Understanding Sofwave: A Deep Dive Into the Revolutionary Skin Lifting Treatment with Dr. Johnny Franco

0:02Hey guys, welcome back to another episode of Skin Anarchy. This is your host Ekta and I'm really excited about our guest today because he's incredibly renowned for his work. I'm thrilled to welcome Dr. Johnny Franco, who is a renowned plastic surgeon and founder of Austin Plastic Surgeon. And as a key opinion leader for Softwave, Dr. Franco combines deep expertise and innovation to deliver top-notch results in aesthetics. And he has tons of training, both nationally and internationally. And I can't wait to learn from you, Dr. Franco. So welcome to the show. So I'm super excited to be on it. And I think this is such a great topic and so timely with the all the weight loss going on and skin laxity being such a hot issue now and really probably for the next, you know, five to 10 years.

0:47So I think a perfect topic. Absolutely. No, I couldn't agree more. And I, you know, I think we're chatting before the episode and I've seen soft wave everywhere recently, you know, and I've really been curious about how it works and what it is. But Dr. Franco, if you don't mind, I'd love to learn a little bit about your background because it's truly impressive. I mean, you have such great training and so much experience in the field of plastic surgery. If you could give us a little walk down memory lane maybe and tell us about yourself. Oh, for sure. It's been definitely exciting and definitely a little bit of travel for sure.

1:19And so I'm a board certified plastic surgeon and did my medical school here in Texas and then went to St. Louis for residency and then had the opportunity to actually travel abroad. I did these mini fellowships in Taiwan, Belgium, and then did an aesthetic fellowship in Miami and stayed there for a couple of years. It was a lot of fun, great for training, probably not great from my longevity of living on Miami Beach for too long. And then, you know, got the chance to come back to Texas and start my own practice about seven years ago. I've been super fortunate. You know, we've expanded to almost 90 employees, three locations.

1:58and no question wellness and weight loss has been a huge part of that expansion. So, you know, you know, part of part of our personal journey of integrating with Softwave was, you know, how are we helping those patients that have and I've personally lived it, I've lost about 90 pounds over the last two years, these medications. And so some of it was from a selfish endeavor of what I do with a little bit of skin laxity on my neck and tummy and those type of things. And so probably some other areas too, but those are the ones I can see. So I worry about them. And so, you know, how can we treat that?

2:32Because I felt like a lot of the patients were having the same, you know, journey and, you know, challenges that I was. Yeah, no, that's really fascinating. I mean, that you can speak from a personal stance, because I really think that sometimes with aesthetics, it becomes very hard to understand because maybe doctors haven't experienced it personally, or it's just hard to explain, you know, a lot of times. I've encountered that a lot, you know, when I'm trying to inquire about new techniques and new innovations in the space. But I just want to start off by understanding what exactly is SoftWave, if you can explain to us, and what does it do?

3:05Yeah, it's pretty interesting. And SoftWave actually has become a platform at first. It was SoftWave, which was a purely skin tightening device. It was a ultrasound device, which isn't necessarily new to the skin tightening and innovation world, but it's really how it's developed these beams and the levels of which they target that energy that has been super unique. And so I think a couple of the unique innovations for SoftWave is that, you know, it's a more focused parallel beam ultrasound that really hits a very specific layer in the skin to maximize the skin tightening without causing damage to other tissues.

3:42And then while also trying to cool the skin at the same time, so to make it as comfortable as possible for patients. So they've basically taken technology that's been out for years and kind of refocused it in a way that is more controlled, more beneficial. And it's one of the things that's been interesting, even as a plastic surgeon, is how our understanding of anatomy continues to get better, even in this world of technology and AI and everything else. So, you know, they've really done a lot of work and innovation to kind of make this more efficient for patients. That's so cool. Yeah. I mean, I think, you know, it's always interesting.

4:20Like, you know, with human anatomy, I was wondering we are the greatest machine, you know, at the end of the day. So the more we learn about the human body, the more, I guess, innovation stems from that, because it's it's just like layers upon layers of just not first we don't know. And then as we find out, you know, the technology really adapts to it, which is very interesting to me because plastic surgery, I think people have this misconception from the individuals I've spoken to where, you know, you just get a procedure done and that's it. But no one really talks about like maintenance or anything.

4:49So do you think software falls under that maintenance category? I think it's a little bit of both categories. I would definitely say if we went back a few years, I would definitely put it in the maintenance category or maybe people are just trying to avoid surgery. But we have this whole unique new, and I call it the exemplification of aesthetics, because you have all these really young patients now with skin laxity and volume issues and stuff. And the type of issues and problems and concerns that we typically saw in our more mature patients. And now you have these 20, 30 year olds that have lost some weight.

5:26They got a little bit of skin laxing, you know, it's still hard for us to offer them a facelift or tummy tuck when they're so young. And so, you know, I think Softwave has been a solution for a lot of these patients that are at a point in their life that they're not really ready for surgery. I think for us as surgeons, it's hard to offer them surgery at this point. And so, you know, I think it used to be for maintenance and now it's a bridge. For some of them, it is the treatment, you know, for them because they they're young, they still have good skin. They've just lost a little weight. And and it's interesting.

5:56Those patients are actually extremely, extremely responsive to these type of energy devices because they still have a lot of collagen, a lot of elastin that can be really responsive to these energy devices. And so it's been super successful as the treatment for them. Oh, wow. So in terms of like the best candidates, like who who's truly in that demographic, you know, that you would see is like this is kind of like the ideal candidate for this. Yeah, I think to really be transparent is I know a lot of your listeners really, really trust you and trust the guests you bring on is, you know, want to make it super clear to them, you know, our technology still isn't to a point where this is a replacement for a face and neck lift, right?

6:35If somebody needs a face and neck lift and they just have a lot, you know, significant amount of loose skin, you know, then they may still need the surgical conversation. But I think for patients that just have a slight amount or moderate amount of skin laxity, or they just know that like, hey, I'm not ready for surgery. I think those are the great patients for it. I think what's really, really unique about Softwave is it's safe in all skin types. So whether you have a lot of pigment in your skin or not, this is an option for you. The really nice thing for a lot of us that are running around and busy and those types of things, there's actually really very minimal downtime.

7:09You may have a little bit of redness to your skin, but for most people, you can go back to work that afternoon, that next day. Wow, that's really fascinating. I mean, I think that, you know, for me, it's always interesting to see like how these treatments really work because skin laxity, I mean, I just want to like go back a little bit. Can you go a little deeper into what is really behind skin laxity issues? Yeah, I think, no question, skin laxity is some loose skin. And, you know, some of it is really hard to predict. And we have a lot of patients that ask us about it. And no question, people can get loose skin from all sorts of different reasons.

7:46One of the most common is weight loss. And I'll tell you, the thing that's challenging is when we're 20 years old, our skin tends to bounce back for most of us, not for everybody, because everybody's skin is just a little bit different. You know, just like some of us are tall, some of us are short, some of us have different color hair and so forth like that. You know, we have different kind of elastin and thickness to our skin and how responsive we are. But no question, weight loss is something that can cause skin laxity or loose skin. We definitely see it after pregnancy and different hormonal changes.

8:20We can see that for sure. Other areas that sometimes people see it is, you know, if you're a little bit more mature person like myself in terms of age, I see both men and women having skin laxity issues. And it used to be something we just associated with the older, older, more mature patients. And, you know, with now all the weight loss medications and so forth and things out there, that's not true anymore. We see the spectrum of people in their 20s all the way up to their 60s, 70s. The other kind of thing that's interesting is that, you know, we get a lot of patients coming in and saying, you know, well, am I too old to do a treatment or to care about this?

8:55But honestly, we have so many patients that are living longer and living better. And so, you know, I mean, you know, so I think that's changed as well because of, you know, just the way life is. sometimes it takes people a little bit of time to be able to take care of themselves because they're worried about their, their kids and family members and other things like that. And so, you know, I think there's definitely people that are being super active, much older into life and, and no question, you know, do, do, it would make you feel good. Absolutely. No, I couldn't agree more, especially now we have all this buzz around longevity and the science of longevity.

9:31So yeah, definitely. People are definitely living longer and more robust lives. So it's going to be an issue that you deal with at some point. Oh, no question. It's just a matter of when. And there's definitely some good things that you can do to help decrease that. And we definitely tell people, especially something like Softwave, the sooner you can get started, the more you're going to respond to it, the better you're going to do. Because the problem is if you just wait too long to do things, then you may even pass the tipping point of where something like Softwave, as great as it is, is going to be able to help you.

10:03because there is a limit to the amount of loose skin that you can have before it really helps. Yeah. So it's almost like preventative then also in many ways. No question. And for a lot of our patients that are on their weight loss journey, you know, we'll actually refer to it as like a ozempic prevention and treatment plan, because if you know that you're losing weight and it's the one thing in my personal journey, if I could change anything, I would have started my treatment sooner and not waited till I got so close to my goal weight because then it takes because then you're super excited about the weight you've lost and how you feel.

10:35And you're like, well, I'm waiting for my skin to catch up. And so if I could have been a little bit more proactive about it, I think it would have been something I would have changed personally. How long does it take to see sustained results with SoftWave? Most people, it takes at least six weeks to see kind of your full results, but usually people will get better for a couple of months. I see. Okay. So in comparison to like, because I know that people have I mean I've had friends in the past who've lost like you know a huge amount of weight right because of health reasons and and so seeing their journey with just you know the skin catching up as you mentioned earlier I know it can be a very long process you know that's that's very very hard and sometimes you have to go through surgery to fix that but I mean in comparison would you say it's like it's accelerated using soft wave I mean for for certain patients or Or have you seen a difference is my question, really?

11:29I mean, we've seen a pretty dramatic difference in terms of people's results using SoftWave. No question about that. And I think I maybe alluded to it a little bit earlier, too, especially our younger patients that have some loose skin because of weight loss or other medical issues. They have some really thick dermis, elastin stuff, and they have responded extraordinarily well to it. And so I think this is to your point earlier, the sooner you can get started, you know, whether you want to call it maintenance or preventative or, you know, just being proactive in your skin care, I think it can be extremely, extremely helpful.

12:09So what is the real science behind this doc? Because I feel like it's hard to understand in terms of what is the body doing or what is this eliciting that's causing the skin tightening benefits of this treatment? I mean, if you could walk us through the science of it. It's basically the energy that it's applying. So it's basically like a heat and energy that's applying. What's challenging and the innovative science about this is how do you apply this heat or this energy to the underlying structures? Because what you want to do is basically control trauma to the deeper layers of the skin without burning or damaging the superficial layers.

12:51And so that's what the science is, is how these unique ultrasound beams can target a certain depth below the top layers of your skin and then basically cause these little controlled injuries at these precise levels of the deepest layers of your skin to cause that skin to contract. And so it basically gets it to shrink in. But if you think about it, if it's causing it to shrink at microportions, you know, throughout your entire face, those microportions kind of shrink in, you know, throughout the face leads to much larger changes. And so that's always been the challenge. And we've always known that energy and heat and these type of things can cause skin to contract and shrink.

13:30But, you know, the challenge has always been, how do you apply enough to see a meaningful difference without damaging the superficial layers of the skin? especially something that you can do with all type of skin types. And that's really been some of the technological breakthroughs of Softwave is being able to apply that energy to the deeper layers of the skin to get all these micro contractions throughout the entire face, buttock, thighs, so forth to lead to a meaningful change for them. Wow, that's really fascinating. That's really, really cool. I mean, I would love to like do a deeper dive, you know, on my own time and just figure out like what's going on, because I just find it so fascinating that, you know, we've come up with these solutions.

14:09I mean, it's crazy to think 10 years ago, there wasn't something like this and now we have a solution. So no question. I think that's some of the things that technology is getting so much better at. And what some of the newer devices is, is how can you really be so precise about the energy where you're delivering it? And this is where I think some of the AI stuff is going to help us be even better about this, right? Because you meet, you know, your, your million listeners out there, all of us have a little bit of differences in our skin. And there's actually some, some technology, you know, being developed currently that, that actually can use some of these, these ultrasound imaging things to actually measure, see where the blood vessels are, see the levels of your skin, and then actually, you know, make micro changes to the depth, to the energy that is just personalized to your skin stuff.

14:58So, I mean, I think that's going to be some of the new iterations over the next couple of years that we're going to see that where even little micro changes can make bigger differences because you're really getting to the exact area that that's most beneficial for that personalized person. Right, right. That's yeah, it's really fascinating. And I want to actually learn. So I know another thing. So what is pure impact? Yeah, that's something that I've been super excited about as well. And one of the things that's been very interesting and, you know, Kudos to SoftWave for doing this in this day and age of, I feel, all the industry trying to develop more capital devices for aesthetic practices to buy, which unfortunately leads to more expense for patients and people listening out there.

15:42But the really cool thing about it is that Pure Impact is basically a plug-in or these devices that can work off the same SoftWave platform. What's really unique about it, it's an e-stem, so electrical stimulation. And so there's been other like magnetic stimulations and so forth out there that help stimulate muscle contraction. And so, you know, but this is really like a fourth generation of it. And what's really unique and cool about the technology of what they've done is, you know, some of their team is really look at all the different exercises, these plyometric exercises that we do at the gym.

16:17And you can now actually set the device to go through these different exercises. And so instead of just kind of mass stimulating your muscles, it actually cycles you through the different workouts, depending at the level of which you're acting. So if you're looking at abdominal muscles, it can actually fire the top portions of your muscles, the obliques, the lower portion of your rectus in a very precise and controlled manner that actually stimulates the different exercises that you would do at a gym. So, you know, and obviously it does it for the different body parts, arms, buttock, quads, hamstrings, but super, super innovative that rather than just trying to, you know, stimulate your muscles a mass into a fatigue is that you're actually doing them in a way that stimulates what you would do at the gym with very, you know, challenging exercises.

17:07So that is super neat. Wow. Yeah, that sounds really cool. Well, so what is, I mean, muscle toning, I feel like is, it's been discussed a lot, you know, the aesthetic space, but like, I'm curious, what is, what's the differentiating factor here from other treatments that you've seen? Yeah, I think that's, that's the, I think there's, there's two parts to this. There's the timing and there's the kind of the acceptance and then there's the, the technology. So, you know, from the technology standpoint, I think the idea that, that we can be so precise in terms of these, because it is individual patches that you can control and really, I think some of it is technology catching up to like what we're trying to do.

17:46You know, the idea that the computer system can, you know, make these pulses fire at such a rapid and controlled sequence that it can mimic the exercises so that the computer can actually be like, okay, this part of the muscle, this side of the muscle, and then that muscle all fire, you know, one millisecond, you know, next to each other to kind of, and when you feel it, you actually feel like you're doing a certain exercise, which is, is mind blowing and something you'd have to really experience. But if you can kind of imagine that, like you're trying to do kind of a side worse crunch, you can simulate, simulate that.

18:20But I think the other part, and the reason that this has been so impactful by Pure Impact is that with a lot of patients being on these weight loss journeys, they've seen some of the data stuff that, that, you know, a lot of people when they're on these weight loss journeys, about a third of their, their weight loss is muscle mass. And so, you know, a lot of patients that are kind of turning into this overall wellness and fitness lifestyle, you know, one, it's there's the skin lax that they can see, but they're also trying to, you know, they look better, they feel better, they want to enhance that.

18:51And so I think, you know, they know that that a muscle is a big portion of them continuing to burn calories to lose weight and just feel strong and better about that. And so, you know, the fact that it's become such a, a public topic and something that I think patients have become much more aware. I mean, you know, because of podcasts like this and, and other technology and information out there, I feel like patients have become much more savvy. And so they, they know that these are some of the side effects of, of some of their medications and, and weight loss stuff. And so, you know, they're looking for solutions and ideas like this that can, patients can come in.

19:24I've done the pure impact and software stuff myself. I'll tell you when I do the treatments, I feel it the next day. And so, you know, I think that is, is what resonates with patients because they try it and they're like, oh, wow, you know, this really did, you know, get me just as sore or not more than, than I do at the gym. So I think that's been, been what's resonated so well with them. That's so cool. I, that's just so, I'm sorry. That's so fascinating to me because I absolutely hate going to the gym. So like, I'm not going to lie. I really, when you're targeting a muscle group, it's like the most annoying thing when it's not working, you know, and you're hitting the gym over and over again.

19:57It's not really resulting in what you want, you know, so it's really cool to see that there's something that can still stimulate muscle groups like that, you know, and, and have those effects. I mean, that's very fascinating. And, and, and the fact that like they, you know, and they've released a bunch of exercises that it's doing, they have more to come. And so the idea is that you can, you know, the day, I don't think as far away and as, as much, uh, they're so committed, you know, the, the soft wave team with, with pure impact of really being able to personalize this gym workout through it.

20:29And that's why we have loved it so much is because, you know, it's more than just like, Hey, we're just going to stimulate this muscle till it gets tired. And then, you know, hope that works for you to the idea that you can actually, you know, be like their personal trainer in terms of doing these very specific exercises, I think has been huge and key and so unique to, to them versus other things out there. They're like a limit to like how many a week or like, you know, how does that work in terms of designing that plan for a patient? Like this is how many treatments you need, you know, there is, is sort of just like regular working out.

21:01You can over fatigue a muscle because you want to fatigue it. You want to really stress it, but you also have to give it a chance to recover. So typically with like a pure impact, most people will do, you know, uh, four treatments in, in a two week period. And then, uh, you can kind of do, do it to a portion. Most people will do it once a month or so each muscle group to supplement their, their current workouts. There are people that are either rehabbing or recovering from surgery or other things that will do it more often for sure. Uh, but definitely something you want to be guided by your provider a little bit, because you can like anything it, you know, Things are great in moderation, but you also do have to give those muscles time to recover and heal to improve.

21:44If you just constantly fatigue them at some point, it's going to be diminishing return and actually keep you from making improvements.

21:53It's the same thing we see with Softwave, you know, is that, you know, we want to and some of it is we want to be conscious of people's, you know, money and time and stuff like that. So, you know, we typically push people, give things at least, you know, three to six months, let's see where you're at, and then decide where to go from there so that they're getting a good use of their resources. That's really, really interesting. And I'm curious to see, like, you know, because so many people, I know the new year is coming around, and everyone's, you know, biggest resolution is, I want to lose weight this year, you know.

22:25So like, I feel like it's good to understand what's out there that can help you, you know, in your journey and really like understanding what comes with weight loss too, right? I mean, I find that I find it to be interesting from that angle, because a lot of times we go into things without understanding what's going to come as a result. And I know with Ozempic on the rise, I don't think anyone really anticipated all of the different, you know, like, I guess you could say the downstream, you know, problems that you're facing with like, you know, loss of volume, like you mentioned and all that. I mean, it's just something you don't anticipate.

22:57So it's really good that you're, you know, you're able to use this as a preventative measure as well, you know, and you're able to kind of plan ahead by incorporating these different techniques. And 100 percent. And to your point, too, most people don't don't think about it as well. If you're really trying to look great for your, you know, spring break season or summer bod, this is the time to do it because you talked about it earlier. it does take a couple months to see the full results from, from some of these treatments, especially something like a pure impact that people are going to need to do multiple treatments or, you know, soft wave that that may take a couple of months.

23:32You know, I think people forget that these winter months are the time if you want to, you know, try and improve some things for, for bikini season, because if you wait till the summer or the week before, you know, an event and, and I'm sure you've talked about it before on your show, but you know, the, it's the week before your wedding's not the time to, to try some new treatments. And so that is definitely super helpful. Absolutely. Yeah, no, I'm glad you mentioned that. But I mean, this is really cool, though. And I really hope anyone tuning in, if you guys have tried Softwave or Pure Impact, please let us know, chime in and, you know, add to the discussion.