of been sort of in the same spots at the same time, and I was at RealSelf, and RealSelf had a big part of how you sort of got your practice off the ground when you went out on your own. And back then you were really known for BBLs. People were coming from all over the country. You have some nicknames right, about BBLs?

Dr, Franco (06:47):
I mean, I have a self-proclaimed license plate that says the BL King.

Eva Sheie (06:51):
Do you really?

Dr, Franco (06:52):
Yeah. So you probably see it around town sometimes. Sometimes I get notes left on my car, so if anybody sees me and wants to leave a nice note, hey. I recently had somebody stop me at the gym asking like, Hey, I just got to approach you. Are you a plastic surgeon? I've been following this car and it says BBL King, and then now you're here and I see the car.

Eva Sheie (07:12):
That's incredible. Okay, so back then you were known for BBLs, so much so that it's on your license plate. And do people find you for other things now too? Is that still really the heart of what you're being found for or are there other things that are happening?

Dr, Franco (07:28):
Yeah, it's super interesting and one of the things that we've kind of incorporated in our practice, I truly believe in the riches and the niches, and it's kind of a catchy statement. But really especially our practice with multiple plastic surgeons, multiple injectors, the idea is that whatever people come in for, we have someone that really specializes, someone super passionate. I think especially in cities like Austin, Dallas, Houston, there's no reason not to go to somebody that's super passionate about the procedure you're wanting to have done. And in a city like Austin, you have choices. There's a lot of great plastic surgeons. But I think the beauty and kind of unique to the city here of how many incredibly talented individuals are with very subspecialties and so probably fat transfer is still the number one thing I do. I think there's been a little bit of tweaks in the evolution of the BBL and so forth.

(08:16):
I would say now a lot of patients have fat transfer in combination with other procedures, tummy tuck, they're looking for a little bit more of that athletic look, maybe some high HD lipo, that type of stuff. So it's transitioned from this huge curve ous look to more of this Pilates body. It's a little fit, a little fabulous, but I think a little bit of that has been the overall kind of seismic shift in a little bit of fitness overall post pandemic era. I think most of us add a little bit of weight. I think the whole weight loss revolution with the skinny shot, I think people getting back into activity, I think Austin's always been a little bit more of an active fit lifestyle city compared to maybe some of the other cities I've lived in. And so I think all those things together have paired.

Eva Sheie (08:58):
The Skinny Shot revolution is not something we can ignore.

Dr, Franco (09:02):
It's been super interesting. We see about 2000 weight loss patients a month in our office, and I think that number's only going to grow. We've even started talking a little bit about something that I call beyond the weight loss revolution because I think now you're going to see all these patients who have skin laxity, some changes in their body, and I think being able to address and speak to that, I think as a plastic surgeon, whether you want to offer weight loss treatments in your office or not, you can't ignore this. The amount of people that are going to be on these medications is just going to be innumerable. I have to check the final stats about where it finished off, but it was on pace last year to finish the year as the number one was on pace to be the number one most sold drug ever in America.

Eva Sheie (09:48):
More than Viagra.

Dr, Franco (09:49):
More than Viagra, more than if you think about how many people are on heart medications. I mean, it's just an enormous amount. They recently released a tirzepatide medication, which is basically the same medication as Mounjaro, but called Zepbound that was FDA approved for chronic weight management, which also is such an interesting pivot of how the FDA views obesity and weight management in the United States mean. So they no longer see it as an acute issue of needing to course correct. They see it as a chronic issue, and I think there's a lot more to weight than just self-control so forth. And I think it had a bad stigma in the past, but now with a lot of people coming out, Oprah recently after denying it for a year and a half that she was on some of the weight loss medications. Charles Barkley recently was on TV saying that it was the biggest change in his life for himself.

(10:42):
So I think it's interesting because it normalizes the conversation of weight. I think in the past there was sort of this weird view of it that the people thought it was just a personal issue that you just weren't eating. You just didn't have any self-control. And by you, I mean me, I had all of this. I mean, I had a BMI of almost 40, I was 260 pounds at five eight. And so I'm in that category, but I think we now see that there's more to it. I also see that there's going to be a change. And now that we see it, if you look at the statistics, it's just groundbreaking. I mean, we were on pace that by the year 2030, 80% of Americans would've either been overweight or obese, 80%. I mean, the healthcare system couldn't support that. And not to go down a rabbit hole, but it just shows you the ripple effect this could have.

Eva Sheie (11:29):
I love this rabbit hole. It's completely changed my life too. And that is actually directly because of you. And so what happened to me was, I had already heard it from my internal medicine doctor, and I said, no, no, no. I'm going to go back to Orange theory and do the transformation challenge again for the third time. And I happened to go to your office for something else. I think I was dropping something off for you. And they were like, Hey, we're practicing consultations today. Can Dr. Aradondo practice consultation on you? They weren't like, Hey, you're overweight. You know, you should do this. They were like, can you practice on? And I love doing that kind of stuff. So I was like, sure, I have time. And he talked to me for about half an hour. He had a really compelling case, and at the end I was like, yeah, no, I'm going to do that.

(12:18):
I'm going to go back to the gym. And he goes, if you say no, you're only going to be the second person out of the 30 that I've already talked to who said no. And that really made me mad, and I still don't know why it made me so mad that he said that, but I wasn't mad at him. And so I said, fine, if I try it and I don't like it, I just stop, right? And he said, yeah, just stop if you don't like it. And so I noticed my anniversary was two days ago.

Dr, Franco (12:50):
Oh wow.

Eva Sheie (12:51):
Of one year. And I've lost 67 pounds in one year, and I have an absolutely great experience with your team, and I'm not doing a commercial for you right now. It has completely transformed my entire life.

Dr, Franco (13:05):
But I think people like you who are using this as a jumpstart, they're still doing the other things. They're still trying to make changes. They're still being active. So it's not like you're just using this as a get out of jail free card. I mean, this is a jumpstart. This is to adjunct the people like you who are still being active, still trying to make lifestyle changes. Those are the people that succeed. We have people that do the shot, still come in with their venti frappuccino with extra whipped cream and sprinkles on top, and they're like, I haven't lost any weight. I'm like, yep. Kind of interesting. Even if you look at the study last year on coronary artery disease, most people say like, yeah, you lost weight. Of course, their coronaary artery risk disease should go down. But if you actually normalize the study to take out the ment and match them up for weight loss in those two groups, still the people on the semaglutide medications still lowered their risk. So interesting. Obviously they lowered it pretty substantially because you did lose the weight, which definitely helps decrease the risk of coronary disease. But even if you factored that in, they were still at a lower risk. So agree. I think there's a little bit more to this. It is pretty interesting too. They're also doing some studies ongoing now for using some of the semaglutide, the GLP stuff for other type of addictions and cravings. And so interesting how it's going to affect that for smoking, alcohol abuse, other things like that. So still tbd.

Eva Sheie (14:23):
I think one weird thing that happens to me, and maybe this happens to you too, is there's days where I'm like, I need a cookie. I can't do anything else until I have a cookie. It's not like it used to be where I'd be like, I need a bag of cookies, but my body's telling me I need something and I listen, but I don't, like there's no binge eating anymore. So one of the things I've started to confront and actually going to confront on a podcast is how did I end up there? And I'd never ever admitted to myself that I was a binge eater. We ate to celebrate. We ate when we felt bad. We ate because we were bored. We ate for a lot of really stupid reasons.

Dr, Franco (15:08):
And it's interesting because one of the things that we actually educate our patients on, most of us that eat through our emotions and so forth, life's going to happen. Shit's going to happen. And so whether it's a marital thing, a relationship thing, a work thing, a death in a family or a friend or something, I mean, something's going to happen. And so just being a little cognizant of that, if you need to change your doses, restart, do something like that. You don't want to slip back into bad habits.

Eva Sheie (15:35):
You're giving me a perfect transition. So I have such great support from your team. I see Ashley, I've seen Sarah, I've seen a number of really great people there. And I don't want to say they're interchangeable, they're all special, but they really know what they're talking about and most of them have done it. What we have a big opportunity for is people will go to their regular doctor and get a prescription. They may run into a shortage or they may run into the problem that they're not covered by insurance, and then they don't think, oh, I should ask a plastic surgeon for this. And I think there's a lot of people going online and using potentially dangerous sources, and that's really troubling. So how do we make people aware in the middle that this is a great resource and it's safe, if not safer. I could argue that it's safer because you have support, someone cares about what's happening to you.

Dr, Franco (16:31):
I think it's us as plastic surgeons, I think it's us as aesthetic providers to really be part of the conversation. I think in the past some providers offered it, they didn't really want to talk about it. They're worried about misstepping. I'll say to the credit of ASPS and their president, Steven Williams, he actually reached out last week. And we're actually looking at how we can integrate some of the weight loss wellness overall into the next ASPS meeting in San Diego. Because some of the idea is just that this stuff is out there for us not to be part of the conversation is not doing a service to the public, but also to our plastic surgeons, to not educate them, not to be a resource for them, not for them to be able to feel like they're getting information from a good place and patients are going to be talking about it.

(17:15):
And if we can't answer questions or be educated about, they're going to go somewhere else and ultimately get procedures and things done by someone that's not trained. So I think it's pretty phenomenal that they've taken a big step in terms of really trying to educate its members, which will filter into educating the public in terms of these treatments. And even if they're not going to offer the medications, I still think that you need to kind of understand the process. You need to understand what's going on. You need to understand what the conversation is so that you can make sure that you're involved. When am I getting people off these medications? What do I need to educate them on? What do I need to know about it? And so I think to just try and avoid the conversation as a whole is not doing your patients a service.

Eva Sheie (17:59):
How are you thinking about getting people off? What does that look like?

Dr, Franco (18:03):
I mean, even for myself at this point, I think I've done one, maybe two shots in the last two months right before the holidays and that was it. So for the most part, we usually get people to a good goal weight, keep 'em there for at least two months and then slowly start to wean down, and then monitoring them to making sure that they are holding into a good spot. If we need to tweak, we can do that. And then phasing people out. So I think there's going to be some set of people that need to chronically be on a low dose. I think there's going to be a small set that can completely come off. I think there's going to be some people that are going to have to be a little aware of their body of when they need to come back on.

Eva Sheie (18:38):
So you're only taking it here and there. What's your own criteria for taking it and are you hungry again? Is any of that stuff coming back that was there before?

Dr, Franco (18:46):
I've kind of done it prophylactically. I've only taken it when I was going to go see my brother for Thanksgiving, and I knew it was going to be surrounded by stuff. So it was more of a preemptive than really I needed it.

Eva Sheie (18:58):
Wait, didn't you tell me you ate too much on Thanksgiving anyway?

Dr, Franco (19:01):
Oh, well that was the year before.

Eva Sheie (19:04):
Oh, that's right. That was a year. I can't believe how much time has gone by.

Dr, Franco (19:08):
Yeah, honestly, I still feel really, really good. We'll see. I still monitor my weight weekly to make sure I'm staying in a good spot. And so I'm definitely not closing the book and that I need to get back on it on a new regular basis. But as long as I can hold the line and still do good, and I think I've gotten into a better workout. I've gotten better into eating well and those type of things, so I think that's helped. It definitely got some work to go, but still a work in progress.

Eva Sheie (19:35):
Well, if someone's listening and they want to find out more about you or Austin Plastic Surgeon, tell me again where the three offices are and best place to follow you online.

Dr, Franco (19:45):
Yeah, easiest place to follow us is on social media at Austin Plastic Surgeon. We've got three offices, one in North Austin by the Domain, one in Westlake, and then San Antonio as well. And then our website is www.austin plastic surgeon.com.

Eva Sheie (20:00):
Wonderful. Thank you Dr. Franco.

Dr, Franco (20:03):
Thanks for having me. Appreciate it.

Eva Sheie (20:08):
If you are considering making an appointment or are on your way to meet this doctor, be sure to let them know you heard them on the Meet the Doctor podcast. Check the show notes for links including the doctor's website and Instagram to learn more. Are you a doctor or do you know a doctor who'd like to be on the Meet the Doctor podcast? Book your free recording session at Meet the Doctor podcast.com. Meet the Doctor is Made with Love in Austin, Texas and is a production of The Axis THE AXIS.io.