The Skinny Confidential Him & Her Podcast - Dr. Cameron Chesnut On The Biggest Things Aging Your Face, Modern Facelifts, & How To Look Younger Without Looking Fake

Episode Date: June 29, 2026

#984: Join us as we sit down with Dr. Cameron Chesnut – a world-renowned facial plastic surgeon known for delivering natural, transformative results. Trusted by high-performers from around the globe, Dr. Chesnut has built a reputation for helping patients look refreshed, youthful, and authentically themselves – never overdone. In this episode, Dr. Cameron Chesnut breaks down the evolution of modern facelifts, why the best aesthetic work should be undetectable, the role of fat transfer in restoring facial volume, and how personalized treatment plans preserve each patient's unique identity. He also dives into the psychology of facial recognition, the truth about anesthesia, how lifestyle choices directly impact the facial aging process, and the performance-driven routines that allow him to operate at the highest level. Plus, Dr. Chesnut shares the latest innovations in regenerative medicine, recovery protocols, and the future of facial aesthetics.   For Detailed Show Notes visit TheBossticks.com   To connect with Dr. Cameron Chesnut click HERE   To connect with Lauryn Bosstick click HERE   To connect with Michael Bosstick click HERE   Read More on The Skinny Confidential HERE   Head to our ShopMy page HERE and LTK page HERE to find all of the products mentioned in each episode.   To learn more about Dr. Cameron Chesnut visit https://hubs.ly/Q033ppVB0. To start your journey today visit https://hubs.ly/Q033pp8J0.   This episode is sponsored by The Skinny Confidential  Reduce puffiness and boost radiance with The Skinny Confidential Mint Roller, now available at http://shopskinnyconfidential.com.    This episode is sponsored by Paleovalley Head to http://paleovalley.com/skinny for 20% off your first purchase.   This episode is sponsored by Unreal Snacks Visit http://Unrealsnacks.com/SKINNY to get $4 off a bag of Unreal.   This episode is sponsored by Vivrelle Go to http://vivrelle.com and apply for a membership today using referral code SKINNY for 40% of your first 3 months of membership during their Summer Event.   This episode is sponsored by Little Spoon Get 30% off your first online order at http://littlespoon.com/SKINNY30 with code SKINNY30.   This episode is sponsored by Mara Labs Visit http://mara-labs.com/SKINNY for 25% off your first order.   This episode is sponsored by Granola Ai Get three months free at http://granola.ai/skinny.   This episode is sponsored by Jolie Try Jolie risk-free for 60 days by going to jolieskinco.com/SKINNY. Produced by Dear Media

Welcome to the Bostics, starring Lauren Bostic and Michael Bostick. Together, they are the Bostics. Okay, so I'm so excited about this episode, I have 8 million questions. I love it. Let's go. Thanks for having me. What makes a bad facelift? Ooh, well, facelists have been through an evolution. In a nutshell, if I could answer it in one is the facelift that you can tell happened. Basically, you see it, you know.

And we all know what that looks like. no subtleties around that. It's people call it wind blown. There's some very telltale signs that are kind of fun because once I explain them, you'll see them everywhere. One of them is where your earlobe is pulled down, which is called a pixie ear deformity. Or if you can see inside of somebody's ear, like the front anatomy of their ears pulled forward and it looks, we call that like a gun site deformity. You can look down inside of their ear. There's all kinds of these little telltale signs. The most obvious one walking around is what we call sweep. And that is where there's like a Nike swoosh going from the

corner of your mouth to your ear, like this tight sweeping motion that happens when the lower face is pulled too tight and the upper face continues to sink down on it. These are all very much, they're still walking around now, but they're somewhat dependent on technique and some of the older school techniques are notorious for those because facelifting started with just cutting and pulling skin and then it went to some slightly more, slightly deeper, but still superficial layers. And now we're just in a whole different avenue of, in a pretty rapid evolution. And even over the past, call it five or six years and how facelifts are being performed. So would those faceless of the past not happen any longer?

They still happen now. It's in transition, I would say, based off of training, belief. And, you know, I can't take it away from somebody who does an older school technique. If they've done it tens of thousands of times and have good successful, happy patients, then so be it. Like, that's a successful measure. That's a good question. What makes a successful facelift? If it's when the patient's happy or is it when it could, it's the best facelift it could have ever been?

Those are different answers for different people, right? Like, what are you seeking? Are you seeking the best? Are you seeking something that's going to make you happy? So they still exist in evolution, but some of those telltale signs certainly still happen. Is this a technology thing that has changed or is it just a tech, pure technique? Yeah, great question. There's no tech difference here.

This is all technique driven, which is really actually that's an insightful question because I haven't thought about it quite that way, but this is all technique driven. People may be progressing different aspects of the procedures, everybody kind of adding their own things. And the way that teaching works now is more rapid. And this, I mean, we could apply this to anything. The way that seeing before and after photos works now is much more rapid. And so word spreads fast. Techniques spread faster.

They're more easily adopted. They're easier to communicate. You can see it on video. You can see results. So it's all technique driven, which is really cool. I'm noticing that some of the best facelifts are on younger patients. Yes, for sure. And there's this look that is almost effortless that I can't really

put my finger on that I see around the 30 to 45 year old mark. Are you seeing a lot of people want to facelift earlier? And do you think it's strategic? Yes. So you said one thing in there that's really important is that you recognize that it's better, but you can't put your finger on it. Yes. This is like my goal with every procedure that I do, which is heavily leveraged around how our brain interprets faces. You're not, you never even go into your analytical frontal cortex. It's all in the core of our brain and your emotional centers and your reward centers. It's attractive, trustworthiness, all these core elements, that's the goal, is to stay in those regions and have it be better, but you don't even know why. And eyes and mouths are really important

to that. And so a lot of times when people are talking about facelifts, there's actually an element of what happened with the eyes and the mouth that go into that, because as you can imagine, as humans, we're uniquely programmed to pay attention to eyes and mouths more because they're communicating emotion and quite literally our nonverbal communication, right? So people seek lifts younger now, partially because techniques have improved. and you can do them better at younger ages, partially for all of the other aspects of just understanding that you can do them younger,

seeing more of them via social media or media, whatever it may be. And then also just the shift in what the goal of the facelift is now. Facelift isn't for like old faces necessarily. My goal with any procedure is to, the thing that I want to hear my patient say is that, you know, I feel great, I'm pulling all the levers that I can pull with my health and my wellness and, you know, I'm very realistically, reasonably exercising and eating well. And now when I look in the mirror, it just doesn't quite look like how I feel.

Like something along those lines, that's like a really good sign for me that we're going to have a really successful procedure because I'm trying to rejuvenate, right? And even in your 40s, there's changes that can be rejuvenated. Now what's the best way to do that, right? Well, first you have to understand what changed and then kind of what we have to do to correct those things. Is it worth worth it for you? are you ready, right, at a young age?

Because you can only do so much. You don't want to overcook, right? You want it to be just subtle inbound, not be able to tell what happened. So there's some advantages of doing it younger like you're seeing, which is you don't need as much surgery to get it done. Like a lot of my younger patients, I'm using like a scarless facelift technique where I make a little access in their temple and I'm addressing their entire face without any incisions in front of their ear.

So the initiation hurdle to cross into doing that is less. And let me ask you this. If you do it at that age, does it buy you? you more time to not have to do more later. Because sometimes I will watch, and again, I have no judgment in the space, but I will hear some people when a young person talks about doing something, it's almost like they shame them. You're too young.

You shouldn't do that. Why are you thinking about way too? You're older. But when I hear that, I think, well, is this going to make it so that they don't have to do as much older? Because then it's like, this is a dumb way to look at it. It's much easier to build muscle when you're 13 to 20 years old than it is to be. build muscle when you're 30 to 40 and beyond.

And so I, but like, for my sons, I'm like, I'm gonna make them work out when they're young to build the foundation so that later it's easier for that. Does that make sense? Yeah, I think about it the same way and something like this. Absolutely. So the answer to that is yes. And I would say that what you just said

is one of the three main aspects of doing it younger is that you buy time, basically. What you do when you're younger will last longer because your tissue, your fat pads in your skin are as strong as they'll ever be. So when you put them to a new place, they're gonna stay there for longer, which is great.

You also need less surgery to get there. So you can do those different techniques I was talking about. You don't need to do as much these big open facelifting techniques. And then the third one is I'll get you to a better place or we will get you to a better place. If you get a facelift at 48, it will almost by definition be a better result than had you waited until you were 68, right? So there's all of these benefits to doing it earlier if it crosses that threshold for you a little bit. And I have patients who kind of have taken your approach where they did something little kind of early on. then they get to, you know, their 50s when they probably would have done the first thing they were going to do, and they just don't need as much.

It's like another little procedure later on. It's not to say that they'll never do anything again. It's not an indefinite situation. But if we can, like, keep you nice in line with your aging curve, it's you're always ahead of it at that point. So again, I'm not pushing young people to go get surgeries, but I guess if I was playing it out through a lifetime and at some point you're going to do it, from your perspective, do you think it's smarter to start younger as opposed to jumping and older? really case by case. Yeah, it's all to the individual value proposition. It's really fascinating when I see patients who come in at 45 years old, say, and they're,

they look pretty good. But to them, they're seeing like, oh, what there's definitely been a change, real change, no question about it when you look at before and after photo or before photos and where they're at now, but to, you know, me projecting my values, like, well, is it worth it to do right now, but I can't project my values on them, right? It's, they feel this dissonance, cognitive dissonance of friction, and they want some relief from it. I'll also see somebody who's 65 years old, severely aged, and they're coming in for the first time, just sort of crossed over that threshold. And in that each of those people, if you were to like switch their brains into their other bodies, they would have been in at very, very different times, right?

It's a very subjective experience of what's happening with the aging process. So can you like look at someone and tell them if they need a facelps? Like, can I ask you right now? Don't look at me. No, I want him to look at me. Do I need a facelift? A little juzh. I can look at someone and say, here are some things that could be improved.

And sometimes, honestly, they're so subtle. Like what for me? Do it live. Do it live? Yeah. Let me see. Turn sideways for me. You're in a great spot.

You've got some volume in your midface that's kind of keeping things cohesive. You're going to experience a little gravitational change there. You've got barely anything happened. in your neck. If you were to do something, you would fall into that category of, I would make an invisible access hidden in your temple. And I would just support what's happening around your eyes and around the edge of your cheek where things are just doing home. So you just do a little, it's a little tweak. It's a little baby tweak. And I have a couple questions. Yeah. In the hairline, I've heard that you can lose hair. Oh yeah. Yep. Is that true? Absolutely true. It's all,

it's very technique dependent, right? See you, Michael? What do you mean? If you do so, if you cut someone's hair line. If you make an incision in a hairbearing area, you've got to be exquisitely careful about not damaging the hair follicles that are there. So it's kind of a joke with my fellows, the people that I teach, every procedure is like goal, zero hair loss, not a single hair, not an eyelash, not an eyebrow, everything's protected. That's a selling point for me. So you do know that you're not going to lose a hair. You don't want to lose any hairs whatsoever, right?

You want to keep that. That's how it's very stealth that way. It's invisible. It's like not exaggerating. It can be very difficult to even find that incision when I'm, trying to down the road later. I go back and forth. I'm like, should I just like ride it till the wheels go off?

No, I don't think you're ready for anything. Or should I get something? But then again, I'm starting to see these guys and these articles. I don't pick on anyone individually where they get this hyperfeminized look. And we had Terry DeBrow on, friendly with the show. And he told me that I would look like a freak if I did something. He said, I would look too feminine. So now I'm like that.

What do you think? Well, so what I get this forehead to stop falling down? What you're describing? Then that you just nailed it actually. you're describing when guys tend to get hyperfeminized, it has a lot to do with their upper eyelids and the volume of their upper eyelids. Yeah. And celebrities have an unfair version of this walking around because we can all like put fingers on male celebrities that have had this done and they look maybe more feminized. And I give them a little grace because most of us aren't

walking around with our before and after photos next to us. And if we were, we could all be critiquing. But they, everybody has their before photo ingrained in their head. And so, I've done a show for the last 10 years twice a week for 10 years straight. People so people would know. But you just know that a lot of times, and this is a, I think a PSA with anybody who's considering an eyelid surgery. And I'm going to say this out is that's almost never. I don't want to say never, but almost never an isolated situation where you should just be getting an eyelid surgery. How? Because it's a fixation point and a lot of what's happening is coming from forehead scalp and it's sinking down. And there's some width differences between the top of our head and our lower head,

and as it sinks down, it bunches and creates crowding, which is a little bit of what guys often get. So it's little to do with their eyelid and a lot more do with what's happening in their forehead and their brow. And so a minor amount of support there can go a long way and oftentimes mean no eyelid surgery. Well, you know, for me, when I was younger,

used to box and just get hurt sometimes and I've had like stitches here and there and here. And so I'm like, oh, my God. How are we on our show and talking about you? I have questions about myself. Because I also want to know, for the guys out there, it's like, well, for me, it's like, it's like, I'm like, I don't know. Like, I do feel like I have a hooded, heavy brow with also some damage, but then I see that.

I'm like, well, maybe I'll just leave it alone. Yeah. Well, you're allowed to have either way. I mean, whatever you want, the lines that guys get in our forehead forehead. Often tell, they tell a story. We get them because we're functionally trying to lift our brows up because we have heavy brows. It's not because we're animated or we look surprised. It's literally a functional, a functional outcome.

You can tell, well, you have forehead lines. You're using that muscle. And so we're trying to basically let your forehead relax a little bit so that the muscle doesn't have to work so hard. It's kind of back in its normal place. And that should never be feminizing for a guy to do that. Are there things that you think are good ideas for men to consider, to look into? Yeah.

Yeah. So, guys, my male patients, it's very eye-directed, usually. Because we can move the needle so much with very little changes around the eye. You look better, but I don't know what happened type of thing. And you can maintain masculinity and all. those things. You know, I, like, compete in combat sports as well, so I can relate to, like, the scar tissue that you get built up and things like that. So we want to, like, keep all those things that make you uniquely, Michael, who you are, and give a little support. Because if I

look at that photo from you when you started the show 10 years ago, there was a difference, right? So that's what we're shooting for, is that right there. And that can, if it's, if it's like a simple, super minimally invasive process to make that happen in a durable way that doesn't have this indefinite maintenance to it forever, that tends to be very attractive to guys is that. And then with that, if you were to do that, I would also be like, okay, while you're here, let's make your skin strong and let's add a little volume back to your fat pads with some fat transfer that's stem cell rich. And that's a very common male plan right there. Somebody hears that I'm hiking in Cortalane. Yeah.

Don't look too deep into it. At the retreat. Yeah. I was told that you should not get a facelift if you are going to get pregnant. And this is the theory. They said when you gain weight and if you get a facelift, And then when you lose a bunch of weight, it fucks with the face lift. Yeah.

There's. Is this true? There's more to it than even just the weight fluctuations. There's the hormonal shifts in fluctuations. There's the stress signaling, cortisol. And this is applicable to any stressful situations, losing a partner, getting divorced, having kids, going through menopause or perimenopausal phase. Ozzympic. Great one right there.

You know, two of my patients last week were in their early 40s, 40 and 42 years old, which is, that's young. That's definitely a sampling error on the young end. But one of them, one of her factors related to having started a GLP1 and she lost a fair amount of weight and noticed that as like a significant trigger of her like early aging changes. And when they get these facelifts, are they obsessed right away? Is there a thing where they're like, I wish we went tighter? You know how when some people get their boobs done? They're like, I wish I went bigger. Like, do you see that sort of like remorse later on?

So it's interesting because you, such a good point. My practice is very rejuvenative, which means I'm like looking at the picture of you from the past and that's our goal. Okay. Nothing. I'm not changing anything from what you were prior. Got it. Versus everybody thinks of any type of plastic surgery is transformative. We're going to, I want to look like this.

I want to change this thing. I want my breast to be bigger, my lips to be bigger. Even orthonathic surgery, like a double jaw surgery is a little bit transformative in a way, right? When you like, it's different than it was ever. We transformed your face. Yeah. I had double jaw surgery. Yeah.

Yeah. Exactly. And so that's like you felt that. It's like a different experience when you're like, okay, you have to get used to that a little bit more. Yes. It's an identity. Fuck. It's a night. Yes. Right. And and neuroanatomically, it is literally that because you've been, you've become accustomed to your identity in the mirror and it changes. And there's no question about that. That's what happened to me. Your sense of self. What is that called? It's it. Well, it's just your, we have this area of our brain called the fusiform face area that just lights up when we see a face, including our own. interestingly. And even just that right there saying that a region of our brain is dedicated solely to facial recognition just kind of tells the importance of every, it gives me pause with everything that I do. Like this is going to be so finely analyzed by everybody's brain because it lights up. And then from there, that goes to our sense of identity and who other people

are. Are they beautiful? Do I trust them? Do I want to mate with them? Should I make a memory about this? Like all, then you even kind of described it. Oftentimes when we talk about faces, including our own, we describe it with an emotion more than something analytical, like tired or sad. That's our amygdala, the emotional part of our brain that's getting activated by this, you know, face area looking. And so when you change your identity, it messes with your brain. This happens in my world when people have an eye surgery and their eye shape changes inadvertently. And they, even just this little millimeter change, and they are emotionally distraught from that. And so I'd fix that a lot, actually.

And I have to be empathetic to that emotional change, understanding that they're not controlling that. It's not, they didn't make that choice. It is the most, I cannot explain it if you've never been through it. Right. Looking in the mirror and not recognizing yourself is one of the most traumatic things I've ever been through. It is such a mind fuck. And I feel so bad for anyone that's had this.

It's really hard. It's really fucks with you. When you look back at it now, how is that, is it adapted? Is it all good or do you still have elements of that? I'm so happy I did the surgery, but I had to go through a lot of things to get to the other side. Does that make sense? Like I'm so happy I did it and I'm like I wouldn't change it for the world and I would do it again if I had to. But I mean like for her and that surgery, I mean like that was going to go off the cliff fast.

I'm just like a sleeping perspective. She couldn't breathe very well. It sounds like I was sleeping next to a chain saw. I couldn't sleep very well. I was like, that was like a actual like corrective procedure. But that's the identity crisis and it is not for the week. Right. And let me tell you, he has like an eyebrow hair that's too long and I have to hear about it for two weeks.

He would fucking, you would lose your goddamn shit if you had an identity crisis like me. You would be so annoying. I would have to put you in a mental institution. Yeah. I mean, that's why like anytime so like I, when you were talking about just like getting back to your young. younger self, that resonates with me. But then there's, I know there's other people that go and they like, their ambition is to literally change their face and change the way, like I would not.

That's not your. No, no, no, that would drop. You're not taking that. That would make me. Absolutely not. And listen, I understand why maybe somebody would do that, but that would make me nuts. Yeah. I think that in my opinion, exactly what you're describing is that should be led by function

and then the form will follow. Form follows function, right? And so that's what you're describing with your orthonathic double jaw surgery. You did it for the function and then the form changed with it. to just change form for no reason other than to change it. That's just not my world, right? And with people that inquire that reach out, about 20% of them, once I've engaged,

I'll kind of say yes to, like thumbs up. Yeah, like we're good candidates. I like, we'd work well together, let's move forward together. But there's a significant percentage of people that I've just, oh, you're not a good candidate or maybe we wouldn't work that well together. And it's just sort of like.

So what makes a candidate you say no to? Sounds like it's a good percentage. Like what you just described is, like immediate, you know, like if they're sending me a photo of something they want to look like that's not them or that's an immediate, no. And then, you know, thankfully at the point I'm out in my career, I get to choose people that I'd want to work with forever. And so that's probably one of the biggest ones right now.

Now I have a selection bias of people that are, you know, relatively like high performers, however we want to define that. They are, they're working. They're doing the things. They're hustling in their craft and they're taking care of their family and, you know, just all kinds of great things going on. They're not people who are like behind in every other aspect of their life and then they're trying to do this. So that's great. That's like beautiful, like a beautiful sample of people to work with.

And then after that it just gets like, do I want to work with this person forever? A lot of people, I'm sure, that come to you too. You have to say no to because it's actually a foundation problem with the jaw. Right? Do you know what I mean? Absolutely. Like they need to go, they need to go maybe have double jaw surgery first. Does that make sense or no?

Who would you say, like say it's a fit. and you like the person, like, and you would want to work. Like, what are things you say no to is like, hey, you don't need the surgery. You have a foundational problem. You have something that I can't fix. Like, what are those cases looking like? If it's someone that I'm like, oh, you're awesome, let's do this. You know, then it's like, well, what are your expectations?

What can we actually do? And, you know, I generally don't have somebody who's like, I want an eyelid surgery because that we got to talk through that. It's like, I am bothered by my eyelids. Kind of like you just said, well, it's not your eyelids. It's your brow. And so, and one of your eyes is smaller. the other one. So let's make sure your eyes are the same size. That's a huge signal.

Is that true? Which one? Not you. I'm just saying like almost everybody. If you really look closely, there's significant asymmetry. If you look at a photograph, if they have a glass of wine, if they're tired, one eye will drop. It's called tosis, this funny drooping word. But we look for those things. And okay, let's make all of these little neuroanatomical cues because I'm looking at, how are these going to play into when people are interpreting your face? Your interface with the world, how is this going to be interpreted? And so we kind of go through that. And if we're not on the same page or doesn't kind of like juice isn't worth the squeeze, then we may not do that type of thing. But I don't compromise basically from what a comprehensive natural plan would be, something

that's going to be a great result, but you can't put your finger on what happened. You don't even know. It's like, this looks better, but I don't know why. That's what I want. It's a real effortless flick of the wrist situation. Right. And without the before and afters, you would never know, you know. You have been called the fat connoisseur.

I do love fat. You love fat. You like to put it in the face. Yeah, I do like to put fat in the face. It doesn't move around? No, good question. I'm scared of it for some reason in my face. And that's a totally valid concern. Dismiss all my mess. Well, I mean, the reason that people think it would move around in the face is because

it often gets directly compared with filler, like halaronic acid fillers, that do move around in the face. And fat is different because fat, the connoisseur thing is, you know, I'm borrowing fat from parts of your body. Usually your abdomen, your thighs, your flanks, somewhere like. that. And then I'm taking that fat and I'm putting it inside of your facial fat pads, which is a beautiful like for like. You lose facial fat. We replace it with your actual fat. There's also a nice regenerative component to that. Regenerative medicine is not the be all end all. It's not like

this miracle, but it's helpful from a quality standpoint. And so when I take the fat out, the common thing would be take it out, put it in. Okay. I take it out. I isolate a stem cell dense portion of it. So it takes a little bit of extra time. I mean, I'm like nerdy. I'm like putting this under or red light before I use it to activate the stem cells. And then I'm putting in a smaller amount than I took out. So if I take out 40 cc's, I might only use 10 of them or something like that, right? So very high quality, low quantity type of rejuvenation. And I'm putting it inside the fat pads to make them stronger, to add a little bit of volume

back to them. But once those fat cells go inside the fat pad, the only way they can survive is by establishing a blood supply. That's what the stem cells actually orchestrate, this whole creation of new blood vessels. If it doesn't establish a blood supply, it will die. So some of the fat doesn't live, a small percentage of it doesn't live. But once it's established a blood supply, I can't move, right? So this is the anti-migration or movement is once it's set up, if it moves, it's lost

its blood supply, it will die. It's a different process than filler. Do I need fat in my face? Where would you put fat in my face? So in my younger, healthier, already doing really great with their volume patients, fat will often be part of a transition away from filler. Whereas we're like removing or moving or filler starts to degrade, we're starting to swap it with fat, which is, in my opinion, just a better long-term play. Because even if we look back 10 years ago, the mindset around filler has

changed drastically to now. And so we're using fat to actually go restore the fat pads. It has a benefit on your skin surface by adding it to your fat pads, by the way that the stem cells communicate. And so for you, like, you're not lacking volume, right? So if I, but if I get filler in my lips, which I do, you would suggest stop the filler in the lips. Let's do fat. Well, filler in your lips is a bit of a different story because it's usually more generally, it's more transformational than it is rejuvenative. You know, it's like getting a breast implant, right? It's like, okay, changing it from one size to another, you know, in a subtle way sometimes, but it's generally not as rejuvenative. So fat transfer in the lips is mildly effective to create extra volume. It's not

going to make your lips big doing fat. So if you get filler, you like the way that that looks in your lips, that's probably your answer. It's just understanding that the filler that you got a year ago in your lips is not gone. The filler that you got five years ago in your lips is also not gone. The filler that you got maybe 10 or 20 years. This was my 42-year-old patient this week who had filler one time 20 years ago. And you saw it. And I was removing filler during her surgery. So you had to remove the filler in the lips? No. And so hers was in her cheeks, lower lids. But yeah, in the lips, it's doing the same thing, right? So you remove it and then you put the fat on top? Yeah, you kind of remove it and replace with fat. So would you tell me to stop getting filler and do it in the lips or no?

This is a very opinion driven thing, right? So I... What's your opinion? Well, I'm looking at this to the lens of a surgeon where I'm in, literally in the face all the time. Yeah. And fillers in my face all the time. You know, I'll be working in areas and it's just like, I'm just filler on filler on filler sometimes. 90% of people that I do surgery on, I'm removing filler as part of their procedure. And that's just the nature of how it is. And there's a bunch of interesting, like, behavioral patterns and cognitive biases that lead to wanting to get filler. It all makes sense. You know, if we really want to break down, like, the decision making that goes into getting it. So it's not bad in and of itself at all.

I just think that there's a very outdated mindset with how it's used, which hinges on how long it lasts. Like you need to get it every year. That's not true. Like we know that the filler from last year is not gone. It lasts decades in reality, which is a really important thing to understand when you're using it. Like are people getting distorted when they get filler and then they're like,

wait, I need to go back and get filler in a year, they still have the filler. Wait, but hold on for the dumb guy in the conversation, me. Does this mean somebody 10 years ago got filler? They assume it's gone, it's dissolved, it's out of their face. You're saying it's still in there. It's still lingering on, but likely it's not holding the same form. Yeah, exactly. It breaks down, it moves around a little bit.

It may not be doing the same, having the same effect that it had before. What about like a Botox? Is that same? Different with Botox, actually. Botox is a protein that gets degraded and taken away versus the fillers are meant to last a while. They're cross-length in a way to keep them present. And so you're exactly right. Yeah, it's still there.

And then you start adding on top. on top. The thing that we're finding now at in decades of use with it is that as they break down, their properties change, they attract a little bit more water. So you may have got, if we were to look at MRI studies of somebody's face, you got 12 syringes of filler in your life. And now you've got 24 ccs of stuck water, you know, around. Because you can't hold it for that long. Exactly. Yep. It just sits around it. And so it actually can balloon up a little bit over time. If I wanted to get fat in my lips instead of filler, do you have to be put out completely? because that feels overwhelming to me.

Yeah, not necessarily. And again, I think back to that, like, you probably wouldn't swap fat into your lips. That's probably not your, if, you know, sort of the look of like a larger, more sculpted lip is what we're after, then that's actually not your best option for that. Got it. Fat does better with, like, a more qualitative structural change.

I tell people it's like, you know, redoing the foundation on your house. It's not sexy. It's really functional to do it that way, but it's not sexy to change to, nobody can sometimes even tell that you changed your foundation, but your house is stronger. And filler can be a bit more like redesigning the room. You can make it look completely different. And it doesn't really do anything for the long-term substance, especially if you, like,

paint the room pink. It can be like really overwhelming. But it doesn't change that sort of long-term, like the way that that structure will age. So where is your favorite place to remove the filler and put the fat? The most common area that I'm doing it is in the cheeks and the lower lids. Sometimes the jaw line, then especially around the eyes. Does it look good? Yeah.

Oh, yeah. It looks good. I mean, this is where the before and after photos kind of show everything. When you're like, okay, I love this. The person looks so much better. I don't exactly know what happened. And that's the goal because sometimes a bunch of little things happen. So it makes it impossible to see.

But the other goal after that is to remove this. And this is one of the luxuries of doing this. It's like once it's done, this like indefinite maintenance of like having to touch things up all the time. or always do this, we've removed that, like, that space from your brain. You don't, it's done. This is solid. Even if you lose weight from your face? Well, I mean, yeah, if you start smoking cigarettes, lose weight, start sunbathing.

It's got to be different. Things will change faster, but you'll be changing from a better, stronger baseline, you know. So you'll always be ahead of the curve from where you would have been, you know, natural progression. What's a secret that celebrities are doing that none of us know? Like, for instance, I heard through the grapevine that there's some rib removal going on. Yeah. That's like extreme and in the body. We can, we'll do that on a different episode. I don't believe that. Is that really, I don't believe it. Yeah, it is. Like rib removal is the thing. This is one of those. This is what I would challenge everybody with as well is. That's one of those where you see, and I've seen these before. This is not my world. I don't do this. So I can be very much a consumer in this space. When I look at the before and afters, I'm like, that is different. But is it better. It's otherworldly. Other world. It looks like alien. And that's, and that's why what I loved how you described the before and afters that you really like, because you're like. It's better, but I can't even tell what's different.

That's what I like. I like effortless. So what's something to the face that's like crazy that you're hearing behind the scenes that no one knows about? I mean, there's so many, there's been trends of this happening and then they emerge coming out, like buckle fat removal. Okay. I know you've talked about that on here before with this like cutting that out. I don't believe in removing things from the face generally. I like to put them back where they came from.

So I actually lift the buckle fat pad when it's sinking. So you're fixing all these people are getting it removed and you're putting the fat back. Yeah. And you got to replace that. And, you know, what can you not fix? There's a lot of things that you can't fully fix, but you're trying to fix them to degrees. And that would be like really significant tissue damage and scarring from maybe prior procedures. You know, like an example of somebody does like a device on their neck that causes loss of fat in the deep structure.

They're trying to get a non-surgical face. This happens to me. It's happened to me this week. They try to get a non-surgical facelift because they're young and they're promised that, you don't need, you're too young for a facelift, you need this thing instead. And they get this really high energy device on their neck, which is the wrong kind of thought paradigm at the beginning. And it cooks their neck, essentially, and it binds everything together.

And then when I go to do the thing that they definitively needed someday, everything is like quite literally melted together or glued together. There's lots of different ways we describe it. And I can't really undo that. I can't regenerate those lost fat cells and the way the muscle stuck to the skin now. But everything's supposed to be in these beautiful glide things. planes. Our face is meant to move, really. And so when things get stuck together in those ways sometimes, those are things that 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 herself some Dr. Levine. What is that been like for your profession? Yeah, it's interesting. 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 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 were 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. She nipped that in the bud. Right. None of those things were true. So there's a lot of, I don't know, just jealousy maybe that goes into some of these situations as well. You know, some of my best, best friends in this world are, you know, highly visible in the

patients that they work on too. 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 their folks. 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. Anyone 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 Chris 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. Yeah. 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. Exactly. And so it's become like this hush, hush thing. To 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. That's my opinion. Normalizes it. Yeah. And even her 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. Yeah. 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, are 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 like the practice I have couldn't exist without social media. So love it or hate it.

Like I'm very grateful for what it. Like my practice is based off before and after photos. That'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 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? Because once in my world, once we've worked together, we are forever enmeshed to some degree. And 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.

And then you want to get into like safety and, you know, what they're, you can look at their reviews. So you all like just kind of dig a little bit at that point. But, 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, iranose and throat. I came from dermatology into it. And in the middle,

we all sort of meet with this like subspecialty fellowship training, um, 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. And 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 browlift 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 feather out those little nuances of details.

You don't want to get to some guys like, well, this is going to be the first one I ever done of this thing. Right, yeah, yeah. 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'd never know. Okay. Is there someone that you've seen that you just made? Well, let's say that you think they have a good facelift. Oh, man.

Let's see. Who would we know? Like Chris Jenner. Okay. So you'd already brought that up. Okay. One of Chris 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. And 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 Chris Jenner had two.

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. facelift. Do you know what I mean? Strong structure. Yeah, exactly. She like, I mean, yeah. Gorgeous. And then so you do a facelift and it's like crem della cram. Yeah. And like you, and just to describe to the layperson'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 subsequent down the road soft tissue procedure, you've got a better foundation for it to be built upon for sure. Okay. So you do, you have to tell Michael about this, this situation that you do. You do an opiate free, benzoprary, neuroprotective anesthesia. Yes. Tell us about that. So, that's interesting. Yeah, this is just basically, and a lot of my practice is built this way. Everything is very, like, thoughtful and curated. Like everything has a reason from, you know, 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 yourself. Everything inside the day is very controlled. You know, I'm on like a

microplastic free operating room and EMF protected homes. And yeah. Oh my God, that's a selling point for me. Right. Well, this is my world, right? Like I could get into all the nuanced details of, you know, reducing inflammation in 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. I 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 hyperbaric's in 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 postoperative cognitive dysfunction, which is brain fog, basically. And I have to be careful talking about this in the anesthesia world because, let me just be very outright. Anesthesia is incredible. General anesthesia is a miracle of modern science and medicine that we can 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 just completely out. But that's an insult to your brain to some degree. It 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. 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 into 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. And as you said, like, your surgeon, if you ever have any kind of surgeon, 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, 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? So the experience is better. It's better for your brain. You're sleeping better. And then, you know, I just, it's, 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. So 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. One night I had a Herks 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, it was the whole thing. It was crazy.

So anyways, the Herks was anesthesia in my system that came out. Not like the actual anesthesia, but like you... No, she said the anesthesia was like in my fascia. This is what she said. No, she's saying the reaction that you had was your body like purging. Maybe the trauma, 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 she, I talked to her afterwards and she said the anesthesia gets held in the fascia. I swear to God, go look at it. But the way you're describing it is not the anesthesia, like the actual substance. It was just the trauma of the surgery. Yeah, 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. After you shit and puked yourself. I did not shit and puke myself. It's a purge. It's a purge. That's disgusting. It's sounded like a wild animal is dying in there.

I did it. But then she felt better afterwards. Yeah. I don't know. I was, I didn't feel very good. 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. It 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 like 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 see just don't feel.

Is 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 bupivocane 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. That is what you just said. So smart. More surgeons need to hear what you just said. That's very smart. Yeah. 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, but what about what's going on our bodies? We did an episode years ago where we learned all about the effects of what's going

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Just head to granola.a.ai slash skinny. That's granola.a.i slash skinny to get your time back. Get three months free at granola.a.coma 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? Yeah.

The most common thing that goes 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 sometimes I'll be drawing on them and explaining, and there are just some really fun personalities.

And I love those because people that are watching that are usually by definition very, very interested in working with me. That's why they're so deep in this like interpersonal journey. 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 10. So what are some beauty treatments that you're rating? Give us a couple. Oh, like fat transfer, laser, tightening devices.

What's tens? Sona, guasha, 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 or because they're like neutral to positive, usually positive, no chance of hurting. And then some things like, you know, like neck tightening devices, like minus 10, you know. What gets a 10 from you? Like laser resurfacing's, 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. If 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 facelps, it'll tighten everything up, run away. Don't walk. Get out of there. Did you like CO2? So I, so I. 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. Laser 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 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. Like 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 strip.

That's just how my mindset with it works. It's like, let's get this done. Yeah, you might have a touch of recovery. You're going to highly, you're, 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. I'll go in.

I'll go first because I'm less scared than you. I'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. As long as it makes sense. I guess I'm doing it for less reasons of vanity

and more reasons for like healthy aging along the way. Right? Like when I tell people about like, I'll just pick on hormone replace them. 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. Thank God you have me.

Can you imagine if you didn't have me, he'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 at the same way that I look at the gym or that I look at a sauna or that I look at skincare. 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 who. 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 looked like. Yeah. 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 up 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. 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-all messages. 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. The top still going to be. Exactly. And then the eyelid surgery only thing. I think that

that's really, that's changing for sure. I'm working really hard to change that mindset around that. And then again, when we talk about like fillers and devices and things like that, it's just sort of like using them for what they're good at and intended for and not as like a sole strategy in the long term. Are there things that this is my personal perspective. I'm not a face guy, but I personally believe that weightlifting actually helps keep your facial structure. Oh, for sure. And I say that to people sometimes and they look at me like, what does your lifting weights have to do with your face? But I believe that having muscle does that.

Absolutely. 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're going to talk about heat shock proteins, which are actually a damage-associated protein. We call them damps. These damage-associated molecular pathways, heat-chalk protein from a sauna, right?

That's going to change the way things work. Myokines get released when we live. lift weights, you know, and they're not related to damage as much as they are related to, like, sort of growth and regeneration. Like, okay, now I got to heal stronger. A myokine. There's your link to what you're talking about. It does your interface. Yeah. And then we have brain-derived neurotropic factor, which is something that's like 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. Are you single? No. No. Okay.

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 they, it'd be nice if you could also do my face. Well, I can't, Lauren. I mean, I could try. That would be, like, so amazing to be married to someone that could do your face and your neck

whenever you felt like you needed. I'll be like never done one of these before. I got a little bit of you. I got a little bit of... I would be so annoying. I don't know. My hands are more steady these days, but a little too shaky, I think, for that line of work. No, you don't have surgeon hands.

Where can everyone say hello to you, ask you questions, book you? I'm sure you're booked in advance. I'm just going to put that out there. Yeah. Instagram is my social where I'm the most active for sure. I 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 juge? 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 tea 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% are international and about 70% are from the U.S. And so that's our way to kind of make contact first.

You can send me photos and 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 we can start the whole virtual process from there. Every morning before coffee, I have my protein powder.

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Go to shopskinicconfidential.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. I mean, you've got the cupping marks. Go watch the YouTube. 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 and 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 is 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 to 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. I have, like, a

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 got into experiences, 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 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 same chambers my patients use. And 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 often. 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 so it's a long time. Wow. And then this is why I only do one procedure a day. And then that's a long procedure. This is the one that nobody talks about with 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

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 and a, 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. You know, it's funny. 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 it would be to talk on a mic, but like, I just got back from. I mean, I think you, I did, yeah.

I was going to, because I went to look at your stuff, 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 like we think about it the same way it's like we're recovering prepping working out being calm and then like then you're able to go but i think like a lot of people they talk about burnout on this show where people was like 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 and she's young so maybe she doesn't figure it out she's like what do you do to avoid burnout she's like

I just have another coffee. I'm like, it's not going to work for that long. Yeah, probably the opposite. That's going to catch up for you. Yeah. But no, we think about it in the same way where it's like you know what's coming down the pipeline and you have to prepare for it in advance. Yeah, and you got it's pre-covering.

You're basically described what I call like pre-covering. You're like you're ready before the stress happens, basically. And that super applies to patients too, right? Because they have their pre-then-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 than a focal recovery.

There's 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 a, it can lead to burn. I can take a toll on your life. Yeah, no, for sure. That'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 podcasts, no way. Yeah. Like I got a step back. I got a recharge. I got a sauna. I got a cold plunge. Yeah. 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. I can't believe this. You've been thinking about what that's going to feel like. Well, and you guys, you learn how to get yourself into that state because you've done

this for 10 years. You 100% know how to get into it. At first, if you, I'll bet 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 because time flies, you have no concept of it. performance goes up. It's a lot of energy is going into it.

Your brain's consuming more glucose or ketones. It's another thing. I use ketones before surgery to help that process. 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, and surgery is probably more what 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 time I'm doing it. You don't dance on TikTok. Yeah. No, no. I much to my social media team's chagrin, not a dancer on social media. They 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 where they are. I don't know. I don't know where 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. I'd have to leave that opportunity on the table. Good for you. For you that point in career. Normally when Michael's talking to me when I'm in my flow state, I'm like I'm over stimulated. 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 it throughout the office. Yeah. Well, seriously. Because like, this could have waited until 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 about it. My favorites when I'm walking into a podcast and someone's like, hey, can I pick

your brain? I'm like, I got to 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 now. This episode is so good for me at this moment. Wow. You know what I equated to? It's kind of like, and again, like not throwing shade here. You know when you're in a restaurant and you never. 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, oh my God.

It's like that. Couldn't pick the worst time. The worst time in the restaurant. Yeah, read the room. And read the room. Read 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. Yeah, see next week. Thanks for having me.