Dr. Cameron Chesnut On The Biggest Things Aging Your Face, Modern Facelifts, & How To Look Younger Without Looking Fake

31:19And so when things get stuck together in those ways, sometimes those are things that are, can be really difficult to fix. What is the Dr. Levine effect? What effect has that had on your profession? Because we've seen the name everywhere. Chris Jenner, KJ loves, loves herself some Dr. Levine. What has that been like for your profession? Yeah, it's interesting. um dr levine does a very sort of like reliable straightforward type of procedure he's very word of mouth driven and he's good at what he does right and so it's all i think that's all good for our field as a whole and i'm going to just say the world of any sort of facial surgery because he's producing good results his patients are happy it's all great you know a lot of the we had some colleagues in the field who are very critical of his results and started this like you know she's unhappy with her results type of that rumor was floating around for a while and she nipped that in the bud right none of those things were true um so there's a lot of i don't know just jealousy maybe that goes into some of these situations as well um you know some of my best best friends in this world are you know highly visible in the patients that they work on too um and that's just their personality and how things you know roll along and so it's all good As long as people are, you know, obsessed with their results, they're doing good things, they're taking good care of their patients and they're focused on themselves and what they're doing versus critiquing other people, which he's just the victim of a lot of times, then, you know, I think it's all good for our field.

32:50Anyone who's mad that's in this profession that he got all this attention is crazy because all it's done is it's put more eyes on what's actually happening. For sure. The fact that Kris Jenner came out and talked about her facelift to me is so amazing because what she could have done is not said anything or she could have lied. What she's now done is she's taken the air out of talking about this. And to me, she's brought more eyes onto everything that you guys are doing. Because most people who are celebrities or influencers, as we know, don't talk about it. And so it's become like this hush, hush thing.

33:28To me, Chris, talking about this and talking about Dr. Levine is amazing for the industry as a whole. And it's amazing for women who are comparing themselves to people who have had facelifts because they're lying about it or not telling people. Absolutely. Yeah, it normalizes it. Yeah, and even her opening up is a very, like you're saying, it's a... Refreshing. And it's very one-off. Like, I guarantee that some of Steve's best work, like most of my best work, will never be seen by anybody. You'll never know that it happened, right? So it's very unique that she opened up about it. And yeah, it definitely normalizes something that happens a lot.

34:04Yeah. Yeah. The question I was going to ask is, what are some red flags or things that patients should avoid? Say they go and get a consultation with a doctor in your space. What are things that they should look for as red flags, I guess, or things to run from? There's a lot of ways. I empathize with the consumer in the space a little bit because it can be really challenging to sort out what's what. You and I were kind of talking offline beforehand that the practice I have couldn't exist without social media. So love it or hate it, I'm very grateful for what it, Like my practice is based off before and after photos.

34:37That's what everything's about results, right? And now before and after videos. And now like everything has morphed into that. And so that's the most powerful thing. Because ultimately my patients who have, you know, value their time, their results, their attention. Like this is what I'm working really hard to protect for them. Kind of giving things that are sure things, no brainers. You know, move the needle for what they're after. You can pick that up thankfully in a visual specialty like I'm in. and by looking at the photos looking at the videos how they move afterwards this is like that's the progression of how things have gone from photos to videos to movement right are all these things moving naturally that should be the first and foremost like okay are we you know does that resonate with you and then once you've done that then it's meeting the person would you want to work honestly would you want to work this person forever and because once in my world once we've worked together, we are forever enmeshed to some degree.

35:30And that's one of my unique, it just fits my core values. Like I love the relationships that I make with my patients. And it took me to be a little bit more of a mature surgeon to understand that because before it was just like, all right, you know, more objective. And now it's very much like I do one patient per day. That patient is very special to me. We have a relationship before and after. That's the only way that I'm happy doing it. And so does that resonate? Because for some people, they just don't really care about that as much. Um, and then you want to get into like safety and, and, um, you know, what they're, you can look at their reviews, see all like just kind of dig a little bit at that point.

36:06But, you know, obviously you want the other things to be in line first really is to like, you know, I've been doing just faces for 12 or 13 years. And so do you want to go to someone who specializes in like just one thing? Well, I mean, I'm going to be biased in that obviously, you know, I actually came from a bit of a different training background where, you know, the routes into facial surgery can come from multiple ways. You can come from general surgery into plastics. You can come from ophthalmology, ear, nose, and throat. I came from dermatology into it. And in the middle, we all sort of meet with this like subspecialty fellowship training where we have a year or two where we just do a ton, a ton, a ton of this after coming from ear, nose, and throat or ophthalmology or whatever.

36:46And in that space in the middle, like I would say, yeah, make sure that your surgeon did a fellowship's done a lot of cases my bias is that you know i only do this it's the only thing i've ever done and so you know i work i'm very deep in a very narrow field and i think that that adds value because when we talk about a brow lift in my head maybe literally 28 different things are going through my head about different ways that i could do that it's not like this is the brow lift that i do on everybody who walks through because you know like as you get to mastery and you know virtuoso levels of thing you tend to make them a little bit more complicated sometimes just to to feather out those little nuances of details you don't want to get to some guys like this is gonna be the first one i ever done of this thing right yeah yeah or or you know and a lot of people do great body work and facial work and so it's it's i just want somebody who's like hyper passionate about what you're doing yeah who has the best facelift that you've ever seen who i know you can't confirm that somebody that you would never know okay is Is there someone that you've seen that you just made, well, let's say that you think they have a good facelift?

37:48Oh, man. Let's see. Who would we know? Like Kris Jenner. Okay. So you'd already brought that up. Okay. One of Kris Jenner's challenges is she is just a little bit older than the average facelift patient. So it's harder to, like we talked about, it's harder to get that good result on an older patient. So, you know, kudos there. Let's see. Denise Richards just had a facelift with one of my best friends in this world. and it's a really really great lift and honestly in a very challenging situation because she'd had previous procedures previous filler I'm sure Kris Jenner had too and I'm just using celebrities because these are already all known about types of things right and then there's all the speculation about other celebrities having things done you will understand what I'm about to say Denise Richards has the perfect foundation of a face for a facelift yes do you know what I mean strong structure yeah exactly she like she i mean yeah gorgeous yeah and then so you you do a facelift and it's like creme de la creme yeah and like you and just to describe to the lay person's like you're describing her bony substructure yeah because a facelift is a soft tissue procedure it's fat pads and muscles and skin and if the substrate like you have a double jaw surgery you have a whole new substrate now like if you ever have a few subsequent down the road soft tissue procedure you've got a better foundation for it to be built upon for sure okay so you You do, you have to tell Michael about this situation that you do.

39:10You do an opiate-free, benzo-free, neuroprotective anesthesia. Yes. Tell us about that. That's interesting. Yeah. This is just basically, and a lot of my practice is built this way. Everything is very thoughtful and curated. Everything has a reason. From eight weeks before the procedure, when I start preparing my patients, before they come to me, to what it looks like when they get there, to the procedure itself, everything inside the day is very controlled. You know, I'm like a microplastic free operating room and EMF protected homes. And yeah. Oh my God. That's a selling point for me. Right.

39:43Well, this is, this is my world, right? Like I could get into all the details of, you know, reducing inflammation, the post-op phase. A lot of people focus for me on the recovery part of it because it's very unique and very in-depth. It's all done in-house. So you have a procedure. You're staying in our retreat homes. My staff is with you afterwards. You're getting checked on every single day. You're seeing my staff every day. You're coming into us for your hyperbarics and your IV nutrition and your red light therapy. Are you selling me on a facelift? Maybe I should go get one next week. I could use a break.

40:10I could use vacation. Exactly. So it's very, and it's very in-house, right? This is all curated within us. So everything has a purpose, but the anesthesia, now I'm not an anesthesiologist, right? I'm a surgeon, but I work in my space, my OR, I own it. It's only me operating there and my team. And so I get to choose my anesthesia team to be like, okay, are we on the same mindset? here's what i want and yeah i really only work with like two anesthetists basically and in that like this is what i would want because i want to restore your sleep architecture after your procedure as soon as humanly possible because all of the other things i described the hyperbarics and the red light and all of that is nowhere near as powerful as getting really good high quality sleep right afterwards nobody thinks about that though never i literally never heard another surgeon talk about that in that way so i want to use agents that are going to help you get your sleep architecture back asap right then you start talking about this idea of this this post-operative cognitive dysfunction which is brain fog basically and i have to be careful talking about this in the anesthesia world because let me just like be very outright anesthesia is incredible general anesthesia is a miracle of modern science and medicine that we can do put somebody under to do these incredibly life-saving procedures it is so safe so remarkable like it's incredible for what i do i don't need that level of anesthesia i don't need somebody to be pushed to the bottom of the ocean kept alive by you know a breathing tube and all these things because like we were talking about there's a level of controlling consciousness and a level of controlling pain and general anesthesia just knocks them both out can't feel anything can't you know you're you're just completely out but that's an insult to your brain to some degree.

41:56It just really is. Surgery itself is a metabolic insult. And I look at, I treat my patients like an athlete, like this is an injury to them, right? It's a metabolic challenge that they have to overcome. So I don't want to add any more with the anesthesia that I have to, especially when it comes to neurocognition, because we know that neuroinflammation, inflammation in your brain after surgery, which can happen from surgery, from anesthesia, from all those things, can have negative predictors for long-term cognition, right if somebody gets general anesthesia a lot of times if it's a kid we know that their iq is lower when they're older if it's an adult we know that it probably eats to their cognitive reserve and leads to earlier onsets of cognitive decline that's why i can't pronounce words so for us in our like world you know we're like all have young kids and this is what i don't i'm not going to take an insult to my brain for an elective cosmetic some people also have genetic so i just you know we get these tests and we test our genetics and i just did this one and my doctor called me and said, hey, if you ever go under anesthesia, you have to tell the person that you have a harder time, I guess, removing it from my system or coming out of it, coming out of anesthesia.

43:02And as you said, like your surgeon, if you ever have any kind of surgery, needs to know about this because genetically, like you will not do as well as somebody else. 100%, right? And so that's like, that's so new, but that's been happening forever, right? And so now can we custom tailor your anesthesia to like get around that a little bit, which is huge right um so the experience is better it's better for your brain you're sleeping better um and then you know i just i don't want the long term that's the big outstanding one because that's really arguable because there's not enough long especially if we get really nuanced with the changes there's not enough long-term data to be like yeah you know actually you do have trouble finding words because you've had anesthesia there's nothing that really tells us that beyond just like a mechanistic potential can i tell you something weird but i feel like i can tell you this Let's hear it.

43:51So I started doing cranial sacral therapy. And in the cranial sacral therapy, I did it for like seven months. I'm still doing it once a week. What kept coming up for me was anesthesia and being in surgery. Kept coming up. Like that's, you like start, you like envision stuff when it's coming up. Yeah, yeah, yeah. One night I had a Herx where you like, I don't even, it's really like you like throw up basically. I think you were doing more than throwing up. It was the whole thing. It was crazy. So anyways, the Herx was anesthesia in my system that came out. Not like the actual anesthesia. No, she said the anesthesia was like in my fascia.

44:37This is what she said. No, she's saying the reaction that you had was your body like purging. Maybe the trauma of the anesthesia coming out. Everybody talks about fascia. Okay, so it was crazy though. because right when it came out, I immediately felt better and clear. And I talked to her afterwards and she said the anesthesia gets held in the fascia. I swear to God. But the way you're describing it is not the anesthesia, like the actual substance. It was just the trauma of the surgery. Yeah, I get it. I get it. Okay. I'm just saying the cranial sacral like made me feel so much better. That's interesting.

45:14After you shit and puked yourself. I did not shit and puke myself. I do not shit. That's disgusting. How do you purge? I don't know. It sounded like a wild animal was dying in there. No, it didn't. But then she felt better afterwards. So there we go. I was, I didn't feel very good. I'm just saying if you have a patient that gets stuck in anesthesia, look into cranial sacral. I feel like you appreciate that. Totally. I'm open to any ideas. I mean, I have patients who do rectal ozone after their anesthesia to help them clear it faster. What does that do? It makes you like go? No, actually that you put the ozone as a gas in your rectum.

45:47It gets absorbed. It upregulates your own internal antioxidant system, this thing called superoxide dismutase, one of the ways that ozone works. And it helps you metabolize your anesthesia. I mean, I'm giving my patients at the end of their surgery, I'm giving them glutathione and they're getting magnesium before trying to reduce their anesthesia. I'm literally giving them headphones that play delta theta waves of binaural beasts to try to reduce the anesthesia that I need. That is so cool. No opioids, no benzodiazepines, including in the post-op period. About 95 % of people don't ever take a pain pill after surgery because I can use these long-acting nerve blocks in the face to make a sleeper still feel.

46:21Is that like gabapentin that you're using? Gabapentin can be an adjunct at the beginning before surgery. What I'm talking about for the nerve blocks is actually a liposomal, which is like a lipid-coated version of a local anesthetic called bupivacaine that I put around the nerves. And then it stays for about 72 hours. So where you would have had pain in a region of your face, you're kind of blocked afterwards. That is what you just said. So smart. More surgeons need to hear what you just said. That's very smart. Quick break to talk about Jolie. Lauren and I love this product. We talk all about what we're eating, what we're ingesting, what we're putting in our bodies.

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52:47Get three months free at granola.ai slash skinny. What has gone viral for you on social media? I know you've gone viral multiple times. What are some things that has gotten a lot of attention and the peanut gallery is going wild for you? Yeah, the most common thing that goes viral, the ones that I would say I love this the most, I'm biased towards this, are the really fun preoperative conversations. Okay. Where I'm just like talking with the person before their surgery. like sometimes literally like right before their surgery and the sometimes i'll be drawing on them and explaining and they're just some really fun personalities and i love those um because people that are watching that are usually by definition very very interested in working with me that's why they're sort of so deep in this like interpersonal journey um the other ones that people love to seem to watch are like my rate it quickly opinions on beauty treatments like rate this one to ten so what are some beauty treatments that you're rating give us a couple Oh, like fat transfer, laser, tightening devices.

53:47What's tens? Sauna, gua sha, like all types of things. I hope you like ice rolling. I got you an ice roller. Thank you. I love that. So it's so funny because I'll usually give those things like a mid-tier score, like a 4.27 or 5 because they're like neutral to positive, usually positive, no chance of hurting. Okay. And then some things like, you know, like neck tightening devices, like minus 10, you know. What gets a 10 from you? Like laser resurfacings. Get a 10. Okay. Especially if they're geared towards skin quality as opposed to being a non-surgical facelift. There's a really interesting delineation in there.

54:23If you're going to get a laser from somebody and they're saying to you, yeah, this is going to make your skin better and we'll make you, thumbs up. Do that. That's a great idea. If they're telling you this will be like a facelift, like a non-surgical facelift, it'll tighten everything up. Run away. Don't walk. Get out of there. Do you like CO2? CO2 is a great. So I call my lasers that I, almost every surgery that I do, just about every surgery, I use laser with it. Okay. I'm also using fat transfers. They're non-surgical like add-ons, adjuncts to my procedure that are really important. No surgery that I do will ever change the quality and strength of the skin.

54:56Laser is the thing that does that. So it's an important part of the whole procedure. CO2 is one of the mainstays of that. It depends. I call it a cocktail because it's quite literally a little bit of a different mix for everybody. if I'm targeting red, brown, deep wrinkles, like whatever it may be qualitatively. But I do love CO2 laser. Fat transfer would be a 10 out of 10 for me. I would do lasers for me. I would do it. I like a laser. That's a common guy one too. You know, simple, non-surgical, straightforward. I did a laser like maybe two weeks ago. I would do a laser like a habit stack though.

55:27Like if I was going to get a facelift, I would maybe do a laser. Yeah. And that's what most people do. Again, I'm trying to end the indefinite maintenance. So if we're doing a laser, Michael, it is like, this is it. you probably won't do anything for 10 years. You know, like it's a long-term stretch. That's just how my mindset with it works is like, let's get this done. Yeah, you might have a touch of recovery. You're going to highly, your biggest hurdle to do anything ever is going to be the downtime. Can we get a him and her facelift? Hear me out. Okay, let's hear it. I'll go in, I'll go first because I'm less scared than you.

55:57I'll do a little, a neck, a little lower facelift, and then Michael can go in the next day and he can get a little lift. I'm not scared. What I tell people all the time as it relates to like hormone replacement or these kind of things, I'm open to all of it. Right. As long as it makes sense. Like, because I'm not, I guess I'm doing it for less reasons of vanity and more reasons for like healthy aging along the way. Right. Like what I tell people about, like, I'll just pick on hormone replacement. I'm like, it's not a matter of like, if it's a matter of when for me. And I'm going to do it at the right times to make sure that I'm like aging gracefully.

56:31Thank God you have me. can you imagine if you didn't have me you'd be going to the wrong doctors there's a lot of people that still with a lot of these things there's like a shame around wanting to take care of yourself but i look at it the same way like that i look at the gym or i look at a sauna or that i look at skincare like i look at all of this in the same lane i'm always like trying to figure out like okay like what's right and when and how and i just want to be forever 28 that's how i want to look forever 28 as long as it's you at 28 what you look yeah i know i don't want to look like anyone else i like i want to look like myself that's a good goal before you go tell the audience some things that are so dated that need to change and maybe they can look for these things that are dated yeah well that superficial facelift that we talked about would be one that's there um so just be really cognizant and aware of the type of lift that you're talking about it generally needs to be comprehensive this is one of the big take-home messages if somebody's talking about a lower face and neck lift only raise a brow about that like everything kind of sinks from the top down so if you have like a sagging rubber band why would you lift it from the bottom that's not going to work.

57:29So the top is still going to be exactly. Um, and then the eyelid surgery only thing. I think that that's really, um, that's changing for sure. I'm working really hard to change that mindset around that. Um, and then again, when we talk about like fillers and devices and things like that, it's just sort of like, um, using them for what they're good at and intended for and not as like a sole strategy in the longterm. Are there things that this is my personal perspective. I don't, I'm not a face guy, but I personally believe that weightlifting actually helps keep your facial structure for sure. And I say that to people sometimes and they look at me like, what does your, what does lifting weights have to do with your face?

58:10And I, but that's, I believe that having muscle does that. Absolutely. And there, and we know why these types of things happen. There's signaling molecules all over linked to different types of exercise and a surgery that I'm doing. You know, you want to talk about like heat shock proteins, which are actually a damage associated protein. We call them damps. These damage associated molecular pathways, heat shock protein from a sauna, right? That's going to change the way things work. Myokines get released when we lift weights, you know, and they're not even, they're not related to damage as much as they are related to like sort of growth and regeneration.

58:41Like, okay, now I got to heal stronger. A myokine. There's your link to what you're talking about. It does interface. Yeah. And then we have brain derived neurotropic factor, which is something that's like a, that exercise, even zone two exercise, we'll release that. And that's increasing our neuroplasticity and our mood. And so I'm using that before my patients come see me. You know, you kind of talked about getting ready before surgery for a few weeks. I'm usually getting people ready for months before they come, trying to get them ready to recover from anesthesia, trying to get their inflammatory profiles down as much as I can, get them metabolically ready to have this injury.

59:10Are you single? No. No. Okay. I'm just wondering, I'm just wondering if you're single, because I feel like if you were single, there's a lot of girls that are lining up because it'd be nice if you could also do my face. Well, I can't Lauren I mean I could try if you know that would be like so amazing to be married to someone that could do your face and your neck whenever you felt like I'll be like that when I told you I'll be like never done one of these before I got a little bit of I would be so annoyed I don't know my hands are more steady these days but a little too shaky I think for that no no you know you don't have surgeon hands um where can everyone say hello to you ask you questions book you I'm sure you're booked in advance I'm just gonna put that out there yeah the Instagram is my social where I'm the most active for sure.

59:53I do a lot of education on there. You can see all those before and afters and things on there. That's how I found you. You were served to me. I'm like, does this mean it's time to do a zhuzh? Yeah, the algorithm is very smart. I know. So they must be listening to me saying that. Exactly. I love your social media. Thanks. And what's your Instagram handle? It's my last name with no T in the middle, chestnut.md. And my website's linked on there, clinic5c.com you can get into what the whole process of seeing me looks like i always start virtually when patients so again my patients come from all over the world about 30 percent are international and about 70 percent are from the u.s and cool and so that that's our way to kind of make contact first you can like send me photos and good like the better photos and the better information you send me the more that i can dig in and be like okay here's what we could do realistically based off the concerns you gave me i like you know the more photos the better and i look at these myself and then kind of give you sort of a free opinion basically and then you know sometimes it's that like okay let's talk about moving forward together then then we can start the whole virtual process from there every morning before coffee i have my protein powder and the one that i keep going back to is chocolate water it's not called chocolate water i just call it that my kids think it's called that it's actually the paleo valley chocolate bone broth protein.

1:01:19You gotta froth it up, put it in a little water, maybe a little milk. Froth it up, your kids will think they're drinking a milkshake. But the best part of it is it's packed with protein. I like this protein powder so much that I order it to all the hotels I stay at. Like all of them. I am obsessed. If you're looking to up your protein in general, Paleo Valley also has beef sticks and the organ complex. You know I'm all about organs, So if you're looking for a strategic way to implement organs into your diet because of all the benefits, but you don't want to eat an organ, this is a way to do it.

1:01:57So I like my chocolate bone broth in the morning, frothed up before my coffee. My stepmom adds it to her coffee. You could do whatever you want. My kids think it's chocolate water. And then I'll carry their meat sticks in my purse just for an extra little protein kick in the middle of the day. sometimes for my kids what I'll do too is I'll chop up their beef sticks and put them on toothpicks and it's like a delicacy add some cornichons and some cheese and they have a plowman's lunch and then definitely check out their organ complex if you're afraid of eating organ okay the aminos in organs are amazing head to paleovalley.com skinny or use code skinny at checkout for 20 % off your first purchase that's paleovalley.com skinny or use code skinny at checkout There is this brand called Little Spoon that covers you if you're in the baby stage, like I am, if you're in the toddler stage, like I am, or if you're in the big kid stage, like I am.

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1:04:18I have candy in my house. You have to have candy in your house if you're a parent. I also like candy myself, and I like all the nostalgic kind of candy. I like the candy that reminds me of being with my dad when I was little at the candy store. We used to go to the candy store always before the movies. And now at home, we do family movie night every Friday and we have the same candy every single week. And it is unreal. If you have not tried unreal, you're missing out, especially on the peanut butter drops. So how I use these is I make a big bowl of popcorn. I put some crunchy sea salt on top and then I take my peanut butter drops that are frozen in the freezer and I put them on that popcorn.

1:05:01And let me tell you, my kids think I am a chef. Truly. I like Unreal because there's no artificial dyes or colors. It's just turmeric, red beet, red radish, and spirulina. I also like it because it's non-GMO, it's simple ingredients, and it's real and gluten-free. Okay. They cover all the bases. Unreal's new launch, Peanut Butter Drops, reinvents the poppable bite-sized peanut butter snack you grew up with with a taste that's even better than you remember. 33 % less sugar than the leading brand, organic peanut butter and four grams of protein per serving you can also find unreal products including their new peanut butter drops anywhere cravings hit including at whole foods target costco and other grocery stores as a special offer for our listeners visit unrealsnacks.com slash skinny to get four dollars off a bag of unreal that's unrealsnacks.com slash skinny terms and conditions apply look what we've got here the new mint roller we did a new colorway baby pink it matches with your ice roller and this for me is everything when it comes to travel so how I use this is if I'm traveling or I'm running out the door and I want to use ice on my face so I keep these in my freezer or my fridge just depends on what I'm feeling and then I'll throw it in my handbag so one side is a contour which is amazing so you're going to feel nice and tight and lifted and sculpted when you use this.

1:06:30And then the other side, bite size, is an ice roller. So this one you could use on your neck so you can feel refreshed and de-puffed in the morning. I am obsessed with this because it's compact. It's like a compact ice roller that you can just throw in your purse. If you have not tried our mint roller, go grab it now. Also, it comes in a little dust bag that we designed, which is so fun. You are all set to be tight, sculpted, and de-puffed with the Skinny Confidential Mint Roller. Go to shopskinnyconfidential.com to shop the limited colorway now. Well, outside of the surgical work, it sounds like you're also just like really ahead of the curve in terms of what most medical practitioners are doing.

1:07:13I mean, you've got the cupping marks. I think it's really cool. No, we love stuff like that. I love that people are starting to think about medical care like this and like the preventative and the recovery and how you take care of yourself because I think for the longest time it was just people it was like kind of an afterthought yeah right yeah but it's important I also think sometimes with surgeons and you know this there's certain surgeons that it's like almost like an art project and when the art project's done they're like okay bye right and like what I appreciate in a surgeon what I look for if and when I get everything lifted is like you want someone it's like a concierge service where when the surgery's over it's not like the end of the end of the rope yeah oh my favorite part is usually 18 months down the road yeah when we're like hugging and high-fiving and being like look at this this is so good yeah and you know to your point michael the like it's interesting because if i look back over the course of my career the like health and wellness part of things i mean that was ingrained in me as a child from a mom who was a nutritionist and then being an athlete and realizing oh this makes me perform better so it really came into like my own world of like wanting to perform.

1:08:16I have like a whole flow state routine that I do every day before surgery, which I love, deeply love actually. What's the flow state routine? Well, so to get into a flow state, if anybody who's ever gotten to experience this, it's incredible. You guys have definitely been there where it takes a little bit of friction first, usually like a little bit of cognitive friction, like some reading or some, some sort of like a problem to solve, if you will. So for me, that's like visualizing through my case, looking at photos, going through the key moments. I usually do that in a hyperbaric chamber, like one of the the same chambers my patients use.

1:08:43And then after that, you need a little release. And that would be just like some smooth. So for me, that's like usually a little workout in the sauna under the red light afterwards, like a quick, nothing too taxing, but like a little sweat. And then you get in a state. And then you're in your flow state, which is awesome. And you can maintain it for as long as you usually need to, if you're like engaged in the problem that you're solving. So that for me, that's inside the operating room. That could be four or five hours, could be eight hours, you know, and that's, that's a long time. Wow. And then this is why I only do one procedure a day.

1:09:11And then that's a long recovery. This is the one that nobody talks about flow state is it is so energetically expensive to be in a flow state. You are smoked after that. Right. And so you have to recover. And for me, like last week I did, I did four days of surgery in a row. Me getting ready for those four days was weeks to months of prep, you know, and I'm working, but I know this is a big week. Like I have to be able to be in that flow state four days. in a row. That's hard to do. You work like an athlete. I work like, like if I had to pitch four days in a row or if I was LeBron playing four games in a row, like, yeah, you've got to be ready for that.

1:09:42You know, it's funny. Um, when we talk about some of the things we do and it's different because I, you know, I think people see like the show, like how hard could it be to talk on a mic? But like, I just got back from, I mean, I think you, I did. Yeah. So I was going to, cause I went to look at your stuff and I, but then I saw, I was going to see you, but like what we do when we're about to have an intense week like that, like back-to-back meetings and events and speaking in shows, we think about it the same way. It's like we're recovering, prepping, working out, being calm, and then you're able to go.

1:10:10But I think a lot of people, they talk about burnout on this show where people are like, oh, burnout. And I think the people that burn out is it's just go, go, go, go, go, go. And they don't think about this all the time. We're interviewing a young girl this weekend. We're like, what do you do? And she's young, so maybe she hasn't figured out. I'm like, what do you do to avoid burnout? She's like, I just have another coffee. I'm like, that's not going to work for that long. Yeah, probably the opposite. that's going to catch up for you. Yeah. Um, but no, we think about it in the same way where it's like, you, you know, what's coming down the pipeline and you have to prepare for it in advance.

1:10:38Yeah. And you got it. It's pre-covery. You're basically describing what I call like pre-covery. You're like, you're ready before the stress happens basically. And that, that super applies to patients too. Right. Cause they have their pre and then they have their surgery, which is a big metabolic stressful event. And then they're into recovery in a big way afterwards. You know, theirs is probably skewed the opposite of mine. Mine is heavy prep and then a focal recovery. theirs is a focal prep and then a heavy recovery but you know if i'm having surgery if i need something done even if it's my orthopedist or something i want them like i want to know they didn't drink the night before they had a good sleep they've been thinking about this they were managing their cognitive load they didn't have a fight with their spouse the night before like all of those things can affect your performance and this is why being like obsessed with their process can you know take it it can lead to burnout can take a toll on your life yeah No, for sure.

1:11:25That's a good point, especially if you're having somebody work on you. I've never heard of it. I do the flow state without knowing that that's what it's called. I think a lot of people get there. I didn't know that that's like, I can't socialize a lot before, like if I have a week of podcast, no way. Like I got to step back. I got to recharge. I got a sauna. I got a cold plunge. I would also think that prep work enables you to get to like, once you get in it and it's stressful and a lot and taxing you've kind of already like you're aware of what that's going to be before yeah you know you're not like surprised like oh my god this is like i'm overloaded you've been thinking about what that's going to feel like well and you guys you get you learn how to get yourself into that state because you you've done this for 10 years you 100 know how to get into it at first if you all but if you reflect back 10 years ago it was a little bit more sporadic and things were kind of being figured out on the fly because this idea of flow state is described this is not I know that's not what this episode is about but it's really interesting time flies you have no concept of it your performance goes up it's a lot of energy is going into it your brain's consuming more glucose or ketones or like that's another thing I use ketones before surgery to help really cool and you know in reality like you're in flow state you're almost like just rolling with the decisions if we really want to get nerdy with it in surgery is probably more we'd call like neurosynaptic coherence where everything's in line but things unexpected are happening like you're making a million micro decisions in that surgery but same idea like you're flowing things are going you're rolling with decisions i have no idea what music's playing i'm not generally i'm kind of boring in the operating room like i'm not i'll be able to talk and explain it when i'm teaching but for the most you don't dance on tiktok yeah no no i much to my social media team's chagrin not a dancer on social media.

1:13:13They were having me do TikTok videos and I just went to the team. I said, just shut it down. I don't know where they are. I don't know. Watch them. I'm over. I don't care. I'm probably missing views and revenue, but I don't care. I can't do it. I've reached a point in my career where I just might have to leave that opportunity on the table. Good for you. Normally when Michael's talking to me when I'm in my flow state, I'm like, I'm overstimulated. Stop talking to me. Now I'm going to say I'm in my flow state. Well, and so, but that's good for literally for your team because your kids and Michael may not adhere to that as much but for your team to know that like i have a big day today like do not drop a bomb on me right when i'm about to start because sometimes like carson pull that clip and just play throughout the office yeah well seriously because like this could have waited till after this podcast they could have asked you later but now you've had it in your head all day with nothing you can do my favorites when i'm walking into a podcast and someone's like hey can i pick your brain i'm like i gotta go do this right or i'll be scrubbing for my that's like my last really focused time and if someone walks up to me and like hey can i ask you something i'm like is this like absolutely essential at the second because if the answer is no the answer is hard no this episode is so good for me at this moment wow what i equate it to it's kind of like and again like not throwing shade here you know when you're in a restaurant and you have a huge bite of food in your mouth and the waiter comes i was like you need anything else right now so you're like you're like oh my god it's like that's the worst time in the restaurant yeah read the room and Read the room.

1:14:35Read the room. We should call this episode that. Thank you for coming on. Thank you for doing this. I'll see you in a year. See you next week. Thanks for having me.