Interviewer: Welcome to RealSelf University. Dr. Franco, happy to have you here. This is our...one of two South by Southwest episodes, even though South by Southwest is not happening. Luckily we were both Austin-based so I was able to still keep some of these on schedule, and as you can see by going outside, there is nothing happening for South by Southwest, other than this podcast.

Dr. Franco: No, I appreciate ya' having me, I'm at...I'm excited to be here. It's been a whirlwind last couple of weeks, for sure.

Interviewer: It has. What have you seen in the office as far as behavior changes or coming in from patients who are affected by what's happening?

Dr. Franco: It's been a little bit across the board that we've seen in the office. I've actually been surprised how busy the office has still been with people coming in. I think people sometimes forget that our office isn't like a Nordstrom's or retail store, we can't just close our doors, because we've serviced people who've had surgeries over the last couple months and we still have to provide care for them, one way or another. I think a lot of our patients have planned for some of these procedures for a long, long time, and I think it's really detrimental to them to just close.

And so we've made a lot of changes in the office. One, and I think we might get to it a little bit, we've offered everybody who wants to do online or virtual appointments, we've been willing to convert those. Obviously there's a few people who need to be seen, have sutures removed or different stuff that don't qualify for that, but a large percentage of people qualify for that. We've obviously instated some of the no handshaking. My favorite is the elbow, dolphin fin shake stuff that we do in the office, you know, among... I think people don't realize a lot of the good hygiene stuff, most medical offices already implement it.

Wiping down every exam room between...you know, we have a schedule where we wipe down all the room stuff, all the gowns and other stuff, if they're one-use, they're disposed of, if they're multiuse, they're a chlorine bleach type, you know, wash stuff that's reused. And I think it's important for people to know that a lot of these good practices are already done in most medical offices, so...because this is something that obviously is very important right now, but something that all of our offices take seriously throughout the entire year, and day, and entire careers.

Interviewer: This is normal for you. So, then I had this big light bulb yesterday, I think of anywhere you could go, a plastic surgeon's office is probably about the safest, because it's already extra, extra clean to those super high standards that you maintain, but there's really no sick people there, either. So it's not like going to the ER.

Dr. Franco: No, it's not like going to the ER, but we've implemented... If any of our staff even feels remotely that they are sick, then we have them don't come in. We've implemented some other things to assist with those for our staff that maybe haven't accrued sick days or have used all their time, and so we're trying to work with everybody to make sure that they are still well taken care of and that, you know, they're doing the right thing.

Interviewer: Have you had any sick people come in that you've had to say, "I think you should go home"?

Dr. Franco: We haven't. I have been pretty amazed by how responsible patients, staff, other people have been. We've had people call and say that they're not feeling well, and we've either rescheduled their appointment or switched them to an online virtual appointment. So we've tried to work with people and I think people have been extremely responsible, which I applaud their initiative.

Interviewer: Yep, make sense. What about South by Southwest? You know, you were really looking forward to doing some of the things.

Dr. Franco: Yeah, I think there's a couplefolds there. From a selfish standpoint, I was really excited. As someone who got to participate in the Modern House of Beauty last year, I think it was an amazing event last year and sound like it was just gonna be exponentially better this year. I think for our patients, that the best way to describe it is, it's basically like going to an Apple Store, except for plastic surgery.

And so you get exposure to...you know, I feel like we are the geniuses at the Apple Store...at the Modern House of Beauty, so you have plastic surgeons, dermatologists, facial plastics that you have direct access to, all the different devices and so forth. So even from a physician's standpoint, it's like a kid in a candy store for me.

Interviewer: Yeah, it was really unique. I think putting doctors and patients and brands, treatments, in the same space together, really had never been done before that. So I know everybody at RealSelf's really excited to get it back on the calendar as soon as possible, because we've had such an unbelievable response to it.

Dr. Franco: No, I...everybody who I talked to that was at it last year was excited about it again this year, and I know a lot of companies were excited. I know as physicians, we couldn't wait. But obviously I think it was an extremely responsible thing RealSelf did, because I don't know if most people realize, RealSelf actually took the initiative to pull out before Southwest...South by Southwest was even canceled, which I think goes a lot to their credit of...

Interviewer: Having just been in the Seattle office, I can tell you the mood was calm, everybody was at peace with it, but we all knew we had to protect each other first, and that was what drove that decision, and I really respect our leadership a ton for making that tough call. It was really hard. Okay, so let's go back in time a little bit. We haven't talked about you and how you ended up here, not just in this chair talking to me about your practice, but go all the way back to Miami.

I think I met you for the first time when you were practicing in Miami and you were with a group. What was that like, and what inspired you to want to leave Miami and start over from scratch in Austin?

Dr. Franco: Yeah, think it...it's a little couplefold, so if you'll let me back up even further, I actually grew up at...in the Texas-New Mexico border on a little pecan orchard, me and my identical twin, Johnny and Jimmy, and then my little brother, Fabian [SP]. But I did my med school in Texas, got...had the ability to spend two years in Austin before there was truly a med school in Austin. Galveston's med school had outgrown the city a little bit there, and so they sent some kids to Austin, and I just absolutely loved my time here and so always, you know, wanted to come back.

And then through a roundabout way I did my residency in plastic surgery at St. Louis U and then had the opportunity to spend some time in Taiwan at Chang Gung Hospital doin' some microsurgery, and then in Belgium doin' some fat transfer and other reconstructive type things, and then did a...an anesthetic fellowship in Miami, and that's how I ended up there. So, it wasn't like it was a city that was on my radar, but it was just a great opportunity to train at Miami Plastic Surgery with a group that had a show on TLC and had a well-oiled machine and very outstanding physicians, and so just thought from a learning and career standpoint, it was an incredible opportunity.

So I took it, and it was great, it was super fun. Probably wasn't great for my longevity, staying there, just because it was too much fun. But finally got a chance to move back to Austin and, you know, I probably came back and visited Austin at least once a year, so it was always kind of in the back burner. And then I actually joined a derm group here for a year and they were in the process of getting bought out once I had joined them, and so just ended up not being a perfect fit for me, and just a little over two years ago, decide to start my own practice. And kinda been a whirlwind two years, for sure, but I've loved the journey, with its ups and downs, for sure.

Interviewer: I've seen a lot of practices get off the ground from the beginning, just in my own career that has gone... I don't wanna show my age too much, but I started working on this, on cosmetic marketing, in 2003, before doctors had website. There was no RealSelf. You know, it was a really different time, you couldn't look up a procedure on the internet, and so I was writing procedure content by actually going and interviewing doctors about it because there was nothing to look up. That's how far back I can remember this.

Dr. Franco: I hadn't even started residency then.

Interviewer: Right, exactly. I'm just a few years older than you.

Interviewer: So you started from scratch, and I think kind of watching what you were doing, you did it in a really scrappy way. And I've seen a lot of people come in and think they need to have a giant pile of money or they get a enormous, very painful loan to open up - and you didn't do either of those things. How did you start? I mean, you did one year in the derm ops, but then how did you kind of get going after that?

Dr. Franco: I think it was a couple of things. So one, I just rented some space out from another plastic surgeon, so was able to run pretty lean, and then hired just very specifically. I had a coordinator and an M.A., and that was it, and so between the three of us, we got everything started. I think in this day and age the use of social media and RealSelf online type things has really made stuff a little bit different.

I think in the old days it was really hard, you either had to build practices over time through just working in ERs and doing other things like that, which were hard because it was working towards a goal that wasn't your end goal, if you had a specific niche. I think secondly, didn't overspend in a massive amount of office or staff where it put you in a bind not to be able to do other things. I think sometimes when you do overspend in some of these initial onsets, I feel like you...it starts to take some of the joy away from what you do, because you feel like you're doin' just to keep yourself afloat rather than just doin' what you love because you love it.

I also think I was a little lucky in terms of staying true to what I do. When I was in Miami, I did a lot of butt augmentation, and I remember when I first came here, one of the reps here in town was like, you know, "Oh, you did a lotta butts in Miami," and they're like, "you'll never do any here in Austin, people just don't want 'em." And it was interesting, it's not that people didn't want them - nobody was offering the service. People were getting them down, they just weren't getting them done here, and it created a nice, natural niche.

I think some of the stuff, with Miami being such a competitive market, I think we learned some very good stuff in terms of how to reach patients, how to treat them, how to be, you know, aware to their needs and so forth, and I think they gave a really good platform for us to be able to get our message out to people.

Interviewer: So, it sounds like you're saying you focused from the beginning?

Dr. Franco: Focused from the beginning. When we were starting our practice I just made the decision that we weren't gonna take insurance, we were gonna just focus on aesthetics, and I was just gonna do what I love. And it was funny, I...it actually made it harder for me to get a loan in other things when I was trying to, because the banks didn't like the idea that I was just goin' all-in with my dream here. They wanted me to have a second job, they wanted me to sign up to do other things, but then that was gonna detract me from what I wanted to do, and instead just put all the focus on building this practice the way I wanted it.

Interviewer: In your office, you have a map. Is that map still there?

Dr. Franco: The map is still there.

Interviewer: And you actually had push pins in it.

Dr. Franco: But with push pins. It's a map of the United States, and then we got some little tags if you're from outside, but when patients come to the office, if they'd like, and they are not from Austin, they're...put a pin up on the wall, and so we have...we're trying to fill up every state. I think we've got 30 of the 50 states so far but we're makin' some progress, and so fillin' as much of that board as possible.

Interviewer: So they're coming to you from all over the place. How are they finding you?

Dr. Franco: A couple ways. One is just online searches, and I would say RealSelf is a big part of that. The other part is through social media - Instagram, Snapchat, those type of stuff - and so... Because I think people don't realize, especially with plastic surgery, it's not like orthopedics where if you break a leg, you go to the ER, somebody sees you, most people... And we got it yesterday, somebody came in the office and is like, "I've been following you for two years, now I'm ready."

Most people have been thinking about this for a long, long, long time. And when I was a fellow in Miami, one of the physicians there told me, he's like, "When people meet you, a lotta times they make their decision right away. They're like, 'This is the person I want to do my surgery,' but it may be eight years before they come back and see you, because it's not the right time in their own life." And so I think the thing where some of the online stuff, some of the social media is really changed and has really done well for our practice is, it's been able to be in front and center of people on a daily basis.

You know, we used to do newsletters that people saw once a day - now we post every day on our story. We're on IG Live right now doin' this, so just...because people get a real inside look at our practice, at what I do, and, you know, we'll commonly have between 5,000 and 10,000 people on our story see us every day, and so they know what they're getting.


Interviewer: So obviously, not everyone can just fly here for a consultation, they have to meet you somehow, and that...and we know from lots and lots of research over many years that people choose a surgeon because that doctor makes them feel comfortable.

So there is the moment where they have to bond with you and make that choice - like, "This is who I'm going with." And like you just said, they...that could go back a decade, or eight years. Or it could be yesterday, and you...and you're ready to move forward today. We can predict how long it's gonna take someone to move forward. What do you do when they're far away to get them to know who you are and to maintain that sort of authenticity we see from you online, in a one-on-one setting?

Dr. Franco: So I think there's a couple things. I think sites like RealSelf, I think sites...you know, Instagram, Snapchat, or something where patients get a really good inside look at you before they ever come. They can read reviews, they can watch videos, they can read questions that you've answered, in terms of getting an idea, and I think the more active you are on any of these platforms, which is probably true for most things in marketing business life is, you know, you basically get out what you put into it.

So if you're into it and you're doin' stuff all the time, you know, people make a connection. If you're only doin' things every now and then, you never really are consistent. And hopefully we'll circle back to that, but that's one of the keys to social media, you can't do one great post and not do anything for a month. You'll never build that traction. But goin' back to what our patients from outta town do, we actually have a virtual online system which, you know, is mostly done by my staff coordinating and doin' all the legwork that makes it smooth for patients and for me, in that what we'll do is, patients, when they reach out, if they're outta town and wanna to a virtual consultation online, we'll have them send pictures.

The better pictures they send, the better the consultation. And we have them send some...or fill out a questionnaire so I have a good idea in terms of needs and other things, and then we actually can go through... Now there are so many platforms, we...a lot...most of the time we'll just do FaceTime, sometimes we do Skype, if they're international, we'll do WhatsApp - but those platforms make it easy to have a face-to-face conversation. And honestly, so many people in the business world now, you know, we've lagged behind this.

Do Zoom and other things where they do videoconferencing all the time, that for most people outside of the medical world, this is just another Tuesday. They are so used to it. And for most of them, just from a busy schedule life, they love it. From being able to spend time with us, they love it. I think, like you said, it also gives people access to care that would have been really, really difficult. Look at the state of Texas - we don't even have to go far. You go out to rural Texas, there may not be somebody that does your specific procedure. And now if you think about it, it's one thing...you hate Austin traffic and you wanna...don't wanna drive 30 minutes to appointment.

What about the people in rural Texas that are driving six hours for their half hour appointment, and then six hours back? I mean, virtual online consultations has changed their world. I mean, and if you think about it, even from a post-op standpoint, because patients see like, "Oh, this was easy for my consultation." You know, there's definitely some visits that need to be seen in the office, but if you think about it - again, for patients outta town, for patients who, you know, now you've taken two weeks off work, it's hard to ask for another day - if there is just some little question stuff, they can send a picture, we can schedule a...you know, an online virtual follow-up, and they don't have to make a 12-hour round-trip to get that seen.

And so I think they love that, and we can still make that connection because we see each other face-to-face. And then, you know, we've recently...because of the COVID-19 stuff, we've expanded this so even patients in town, we are willing to offer any type of virtual online appointment, unless they're an injectable or someone who needs some type of hands-on treatment.

Interviewer: How is the virtual consultation different from the in-person one? Or are they the same? Is there some...the key differences?

Dr. Franco: I think there are some key differences, depending on... The consultation, the quality stuff, is definitely directly dependent on the pictures that patients are able to send. So I think that makes a big difference, the better we can do in terms of that. I always think there is this...especially if we're talking about lipo or something where we're trying to judge skin texture and those type of things, I think it makes it a little bit harder on the virtuals and online appointments. No question, I think the more that we've done it, the better we've gotten at the process.

And there is a lot of work upfront that, again, is credit to my office in terms of doing those virtual online consultation, because if people are flying in, this needs to be silky smooth for patients because we don't want them to have a big hiccup. So a lot of patients, what we'll do is, we'll do these online virtual consultations, they can get all their labs clearances stuff at home from their own primary care physicians, and then we actually see everybody in person at least the day before, so this way if we need to audible or change our plan, we can, because now we've had our official visit in-office.

But then it's, we can do the surgery the day before, we see them...do the surgery the next day, see 'em the day after, and then see them again, you know, at appropriate time and intervals for follow-up. And then a lot of our patients even from, like, San Antonio, we'll do an initial post-op in the office, and then alternate. Maybe do a virtual follow-up and then come back again to the office. And so there's a lot of really good things and we're in the process of improving our bank of videos.

And in terms of showing people how to massage, how to do different things that, you know, we've typically done in the office but don't necessarily have to come for me to show you how to do a massage or wear...to place foam or different things in your garment. And we're workin' to get even better about that for patients.

Interviewer: I know you can post those videos on your RealSelf profile too, which makes 'em even easier to find. So as you talk to patients about this process, do you give them guidelines for the photos, or is there something you ask them to do specifically, like, "Don't stand in the bathroom, or..."?

Dr. Franco: Yeah, we do. We have specific instructions that we send the patient, and depending on what areas that they're concern for, we even give 'em instructions and what type of underwear to wear and those type of things, and what not to wear to make it appropriate lighting, angles to take. We typically try to get them to have somebody else take the pictures, because the selfies are great for selfies, I guess. Snapchat, but not for necessarily like a medical consultation.

Interviewer: Or use your timer.

Dr. Franco: And timer. I think the other thing that, you know, we try to remind people is, when we're actually spending our time, though, make sure that you're in a good location where you can hear us and you can concentrate. Because I think sometimes people forget and don't realize that that time is important to be able to hear and understand. So to do it while you're driving, to do it while there's other people in the car, to do it, you know, in the bathroom at work, tend not to be the most ideal. You know, and so that's one extreme.

The other extreme where it's really great, is that a lotta people like to take advantage of it that maybe husband, wife, or whoever is going to be helping, it's a time they can both be together on that couch, they can both listen, they both kind of understand that process, and so this makes life a lot easier for people, because sometimes really hard when you have multiple people that work, kids and so forth, to get everybody into the office at the same time.

Interviewer: Absolutely. It's really challenging. Everybody's so busy. Yeah, that's really hard. Okay, let's talk about another kinda video, the one you're most well known for, which is, we're doing live surgery on Instagram. Which, I watched a number of those yesterday and I think I could...it was easy to see over time how much better you've gotten at this. At these videos. Not that they were bad at the beginning, but they're actually really engaging now, and kind of...I mean, I'll admit, they were kinda fun to watch, and I found myself really enjoying it. So, what can you tell us about how you've gotten your videos to this point? And what goes into making them?

Dr. Franco: I think there's a couple things when you're trying to make these videos and so forth. One, you never wanna do anything that's gonna be disrespectful to the patient, you never wanna do anything that's gonna subtract from the care of the patient. So I think that's number one.

Interviewer: Sticking emojis over body parts?

Dr. Franco: Yeah.

Interviewer: [inaudible 00:23:31]

Dr. Franco: But also making sure we have a really good process in terms of consents, and making sure patients understand, and that they have given their approval to this. I think, but too from a physician's standpoint, you just gotta get started. You just gotta do it. I think all of us are very self-conscious. You know, we are perfectionists, or we probably wouldn't go into medicine and this type of thing. And so we're self-conscious about how we look on camera, and some of it, it's just like anything else in life, the more you do, I think the more comfortable you become, the better it becomes.

But I'll tell you, the feedback we get from our patients, from people who watch - overedited, overpracticed, overrehearsed stuff is boring. They don't wanna see an automated ad, they wanna see the real thing, they wanna hear what you really have to say, they wanna hear what you really believe, and a lotta times what I see on videos comes from either recent interactions. I've had questions patient have recently asked me, concerns patients have recently had, and again, just trying to, "Hey, this person's a good candidate for this. Hey, and this type of person, I'm worried about X." And so, people can relate to that and, like, "Oh, okay."

And I actually see when patients come in and they followed us, we have a better conversation in the office, because they may screenshot, they may bring stuff and be like, "I didn't understand this part," or, "I see why you want me to take three weeks off, I see what...how you pull my muscles and you lift my whole belly and put it back together. That make sense." It's taken away this mythical black box of plastic surgery, that we ask you to do all these hard things and then it's just supposed to come out good at the end, and there is this whole part that nobody understands. And I feel like, hopefully, we're getting rid of some of that.

Interviewer: Absolutely. I know you are.

Dr. Franco: We're trying.

Interviewer: And we see this in RealSelf reviews, where people will document their journey all the way through, and sometimes we'll end up with 50 or 100 photos of their...of themselves from beginning all the way to end, and everyone wants to see that. Those are the most engaging reviews on RealSelf.

Dr. Franco: It makes sense because, again, even on... And there's just no way kind of on our websites it...the [inaudible 00:25:32] to do somethin' at every, like, week interval, we just...one, we don't torture people to come in, you know, three times a week to take pictures of them. But it's just, again, most people see the beginning, they see the end, but it's nice to know, like, "Oh, this swellin' is normal, this bruisin' is normal, this is the whole... What do they mean by my implants are going to be high?" It's nice to actually know.

Interviewer: It is. It's very helpful. How many people are helping you with the Instagram work that you're doing right now?

Dr. Franco: We've tried to make more. So I would say the big change in our Instagram turn when we hired a specific person, who comes the surgery center with me and films, we try to edit the videos very little so that it's real, so that it's there. Obviously, you know, we'll shorten them if there is just blank times that aren't talkin' or those type of stuff, but basically one other person who comes and films. We've tried to get more of the office staff engaged, and hopefully people have seen that change recently, because what I want is people to understand, everybody in our office...because the whole team is what makes this a good experience for them, and it's nice when they come in and they already know everybody.

Again, to our online stuff and even our surgeries...we don't have a surgery center at our facility and we use two great surgery centers here in town, but it's nice because the nurses and anesthesia providers have become part of this. And so they are already nervous, and when they come in and they already know, like, "Hey, this is Nurse Sally and Nurse Betty, whatever," they already have a connection, and that's a calming force for them, which I think is super helpful.

Interviewer: It is. The staff are the second most important thing. Actually, sometimes they are the most important thing because your time is very limited and the people around you have to make up for all the other things the patients need throughout that journey, so I know...

Dr. Franco: New question, because they may never get to see you if the staff and team doesn't give them a good experience on that first phone call. Also, you know, with surgeons I think it's always a unique perspective in that, we're outta the office more days than we're in. I typically operate three days a week, I'm in the office two days a week, so I'm gone more often that I'm not, and so part of them having a good experience is making sure that our staff can help triage calls and stuff that needs to get to me.

Because again, don't want to detract from the patients we are doing surgeries or delay those dealing with other things, but this is where having an incredible staff makes it an incredible experience for our patients.

Interviewer: It sorta makes me wonder if you do anything in your free time, or are you just really focused on work almost 100% right now?

Dr. Franco: No, I...I mean, right now I feel like I'm focused on work since I'm a big sports fanatic and all the sports have been canceled, so it makes me rein it in a little bit. But no, I love outdoor stuff, I love getting out of...going to the gym, doing different things to stay active, I love doin'.

Interviewer: Are you a early morning guy or are you a night owl?

Dr. Franco: Oh, I'm an early morning. No, I'm an early morning, oh yeah. By 9:00 I'm in my PJs, I'm laying down.

Interviewer: Oh yeah.

Dr. Franco: Yeah. But I'll be up by 3:30 or 4.

Interviewer: It's like having toddlers. Are you a, like, 3:30 in the morning guy?

Dr. Franco: Three-thirty or 4 I'll be up...

Interviewer: Aw, man...

Dr. Franco: ...get this day started.

Interviewer: Those are the best two hours of the entire day, is, like, 4 to 6.

Dr. Franco: I love it, it's a chance to get some stuff done, get the day started. I love just gettin' the day started productive, because then I feel like even if I didn't...don't do anything else, by 7:00 I've got an...a big lump sum done and ready to go here, so...

Interviewer: My grandpa was the president of a hospital...

Dr. Franco: Oh, great.

Interviewer: ...and he always said that the early bird...well, he had a lot of sayings, but they were mostly about getting up early in the morning, and how that would make you successful. I didn't listen to him for a really long time.

Dr. Franco: I think if some physicians or other people are looking for some tips about social media, a few key take-homes I would tell them is, you know, number one, you gotta be consistent. Doing it sporadically is going to be really hard. Even if you don't hire a separate person, I think you need to assign somebody in your office. Just like you wouldn't buy a big device or laser and not have a lead, you need somebody who's gonna help you and be that lead and be like, "Hey, come on, let's talk about this, let's do something," because you need somebody to help spur you to [inaudible 00:29:53] this point.

I mean, you get busy, it's easy not to, and then a day goes by, then a week goes by, and then two weeks go by and you haven't done anything. And so, you know, I do something where every morning I just do a little, "Good morning, team," and it...part of that is just, one, to say hi to our team and appreciate everybody who follows us online, but two, it just gets me started with it, because then the day hasn't gone by and it's noon, 2, 3, and I haven't posted anything else. Like, "Oh, well the day's gone, I'm not gonna do anything." It at least gives you in that routine right off the bat. But whatever it is, make sure you're consistent, assign somebody to help be your lead so that they can help you do that.

Also, to be authentic. Just be you. If something's not perfect, that's fine, people appreciate it. It's funny, we've hired, you know, high-tech people to come do these professional videos in the office and they get no views compared to me drinkin', like, Summer Moon and wearin', like, a Boom T-Shirt. And it's just, they just wanna know what...who you are...

Interviewer: They do.

Dr. Franco: ...because to your point, they wanna make an...a connection. They wanna know, hey, if things don't go perfectly, are you someone that's gonna be on the journey with 'em? Are they...you someone they're gonna connect with? And then, you know, I think for...sometimes people struggle with what to do on it. The same questions and issues that you get in your office, that's what people wanna hear about. So, just like you answer questions on RealSelf, you can answer those same questions on your Instagram and other things. You know, we've tried to just film our whole process.

Some of the stuff we're trying to do over the next couple weeks is even some of the process that doesn't involve me, because again, to your point, that's a huge part of the office. And then, you know, the goal's for them to know every single person in the office before they ever come in.

Interviewer: That consistency and authenticity, those are the two keys.

Dr. Franco: Big ones.

Interviewer: Yeah. I think you're an outlier on Instagram, and on social media in general. You just have a knack for it that a lot of doctors don't. And so I don't want anyone to think like, "I have to be just like Johnny Franco on Instagram, or I'm not successful," because success is different for everyone. And it just goes back to what you said earlier about how what you get into it...what you put into it is what you get out of it. And that's true of all platforms, it does not matter. Except I would say right now, you should probably still be avoiding TikTok. What do you think about TikTok?

Dr. Franco: Depends who you ask. My little brother goes crazy about TikTok and just... Yeah, there's some concerns.

Interviewer: There was a piece in "The New York Times" within the last month about doctors on TikTok, and there was a plastic surgeon quoted and he said he tried it, and he realized very quickly that the audience was way too young for what he was doing, and he stopped immediately. So I think right now, it's probably not something we should be messing with too much.

Dr. Franco: It's almost hard, though, because it's...the age and stuff changes dramatically. I mean, if you think about it, a few years ago, Facebook and Instagram was considered very, very young, and now Facebook seems like...you know, it's considered an older population versus Instagram, and it's... You know, I think there's a couple points there. One is, you wanna be in terms of a lot of catchy stuff because you don't know what's gonna resonate with their patients. To your point, you know, everybody's population and their practice is different.

I think that you should have some social media presence even if you are not trying to get to a million followers. At least somethin'. Just like back when websites started, you didn't have to have the best website in the world but you needed to have something, because a lotta times people wanna just jump on and see your profile, maybe they're just looking for your phone number, or maybe they're looking for somethin'. So, I think having some presence is key. I also, to your point, don't want people to get discouraged. I think getting into Instagram, Snapchat, those type of things when we did, stuff was a little bit easier to build your following.

I'll be honest with you, our following has...growth has slowed over the last probably six, nine months as Instagram has made some algorithm changes and so forth. So just because you're not growin' exponentially doesn't mean you're doin' a bad job, it doesn't mean you should be discouraged, because if you think about it, look at how many people open your monthly newsletter, and look at how many people watch your stories. I think you're going to be pleasantly surprised, even if you only have 10,000 followers.

Interviewer: We did a lotta work around that Instagram algorithm change to identify what caused it and what to do about it, and I think the big takeaway was that you needed to get people who already know you to follow you, because it's much harder now to get people who don't know you, to get your content in front of those people. So if you start by focusing on people who already know you, the rest will follow.

Dr. Franco: The rest will follow. I also think, you know, it's...the whole idea of buying followers or these huge numbers doesn't mean anything. You'd rather have, you know, 10 people that are super engaged, that wanna come to your practice, that wanna see you. Doesn't make any sense to have 100,000 people, and only 3 of those people actually care about anything you're doing. So again, this artificial type stuff just, in the end, doesn't mean much. Other than, I guess, if you wanna brag to other plastic surgeons, but I don't know what that's gonna do.

Interviewer: Make you feel temporarily superior. I know if it seems too good to be true, it always is, and I've seen this play out over and over and over. It was buying links, it was buying followers, it was buying likes - there has always been a way to cheat. And I, to this day of 17 years of marketing, there has never been a payoff for cheating that I have ever seen work. So I just don't...I mean, there's...I don't wanna see it anymore, I want it to go away.

Dr. Franco: Yeah, no question. And Instagram itself is cracking down on all...a lot of these, and they've gone through and deleted a lot of accounts and so forth. On the flip side, I think it's become harder too because we've also even started getting spamming and people trying to hack our accounts and other things like that. So, you know, just making sure you're being very careful about sharing passwords, anything like this. Same thing, be careful if you ever open links. You know, unfortunately scammers are not opposed to your social media accounts, either.

Interviewer: No, they are not. You have several accounts, I noticed. How do you use them differently?

Dr. Franco: So we have one for our surgery account, Austin Plastic Surgeon, and then we have one for our medspa. For people who maybe don't wanna see the more graphic type stuff it makes it a little bit different scene where they can avoid some of that. And then we have one for our podcast, "Plastic Surgery Untold" that we tape here in Austin. So we've actually started a podcast, and this is something that we've been able to do to try and spend a little bit more time...because some of the things we've gone...feedback on our Instagram has been that people want more knowledge on a specific topic. Which, again, is very hard to do when you do a 15-second-story clip. But our podcast has been able to let us dive deeper into topics, just as you're doin'.

Interviewer: Exactly. I heard a interesting tidbit the other day that an exec at Allergan had over 200 invitations from doctors asking her to be on their podcast that they were just starting, and I went, "What is going on?" Everybody wants now to have their own podcast, I don't actually think people realize how much work goes into that and that...what's behind that. But you've already been doing it for a while, I've listened to yours, it's very entertaining, and it's a great example, if you're a doctor, of how to do it and what it should look like if you're trying to do something to be helpful to your patient base.

Dr. Franco: I appreciate it, it is a lotta work. I think we are scheduled to start filming our 13th episode tomorrow, so we've been makin' some progress, but no question it's a lotta work. Also, getting stuff out there. And again, you don't wanna overly spread yourself too thin, so, you know, pick some projects you can do. I had a couple other friends who wanted to do the podcast with me, they were in the medical field, and I think having a group of people to help has been really instrumental, because as you know, if you're doing this all by yourself, it can be a daunting task.

Interviewer: It can. I try to pack all my recordings into small batches and get them all done in short amount of time so that then I can space them out and the work is in batches instead of constant, which isn't... That's made a big difference for me and for my team, because we're just able to keep rolling and not feel like we're doing tons of work all the time.

Dr. Franco: Exactly.

Interviewer: What's your next episode going to be about?

Dr. Franco: We're actually going to talk about virtual and online appointments, it's gonna be a big one. Since we've been pushin' that and offerin' it to all of our patients, I think a lot of people don't understand, and we're gonna bring our patient care coordinator on with us, and that way she can explain the process of how it goes and what's it's...what's done with that. Because I think it sounds cool but I don't know that everybody truly understands what a virtual consultation or online consultation is, and this is something I think we were fortunate that there was a pretty big part of our practice already.

We do probably about 10 virtual consultations a week prior to the whole virus rush, it'd be interesting to see a month from now where that number is. But the fact that our office had a streamlined fashion and bringing in some of our staff who actually help with this, I think to do step-by-step of, "This is what we can do, this is how we do it," I think's gonna be very helpful for patients that are interested but don't understand. Because I think sometimes people use virtual consultations but it...they click on some Google link and they push a few buttons, and then it says, "Ultimately, somebody is gonna get back to you," and that's not what we're talkin' about.

We're talkin' about getting something set up where you actually get to speak to a physician or a provider face-to-face, and they can help you. Laws are a little bit different, whether it's in state or outta state and those type of things, and so we can help navigate some of those stuff for people, but I...in my mind, this isn't going away, this is the wave of the future. You know, one of the big pushes in our office is this uberization of plastic surgery, that we wanna make it efficient, we wanna make it cost-effective for people, we also wanna give them an incredible service where they know what they're getting upfront.

And not to get off tangent, we've really tried to change a lotta stuff that we do in our office. We post prices, we've tried to post...we...one of the things we're trying to do is, after every video, we try to post the price of that video...of that procedure so people know like, hey, this is what I'm getting into. I want people to feel like they are getting a good product at a good price and a good service, and they feel like there's no surprises, everything's upfront, and this is something they're happy with the entire process and they wanna come back. And it's funny, as much stuff as we do on social media, on RealSelf, online, our number one referral source is still patients.

Interviewer: As it should be. So you're recording tomorrow. When can we actually hear that episode?

Dr. Franco: Every Tuesday. Every Tuesday we'll release 'em.

Interviewer: And so it'll be right out, like, three days from now?

Dr. Franco: Yeah.

Interviewer: Awesome.

Dr. Franco: We hustle. We gotta hustle.

Interviewer: And where can we find it? On Apple?

Dr. Franco: You can download anywhere where you listen to your favorite podcast. We actually are on iTunes, we're actually on iHeartRadio now, pod...Pandora, Spotify, so wherever you get your...listen to your podcast, download us, "Plastic Surgery Untold," Dr. Johnny Franco.

Interviewer: Okay, so on this podcast, on the "RealSelf University Podcast" we end every interview with a...the same question, which is, what is your unique superpower?

Dr. Franco: I would say my unique superpower is, I feel like I do a really good job in terms of making connections with people, and I feel like in terms of somethin'... And it's funny because my twin and I, I feel like, are very similar in this, in that we get a very good sense of people. I feel like some of this just goes both ways. I feel like we both wear our emotions on our sleeve, and so we are very transparent about who we are and what we're doing, and I think in return, people do that and reciprocate that. And I think that's where the feeling of being able to read and understand people comes, but I think they are just reciprocating what we're sending out.

Interviewer: Does anyone ever mistake your twin for you?

Dr. Franco: Oh yeah, all the time.

Interviewer: And he doesn't even live here, right?

Dr. Franco: He doesn't live here. Occasionally he'll be somewhere random, and it'll be crazy but the world has just gotten so small, and he'll be like, "Oh, somebody started talking to me," and he's like, "they were in the medical field so I'm pretty sure they thought I was you." And he'll just send me a random text. I think with social media and so forth there is definitely times where people have stopped him and asked if he was me. That's the other kinda cool thing about social media, is that, you know, I'll be out at dinner and somebody'll come up to me and ask if they can take a picture with me. Or I was at dinner once, somebody came up to me and they whispered, "I know who you are," and then walked off.

Interviewer: Oh, man...

Dr. Franco: Which is fun, and I appreciate everybody.

Interviewer: I saw yesterday that in "Forrest Gump," Tom Hanks, you know the scene where he's running across the country and his...

Dr. Franco: Uh-huh.

Interviewer: ...beard gets really long? That was actually his brother standing in for him as the body double because none of the stunt doubles could run the way that Tom Hanks run, except for his brother.

Dr. Franco: Huh, I didn't know that.

Interviewer: Yeah, it was kind of a cool anecdote. And I can just sort of see your twin out there, like, maybe there's a day where you need him to stand in for you for something that you can't do.

Dr. Franco: Oh, I would love that. I would love that.

Interviewer: You should get him over here.

Dr. Franco: We should, we will.

Interviewer: Okay, well thank you so much, it was extremely interesting and such a privilege to have you, so...

Dr. Franco: I appreciate you having me...

Interviewer: ...love to do it again.

Dr. Franco: ...this was great.

Interviewer: Yeah, okay, thanks.

Dr. Franco: I'll see you guys soon. That was awesome.