The Skinny Shot: The Truth About Semaglutide for Weight Loss with Dr. Johnny Franco

Dr. Bob Basu (00:08): Welcome back to Behind the Double Doors. I'm Dr. Bob Basu. Today on our podcast we have our first guest, plastic surgeon. I was actually in Austin, visiting to prepare for the American Society of Plastic Surgeons annual meeting, which will occur in October of this year in Austin. And I'm really excited to introduce you to Dr. Johnny Franco, one of the nation's top aesthetic plastic surgeons, he practices in Austin. He is a founder of Austin Plastic Surgeon. So Dr. Franco, welcome.

Dr. Johnny Franco (00:37): I'm excited to be here. This is great. So appreciate you having me on and even more honored to be your very first guest.

Dr. Bob Basu (00:43): That's right. Well, we're excited to have you and we're going to have a great conversation and I think our listeners will find our dialogue to be quite enlightening about trends and cool things that are going on in aesthetic plastic surgery. So, the first thing I want to dive deep on is the skinny shot. So Dr. Franco, you've been championing the Skinny Shot and you're on it. Can you tell us a little bit about what it is and what your experience has been?

Dr. Johnny Franco (01:04): It's funny because we talked about this a couple months ago and since even we last saw each other, I'm down about 45 pounds. So I've been on it just a little over three months. I'm down a little over 45 pounds in terms of this, it's basically the Semaglutide that a lot of people have talked about. So a once a week shot. This has been game changing for me personally. I'm someone who's always struggled a little bit with my weight. I've done some of the yo-yo dieting, like I'm sure most of your listeners have at some point. I started this. It was something I wanted to be able to offer to our surgery patients because we always talk about as you do in your practice, we want people in the best possible shape going into surgery because they're going to come out in the best shape possible afterwards.

(01:42): But I was like, I don't want to just offer to our patients. I want to try it for myself, make sure this is something that works. Because something that I think sets us plastic surgeons apart from other people is that we take everything very personal and want to make sure that it actually works. And so I've been on it for about three months, down 45 pounds. I honestly just overall feel so much better, so much more energy. So we've now included it into our program for our surgical patients and even their significant others because we have a lot of patients that want to bring their spouse in to be a part of it.

Dr. Bob Basu (02:08): Yeah, it's a really powerful tool. And for our listeners who can't visualize our podcast, Dr. Franco's looking great with this 40 pounds of weight loss, so awesome job. So tell our listeners a little bit semaglutide, how does it all work?

Dr. Johnny Franco (02:22): And I think people get scared a little bit because they think this is a new drug, but it's not a new drug to the world. I think it's been around for a long time, originally treating diabetics by some other name brands. We've been able to incorporate some other basically generic versions of this that make it available to the masses at a very reasonable cost effective, which I know was prohibitory in the past.

(02:43): But what's really makes it unique, unlike some of the other drugs that have been out there in the past, is it doesn't just get your heart rate up. It doesn't make you just not be able to absorb fats. It actually makes lifestyle changes, so it decreases your appetite. For me personally, I was a big snacker. For both of us, we operate all day. We may not get a break. And so 12, 14 hours when you're done operating, you stop and you try and eat makeup for the whole day, which isn't great.

(03:06): The thing about this is I just don't snack. I'm not super hungry, so I eat reasonable portions. The next step in my journey is to clean up my diet, but I've decreased my calorie intake by half. So I'm still being healthy. I'm still eating, but I'm not grazing all day, snacking on the nice treats that we thank all of our people for sending. But half cookie times six is about three cookies instead of half. And that's been a big change. But the other thing we were talking about before the podcast is the long terms of this. There's been no other drug on the market ever that has had such a low rebound when people stop taking it five or six months later. And that's exciting.

Dr. Bob Basu (03:41): Yeah, that's right. So now most patients are a candidate for this, but who's not a candidate who shouldn't be considering this?

Dr. Johnny Franco (03:48): There's only very few. And kind of like you said, when we first started, we were trying to get people to... we both have BMI cutoffs for our practice just from a safety standpoint because that that's our priority. And so what we do is we were first just treating people to get them to a good healthy BMI for surgery. My personal passion for this has pushed us to expand this. So now basically anyone that's trying to get to a better healthy weight, I do think there's some limits and want to get people to a good spot with that.

(04:14): The biggest contraindication is just if anyone has a history of a medullary cancer, if people do have diabetes, some other things are on other medications, we'll have to work with our internal medicine doctor. But just like any other treatment protocol that comes through our office or your office, we make sure we do a good medical history. They always see a provider and then we see them monthly to make sure that we're going to be with them throughout this journey, not just giving you a medication because the idea is this medication is jumpstarting people, getting people to a good spot and it's that motivating piece. But just like we both counsel our surgical patients, it's not just surgery, it's not just this medication. It's making some lifestyle changes.

Dr. Bob Basu (04:49): Absolutely. So the contrary indication really is for anyone that's had a history of medullary thyroid cancer, but if you don't have a cancer history, if you're a diabetic, we may need to get your primary care doctor involved, we want to make sure this is safe for you. But basically most patients, if they're healthy, are really good candidates for this, right?

Dr. Johnny Franco (05:09): Exactly. And people have very little side effects, which is great.

Dr. Bob Basu (05:12): Right, which, you read my mind. So side effects. So when you get on semaglutide, what about nausea? Can people get nauseous or have some vomiting? Any side effects that have to be concerned about?

Dr. Johnny Franco (05:22): In our practice, and we probably have about 300 people enrolled in our program already just over the last two months. And so nausea is typically the number one concern for people, they'll have a little bit. I'll tell you, me personally, I've only had two bouts of it. One is when I went to the Texas monthly barbecue, which is great, wasn't great for my tummy. And then when I went to visit my brother and his wife who made a ton of food and desserts and so forth. But I think some of those are also coaching you about what you can and can't do from a healthy standpoint of that.

Dr. Bob Basu (05:51): So if you overeat too much carbs, it can trigger some nausea, but if you watch your carbs and you don't overeat, you should be good to go. Right?

Dr. Johnny Franco (05:59): I think you're really good. I think in the beginning I had to be a little careful with carbonated fizzy stuff because it can just make you feel a little bit more bloated and full. But I probably need to cut out some of the sodas anyway.

Dr. Bob Basu (06:11): Well, that's awesome. I'm really proud of you for the weight loss. You're looking great. You're feeling great. This is awesome. And you are a role model for everyone that's been trying to lose some weight and now we have an effective tool.

Dr. Johnny Franco (06:21): And you were telling me before the segment that you've already started a process of incorporating this into your surgical packages to really help guide people, set a timeline, set a goal for them.

Dr. Bob Basu (06:32): Right. So part of my practice, I also help patients with plus size procedures or higher body mass index procedures, either with plus size tummy tucks or modified... different treatment modalities. But I do have a cutoff that I feel is safe in my practice. But there are patients that call that are above that cutoff, and I think semaglutide will be a great option to prepare patients for their surgery better. It's almost like when we talk about facial rejuvenation, we talk about pre rejuvenation. When you talk about a marathon, you talk about training for a marathon.

(07:05): Well, similarly, if patients have too much weight, whether they're higher body mass index or they're carrying too much weight inside their belly called the visceral fat or intra abdominal fat and they want to get a tummy tuck, this'll be a great tool to prepare them, get the weight loss off, get them to a better body mass index or get their intra abdominal weight off and then they'll be a better candidate. So you and I can give them a better outcome and a result.

Dr. Johnny Franco (07:29): And I loved that you are setting up for your patients an entire kind of nine month plan because it sets a goal for them, sets a time thing. And I think most of us, when we have deadlines and goals and stuff, it's a little bit easier to follow that. So I thought that was a great idea.

Dr. Bob Basu (07:44): So how are you seeing it fitting into your surgical practice right now?

Dr. Johnny Franco (07:48): So we've done both, one in preparation for surgeries. It's funny how many patients have brought in their significant other because it's so much easier in a house if everybody is doing it and you're on the same protocol. I'll tell you the kind of unintended, and it's been so helpful because how many patients do we have come back where the surgery went great, we did either lipo, tummy tuck, but they just have some of that visceral, that internal fat you're talking about. And so I'll stand in front of the mirror and be like, look, you're like me. I pushed, there's now more to lipo, tummy tuck. It's all inside. In the past, we'd be like, Hey, do some exercise, clean up your diet. But they're kind of like, I'm trying.

(08:23): And now we actually have a way to help them. And I think going into this, I didn't even realize how many patients that had past procedures that just want this little tweak that have been so happy. And I tell them, "Hey, instead of spending 15,000 on a secondary surgery, why don't you do this medication and see if you really even need anything".

Dr. Bob Basu (08:41): Right, exactly. Exactly. So yeah, great. It's a great tool for before surgery, after... I mean so many options to help our patients.

Dr. Johnny Franco (08:47): And you talked about, this is the first time we have a chance to make an overall change in their health lifestyle, not just the length of life, but their quality of life for the next 40 years.

Dr. Bob Basu (08:58): Right. Yeah. We were talking about this earlier that we're really seeing with semaglutide a merger of aesthetic plastic surgery and wellness and lifestyle changes. I mean, really what we do is it's about helping patients live their best life and quality of life. And I think with ongoing weight loss and Semaglutide being a great tool, I mean, it all fits together. It really fits together. It's really exciting stuff.

Dr. Johnny Franco (09:21): Yeah.

Dr. Bob Basu (09:22): So Dr. Franco, I did hear that one of the news stations asked you about their concerns about shortages of some of the brand names of semaglutide out there. Is this having any impact?

Dr. Johnny Franco (09:34): I think it does, and I'll tell you, it's been interesting because I think actually by being able to do some of the generic compounding semaglutide stuff, we've actually eased some of that strain for people who are trying to get medical supply. And it's been interesting, we've actually had some primary cares, we've had some patients who've been unable to get their prescriptions filled from the name brands such as Ozempic, Mounjaro, those type of things coming and reaching out, asking if we would help them bridge the gap until they can get this.

Dr. Bob Basu (09:59): Wonderful. Excellent.

Dr. Johnny Franco (10:00): We're not taken away from them, I think is the key point.

Dr. Bob Basu (10:03): The key point. Okay. Awesome.

Dr. Johnny Franco (10:04): And then the other thing, and any of us who've looked into these, some of those drugs are almost price prohibitive.

Dr. Bob Basu (10:09): Super expensive.

Dr. Johnny Franco (10:10): Especially if you don't have insurance. I'm biased. I feel like we offer good insurance at our practice. And even then, I mean these drugs without insurance are $1,400, $1,500.

Dr. Bob Basu (10:19): Yeah. Very expensive.

Dr. Johnny Franco (10:20): Not true in our programs because of the things we've been able to work out.

Dr. Bob Basu (10:23): Right. So since semaglutide can be offered through sterile compounding pharmacies, we can get the prices down for our patients to a few hundred bucks a month, make it very manageable, make it accessible, and it doesn't interrupt the supply chain for the brand name products that other physicians are using for their patients. So this is a win-win across the board.

Dr. Johnny Franco (10:44): And I've had some of our patients that I don't know if you've had these questions about asking about the potency or effectiveness of compounds versus some of these, and I told them, you and I both get these from American compound pharmacies where we've already typically gotten our numbing cream, other medications that we use in our office. So we have a good relationship, we trust them. So I do think you have to be careful where you get it from. I think that's why I'm making sure you go to board certified plastic surgeon, physician who is doing this and not just kind of like anything. It's too good to be true. It probably isn't.

Dr. Bob Basu (11:13): Right. Absolutely. Great point, Dr. Franco. And that's important to source the medicines from FDA approved facilities that have right sterile protocols. And Dr. Franco, you're proof positive, right? You're taking that medication yourself and you're doing amazingly well. So you're a testimony, walking testimonial for its effectiveness.

Dr. Johnny Franco (11:32): And I think it's like you were saying earlier, it's more than just the medication itself. We see our patients, one of our providers sees them regularly because there is some art to adjusting the dose, making sure people are to a good spot. And we were talking about dosing earlier, and so there's a lot of factors that go into this and timing of the surgery.

Dr. Bob Basu (11:49): Absolutely. Absolutely. How long will patients be on semaglutide?

Dr. Johnny Franco (11:54): We typically tell them that they're going to be on it for at least five to six months, because one of the studies that was actually super impressive had over a thousand patients enrolled. Half the patients did it for five months, half the patients did it for 72 months, and they evaluated everybody at 72, I'm sorry, 72 a weeks. And everyone at 72 weeks got evaluated. But even the patients that only did it for five months only had a 5% rebound, which is unheard of with any other weight loss medication.

Dr. Bob Basu (12:21): Yeah, that's fantastic.

Speaker 4 (12:24): Basu Aesthetics and Plastic Surgery is located in Northwest Houston in the Town Lake area of Cypress. If you'd like to be a guest or ask a question for Dr. Basu to answer on the podcast, go to basuplasticsurgery.com/podcast. On Instagram, follow Dr. Basu and the team @basuplasticsurgery. That's B-A-S-U Plastic Surgery. Behind the Double Doors is a production of The Axis, the axis.io.