The Dark Side of Fillers, Botox, and Anesthesia and How Beauty Controls Our Perception - With Dr. Cameron Chesnut

26:32But for what I'm doing, which is completely elective and cosmetic, it's not that this is me projecting my values, I guess, a little bit in real life, but I don't want to do that to somebody. I don't want to compromise their long-term cognition over something that's very, very elective. So I choose to do what I would want if I were having surgery. And that is this idea of a opioid-free, benzodiazepine-free, very gentle, neuroprotective anesthesia that prevents post-operative cognitive dysfunction, which is really driven by neuroinflammation, inflammation inside of our brain. So that's what we're minimizing.

27:08Yeah. Oh my gosh. That's a lot to that. That was very much a lot in there. Just do not hold back at all. This is fascinating. You know, I don't really think we think about this, which is, you know, especially in the condition where, again, a grandparent or somebody undergoes surgery, we tend to attribute it, if there's a problem, they're never the same, the issue that they had the surgery for versus the potential of the surgery itself. Right. And just the incredible burden that it puts on our body, in particular, our brain and not being educated or aware of that. And also just, we have a, you know, a certain standard of care, the way that things are done.

27:48And fortunately, again, voices like yours, conversations like this, it's helping to get this education out there, changing the paradigm. And, you know, we see it's again, like the data is there with anesthesia and the more that you're, you know, the longer that you're quote under, the more times that you have this and we see this degradation related to Alzheimer's, dementia, cardiovascular issues, the list goes on and on and on. This isn't just like you just get put to sleep and that's the end of the story. What's so fascinating about it is I don't think we exactly know how it works. We know that it works, but it's different from quote being put to sleep because when we're asleep, we can be woken up by pain, right?

28:35We become, not only are we unconscious, but we're insensitive to pain. Like this is a whole different, you said push to the bottom of the ocean is such a great analogy. I started seeing images of get out by the way. I don't like it. Yeah. It's fascinating. Yeah. And what you said is nailed very, I don't want to scare people about anesthesia because it's incredible, like I said, and it's changed the way that our whole health system runs. It's very safe overall. I'm talking about what I would see as the next low-hanging fruit to go after. And there's progressive providers who are doing that. It's challenging in our health system in the United States where it's very insurance-driven because the type of anesthesia that I described is very high touch.

29:21It's more expensive, takes more care. It takes a hire trained staff. There's a bunch of things to do that. And, and I'm operating in a situation that I get to control everything. This is my private operating room in my private, you know, building then with my practice, with the people that I chose in a hospital setting, it might be that you're the surgeon and you don't even know who your anesthesiologist is going to be that day. It's just whoever gets assigned to you. So there's not even necessarily a match there quite as well, which is, I would say a take home message, an actionable item is ask your surgeon about this before your surgery, not the day of, because there's a low likelihood you'll get much time with your surgeon the day of your surgery.

30:02And then same with your anesthesiologist, let them know that you care about this. And at the very least you raise awareness and let this person know that like, okay, you're going to be paying attention to this afterwards. This is one of your metrics of success for the procedures. What do you like afterwards. The other thing you mentioned that I think is really insightful is the sleep part of it, which I kind of hinted at, but it's, we say sleep in a term that has nothing to do with regular sleep. There is no normal sleep architecture when you're under this type of a general anesthesia. That does segue into one of the agents that I choose is very specific because it really mimics non REM sleep, like Delta wave type of sleep.

30:43If we were to look at what happens when you're under this particular type of anesthesia. So it protects your sleep architecture a little bit. All anesthesia is very difficult on your sleep architecture and sleep recovery. This one is, let's call it a neutral to neutral. It's not really maybe a positive, but it's definitely not a negative to your sleep architecture afterwards, which, you know, we'll get into all the, you know, mechanics of sleep. Probably the best thing we can do to recover from our surgical procedure too, is like have that re, you know, restructuring and that regeneration that happens during sleep.

31:15So that's something that I think about during my procedures, restoring sleep architecture. I start preparing my patients for restoring their sleep architecture before the procedure as well, whether that's with melatonin or using some specific types of magnesium and things like that to get them even IV magnesium during their procedure to say, okay, we're done with surgery. Now let's get you back to a normal sleep pattern. So we're not, and my patients are traveling. So I have time zones to think about and things like that. So there's a lot inside of that, but, uh, you, people will get really disturbed sleep.

31:44It is not actual sleep after a normal type of anesthesia. It's usually disrupted for days to weeks afterwards. Yeah. Thank you for this because we can do better. This is the thing, you know, uh, the way that things are structured, as you just mentioned, you're probably not going to get much time with your surgeon, right? So it's, it's unfortunately, it's more of a conveyor belt system for the majority of procedures today and we can do better, which is having more awareness, education, resources, access to the post-op procedures and also prehab stuff too. This is why you have people come out and they have this environment and this experience because not only are the outcomes going to be better for whatever surgical procedure we're looking at here, but you're going to feel better.

32:30You're going to be, you're going to recover faster, all these different things with certain things being implemented. So what are some of those things that you're doing with your patients that are helping with this process? Yeah. So this, I have a pre, we kind of just talked about what happens during surgery. I could go very deep into all the other fun things I like to do during surgery, but from my patient standpoint, they'll notice a pre and a post operative regimen that I have them doing. The post operative one is the very in-depth one that has sort of the most fun, unique things in it. And you sort of mentioned healing faster, which is definitely part of it.

33:03And if I were to flashback 10 years into something like hyperbaric oxygen, which is a staple of my postoperative recovery, that's mostly what it was cited for. It makes people heal faster. And that's very, very, very true, like to a noticeable, statistically significant degree. But interestingly, where my real passion in this lies is that I want everybody to get better faster, but the things that I do also make our results a little bit better. And when you're, you know, when you're already achieving very, very good results and things, I'm looking for every degree, literally one degree of improvement that I can get.

33:37I'll take anything, whatever it is. And so that's the real truth to a lot of these, like hyperbaric oxygen back to that. It doesn't just make you heal faster from your surgery. It makes the quality of your healing better. So if I take fat from like, instead of filler, This is a nice, you know, segue into that earlier, you know, pulling in the early part of our conversation. An alternative to using filler and your face gel would be to borrow some of your own fat from around your belly button or your flanks and move it to your face. So now we're taking lost facial fat and replacing it with your own fat, which is incredible like for like, but it's also highly regenerative.

34:12Our fat is a very rich source of a certain type of stem cell called the mesenchymal stem cell, which are incredible for so many reasons. but they help regenerate the structure of our facial fat pads. And when you put them in the fat, they do a really great job doing that, but they do a better job if they're exposed to hyperbaric oxygen right afterwards. So prime example of that fat does a better job, heals better, looks better if you have this hyperbaric. So just as a, to get into it, like I really want people to heal fast, but I also looking at better. I want things to be better. And after surgery, I'll have them do hyperbaric oxygen.

34:46That starts right away. They're usually doing that before surgery as well. Hyperbaric oxygen from a evidence standpoint and medicine is wildly well backed to help things heal better. Whether that is a chronic wound on a diabetic person's leg, or whether it's a surgery that's struggling to heal, or in my case, a surgery that's not struggling to heal, or just early on. Hyperbaric oxygen is like the most evidence back. That's the staple of what it should look like. And just so everybody knows, that's just a chamber you get in. It's a, It's like a big tube with a giant glass wall on it and it pressurizes down.

35:20So we call it a dive because historically this is used for divers who get something called the bends. When they go too deep and then come up too fast, they get little bubbles in their blood. So you push them back down to depth and then bring them up more slowly, but you do it in a hyperbaric chamber. So it pressurizes and then you breathe in oxygen. And when you breathe in, you and I right now walking around, our red blood cells that carry oxygen are saturated to 98%. You know, they're doing all they can do, basically. When we get in a hyperbaric chamber, we don't need just red blood cells anymore because we can directly put the oxygen into the plasma of our blood, just like a soda gets carbonated with pressure.

35:59That goes in there, and when you open the soda, it all comes out. Same thing, we can push oxygen into the serum of our blood, and it goes to healing tissue and helps it heal faster. So hyperbarics, that's a nutshell of how it works. It's very fascinating. It's good for longevity, good for exercise recovery, great for surgical recovery. Other things that I would mix in would be something like pulsed electromagnetic fields. And this is like a little, we all hear about EMFs all the time. This is a very specific type that we use. It's a frequency for healing specifically. This also has really strong data behind it.

36:36It has an FDA, which is an American Food and Drug Association indication to help healing of bones that don't heal after surgery or breaks, things like that. Super simple. We could be sitting on it doing our PEMF treatments right now, and I get to use that after surgery on my patients and help them heal faster and better from their surgery. It's a little bit of a different mechanism, the hyperbaric oxygen too. So now we're stacking things that are doing different things. Light therapy. This is a huge one. And I know you love this. And different wavelengths do different things. Really strong data behind light therapy for wound healing.

37:11Very well backed for that. But when we use it in a post-surgical setting, we have a bunch of things going on. We have a wound. Oftentimes for me, I'm using a laser as part of my facial procedure, which is non-surgical, but it's just sort of like icing on the cake. You know, I'm treating somebody who's, you know, we're doing a little bit of anti-aging and I'm gonna help their skin with this laser as well. So they quite literally have a skin surface injury that we're healing. They have the actual surgery itself, but then they have just the whole metabolic cascade of healing as well. So something like red light therapy, near infrared light plays a wild role in helping all those physiologic functions happen better.

37:48Helps the direct injury heal, helps the surgical healing better and helps the overall metabolic profile. like everything meets in the mitochondria there a little bit, you know, and then we can get as much of these as we want, but I use a very specific IV nutrition protocol. So if you're coming to me and I have your laboratory work, like your genetic work, any metabolic profiles I have, I can custom tailor your IV nutrition afterwards to, you know, what you need to heal. Like let's say how you methylate this or what your micronutrient deficiencies are, et cetera, et cetera. I can make these very customized IVs.

38:21I like to use peptides in my post-operative and pre-operative healing protocol. A lot of nutrition-based things and then some supplemental things, enzymes, things like that to help healing. There's a lot to it. I don't want to talk about this for too long, but there's a lot that goes into it. Yeah. And the thing is, again, just having a couple of these things start to stack conditions and better outcomes and better recoveries. And so So again, hopefully, again, we can have a vision of the future where these modalities are utilized in conventional medicine just to help people to feel better and to get better results.

38:54Like it just, it's kind of Captain Obvious that we should. But again, there's complexity here. This isn't like readily available, but it can be because we're talking about conventional medicine here. Like there's endless possibilities of what can be done, but there's so much money that's wasted in the system right now as well. Yeah. And it's interesting because as you said, I haven't really talked about this or thought about it, but what you just said, you know, kind of made me think that we do use them in medicine, like hyperbarics or PEMF, for example, but we use them when things have gone bad, when it's too late, basically, when things are out of control, then we call them in.

39:30But yeah, what, you know, what's the threshold to kind of be using them in a normal situation or maybe somebody's at risk, but it hasn't gone bad yet. Yeah. Yeah. What a concept. Yeah. Right. Proactive. Proactive. You know, it's fascinating to me as well that, you know, you mentioned one of your great tools that you utilize is lasers, right? And just to think of the power of light to be able to do all these remarkable things with our biology, right? Whether this is like sculpting or, you know, creating some molding. Matter of fact, I want to ask you about the name plastic surgery itself. Yeah.

40:06Right? Right. So when, when I was a kid, you know, I would hear plastic surgery and I would think like there, and of course some of the results that I would see as well with, with people on television is like, oh, they're getting plastic in their body. Yeah, totally. And sometimes that's not far from the truth. Right. So what, where does this, where does, what, what does plastic surgery mean? Yeah. And let's just go there first. Yeah. So plasticos is like the Greek or the root word that leads to it. And plasticose just means that something can be easily shaped, molded, formed, and hence why we have plastics.

40:42They can be so easily shaped, molded, and formed. And that's where the plastic in plastic surgery comes from, is that you're changing form, changing shape, remolding things. So pretty simple root word there. But I think the irony is that it really kind of gives that idea of, yeah, silicone or whatever kind of goes into to change shapes that we may perceive as not being good or not being as good as it was before. The ultimate intent is to restore form and function. That's how plastic surgery started. Yeah. Yeah. It started in wartime basically to restore form and function to soldiers. Yeah. Well, ironically as well, let's talk about actual plastics in plastic surgery today.

41:25Okay. Just, you know, obviously there's a lot of education about this now, just in our environment and our personal care products and whatnot. But let's talk about microplastics, nanoplastics in relationship to plastic surgery. Yeah. So this has been a very deep rabbit hole of mine. I don't really know any other colleagues who have quite done this yet. I think that we will see more of this because all the things we've talked about, I mean, if I were to just kind of say like of the scope of surgery or plastic surgery, what we're just talking about here is now we're about to get into a narrow rabbit hole of microplastics, you know, your audience is going to be much more familiar with them than everybody else walking around in the world, just from, you know, being a little bit more tuned in.

42:09In medicine in general, if I go back to thinking about medical school and my first times in the operating room, I remember this day, uh, you know, you're a medical student, you scrub in and you just like, don't touch anything. You're so nervous. You know, I don't want to touch anything. I don't being three giant full garbage cans full of plastic, just dumped everything. Everything's disposable. And at the time that was probably more eye openings from a waste standpoint, which, you know, isn't really the point of the topic here. But I remember even then thinking like, wow, we're using a lot of stuff, a lot of plastic that's disposable to do this.

42:46Flash forward years. And now this is even just within the last year with full transparency in my own practice. When I was kind of thinking about like, again, I think in these, like, what can I do to make things 1 % better all the time? And I was just thinking and looking at microplastics in general, because there's been a lot of small studies coming out on how they're affecting our bodies, where we're finding them, where they're coming from sources. And just had my wheels turning in the wellness world a little bit as I was looking into these and thinking like, I'm using a lot of plastic in my world at a necessity, just like using anesthesia as a necessity.

43:20But in my world, I'm thinking, okay, how can I, what do I need to look at? And how can I get into this? So I started looking at some very specific plastics or plasticizers, phthalates to be very specific if we really want to get into it and what their places are in medicine. And what, in a nutshell, these particular types of plasticizers make plastic soft and moldable like an IV bag, which I use all the time, or like the tubing for the IV, which I use all the time. So I started digging into, well, what's in these, is this something I'd want to be putting in my body. And I found not so much. One of the very specific plasticizers has been known for a long time to, let's just say, not be great for us.

44:05And when kids get it over and over and over again, we would see issues with them with their development, just like anesthesia in kids. As a side note, when kids get repeated bouts of general anesthesia, we know that those kids don't have as high of IQs as they grow up. Back to that topic. So in kids, we know that in vulnerable populations, these very specific plasticizers were not great for them, but for you and I in normal life, probably not as big of a deal, you know, not as detectable, maybe the same things in Europe are not available, not used. So a side note. So I started going, okay, are these in my products basically?

44:41And so I started kind of going back and I did a very deep dive again. I own the operating rooms on the system, only everything. So I can do this. If I were at a hospital, this would not be possible, but I rallied my, I did my own deep research. I rallied my staff and I was like, okay, let's go look at every plastic product that we use. And here's what we're looking for. And here's what's okay. Cause there are some plastics that are okay. That don't, you know, do this as much. And we had a very, very deep dive and discovered, yeah, that we did have some of these in our protocols. It's been very well shown now that with things like IVs, that some, some sources even suggest that you like run a third of the IV through the tubing before you start putting it in somebody because of the microplastics and nanoplastics that are in it.

45:23So, you know, we, we totally purged all those out of our operating and it was a very expensive endeavor. And I love my staff for this because they were very much on board, but this would have been something that like, you know, the nurse of the hospital is like, I quit, I'm not doing this. You know, my staff's like, Oh, we can make this better. Let's do it. And so, you know, very happy to say that we have a operating room that has, you know, we still use plastics, but plastics that I would use on myself now. And, uh, and it's, uh, I think we'll hear more about that topic. There's, again, there's so many other things.

45:52This might be a little bit of a higher hanging fruit, but in my patient population, who is very well-researched and very aware, this is something that they value. I value for sure. And they value as well. So, and I think the thing we didn't talk about that's really important is, well, okay, microplastics. So what? At a cellular level, this is what peaked me in the first place. If I go back to the beginning of the story, at a cellular level, they're causing a burden, an inflammatory burden, a mitochondrial burden, and we can't heal as well if those things are present in us, especially if they're very acute and there's a high load of them.

46:27So this all boiled down to healing for me too. It's like, if I'm inhibiting their healing even a little bit in that postoperative period, I don't want to be using it. And that's where the plastics come. Yeah. Wow. What I found to be my personal favorite when it comes to red light therapy, and I actually keep this device right on the arm of my couch at all times. It's a portable device and is designed by an incredible physician and inventor, Dr. Vivian Chin, and it's registered with the FDA. And it provides both red light therapy and near infrared light therapy in one device without the damaging UV rays.

47:03The wavelengths and radiance have been verified in third-party labs, and it meets the IEC safety standards for electrical and EMF safety. It's literally the Swiss Army knife of red light devices. It's lightweight. It's portable. I actually have mine right here. And again, it's portable. This is always on the arm of my couch. And I travel with this as well. It's great for post-workout recovery, for my son who plays AAU basketball post-game. So we got a lot of uses for it when we're traveling as well. But again, it's great for skin health and so many other applications that we've already covered.

47:42Again, if we're talking about an aspect of the human body and a certain treatment that we want to undertake, we got to understand certain things can be just a few minutes, a couple of times a week. Certain other things can take months of consistent use to see notable difference. But truly, there is nothing else like the Loom Box. The Loom Box is the very best red light therapy device. Again, it's like a Swiss army knife, super easy to use. And Dr. Vivian Chen, the inventor, an incredible physician as well. She is also one of the most intelligent, most insightful, and also most generous people that I've ever met.

48:26She's absolutely amazing. and she shared with me that for my family, my friends, and my community, she's going to be giving$260 off of the Loom Box. So you can grab your own Loom Box right now by going to theloombox.com forward slash model. That's T-H-E-L-U-M-E-B-O-X.com forward slash model. And you're going to automatically receive the Sean model code that will get you$260 off. It's an incredible opportunity again to own your very own science backed red light therapy device. head over to theloombox.com forward slash model this is again this is going above and beyond yeah it's not not remotely normal no for sure and um it's just it's very admirable to be just even considering and try to figure things out um yeah i mean we'll put a couple of studies up for everybody to see like one of them it's just obviously with our exposure today you can't escape this you can't escape microplastics nanoplastics but you know pretty much everywhere that they're looking in the human body, they're accumulating in our tissues.

49:41And so one of the studies we'll put up for everybody found the accumulation with our cardiovascular system. And it's one thing to have it there, but does that, does it mean anything? Well, they actually found it correlated with higher incidence of cardiovascular issues, right? So heart attacks, strokes. And then of course, the famous study with studying 11 testicles. I don't know where the pair went, but every testicle they analyzed had microplastics accumulating in it, you know? And again, everywhere they were looking in the brain just, and so we're living in a very plastic world. And it's one of those things that we can start to be aware of and just mitigate the effects because the human body is incredibly resilient.

50:26And one of the things that I'm hearing again, like we're like, whether it's, you know, fillers, for example, and we're, then we're got this huge plastic burden. Like we're just filling our tissues with all this stuff that's at its essence, creating inflammation and damaging the potential of our mitochondria. Right. And so that's one of the things as well that you noted is surgery as a mitochondrial stress test. Yes, absolutely. Right. Talk a little bit about that. Yeah. So, I mean, this happens in every facet. And again, I think all of those modalities that I mentioned sort of meet in the mitochondria because that's what's fueling our entire recovery.

51:05It's a big recovery response. We talk about regenerative medicine, which is essentially what a lot of my practice boils down to, utilizing regenerative medicine as part of my surgical or procedural processes. But we have to regenerate. We have to make something. That's the generation part of it. And that takes a lot of energy. And when a lot of that's happening at the same time, we have to have very efficient systems for that. And, you know, we talked about red light. We talked about, you know, supporting our metabolic health, which starts before surgery for me, whether it's some very specific fasting regimens that I'll have people doing or creatine before surgery.

51:42All of these are aimed at metabolic flexibility, fuel usage, how ketosis versus glucose versus even creatine as a fuel source. I want people to have all these options available to them. I want them to have great carbon dioxide tolerance before their procedure. I want them to be in good shape because they're going to heal better afterwards. Their mitochondria are going to be more efficient in these stressful environments. It is the ultimate stress test to do something like this. This speaks back to, again, light being used as medicine, whether it's the lasers, the red light therapy, in particular, the impact on the mitochondria, just helping everything to work a little bit better.

52:18Yeah. Lasers fitting into this like photobiomodulation thing is really interesting because lasers have been around for a long time. Um, one of my mentors was a father of like the old lasers and medicine and, you know, like the seventies and it wasn't talked about in the same way. And I think it's really that the availability to, to us at home or, you know, something like red light therapy that is like, has an incredible safety profile and very little to no risk with it has really brought this into the world that light has a very potent interaction with our body. but when we really look back at it in the old school i'm like these guys were you know a laser is by definition a single wavelength of light one wavelength and they were figuring out what that wavelength did in our body basically what it hit and how that energy affected that target that it had it's called a chromophore a fun word so a specific wavelength of light hits a very specific chromophore and there's an interaction that happens and so some of the chromophores are red blood cells and that shuts down a blood vessel if it gets heated.

53:21Some of them are collagen, some of them are pigment. If we want to get rid of, you know, sun damage or moles or whatever it may be, things that have like melanin in them. So if we go, these guys were very old school, you know, pioneers, basically figuring out like what wavelength of light did exactly what in our scan and then applying them in incredibly life-changing ways. It's pretty cool. But it's like the OG photobiomodulation basically. And now it's so popular and, you know, red light has a different effect. Red light's targeting our mitochondria, largely, you know, cytochrome C oxidase. And so it's really cool to see the evolution come and have it sort of be for who we're talking with sort of a household, you know, idea.

53:59So cool. So cool. Light and sound in medicine as well. Yeah. Just really interesting stuff. So, you know, you mentioned earlier about the performance and recovery of patients and utilizing, you know, very intentionally proven modalities. But also I was thinking about in terms of your performance and the performance of your team, you know, and doing very complex procedures. And again, thousands, since people push play on this, just in our surrounding area right here of people are undergoing surgery as we speak. Right. And, you know, we don't have conversation or awareness of the conditions of our surgeons.

54:45And so, you know, I've been talking about this for years, you know, going back to in my first book, I mentioned a study published in The Lancet that looked at medical doctors doing a procedure, had them come in, checked all their metrics and then sleep depriving them. Oh, yeah. Okay. So just 24 hours, which is not abnormal. And then had them to repeat the same procedure. Here's what happened. They made 20 % more mistakes doing the exact same thing. And it took them 14 % longer to do the exact same thing. Right. And a lot of times we're sacrificing that efficiency, right? We're just working and working and working, thinking we're getting more stuff done, but we're losing efficiency.

55:26We're making mistakes that we got to go back and fix. Absolutely. Right. And so I've been talking about this for quite some time because as you know, just the field of medicine, the training in medicine is like, it's like a badge of honor to mess yourself up, you know, to just run yourself to the ground. and you know i get it for those situations where you need to overcome extreme amount of stress but in general we can have a society and a culture to where our physicians are on top of their game yeah and they're feeling their best and they're locked in and they're not making as many mistakes because they have the performance element as well not just for them patients for their patients but for themselves absolutely yeah you nailed a lot of things our culture is a big part of it the culture of sleep deprivation, working too hard.

56:16And there are mistakes that get made. It's funny because when we think about this, we know we would think about LeBron or Jordan, like, oh, we can remember games that Jordan was sick and had, you know, like still performed in that particular game. But when it comes to surgeons, we just don't think about this at all, which is crazy. You know, nobody's asking their surgeon, how'd you sleep last night? Did you drink alcohol last night, even though we know objectively and evidence back that that's going to affect their performance on your procedure that you're having. You just assume that they're going to do it.

56:47But if we 30 ,000 of you look at the, I guess, look at the world of surgeons, you know, when we think about people that we want at peak performance and by nature are probably really, really high peak performers, that gets beat out of them a little bit or beat out of you. And you see people who are not healthy, who are not at their top, the top of their game in any aspect of life, overweight and metabolically unhealthy. And that's the person operating on you. I think it's a little naive to think that that person's actually at peak performance, you know? So, and you could argue with that a little bit, but it just boils down to a, this is the culture of my team and myself is one of peak performance.

57:27We want to be at our best. And this was really driven. I would, it's driven by athletics for me. That's where I got this from, uh, this mindset around, and we know this with athletes, but I just carried it over. And so my, I would say my life, uh, largely revolves around being a peak performance for surgeries. So I know in my head when my next surgery is, and I know how much I want to break myself down so I can rebuild in time. It's like, I'm hitting a trajectory of peak performance and it's a, it's an up and a down, right? We get strong, we break down, we get stronger, we break down, it goes back and forth.

57:58And that's not just physical. That is emotional. It's cognitive, like how I'm breaking myself down, how I'm stressing myself, what I'm eating, how I'm exercising. Thankfully, I can pay attention to how I feel, but I also have tools like biometrics to pay attention to. I'm paying attention to my heart rate, my heart rate recovery, my heart rate variability in a workout. How am I feeling? What's happening? And then I'm using tools to improve those so that I can be at those peak performances at those right very specific times. I'm not drinking alcohol. I'm, you know, often fasting leading into the day before surgery so that I get into ketosis.

58:31And then I stay in ketosis through my procedures because I feel sharper that way. No question about it. And so there's a lot that goes into that. And then my actual day of surgery is one of my favorite times. The morning before every surgery, I have a flow state entry routine that I do. And I wake up early. I get in the hyperbaric chamber myself. The same thing we just talked about for recovery. I get in there myself as sort of a sensory deprivation chamber. I do some very specific visualization of the procedure that I'm doing. So if it's you, I'm visualizing through every little aspect of what we're going to do that day.

59:01Where am I going to find a problem? How am I going to solve that and move around? Then I have an outcome visualization. This is what I want it to look like at the end, which is heavily based in my love of neuroanatomy. Here's what I'm trying, the micro changes I'm trying to make. And after the quiet time, I would say in the hyperbaric chamber, I head into a sauna. And in that sauna, I am doing a very specific, like stimulating balance-based workout, because I think a lot of people have felt that, you know, I just have like a little bit of a better performance. I'm a little bit more clear if I had a chance to work out in the morning.

59:34So it's nothing crazy. I'm not murdering myself, but I'm definitely having a little bit of a metabolic stress in front of the red light in the sauna and getting ready to kind of then go get in a true flow state in the operating room. It's very interesting. Wow. Yeah. Amazing. Yeah. Then after the procedure and I take a a little bit of time to, I call it like watching film, like you would do after a basketball game or a football game. You know, you immediately next day, usually watch yourself and say, okay, here's what I could do better. Here's what I liked about that. I don't get feedback on my performance for six months, maybe till the results are done.

1:00:08So I take very detailed notes to myself, different than the medical record. The medical record says, here's what we did, right? I'm making notes about here are the micro decisions I made along the way. And here were the branch points and what I considered and why I chose this, basically things that only I could know. And I take a very detailed note to myself, things I would never remember, basically. And then six months down the road, when I get to see the patient and get to go through videos and photos, I go back to that and I watch my film. And I think, okay, here's what I was thinking. Here's what happened.

1:00:34Here's these 1 % micro adjustments that I get to make. Like, okay, this worked really great. I'm gonna explore that more. A lot of curiosity in that. This is amazing. It's cool. This is really amazing. And you can apply it. I mean, I think that these are applicable to anything. Like you can do these types of things. You just have to find what works for you. The flow state entry is very unique to find kind of what works for you to get you in that state. It's an incredible mental place to be. One of the things that really resonated with me about you was your dedication to excellence and performance and to being at your best, which again, I would love to normalize that.

1:01:11Right. Right. But, you know, with this being said, you're in a field where there's a lot of complexity, both physically, you know, biologically, but also psychologically. Yeah. Right. And so there's this emerging field and just even part of why you're here in town, you know, for this conference related to the neuroanatomy of how we look and how we perceive faces. And, you know, I'm curious from your perspective about our healthy desire to look our best. Yeah. And then how that can mutate or evolve, devolve into something where it's an obsession and it's an unhealthy desire. And I know that you have experience in this more than most.

1:02:06So can you talk a little bit about that? Yeah, there's a lot to this. This is the idea of using neuroanatomy. This is an area for me that I have gotten very academic in. I've done very deep dives publishing on this topic of, with a motivation for me publishing on this topic to just understand that, understand what I'm doing basically, which is, you know, very simple way to say, but I want to know when I make a minor change to an aging face, what that's doing to the interpretation of the person that I'm doing it to when they look in the mirror or when they see a photo of themselves and to what they're putting out into the world, how the world reacts to that micro change that I've just made.

1:02:46And this is understanding the neuroanatomy of facial recognition, facial beauty, the behaviors that surround it and how that goes. It's a very complex system that has some overlap with facial recognition, emotional recognition, language, just regular beauty, how we interpret art and that beauty sense, a lot of decision making and a lot of emotion, positive and negative, actually. So I want to know how these things happen. The eyes and the mouth are really great examples of this, which kind of makes sense because that's our nonverbal communication. So we're very in tune to this. And it's different when I look at you versus when you look at yourself in the mirror, different regions of our brains activate and light up, which makes sense because you're not looking as much for how trustworthy you are, what your identity is.

1:03:35You're looking at analytically, how do I look? And so it's very, very different on how these things go in, but I want to understand, and this is what I'm teaching about, my colleagues in dentistry, orthodontics, facial plastics, injectors, all kinds of anybody who has anything to do with the face, I want everybody to understand that when we make these micro changes, what's happening, how are those interpreted for what the core purpose of our faces really, which is to communicate and convey. And, uh, you know, I think some of the most fascinating highlights of that are that when we look at faces, we make instantaneous judgments, subconscious.

1:04:13Uh, and those are based off of expression, symmetry, things like that. We know how likable the person is, how trustworthy they are. We're not consciously deciding those things. We have a feeling right away. We know when things look really off when things are grossly asymmetrical or when they're outside of the norm for what we have as a comfortable average. We call this like the uncanny valley a little bit where it's like, it's kind of humanoid, but it doesn't quite look right. It's almost a little off-putting a bit. And so that's like a recognition part of our brain a little bit. But we also have a lot of reward systems linked to this.

1:04:48So when we see a pretty face, the reward areas of our brain light up. This happens in babies who actually have no cultural concept of beauty. They will linger on a beautiful face for longer. And they, the regions of their brains that have to do with a reward will light up a baby. Right. So, and, and we have the examples of this, even in cross-cultural things, like a lot of the things that make a face beautiful are, you know, crossed through, it doesn't matter what culture or what race you're from. They tend to kind of be pretty uniform. So this argues for a very sort of core network that we have that does this.

1:05:19But when we get into some of the really fun things about it is like, okay, well, why do we have this in the first place? Right? Theoretically, we're trying to choose mates, right? Not only do we want to protect ourselves, like, are you going to hurt me? Who are you? Things like that. But then the next level of thinking is it's into our emotions and complex social decision-making is, do I want to mate with you? Uh, what are your genetics look like? And that gets conveyed in our face. How clear is your skin? How symmetrical are you? Things like that. How old are you? Uh, that can all fall into this.

1:05:45And that's one of the theories that we, we look at genetic. There's probably truth to both of these, but that we're looking at genetic information. The other part of it is that the more average faces, the more average somebody's facial features are. And even if you were to, you know, create this face, that just tends to be a more attractive face universally, average lip size, average face dimension, average eye aperture, whatever it may be, people tend to find that face really attractive. So there's this other theory that we tend to find that attractive because it takes less processing and just like, Oh, that's easy.

1:06:14You know, and the The truth probably lies in some complex interplay of those things. But so we have this reward, this emotional reaction to faces beyond just the reward centers. When we see a beautiful face and when we see an unattractive face, we have strong emotional reactions in an area of our brain called like the amygdala, something that a lot of people have heard about. And we know that when emotions get tied to things, memories get made, too. So when we see an attractive face, we get an emotional response beyond our reward system, beyond whatever. and we tend to remember that face more.

1:06:46We get triggered into this more emotional recognition and memory part of things, which is really fascinating and cool. But we can also be off-put by a face we find unattractive and have a similar but different response to a memory with that. And so it all argues for a very complex, non-linear interaction of how we view somebody's face and how we react to it on an internal level. We don't get to the analytical frontal cortex part of things until a little bit further down the road. and that tends to be what we look at when we see ourselves in the mirror like i was saying we look at ourselves we get a sense of like oh how do i look today oh i don't like this thing about myself but we have to like quite literally understand that that's not what other people are seeing which sounds a little cliche but on this neural anatomic is actually true of how we look and then my job is to understand what traits affect that so for example resting mouth position can give a lot of information as to somebody's baseline emotional state how likable they are how trustworthy they are eye shapes.

1:07:43Uh, when somebody has hooded outer lids and lifted inner lids, it can kind of give a sense of, of, you know, kind of looking desperate or when the middle part of the brow drops, it can look a little bit aggressive. Um, when there's hollowness in the upper eyelids, all of these things trigger core reactions in us. So then, or there's a really interesting one that if we can see the whites under somebody's eye, which is called scleral shell, that's the fun word, but the white below the colored portion of the eye, like the lid margin sits below that, we get a negative trigger in our amygdala emotionally that like something is off because it kind of looks like the puppy eyes, like the sad look.

1:08:19And so we tend to have some mirror mirroring to that. And we get a sort of a negative emotional response in our amygdala from that. So it's very fascinating because these are these little microscopic changes that I'm managing all the time, but trying to understand how important are they? What do I need to do with them? What's normal? What did this person look like 10, 20, 30 years ago? Oh, there's lots of factors that go in, but you know, knowledge is power when it's acted upon. And this is my, you know, very unique chance to do that. What? So it gets like, yeah. Wow. I'm just thinking about, I just ran through so many phases, including Ice Cube, by the way.

1:08:53He's a fun guy, but he looks mean AF, you know, it's just the way his eyes are shaped, you know what I mean? And the eyebrows, holy moly. And there's some sexual dimorphism to this in humans as well, meaning men look different than women. And so we have different recognitions of those things, kind of gets into the more recognition side of things. Is this a man or a woman? We know that right away. You're not thinking about that consciously. It happens. And sometimes when it's hard to tell, then we get tuned in. Like, I can't really tell what this is. We get very tuned into that. So part of my job is that, too.

1:09:28I want to make men stay masculine and I want to have women stay feminine and not cross that over at all. Cause we see that far too often, especially with men getting feminized. Yeah. That's, you know, that's one of the things that you might see in like popular culture, you know, with, you know, actors having procedures done who were not intending to look more feminine, but just some of the results. That's, that's so fascinating. This is, man, I just want to keep talking to you and asking questions. This is so fascinating. You know, I think in closing, it would be awesome because obviously, you know, it's a, if number one, if people are not in a position where they're even thinking about something like plastic surgery, let alone being able to work with you because, you know, you're one of the most in-demand people in the world.

1:10:16what are some things again just with people who want to just look their best and feel their best are there any things that you recommend people to do just for their general self-care when it comes to um you know just being able to look and feel their best yeah this is a great topic it's a big one and i talk about these types of things a lot on my social media for example like here's what i would do in my 20s my 30s i kind of go by the decade or just there's there's lots to this because in reality, I'm thinking about this with my kids already. I'm thinking about their skeletal structure with their orthodontics to their airway and how that's going to affect their jaw in the long term, which is very functional, but also will affect how they look, honestly.

1:10:58So it really is at every level. We really want to be thoughtful about this. But the best advice I can give, because this spans every decade, even for my kids, honestly, to somebody in their 60s, 70s, 80s, is paying attention to your metabolic health. Very cliche. but let's talk about something like blood glucose levels super simple we can measure i'm wearing a continuous glucose monitor right now i kind of always know what that is i use it as more of a systemic stress metric for myself to know what my cortisol levels are approximately doing but when we look at what's happening with our blood glucose levels and we we know that as they get high those things will age you faster very simple example of that right it's called the glycosylation Attaching a glucose molecule to a protein makes the protein not function well.

1:11:44And this happens in our arteries, happens in our facial tissues. Not great for how things function, especially when they're elastic and meant to flex like our skin or our blood vessels. And we can measure this. A fun fact, people may have heard of this lab test called a hemoglobin A1c. That is measuring exactly what I just talked about, how much glucose is attached to our red blood cells. And it gives a really reliable example of like, you got a lot of glucose going on and it's attaching to your proteins. This is not good, but a very simple, basic, I think, rubber meeting the road example of how our metabolic health affects our aging.

1:12:22Because what we're seeing externally often is reflecting what's happening internally, metaphorically, and quite literally in that situation. If you're having a breakdown of your elastic tissue of your skin, I'd be highly concerned that that's happening to your arteries as well, which are also very, very elastic. Same process is happening. So this is systemic inflammation, it's toxicity, it's glucose levels. These are all things that we want optimized before surgery, going back to that, but they're going to help you at every phase of your life moving forward. The challenging part is, and I think that we're going to see more of this as this gets into the health span, lifespan discussion a little bit.

1:12:58We want both of those to go up and be better, but we do see a decoupling. We were talking offline about this a little bit before. the patients that I work with are often very, very high performers, like the best in their fields. And they are very metabolically healthy. They've taken care of themselves. And this is a selection bias of the people that, you know, I gravitate towards and gravitate towards me. But at some point it starts to decouple a little bit. And I was kind of saying, you know, this gets into our neuroanatomy. I was working out with Laird Hamilton this morning, his early sixties.

1:13:28And when you look at him, you maybe don't know exactly how old he is, but you know, he's older than you. But when it comes to the actual performance, he can hang with me easy or better. And, but when you look at him, you get a different judgment of that, right? So if you take that from the athletic world to the business world, to whatever, wherever we live, there starts to get a bit of a decoupling as to where we're at and what we're capable of and what we look like or what we're putting out into the world. So the space I live in is really erasing that cognitive dissonance and trying to put those things back together, just in a nutshell, making people look how they feel or trying to.

1:14:03And you can protect that gap from opening by starting early, by being metabolically healthy, by being present and aware of who you are, what you look like, what your goals, missions, and values are, which is a big mission to do to figure those things out. But that all kind of helps kind of things stay cohesive and prevent needs for distorting or altering or doing other things down the road. But at some point I, you know, this is where I get into it is like, I see that as part of the health metric is, you know, you, this is affecting your performance. It's affecting what you put out into the world.

1:14:36It's affecting how you feel about yourself. There's no question that how we look affects how we feel and our overall health. No question. Very well studied. Lots of things that look at that. Um, and so, you know, I get a chance to be part of that health journey for a lot of people. That's beyond just what they look like. I want, I want to help them look how they feel, but then I also want to make them more healthy and make them look better for longer. So there's a lot to it, but, uh, very simple, just kind of like, you know, do the things, do your exercise, you know, that's going to keep your chronic inflammation down.

1:15:04That's going to make you age more slowly too. You know, it's going to make your blood glucose levels better. They're all intertwined with one another. Yeah. It's very practical. Yeah, for sure. Yeah. Wow. This has been amazing. Um, if you could, can you share where people can follow you, get more information, um, you know, find out about your work and your clinic? Yeah. I'm most active on, on Instagram of all the social handles. Um, I think that'll be linked in here. It's my last name, chestnut.md, no T in the middle, as you were teasing me about before. Um, and yeah, that's a great place. Like I said, I go through a lot of education and a lot of kind of what we just talked about what to do in your twenties, thirties, forties, what to, I mean, what to watch out for and what to look for, um, what to avoid kind of like traps.

1:15:46And then, you know, a lot of, there's a lot of before and after results and stuff on there too. Yeah. It's pretty shocking. I mean, just wow. Wow. Amazing, amazing stuff. Well, you know, I appreciate you so much because again, you are very vocal about making just your industry, let alone medicine overall better. Thank you. And we have the ability to do that and it's just really inspiring to see. So I really do appreciate you for that. Appreciate that. Yeah, I love that. That's definitely one of my missions, goals and values right there. So appreciate that recognition. Amazing. Well, again, we'll link everything in the show notes for everybody.

1:16:23So make sure to follow Dr. Chestnut. Thank you so much for coming to hang out with us. Thank you so much for having me. I really enjoyed it. Amazing. The one and only Dr. Cameron Chestnut. Thank you so much for tuning into this episode today. I hope that you got a lot of value out of this. Please share this with your friends and family. You never know who's wanting to get some work done and getting a holistic and hearty education around the subject, not just taking it for granted that things are going to be done, quote, the right way. But this is incredibly valuable for any aspect of medicine and having major procedures done, just having better education, asking more questions.

1:17:07And, you know, that's what it's really about. again. It's just about being empowered and educated. And I'm so grateful again for you taking the time to hang out with me and Dr. Cameron Chestnut today. We've got some amazing things in store, some powerful masterclasses and some world-class guests coming your way very, very soon. So make sure to stay tuned. Take care. Have an amazing day and I'll talk with you soon.