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 it's not gonna 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. Just understanding that, like, this is more powerful. It's the mind body connection. Not to sound cliche, 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?

Let's do this.

My guest on today's show is surely in a flow state.

Oh, so much so.

He is a flow state expert, more so than I even realized the first two times I interviewed him. His name's 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. 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 three. We're sitting at his clinic. I never know whether they call it, 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 waiting until we Were just about to deboard to ask you what you do or on an elevator. How do you describe to people what you actually do?

You know, I just kind of give the basic rundown. I'm a facial plastic surgeon. You know, I practice here in the 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, you know, 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 8020 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, like, 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 like.

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

Sure. It's just like 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 like, facial plastic surgery. And plastic is 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 it's like for somebody listening in who's like 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 bring full of plastic.

Exactly. You can change the up. 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 up. That's called wakeboarding.

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

Oh, that's ocean surfing.

Yep.

Okay. And you, you played football for wsu?

Yeah, played golf. Golf at wsu.

Played golf. Two sport collegiate athletes.

I was a. Yep, yep.

And you competed in Kona and Ironman.

And I competed in Kona and Ironman. And now I'm a competitive jiu jitsu athlete and I play pickleball. I just like. Yeah, I'm a dad at this point in my life. I'm really, you know, 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 field of cosmetics, are there new cool protocols that you guys have introduced?

Yeah, one thing that I've really been working on hard 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. Right. And the facelift. Right. 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 like burn victims and more just like, sorry to stereotype like 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, like, transformational plastic surgery where you're kind of, like, maybe trying to achieve something you never had. I would say rhinoplasty, like, 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, then 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 of, 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. But you're starting to notice, like, well, I'm getting, like, this loose sort of skin in these bags under my eyes. And my upper lids droop a little bit more than they used to. And one of my eyes is. 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. And 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 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, you know, turn back the clock a little bit.

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

Yeah, this is my life, unfortunately, very much. And, you know, I don't, like, 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 like, just a. You know, I take that challenge on. I kind of like it. It's. 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 norepine, the EPI release when you're doing these cases. Like, I don't even know what I'm gonna find when I get in there, type of things. And that happens all the time, basically. That would be like, 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 like, 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 seven out of 10. But he wants the nine 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 two friends now, possibly a third soon, who have done a procedure with you. And they look like absolute shit afterwards. Faces all swollen.

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

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, like, laser cocktail, this laser resurfacing that I do at the end. Right. So we'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 non surgical, ironically, very non surgical 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 in a way and hidden. But this, like, 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. That's 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 nother 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 it's kind of. 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 like 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. 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 lights created equal. So that's one aspect of it. And then you got to think about what you're trying to do with these, you know, sort of regenerative modalities. Like a red light. I see it. And it can improve your surgical recovery. Number one, it can slow your aging process. Right. It has 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, like, reverse the aging that you have? Probably not. Can it pump the brakes on the process that we're all experiencing? Absolutely. 100%. Right. 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 pick.

Oh, yeah. And it's awesome. And I mean, I don't know if anybody's ever been in front of red light. You just feel awesome too.

Oh, yeah. I do it every day. I don't do the face every day. I do. I think I told you this on the last podcast to 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 on 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 in 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 like 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 angio neogenesis. 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 a lot about hair loss and growing hair in our last show. I think you told me, like, if you do a follicular transfer, you could even use, like, your pubes for. I think you said that, didn't you?

Suboptimal to do that, 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.

So 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 three liposuctors, 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 3000ccs of fat or huge amounts, thousands of ccs. I'm taking tens of ccs or 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, you know, I'm, you know, basically selecting and then, you know, putting the rest away.

Is that all same day for that fat withdrawal procedure? Because you obviously can't 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 fat cells. 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. You're making medicine.

Yeah, essentially. And you can do that within clinical trials, like certain clinical trials. 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, but it's still kind of murky about the legality of that. And right now it's mostly overseas.

Exactly.

And even the overseas clinical, a lot of them are using just umbilical. Umbilical derived MSCs now to skirt that whole issue. And 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. Vers. Most of my practice I'm using autologous from you, which is fat or bone marrow or things like that.

Usually I wouldn't want to give the impression to people that expansion is always good. I Learned this from Dr. Do you know Dr. Adeel 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 two to three expansions, two to three 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 how it goes. You get your line and you kind of.

It's like your bragging rights is how long you've expanded the them for. But apparently that's not necessarily good. The other thing I wanted to ask you about, this is actually related to Dr. Kahn also. He did an injection in my knee in which he used something called hydrogel, which is apparently a hyaluronic acid scaffold for the stem cells. Obviously hyaluronic acid is something that's talked about a lot in beauty and cosmetics.

Absolutely.

Use that.

Yeah. So when we want stem cells to kind of do their thing, if you will, they generally need, you got to have the stem cell and then you got to have something stimulating at growth factors and stem cel will auto stimulate themselves via that sort of paracrine release of these exosomes. Or like 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 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's 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. 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 in 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. Every and everybody's the world's expert, right? Tons of experience, and this is math 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 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 logically doesn't make sense. If it's 15% of your aging, it shouldn't be 100% of your strategy. And then this idea that they're very temporary, you get it, and every six 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 of these 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 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 complex. 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 into 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, like, biopsy skin and sample for those things. And so. But 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 seven in there. So it's a good protein source in and of itself minus that one amino acid. And so maybe if you're deficient, it's helping that get across. But it's hard to argue with the clinical studies, they're not real strong to be honest, but 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?

You know, 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. You know, I want to be able to be dynamic and you know, be resilient. And so, you know, 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 omnipep to whatever.

Exactly, exactly. Right, yeah.

That person for the day is then screwed.

Right. Or, you know, and even. Okay, so I feel like, oh, what if I'm at 98% instead of 100 today? You know, 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 like, you know, I just know the key parts of it to understand and it is atypical among surgeons to do that. And it's interesting, this is a whole nother 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, it doesn't teach flow state for sure. But it also doesn't te anything about like how to like 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 like 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, it's brutal. You get beat down and you're working way too many hours and you're unable to 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 my, I think, world, and talking about this, my audience has turned into a lot of my fellow surgeons who are sort of like, into this idea of like, yeah, I feel that. And it just resonates and like, well, how do we change that a little bit? And these things for your audience are going to be like, kind of like, yeah, you watch your hrv. Of course you do. Most of my colleagues have no idea what that even is. Right, right. And so it's like, what a simple tool, like, improve your sleep and your surgeries will be better. That's like, mind blowingly novel to people to think, like, oh, yeah, you know, what would you want your surgeon to do if you had to have anything done? You know, you want them like, yeah.

Fully optimized.

I'm so stoked to be there. Right.

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

Yeah. Oh, totally, totally. And again, that just turns into this, like, there's more to it than just, you know, like, I could operate all day, every day, you know, 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.

You could buy another boat, but you'd have a lot of people walking around.

With crooked noses or just like, yeah, I wouldn't be 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 what was done. They definitely don't look like they had surgery, but they look just so much better afterwards. Like, 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. You know, I kind of told you, and I am, you know, 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.

You watch the way you explained this to me when you said, you told me that 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 like, maybe six months after. So describe to me that protocol you're telling me that you do with your kind of, like, film watching type.

Yeah, and I use. I call it like watching film because anybody who ever played a sport, like, you know, whatever, you might have watched film afterwards of yourself after the game. And usually you watch it, like, the next day, and you get this immediate feedback as to what your performance was. And, you know, this is drawing from that sports analogy where, like, for me, I said, I visualize, right. Visualization for me is reps. If I was a basketball player, I take hundreds of shots a day, you know, 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 go. I have to get those reps for me visualizing. When I get to my product afterwards, I don't get immediate. 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? You know, who. 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 because I'm 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 outside of the norm slightly compared to the case before the case after. So I write this very detailed 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 four and a half months, six months.

My face melted off. And you go back to your journal and be like, what did I do?

Yeah, what happened exactly or like this looks really incredible. Like 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 this is my those days are really fun for me. This is usually like 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 entries from four, five, six months ago and I'm going to adjust to their photos and I'm going to like learn.

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One of our friends, Dr. Phil Leno. I'm just going to interview Phil. We were talking about him the other night like 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 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 or are you just kind of remembering all this and writing it down when you walk?

Yeah, I note Some things to my team to 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. 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 again. I'm super proud of my results. I love them. But every time I look at them, 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 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 talked 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, maybe that. No, I mean, to be fully honest, no. A lot of 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.

They don't fly home. They're staying like at a hotel here in Spokane.

Yeah, not usually a hotel. We have places for them to stay that we have kind of teed up that are very sort of like, you know, curated for their recovery, if you will. Even like to the plants we have in there and stuff like that.

Right, but you mean like a home, like an Arizona or something?

Exactly, exactly. Yeah. And so. 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 DNA genetic profiles or their lab work or whatever, or even what procedure they have.

Unless they're staying in my house, where we just do it all in my basement.

Yes, that's happened. Right. So I want that experience to be good, basically. And so there is 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 two 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, they're 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 do, 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, it's 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 gonna do that to my patients for a cosmetic procedure.

Kinda 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 like our lower eyelid, cheek and nose and upper lip area, there's one little nerve that comes out of our chest 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 one to three days they just kind of like.

So a nerve block is just anesthesia.

At the nerve root? Yeah, exactly. Local anesthesia at the nerve root. Pretty simple. It's a skill set, right, 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. Right. And So a lot of surgeons will just put their patients on 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.

From cytokine cell signaling.

Exactly. Making new collagen. Elastin is an inflammatory process. Right. So if you completely, completely blanket, knock that out, you're going to change.

Why you wouldn't want to finish a workout and go take a bunch of synthetic vitamin C and vitamin E and jump it all. 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 like what's going to turn into sort of chronic painful inflammation. Because part of chronic pain is definitely just an inflammatory cascade. 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 a much better experience.

Vein in your newly formed face constipated and raising your blood pressure, trying to squeeze one out.

Which for my surgical colleagues is a super great point. We know we don't want to our patients what's called the Valsalva maneuver, when you kind of 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. So your dad, how many kids do you have?

I'm a dad. I have three kiddos.

Yeah, three 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, facial plastics, I mean this like everything that I do, I kind of like, 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 like passionate things in there. Right. And so when the opportunities present themselves, we definitely talk about, you know, they're not in flow state yet, they need to practice. They're not, you know, quite ready for that yet. But, you know, they definitely know about visualization and like kind of thinking through things and using those as tools for when they're feeling stressed or overwhelmed. And it's really just sort 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 gotta be ready to answer them. Right. And you don't know all the answers. And we're all figuring out as we go. You know, 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 gonna be like. I don't know what questions he's gonna ask me then. And I'm just trying to be ready for when he does. Yeah.

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

Yep. That like kind of last little touch point for me is that's when I'm doing that, you know, as that's 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 like this sort of like internal expression of like 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. And it's just. It's such a wonderful feeling. Yeah. And you know, that we definitely are incorporating with our kids too. You know, they're very much sort of in tune with that, like, you know, giving thanks, being grateful, you know. 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 like, 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? I probably didn't hear that episode.

That's a good one. And my thoughts on that are probably modified since that podcast. Something I think about and wrestle with all the time. And it actually is. That's. That's integrated in my practice. That answer a little bit. Because you know what? When you see a client, right, and you kind of, like, see somebody who's maybe struggling with their health and you coach them up, right? You get them to where they get done, and they are like, man, 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 like you change their life, really. And they feel so good. But they look 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 just with a little knowledge and effort, right? Well, my practice is kind of like the ying 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 really motivated and on this sort of health journey, they're going to experience some normal aging changes and 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. 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 cliche, but it's true and it's real. And it applies to how you look, too. What's the point of having a telomere link 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. 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, no offense to anyone, mole on your right cheek that's distracting everyone, think about getting it removed. 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 out 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. I'll link to the socials and to the optim 5 clinic. Optim, the number 5, right?

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

Rather clinic 5C. I'll put a link to all that if you go to BenGreenfieldLife.com Cameron3 Cameron the number three. I will also link 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. 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 this.

Me too. Absolutely. Thanks Ben. Appreciate it.

All right folks, I'm Ben Greenfield along with Cameron Chestnut. Sign out from Ben greenfieldlife.com have an amazing week.

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