The Melanie Avalon Biohacking Podcast Episode #274 - Dr. Cameron Chesnut

TRANSCRIPT

(Note: This is generated by AI with 98% accuracy. However, any errors may cause unintended changes in meaning.)

Melanie Avalon:
Welcome back to the Melanie Avalon biohacking podcast. I am Melanie Avalon and I am so excited to be here today with a guest that is about a topic that you guys are very, very obsessed with. So the backstory on today's conversation, a few months ago now I actually got an email from Ben Greenfield who I know you guys are huge fans of and I'm actually going to have on the show in a few months so stay tuned for that. But he reached out because he said he had quote, a unicorn in the beauty industry. I'm literally reading from his email who he said is quote, pretty much the smartest coolest doctor I've ever met in the field of cosmetics. And there was a lot more beyond that. But just hearing that hook, I was obviously immediately intrigued and anybody that Ben Greenfield recommends is obviously like very high on the totem pole. So I was so excited to learn that this was Cameron Chestnut friends go to his Instagram right now so that you can get a vibe and a sense for what he does because it is so incredible. He has so many followers and is doing such incredible work. And it's exciting because we were talking before this. It's about a topic that I know a lot of listeners are really, really interested in, which is the world of beauty and cosmetic surgery and fillers and Botox and all these things. And what's interesting is I think there is this attention because I think a lot of people in the health and wellness sphere, the biohacking world, they feel like they shouldn't be doing these procedures, maybe that they're unhealthy, maybe that it's not being your quote, natural, beautiful self through health and biohacking and all the things. So I know there's a lot of interests because I get so many questions about it. I feel like a lot of questions I get, they also come with disclaimers to make it clear that people want like a healthy approach. So I was really excited talking to Cameron because we were talking back and forth on email. And oh, my goodness, his approach to this, I am just so excited to dive into. He is all about a really, and I'll let him talk about it more than I do, but a really unique approach that takes into account minimal invasiveness when it comes to things like pain medication and anesthesia. And he focuses on optimizing recovery through a lot of really cool modalities that we're going to talk about. So Cameron, thank you so much for being here.

Dr. Cameron Chesnut
Oh man, thank you so much for having me, Melanie. That's really nice introduction. I appreciate it, especially like the unicorn part. I have a couple of daughters at home, so that one hits deep with me and makes me kind of chuckle. So I appreciate being on here and really looking forward to engaging with your group and your audience and hopefully giving them some great info to take forward with them here.

Melanie Avalon:
Oh my goodness. Yes. Okay. So many things. First of all, I love unicorns too. So this is, so we're in a good place. I actually have a question now about unicorns related to this. I'm going to save it. And then I wanted to emphasize, I said this already, but I was just so impressed with your emails and everything that you were saying about what you do and your approach to all of, all of this stuff. I'm super curious. Like, were you always like this, having this approach to plastic surgery or originally were you going to be a quote conventional plastic surgeon? Like, where did this perspective and paradigm come from?

Dr. Cameron Chesnut
Yeah, that's a really great question. For me, it comes, my mother was a nutritionist, a registered dietitian. And she was very progressive with her view on things as I was growing up. She was into omega 3s before they were popular and cool. And we didn't eat margarine when that was the trend in her field. She was definitely a little bit ahead of the curve in just the way that I grew up. And I didn't understand it at the time. She did her best to educate me. But that was just sort of the life that I lived in. As I became an athlete, and especially as I got really deep into that, I appreciated how that gave me an edge and made me better, just that sort of background knowledge. And so for me, it was a collision of two worlds, this world of my baseline health that I grew up in that I rebelled against a little bit, honestly, and my desire to be the best athlete that I could be. So I had that in me a little bit. And I was actually going to be a nutritionist. I was going to follow in her footsteps. That's what I majored in in college, actually, was nutrition. And medicine was always on the back burner, and I always knew about it. And as I sort of got into that a little bit, it was a better fit for me. And so I carried forward as an athlete, most of all, honestly. The nutrition was just a supplement to that. And my practice now within facial plastic surgery is very niche, very, it's a million miles deep and very narrow. And that just suits me well. But carrying that background as an athlete, and let's just fit nutrition now into this sort of wellness world, really just came along naturally because I knew what having a baseline solid foundation in your health and wellness can do for your athletics, or in my case, your surgical pre -covery, I like to call it, and recovery. So it just kind of came from that. And with my patient population, again, I'm a million miles deep and one mile wide in this facial plastic surgery realm, I just started finding people that really resonated with that. So it's very much my practice is the world's high performers. It's people who want the edge, want the best. They care about results. And they're willing to put a little work in. In this case, work comes in pre -covery and recovery to get those best results. So it just matches up really, really well with that background. And I find like -minded people who value that as well.

Melanie Avalon:
I love it so much. And what's so interesting is that topic seemingly applies to both the patients and you, right? Like, so like the way you approach as a surgeon, you can practice all of this and then also using these approaches for your patients for recovery. Is that correct? Like is everybody kind of on board here?

Dr. Cameron Chesnut
Yeah, I mean, you absolutely said it perfectly. I apply this athlete's mindset to my patients and to myself, and I kind of break it into these ideas in my head that are the pre -surgical timeframe, the during surgical timeframe while it's happening, and then the recovery timeframe. And I have those for myself, again, approaching this like an athlete before the biggest event of their career, of their season, whatever it may be. So I am, you know, pre -surgery, visualizing both outcome visualizing and process visualizing, and I am getting ready. And, you know, like I said, it's my biggest event. And then during the surgery on the morning of, I'm going through an entire flow state preparation routine to make sure that I'm at my absolute best during that actual day of surgery. It starts with time in the hyperbaric chamber in the morning with some quiet time. And then I carry it into the sauna where I'm doing a corpus callosum stimulating workout, trying to link the two hemispheres of my brain to my body, just getting in a very unique and rare state to get into that takes a lot of energy and focus. And then for me after surgery is recovering, I'm journaling about the surgery that I did so that I can get feedback on all the decisions I made later. And it's very much like watching film after a surgery. So for me, that is like an athlete preparing for, going through, and then getting feedback on that biggest event sort of of their season that year. And I do that for every single surgery and it takes a lot of time and energy, which for me means that I'm limiting the number of surgeries that I'm doing. I'm not operating 12 times a week. I'm keeping it very, very manageable so that I can deliver quality instead of quantity in that mindset. And that carries into my patients as well. I'm looking at their pre -surgical optimization. We have a whole protocol that we do. So Melanie, we sign up to do surgery. All of my patients travel to see me. So they're coming in from afar and we've engaged virtually, generally leading into that. And then for the month prior to surgery, I have you on a protocol that honestly, a lot of your audience is probably already doing to optimize your inflammatory profile, optimize your antioxidant profile, just gets you in the best possible position we can be to recover from a stressful event like surgery. And then on the day of surgery, I'm using a lot of regenerative medicine for you. And then the big difference comes in this sort of idea of after surgery and that whole recovery protocol that I've been working on for many, many years to optimize, to get you better as quick as I can and to improve the end results of what we're getting. So it's a really nice double benefit. And we can talk more about what those modalities are, but it's a relatively in -depth and unique protocol to engage in after surgery. And it doesn't matter if it's facial plastic surgery or any surgery, it's wildly helpful to take that approach to it.

Melanie Avalon:
I'm actually having flashbacks right now because so I had a rhinoplasty septoplasty. So in layman's terms, a nose job, which also fixed my deviated septum, honestly, one of the best decisions I've ever made in my entire life, it didn't really change the way I looked from the front, but I had a dorsal hump. So I had like a bump on my nose that always really bothered me from the side from my profile. It bothered me honestly, since middle school, and getting rid of that, I can't express like how happy it makes me even thinking about it now, just because it was something that really bothered me personally. So I'm all team doing, because I talked in the beginning about how people kind of approach this hesitantly, I'm all team doing what you want to do to, you know, make, you know, help yourself feel the most beautiful that you want to feel in your own skin inside and out. I mean, maybe we can talk more about the, you know, the esoteric concepts there.

Dr. Cameron Chesnut
Yeah, there's a heavy topic there for sure. Absolutely.

Melanie Avalon:
The immediate question I had, just because I'm having flashbacks to that procedure, I'm having a lot of flashbacks, but one of them was, remember when I was scheduling the surgery? It was on a Friday. It was early in the morning and they told me I was his last patient, I think, of the day. And I remember thinking, oh, okay, so he's doing like multiple surgeries back to back early in the morning. I remember asking them, I was like, is he tired? Like, is it a problem if I'm the last patient on a Friday? So I guess my question there. It all ended up being completely fine and he was amazing, but is that something we should be concerned about in general with plastic surgery, like the state of the doctor and everything?

Dr. Cameron Chesnut
I mean, I, this is where I'm going to have colleagues who disagree with this. And, you know, I wouldn't necessarily argue with that overall that, you know, you, your surgeon did a great job, right? And that's awesome and incredible. I take more of the mindset that I live in this very, again, I have patients traveling to me from all over the world. 65% of those people have already had prior surgery that I'm fixing or making better. Let's just say that. And so I'm living in these top individual percentage points of improvement. They, you know, got a seven or an eight out of 10 on their last surgery, and they're looking for a nine or a 10. So I'm really picking the high hanging fruit. And that takes a little bit of extra focus. And so I'm working in a narrow space. And I would argue that after doing that as best I can for that individual person, I'm not as capable of getting there again now. And I'm built for resilience and I'm built for the grind. And I do all the physical things in the weeks leading into surgeries. I mean, I'm training for these moments. So once I've been in that flow state where I've taken all that energy to get into that space, and I've put all the work in to get in that flow, it's a, it's energetically expensive from a cognitive and a physical standpoint. So to get back in there again is very difficult. And it's not the same to keep going there over and over again. It's like playing multiple games in one day, it's hard to get up there every single time. And so for me, I'm not saying that every surgeon should only do one surgery a day or whatever that is. But for me, I find that I am getting that actual best result by going there one time very intensely, giving it my all, and then really focusing on for myself recovering to get ready to maybe do it again the next day, or sometimes I don't want to do it again for several days. But I approach that as this is my big event. Think of you, Melanie, that day, that's the only time you've ever had that done, right? That was a huge, massive, major, mega event for you. And I want to be on the same page with my patients for that. I don't want it to be one of three or eight things I'm doing that day. I want it to be, this is the one, you know, this is all I'm focused on. So I choose to take that approach to it. And I'm not saying that's right or wrong. But for me, I know that that's how I perform the best. And that's what I do. That's how I like to, you know, kind of function in that category. And it's the same for my whole team. There's a lot of people involved in this. And we know that this is our focus for the day right here, this kind of one big thing that we're doing.

Melanie Avalon:
sort of related the other flashback I'm having is I remember when I because I was really nervous about it, which I imagine a lot of people are. I think one of the things that made me most nervous was somebody told me who told me this? Honestly, it might have been like one of my friends who was a podcast guest who was a doctor. And he was saying that I needed to understand the perspective that this was going to be a major trauma for my body, even if I wasn't aware of it happening. Like basically this concept that you are doing surgery on your body and even though you're not awake, like that's still happening and that trauma registers in the body. Do you have thoughts on that idea? What the body actually experiences during the surgery and whether or not you're conscious of it? Does the trauma from that linger?

Dr. Cameron Chesnut
100%. And I think that there's a couple of implications there in which your guest told you you have the idea of maybe some psychological trauma. And then there's just the physical or physiologic trauma. And there's no question that those are linked. And, you know, you mentioned even my anesthesia protocol that I do, you know, I want you healthy going into this physiologically, emotionally, I want you mentally ready and understanding what we're doing, because that helps to mitigate some of that trauma that you're talking about afterwards, it takes the fear of the unknown out of it, I don't want any fear in this, you know, I want us on the same page. And then the recovery, we know that we're in it together, there's contact with myself and my staff every day, which is just helps with coping mechanisms, right? So there is that part of it. And that is not to be neglected, even just honestly, only how you're sleeping after the surgery affects both of those wildly, what's your emotional state? How can you cope with things? How are you physically recovering? So I'm super focused on my patients sleep after their surgery. And I don't know that you'll hear a lot of other surgeons talk about that ever. But in this situation, the anesthesia that I'm choosing has no opioid medications in it. I'm not using benzodiazepines, we know that those not only are very difficult on your brain, just the actual cognitive function, but they also can severely disrupt sleep afterwards. So I'm doing a very progressive anesthesia protocol that does not involve general anesthesia, inhaled gases, things like that. It's enough to put you to sleep. And then I'm utilizing this is what one of your your friend was talking about. I'm utilizing local anesthesia to block any pain signal to your brain. So there that you're not getting a signal in your brain, that is that there's pain happening, it's getting blocked before it ever gets there. So there's data to show that if somebody has general anesthesia, where they're asleep and, you know, kind of unconscious, but they're still getting that pain response from the surgery itself, even though they're not registering it while they're under anesthesia, they have more pain when they wake up and when they're moving forward. And so now with that information, even in general anesthesia, general surgery, a lot of surgeons are starting to utilize a lot more local anesthesia to block that signal from ever getting sent to the brain in the first place. And this is something I've been doing for years and years. And I think it hits on what you're talking about a little bit, even when you're asleep, if you're getting that pain signal, it could be detrimental to you afterwards. So I just take a very progressive approach to that that makes it a very simple and very, I mean, I'm going to say even pleasant recovery in comparison to that you can, you're not, you're not needing pain pills, because I'm utilizing that local anesthesia and a long acting nerve block after the procedure. And you can go to the bathroom because you're not on an opioid medication. And there's just a, it's a very different experience to recover surgery with that progressive mindset.

Melanie Avalon:
Are you saying that the majority of people who get general anesthesia, it does not have that local pain blocking part as well? That's something unique that you do.

Dr. Cameron Chesnut
So even when people are under general anesthesia and they are asleep and they're getting no, they're paralyzed, they're not breathing for themselves, we know that there's data to show when they have a painful stimulus, let's say someone's cutting on them during surgery, when that signal gets sent to the brain, even though it's not being registered in the brain, it opens up those pain pathways for them. And so they're in some sense still experiencing some of that trauma. And when they wake up, they have more pain post procedure than if the surgeon uses local anesthesia, which blocks it before the pain signal ever gets sent to the brain. Those patients that get general anesthesia with local anesthesia do better after surgery from a comfort standpoint. And so that's something that I've been doing for years. And if this is the exact application of it, I don't put them under general anesthesia. They're not completely slammed to the bottom of the ocean, not breathing for themselves. They're just barely asleep. And then I block any pain signals from going to their brain whatsoever. And so when they wake up, it's a relatively simple, pleasant experience. They aren't having much postoperative pain. I use long acting nerve blocks after their procedure that last 72 hours to eliminate any pain signals being sent. They can go to the bathroom because they're not taking any opioid pain medications. They can think clearly it's just a whole different experience recovering from surgery with that type of a progressive mindset.

Melanie Avalon:
Whoa, okay, this is so fascinating. So when I got mine, so do other doctors who do general anesthesia, do they ever do the local as well or do they pretty much not because general's knocking you out conscious wise?

Dr. Cameron Chesnut
For the most part, they don't do that, but it's starting to get traction a little bit to think that way because adding local anesthesia takes additional time. It's a whole skill set in and of itself to be able to do it effectively. So there's a learning curve to it, basically is what I'm saying. And again, it's going to take somebody with a little bit more of that progressive mindset to apply that, you know, if you're having your appendix taken out or, you know, something very basic like that from a general surgery standpoint, it's going to take a special surgeon to do that. So it's not overly common of an approach right now.

Melanie Avalon:
Wow, that completely makes sense though. It answers a little bit. Like I said, the question I had about still experiencing that pain, it completely makes sense that even if you're not consciously aware of it, if you're getting those pain signals, you know, stopping those from even happening would probably have a beneficial effect for any long term, even psychological trauma from that. That is so interesting. Okay.

Dr. Cameron Chesnut
Yeah, there's I mean, there's a lot that I think I believe there's this microscopic versions of this too. It's a spectrum and what we experience afterwards. And I know this is true from a physiologic standpoint when my patients that are really progressive with their biometrics and sort of know things inside out, you know, for an example, I'll see somebody's heart rate variability elevated for three months after a procedure like this. And that doesn't mean that they're constantly, you know, reliving or experiencing this trauma. But I know that they are physiologically experiencing some degree of stress and inflammation and recovery from the per surgery that they, you know, chose to have in this case, it's very small amount, but it's present for months after the procedure. And I don't think that that's unique just to the physiologic part of it. And I think that if you don't deny that and pay attention to it, you can improve or limit the amount of effect that that's going to have on you.

Melanie Avalon:
I got the aura ring probably a little bit after I got that done, so I didn't have the aura ring yet. I would have been really interested to see if I saw effects.

Dr. Cameron Chesnut
Absolutely. And you would have probably been one who would have noticed like, oh, this is interesting. HRV is 10% elevated over its baseline for a few months afterwards.

Melanie Avalon:
Yeah, I know that the sleep was not the easiest thing ever after that. I do know when I went in, I went in for my, what was it, my six months, I think, follow -up, and the doctor was shocked because he said it was completely healed, and he said normally it took like a year. So that was promising. I was like, okay, but okay, so other questions. So you talked a lot about the before and the after and the during for you and the patients. Do you find that for the patients preparing, what has the most effect? I know they're both important, but the pre -surgery preparation or the post during the recovery?

Dr. Cameron Chesnut
Yeah, I think I'm a bit of a sampling error. This is a great question. And this is a, you know, through publications and research is something that we're sort of looking into. And my patient population, this is unquestionably the after, but I have a sampling error. I'll openly admit I have a sampling error of patients who are sort of your followers, if you will, who are already, again, very progressive in their baseline lives. And so that takes a little bit away for something, let's go to a very basic level. If we take a standard American population and pull somebody into just a surgery that they weren't expecting to have, right? We know that something like their baseline vitamin D levels are wildly important to what the outcome of their surgery is going to be from an infection recovery standpoint. So just something so basic and simple that's nutritional, right? And that's a little bit of a gray area of what's the right levels. And we just know that in that baseline population, who doesn't maybe live the healthiest lifestyle, there can be major low hanging fruit in the pre -operative period even now. And that's for in the surgery, the selective, non -elective, whatever it may be. Now, my population is coming to me voluntarily, they're high performers, they're already relatively optimized. And so I work to optimize and maybe a little bit more, but there's not as much needle to move there. That's a smaller lever. The after procedure, this is where it really gets into recovering like an athlete. Like you have a major event, you know, you run a marathon or something and you're a professional marathoner and now afterwards you're sitting in the hyperbaric chamber, you're getting targeted IV nutrition, you're doing post -electromagnetic fields, you're doing the red light therapy, all of these things that I'm utilizing, that's really the most helpful without question to get somebody back to life faster. And then again, like I said, even to improve the outcomes from the surgery in my world, that's really what drives everything is my results and my outcomes. That's where my obsession lies. Like I want every bit of improvement that I can get. And so if I can use something postoperatively, I'm not even operating anymore. That part is done. And if I can utilize these little tools to squeeze an extra percentage point or two of improvement, that's very worth it in addition to recovering faster. So it's this multifaceted benefit to what happens in the recovery period.

Melanie Avalon:
Yeah, well that completely makes sense that your population is pretty biased going in for the recovery protocols because I do get a lot of questions, not usually about plastic surgery per se, but there was a lot of discussion in my audience, my Facebook groups about recovering from surgery in general and people ask about different modalities. We get a lot of questions about like red light, for example, and near infrared. Is that something that you use?

Dr. Cameron Chesnut
It is. Absolutely. Yeah. And this is a great question. I think you said it really well. This is what we're talking about here isn't as unique to facial plastic surgery as it is to just surgical recovery in general. So, you know, and I can break it into even which modalities are helpful for what based off of the type of procedure you're having. But infrared light or near infrared light, those are very simple, very attainable. You don't have to have like the most helpful of these just to get to that as a hyperbaric chamber. That is hands down the most beneficial to a specific surgical recovery, especially in the first weeks postoperatively. It's going to help with swelling. It's going to help with inflammation. It's going to help with tissue healing. It is that is kind of the one that's the most helpful. But towards the end of the recovery period. And so I put my patients in there at day one. My mom had surgery last week and I carried her and literally carried her in there at day one after her other surgery. She had an orthopedic surgery. But so just to, you know, kind of put my money where my mouth is like this is wildly important to the postoperative recovery period. Things like red light therapy are absolutely helpful as well. And in my world, I'm usually addressing the skin with something like a laser cocktail that I'll put together for that individual patient. So now that light therapy has an even more superficial target to hit in that purposeful injury that I gave to the skin to help it heal. So that's a great situation. But even if you just had an orthopedic surgery, great. We know that your physiology is working hard to recover. And if you can get something like photobiomodulation to optimize your mitochondrial function when you're recovering from any surgery, that's helpful too, especially because it's essentially zero input other than, you know, spending some time under the red light, which has all kinds of other going back to the, you know, the psychological trauma has a bunch of like stress and cortisol mitigating factors to it as well. So again, it gets very multifaceted, that's wildly helpful to use, you know, near infrared, LED, infrared, whatever it is in that recovery period.

Melanie Avalon:
Yeah, I honestly think for the red and the near infrared, one of my mostly the red, because that's what you see. But one of my favorite benefits of it is what you mentioned with the stress, like I turn it on in the evening, and I just instantly feel like a state of calm. For the hyperbarics, does it matter? Does it need to be a hard chamber? Or how do you feel about those soft chambers?

Dr. Cameron Chesnut
Yeah, that's a really great question. This gets into the accessibility of it, too, quite a bit. The thing to understand with hyperbaric chambers is, as well, at a baseline what they are, it's a pressurized chamber where you breathe in oxygen and it helps the oxygen get to your tissues more than you can deliver with just normal breathing. The real equation to this is a three -part equation, and it's very simple. It is your depth or the amount of pressure that you're under, the time that you're under, we call it under, we call them dives, you're just in a tank, and then the percentage of oxygen that you're breathing in. Most of the time, the percentage of oxygen you're breathing in is 100 percent or 98 or 99, so that one is kind of a moot point. The other one then boils down to, what's the pressure you're under and how much time are you under? You can manipulate those, so the chambers that I use, we call them hard -sided chambers, they're medical chambers. They can go very, very deep, and there can be levels of tolerance. Somebody who's in their first post -operative day maybe can't tolerate a really, really deep dive, so we might dive them for just a little bit longer. The issue with the soft -sided chambers that are zippers that you might have at home is they just can't pressurize as deep. They're usually 1 .3 atmospheres instead of two or two and a half, so to really get the benefit, you need to stay in them more than twice as long or twice as long, and that can just be difficult in the post -operative period. You're not going to dive for three or four hours in the post -operative period for most people, so that's where the hard -sided chambers really come in, but it does not mean that there is no benefit to the soft -sided chambers. It just means that if you have the option to choose between the two, you're certainly going to choose a hard -sided chamber because you're going to get sort of double the benefit out of every minute that you put into it.

Melanie Avalon:
Okay, that's that's good to hear. Yeah, because my I've only done the soft chamber, because there's this chain called restore. I don't know if they have it. And where you are in Idaho. Yeah, they do. Okay, so they they some of their locations have hyperbaric chambers, but they're all the soft ones. So I know that's something more accessible to people, but I also didn't know, you know, if you're getting your bang for your buck sounds like you would need to do more that it's not the ideal form.

Dr. Cameron Chesnut
Exactly. And for a lot of people in various places you live, again, for my patients who are traveling to me, we have multiple chambers. This is part of the recovery protocol, which is, again, a very progressive view in surgery. You're rarely going to find anything like that. But that being said, there usually are hard -sided chambers available. They're usually more of a medical setting. So they're around. You just have to seek those types of things out.

Melanie Avalon:
What about cryotherapy or cold plunges?

Dr. Cameron Chesnut
Yeah. So that's a really great example of something that I like to use, I'm going to call in the pre -covery phase mostly. So there's, I think, you know, again, this is going to be one of our themes that when we get to the end of this, I think that there's a big double benefit there too. There's the physiologic benefit of it, right? And we could talk about it as a whole podcast of all the physiologic benefits. But I also think that there's a huge cognitive benefit and emotional benefit to purposefully putting yourself in an uncomfortable situation that you know is good for you and you know is going to be good in the end and then sort of enduring it a little bit while it's happening. So it builds some resilience, very certainly emotionally and cognitively. And that is very analogous to what you're doing with your, let's say for you Melanie, with your septarineplasty. You're going through a difficult situation that you chose to put yourself in and you know it's going to be good in the end, but it's a little bit difficult right now. So I really like this in the prehab phase or in the pre -covery phase for my patients before they come see me, because it really helps get them sort of mentally strong. You just know that you're doing something good for yourself and you know it's hard and you know it's good at the end. Not to mention all of the physiologic benefits that it's giving them to their inflammatory profiles, to just optimizing their physiology coming in. Their immune system's a bit stronger. So I like it more in the pre -phase than in the post phase. And part of the reason in the post phase is that we have to understand with all of these things, whether it is sauna, whether it is cryotherapy, that those are hormetic stresses. This is probably something you talk about all the time, but those are things that we need to account into the overall stress load that we're putting into our patient in this case, or for me and my patient who had surgery. And I don't want to overload them from a hormetic stress response when they're already relatively stressed from the surgical recovery itself. I don't need to add that stress necessarily to get the response, but I want them strong in condition going into it. So I like those more for pre, and then once we start introducing them in the post -operative period, it tends to be weeks later, like let's call it around two weeks for most patients before they're getting back in a cryotherapy or doing a heavy sauna session.

Melanie Avalon:
It's probably a good thing I wasn't doing cryotherapy yet during that point in time because it would have been hard to pull me away from it.

Dr. Cameron Chesnut
Yeah, and you would have been all over it, right? And that's a good example of, it's probably a little bit less stressful for you now than it was when you first started doing it. So you would be somebody who could resume faster because you don't experience the same stress level as somebody who's brand new to it.

Melanie Avalon:
It's nice to hear you say this because I'm so like, I'm so obsessed with all the things I do that it can be hard for me. It can be hard for me to know if it ever is at a point where it's on the hermetic stress level, not really being hermetic and, you know, being too much. I remember when I had COVID because I have a sauna at home and I was like, oh, it's fine. I'll still like do the sauna and all the things I like almost passed out. And I was like, okay, I guess we're not supposed to do this right now.

Dr. Cameron Chesnut
Yeah, and that's an absolutely perfect example where your body's recovering from something and you add a little stress. Even though it's not much, it's just a sauna. It's the same for exercise, you know, there's the mechanical part of exercise, but there's also, we have to remember that exercise is a physical stress load. So, you know, getting, this is a big conversation with my patients, you know, uniquely, I think, versus a lot of other surgeons, is when they're asking me about exercise, they're not asking about, you know, getting to zone two on the elliptical. They're generally, you know, a little bit more hardcore. So, it's a whole different conversation about, you know, what the resumption of exercise looks like. It's very interesting.

Melanie Avalon:
What about to you to use NAD?

Dr. Cameron Chesnut
I do. I like NAD. And that's part of that post -operative IV nutrition protocol that I utilize for my patients. So this gets into like another phase of what the recovery looks like post -operative day one, like that, you know, you're getting an IV during surgery and that's a little bit different than post -op day one. Now we're getting a little bit more focused on what we're putting in that IV. And for most of my patients, I thankfully have their genetic information or their genetic profile that we've done before they come see me. So we have a very good internal picture of their nutrigenomics and how they're methylating B vitamins, for example, something very popular and hot. And so we can quite literally customize the IV for them based off of what their physiology is, what their genetics are, and what procedure they had even. And NAD plays into that as a really potent and powerful part of the recovery. But as you've probably experienced with it is, you know, it's not something to mess around with. It takes a little bit of extra time for that particular infusion, but really, really helpful for the cellular recovery that everybody's experiencing. And again, it's just thinking of surgery from the physiologic and cellular recovery standpoint is very unique.

Melanie Avalon:
So here's a major question. The role of inflammation in the recovery process, is it important for the recovery? If we're doing a lot of modalities which actually would suppress inflammation, is that actually counterintuitive? What is the role of inflammation?

Dr. Cameron Chesnut
Oh man, this is such a hot topic and really great question because it gets into the word inflammation in general. Immediate connotation is negative. Inflammation is bad, right? But we know that's not true. Inflammation is our response to injury as well. And so you said it really well that do we want to stop all inflammation or do we want to kind of help inflammation along? And that's what actually my recovery protocol is more doing is helping the process that's naturally happening anyway be optimized, be more efficient, have more substrate and tools for that to happen. The hyperbaric chamber being a prime example, more oxygen present, doesn't necessarily stop inflammation right away. It delivers a tool that that inflammation is really trying to do to help the healing process. So post -surgery, let's say I do a fat transfer procedure, something we'll probably talk about later if we get into filler alternatives. Say we do a fat transfer procedure. I'm taking a free step fat -based stem cell usually and moving it to a new location. And for that stem cell to survive there, it has to turn on, it has to induce the creation of new blood vessels, which we call angioneogenesis, making new blood vessels. And in that process of angioneogenesis, it takes inflammation to build blood vessels to that cell that needs those blood vessels to survive. So in the interim, it's being fed by this hyperbaric oxygen for the cell to be stronger because it's essentially orchestrating its own survival and for that process of creating new blood vessels to happen faster and more efficiently. So I am not shutting down inflammation. I'm actually helping that inflammation happen more efficiently, which then makes it go way faster because it's done more quickly and more efficiently. That's really what it's about. So something like, this, I talk about this all the time, it's very common after almost any surgery, not just in my world of plastic surgery or even more specifically facial plastic surgery, but just any surgery that after surgery, you'll see the patient beyond an anti -inflammatory, most commonly a corticosteroid, like a potent anti -inflammatory. This to me is such flawed logic. This is part of the comfort crisis that we have as humans right now. Putting somebody on a steroid postoperatively makes everybody feel better. There's less swelling. The patient isn't as uncomfortable, but it's also completely, completely stopping the healing process because it's a blanket anti -inflammatory. It stops all processes from happening. You're not making new collagen. You're stopping your creation of new blood vessels. All of those things that need to happen to heal are essentially halted in the most important time period. The first few days afterwards, you're not recruiting the right inflammatory cells to the area. You're not basically just shutting down healing for the sake of feeling more comfortable. I think that everybody who's listening on your end is going to be very familiar with, you know, oh yeah, we have comfort to slow death, right? We don't want that. We want things to happen. We just want them to happen more efficiently. My protocol is more designed around letting the things that need to happen happen, but helping them happen quickly and more efficiently and more effectively in the end.

Melanie Avalon:
So I'm curious, I remember when I had my surgery beforehand, there was this intake form of all these different supplements not to take for a few weeks, I think, or before the surgery, but they did include things like omega -3s and aspirin. Was that for the anti -inflammatory part of it, or is it because of the blood thinning?

Dr. Cameron Chesnut
That is for the blood thinning. That's a really great question. Yeah, there's a lot of supplements that will increase your bleeding, your bleeding time, aspirin, anti -inflammatories, fish oil. And so most of that is coming in the form of not wanting to experience any surgical complications. So that is very relevant as a pre -covery type of idea. And most surgeons are going to do that because it makes their life, honestly, it makes their life easier, more comfortable if their patient's not bleeding as much. It makes the surgery faster, more efficient, less difficult, all those things. So that makes perfect sense. And I will have my patients now, just as a blanket, I love fish oil for most people getting into that world, but I will have my patients stop that preoperatively. So when I'm talking about optimizing their inflammatory profiles and their antioxidant profiles, I'm doing that more through the diet that they're eating. So I'll still let them eat salmon and fatty omega -3 fish, but I don't want them taking the extra supplementation on top of what their diet's delivering. So that would be very inbounds as far as things to do leading into surgery.

Melanie Avalon:
What about enzymes? So I have a supplement line, and I launched it with seropeptase, which is one of my favorite supplements of all time. And I know there are some studies on it for post -surgical recovery. I think the studies though are mostly for like oral surgery, but I get a lot of questions about seropeptase. Are you familiar with it?

Dr. Cameron Chesnut
Not familiar with seropeptase directly, but a lot of the proteolytic enzymes are really helpful post -operatively. Oral surgery, plastic surgery, orthopedic surgery, it does not matter, and it's in that process of inflammation is sort of clearing out some of the back end of that to allow it to happen more efficiently, you know, sort of like cleaning up the work site, if you will. And they, you're right, a lot of studies showing those to be very, very effective, and expediting the post -operative healing process.

Melanie Avalon:
Okay, awesome, awesome, awesome. I'll have to send you my syrup prep taste. I'm obsessed with it, it's so amazing.

Dr. Cameron Chesnut
Definitely have to check it out.

Melanie Avalon:
It's from the Japanese silkworm and it's the enzyme responsible for breaking down its cocoon without injuring the silkworm. So it selectively works in the body to target, you know, nonliving and problematic tissue. And it's just, it's fabulous. Some other questions. This actually relates, okay, I'm trying to decide which direction to go. You mentioned earlier the fat transfers, the fillers, that whole world. So in the procedures that you do, do you also do, I was going to say superficial things. Do you also do things like Botox and fillers or are you mostly focused on surgery?

Dr. Cameron Chesnut
Yeah, that's a great question. So I'm looking at things very, I want to say the word holistically, but that's probably not the right word here, comprehensively. How about that? And how facial aging is happening? Because that's sort of my world that I'm living in. And so if somebody is in sorts of, let's say something like surgery, or even if somebody is not in search of surgery, we have to kind of, my job becomes helping that person navigate, here's your goals, here's what you're noticing that you want to improve, whatever that is, how can we achieve that in a way that looks really natural? That addresses the right underlying issues. And when you don't do that, and you just kind of, if I just did what every patient came in and said they wanted, there'd be a lot of really funny people walking, funny looking people walking around. And we see that all the time, people who just looks off. And that's just based off of a lack of understanding. It's trying to, you know, just make the patient happy based off of what they're telling you, but nobody has a deep understanding of what's really underlying. And I say all of that to say that almost no matter what somebody's seeking from me, I'm addressing multiple facets that contribute to that issue. So if you are in your 50s, or 60s, whatever it is, there are big qualitative and quantitative issues that have changed that we're going to want to address. So with most of my surgeries, for example, I'm also utilizing these more qualitative things like laser resurfacing, because we're talking about the quality of the skin, overlying everything, and no surgery improves the quality of the skin. That's really, really important. Fat transfer is essentially regenerative medicine. It's utilizing fat -based stem cells to rejuvenate in a qualitative, in somewhat a quantitative way, fat pads in our face. It's making them stronger, more resilient, more appropriate in their volume. And so that's another really important tool, because let's say I'm doing something like a facelift or a brow lift. If I'm moving around fat pads that are not optimized, they're not appropriately strong or volumized, I'm only doing part of the process. I'm only addressing part of the things that have changed. So I'm very keen on using those non -surgical options that are more qualitative, along with the surgical procedures that I'm performing. And on the flip side of that, if somebody really wants to address these, they want to have an improvement in their face, and they want non -surgical things, we can talk about these qualitative issues. But I think this is where I bring to the table that's very, very unique in our world, is I can also do things that are essentially scarless or invisible access procedures to actually address the underlying issue in a very non -traditional way from what you think about from a cosmetic surgical standpoint. That's one of my calling cards is achieving these very, very beautiful results, which you can't even tell what happened or how it happened. And that's what you'll see if you look around on my Instagram, like you were talking about the very beginning.

Melanie Avalon:
So some more questions here. So you were talking about how people can get a little bit distorted in their view of what they, I guess what they want and then how that actually manifests on their face. Okay, there's this concept that beauty is in the eye of the beholder. So I'm super curious when you are talking with somebody and they're expressing to you what they want in their face. How do you know what actually best accomplishes the goal, suits what they're looking for? And if beauty is in the eye of the beholder, and if they want something different, how do you take that into account? Like, are you looking at like, what's the word, like the ratios of what makes the ideal face? Like, how do you approach what somebody actually should do to their face?

Dr. Cameron Chesnut
So when it comes to the ratios, I think that those are a really important thing to understand, but it's also important to understand that the ratios of the face are not universally applicable. In fact, nobody really meets those ratios perfectly. So chasing that is chasing a false reality. It's a fool's game to go after those ratios. That's not what we're trying to achieve. Instead, I'm going through this very in -depth conversation with my patient trying to understand what it is that's leading them to say something like, well, I want a lower facelift. OK, great. Why do you want a lower facelift? What are you seeing in the mirror? What are you feeling that's making you say something like a very specific procedure that allows me to then go into this idea of utilizing the Pareto principle, this like 80 20 rule where I can say, OK, what's our 20 percent input that's going to get us 80 percent of those results that you're seeking in this process? And that is an equation a lot of people can resonate with. Minimal input to achieve this maximum output. And I tend to function this world more of rejuvenative procedures versus transformational procedures, meaning I'm trying to just help somebody go back a little bit to a place that they were before instead of trying to create something that they never were. And a lot of times my patients will have photos of what that looks like. You know, they'll have a picture of themselves says, hey, this was me however many years ago. This is kind of what I'm thinking about. Great. That gives us a very tangible metric to work towards together. And my job becomes helping them achieve that in a way that sort of, you know, resonates with their value system.

Melanie Avalon:
Okay. So I have to know, I get this question so much and I personally do do this. So what are your thoughts on Botox? I use ZMN, not a lot, but I do it in my forehead, my globala, globala. I think that's the only place I do it. What are your thoughts on that?

Dr. Cameron Chesnut
So, as we get into this, I'm much more, I'm much more neutral on something like a neuromodulator, like Botox, ZMN, Dysport, Daxify, something like that. Because they themselves are an option that's just fine to do. I just think that they're very misunderstood, meaning those are meant to disrupt the communication of a nerve of a muscle, specifically, in this case, in our face, so that those muscles don't pull so hard on our face to create an unnecessary stress on our face. When we're young, we use those same muscles, the muscles of facial expression, to express, to emote, to show emotion, to non -verbally communicate. And our skin is just so strong that it doesn't matter. We don't create any semi -permanent wrinkles, we don't damage our skin, it's all just fine. As our skin ages, that stress starts to become more noticeable, the stress of the muscular movement on our skin. So there's this very sweet spot, where if you slightly weaken the force of the muscles on the skin, now notice I said slightly weaken, as opposed to completely eliminate the force of the muscles on the skin, you can prevent some of the aging that's happening, or some of those, instead of aging, let's just say wrinkles, because that's what everybody's really chasing, is wrinkles. So the wrinkles between your eyes, or whatever it may be, you can reduce that from happening. The problem for me becomes when the idea is to completely paralyze the muscles, and that is by far, hands down, without question, the most common way that it's used, just completely eliminate the muscular movement. The reason I don't like that is because those muscles are meant to move together as units, they're functional, they're how we non -verbally communicate, we literally have sections in our temporal lobe of our brain that are meant just to recognize how those muscles are moving. So we don't want to completely eliminate them, and very commonly that's how they're utilized. The other issue is that a lot of people aren't getting them until they already have these permanent wrinkles, these, we call them static wrinkles, they're there at rest, when the muscle's not moving. So if the wrinkles there when the muscle is not moving, and the goal of this drug, or this toxin in this case, is to make the muscle not move, the wrinkles are still going to be there, when the muscle's not moving, there's no change to them. And so that's where people get into trouble, like the most common one is lines in the forehead. If you already have lines in your forehead, we know that you're using that muscle for a functional purpose, usually it's to lift up your brows and your brows are a little bit heavy, so the muscle's doing its job. So now you go treat that muscle and try to immobilize it, and you've taken away your ability to compensate for your heavy brows, so people will commonly notice that their brows feel heavy after they get Botox, I hear this all the time. Well, your brows were heavy before, the Botox just took away your ability to compensate, and for a lot of people, that muscle, I always kind of tease that life finds a way, that muscle will try to fire, no matter what it can do, and you start to get these really funny forehead and brow positions, people call it the Spock look or whatever it is, in that muscle trying to break through the immobilization. So I think I'm very neutral on it, I think it's very fine to do, I will say my one caveat out to this is a very narrow group of moms, maybe and dads, moms and dads with young kids where your primary version of communication with them is non -verbal, like let's say you have a baby, that baby does not understand anything outside of the tone of your voice from a language standpoint, but they can certainly look at your face and understand your emotions from your face. So I would say for a mom with a little kid who they're communicating with primarily non -verbally, don't get Botox, don't take away that ability for them to emotionally and socially develop those recognition and language skills and things like that, and that might apply to dads too, but definitely to moms.

Melanie Avalon:
I love this conversation so much. And thank you for talking about the mechanism of action. I know like even for me, so my, my experience was I went in to get it in my jaw for my, my TMJ pain. And then when I was in there, she, that's when I finally was educated on what it does. I don't know what I thought it did. I guess I thought that it was, I don't know. I thought it was like inject. I don't know what I thought. I didn't realize that it was like, I didn't realize it was preventatively.

Dr. Cameron Chesnut
I think a lot of people think that it's an injection for pre -existing wrinkles. That's the most common thing, and they think they're 65 years old, they have had wrinkles for a decade, and they're going to go get Botox, and it's going to make their wrinkles go away. And that's actually something where more like a qualitative treatment, like a laser resurfacing would come in. If the damage is already done, let's erase the damage, and that's where something like that comes in. And then I think it's often confused with filler, too. Or filler is confused with Botox, vice versa, that they're interchangeable, but they're very different things. And we can go into fillers as we're talking about those. These are the most common, with Botox, these are the most common entry -level things into anything cosmetic. And they've been thought of as this, they're these gels that you inject into your face with a needle, and they're meant to make you look younger. That's just, I think, the common thought, oh, you get filler, you look younger. What they're really doing is trying to restore lost volume in certain areas of the face where the fat pads have changed. The issue with them is a lot of misunderstanding there as well. People think, oh, I'm going to get filler in my face and look younger, or that I'm going to get filler, and it's going to be like a facelift, or there's all kinds of thoughts about them, including that they only last a year or two, and then they go away, which is not true. They last decades, they migrate around your face once they're injected, they don't stay in the place that they were put, because they're essentially a free implant. They're this gel that gets put in a space, and then it's going to move around as the muscles move. There's just a lot of misunderstanding on them, and it's not just from patients, it's from injectors as well. And so a lot of my practice from a surgical standpoint involves fixing or at least managing filler that was done in a way that looks really unnatural now. There's too much of it, or it's in the wrong location, or it's moved to a place that it wasn't originally put, or it's been present for many years, or most commonly, all of those mixed together. So it's something to be really thoughtful about, and they're not as simple as I think a lot of patients and injectors think that they're going to be, and you could, with where you're at, there's probably ten places within five miles of you where you could get these things done.

Melanie Avalon:
more than that. There's so, so many. Do you dissolve a lot?

Dr. Cameron Chesnut
Yeah, I think that's another misconception is that these are sold as this idea that, well, if you don't like it, you can just get it dissolved. And like there's a magic wand that we wave over it and everything goes away. Well, the dissolution also doesn't work perfectly well. It depends on the filler that you're getting and how long it's been there and where it's located. There's so many factors that go into it, but I'm usually telling people we're not going to dissolve all of your filler. It's not how it works. And the filler over time breaks down and attracts water and causes these unnatural swelling looks. And in some of those situations, it's a little bit easier to dissolve. But the most common situation in my world is that somebody has a problem with their filler. They finally realized that they don't look like themselves anymore, which is this idea we could talk about called perception drift, but they need to do something that's like definitive. The thing they needed to do in the first place that they didn't, they were afraid to do or thought that the filler was going to replace something like a surgery. And I'm manually removing a lot of their filler during surgery because the filler is usually in the location where they needed the surgery in the first place. So I'm manually removing as much of it as I can. And then anything that is sort of outside of our mobile map bounds, sort of an out of bounds area, then we'll use a little bit of dissolution for that. But even then I can't get rid of all of it. It's sort of, you know, becomes part of their face. And that idea of perception drift that I mentioned is just this filler happens very slowly over time. And with this idea that's false, that you need to get it every year or every 18 months to kind of quote unquote, touch it up or refill it or whatever it may be. You're really just adding on top of what's already present. And so you could see how you get at one time and you notice a change, but I always challenge my patients to say, this is look at my before and after photos and everybody's before and after photos. It's different, but is it better? Right. And this is where I challenge filler a lot of times. Yes, it looks different, but it's not better. That's not how your lips are supposed to look when you're 35 years old, you know, they're big and they're hanging and they're out of proportion and they, your muscle doesn't move the same anymore, but they look different. And so people take that different as like, Oh, something happened. And so they'll go get it again and again and again. And as that happens slowly over time, you kind of lose touch with what you looked like at the very beginning because of such a slow incremental process that you have time to adjust to when you're looking at yourself in the mirror. And then eventually, usually somebody tells you, or you finally see an old picture of yourself and you realize like, I don't look like that anymore. And you've, you know, that drift kind of comes to a screeching halt a little bit. And that's often when I'm seeing people.

Melanie Avalon:
To that point, I'll share my two mistakes or negative experiences I had with both the Botox and the fillers for the Botox, and again, I get ZM in just because it doesn't have all the ingredients that Botox has, but I understand that it's still a neurotoxin and everything. I don't do a lot. I go really light, but one of the first times I did it, she like way overdid it to me and it made me have a really heavy forehead. And I don't ever really feel like I'm a very happy person and I don't struggle with depression or anything like that. I literally felt depressed for a few days because of, and I think it had to do with, because how it was like changing my forehead just felt so heavy and it was like changing the way my muscles were. And you were talking earlier about, you know, the brain and it registering those muscles. It was a really, I remember I was like, when I seeing my therapist and I was like, this is such first world problems, but I was like, I had like so many stressful things in my life happening that weren't even facing me. And I was just so upset about this Botox experience.

Dr. Cameron Chesnut
That's really interesting, and I'm sorry to interrupt you, but that's really interesting because there's certainly a connection from our emotions to our facial expressions, right? No question about it. That's how we, for the most part, that's how we show those. It's way more primal than even a verbal communication of those emotions, right? And so to disrupt it would certainly make sense that you're going to feel that on an emotional level. But the reason I think this is so interesting is that it's very often sold in the industry world to injectors and things like that, that there's usually, according to these studies and data that are done, of course, by the companies that make these products, that there's an improvement in mood for people who get these neuromodulators like Botox, Dysporzium, and that they actually are, they feel better, they're happier after they get the, you know, the treatment done. So, you know, I think it's fascinating that, you know, of course that's an anecdotal example for you, but it also makes sense in the opposite direction to me.

Melanie Avalon:
Yeah, no, it completely does. And I just learned so much. And now I go so like, we're so slow, and we don't put much in. So I think I found what works for my face. I really appreciate it. I like what I'm doing right now, basically, for the my filler mistake, I do put filler in my lips, and I definitely the beginning went too fast. And I was doing exactly what you were saying doesn't need to be done. Like, I was like, going in and then getting more and I really want to build them up. And so I had migration. And I went through and I actually dissolved my the top and started started over. But now I go again, like you said, you can't completely like start over. It's not clean slate, the dissolving process is not a precise science. So I've learned a lot there too. I just think there needs to be more like education about all of this.

Dr. Cameron Chesnut
And I think that if it's thought of more of to what it is, it's an implant, right? And so I think the analogy that's not perfect, but that people grasp really well, let's just talk about lips specifically, because that's a really common area to go first, especially when you're younger, is that at that point, you're essentially putting an implant in your lip, just like you would put in your breast as a breast implant. When you're 20 or 30 years old, you've lost very little volume in your lip, say, and your desire to correct it is just to change it probably a little bit from what it was to make it more shaped or bigger. And that's totally fine. But we have to understand that that's a free implant that you're putting in your lip in a muscle, right? There's not like major fat pads in our lips. This is for the most part getting put into a muscle and that muscle moves. And just like you experienced, the only is that filler is going to migrate. It's going to move to other locations. When you pair that with this mindset that you have to redo it every single year, you just give more and more fuel and pressure to this migration. And that's where things get problematic. If it were approached from the mindset of like, okay, I'm getting this implant put in, and I only can do this to so many times or to this amount of volume, I can only do this much volume, whatever it is, then we're safer. You're looking at it as the augmentation that it is. And you know that there's a finite limit on it. You would never get breast implants. And then as they got saggier over time, just add bigger implants. That's not what you do. We all know that that doesn't make sense. You don't just get bigger and bigger as they get lower and lower. At some point you say, okay, I need a breast lift now. And again, this is not what I do, but I think anybody who's getting a breast augmentation surgery should be having that conversation with their surgeon that down the road, they'll probably need something else done. They'll need a lift or they'll need a replacement or removal of their implants, or something is going to have to happen because you're artificially adding mass to this free soft tissue. It's the same in the lips. And with one of my fellows a couple of years ago, we did a study when we were doing these lip lifting procedures, which is just as it sounds, it's elevating a sagging lip. We looked all the way up at the base of the nose in 50 consecutive patients who'd had lip filler. And in 49 of those 50, the filler had gone all the way up around their nose from their lips. So it moves quite a bit.

Melanie Avalon:
Oh wow.

Dr. Cameron Chesnut
Okay, yeah. So it's just a mindset shift and it's totally fine and it's not bad, it just needs to be approached. Like you said, I forget exactly how you said it, but I often hear that people want to fill it up over time. They want it to tolerate it so they get it done. And then six months later, they let it settle and they go back in for more. Well, that settling is just the filler migrating out of that space, making room for more behind it.

Melanie Avalon:
I definitely have had the complete, the paradigm shift that you're, you're speaking to. Now I'm like, let's see how long I can go. Like, like, I don't need to keep adding to it. The perception drift, does that also relate to, I remember, I think the idea, okay, they did a study and it was based on plastic surgery and that's where we got the, okay, it's coming back to me. Oh, okay. I know what it was. They say that it takes like 30, 30 or 60 days, 60 days to change a habit. I don't know if you know where I'm going with this. Basically this idea that we have, it's either 30 or 60 days to change a habit is actually based on plastic surgery studies where that was the amount of time it took for people to see themselves as the new, like, identity. Do you know what I'm talking about?

Dr. Cameron Chesnut
Yep, exactly. And this gets very hardwired into our neuroanatomy, basically as to how we have parts of our brain for facial recognition. And those are heavily tied into emotional areas of recognition and our amygdala. And those are heavily tied into areas of understanding facial expression. And so yes, for all of those areas to meld together, which is be like building a habit, you have to have the desire yet to have the sort of automation basically happen in it. It takes time for that to happen. It's a slow process. And interestingly, the most, this gets a little off topic, but also very on in the sense of the most important areas of that, as we're looking at facial recognition, and then self identity happen around our eyes, actually, the shape, position, like that's obviously where we show a lot of emotion, nonverbal communication anyway. But those areas in particular have a lot with self identity. And then yes, that ties into the idea of how long it takes for that sort of neuro anatomical change or that those neural pathways to form.

Melanie Avalon:
I love that you knew what I was talking about there. I'm super curious because you're speaking about this potential with the eyes and everything. When people come in to see you, do you have a favorite procedure or favorite surgery? Do you get really excited when somebody wants to do a certain thing, or how do you approach with excitement all the different cases of people who come into you?

Dr. Cameron Chesnut
Thankfully, I'm very fortunate that at this point in my practice, I have a very narrow likes, again, the mile wide thousand miles deep type of idea. Like I'm in a very narrow world of things that I do. So I kind of have gotten to do only those things that I really love, which is great. And I'm very grateful and fortunate for that. In those narrow windows of things that I do, you were kind of hinting at this, and I think running with that a little bit is this idea. Very commonly, someone will notice changes in their lower face, neck, jawline, things like that. First, even people in their thirties and forties start to notice those changes. And they're very bothered by it, which is very fascinating. And it's usually one of the first issues I'm going to say that will lead somebody to seek help. But interestingly, it's our eyes that often show the first signs of aging from an emotional standpoint. And it's our eyes that everybody else, not you looking at yourself, but everybody else is noticing about you. Because when you meet somebody for the first time, you are heavily focused on their eyes and usually their mouth a little bit to our areas, which makes sense. This is our nonverbal communication, but that's how you're assessing somebody's identity. You're assessing their mood. You're assessing if they're, you know, think primarily if they're going to hurt you, you're assessing how old they are and how beautiful they are. And a lot of that information happens in the eyes. So in this paradigm of somebody approaching me and saying, you know, I'm really concerned with my jawline, even if you're 42 years old, it's like, great, well, let's talk about that. But let's also take a look in your overall concerns here of the little changes that you have around your eyes, because those tend to be heavily weighted from an impact standpoint, but also much easier, smaller things to address and correct. So kind of a better proverbial bang for your buck in those areas. So I will often, and I love eye procedures and, you know, I'm very progressive with them, doing a lot of them in these scarless techniques. And it's really cool. And when you look at my before and after photos, you'll see a lot of those changes that are just sort of that, like, this is really nice. And I have no idea what happened. Well, that's my goal. That's what we want to happen. And a lot of that happens with eye procedures. And so I guess to answer in a long way, it's like, yeah, I really like a lot of what I do, but the procedures around the eyes are a big, carry a special weight to them for sure.

Melanie Avalon:
I love that. And when you say scarless, do you mean there is a scar that's just hidden?

Dr. Cameron Chesnut
Yeah, sometimes there are procedures where I'm approaching like, let's say I'm approaching the eye, but I'm doing it from a spot back in your hairline in your temple or something like that. So I would call that more like an invisible access procedure because we can go look back in your hairline and you can see where the access point was. A year later, you might not be able to find it at all. That's the usual scenario. So that's not, you know, truly scarless in that sense. Something like that would apply to with like a lower, this would be a really, this is one of my favorites is when somebody has lower eyelid bags or hollows or tear troughs or whatever they want to call them, there's often a really strong genetic predisposition there. And that patient usually had a genetic predisposition that met some early signs of aging. And I will see young people for that people in their late twenties, thirties. And it's, again, it's just genetic for them. They've usually known they'd have those eye bags since they were a little kid. I can address those through the backside of the eyelid in a super minimally invasive way that leaves no external scars, no external access anywhere. There's nothing to hunt for even. And I can have a full rejuvenation for that whole lower eyelid mid face part of them. And that would be more of like I would call a scarless approach to that, which is again, I love that one because it's, I'm always just like, wow, I can't believe we accomplished all that with literally no, you know, incision that you can see anywhere.

Melanie Avalon:
Okay, that's incredible. The thing I want to do, and I don't think there's a solution for it, I have a... I don't know if it's a mole or a cyst. I think I've been told that it's both. I think it's a mole though. It's raised above my skin, so I have to like laser it down or shave it down or... And I want to get it just removed, but they told me that it will make an indentation. Things like that. Are there any solutions for that? Or is it really just you can just shave them down and laser them down?

Dr. Cameron Chesnut
Yeah, those skin related things. So anytime you violate the skin and separate it or damage it to a certain degree, you're going to get healing of that. And this is where we use the dreaded word called a scar. Because anytime the skin heals from an insult like that, it lays down a very specific healing mechanism that creates collagen and a very specific array. And that's what a scar is. And so that happens with incisions after surgery. That happens with trauma. That happens with taking off molds, right? There's all kinds of things that can create that sort of reaction. But there are ways to improve or mitigate that from happening in the first place. And this is where I'm just going to say regenerative medicine comes into this equation overall. Because if you can cause an injury, then in the process of that injury healing, optimize the way that the, we call it fibrosis in medicine, but that the scarring happens, you can make it more normalized. So there is, instead of just collagen, there's elastin tissue, which is the part that gives our skin its elastic properties, which is very unique to a soft tissue like that. So that's a long -winded way of saying, you can utilize some regenerative medicine to make those scars that whoever told you that, not as impactful of a thing. And so now all of a sudden, for a lot of people, that can shift because you're balancing. Like, well, how much do I not like this mole, versus how much do I want to trade it for a scar, right? Well, you can shift that balance a lot of times to be sort of like, well, OK, this quote unquote scar that you have isn't going to be as impactful. And so it makes it a lot easier to make the decision to get rid of something on your skin.

Melanie Avalon:
They were saying there would be an indentation because it would be removed. And so then it would be like a reverse cavity or a cavity.

Dr. Cameron Chesnut
Yeah, and there's there's a lot of ways to address it, you know, and again, hopefully a laser would not be creating that indentation. It would be making it from a three dimensional standpoint, would be making it flush with the surface of your skin flat. Yeah. Okay.

Melanie Avalon:
I had to get my selfish question in there. My other selfish question is for people who are getting Botox. Can you do cryotherapy right after?

Dr. Cameron Chesnut
Yes, you can. Botox's mechanism does not involve any inflammatory component. It works at the neuromuscular junction.

Melanie Avalon:
It won't make the muscles like spas and it spread. That's my concern.

Dr. Cameron Chesnut
No. There's a lot of bad advice based off no evidence about what you can and can't do after Botox, you know, like flying on a plane or going to sleep and they're all based off of nothing.

Melanie Avalon:
The cryotherapy answer is shockingly, like not on the internet. I have Googled it so much. Well, this has been amazing. We talked about your daughter loving unicorns. How many kids do you have?

Dr. Cameron Chesnut
I have three kids. I have a 10 -year -old son, a 9 -year -old daughter, and a 7 -year -old daughter.

Melanie Avalon:
Oh my goodness, okay, I love that. My question is, and this kind of brings things full circle because it has to do with what we talked about in the beginning when I opened this and was talking about the hesitations and concerns and this weird, like, I don't know if I use these words, but there's kind of like a judgment and a morality issue that comes into things like this I found where it's like seemingly not okay or it's superficial or it's selfish or I don't know, people are not about oftentimes plastic surgery, like this whole world. I'm really curious, like your kids, do you think they will be getting procedures and do you even have a dialogue with them about all of this and like beauty standards and all the things?

Dr. Cameron Chesnut
Yeah, it's really interesting. And that's again, such a deep multifaceted question. And my kids know what I do, just from a baseline example, when they were little, they just knew that dad fixed owies, you know, whatever that means on the face, they knew that and as we've got, as they've gotten older into sort of more mature, you know, places, we have a better conversation about what that is, they know that today, daddy's patients from Germany, and or New York or whatever, and for them, I think it's a little curious as to why are people traveling to my dad from somewhere else. And so we talk a lot about why and, you know, honestly, seeking greatness and wanting to be the best at what you do. So there's a lot of lessons there. And then it's about helping people, because like I said, about 65% of those people that I'm seeing are kind of in a bad spot when they come to see me. So about, you know, that sort of idea of that's a service for me, it's a lot of like, I think, from a parenting standpoint, lessons that we can talk about with our kids there, been into beauty standards and what that is. So this is where I really break down procedures into transformative versus rejuvenative, which we talked a little bit about before. And in my world, like yours, Melanie is a very interesting mix, right, where you had a very, very functional part of yours, the septoplasty, right, to make you breathe, physically breathe better. And I don't know how anybody who's especially listening to your podcast would not want to breathe better, right? That's wildly important. And then you had a part of it that was, you know, transformative that kind of took away part of your genetic dorsal hump that you had, right? So you have this like very dichotomous mix of procedures that happened at the same time, right? And then there's this middle category of rejuvenative, I would say, where you take something that has aged or changed and you move it back towards where it was. And this is where it gets very philosophical into your listeners are optimizing their physiology, their genetics, their epigenetics, their aging, they're doing everything they can to improve their longevity, their health, their health span, all those things, right? Well, interestingly, our facial aging does have some impact from those, meaning if you're really optimized in all those areas, your face will age slightly slower, but it's not to the same pace as to your maybe longevity improvement, right? Meaning that there becomes a mismatch at some point. And you certainly, the most common thing I hear from my patients is that they want to look how they feel. And there is, in my world, absolutely nothing wrong with that. You worked really hard to feel good. And this little area of your life is changing that. You've worked so hard with your exercise, with your diet, all these things. Okay, great. Well, we have a solution for that that is relatively low input. And that's maybe not the right word, depends on how you look at it. But we have an option that's very realistic and inbounds to improve and make this match the way you look and the way you feel. And I think that's really important as we look at our health, our emotional health. I don't see anything wrong with that at all. And again, there's different motivations. If somebody comes to me and said, I'm doing this to get my ex -husband back or to get back, I'm not doing that procedure, right? That's not the right motivation for me. So I think that there's a lot of that part of it too, like what's the motivation to do this procedure? And I think you could get really analogous with this with orthopedic surgeries, even optimizing function of your body to match what you like to do. If you're a super high level tennis player, and you want to get this little procedure on your knee, that's really only going to make your knee function 10% better that you don't really, quote unquote, need to have done, but you do it because you want to function at your highest level. That's a lot like having a procedure to make yourself look how you feel so you can function at your highest level.

Melanie Avalon:
I just love this conversation so much. I could not agree more. I find it so fascinating how we silo the different, like you said, like motivations behind things and then do apply judgment to it. So for example, like with the Botox, like if I say that I'm getting into my jaw because it relieves my jaw pain, which makes me happier relieving that pain, like that's okay. But if I'm getting a little bit in my forehead because it makes me happier to be preventively you know, addressing these wrinkles and seemingly that people will judge that is not okay. And I don't really know why that is. And then same with like the the septoplasty versus the rhinoplasty, like the septoplasty, which the thing that the thing that made me decide to do that was I interviewed James Nestor for his book, Breath, which is incredible and I highly recommend it. I read that book and I was like, I got to fix my I got to fix my deviated septum like now, even me, like if I will talk about what I got done, sometimes I'll just say I got a septoplasty and I won't mention the rhinoplasty and I was like, why is that like both have really improved my quality of life. So I'm really fascinated by it and I really appreciate your approach.

Dr. Cameron Chesnut
I think that's very interesting and very well said and you know there's degrees of that it's again it's a spectrum all over the place as I'm having patients you know traveling for surgeries and things like that for some reason the laser part of the procedure is more socially acceptable and it's okay oh you had a laser.

Melanie Avalon:
That's like.

Dr. Cameron Chesnut
Yeah, but the minor surgery part, oh, you had surgery. So, and I'm interested in like, well, they're very similar in their, you know, total recovery and all these things. And so, you know, I use that a little bit in my counseling of folks in their recovery that might say, hey, you know, if anybody ever asks you anything about what you had done, you can always just say, I had a laser done, which is true. You know, if somebody has a history of skin cancer, it's even better because the laser will reduce their future history of skin cancer. And you can say, I had, you know, I had some sun damage, and so I had a laser to reduce my skin cancer risk. And that becomes really acceptable at that point, you know, which is also, you know, partially true. So we have a great scapegoat in there where we take advantage of that a little bit, much like you do with your septoplasty versus having a septoplasty and an anoplasty. You tell me I had a septoplasty, who cares? You know, especially if you think it's somebody that you don't want to have that conversation with, or that they're just like, maybe not open -minded enough to handle it.

Melanie Avalon:
Yeah, it's so interesting. The timing was good for me because I got it done during COVID. So for recovery, everybody was wearing masks anyways. So I was like, this is great. Oh my goodness, I love it. I love it, I love it. Well, thank you so much. Like this is just, I mean, this blew me away with your knowledge, what you're doing. I wish there were more. Are there more doctors like you doing this? I wish there were more.

Dr. Cameron Chesnut
That's so funny, because the one thing you asked me before about, is there anything else you want to talk about? I'm like, oh. The one thing that I think we didn't touch on that would be interesting, and this kind of ties into this other doctor thing, is the use of stem cells in the post -operative period. I do have another doctor, because I've been doing this on my own as part of my recovery protocol for years, and I've been working with Unoptimizing, but that's a little outside of my... I've become quite an expert on it, but that is outside of my normal a little bit to do that, and very recently I've had a doctor join me who's just a regenerative medicine doctor, and he has... So in the idea of using post -operative stem cells for recovery, he has revolutionized my very basic protocol that I was doing before, where I was using them IV, and I was using them at very specific time frames, just again, going back to that idea of optimizing inflammation. That's what the stem cells are doing. They're magnets to add inflammation, and they're helping it be more efficient. Using this in a very much more sophisticated protocol now has been really helpful for my patients in their recovery from their surgery, but it's really cool in that most people coming in have something else going on. They have knee arthritis or an old sports injury or whatever it is, and so the use of stem cells to help them recover from this very poignant thing that they've done with me from a surgical standpoint is also very targeted at helping their overall systemic health or these orthopedic injuries. Stem cells have become really important in my recovery protocol, and we've really taken that to the next level by involving somebody who has that same sort of post -surgical mindset that I do. So answering both those questions, I think, a little bit.

Melanie Avalon:
I love the stem cell conversation. I had a injection of umbilical cord stem cells, embryonic stem cells in my knee. And the thing about it, I think it fixed it. I also don't know time -wise if it would have been healed anyways, but it was something that was not going away and now I don't have it. Now I don't experience that pain anymore. So with your procedures, is it, you mentioned like IVs and stuff. Is it IV stem cells? Is it injections that you're using?

Dr. Cameron Chesnut
Yeah. So I'm using stem cells intraoperatively on every single one of my patients. And you mentioned umbilical cord derived, which is coming from somewhere else. We call those allergenic or allergenic. And in my world, I'm using a lot of autologous, meaning it's coming from you. So if we were doing your fat transfer procedure, your fat or my fat, everybody's fat is very rich in our mesenchymal stem cells. So I'm isolating those out of your stem cells during your procedure and I'm using them to improve the quality, to help the recovery, to do all kinds of things to your fat pads while we're intraoperative. Right. And so that's where, you know, that's my world. And I'm, you know, very at the front of that then after surgery. So now those stem cells are doing their job in our surgical areas, right locally. And then after surgery, I was using stem cells in a more of a systemic way, right, to help everything. And in that process, we're noticing, oh, great, people's, you know, other ailments that they came in with prior are also improving. Right. And so at that point, I'm like, okay, we can do better for our patients than I'm doing in this post -operative period. Because I'm, of course, very focused on the intraoperative timeframe. Right. And that's where, you know, kind of like you experienced, it's like, well, I got better and I'm pretty sure it's because of that and or happened faster or whatever it may be. Right. It's hard to say because there's so many confounding variables happening at once. It's hard to, you know, isolate out what is what. But I certainly noticed doing this a lot and having done it for a long time, you know, anecdotally that it's a significantly better improvement when I'm involving his name is Dr. Meadows, and I'm involving him in my post -operative recovery protocol with my patients. So it's just another option that people can do that, you know, gives them quite a head start on their recovery and gets it done faster. And again, makes the results better in the end.

Melanie Avalon:
The ones that come from their own body, I'm sure, there's probably no legal issues with that approach, is there?

Dr. Cameron Chesnut
Yeah, this is a really great point. So this is a really common misconception with stem cells inside and outside of the United States. What's allowed? Everybody thinks that stem cells are not allowed in the United States, and that is not true. What the FDA, the Food and Drug Administration in the United States limits is what happens with those stem cells. They can't be too altered enzymatically, or they can't be proliferated in a certain way, et cetera, et cetera. But I can certainly take your stem cells, which we call autologous, from you. I can take your stem cells, and I can use them for a very similar purpose. So I'm using fat -based stem cells into fat pads, for example, totally in bounds, totally okay. There is a lot more room for progression and use of stem cells in the United States than people think that there is. I think it's this, you know, you have to go overseas to get it idea, and that is not true. And interestingly, this is a whole side note, of the swing of things that have happened, is one of the things that they could do in, you know, other countries, is they could take one stem cell line, and they could proliferate it indefinitely. So the same stem cell line just getting proliferated, and they harvest stem cells off of it, and they can use those stem cells for therapy. What they've discovered, and they used to do that for years, like there'd be the same stem cell line for decades that they were treating patients with, and what they started to notice was, well, that stem cell line loses efficacy with every single replication, right? And that makes sense, you know, it's not a perfect process, even for a stem cell. It loses some of its ability to, you know, achieve its end goal with every single time it replicates. So overseas, they've gone more towards, they call them these early proliferative lines. So in an ideal situation, it's much like what you had, Melanie, which is, that's the first line. It's never been proliferated. That's as good as it's ever gonna be. You get that put directly into your knee, and that's quite literally the best treatment that you can get, versus you getting the 754th replication of that stem cell line or something, you know?

Melanie Avalon:
I feel like stem cells are, people are just talking about it more and more and more and I'm really excited to see how they continue to be used and evolve. That's so cool that you're using it literally, so literally during the surgery.

Dr. Cameron Chesnut
Like, while the surgery's happening, I'm using them in multiple ways, and, you know, that's, as you talk about it, I feel the same way. I think they're really cool, and I think that medicine's going that way, and I'm gonna drive it in my little niche pocket of it for sure, and I've been doing that for a long, long time.

Melanie Avalon:
Well, thank you for doing that, which actually perfect timing. The last question that I ask every single guest on this show, and it's just because I realize more and more each day how important gratitude is, which is something you had on your list to talk about as well. So I'll turn it into a two -part question. What is the role of gratitude in your practice? And also to end things, what is something that you're grateful for?

Dr. Cameron Chesnut
Oh man, well, so I'm gonna break this into two answers because I'm gonna go work and I'm gonna go personal. And my practice, things that I'm grateful for are, I'm grateful to my patients for trusting me because this is a, in my world, a very huge relationship. And this is how I select patients, you know, in full disclosure is, this is not a one -time thing and then we're done and we say high five, see you later. This is, these are people that are forever enmeshed in my life and mine and theirs. And it's a really, really big relationship to me. And I want that to be a happy thing for everybody. And I'm just so grateful for those people who trust me in a very challenging situation. You experienced this with your surgeon too. And I don't know if you feel that way about that surgeon now, but I want, I want my patients to feel the same way that I do, that we're sort of forever linked. You call me anytime we're, you know, on that level. And so I'm grateful for that. And I'm grateful, honestly, just in some way grateful to myself for the work that I did to get where I am. And that's a weird one to say, but it's true. You know, I've worked very, very hard to get here and I've achieved very nice surgical results, which comes with a little luck and all those things too, and that progressive mindset. And I'm grateful for that. But where that really gets passed on now is I'm grateful to all the young fellows that I work with. And these are doctors who are already done, board certified. They could be out in their world practicing, but they come spend a focused year with me and just dive deep and they get this extra special training. They become very, very close to me like family and they're the ones who are gonna carry this forward as time goes on. So I'm grateful to them. I'm grateful to my patients. I'm grateful just for that position that I'm in. And it's just a, it's a really nice mix that has worked out really well. So that's in my work world that I'm grateful for. And then on a, you know, personal level, you know, grateful for my health. And, you know, that takes all of the things that all of your listeners know about. So there's a little bit of self gratitude in there too. And I'm just so grateful to my wife and my kids for being my biggest fans and supporters and, you know, supporting me in time and in energy and in attention, just all those key elements. There's a lot of that that flows around. I do it every single day with my kids, with myself, just kind of talk about those things. I think it's the fuel of life for me a little bit.

Melanie Avalon:
Well, I personally cannot thank you enough. I have so much gratitude for what you're doing. I mean, just to talk about really briefly, again, the amount of gratitude I have for procedures I had done, like that brought so much happiness and uplift in my life. And that was with a doctor who, cause you asked me about like the relationship with the doctor. Like I don't have a relationship with him. I don't, I cannot call him on the phone. I mean, I could, but you know, I wouldn't. But at the same time, I had never thought about that before, but literally I have so much gratitude for him in my mind. Like if I think about him, I just, I'm so happy because of, you know, what he did for me. And I didn't have any complications. It went really well. It is so thrilling to know there's somebody like you out there who's doing all of this with this incredible mindset and procedures and forward thinking approach and bringing all of this health optimization into it. It's just really profound, so incredible. I, I'm just so grateful. So listeners, can you share the best ways for people to follow your work? Do you take new patients? You know, what's the process there?

Dr. Cameron Chesnut
Yeah, so I'm definitely most active on my Instagram, which is just my last name that has no T in the middle. It's at chestnut, C -H -E -S -N -U -T dot M -D. And there's a lot of education. There's a lot of before and afters on there. It'll definitely fit into, you know, what your listeners are interested in because there's a lot of other health -related tie -ins to that, right? It's very much about peak performance, honestly. And so there's a lot there, whether you're interested in cosmetic surgery or not. Again, that's just, it kind of shows everything along those lines. And I do just want to say that I think it's so cool that you're grateful to your surgeon and that's awesome. And honestly, he's the one who's missing out by not having the relationship with you because what did, like, does he even know that, right? Like, you know, I always kind of joke with my fellows that, you know, they're like, all of your visits end with, like, hugs and happiness. And I'm like, yes, yes, that's what we want. That's our whole goal, you know, and, you know, you, Melanie, definitely have the right mindset of that sort of dream patient. So I think that's really cool.

Melanie Avalon:
Oh, well, thank you so much, Cameron. This has been so amazing. I can't wait to see all that you do in the future. You're just awesome. So thank you. This has been really, really incredible.

Dr. Cameron Chesnut
Yes, thank you so, so much for having me on. It was lovely. Pleasure is all mine.

Melanie Avalon:
Awesome, have a good rest of your evening.