My C02 Laser Experience: Dr. Cameron Chesnut Part 2

23:01It's a very important tool for me, which is really what that is kind of saying. So when I harvest the fat, I'm then taking what's in front of me and saying, okay, part of this I'm going to use, part of it I'm not. And I tell people that I'm controlling the number of stem cells that I get from you. And part of the way I'm controlling it is where I take it from, like different areas of our body have a different density. And then also once I sort of work with it and process it, then I can increase the density per volume that way. So I can control the number, the quantity. The quality is up to you, right?

23:36And you come in with that. And so that's why you're an exception to this because you're exceedingly young and healthy and all those great things. So you're going to have essentially, by definition, the highest quality stem cells I could get. But with an aging population, their stem cells are aging too. And so I want to get them sort of teed up and have the best quality stem cells that I can get from them. So then if I get some arbitrary number, a thousand stem cells, it's not that it's millions, but they're the best thousand stem cells. Like they're functioning the greatest they could ever get.

24:05So I take the fat from your thighs for you. And I have, I don't know, 20 to 40 cc's of fat, which is milliliters, same thing. And I'm processing it. And then I can look, immediately see, oh, this is like strong, healthy fat, but this fat's a little bit weak. I see a lot of dietary influence in that, which would argue for how sort of like our cellular membranes function. I think it's probably way too nuanced from a nutritional standpoint to go into those details and a controversial topic when you start talking about what fats are getting implemented into our cell membranes. But I would just say there's a dietary link to it for sure, meaning that some fat cells are just more fragile.

24:44And I don't want those ones. I want things that are anti-fragile. I want this. And stem cells are by definition that. And so with you, it was like pure stem cells. So people that are mean to their fat, who are like fit and like testing their fat often, like metabolically putting it through, like we need fat. We have to have it to live. Fat's not a bad thing. It's a good thing. And I can tell when somebody sort of has their fat's been through some stressful situations. It's survived. And so it does really great in fat transfer, which is great because I don't have to take as much that way.

25:15Dr. Cameron Chesnut:Yes. Yeah, I can get a very high quantity with a very low harvest. And that was you. We spoke about this on the first interview, but I think it's worth mentioning again. I think there is this, like I talk with my girlfriends and there's still an obsession with filler and sculpture. Sure. Why is fat so much better than those two options? Well, I mean, so this is opinion driven, right? Because they do different things. It's almost unfair to compare them directly other than they're all applications to the face that there's some overlap in the Venn diagram of what they're trying to do. Right. And there's, I think, some behavioral patterns and some cognitive biases that go into this.

25:52Well, we didn't really get into this last time, but there's this avoidance behavioral pattern that happens. Avoidance coping is what it's technically called, which, and we feel that with every aspect of our life. This is not a cognitive bias. It's just a behavioral pattern that we all have that's sort of like the big decision, like the thing you did, the big decision is uncomfortable, hard to make. So I'm going to choose the things that are easier decisions, which is like the perpetual maintenance model, right? That's the filler sculpt type of model. and those have cognitive biases in them that are like the status quo bias that's kind of what everybody does yeah the presence bias you can do it right now it's easy to do um there's like a loss aversion bias that like well if you do that other thing it's really risky it's a lot like you're you're gonna lose time you're gonna lose whatever and so there's a bias there and so um there's a lot that just goes into how people think about those things in it and that's what kind of keeps the the the areas alive but if we go filler filler's not bad i don't think it's bad i just think it has a very narrow range of use where it's like good and intended to be and it's used so broadly outside of that that it's distorting okay we can we talked about that a lot i think that's a really interesting topic yeah but then sculptra okay so let's do an extreme so you have filler on this extreme then you have fat transfer on the other extreme which i kind of made akin before to like restructuring the foundation that's not sexy right that's not this like create you are not experiencing immediate gratification right a lot of people want immediate gratification and so you're not getting that with fat fat takes time it's great it's a long play if you have that sort of foresight and can commit to what you committed to it's incredible because it has so many facets that of things that it can help and that's you've made the long play yeah like there's no maintenance needed with that basically.

27:36And then the biostimulators have been, sculptors and radiuses and things have been meant to fill this like, or at least like, I would say positioned to fill the middle ground between the two. And I just will openly say from a surgeon's lens, I don't love those products. They're not bad. They're not like, you should never get them. That's not it at all. It's just, it depends on what your goals are and what you're trying to accomplish. But I see the changes that they make in the face and they aren't changes that I would want in my face or my patient's face as far as like how they're affecting the tissue.

28:09Dr. Cameron Chesnut:Because the way they sell Sculptra is that it will build upon what's already there, correct? Yep. So they inject it in different planes of the face and the Sculptra injectors will get into it's injected incorrectly. And I just, you know, there's maybe some truth to that, but there's also not just as it's injected in the soft tissue of the face and it creates a, an inflammatory foreign body reaction that lays down collagen, which is like, Oh, great. I want more collagen in my face, but do you want collagen in the place between the glide plane of your fat pad and your muscle? Do you want collagen in your muscle?

28:45Like where are we building collagen, you know, and that, and there's collagen in our fat pads in the like structural honeycomb. And that's what everybody's going to talk about, but I'll tell you being in there it's not where it's at um it's it's everywhere and places we don't like the sculptures going everywhere yeah yeah yeah what does it look like like what does filler and sculpture look like yeah so fun um i have lots of image i actually used to post a lot more images of this but then did they get my little hand slapped by the algorithm and so i was like that that particular platform doesn't love those types of images although my patients did um and so maybe Maybe I should do a second page that's just these sort of like intraoperative surgical images.

29:25But I used to post this a lot more. And filler looks like, if I'm talking about hyaluronic acid gel fillers, when I remove it surgically, which I do 90 % of my procedures, which is a regular thing for me, the most common situation, it's like wet floating sugar. I'm just kind of scooping out this wet floating sugar that's kind of like a few pieces come out. At this point, I can identify what type of filler it is seeing it on my instruments. Right. Like a lot of times I'm just getting in there. It's all over my instruments.

29:52Dr. Cameron Chesnut:Wow. Sometimes it's like these tension laden or these tension filled pockets. And so I, I enter the pocket and it, it's literally gushing out at me. Oh. And those are dramatic, but more rare situations, but they're not infrequent. They happen. Time. Those would be very common in like the lower eyelid, mid facial area. It's just begging to be, you know, kind of let out. Yep. That's usually when filler was placed more recently. I can, you can get a sense of that. hasn't diffused around or migrated or moved or whatever you want to call it to the other planes as much. Then the, I think the most eye opening of them is when the filler, because filler causes an inflammatory reaction, which we can't really argue about it.

30:34We know that it does. And sometimes it gets encapsulated like a breast implant would. And so it's like literally got a covering on it. and I'll scoop out this little BB, slightly larger usually, that has a clearish capsule around it, kind of whitish clear. And I'll take a scalpel and cut into the capsule and pinch it and filler comes out.

30:56Dr. Cameron Chesnut:Wow. And in those situations, it's sort of like, well, no wonder you can't dissolve this. Yes. You know, your body walled it off. And so it's because filler is challenging to dissolve. So that's what hyaluronic acids look like. and then Sculptra's and Radiesse's and things like that. Those are, those ones give me more nightmares. Really? Because it just glues tissue planes together. And sometimes I've seen some of these like literally look like concrete. Like, did this person inject concrete? Oh no, they had one of these other types. Yeah. And then sometimes I'll find like little white BBs, like little fibrotic nodules.

31:33Yeah. That was a very classic thing with Sculptra that honestly doesn't happen as much anymore, that you could feel them. and now you can't feel them as much, but I'll still see them kind of like mini versions of them under the skin or I'll just see an area. I mean, I at this point could picture every aspect of a face and know exactly what a beautiful young face or like untouched face looks like. And then I'll see like streaks of like almost like scar tissue through it or things glued together. And anyway, that's what filler looks like in the face. It's a deep dive into all the different, it looks different ways in different people.

32:04Dr. Cameron Chesnut:And when it's put in the lips, does it travel or does it stay in the lips? It does travel through the lips. When you're putting it in the lips, the lips are actually interestingly a place where a lot of people get filler first. Yeah. Because I would say filler in the lips is more augmenting than it is rejuvenating. It would be like filler in the lips is like getting a breast implant. Right. Just making your lips bigger. It's not usually like, oh, they shrunk with aging and I want to make them bigger. Like you'll hear that a lot, but that's not exactly how it goes. Right. And so you put the volume in there and the volume is not like it's not in an implant like a breast implant.

32:37It has a border around it. This does not. And so you're putting it in a muscle. Our lips have some fat in them. They do. But they don't actually have that much fat. There's a lot more muscle and submucosa and some salivary glands in them and things like that. And so you're putting it in a place that isn't meant to receive that much volume. So you're putting it in a muscle. And then guess what happens when you, like if you were to put a blob of filler in my bicep and I flex my bicep a thousand times, you don't think that it's not going to be in the same place. Yeah. It's going to move through there.

33:06And so that's the same thing it does in our lips, which is why a lot of people think like I got it and it was gone in like two weeks. Usually either you're really swollen and you interpreted the swelling as the volume from your filler. Yep. Or it is just the filler is definitely not gone. It's maybe just moved away from the borders of which it was placed. And the injectors will say that's poor placement, that's poor placement, that's poor placement. And there is some truth to that for sure. But give it long enough, it's not staying anywhere.

33:33Dr. Cameron Chesnut:Okay. Even with perfect placement, it's not staying there. I feel like it's become a little bit less of a trend. Maybe I'm wrong. But when I lived in LA three years ago, it was such a big thing in LA. The girls were going every three, six months to get more. And I fell into that trap. I haven't had it done maybe in three years and it is still... Yeah. You still have volume from it. Yes. Yeah. And I would call that like this example, when I think of that, you know, it's hard. It's like, dang, but that's like Hamlin's razor, this idea, this like thought paradigm around nobody was doing that to be malicious in my opinion.

34:04They were doing it because that's what they truly believed to be the right way to do it at the time. Over time, you start to challenge a revenue model, essentially, of coming back every six or 12 months. And that's where then there's some bias in there inherently. And I have bias the other way, too, because I get paid to do surgery. So let's acknowledge that right up front. And I just, and that's why I try not to be absolutist. Like, I do not think everybody should have surgery. I do not think that by any means. I also don't think everybody should have lip filler. And if my 20-some-year-old daughter came to me for lip filler, I'd be like, that'd be a conversation.

34:45It wouldn't be like, just do what you want. You know, it would be like, let's talk about this for real.

34:49Dr. Cameron Chesnut:Are your kids teenagers yet? No, I have a 12-year-old son and then 10 and 9-year-old daughters. Okay. So not quite there yet. That'll be interesting. Yeah, for sure. I'm sure you'll educate them in ways that parents usually can't when it comes to the face. It's funny. And they know what I do. For a long time, they didn't really know. They, you know, just like daddy fixes owies. Like, okay, whatever that means, right? But now they start to understand a little bit more. And it's interesting because I haven't gotten any really insightful questions yet, which I'm constantly curious about and prepared for because, you know, I want my value system to be fulfilled with my work as well.

35:24and that is like helping people be performing in line feeling good yeah looking like themselves never looking like somebody different that's like the traditional plastic surgery thought paradigm is like oh you change somebody to look different no i do the opposite of that you know i make people look like themselves and a lot of times the most common thing i hear is like i just like see myself in the mirror again it's like yes that's the win the best that's the dream yeah And that can happen at any age, really, you know.

35:52Dr. Cameron Chesnut:You're, if you guys are listening, go check out Dr. Chestnut's page because you just see some beautiful rejuvenations on there. Like there's one I have in mind, beautiful woman with gray hair. And you just make her look so. Thank you. And you would have no idea. Right. Like there's a look and, you know, to people who have had obvious facelifts and these people do not have a look to them at all. There is a look. And you're exactly right. and you can't put your finger on it, but you know it when you see it. I love that phrase. You know, when I was like really swollen post laser, I almost was like, I kind of look like a middle-aged person that got like a crazy facelift.

36:31Dr. Cameron Chesnut:Do you know what I mean? Yeah, well, I mean, because you had that tightness and swelling. Yeah, that swelling. But like it just never goes away for some people. Well, yeah, it's the tightness. It's the tightness in the wrong places that makes a bad facelift, like spotable. And there's a few telltale signs that when you see them, you kind of know forever yeah like oh that person like i talked about that sweeping deformity of the lower face when it's tied to the ear pulling down and those are kind of linked together and um i thought when i first saw you i was like dang she looks like a teenager yeah no i heard that too yeah someone told me i look like kai yeah yeah well okay if that's extreme teenager yeah the other way but you look like the teenage version of yourself yeah which is interesting because it just speaks to like how that you know kind of tautness and things yeah it was kind of amazing And I always like, I think because I wanted this done for so long, I was fully ready to look crazy.

37:24Yeah. And it's being ready is different for everybody. Yeah. Like kind of getting over that initiation rule. I love hearing that. Yeah.

37:30Dr. Cameron Chesnut:It didn't faze me. I was like out and about, got on a plane. Yeah. But you probably could empathize and understand how for some people that would be mentally paralyzing. Totally. Right. Because they're not actually ready. Yes. They want the human nature, right? You want the benefit without kind of going through the process to get there. Yeah. You can't, you have to be willing to feel a little insane for two or three weeks. Totally. And my job, an area that I really work on is trying to decouple as much of that as I can. So yeah, we got to go through the process, but let's make that less friction to get to the end goal.

38:06And I try to be very respectful of that because there's ways that we could like, Like I could have had you looking incredible in two days if I would have given you a bunch of steroids and stuff like that. And that's a really common phenomenon. Interesting. Post-surgery, post-procedure, post-laser. Like, oh, steroids. Because it stops all the inflammation. Just stops it. Like a blanket. Why? At the cost, though, is our long-term results. This is a different mindset that I carry to it. Like I worked out hard this morning. I want to be sore. Like that's a sign of what's building. I could I could take a steroid and block that inflammatory response and not be sore but I also wouldn't build new muscle right and so it's the same after these procedures like we kind of have to have that's why I said it's all about supporting the healing versus stopping it it's a comfort crisis like I could get you through the comfort crisis and just knock it out but not a bad not a

38:56Dr. Cameron Chesnut:good result on the other end I had um because I was posting content I had some people say like how are you okay with looking this crazy and my response i made a video response on tiktok and i was like if you have had acne for as long as i had acne and felt the way i felt with my scarring i'm this is nothing right for me like for me this is so worth it because the scarring and the acne stole my confidence for so long that for me this is beyond worth it yeah you know and and it's so interesting because you know like that's just people who cannot empathize yeah right yeah um and so those are people that are like okay well it's not for you clearly it's not for you let's not do this that would be one of my 80 percent no's yeah right there you know um i thought it was really interesting that we because we talked about this before too like what's kai gonna do yeah right he laughed at me did i tell you that yeah he laughed in my face which i think is like okay what's because if i'm a i mean i'm a parent too like i and i had a laser right after you which is ironic right um but that's the same story my kids are way older so i don't have the same thing but like they're gonna my kids will remember kai won't yeah but you get babies and this is like my love of the nerdy neuroanatomy of how our brains interpret faces which is a very special process yeah kai has this he sees you you light up his brain recognition area for faces and then he gets all these beautiful rewards and bonding and memories and it's it's a wonderful process But he recognizes identity and even beauty.

40:29Babies will linger on beautiful faces for longer. We know that to be true. And so I was a little curious too, like, okay, what's going to happen? Because is it going to interrupt his identity response to you? Which it did not.

40:40Dr. Cameron Chesnut:No. And so he went right into his like cooing, you know, like, and so I think that's really fascinating. Maybe that's also why I was less mentally affected by it because he still was just in love with me and I was, it just felt normal. Yeah. He kind of went, heh. And then that was... That's so funny. I know. Yeah. Like, is that a real laugh to you? Is there a legitimate humor in that for him? Maybe he thinks I look funny. Yeah. I was like, are you terrified of me? Yeah. What's going on? Like a character or something. Yeah. Yeah. Like a... Yeah. Because you were super... I mean, you were in... I know.

41:11...the throes of it when you saw him. It wasn't like, well, let's get through the worst. You were kind of, I would almost say, in the worst.

41:17Dr. Cameron Chesnut:Yeah. It got worse day... But I mean, the first day was actually less swollen. Yeah. It was the next day that it was really like... Yeah. Like my eyes were swollen shut. Oh, yeah. Like not shut, but you know. Yeah, like slits. Slits. CO2 laser has become a much more recognizable term. Yeah, for sure. And it's much more popular online and people have questions about it. Yeah. For people listening who are interested in it, who is a good candidate for CO2? Yeah. Well, it's a broad application depending on, again, back to the Swiss Army knife analogy, it's a broad application depending on what your goals are.

41:54And it's funny, I got asked this recently too, a CO2 laser new. And I'm like, oh my gosh, CO2 laser goes, it has so much history behind it. To say that it has the most of any laser may not be exactly true. But when we come to medical applications, it would be hard to find one that's got more history. It was originally used as a surgical tool, like in the operating, because you can cut skin with it.

42:14Dr. Cameron Chesnut:Oh, wow. And then it kind of got its first application in aesthetics. And then technology advanced to be fractional. So instead of like taking the whole lawn surface off, you were aerating the lawn. So it's had all these advances. And it's funny to see it in the world of, you know, like I trained at like a laser mecca at UCLA where, you know, people are like afraid of, oh, it's a big ablative laser, a big bad wolf type of thing. And so all of these, like, you know, I was in where all the lasers were popping up every day, all the brands. We have like literally hallways full of dead, dying and aging lasers.

42:49And it just is how it is. new technology all the time. So I think it just speaks to efficacy now that we're like, how effective this laser is, what it does. And now everybody's talking about CO2 again, because I'm like, this is so far from new. And that's when people are like, what brand? It doesn't matter. It's the person driving this laser. Like, are you driving a Ferrari or a Lamborghini? They're highly capable. You could get in real trouble with those devices if you put somebody in it who doesn't know how to drive it. Right. And so it's probably more akin to like a Formula One car or a, like a fighter jet, like more of that, like you can get a real trouble.

43:27And so, you know, good, like, and this is with my capacity with it, you can give me somebody in their twenties, thirties, forties, fifties, and I can make it a good treatment for them, you know, depending on, and, and even in my career, the lasers have become so much more adaptable and capable they're all co2s but now it can adjust the densities and the powers and the we call it the fluences and which is the energy that it's putting out and how big the spot is that's hitting your skin and how deep i can control these things so directly that you know i could i could give you a co2 that you have two hours of downtime it's not going to do anything you know but and that's what a lot of these lasers do is like you go to the place that's like well we're going to do a series of three and you get like the little red slap like you got slapped in the face and you're Like, I think it did something.

44:16And, you know, this is not that. So to do that with a CO2 would not be. CO2, let's just call it in that, like, it's not the definitive maintenance device. It's the one you're going to do every five, seven, ten years, whatever it is. Like, I would be a great example. I'm older than you. I have access to anything. Right. And I'm on this cadence of personally doing CO2 laser about every seven or eight years.

44:40Dr. Cameron Chesnut:Is that what you did after me? That's what I did right after you. I was supposed to, after you, I was supposed to go to LA to do some podcasts. I know. It got canceled like at 10 o 'clock the night before I was supposed to leave. It got canceled? You didn't tell me that. Yeah. Well, and just rescheduled. Like some things changed. And so. Can I just tell you that's so LA. That has happened to me a million times only in LA. It's okay. It's okay. Yeah. And it's funny because it's like it's one podcast that has done that to me like two or three times. And I was going for multiple. And then so I'm like, well, shoot, do I?

45:07Anyway, long story.

45:07Dr. Cameron Chesnut:You're more forgiving than me. I would just cancel. I would just be like, I'm never seeing you again. Yeah. I mean, you know, it's grace. I understand. I flew to LA once for six interviews. Every single one of them canceled. Are you serious? Dead serious. It's an LA thing. It's an LA thing. I like have some identity in LA, so I didn't. I'm sorry. People there can be really flaky. It's okay. It's okay. I just, you know what? I'll take any excuse to go to LA too. Like some of my favorite people in the world are there. I get to train with Laird and Gabby when I'm there. No, there's great people there.

45:36Dr. Cameron Chesnut:You're right. But anyway, sorry. Continue. So you did a CO2 after me. So because I had this like 10 p.m. cancellation, I was like packing back. yeah this speaks to my procrastination of packing at 10 p.m. I was supposed to leave I wasn't even finished and I got this like sort of rearrangement and you know thankfully we just like I so I had a some extra time yeah I was supposed to be gone and I reached out to my associate and I was like hey do you want to I'm due I knew I'd been due and I was trying to I knew I thought I had this trip coming up and yeah so I've been trying to like find a time to do it and so boom I did it like literally right after you well you're looking really good thanks yeah so I did so this is okay So this is a prime example.

46:15I'm older than you and I was doing it for different reasons. I'm doing it for like anti-aging refresh. I like don't do Botox because I choose in that paradigm of weakening the muscle versus strengthening the skin. I choose to strengthen the skin. Right. So this is my version of that. They're not the same thing. But like if you don't get Botox, yeah, you might want to do lasers more often or something like that. So this is my like skin strengthener for me. And like, you know, I had some pigment and some fine, you know, I'm in my 40s. And so like, great. um that was my treatment but i did a because i know your settings exactly um i did something to be like more gentle for you because i don't need the full depth structure remodeling that like the co2 could bore a hole in your body like it could go all the way through so that being said is i'm controlling like how deep your scars are yeah i don't have that so i didn't need to go as aggressive of that so i you know sort of documented my journey a little bit um and you know i i was back in the operating room five days later like and you know you could maybe tell but not really even five days into it and by seven days I would say I was like kind of probably where you're at right now yeah so you were you awake so I did mine awake yeah is that like do people normally do it awake um no um it all depends on the person and what they want I will do it with people awake.

47:38I did it awake because it was like the next morning. And I know what to expect. Like I'm part of the reason, part of the anesthesia protocol that you have is just controlling consciousness, which helps eliminate any like sense of time, anxiety, things like that. For your pain control, I was using local anesthesia, the same thing that I had for mine.

47:59Dr. Cameron Chesnut:Right. And so it's it's I'm numb. Yeah, I'm not feeling and I'm obviously very comfortable in my own environment. And so I don't have any of the anxiety around any of those things. And so, yeah, you can do it awake. But it's just like, what are we trying to accomplish? That's why I love my anesthesia protocol is because the penalty of kind of going to sleep. Yeah. You were asleep. Right. This is a really common question. It's like, so with that, am I awake? Like you're not awake. Like for your intents and purposes, you went to sleep and you woke up when it was over. Yeah. No recollection. Yeah.

48:31No. And that's kind of what happened. You're out. You're not talking. You're not. People are like, well, did I say anything? No, no. You're not saying anything. You're asleep. Yeah. And then, you know, so I did it with just like local anesthesia. I didn't know no topical. Like if you're getting topical anesthesia for a laser, either you're going to be really uncomfortable and miserable or it's not going to do much. And I hear that with like these microneedling, radio frequency microneedling treatments all the time. it's probably because the person that is doing your treatment may not know how to do nerve blocks

49:03Dr. Cameron Chesnut:yeah or should be a yellow flag yeah you know because if you're getting a real treatment you like a robust real treatment like you probably need to be like fully numb for that not topical numbing i did um i think i told you this but i did avi clear did you ever hear about that yeah um i did this avi clear laser which claimed to heal acne and i had to do three sessions and it was the most painful thing i've ever done in my life like screaming pain with topical numbing and still yeah topical numbing holding onto the table by the third session they ended up getting me a prescription for like some narcotic of some kind and it did absolutely nothing yeah isn't that ironic um because my you know my protocol for anesthesia is completely opioid free completely benzodiazepine free yeah and in the which but people are under anesthesia so they're like oh anesthesia but if you go do the version of it that's terribly painful they're going to give you a benzodiazepine and narcotic orally so it's like you're getting the thing that we don't want you to have you know for this like yeah mini treatment yeah there's just some irony in there to me a little bit so when someone's like shopping for lasers as you mentioned like they're usually throwing out brand names so confusing like what should what should they do like what what about their skin makes them a laser candidate well i mean to some degree if you have any aging changes or structural changes to your skin you're a candidate for laser that's not like a one good candidate right like literally you like and you know this is a little bit of like we have to you know take this for what it is from the hyperbole but show me anybody who's over 30 and i could do something to make them better with a laser or something maybe not really show me somebody over 40, I can make big changes, you know, and every, it gets more and more important from there.

50:52And so, but it's unique, you know, you are different, like I said, than somebody else, like you are different than me. And we had the same lasers kind of, at least a couple of them, but for completely different purposes. Right. So it's not even like, this makes it muddier, right? Yeah. Because it's not even all, what laser are you choosing? It's like, well, lasers at what settings for what purposes. So you end up not, don't ever go for a laser. Don't go for a fill in the blank brand name laser.

51:21Dr. Cameron Chesnut:I'm doing BBL. I'm doing Moxie. Don't do those. Why? If that happens to be the right one for you, great. But don't go because they have that laser. Like my friend had a Moxie and it was incredible. My friend had a brand name Y and it was incredible. Like that doesn't mean it's incredible. Even if you have relatively similar situations, like that doesn't mean it's incredible for you. You and I have totally different situations. We use the same laser with very good effects for different purposes, right? So choose the person who's driving it. Yeah. And I think I've said this before. We might have talked about this in our last podcast.

51:53Choose the person who's driving it very carefully. Yep. Very carefully. And then let them do their thing. Okay. Which might be more than one laser, especially if you're in your 40s.

52:02Dr. Cameron Chesnut:Like trust them. Yeah. And also be like, which lasers do you have that you're not using on me? That's like a nobody asked that question because if the answer is none, well, either you're getting a bunch of lasers or they just don't have anything. Yeah. Because those machines I'm assuming are very expensive. Yeah, yeah, yeah. They're very expensive. And, you know, the point of that is it shouldn't be that you're just getting what they have. Yes. You know, you should be getting the thing that's for you. I mean, maybe the stars align and you happen to be the actual perfect candidate for the one device they have.

52:35Dr. Cameron Chesnut:but i can imagine it would be really hard to even know that yeah we're not professionals going into these and then i would question if the person who's doing it even really knows that too yeah you know so it might be trained because they get one day usually one day of training on the device that they buy from the company company comes in spends a day with you teaches you how to use this thing and when they're teaching me it's a different story i'm often teaching them back you know like and that's not a bad thing at all it's just like yeah um like this is yeah i've got a lot of experience and know a lot about lasers.

53:05You know, deep in a fellowship train, my associate who did my laser, before he did fellowship with me, did the laser fellowship at Harvard, which is where every device comes out of. It's like the Wellman Institute for Photomedicine. Like anything that comes out goes through there. It's their brainchild.

53:24Dr. Cameron Chesnut:Is your associate who people can book with as well? Yeah, they could book with me. What was his name? His name is Ryan Kelm. Okay, Ryan Kelm. So either you or if you're busy, Ryan Kelm. He's going to be at a different price point than I am. And obviously he has training with me directly and all the surgical things, but he also has this very cool, like only like one or two people a year in our entire world and industry get to do that fellowship. So he just thinks about it differently, which is why I chose him. I'm like, clearly you're my guy to do this to me. So did you bring him to Washington?

53:57Yeah, yeah, I did.

53:59Dr. Cameron Chesnut:because it's such a unique like it's just it's so crazy to me what you've built there it's amazing thank you and by the time this comes out actually because we're like on the preface of this is like we'll be all in Coeur d 'Alene yeah so yeah I know we talked about that a little bit so and Coeur d 'Alene and Spokane are right next to each other but it's exciting yeah it's really special it's a cool little you know it's um again it's this is what I would want you know so the infrastructure is all built around like this is what I would want if I was going somewhere you And it's a very unique situation.

54:29Dr. Cameron Chesnut:Like I've never seen anything like it before. I think it's amazing. Thanks. Let's talk about the recovery. Yeah. I want to make sure I hit everything. Okay, perfect. Let's do it. We did hyperbaric. We did IV. We did red light. We did ion. What was that? The post-electromagnetic frequencies. Oh, my gosh. That was hard for me. Oh, it was? Yeah. I don't know why. Why? I felt like I was having a seizure. Your little contractions, right? Yeah, it was crazy. Maybe because I'm not used to it. I don't know. Yeah, I mean, and you can always say something and we can sort of adjust. No, I did. Okay. I said, can we turn it down?

55:08Yeah, yeah, good. Yeah, I did.

55:11Dr. Cameron Chesnut:And the ladies there are great. And when I get on, I'm like, turn this thing up. I'm going to do everything that I can. Because you can make it unbearably uncomfortable, which my buddy Ben Greenfield. It's like getting, oh, Ben Greenfield, yeah. Yeah, when I do it with him, he just loves to like, it's a torture chamber. I'm sure. But it has some great physiologic metabolic benefits with the way that our cells communicate through their cell membranes. Okay. So it helps with swelling and things like that. And we could go into each one of these into what they do. Yeah. But you had, yep, you had the PMF.

55:37Keep going. I want to see if you remember. What was the last one?

55:39Dr. Cameron Chesnut:It was an ion biometric. You had the biocharger. Biocharging. Okay, what was that? So the order that you just said these in, I think, is really important because I also order things in my head from levels of efficacy or evidence or what they're like, how sure of a thing they are. Yes. Versus like what could go wrong with them. Is this, you know, is this all like hyperbaric is all positive. Yeah. Like it is unquestionably a huge thing. But there's also some risk to you're getting in a hyperbaric chamber like, you know, we got to clear your ears and all those types of things. Right. But that risk, which is minimal, but it's a risk, is worth the benefit, hands down, no question asked, right?

56:20And so that's like a high level of efficacy and literature behind it. Boom. No questions asked. The IV nutrition, that gets into the roots of our physiology. Like we can support your healing with nutrition. There's no question about that. And we get around your gut and go right into your veins with it. So boom, microplastic free, right? Like I don't know if we talked about that last time.

56:39Dr. Cameron Chesnut:Wait, yes. That's a big thing. Well, it is for me. I might be the only person that I know who's kind of like gone in that rabbit hole. So do you, how do you make sure it's plastic free? So the, I mean, in general, the, the phthalates, the things that help plastic be flexible and like clear plastic be flexible are some of the things we don't want in our body basically. And, you know, so getting an IV or being in an operating room, you're just exposed to, I mean, you're getting bags and bags of IV fluid in this plastic. And so there's a lot of microplastic exposure. And of course you could like, this could get torn apart, you know, like what's the evidence behind that?

57:19And well, we know that they accumulate to some degree. They almost unquestionably cause some inflammation in the process. That inflammation is distracting for me from my ultimate goal, which is you healing the thing that we did. So I don't want a bunch of microplastics in you. Nobody wants microplastics in them. Like, come on. So I was like, as I, of course you know like i said this is what i would want and so as i'm the homes that you stayed in have all like you know pfas free cookware and you know like the lighting and the grounded floor like everything is within this and and i'm thinking like am i pumping people full of microplastics when they're in the operating room for that period of time like i wouldn't want that yeah and so that was rabbit hole years ago diving into like and the short answer is like that operating rooms are just full of microplastics to get rid of them is onerous it's hard it takes effort it's expense more expensive um and it takes you have to like look at everything very very carefully right and so i did that much to um i always kind of like give praise to my team here because they just like roll with me when i do these things there's no because it makes a lot

58:26Dr. Cameron Chesnut:more work and friction for them like what did you find out now yeah in order like even in just what they're ordering so now they like got to research everything we order yeah i mean even in like the drapes and stuff like you can have wow so i'm like i don't want that right so i make a huge effort there um cognitively you know monetarily like logistically with my team to get microplastic free for your that's amazing you can do it um you can do it it's like i wouldn't say it's absolute perfect are the bags made of a different material yes right the bags the tubes um if we want to get in really in the weeds here things that have a lipid in them are like will pull more of these like phthalates and stuff out of the tubing so one of the anesthetic agents we use is in a lipid base so that was like i was like instantly on that um and things that are warmed up so like when you warm iv fluids before we put them in people of course that just makes more you know energy it's just you know kinetic energy in the in the molecules so they'll pull more out of the plastic that way and so i'm like so we're giving people lipids they're getting heated oh so it's just like, I got to do this in a way that I'm comfortable.

59:32I can't. This is one of the luxuries of my life, honestly, is that I am not in a, I own my everything. The team, like the anesthesiologist that you met who, you know, they're handpicked. Like they're on board. Yeah. Yeah. They're on board. And so I get to, I don't have to ask anybody and be like, I'm changing everything. I'm changing everything to pink tomorrow. That's going to happen. Right. And so, yeah. So your IV nutrition, a microplastic-free that you got, very dialed in, had amino acids, had obviously vitamins and some specific micronutrients. It had a little NAD, had glutathione, which you got immediately after your procedure as well.

1:00:11I did some magnesium first and some glutathione last. The magnesium keeps the anesthetic dose down. I knew you were sensitive. You had mentioned that. Glutathione helps the metabolism right away. Anyway, and then, yeah, your PMF, you had red light. Red light It would have fallen in this like category of evidence that was lower. But honestly, it's like skyrocketing and it's evidence now. Nothing actually changed. It just now has a lot more evidence behind it than when I first was using it. It was like a charlatan. When did you implement it? I used this before I was in medicine, right, for myself as an athlete.

1:00:44A lot of these things I used before I was in medicine. And so then I get into medicine and I'm like, I'm going to use red light for my patients healing. And it's like, that's pseudoscience. That's bogus. That's not. It's not. And it's like, it's one of those, the, you know, the, uh, the person blazing the trail takes a lot of arrows in the back sometimes for sure. I've definitely felt that with all kinds of things from filler to red light, you know? Um, anyway, then you got red light, you got the PEMF that we talked about, which interestingly, I think a lot of even my colleagues don't know, PEMF has, um, FDA indications for healing, uh, but it's in bone healing.

1:01:18So like very, very, you know, you can extrapolate that to what we're doing with soft tissue healing. And there is evidence in the plastic surgical literature of improved healing with PMF. So it's, it has evidence behind it. Right. But it kind of falls in this like lower evidence category, but also basically no chance of hurting other than it was uncomfortable when you were first on it. Right. So that's okay. That's a downside. Really. You don't want to be uncomfortable in your recovery more than you have to be. And then you get into kind of that other room that you were in where I had the biocharger and I have this thing called a nano V that blows like structured water protein protein folding, which has some evidence and has no evidence in surgical healing directly.

1:01:54Dr. Cameron Chesnut:Okay. Right? I have to say that out loud. Yeah. Like no evidence in surgical healing directly, but it has evidence in sports performance and recovery, a similar process of recovery. Yeah. It is literally breathing something that's blown over your face. So neutral to a likely positive, zero downside, other than I have to have the machine, right? That's my downside, not yours, right? Right. And then the biocharger, similar. You know, I have lots of people who are like, actually, that might be the one, the biocharger, that device next to you. Yes. That's like making noise, which is called harmonics.

1:02:28I got scared.

1:02:29Dr. Cameron Chesnut:I thought it was going to explode. There's light coming out of it. Yeah. Then there's the frequencies and then there's like literally the way that it moves electrons. That's what you can feel. Yes. And I have a lot of people say, that's probably the one I felt, maybe other than the PEMF. Yeah. the energy I felt from that the most was like was this like biocharger which seems maybe one of the most woo-woo hand wavy of them all like it's making noise and flashing lights at me but the did my team show you that halogen lamp that if you move it close it like lights it up so you can have a visual representation of like oh this thing is definitely affecting a field around it no it's amazing I'd never actually heard of that yeah yeah I want to talk about hyperbaric a little bit more because that has become, I think, more well-known now and people are very interested in it.

1:03:13Dr. Cameron Chesnut:So how does it work and why is it beneficial? Yeah, it's blossomed in the just like wellness and longevity world for sure. And again, I've seen that happen in my career from like, I remember when I first came out and I was practicing people like, there's no evidence that hyperbarics helps after facelift surgery. I'm like, all right, you adhere to that world. I'll do my hyperbarics and let's see what happens and guess what everybody does now. You know, like - Everyone does that now? I would say like everybody's a strong hyperbole as well, but you're going to like it's going to be very, very common.

1:03:43Dr. Cameron Chesnut:Like do you think Chris Jenner did it? To find that. Probably. Yeah, probably. That's a whole other topic of conversation than Chris Jenner and like what happened there. Yes. But so hyperbarics for like if we get into what it does, it's a chamber that pressurizes. And that's why we call it a dive because this goes back to like dive medicine. And if you dive deep underwater, like physically scuba diving and you're breathing in oxygen and you ascend too fast, gas will come out of solution in your blood into bubbles and you get this thing called the bends and it can be life threatening in your brain.

1:04:14You have bubbles in your brain basically. So they'll recompress somebody down to depth, make the like just like a can of soda. When it's compressed, the gas can be in solution. And when the pressure is released, it'll come out of solution of fizz over. Right. So they pressure it back down, push all the gas back in. and then they slowly raise the person up the gas doesn't come into bubbles and they save their life that's where it goes way back to that goes to really really deep depths but in that process of doing that because you can put more gas in solution if you're breathing in pure oxygen and you're at pressure you're going to put more oxygen in solution in your blood in your plasma specifically our red blood cells carry oxygen but they can only carry so much they get saturated You and I are probably 99 % saturated right now.

1:04:58So we can't really do much else other than put it in our plasma. Now it has another route to get to healing tissue, right? And so it's been used in medicine to save wounds that are like, this wound is going to, like, this person is going to lose their leg. This wound won't heal. There's not great blood flow. Put them in a hyperbaric chamber. There's direct infusion of oxygen. If they're in a gassist or if you're just breathing it in, it's going through your, like you were just breathing it in, but it's going through your blood vessels to that area. If the surgical complications, there's all kinds of indications that are FDA approved for it.

1:05:30And then the wellness world starts ticking in a little bit because, you know, there's things like trouble that it rescues, right? And then you get into the world that I was in, which was like, my patients weren't in trouble, but they had a real metabolic challenge going on, healing from surgery or from a procedure. And I can support that with hyperbaric oxygen. It makes it better. and there's evidence to show that it makes the fat take better and the fat performs better because it's got the tools it needs to survive better right away. Yeah. So like not only this is the beautiful thing of hyperbarics, it's emerged as not only does it make your recovery faster, but it makes the results better.

1:06:07And if it makes it 0.1 % better, I'm doing it.

1:06:10Dr. Cameron Chesnut:Yeah, like why not? Why not, right? And it makes your recovery faster. So in you valuing time so heavily, that's one of our biggest tools to decrease your time. Yeah. And then the wellness world kicks in. This is where we're really getting to is to, we know that, and this is still being elucidated exactly how, what the right dose is, how frequently, what depths to do it at. But we do know that it lengthens, there's a direct lengthening of this cap on our DNA that's called the telomere. This has become kind of a buzzword that you maybe remember from biology or something. But the caps on our DNA, every time our DNA replicates, which it has to do all the time, every time you make a new skin cell, it's got to replicate, make a new one, then it closes up, then it opens up, makes a new one.

1:06:53So the more times it does that, it kind of like this little cap on it wears down. And so the cell gets senescent, gets tired, gets old, wears out. We know that hyperbarics lengthens the telomeres, the caps on our DNA. So it kind of like you get more good replications out of it. So it's kind of like a, like, you know, metaphorically it's a longevity, you can see the longevity formed by what hyperbarics is doing. So there's benefits to it there. It's great for your skin. I use it as before every surgery that I do. It's part of my flow state because I'm usually recovering from a workout or something or whatever.

1:07:27So I get the workout recovery. It's a sensory deprivation situation for me too. So it's like you said, two hours is a lot to commit for you.

1:07:33Dr. Cameron Chesnut:Yeah. But I think it's also sort of a beautiful time if you feel like, okay, this is by definition me time. Yeah. like yeah you know so for me i kind of have i have things that i save to read in there or whatever yes i'm not what else am i carrying on papers reading i'm not doing that but yeah that's my spot for it you know um your clinic was the first time i've ever done a full session yes because i'm so claustrophobic and anxious how did that go it i told i forget her name but one of your nurses down there she put me in there and she got on the phone because there's like a phone connecting in there and she was like are you good and i was like no i need you to talk to me okay and she for five minutes just talked to me and i she calmed me down and i just kept my eyes closed for the full hour hour and a half and then i was good and then after that i did it every single day and didn't didn't even think about it so you just had to kind of i had to do that one time to make sure i was like to feel safe that's good and then moving forward i was fine well that's hard to do good job thank you yeah i mean that's like i mean maybe the definition of working through a little fear right there i almost got out i was like really scared wow you don't you never got scared going in there um no no i didn't actually well and so i could i think um different chambers have different like levels of that right yeah because you're in a pretty big tube you could sit up in there yeah you know um you could fit two people great could have gone in there with you yeah which i think i teased you guys about um i've been in there with my wife before i've been in there with my kids before and then there's a giant like full-size kind of window right there which i also think is very helpful yes um so it makes it a little bit more user-friendly in that way but you're still in a space you know um some of the old school hyperbaric chambers were like a metal tube oh no with maybe like a little window looks like on a submarine which kind of for the same reason because it's like submarines have to withstand depth so it might be like a little window like this big that you're you know the size of your hand you're looking through that i could see being a little bit claustrophobic yeah i can't do that but this has this that big glass and once you feel the benefits like i feel really good afterwards it's made it really worthwhile and also seeing the recovery on my face yeah which i mean it's hard to quantify that exactly right because you can't blind yourself to doing it or not doing it to from individual to individual but um a lot of people notice that like if i were to take a basketball in there like i'd you know do these pool workouts where i take a basketball and i dive to the bottom with the basketball try to push it down.

1:09:55It's very Laird and Gabby style. The basketball compresses because even at like 10 or 12 feet, you get in that hyperbaric chamber where you're going like 33 feet, which doesn't sound that deep, but it'll crush that thing down or a water bottle, crush it down to nothing. So that mechanical like squeezing is also helping your swelling right afterwards, which is a unique benefit post-procedurally that doesn't exist for maybe a chronic wound or for wellness as much. It's like that's extra helpful when you're swollen. So looking at my like what I got done, what does the map of time look like for me?

1:10:30Dr. Cameron Chesnut:Because a lot of people are asking me about that. How would you map it out? Yeah, such a good question. So we are sort of letting a rebuilding process happen right now. There is these phases of wound healing. These kids are like really nerdy basic science. But, you know, the first start of any injury is to like stop the bleeding. Like literally stop the bleeding. And then you go into this like inflammatory phase of healing. And then we go into this remodeling and building phases down the road. And there's like sort of these time frames that happen with there. We were trying to move through those early times faster.

1:10:59Dr. Cameron Chesnut:Yeah. Which is what we did a very good job at. And now we're in your sort of like remodeling and building phase. Yeah. You, if we, like this is a fun fact, the first type of collagen we lay down is actually not a type of collagen that we're going to keep forever. It's like our, it's literally baby collagen. Type three collagen. Like this is what babies have in the womb. Okay. If you, this is a fun fact. if you do surgery on a baby in a womb like in utero which they can do yeah when that baby's born they'll have no scar no evidence that the surgery was done oh my god that's crazy because there's a bunch of and this is like one of the studies in plastic surgery is figuring out why that happens how can we mimic that yeah which is it's multifactorial and complex so we don't have like a magic wand for it yet but when we first lay down new collagen which is where you're at right now you lay down this type 3 collagen the baby like get the job done make a scaffold basically like you know plug the hole yes you know save the ship okay um and now the ship is saved you know you've got the type 3 collagen laid down and you're starting to like make it more mature and remodel it into type 1 collagen which is like our more adult form strong kind of what we think of as the rebar of our skin basically so that process is happening for you right now as we speak you're also making a bunch of new elastin this is the one that we're really excited about right yeah elastin is the recoil that's happening that's slow elastin's delicate it is harder to build easier to go away it's fleeting more you're making new blood vessels in that area and that's working really hard which is why you're red and you're pink and you had the cool thing happen you want to tell everybody what happened that you texted me about the other day i went in the sauna for the first time because you told me it was okay and i finally was like i'm just gonna do it and i did it for maybe 20 minutes and i came out and i had little red dots under my eye and i sent Dr.

1:12:40Dr. Cameron Chesnut:Chestnut a picture and I was like am I dying yeah he was like no um my blood vessels are more delicate right now so what happened exactly so those are called the metachord for them is petechia which is like little dots of like red blood cells that got out of your blood vessels basically um it'd be like the idea of a bruise but on a microscopic level basically right instead of like one big injury that let it out they kind of like just escaped because your blood vessels are active they're like the ones that were already there are open and they're like open for business They're letting all the nutrients flow through them.

1:13:12You're making new ones at the same time. It's feeding the process that's happening and the walls aren't as strong. When you put stress on them, which I think this is a beautiful example of that sauna is a stress, right? It's a hormetic stress. It's meant to be that. That's what makes it good for us. Just like exercise is a hormetic stress. And I say exercise strategically because that's what most people text me about afterwards is I exercise for the first time, you know, relatively vigorously. I got to zone three or zone four and now I have like dots. Usually it's under your eyes. Or my very fun yogi patients will be like, I did my first inversion since the procedure.

1:13:47Dr. Cameron Chesnut:Like a full headstand. Yeah, like a headstand standing on their head. And they get them from that because they're putting extra gravitational, like, you know, hydrostatic pressure on their blood vessels. And it pops the little red blood cells. I thought that I, like, rubbed my eyes or something. And that could be it, too. And honestly, it could be. But that's not, like, what happened is very normal when you have, like, another little stress. Yes. And maybe you rubbed them. Maybe you rubbed them while they were dilated from being in the sauna. Yeah. It could be one of those, but it happens. Yeah.

1:14:15The other fun thing that's coming down the road for you is this phenomenon called recall redness. Recall redness is, like I said, all those highways are wide open right now. And as things start to slow down, like traffic starts to slow down, the highway will still be wide open. I don't know if I've never used this analogy, but the highway will still be wide open. And so the first time you go to maybe like exercise vigorously again or it's a hot day or something and you'd normally kind of get flushed and red, you're going to get extra red. Yeah. Because you've got kind of opened the flow through those extra channels again that way.

1:14:47That's called recall redness. That'll for some people less. In small degrees to months, a little bit, you know, which just speaks to that segue into the rest of your question is you're going to be remodeling from this for months and months and months and months. as soon as the redness really starts fading away we know we're shifting into maybe our final phase yeah of like solidifying what's happening but if you have any degree of visible pink you are still super active in your remodeling so i'm in it right now you're in it yeah and and that as expected i want you in it yeah the longer you're red the better the result you're gonna get

1:15:21Dr. Cameron Chesnut:got it the more remodeling you get it doesn't bother me i don't care i'm excited about it yeah That's great. And nobody would know. Yeah. No, no one knows. What should I be doing to help that rebuilding? Yeah. So this gets back to the boring basics a little bit of, you know, you don't want to be in the sun right now. We talked about that. Yes. And I have to filter that to be like, I got to be careful because some people will take that as like a fear of being outside at all. I am a little scared. No, I've been going outside, but I'm wearing a hat, gloves and like a wrap on my arm. Yeah. And like sunrise, sunset, go for it.

1:15:56Yeah. Like be out. Yeah.

1:15:57Dr. Cameron Chesnut:Before eight, I don't do a half. Unprotected. Go for it. You are very light, fair eyes, fair hair, fair skin. You're a fair everything. You're not meant to be at this particular latitude. And you're just not. This is not what you're built for. If you look at somebody who is from here, they're not the same skin type as you. True. Right. So that's like, okay, great. Because I just, I say that to say that we all want sun early and late. Yeah. There's so many reasons. That's a whole nother podcast, right? But in the middle of the day, when things are more intense and the rays change, like when you have more UVB and things involved, that's not when you're built to be here.

1:16:35So you should be protected anyway, but especially now because you don't have the intrinsic ability to repair that damage. You also don't want to distract. You want your effort to be going to building, not to repairing, right? And so sun is a big one. But then it's all the other things. As I was talking about elastin in my head, talking about it being sort of a delicate, hard one to build, I'm like, that's the one where your diet and your inflammatory profile and your exercise, that's what's really supporting that. The lower, like your blood sugar, the lower you can keep all those things, the better that elastin is going to lay down.

1:17:07Dr. Cameron Chesnut:That I can do. Yep. So those are the best things you can do now because most people are not going to be in the hyperbaric chamber for months afterwards. Yeah. I'm not either. You know, I'm at the point of only getting in it now for surgeries again. I'm not actually it's not even in my head that oh I'm recovering from my laser so which I am too yeah you know and so yeah you also went through and I felt this too you have these I call it like these like false peaks in this roller coaster of like as you get it and you look crazy and people told you you looked crazy why'd you do this and then you have this like and that sucks like you know like whatever it just sucks I don't care and then you have this period where you're like oh my my gosh, I look incredible.

1:17:46Yeah. Like my life, this is better than I ever expected it would be.

1:17:50Dr. Cameron Chesnut:Yes, when I was a little swollen. Yes. Right? So it's like this false peak in what happens. And then you get on the bottom, the nadir, the low point, right? Which you're not even quite there yet, but you're coming up on. What do you mean? Well, what I mean is like as your swelling is going away. Yeah. Because your swelling was like false hope. It's like this, like, here's what, and it's like, this isn't real. Yeah. This is fake swelling. It's fluid. It's like why you look like a teenager right away. You reach this nadir where the swelling is going away, the bottom now. There's no more swelling left behind.

1:18:19And so it's just sort of like this is what it is right now. Yeah. But you know that if we had two curves going on, the other curve is building up. So as one's coming down, the other one's crossing up. And this is the actual long-term real result of building collagen and elastin, putting volume back in those scars, making all the things we talked about early. But there's a cross point.

1:18:38Dr. Cameron Chesnut:Yeah. until you get to your final results where no inflammation left behind. Yeah. And this has reached its peak too, which is pretty durable. That doesn't have the down part of it as much. So you're trying to support this one building while you're trying to manage this inflammation going away. And so you're on this little bit of roller coaster. And you had it where it was like, oh, my gosh, I look so great. But I'm like, yeah, it's not real. I look amazing. I didn't want to burst your bubble, but you're getting into the low point right now. I would say like right now it's probably about as least effective as we'll ever see.

1:19:11Dr. Cameron Chesnut:Wow. Okay. By the next time we see each other, it'll rebuild up. It's just a - That makes me feel good. It's less immediate gratification. And it's more like - Yeah. It's the long game thing we talked about at the beginning. The other avenue of it is like it gets hard when you're you and not me because I get to see you in chunks, right? And so I get to see these incremental improvements as like bang, bang, bang, better, better, better. You're looking in the mirror on average once a day. Maybe I have no idea. And so you're not, you have like a much slower shift of this, like what's happening than I do.

1:19:42I get to see the beautiful chunks.

1:19:43Dr. Cameron Chesnut:Yeah. And that makes it hard. Yeah. And then we also, this is where we really test the thing we talked about before, which is what are your pre expectations? Like what are we really shooting for? Because this is where people get to like, well, for a second I had no acne scars. And we know that's not going to be the case in the end. We're going for degrees of improvement. And we're going to obviously, when I say you're at the low point, you already have results. Yeah. Right now. So great. We're already winning. So now it just turns into like how much of a win is it? Where's our end result going to settle down?

1:20:15And I wouldn't even judge that for probably a year. Yeah. But in three to six months, you have a really good picture. But like if we really want to get granular with it and if I were to say like if we were to biopsy your skin every month, which we're not going to do, but if we did that, we would see changes happening in volume of collagen and volume of lasserie, maybe for more than a year, closer to 18 months.

1:20:34Dr. Cameron Chesnut:Which is amazing. and not to like tie it back to fitness necessarily, but I think part of the reason I'm mentally like able to handle it and I'm okay with it is because I've done it before in different settings. Like losing 90 pounds took me a year plus. Right. And it wasn't easy. And it wasn't easy. And I've done that before, but it was so worth it. So I know this will be so worth it for me. Yes, absolutely. And I'm so excited. Yeah. And when I talk to people who have had, I have a friend who's done CO2 many, I think not many times, maybe twice. And I was speaking to her. She was like, just wait.

1:21:09Dr. Cameron Chesnut:It gets better and better and better. So I am excited for that. That's a great testament to what you have to look forward to. But yeah, so long and people that work out definitely. And most of my patients at this point, selection bias are like very fit and used to that sort of like what you describe of like, yeah, work hard. It sucks. I go through the recovery, which also isn't great. And then I like what happens at the end. Yes. It makes people like so much more resilient. It's a mindset thing for sure. I mean, I just also cut my hair very short and I'm like, I know that this will be good for it in the long run.

1:21:40Dr. Cameron Chesnut:I'm in that era of my life right now. You know, I'm down for a long game era. I meant to ask you this just personally. When do I start using normal skincare again? I'm not there yet, right? Yeah. So it depends what normal skincare is for you. If there's a lot of active ingredients involved, like let's say a retinol or something like that. No, I never used retinol. just mandelic acid. Okay. Yeah. So active ingredient, you know, I usually have people kind of tailor in slowly to that because your skin barrier, like the actual like brick and mortar part of it, which is pretty accurate because it's like a lipid and a protein together that make the brick and mortar.

1:22:16As that heals, you'll be able to tolerate the active ingredient better again. But that brick and mortar healing doesn't really finish until the inflammation starts calming down more. So that's a really roundabout way of saying start slow, try it. Usually it takes people about a month to be able to tolerate those really active ingredients.

1:22:38Dr. Cameron Chesnut:I think I'm at week three right now. You're at week three. Yeah. So I think I'll wait a little bit. Yeah. So another week and you could like try it and be like, it made me red or it burned or okay, great. You're not ready. But if you did it that day, be like, okay, great. I mean, I'll take tomorrow off. Then try it again. Okay. And then you can kind of tick through it that way. Amazing. Yeah. We didn't talk about Christian. Jenner. Oh, Kris Jenner. I mean, just give us a little like. I would just say this gets back into my feeling a little empathetic over celebrities and having their before and after sort of like in everybody's head already, which is just sort of an unfair comparison.

1:23:10Yeah. And, you know, the person that did Kris Jenner's facelift is great. He does a very sort of straightforward procedure, gets good results. His patients are happy. She was happy and she's older. Right. So this is the other thing we talked about younger patients having surgery which has its challenges and you know nuances to it older patients have nuances too it's it's their tissue quality is not as good their fat pads aren't strong their skin isn't as strong it's harder to make that's one of the benefits of doing things young is that anybody could have made chris jenner look better if she had done it when she was 40 than if she does it when she's in her 70s like you just it's not her first one it's not going to be i don't believe so okay it's not going to be the same end result of those.

1:23:49And then you have that, like, was it her first one? Was it not her first one? That adds, you know, complexities into it. But I think she looks amazing. Right. And if you see her in real life versus the released photo, it looks more realistic. Like, yeah, she looks great. She legitimately looks great. But she also doesn't look like the air brushed version of the first images you saw. And so in our world, in this little microscopic, narrow deep hole that I'm in of like facial plastic surgery, oculoplastic surgery, plastic surgery, my dermatology into like, there's a lot of heat and critique thrown at like, oh, she's mad about it.

1:24:25And that is by haters, basically jealous people who are more focused on others than them. This isn't me. This is him. You know, this is Dr. Levine who, you know, did a procedure and, you know, he did a great job. And then she went on and said, I'm not mad. On Chloe's show. Right. But it just goes to show that like, you know, I really respect my colleagues who are focused on themselves and our field and them getting better and sharing that. And, you know, to be critical of somebody else's and to do so in a false way where you're claiming that she's unhappy, which is like super unfair to Kris Jenner, like makes my heart hurt for her a little bit.

1:25:00It's like sucks. Like somebody's putting words in your mouth and leveraging you for their own agenda because they're jealous of the guy who did her procedure. like totally it's a little bit human and plastic surgeons are really hard about that you know because if you're not the one who did her facelift like you're not getting the attention and uh like that hurts your ego or whatever a little bit so i'm on the other end of that all the time too you know really oh yeah yeah for sure yeah that's what i said the arrows in the

1:25:26Dr. Cameron Chesnut:back idea i would be very hesitant to work with someone who builds their career on you know hating on other people yeah that would definitely i mean everybody knows that's a red flag and red flip you No, it's a red flag. Like, focus on yourself. If you've got critiques of other people based off of, in our world, it can even get down to, like, the nitty-gritty of what your training pathway was. Like, oh, you did ear, nose, and throat and went into facial. Seriously. That's correct, you see. And went into facial plastic surgery instead of, like, oh, I did general surgery and plastic. And I'm like, okay.

1:25:54Wow. Or you did derma or you did ophthalmology or whatever. It really boils down to just, like, at some point, like, the proof's in the pudding. Yes. Like, look at the results and see what you see. And anyway, so that's that's my, I guess, odd Kris Jenner rant a little bit. Just like it makes my heart hurt for her. I'm sure she's a very lovely person. I don't know her. She seems amazing. Her surgeon's, I'm sure, a very lovely person. I don't know him as well either. Another famous celebrity just had a procedure with one of my best friends in the field. And he was and it's a great procedure. She was a challenging situation with a lot of previous filler and surgeries.

1:26:28And he was critiqued for her. And then it's like, what is happening here? You know, so anyway, it's. You know what?

1:26:33Dr. Cameron Chesnut:If you're doing something well, I think there's always going to be feedback. For sure. Yep. Yeah. I used to get a lot of hate on this show, but a lot of love at the same time. About what? What are you getting hate about? Just controversial topics. Yeah. You know, things come up and people get mad. Yeah. Anyway. Yes, here we go. Dr. Chestnut, thank you so much for coming on for part two. Thank you for doing my face. Yes, absolutely. I'm so excited. Thank you for trusting me. Oh. And I say that that is not like a pleasantry. That is like something that is never lost on me when I see a patient. And it's like it's a big it's a trust both ways, to be honest, especially with surgery.

1:27:07A little bit more. Yeah. Because I get to I know what I can create. And it's a trust in both directions that we're like going to be glad that we did that. Yeah.

1:27:16Dr. Cameron Chesnut:You know, I genuinely felt so at peace. I don't know if I told you this, but I've had like when I have my egg retriever, whenever I get anesthesia, I freak out. I have panic attacks. And that was the first time I was like, yeah, I'm good. That's great. I felt so good with you and so good with the team. I love that. so if people want to book with you and your clinic where should they go what should they do yeah so um active on instagram that's a great place to look first just to kind of get familiar because i generally want people reaching out who like kind of know what they're getting you know because i have a unique value proposition is that fit with you right so i want that then you start with just a screening process that i that's free you know It's like, send me good photos.

1:27:56Send me as much relevant information as you think I need. And the more good stuff I get, the more good stuff I can give you back. And that's what I say this about 20 % of the time. I'm like, let's go. We're going to work great together. Let's do this. And for the others, it's sort of like, okay, well, here's maybe not a great candidate for these things. That's kind of not the right path to what you're seeking. Or we just got to give us all kinds of different avenues there. and then we start the like okay let's we meet usually virtually first because everybody travels to see me nobody lives there so it's always a virtual meeting and then that starts the ball

1:28:32Dr. Cameron Chesnut:beautiful yeah thank you so much yeah thanks for having me again

1:28:42Dr. Cameron Chesnut:thank you for joining us on the pursuit of wellness podcast to support this show please rate and review and share with your loved ones if you want to be reminded of new episodes click the subscribe button on your preferred podcast or video player you can sign up for my newsletter to receive my favorites at marielewelan.com it will be linked in the show notes this podcast is a pursuit network production love you pow girls and pow boys i will see you next time the content of this show is for educational and informational purposes only it is not a substitute for individual medical and mental health advice and does not constitute a provider-patient relationship as always talk to your doctor or health team