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Hello, and welcome to The Wellness Mama podcast. I’m Katie from wellnessmama.com, and today I’m here with Dr. Cameron Chesnut in a fascinating conversation from a surgeon’s perspective about peak performance in daily life from a surgeon who trains like a professional athlete. And he is actually a minimally invasive plastic surgeon who does a lot of things much differently than the common model, including some special pre-op and post-op recovery and doing very detailed and minimally invasive procedures for people who want to go that route. But what we talk about today is actually applicable to anyone who is recovering from an injury or surgery of any kind, as well as to anybody who wants to show up with peak performance in any area of life. We also talk about his somewhat contrarian viewpoint on things like Botox and filler and how they actually are handled by the body and what he suggests instead. I always love encountering a doctor who has sort of cutting-edge medical knowledge and also understands a lot of the alternative things that can be very complementary and integrates all of that. So very fascinating conversation. Let’s jump in with Dr. Cameron. Dr. Chesnut, welcome. Thanks so much for being here.
Dr. Chesnut: Oh, man, thank you for having me. I’m so honored and grateful to be here with you today. I appreciate it a lot.
Katie: I’m so excited to chat. You come highly recommended from my friend, Ben Greenfield. And in just the prep for this interview, you are so multifaceted and there’s so much we could talk about. In this first one, I’m really excited to jump into things like how you essentially train for life and for surgery as a professional athlete and all of the ways that you train in your life to show up best in all areas of life. And I think for some background for that to start, from researching you for this episode, you do things extremely differently than most surgeons and medical professionals, which I think is awesome. But can you talk a little bit about that and give us some background of what sets you apart in that world?
Dr. Chesnut: Yeah, absolutely. I mean, I do have a background as a professional athlete and or just as a high-level athlete we could go into. And I’ve just kind of used that framework for preparing myself for procedures and surgeries that I do. I use that same framework, interestingly, for my patients in their journey to before surgery, during surgery, and after surgery. But for myself, I really like to be able to be at that peak performance every time I go into the operating room. It’s a big deal. It’s a big relationship. It’s a big connection. Something I take very seriously and it’s my kind of happy place, my flow state area when I’m in there. And so when I go in, I want to be at 100% every time. And that doesn’t just happen organically for these sort of big events. I want to be able to hit those metrics of being ready and being able to deliver the best that I can, which is a little bit different than a lot of surgeons do who might be operating six, seven days a week
Katie: Okay. Yeah, I love even just the mindset of you thinking like that and doing all of that work to show up at peak performance, especially when we’re talking about something like the OR, because I know that that’s a big decision for a lot of people. And they’re quite literally like putting their bodies in your hands. And so it makes sense to me that you put so much work in to show up at your absolute best every single day. And like you said, I know there’s a lot of personal components of this for the things you do yourself to be able to always show up well. And that, like you mentioned, a lot of that translates into how you help your patients before, during, and after surgery as well. So can you talk us through, I think the key takeaway here for everyone is going to be some of these same things that they can apply to show up in peak performance in whatever area of their life as well.
Dr. Chesnut: Absolutely. Yeah. And for me, you know, I’m tracking those things. I’m working through the best ways to do that. And so, you know, I’m utilizing my wearables or whatever it is to be tracking my sleep and heart rate variability. I’m paying attention to my nutrition and my alcohol consumption, which is none leading into things like that, just to be at those peak levels. And those are applicable to every area of life, really.
And I want that for my patients, too. And so we’re building that into their free routine before they come in. You know, we’re having long talks about how to be like fully optimized healthwise, have their internal inflammatory states optimized, you know, be rested, be ready for their procedures themselves. And it’s just that sort of same parallel back and forth. You know, I want them to be ready and I want to be ready. And of course, that’s just that kind of magical combination leading into it and sort of immediately pre-procedure for me, I have a very set routine that I like to do to get ready for that one big event. This is my, the biggest event of my life to that point in time, every single surgery that I do. So I have a very like flow state entry protocol that I go to flow states of performance state, right? Like I have all the grinding and things to get ready visual visualizing. But when it’s time to actually go, I like to be in that flow. So every single morning I have a pretty robust flow state entry protocol that I go through to get ready for that. And that’s, I think, often applicable to people in life, too, when you’re ready for that big moment, that big event. You know, are you in the right headspace to be there and be at your best?
Katie: And I’m so glad you mentioned inflammatory states because in the over 700 episodes of this podcast, that is certainly a recurring theme that links to almost any chronic disease. It’s definitely something that statistically is on the rise across all segments of the population. And it seems like something we’re not addressing very effectively and potentially, obviously, much more important going into surgery when there’s an additional stress on your body. What are some of the ways that you yourself and with your patients address the inflammatory component?
Dr. Chesnut: So that’s a really great question because I just want to start with, you mentioned post-surgery, right? When you’re creating an injury, like not all inflammation is bad. Some of that inflammation is good, right? We need that to heal from something like a, you know, a small surgical procedure on your face, something minimally invasive, but it’s when that inflammation becomes aberrant, when it’s outside of what we want it to be.
And so going into that procedure, I want things to be sort of as calm and set as they can be. Everything that we do creates these stress, this inflammation, as I’m sitting here in a sauna, which we were kind of teasing offline about is where I come to hide from my kids a little bit when I need to do something important. All of these little things create these oxidative stresses that lead to inflammation, but normally we’re good. We recover from those. We use them to get stronger. It’s called hormetic dosing of these stressors. But when those things get out of line, whether it’s exercise, whether it’s nutrition, whether it’s some other autoimmune type of inflammatory state happening, we want those to be sort of at their best, sort of quiet so that when we go do the actual surgical procedure, and we’re leading to a small injury that’s going to lead to healing and inflammation, we want that to be sort of what’s shining through.
So leading into a surgery, I’m often going through sort of a whole functional medicine protocol with my patients, which I outsource to my team. We have a functional medicine part of our practice that exists really just for this, to optimize surgical pre- and post-operative, you know, sort of patient optimization. And in that, it’s going to be genetic testing oftentimes, some laboratory testing, looking at what is it in you? Do you not methylate folate well and have elevated homocysteine levels leading to oxidative stress and inflammation in your body? That’s a very simple fix that we can do leading into your surgical procedure.
So we make sure that all of those baseline things are very optimized. Then during the surgery itself, I get very, very into a regenerative medicine protocol that’s really utilizing what’s the good inflammation to help those things heal. And that can be with growth factors and stem cells. And we don’t want to stop that all the way. A lot of my colleagues will go to this level of using pre- and post-operative steroids during their surgeries. And the steroids just stop all inflammation that’s happening, whether it’s from the surgery itself, whether it’s from the pre-existing things. And it makes you sort of, if you will, feel good. It’s very comfortable for the patient and the surgeon afterwards. But as we know, I like to say that comfort is a slow death, right? We don’t need to necessarily be comfortable. We need that healing to happen. So we don’t want to blanket knock everything out. We want the pre-existing inflammation to be optimized. We know that we want the surgical inflammation to be at its best. I want to help that along with regenerative medicine. And that gets that whole process over smoothly and quickly to give us those nice results that we’re after.
Katie: I love that. And as you were explaining it, I was thinking how any surgical procedure could benefit from a protocol like that, whether it be a C-section for a mom who needs one or whether it be recovery from an injury. I feel like you have a deeper understanding of the body’s inflammatory process than a lot of people do. And I also, my heart, of course, I understand most surgeons wanting to keep their patients comfortable. Like I understand that often with doctors. So I can understand that being a difficult balance. But it sounds like you found some ways to support the body’s natural process versus blunt it, which I feel like anytime we’re able to work with the way the body wants to naturally work, it seems like it would be longer term much more effective as well.
Dr. Chesnut: Yeah, absolutely. And you bring up a good point. This is applicable to any procedure, any injury or it doesn’t have to be a surgery. You know, I do facial plastic surgery. That’s my world, but you’re right. It doesn’t matter what the injury is or what the surgery is. These are going to help optimize those things and sort of make them as absolutely good as they can be. And the comfort is totally right. You know, that’s a huge part of our thing. And that gets into this other little aspect of, you know, during my surgery, sort of understanding how our neurocognitive, you know, mind-body connection and things work.
Like I don’t like using narcotics after my surgery or opioid pain medications for that same thing. And it’s, when I said the steroids, the comfort part is just, you know, swelling and things like that, getting used to knowing that, you know, we’re going to be swollen after a procedure for some small period of time. That’s normal. We don’t need to necessarily knock that all the way out. So that’s that kind of comfort that I’m talking about. When we talk about pain comfort, that’s a whole nother interesting discussion about utilizing other modalities for pain control post-surgery that are not narcotic or opioid-based pain medications. I don’t like to use those during my anesthesia. I don’t use them afterwards. A part of that whole, just like improving the entire sort of recovery process and that sort of neurocognitive mind-body connection.
Katie: That makes so much sense. And one thing that really stood out to me in the pre-interview research I did for this and your answers to our pre-interview questions was your talk about curiosity and questioning everything, which longtime listeners know is very much a core value for me as well. But you had an awesome quote. You said, curiosity is a muscle and it’s the antidote to many of life’s struggles. So I would love to talk about the mindset piece of that and maybe through the lens of, I know one place this seems like it exhibits for you is questioning the narrative around things like Botox and fillers, which have become so ubiquitous in today’s world.
Dr. Chesnut: Yeah, absolutely. So really good point. And I do think that intellectual curiosity or curiosity in general, as we see in our kids often, it’s such a beautiful thing. Right. So beautiful. And we lose it as adults a little bit. And keeping that alive, definitely. When I said the antidote to many of life’s ails, I’m thinking about just even sometimes anxiety, depression, like loss of interest. You know, anyway, curiosity. I love, I love that aspect.
But you know, what you mentioned about Botox and fillers is very prevalent in my world, kind of when we’re talking about facial aging and facial plastic surgery. And Botox and fillers are different. I think this is a baseline thing. Botox is a toxin that comes from botulinum, and it’s meant to immobilize or soften or paralyze muscles. That’s its main purpose. And so as we get facial aging changes and we immobilize or soften the muscles that are there, you can reduce some of their stress on the skin surface. So it’s for movement, it’s reducing movement.
And so we have to think of it and know, you know, how is it good to reduce movement? How much is it good to reduce movement? Our face is very, very, very important in our nonverbal communication. And we want to make sure that we are still able to have those very, very important things. We are very hardwired to recognize facial changes, facial beauty, facial aging, and facial emotion, right? So Botox is that.
Filler is a different avenue. Filler is very commonly referring to these hyaluronic acid gels. These are this cross-linked gel that’s meant to go in and replace lost volume, right? You put it in an area that’s deflating, and it’s supposed to puff it up and add volume. Well, if we flashback to, you know, the oldest of these in the United States has been FDA approved for over 20 years now. So we have quite a bit of data with them. And we know that they’re not quite what we thought they were initially, as far as they’re often thought of to go in and last six months or 12 months or maybe two years, and they go away. And so it’s turned into this sort of like this paradigm of like constantly updating them, doing them over, touching them up.
But as time has gone on, we’ve started to realize that these do not go away after a year or two. I very commonly see them 15, 20 years after they were inserted, still present in the tissue, still causing changes there. And so you can imagine with the paradigm of trying to get it every single year, knowing that it’s not going away can really accumulate and can be a really big problem with the long-term aging strategy of using that as your way to rejuvenate an aging face. It’s really just based off the understanding of, you know, what part of our facial aging is from volume deflation, how much of it is actually just losing volume, because that’s all filler is really able to do. And so if that’s just a small percentage, call it 10, 15, even 20% of our facial aging, but 100% of your strategy is to add volume back, it gets problematic. And we start to see what we all see with filler, which is this sort of like unnatural, overfilled, puffy, pillow-faced looks that whether you know it or not, you’ve seen it and it’s caught your attention. It’s like something is off with that. And we’re very, very sensitive to that. So it’s, it’s turned into a problem over the last 5 to 10 years, especially.
Katie: That’s so fascinating. And that’s honestly not something I knew a lot about before this. I’ve not personally ever tried Botox or fillers. And it makes sense when you explain it. But for fillers, especially, is this something that the body recognizes as foreign? Because I know there has been also increased conversation about anytime there’s any kind of foreign object or implant put in the body, there’s a potential for the body to mount sort of an immune response because there’s now a foreign substance in the body. Is there a potential for that with filler as well?
Dr. Chesnut: Yeah, absolutely. It’s a really great question. And if we go back to sort of what’s taught about these along the same lines as they only last, you know, 6 to 18 months is taught that they’re totally inert in the body because hyaluronic acid is something that exists in our own skin. It’s a structure, structural component of our skin that gathers and absorbs water, right? Well, these are a little bit different. It’s that same hyaluronic acid, that structure of hyaluronic acid is sort of equivalent across all species. But when it’s put together, it’s cross-linked to make it this sort of like harder gel, if you will.
So the teaching is that it’s inert. It goes in. It does not cause any changes. It’s just sort of an implant that sits there. What we see actually over time, though, is that it could be years and years after an injection, if you have a systemic inflammatory reaction, call it hay fever, a cold, you get a vaccination and you have this sort of systemic inflammation that gets revved up, your immune system just gets turned on. We do see areas that have had filler get inflamed, get warm, get tender. And so we know without question that the immune system does recognize the filler that’s there. And this is very sort of, you know, in my world, it’s put aside as, well, that’s not true or that’s the studies don’t show that. But we know without question that that’s a very common thing. During the COVID vaccines, actually, it was well documented. It kind of became mainstream news for a bit that people’s filler was becoming inflamed when they had it done. And so there is an immune phenomenon with them that is still being delineated, I believe.
Katie: But it sounds like definitely an area of at least worth further questioning and some skepticism, especially for a person who might already have some autoimmune markers or elevated autoimmune markers in their body that we would want to question that before just assuming the narrative that it’s inert.
Dr. Chesnut: Absolutely. Because like you’re saying, you know, when the immune system is turned on, as it is, if there’s any autoimmunity, it doesn’t take the hay fever or the cold. It’s just sort of on some low baseline all the time. Just a significantly greater chance that that filler is going to be recognized and become problematic. Absolutely.
Katie: So as a follow-up to that, if someone has had filler and is concerned about it, is there anything they can do to help the body kind of either clear the filler or get rid of that inflammatory response? And or if someone has not gotten filler or Botox, but is considering it for the anti-aging side, what would be alternatives that they could look at?
Dr. Chesnut: Oh, such great questions. Okay. So this gets into another very sort of counterculture point of view. So there is an enzyme that our body makes naturally called hyaluronidase, because we’re talking about hyaluronic acid fillers. And so our body makes an enzyme that breaks that down naturally, because we constantly have this turnover in our own body. We have that enzyme that we can also utilize exogenously as an injection to try to dissolve the filler. And so this has become very popular in people doing filler that say, oh, if you don’t like it, we can just dissolve it. We’ll just put in this dissolution agent, which sounds so simple and beautiful. Like, what a wonderful option.
Well, the problem is the dissolution agent is not perfect. It does not work. It’s not a magic wand that magically just erases everything. It can help accelerate the breakdown, but it does not get rid of all of it. So that’s kind of part one is that you get filler, you really don’t like it, or it’s causing a problem. You don’t really have this magic bullet to get rid of it. You can try to dissolve it, which will help. But then there’s these issues with the dissolution agent itself. And this is a very, very hot topic, very polarizing, because the data would suggest that the agent, this hyaluronidase, does not damage our native facial structure, our native skin. It’s totally fine. It exists.
Well, it exists in very small quantities within us. And so when we provide it exogenously in really high doses, very frequently, it can certainly break down our native hyaluronic acid, which is an important structure of our skin and our other soft tissue. It can break that down to the point where we might not be able to regenerate it quite the same that we could before. So in this attempt to get rid of the filler that you have, there is a potential that you’re also damaging your own native soft tissue that’s surrounding the filler.
And so the question is so good because, you know, can you break it down if you want to? Yes. With an asterisk, that’s not perfect either, right? If you’re having an immune response to it, can you stop that immune response? Well, hopefully you can get rid of enough filler that you can do it. But in reality, some of that filler is there forever and ever. It’s not going away. And so, you know, it’s a really great sort of hot topic to, you know, how much can we remove it? A lot of my practice ends up being manually removing the filler. So I may be somewhere, you know, in a very minimally invasive way, let’s say somebody has filler along their whole face and cheek and it’s getting inflamed and it’s bothering them and they’ve tried to have it dissolved and it’s not working. Well, I can scarlessly go approach that area and remove the filler manually, which is great. But, you know, now you’re having a small surgical procedure to get rid of it. That it’s silly to do that for something that the whole benefit in the first place was it’s non-surgical. So simple. You can, wherever you guys are watching this from, anybody who’s watching this, my guess is within five miles, there’s multiple people who would give you filler if you went there to get it. It’s just so readily available right now, which becomes problematic when it becomes commoditized. And, you know, it seems such like a simple, you know, harmless thing to get until you get down the road with it a little bit.
And the next part of your question, which was really good, is, well, what are the alternatives to doing that? Well, filler’s not bad in and of itself. If you understand what part of the aging curve that it’s responsible for, you can use it responsibly to just correct that. And if you don’t want that foreign implant in your body, there are alternatives that come from you directly. So my favorite thing to do for this is we call autologous, which means from you, autologous fat transfer, where we borrow fat from around your belly button or your flanks or your inner thighs with a very, very small, simple procedure done by hand. We just take a little bit of that fat out and we can turn that into a filler, which is essentially just using that fat to replace lost fat in your face, which makes total sense. You’re replacing like for like, your own fat for your own lost fat.
And there’s this beautiful other aspect to it is that fat is one of our richest sources of stem cells in our body. So I can take yours, especially if we’re young, I can take your fat, isolate it down to just the stem cell portion of it and put that in your face. So you get this volumetric benefit from adding lost volume, but you also get this whole, we call it paracrine, this whole stem cell effect to your surrounding fat pads and your surrounding skin that makes that better over time too, by adding the stem cell density to the area. But it’s the same limitations of just only so much of our aging is from volume. We also have skin changes and gravitational changes. So we just have to really understand what can be corrected with something like that.
Katie: That is so fascinating. And it’s great to know that there are options that are already in your own body that are not going to obviously create a foreign reaction because they come from your body. It’s exciting that we’re seeing innovation in a lot of these areas. I’m also curious, just kind of rapid fire to get your take on other things that are often suggested for that aging component or for skin. I know like red light often makes that list. I’m curious your take on things like red light, as well as like, I’m a big proponent of at the very least morning sunlight and watching the sunset. But I know many people entirely avoid the sun to avoid the aging component of it. So I would love your take on sort of the light equation for aging and skin health.
Dr. Chesnut: Absolutely. Yeah, this is blasphemy in my world. So before I did facial plastic surgery, I did dermatology. I never actually practiced it, but I got board certified before I moved on. And so in that world, you’ll find dermatologists who are just completely sun shaded all the time. That’s the person on vacation with the hood and the hat and the sunglasses. And first thing in the morning, there’s just no there’s no such thing as good sun.
Well, I would you know, this is my intellectual curiosity. Like, I don’t believe that at all. We are meant to make vitamin D from the sun. One of our arguably our most important, you know, vitamin or hormone that we’re getting, we’re making from the sun. So we need that sun exposure. Exposure early morning, late night is hands down the best time to get it, especially if you’re a lighter skin tone, because you can get some of the benefits of it. In addition to the whole circadian rhythm setting that you get from early morning and late afternoon sunlight, which completely helps our whole sleep cycle. So a lot of benefit to that early morning, late afternoon sun exposure, helps set our cycle, helps us make vitamin D. That’s great. Midday, let’s say you’re living in the northern hemisphere and it’s noon on July 1st. Might not be the best time to be out baking in the sun at that point, because we’re certainly accruing damage from that intense UV light in our skin, and that’s going to accelerate our aging. But at those other ends of the spectrum, really great option.
You asked about, you know, let’s just call it photobiomodulation, which is just kind of breaking down to like how light waves can interact with our body and red light being hands down the most popular unquestionable benefits to just anti-aging in general. Now, these aren’t huge. This isn’t going to be some miracle that you’re going to get a red light on and reverse all of your aging. And I’ll find that with a lot of these sort of like, let’s call it wellness or biohacks. They’re not turning back the clock as much as they’re kind of pumping the brakes on the process that’s happening. Red light’s a really great example of that. Certainly improves our mitochondrial function and these very specific cells called fibroblasts that make collagen and elastin.
Elastin, we talk about collagen so much is like that. That’s the one we want. But in reality, we want more elastin tissue. Elastin is creating that elasticity and recoil of our skin that changes. And so red light can really, really help to accelerate those things. I use all kinds of different wavelengths of light in my post-operative recovery protocol after my procedures. Most of the procedures I’m doing are on just younger people. They’re incredibly minimally invasive or scarless. And so the people that I’m working with tend to be a little bit younger early on, and they have this incredible capacity to heal afterwards. And so I am doing everything I can to accelerate that with hyperbaric oxygen, targeted IV nutrition, post-electromagnetic fields, and light therapy. These are big, big parts of that recovery protocol. So there’s lots of these little things you can do that you may apply to your overall daily wellness that can really, really help in that post-surgical time, red light being a big, big part of that.
Katie: I love your approach because it lines up, I say so often, probably to the point that people are tired of hearing it here, is that like at the end of the day, we are each our own primary healthcare providers and our bodies are always working to our benefit to be in their optimal state. And so I feel like anytime we have the opportunity to support the body in its natural process or its strengthen or enhance something the body already knows how to do, like I said, we get such great results. And I also love that your whole approach centers around this idea of curiosity, not judgment, but asking those hard questions and not just accepting the mainstream answers. It’s so fun to see that entering the medical world. And I love how you’re innovating in this world. And I know we’re going to get to do another interview that will actually be an entire deviation and talk about parenting, among other things. But for this episode, two remaining questions. The first would be if people want to work with you, since you have such a novel approach to this, where can they find you? And secondly, what would your personal 80-20 be that you would give people as kind of a key takeaway of things to focus on?
Dr. Chesnut: Oh, I love this. So finding me is pretty easy. Social media, specifically Instagram. There’s TikTok and Instagram. They’re the two I put the most energy into. And that’s just my last name, Chesnut, with no T in the middle, chesnut.md. And that, my Instagram is very focused on, my practice is built off before and after photos, really. People travel from all over the world. All of my patients travel to see me. We have a process that’s very, very dialed and frictionless, and it’s a wonderful experience of recovery. When you come to visit me, I live in the Pacific Northwest. And so, but my social media is based off of really what the photos of the before and afters look like. And then a lot of patient-facing education. So you can get a lot of information on there about these things, about surgery, about filler, recovery. And then a big part of my audience is my fellow surgeons who are into this sort of like surgical optimization. And so you’ll see a bit of that on there as well. But social media is a really, really great spot to find and follow along and just kind of learn more.
And then my personal 80-20. I love this because I love the Pareto principle the 80-20. This is how I get through all of my surgeries. When I’m seeing you for the first time, we are really going through like, what is your 80-20? What are those, I call them low-hanging pieces of fruit that we can go after that like involve very minimal input to get to, but play this big impact. And so it’s that sort of reverse 80-20 rule, right? It’s like, that would be my advice to anybody is go to somebody or find somebody or talk to me who understands what those real, the key intricacies that we can target that like don’t really involve much to get to. It’s relatively simple, relatively minimally invasive, maybe non-surgical altogether. And you can target those things to kind of achieve that. That’s the recipe for looking natural. That’s the recipe for getting longevity out of your results, making them durable in the long-term. And that’s the recipe for kind of like being able to take along with this over time.
And just like I said, maybe pump the brakes, maybe turn it back a little bit, kind of understanding all the multiple facets of aging that are happening internally, externally, you know, you’re so big on this. Like, you know, we’re slowing down our biologic clocks. A lot of people, we’re literally turning back our genetic aging, right? Which is incredible. And, but when we do that, we want, there’s, there’s certainly this connection between our mind and our body. We look good. We feel good. Vice versa. You know, when you, when you have this magical change to your health, you feel incredible. It’s like almost hard to explain. Right. And you look a little bit better too. So my world is a little bit flipped on that. We, we take that, you know, looking better and we make that, you make you look a little bit better. It’s great. It’s, you know, easy to see, but you feel better because of that too. So they work really well together to use those. And that’s my, that’s my 80-20. Is understand how those things relate together, pick out the low hanging fruit and work through those.
Katie: I love that. Well, you are so fascinating to talk to. I have so much enjoyed this conversation and I look forward to our next conversation. Thank you so much for the time today.
Dr. Chesnut: Absolutely. I appreciate it. Thank you.
Katie: And thank you for listening. And I hope that you will join me again on the next episode of the Wellness Mama podcast.
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