How To Avoid Botched Facial Plastic Surgery, Do Red Light Masks Actually Work?, Opioid-Free Surgical Recovery, & More With Dr. Cameron Chesnut.

My name is Ben Greenfield, and on this episode of the Ben Greenfield Life podcast, the most common thing I hear from my patients is, I just want to look how I feel. That's back to this rejuvenated thing, right? I want— they want to look how they feel, and they feel like there's a mismatch. Well, nobody wants a mismatch with how they feel and what they see in the mirror, right? And if we can do these little small things to make them make that match up better, they look better and they feel better too. So it's like this chicken or the egg thing a little bit. But when you're working with somebody who's, you know, really motivated and on this sort of health journey you know, they're gonna experience some normal aging changes and they're— it's not going to feel right to them. So I'm able to kind of put those together a little bit. And that's, you know, that's been a big evolution in my practice of just understanding that like this is more powerful. It's the mind-body connection. Not to sound cliché, but it's true and it's real and it applies to how you look too.

Fitness, nutrition, biohacking, longevity, life optimization, spirituality, and a whole lot more. Welcome to the Ben Greenfield Life Show.

Are you ready to hack your life? Let's do this. My guest on today's show is surely in a flow state.

Oh, so much, so far.

He is a flow state expert more so than I even realized the first 2 times I interviewed him. His name is Dr. Cameron Chestnut. And here's the deal, I've interviewed Cameron twice now by my rough count. And if you don't know who Dr. Chestnut is, then you should you should definitely listen to our first two shows. I will link to those and also everything Cameron and I talk about if you go to bengreenfieldlife.com/Cameron3, like bengreenfieldlife.com/Cameron, the number 3. We're sitting at his clinic. I never know whether to call like a medical spa or dermatology or cosmetic clinic or what do you even call—

You know, this is like the functional medicine portion of our practice that's built as a supplement to my surgical practice. This was born out of the recovery for my patients post-surgically, like all the modalities and things that we have down here. This is how this came to be.

So if I'm sitting next to you on an airplane and you've got like a minute, I'm about to get off the airplane because I'm the asshole, waited until we were just about to deboard to ask you what you do, or on an elevator, uh, how do you describe to people what you actually do?

Um, you know, I just kind of give the basic rundown. I'm a facial plastic surgeon. You know, I practice here in the, you know, Northwest, and my practice is based off people who travel here to visit. So the space that we're sitting is where my patients spend a lot of their time when they're visiting, doing their recovery modalities. We have a patient right next door in the hyperbaric chamber as we're recording this podcast. And, I just do facial plastic surgery a little bit different than most of my contemporaries do.

What do you mean different?

Well, I just kind of take a little bit of a different intellectual curiosity and approach to it. I did dermatology before I did facial plastics, and so I have sort of that background there. I have this background as an athlete that I like to integrate into what I'm doing with my preparation, my intraoperative protocols and even my recovery for myself and my patients actually. And so, putting all those things together just creates this little intellectual curiosity, I would say, about— and skepticism, healthy mixed together about like, "Well, what works? What can we do a little bit different? How can we make things sort of better? How can we pick the low-hanging fruit?" Basically, how do we apply the Pareto principle, the 80/20 rule to our procedures and kind of get the most we can out of it with as little input as possible?

I'm a total dummy when it comes to this stuff, so I apologize if I ask stupid questions. You said dermatology and facial plastics.

What's the difference between those? Yeah. So, dermatology is just one specialty of medicine that you can go into. And so, I did my initial training in dermatology, got my board certification, then did subsequent and further training into facial plastic surgery.

Dermatology is just like these are weird growths on my skin, doctor, tell me what this is.

Sure. It's just all manifestations of skin, hair, and nails basically. And so, in skin or in dermatology, there's a lot of treatments for skin cancers, which is a lot of skin cancer removal, reconstructive surgery on the face primarily. And so, there is this whole surgical aspect of dermatology. And, I took it sort of a step further with additional training into facial plastic surgery. And, plastic just comes from a Greek root that just means kind of to change the form of something, right? And so, if you have a hole in your face from a skin cancer and you fix that, that is plastic surgery in a way. You're changing the form of that afterwards.

So, for somebody listening in who's the extreme orthorexic biohacker who's been reading a lot about microplastics, facial plastics doesn't mean you're actually getting plastics There is zero plastic involved in my practice.

That's good.

I wouldn't have known that. So it's more like the term— like, we hear neuroplasticity.

It doesn't mean exactly you can change the— yep, exactly.

Okay. And then you're also an athlete. So background that you and I talked about before in our other shows, like, we used to go head-to-head in Ironman.

Absolutely.

Triathlon. You have the poster on the wall here that people probably can't see because it's out of perspective on the camera, but that's you like wake That's called wakeboarding?

That's just straight surfing right there. That's ocean surfing.

Oh, that's ocean surfing. Yeah. Okay. And, you played football for WSU.

Yeah, played golf at WSU.

Played golf. So, two-sport collegiate athlete.

Yep, yep.

And, you competed in Kona and Ironman, right?

And, I competed in Kona and Ironman. And now, I'm a competitive jiu-jitsu athlete and I play pickleball. I'm a dad at this point in my life. My craft is my passion and I love to be active and competitive with other outlets. There it is.

Are you doing new— because I want to talk more about athleticism and the crossover between that and a highly specific and high-stress practice like you operate in. For sure. But are you doing new things at the clinic since the last time that we talked? Like, in the, in the field of cosmetics, are there new cool protocols that, right, you guys have introduced?

Yeah, one thing that I've really been working on hard, um, in the past— well, my whole career, but especially really come to fruition in the past couple of years— is just these more minimally invasive ways, minimal access ways to sort of lift and elevate sagging facial soft tissues. And, the facelift, let's just call that the quintessential facial plastic surgery procedure. To clarify, my practice is very, very cosmetically oriented. All my procedures are cosmetic in nature for the most part.

Does that mean that you're not getting burn victims and more just like— sorry to stereotype, rich Stepford wives who want to come in and look prettier or actors or celebrities?

Sure. Yeah, that would be more along the lines of what I'm doing. Just, you know, it's facial rejuvenation. And, I don't do— and if you divide it down even further, there would be transformational plastic surgery where you're kind of maybe trying to achieve something you never had. I would say rhinoplasty, nose jobs fit into that for me. And, I don't do those because that is kind of taking the nose that you have and changing it to something totally different. My practice is very much different than that in the sense of you are just aging and we are kind of rejuvenating those aging tissues a little bit. Sometimes that's elevating them, like putting them back to a different place anatomically. Sometimes it's qualitatively adjusting them. You've lost collagen, you've lost elastin, you've lost fat volume, and we're changing those types of things with it. So, that would be more of this rejuvenative pathway of facial plastic surgery. Facial rejuvenation, Ben, would be something transformational like We're giving you something you never ever ever had before.

How would you— like, what would be an example though? Like, if I've got bags under my eyes, I've got like droopy, I don't know, like skin around my mouth or double chin, like what do you actually do?

You're 52 years old, you're super beautiful, you have been your whole life, showstopper. Yeah, walking in the room, everybody stops to look at you. And but you're starting to notice like, well, I'm getting like this loose sort of skin and these bags under my eyes, and my upper lids droop a little bit more than they used to, and one of my eyes they look a little bit different, they're asymmetrical. This one's now like a little bit droopier, especially at night or in the morning or when I take a photo or something like that. And it just looks a little bit different. Now I'm starting to notice like along my jawline it's getting a little bit lax, and I've got this laxity in my neck, and those types of changes that come along. That's my jam, that's my practice, that's my world. You come see me and we say, okay, well, let's like put all these things together and let's find this like super minimally invasive way that we can go rejuvenate these things that are bugging you super simply. And just kind of turn back the clock a little bit.

You ever stand at the grocery store or go somewhere and just see a botched job, like somebody got a bad plastic surgery done?

Yeah, this is my life, unfortunately. Very much, and I don't try to pay that much attention to it, but at this point in my career, so much of my practice is revision surgery. So, most of my patients, greater than 50%, well over, are coming to me after they had that botched job somewhere else and I'm fixing it. And, that's just a— I take that challenge on. I kind of like it. It is way more challenging. It's way more unknown. But, our brain kind of loves that uncertainty, that novelty, that our brain loves maybe, right? So, it gets a little addicting in a way. You get the dopamine, the norepinephrine, the epi release when you're doing these cases like, "I don't even know what I'm going to find when I get in there," type of things. And, that happens all the time basically. That would be the bad job. Sometimes people had a prior surgery and they just— I just had this the other day with a guy who came from Argentina and he had a 7 out of 10 result. You got a surgery and he's like, "It's okay. It's pretty good. It's like a 7 out of 10," but he wants the 9 or the 10 out of 10. And so, that's my life is also kind of filling in those gaps to get to that point.

What is the procedure? I'm only asking because I have 2 friends now, possibly a third soon who have done a procedure with you and they look like absolute shit afterwards. Their face is all swollen.

You're talking in the first week they look like that, right?

Well, yeah, the first week. It's like scary. What is that procedure? Why would somebody do that? Yeah.

Most of what you're seeing there interestingly has nothing to do with the surgical procedure that was performed and it has to do with this laser cocktail, this laser resurfacing that I do at the end, right? So, I've done all the surgery, everything's all done, and then the very end qualitatively, our skin quality, no surgery really changes that, right? You can adjust position and where it's living and how much of it there is, but you can't change the composition of it unless I do something like a laser. And, in that sense, then I can actually change the collagen and the elastin composition of the skin. So, it's this very nonsurgical, ironically, very nonsurgical part of the procedure, but it's the last thing that I do generally and it causes swelling of the skin. And, you can see it on the skin surface. Most of the other stuff I do is so minimally invasive, it's deep down under. You can't really tell what was happening. Everything's buried and away and hidden, but this skin resurfacing at the end is what you see paired with the PRP or the growth factors that I'm injecting afterwards, paired with the long-acting nerve blocks that I do at the end of the procedure to avoid needing any opioid pain medicines. A big part of my life. Yeah, I don't use any during my anesthesia and I don't want to use any postoperatively, which is a whole other topic. But, I basically kind of swell them up a little bit at the end to utilize these sort of growth factors and this long-acting nerve block. And so, one of my fellows teased me, he's like, "You do all this work to get through a surgery that's so delicate and minimally invasive, it's such delicate tissue handling, and then to reduce swelling." And then, everything that we're doing in our space right here with our hyperbarics and our PEMF and all the light therapy that we're doing meant to make people heal faster, but the very last thing I do in surgery is really make them swell up bad.

How big of a difference those lasers make?

Oh my gosh, they're, um, it's interesting. Arguably, sometimes they're the most rejuvenative part of the whole procedure.

Really?

Yeah, absolutely.

Do those red light face masks work at all, do you think?

Well, you know, so this, like, this great question of photobiomodulation— red light definitely works, right? But not all red light's created equal. So that's one aspect of it. And then you got to think about what you're trying to do with these, um, regenerative modalities like a red light, I see it and it can improve your surgical recovery, number 1. It can slow your aging process. It undoubtedly has mitochondrial benefits. It makes our fibroblasts behave differently. Those are the cells that create that collagen and elastin that I mentioned with the laser. The issue is, is it going to reverse the aging that you have? Probably not. Can it pump the brakes on the process that we're all experiencing? Absolutely, 100%. That process is very internally driven by every sort of subsystem of our body, our sex hormone levels, it's driven by our internal inflammatory milieu. All these things change what's happening with our skin, and we can apply this nice external benefit with a red light and sort of like ease that process of aging a little bit. It's great for a social media pic. Oh yeah, and it's awesome. And I mean, I don't know if anybody's ever been in front of it, like, you just feel awesome too.

Oh yeah, I do it every day. I do the face every day. I do— I think I I said this in the last podcast, I do a clay mask and the red light once a week and I feel great. My skin feels great. The PRP and the growth factors, we actually talked about that in our last show, but obviously, there's a lot of other forms of so-called prolotherapy like stem cells, exosomes, et cetera. Are you using any of those type of things in addition to the PRP?

Yeah, absolutely. So, stem cells or fat-based stem cells for me are a big part of my practice. And, these are progenitor cells, right? They're coming from you.

So, when a patient comes in, you're doing autologous removal of their fat.

Right. Yep. And so, I'm doing that for my facial aging protocols because fat loss is some percentage of the aging change that we have in our face. We have multiple layers of fat pads. They're very intricately arranged and they lose volume, right? Not only do they lose volume, but they change their shape, direction, orientation. Lots of aspects of these fat pads change. You can think of how a breast changes with time, right? It changes shape, position, orientation, all these things. Well, our facial fat pads—

You have furniture disease. Your chest falls into your drawers.

Right. I've never heard that before. I like that. So, you get furniture disease on your face. And, I can use your fat that I harvest from you to rejuvenate the volumetric change in those fat pads, right? They've lost volume, I can replace the volume that's there. But, we also know that fat is a rich source of mesenchymal stem cells for us. And so, when I do that, I can isolate your fat to get the stem cell dense portion of it. I actually kind of just discard the rest of it, throw it away. And so, I'm basically selecting or choosing that fat that I'm rejuvenating your face with. So, you get the volumetric, just the actual extra fat in your face, plus you get all of the paracrine effects from the growth factor secretion of those progenitor stem cells. And, the stem cells in our fat aren't just fat precursors, which are called adipocytes. Some of them are vascular precursors too, these stromal cells, pericytes that make new blood vessels, which when I put new fat in your face, it needs a blood supply. So, brilliantly, we can create new blood vessels via this process called angioneogenesis, and the progenitor cells in the fat help that process so that fat stays better, it lives longer, and it rejuvenates the surrounding tissues via that paracrine growth factor secretion, which comes in exosomes.

We talked about, um, a lot about hair loss and growing hair in the last show. I think you told me, like, if you do a follicular transfer, you could even use, like, your pubes for follicular transfer. I think you said that.

Suboptimal. You can use body— you can use body hair.

So it begs the question, where are you getting the fat from for this?

Yeah, good question. So just to go into that, if you're using body hair for your hair transplant, you are reaching, right? It's there, but you're reaching.

You mean normally you take it from some other place on the head?

Yeah, usually it's the back of the head when we do that because we have an abundance back there. But, when we're taking fat, this is a super good question, probably one of my most common fat transfer questions that I get from patients is, "Where does the fat come from?" And generally, we're choosing— Right. Yeah. Generally, we're choosing around your belly button, your flanks, or for women especially, your medial thigh area. We know we have a really great stem cell density there. Those areas are relatively easy to access. It tends to be stubborn fat for people anyway. And interestingly, you just mentioned that liposuction. When I'm doing that, my goal is actually to leave absolutely no trace that I was there. This is not a body contouring procedure. And for reference, like a plastic surgeon who's a body plastic surgeon that goes through liposuction, they might take 3,000 cc of fat or 5, like huge amounts, thousands of cc. I'm taking like tens of cc, so a couple orders of magnitude less than that.

Yeah, that can be like one syringe.

Right. Well, yeah. And I would average on take 40, 60, 80, 100 would be really big. But of that, I may be only using 10 or 30. I'm basically selecting and then putting the rest away.

Is that all same day for that fat withdrawal procedure? Because you obviously can't even legally expand it, but do you actually take it out the same day? And is it spun to separate the stem cells?

Yeah, exactly. In the United States, for stem cells or progenitor cells as we draw them out, they have to be from you, autologous, right? They have to be like for like. They have to be used for homologous use, they call it. So, in this case, we're replacing lost fat, with lost fat, and they have to be minimally manipulated, right? So minimal manipulation can be like changing the size, cutting them up, centrifuging them. That's what we're doing with that. So I'm using the density gradient in a centrifuge to select the younger, more dense stem cells away from the more mature, older fat cells that I don't want. And that's how I'm getting my, you know, fats. Then I size it from there. Yeah.

And I could be wrong, but I think according to the FDA, if you were to expand it, you're considered to be like a pharmaceutical manufacturer, right? You're making medicine.

Yeah, essentially. And you can do that within clinical trials, like certain clinical trials. Then I believe that there's some things going on in California right now.

There was a case in California where the judge ruled in favor of a clinic that was expanding, right? But it's still kind of murky about the legality of that. And right now it's mostly overseas, right?

Exactly. Yep, yep.

Yeah, and even the overseas clinicals, a lot of them are using, um, just umbilical-derived MSCs now to skirt that whole issue. Yeah, you seem to be able to get a pretty good MSC count and good viability from that. And, if you combine it with the immune-modulating properties of exosomes, less of a chance of a hyper-accelerated immune response to an umbilical versus autologous tissue.

Right. Yeah. And, that expansion that they can do overseas is taking those same sort of progenitor cells and then making sort of a line from them, right? So, you kind of do that and then expand them forward. And, there are umbilical-derived stem cells available in the United States, they're just not expanded. So, you can still get those. And, those are called allogeneic. Those are coming from somebody else versus Most of my practice, I'm using autologous from you, which is fat or bone marrow or things like that usually.

Yeah. And, I wouldn't want to give the impression to people that expansion is always good. I learned this from Dr.— Do you know Dr. Adil Khan?

Yeah.

You heard of him? I was down in Cabo and I did a podcast with him and had a chat with him about expansion. And apparently, once you get past— I don't know the technical term for this, but basically, it's 2 to 3 expansions, 2 to 3 stages of expansion you increase the teratogenicity, the cancer-causing potential of the stem cell line. And so, it's better if you're going to expand to limit the amount of expansion that you do, which is interesting because I know doctors who brag about how they've been expanding for a dozen years and they have 20th generation stem cells that apparently could be more carcinogenic.

Yeah, that's interesting because the norm is the latter of what you're describing there. That's sort of how it goes. You get your line and you kind of—

It's like your bragging rights is how long you've expanded them for, but apparently that's not necessarily good. The other thing I wanted to ask you about, this is actually related to, to Dr. Khan also. He did an injection in my knee in which he used something called hydrogel.

Yeah.

Which is apparently a hyaluronic acid scaffold for the stem cells. Right. Obviously hyaluronic acid is something that's talked about a lot in beauty. Absolutely.

Yeah. So, um, for when we want stem cells to kind of do their thing, if you will, they generally need— you gotta have the stem cell, but then you gotta have something stimulating it, growth factors. And stem cells actually auto-stimulate themselves via that sort of paracrine release of these exosomes. Or, I like to use PRP with my stem cells after I put them in with all my fat transfers. It's one of the processes within that. But then, you need a substrate, you need a scaffold, you need something like that, right? And, this is where the hydrogels come in, hyaluronic acid being a really common one because that's a native part of us anyway. But for me, my scaffolding is usually the fat pad that I'm putting it in, right? I have that native scaffolding right there, that collagen, that elastin structure that is is damaged, oxidized, whatever it is, losing volume, changing, that's my scaffolding that I'm generally using, which is a little bit different than— it's an interesting thought though with hyaluronic acid, like you mentioned, which is really common in beauty because hyaluronic acid is a part of our skin. It's called a glycosaminoglycan. It attracts water. It holds structural, right? But, the fillers that are so crazy prevalent in facial aging right now, are made out of hyaluronic acid, out of high and low molecular weight, and they're crossing together, and there's multiple versions of them available. But these hyaluronic acid fillers have really gained a lot of traction in sort of this world of facial aging.

Are they good, the hyaluronic acid fillers?

That's like a huge question. Um, the fillers themselves are fine, right? They're just— they're an implant that goes in to replace lost volume. And like I kind of said earlier, some percentage of our facial aging is due to lost volume. It really is. It's just not the only thing that's happening in our facial aging. The problem with these products is misunderstandings and misuse of them, right? And, you know, 10 years ago, you know, they were prevalent and picking up steam, but it was really done by people who, like, highly knew what they were doing. It's like a smaller group doing them. Now you can get them done anywhere. With where we're sitting, within a mile, there's 10 places you can go get filler done. And you— and everybody's the world's expert, right? Tons of experience in this, in that, and others. But some prevalent misunderstandings about them lead them to be problematic in ways. So, when I'm doing facial surgery, it's rare now that I'm not removing or dealing with problems from prior filler. It's a natural first place for people to enter. They're like, "Well, my face is aging and there's this simple thing I can do. It's like a magic wand and it makes things all better." but the misunderstandings are driving them. And those misunderstandings are basically that, you know, a small percentage of our facial aging is from volume loss. For a lot of people, that's 100% of their strategy to address aging. So that just, you know, logically doesn't make sense. If it's 15% of your aging, it shouldn't be 100% of your strategy, right? And then this idea that they're very temporary, like you get it and every 6 months it goes away and you have to top it off and do it again. We know, no, no, that is not true. We know that from histology studies, seeing it under the microscope. We know from imaging studies on MRI. We know from seeing it surgically all the time that it lasts decades, which is quite different than thinking that it lasts a year or under, 18 months. And so, this idea of getting it frequently redone turns into a very problematic scene of just collecting gel, right? And, the gel attracts water and it breaks down and it migrates around through the musculature, It can be problematic. And, most injectors still believe that, yeah, it only lasts a year, 18 months, it's dependent on metabolism. You're super active, Ben. Your filler is going to go away real quick. That's not going to happen. It's going to be there for decades after you get it.

Now, I'm in the supplements industry, so I'm constantly getting— well, not constantly, but occasionally I'll get supplements that are supposedly ingestible beauty, collagen, amino acids, and gelatin, and I think even some form of hyaluronic acid. And apparently, these can raise your availability quality of these, uh, glycosaminoglycan groups. I'm curious, do you think there's much to be said for adequate collagen intake, adequate gelatin intake, or the dietary aspect of proteins when it comes to the link between that and beauty?

Yeah, so this is a great question that is super common as well, in the sense of just like, I, I think that people believe that they're going to eat a collagen powder and that collagen is just going to transport across their gut to their skin and they're just going to have collagen there. And as we all know, that That process is way more complex, right? That protein is an amino acid sequence that's highly folded and has to get broken down in our gut into the individual amino acids. So, I kind of tell people this is like you have a novel and when you eat it, you're breaking it down in individual letters that are in the novel. And then, they got to be reassembled into words and sentences and chapters and thoughts. And, that's how you remake the protein. And so, there are certainly studies showing that eating dietary collagen can increase the collagen in our skin and we can biopsy skin and sample for those things. And so, It's giving you the precursor amino acids that you need to do it. Collagen in itself is missing one of the essential amino acids, actually. Tryptophan is not in collagen, but it's got the other 7 in there. It's a good protein source in and of itself minus that one amino acid. Maybe if you're deficient, it's helping that get across. It's hard to argue with the clinical studies. They're not real strong, to be honest. They say, "Yeah, eating collagen may help that," but it's not by the process that everybody thinks that you're just going to go What about nootropics and smart drugs and mental-enhancing compounds?

Is that looked down upon in surgery? Is it something that you do or where do those fit in?

I'd say I'm sort of agnostic to doing that or not. I don't use them personally. I like to be sort of self-reliant on those things. I want to be able to be dynamic and be resilient. And so, I don't want to—

You mean you don't want to be on your way to surgery and freak out because you can't find your Omnipact or whatever?

Exactly, exactly right. Yeah. And, the person for the day is then screwed. Right. I feel like, "Oh, what if I'm at 98% instead of 100% today?" I don't kind of mess with that. I'm very intrinsically driven and motivated by those things and I don't rely sort of on anything external. I can take that flow state routine and I can modify it to wherever I'm at to do— I just know the key parts of it to understand. It is atypical among surgeons to do that. It's interesting. This is a whole other topic, but the medical training system doesn't teach you that. It actually kind of beats it out of you.

You mean it doesn't teach flow state?

Well, it doesn't teach flow state for sure, but it also doesn't teach anything about how to peak your own performance, right? I think I'd argue that it's quite the opposite. You look at the surgeons around and these guys are incredibly high-performing badass people, right? They were the cream of the crop and still are. But then, just to get through the system of training that we go through, it's brutal. You get beat down and you're working way too many hours and you're unable physically unable to do these things to optimize your sleep and your health because you're working 110 hours a week or 120 hours a week. And different types of surgery, it's different. Neurosurgery is different than whatever it may be. And so, it kind of gets beat out of you. You lose this a little bit. You get turned into this workhorse where you're constantly functioning at 50% or 80%, and you do pretty well there because you're, by nature, a badass, but you're definitely not for yourself at that 100%. And so, I think we're all been talking about this. My audience has turned into a lot of my fellow surgeons who are sort of into this idea of like, "Yeah, I feel that and it just resonates." And, well, how do we change that a little bit? And, these things for your audience are going to be kind of like, "Yeah, you watch your HRV. Of course, you do." Most of my colleagues have no idea what that even is, right? And so, it's like what a simple tool, like improve your sleep and your surgeries will be better. Mind-blowingly novel to people to think like, "Oh, yeah." What would you want your surgeon to do if you had to have anything done? You want them like—

Yeah, fully optimized.

I'm so stoked to be there.

Yeah. Would it be fair to say then that you do fewer surgeries than you actually could based on your demand?

Oh, absolutely. Yeah. Oh, totally, totally. And again, that just turns into this like— there's more to it than just— I could operate all day every day. And that's great, but I wouldn't be happy with that. I wouldn't be putting out that— I'm like obsessed with my craft.

Like, you could buy another boat, but you'd have a lot of people walking around with crooked noses.

Or yeah, or just like, yeah, I wouldn't be— I'm like, my results, my practice is built off before and after photos. My results are what set me apart, right? And anybody who kind of goes and looks and go check them out on social media, you'll see what that means, right? Like, this person looks incredible. I can't even tell it was done. They definitely don't look like they had surgery, but they look just just so much better afterwards. That's my jam, right? And so, I strive for those results and I work hard and I think about them and I journal and I watch film. I kind of told you. And, that's what's important to me. And, if I did that, if I was just pumping out a high quantity of those, it wouldn't be the same quality basically.

The way you explained this to me when you said you told me this, this was not here on the podcast. It was at dinner the other night. You don't know the exact outcome of a surgery until maybe 6 months after. So, describe to me that protocol you're telling me that you do with your kind of film watching. Yeah.

And, I call it watching film because anybody who ever played a sport, whatever, you might have watched film afterwards of yourself after the game. And usually, you watch it the next day and you get this immediate feedback as to what your performance was. And, this is drawing from that sports analogy where, for me, I said I visualize, right? Visualization for me is reps. If I was a basketball player, I'd take hundreds of shots a day, tens of thousands a month. I'd take millions of shots over my career and I'd be so dialed with that shot, but I can't do that surgically obviously, right? So, I have to get those reps for me visualizing. When I get to my product afterwards, I can't do next-day feedback, right? It takes me months to get to my final product after a procedure. And so, I have all of these things that I am so excited about. And you said like, what am I guinea pigging that day? It's not how I describe it, but every time I'm doing it, I'm doing something a little bit different, right?

Because tweaking, perfecting.

Yeah, I'm thinking through what happened in these branch points. And so right when I get done with the procedure, oftentimes the same day— this is part of like my flow state step down— I'll debrief. And I have a procedural journal that I write down everything about that case that was unique. This is different than the medical record, the operative note. That's like the facts of the case. But I'm like kind of writing down what I was thinking, what decision points I got to, and why I made one versus the other, and what I want to watch from that, and all these little nuanced details. Like anything that I did that was cool, different, that was like outside of the norm slightly compared to the case before, the case after. So I write this very detailed, you know, journal log, and then I don't really reference back to it until months later when I have my before and after videos and my before and after photos, when I'm seeing that patient back. And now I'm seeing you, Ben, it's been 4 and a half months.

Ben: 6 months, my face melted off and you go back to your journal and be like, "What did I do?" Yeah, what happened? Exactly.

Or, this looks really incredible. What about this was I— oh, I'm like, "Oh, the right and left eye, they were slightly asymmetric for this and I saw this dynamism and I did this little thing different." And so, I can get that feedback. So, those days are really fun. I mean, for me, this is usually Saturday morning because it's like Friday is a big follow-up day for me. I see people back and I'm like, "I saw so-and-so yesterday. I have these photos and these videos and I'm going to sit down and digest through their journal entry." from 4, 5, 6 months ago, and I'm going to adjust to their photos, and I'm going to learn.

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One of our friends, Dr. Phil LeNoel, I'm actually— I'm just going to interview Phil. We were talking about him the other night. He's the wizard with the ultrasound. He just hooks it up and he can see everything that's going on. Shout out to Phil. Yeah. And during an analysis, he's saying things. He's saying like, take a picture, do this, take a picture of that, log this. During the actual surgery itself, are you saying things? Are you just kind of remembering all this and writing it down when you walk out?

Yeah, I note some things to my team to like kind of write down. That's actually usually more for the medical record, actually. Like, here's some important things to put in there. I did this different than the other side. That's more like the facts, right? Yeah. So, there is some of that in this journal, but a lot of the journal is more of my thought processes and my decision-making that I was coming like, here were the branch points because there is no such thing as a perfect surgery and I will forever seek that. But, when I get to the end, I'm always looking through like— and again, I'm super proud of my results, I love them, but every time I look at them, I'm actually— I love the positive feedback, what was good, but I'm also looking at what could I have done 0.5% better. And, that's what I'm going back to like, "I wonder if at this branch point if I would have made this, if that would have been a different decision." And, that's sort of my game film.

Okay. And, related to this post-game analysis, you talk about opioids and how you don't like to use those to manage pain afterwards. Is that just because the opioid epidemic and the likelihood for addiction?

Oh, my gosh. Oh, maybe that. No. I mean, to be fully honest, no. Again, all my patients are traveling to see me and I want them— they're here for about a week afterwards, right? I want that week to be productive. I want them to heal quickly and I want them to have a great experience.

I mean, they don't fly home, they're staying at a hotel here in Spokane or something like that?

Yeah. No, usually a hotel. We have places for them to stay that we have kind of teed up that are very sort of curated for their recovery, if you will, even to the plants we have in there and stuff like that, right? Oh, wow.

You mean like a home, like an Airbnb or something?

Yeah, exactly, exactly. Okay. Yeah. But, where we're physically sitting, they're here every single day usually doing some modality or combinations usually. Targeted IV nutrition based off of their, you know, DNA, you know, genetic profiles or their lab work or whatever, or even what procedure they have.

They're staying in my house where we just do it all in my basement.

That— and yes, that's happened, right? And so, so I want that experience to be good, basically. And so there's all the things about addiction and things like that. I'm not as worried about that. My patients is just like what the opioids are doing to their brain and what the opioids are doing to their gut and their genitourinary system. And, if you have opioids during your anesthesia and for 2 days you can't go to the bathroom or you're foggy or you can't pee, that's pretty miserable, right? And opioids are sort of like cheating. You can do it with them and they are wonderful with their wonderful receptors in our brain, but you don't need it, right? You can innovate around that to not need it. And, it's the same for pain control afterwards. So, no opioids during the anesthesia protocol, which is for me is IV sedation. My patients are not under general anesthesia, they're not intubated, with a tube in their throat, way safer, way simpler, and way more neurocognitively protective. We know that repeated bouts of general anesthesia lead to lower IQs in kids or earlier onsets of dementia in adults. I'm not going to do that to my patients for a cosmetic procedure.

Kind of makes you worry about all the people snorting ketamine in LA.

Right, exactly. Well, and ketamine may not fall into that as much, but when we get to the pain control afterwards, that's what most people are concerned about. They're like, "Do whatever you want during anesthesia." They're asleep, right? But it's the pain control afterwards where people can get nervous, like, well, I don't want to be uncomfortable. And so, to get around that, I utilize long-acting nerve blocks, and these last about 72 hours. Thankfully, on the face, we can be very good about blocking small little nerves and getting a lot of regional anesthesia from it. So, that works really, really well, right?

What's a nerve block for people who don't know that term?

Yeah, a nerve block is going to the root of a nerve. So, if we're talking about our lower eyelid, cheek, and nose, and upper lip area, there's one little nerve that comes out of cheek that serves that entire area. All the sensation that area comes from this one little nerve. So, I just go to the teeny little nerve root and I put a little bit of this local anesthesia right around the nerve root. And, for 1 to 3 days, they just kind of like—

So, nerve block is just anesthesia at the nerve root?

Yeah, exactly. Local anesthesia at the nerve root. Pretty simple. It's a skill set to know where the nerves are and how to block them and things like that. And so, that does a really great job. Part of pain after surgery is also inflammation. And so, a lot of surgeons will just put their patients on stero— steroids afterwards, whether they're injecting steroids or whether they're doing systemic steroids. To me, that is like blasphemy, right? I don't want to knock down all of my patients' inflammation. Some of that inflammation is good. That's how we heal, right?

Cytokine, cell signaling.

Exactly. Making new collagen elastin is an inflammatory process, right? So if you completely, completely blanket knock that out, yeah, you're going to change—

you wouldn't want to finish a workout and go take a bunch of synthetic vitamin C and vitamin E and jump than a cold plunge for 10 minutes.

A million percent, right? Yeah, you blunt all of those, like that good inflammation, that healing inflammation. And so, I'm utilizing the growth factors from the PRP that we're using or from the autologous stem cells that we used. And, that's modulating their inflammation. It's not shutting it all down, but it's kind of keeping it on, let's say, on the healing spectrum, pushing it towards healing and away from just what's going to turn into sort of chronic painful inflammation because part of chronic pain is definitely just an inflammatory cascades. So we're avoiding all those things, and some of my patients just don't need opioids afterwards, which is, you know, again, like a thought paradigm shift a little bit. It's very different than usual, but also very, very successful and makes kind of everybody happier. You're going to the bathroom, you're thinking clearly. It's, it's a much better experience.

Vein in your newly formed face constipated and raising your blood pressure trying to squeeze one out, which, which for my surgical colleagues is a super great point.

We know we don't want— our patients, what's called the Valsalva maneuver, when you kind of like bear down, right? We don't want them doing that afterwards. And if you can't go to the bathroom, guess what they're doing afterwards? And so we don't want those blood pressure raises.

You send them out over the coffee enema kit or something.

Yeah, that's a good point. Yeah, or just the rectal ozone, right?

Yeah, that too. Um, so you're a dad. How many kids do you have?

Um, I'm a dad. I have 3 kiddos.

Yeah, 3 beautiful kids. We had dinner with them the other night. How much of this do you take home and teach to your kids? Like the flow state concepts or the visualization concepts or the post-game analysis to learn from your failures, your mistakes, your successes concepts?

Yeah, I think I take pieces of that home to them in age-appropriate digestible formats for that. They definitely see and feel my passion with what I do, and I don't mean passion just for my craft, you know, facial plastics. I mean this everything that I do. I'm a passionate person, right? So, the way I love my wife, the way I play pickleball, the way I exercise and train, and the way I read to them, they see those kinds of passionate things in there, right? And so, when the opportunities present themselves, we definitely talk about— they're not in flow state yet. They need to practice. They're not quite ready for that yet, but they definitely know about visualization and thinking through things. And using those as tools for when they're feeling stressed or overwhelmed. It's really just sort of like kind of the same thing you do. It's like you kind of lead by example and as their curiosity sparks, they ask questions and you just got to be ready to answer them, right? You don't know all the answers and we're all figuring out as we go. I have a 10-year-old. That's my oldest. I've never had an 11-year-old. I don't know what that's going to be like. I don't know what questions he's going to ask me then and I'm just trying to be ready for when he does. Yeah. Yeah.

Do you incorporate any of your spiritual life in your practice or anything like that? Do you pray before surgery or meditate or talk to God or anything like that?

Yep. That kind of last little touchpoint for me is that's when I'm doing that. Like I said, I'm sort of connected with the patient and it's a spiritual meditative grateful prayerful time for me. And, it's nothing complicated, it's just this sort of internal expression of how stoked I am to be there, how grateful I am to be there, how, you know, all the hard work and grinding and things that kind of got me to that point, and I finally get to do it. Yeah. And it's just, it's such a wonderful feeling. Yeah. And, and, you know, that we definitely are incorporating with our kids too. You know, they're very much, um, sort of in tune with that, like, you know, giving thanks, being grateful, you know. Yeah, yeah, yeah.

We actually had, related to kind of the spiritual piece, I suppose, a little bit of an interesting chat in I think it was our last podcast or our first podcast where I asked you if you ever get concerned about just promoting vanity or narcissism or just this general idea that you might be unhappy or ungrateful for your body. I forget exactly what you said, but how do you tackle that?

Yeah, that's a good one. And, my thoughts on that are probably modified since that podcast. It's something I think about and wrestle with all the time. And, it actually is— that's integrated in my practice, that answer a little bit because when you see a client and you see somebody who's maybe struggling with their health and you coach them up, you get them to where they get done and they are like, "Ben, I feel incredible. I feel so good. I can't even explain how good I feel." Right?

I feel so good I'm peeing methylene blue.

Right. Yeah, or just anything. You change their life really and they feel so good, but they look a little feel a little bit better too, right? So they kind of have this double benefit, and you've reduced their metabolic age, and you are going to make them live longer. Like, all these things that, you know, we can do now, um, just with a little knowledge and effort, right? Well, my practice is like kind of like the yin and yang to that a little bit. So patients come into me and they feel great, and the most common thing I hear from my patients is, I just want to look how I feel. That's back to this rejuvenated thing, right? I want— they want to look how they feel. And they feel like there's a mismatch. Well, nobody wants a mismatch with how they feel and what they see in the mirror, right? And if we can do these little small things to make them make that match up better, they look better and they feel better too. So it's like this chicken or the egg thing a little bit. But when you're working with somebody who's, you know, really motivated and on this sort of health journey, you know, they're gonna experience some normal aging changes and they're— it's not going to feel right to them. So I'm able to kind of put those together a little bit, and And, that's been a big evolution in my practice of just understanding that this is more powerful. It's the mind-body connection, not to sound cliché, but it's true and it's real and it applies to how you look too. What's the point of having a telomere length that puts you as 20 years younger than you are if you're aging on top of that and you don't like the way that that's going along?

Yeah. I was actually working last week. It's one of the monster chapters of "Boundless," the chapter on beauty and symmetry.

You're in it.

You're in that chapter. I don't know if you were in the first version, but you're in the second version. Awesome. And, I talk about that a little bit in that chapter about how this is not an endless vain grasp at somehow trying to look as good in a bikini at 48 as you did at 16. It's more about, well, first, just accepting the reality that part of success socially and from a career standpoint is a little bit based on how you look. That's just part of living in the world that we live in whether you like it or not. So part of it is that, like, put on nice clothes, make sure they're not dirty, comb your hair. And yeah, maybe if you have a giant— you know, no offense to anyone— mole on your right cheek that's distracting everyone, think about getting removed, right? Right. And then the same thing with fitness, right? Like, don't be dumpy. Not only because that's going to affect the way that you're judged in most cases, but also because that's going to induce confidence, and confidence is going to induce impact, and impact is going to induce you better being able to live about your life purpose, whatever that might be. So, if your skin is glowing and you're symmetrical and you feel good about the way that you look and you have a full head of hair that you like and that you can be proud of and that might even express the way that God created you, then when you step out into the world, you're stepping out into the world as a better performer in the same way that someone might hit the gym daily is going to be a better performer. I think that beauty goes hand in hand with fitness. And, I do think it can be taken too far. I sent you just a funny video before this, the lady who got just too much work done. You can tell. Those people who have just put way too much into it. But I think that paying attention to symmetry and beauty and hair and your appearance is something that is a healthy form of pride. And Spokane, Washington is the fly-in airport. Yep. Uh, I'll link to the socials and to the Optum5 Clinic. Optum, the number 5, right?

Yep. This is, uh, yeah, Clinic 5C is the name of our clinic. 5C.

I'll put a link to all that if you go to bengreenfieldlife.com/cameron3. Cameron, the number 3. I will also link to to the other two episodes that we did. People love the hair one, by the way. So if you guys want to know about like going bald, gray hair, follicular transplants— preferably not from the pubes, we've established— and a lot more, um, Cameron and I have geeked out twice. So if you guys like this episode, there's a ton more that we didn't even scratch the surface of. Cameron, I love chatting with you. People love to hear from you.

So thanks for doing it. Absolutely. Thanks, Ben. Appreciate it.

All right, folks, I'm Ben Greenfield, along with Cameron Chestnut, signing out from Ben bengreenfieldlife.com. Have an amazing week.

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