Dr Chesnut is the facial plastic surgeon for the world’s high-performers. He is truly on another level. People from all corners of the globe seek his next-level results - with astonishing outcomes from minimally invasive procedures that leave his patients looking natural, rejuvenated, and seemingly untouched. He is renowned for his progressive use of regenerative medicine and postoperative recovery techniques, as well as his dedicated personal preparation for performance readiness.

> During our discussion, you’ll discover:

(00:09:35) What made Dr Chesnut choose aesthetic medicine

(00:14:01) The difference between regenerative medicine and aesthetic medicine

(00:16:01) Can aesthetic surgery decrease stress and therefore slow facial ageing

(00:20:56) How Dr Chesnut treats patients with more than just aesthetic conditions

(00:23:28) Why is collagen important for ageing skin

(00:30:49) The role of HRT for anti-ageing

(00:39:21) The most important therapies to prolong healthspan

(00:43:04) What other information do you need for aesthetic medicine

(00:45:46) Epigenetic testing

(00:47:57) The best post-op procedures after aesthetic surgery

(00:58:33) Is cold therapy good for you

(01:01:41) Dr Chesnut’s thoughts on peptides

(01:09:25) Should you take HGH as you get older

(01:11:34) Is ketamine a good anaesthetic for reducing inflammation

(01:16:59) Molecular hydrogen

(01:17:30) What is the best daily practice to support aesthetics

(01:18:59) The #1 aesthetics/cosmetics trend people waste money on

(01:20:15) The #1 regenerative trend to look out for

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Research Links:

• Cosmetics Inquiries | Clinic 5C
• Cameron Chesnut, MD
• Dr Chesnut | Instagram

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Welcome to the VP Life Podcast, the show

where we bring you actionable health

advice from meeting minds.

I'm your host, Rob.

My guest today is Dr.

Cameron Chesnut, a board-certified facial

plastic surgeon and

the founder of Clinic 5C.

Dr.

Chesnut blends regenerative aesthetics,

functional medicine, and longevity

science to help people look on the

outside how they

actually feel on the inside.

Expect to learn why regenerative

aesthetics isn't just cosmetic and how

stress, self-perception, and systemic

inflammation can

intersect with the aging process,

how skin aging reflects deeper

mitochondrial, hormonal, and metabolic

shifts within the body, and how Dr.

Chesnut integrates surgery, functional

medicine, red light, peptides, and

advanced recovery protocols to optimize

both healing and long-term health.

Now, on to the conversation with Dr.

Cameron Chesnut.

Good morning, Dr.

Chesnut.

Attempt number two.

So thank you for being here.

Now, I know you've got a pretty stacked

diary, and like I said

earlier, your time is appreciated.

Now, of course, we're here to discuss,

well, pretty much everything with

regenerative anesthetic medicine.

But before we dive in, would you mind

introducing yourself and how

you ended up in this space?

And by that, I mean this sort of

functional regenerative space.

As I know, you're obviously far more than

just a "plastic surgeon."

We've done plenty.

And to be honest, the longer your intro,

the more time I have, as I mentioned

earlier, to sort of get my adenosine

receptors a bit more knocked out with a

little more caffeine.

It's been a long day.

But yeah, anyway, I'll just let you get

to it and let you do your thing.

Yeah, thanks, Robert.

I appreciate you having me.

And my name's Cameron Chesnut.

I am a facial plastic

surgeon very specifically.

So if I were to go into my actual

surgical practice, it's that.

But it's a bit different as you were sort

of hinting at in that I use a lot of

regenerative medicine and a lot of things

that classify more into the longevity

space as part of my surgical practice.

Patients travel to me.

I'm in the Pacific Northwest part of the

United States, and patients travel to me

from all over the world for this sort of

retreat experience as they're doing their

anti-aging or

rejuvenating type of procedures.

And that's set up in something that kind

of I divided into this pre-recovery

phase, or I call it pre-covery during the

actual surgery, then our whole recovery

phase and experience while they're here

that lasts about a week.

And it's very different than what you'll

find typically in our industry.

And it's very regeneratively based.

And part of that, I think we're going to

get into this later quite a bit, is just

to enhance the

durability of these procedures.

I want them to last a

long time when we do them.

And I also want to do as little as I can

from the get-go to hit the goals or

results that we're trying to achieve.

So that'll be, I think, one of the

questions too, is why

are we doing this at all?

And the more that we can lower the

barrier to entry, the better the total

outcome is when we kind of go for a ROI

type of look at it a little bit.

So I got into this space just simply off

of personal interest.

My practice is my practice.

I could be any type of surgeon, and this

would be beneficial.

So for anybody listening to this, there's

a high likelihood that at some point

you'll have a surgery elective or

non-elective at some point in our life.

And I think a lot of things we'll talk

about are wildly applicable to all types

of surgery, if it's orthopedic, if it's

general surgery, or if it's something

that's more elective, like

in my world a little bit.

And I love longevity for myself and my

peak performance, and just for the same

reason that we're all listening to this

in the first place, for

the benefits it gives us.

But there's a lot of crossover and

applicability, and using it in a

post-surgical setting exposes some of the

benefits that we can get

just in regular life as well.

And I was an athlete and

still am, and highly competitive.

That was sort of my identity and

upbringing, and I've carried a lot of

that mindset into what I'm doing now,

from the way that I prepare myself and my

patients, the way that I execute during

surgery, and then really in the way that

we're recovering afterwards.

When I was training and growing up and

competing, recovery was just sort of

coming in to be something that people

were talking about a little bit more, as

probably the most

important part of our training.

And now it's very infat and people are

talking about it a lot, but a lot of

those mindsets carry over again to this

post-surgical setting in ways that we can

really enhance recovery, especially since

we get to know essentially when that

injury is happening or

choosing it in a way.

So that's kind of a long-winded way of

the different cross-pollinated facets

that led me into where I am today.

That's amazing.

Thank you for that.

Just on the functional

integrative side, did you do any,

I assume you do training beyond your

traditional medical training, or are you

like a fair number of physicians?

Did you sort of pick a lot

of this up as you went along?

Yeah, exactly.

And it's interesting, because when you

look at who's in this longevity,

regenerative medicine, functional

medicine, whatever we want to call it

space, it comes from all over because

there is no particular board

certification for it that's recognized

by, in America, by the

ACGME, we would call it.

And so you're going to find, I think

interestingly, in a good way, you're

going to find a sampling error of people

that are just a little bit more

avant-garde or progressive or thinking

about things a little bit differently.

At some point, I think it will narrow

down in its specialization a little bit

more, but you'll find very few surgeons.

I would probably be on the more rare end,

but more of the primary care specialties

or physical medicine and rehabilitation.

And one of my goals, objectives, and

values is to sort of spread this to my

other surgeons, because I think that we

underutilize it, and we can maybe have

some of the most benefit, because as

we'll talk about when we get into a lot

of these longevity things, everything's

just magnified when we're in a really

post-surgical healing inflammatory state.

That's when we get some of the most

benefit out of a lot of these things.

Yeah, definitely.

I think it ultimately

comes down to the practitioner.

And look, I've obviously not been through

medical school, I've been through

biochemistry school, but that's

completely different.

It's a desire for an individual to have,

of course, talking about the functional

integrative side of it again, a deeper

desire to understand the physiology and

the biochemistry behind medicine.

Correct me if I'm wrong, but I think some

of that is definitely lacking and maybe

in a sort of

traditional medical training.

I assume you get as far as the crepe

cycle and maybe a bit

more, but you sort of...

After that, it's really about working

through the traditional medical sort of

framework, medical schooling framework, a

lot of which is based of pharmacology.

And then as someone such as yourself, you

specialize and you get caught up in that.

But I think sort of bringing it full

circle for me, being someone who is

really good at this sort of functional

medicine stuff is fundamentally just

having a love for biology, which you

obviously emulate in spades.

So, yeah, no, that's

all points well taken.

That's a really interesting point.

And sorry to interrupt you because I'm

kind of thinking on the fly with you here

a little bit about what we do learn and

reflecting back on that.

And I have had these reflections before,

but as you just said, you're

learning the crepe cycle, right?

Because we're going to talk a lot about

mitochondria today and this is what's

driving them, right?

So we learn about it and at one point

you're just rogue memorizing it.

You have to memorize the crepe cycle with

no real applicability until, like you

just said, you get into pharmacology.

And not that that's not valuable and life

changing and wonderful, but when we

really get down to the root of it, we're

not really talking about just the basic

everyday regenerative functions that the

mitochondria can have.

It's interesting to

really reflect on that.

You're memorizing the crepe cycle for

applicability to pharmacology, not for

its daily function quite as much.

And as we get back into, I think when all

of my colleagues start getting back or

coming back into full circle of like,

well, let's look at the mitochondria and

how we can improve their function.

We kind of get back into the crepe cycle

like, oh yeah, I remember learning this

back when and then you kind of like purge

the information

because it wasn't valuable.

But I think everything meets in the

mitochondria a little bit here and it's

kind of fun to talk about.

Oh yeah, for sure.

I had the pleasure of interviewing Dr.

Thomas Seafree to show you from the

lithic cancer biology

just a few weeks ago.

And yeah, I mean, he

fundamentally said the same thing.

I mean, obviously all his work is

mitochondrial in nature.

It just looks through the lens of

metabolism when talking

specifically about cancer.

Right.

And what a unique contrast.

Now you're talking to a plastic surgeon

and a deep cancer researcher and

essentially we're going to boil down to

the same foundation.

That's really cool.

Yeah, no, it is.

It is what makes me

grateful for my background.

Granted, it's nothing like yours, but

having this sort of vague idea of how

biochemistry and physiology work just

allows me to sort of maybe bridge these

gaps and at least try and answer the ask

the odd question that's

in some way interesting.

Anyway, Dr.

Chestnut, I reckon we might as well deal

with the elephant in the room.

And that being sort of plastic surgery

and aesthetic medicine now, it's got a

certain stigma about it.

And I think it's traditionally seen, and

correct me if I'm wrong, and I think it's

changing as being very superficial and

unnecessary outside of a reconstructive

setting when someone's obviously had an

accident or car crash and they need

reconstructive surgery.

I suppose it's a bit of a follow up from

my last question, but what made you

choose aesthetic medicine just broadly

speaking as a speciality?

Yeah, it's interesting because when we

train in any type of reconstructive and

plastic surgery, that'd be like the broad

name that encompasses whether we're

talking about faces,

bodies, anything like that, eyes.

We start with reconstruction and the

aesthetic part really comes with this

idea of restoring form

and function a little bit.

And for me, it was driven a lot by this

regenerative aspect of it, because there

is this superficial view of it.

And I think that the cliche view of

plastic surgery is

that it's transformative.

And this is a big delineating factor.

This is a wildly important point, which

is there is the transformative side of

things, which is taking something that

never existed and creating it.

And that's just not the type of

particular practice that I have.

That would be something

like breast augmentation.

In general, it's just making something

different than it ever was before.

I'm in more of a rejuvenative or

regenerative side of this.

So I am trying to take things back in a

direction from which they came.

And I think that just by nature, there's

a little bit of less superficiality in

there, not that there's none.

But it would be, I just think of it in

the same way as I would that we're

clearing out a coronary artery.

We're taking it back in the direction

that it went before.

Or I love this.

I have a story of a patient who was

married to somebody who was a really

famous major league baseball

pitcher in the United States.

And her husband was one of the best ever.

And as he was getting towards the end of

his career, he was still a huge

contributor in the

league and on his team.

But he had some degenerative changes in

his shoulder, as we might imagine would

happen with repeated use of this thing.

And so if we kind of subscribe to this

idea of we'll just let things happen as

they go and just age naturally.

Him performing as the pitcher would have

been, well, he's got use out of his

thing, age naturally and

just kind of fade away.

But he didn't want to do that.

He didn't need to do that.

He still could contribute and he could

take some simple steps with some

regenerative medicine, which is a little

bit of an application to now, not as much

when this is actually happening to him,

where he could have this little minor

surgery that was arthroscopic, small

incisions, still

surgery, unquestionably surgery.

And he could extend his performance and

his identity and his physicality for

extra years and get a little bit more out

of what was degenerating naturally.

And so of course he did that and extended

his career and wasn't the best he'd ever

been at that point, but still kind of

extended things a little bit.

And interestingly, that's

a lot of what I'm doing.

And if we want to, you know, we have to

really at some point accept that what we

look like and put out into the world

affects our performance or how we're

influencing or just, you

know, our aura around us.

I'm just altering that a little bit.

I'm not changing it.

It's not dramatic.

It's all these little subtle changes.

And I think if my practice is built on

before and after photos, and if you go

look at those photos and videos, I think

that's why a lot of people gravitate

towards me as like, can't

even really tell what happened.

The person just looks a little bit more

vital or more refreshed afterwards.

They don't look different.

They don't look even

necessarily like way younger.

It's just a little bit of like, oh,

that's a fresh look.

And our external appearance wildly

reflects what's happening internally.

This gets to the nitty gritty I think of

our conversation later is unquestionably

we can look at our epigenetic markers and

we can really get into predicting what

somebody is going to look like just based

off of, you know,

what's happening internally.

Those are excellent points.

And I really do sort of appreciate the

fact that what you're trying to do is

sort of almost reestablish the baseline

rather than augment, which I suppose

fundamentally is what it is.

Again, I probably should have mentioned

this earlier, but would you mind for the

audience quickly just sort of breaking

down the difference between regenerative

medicine and again, this aesthetic side,

something I should have brought up

earlier, but I think it's probably quite

an important point to make before we

carry on any further

with the conversation.

Would you mind just breaking down those

two terms quickly for the audience?

I think I should have

carried up on that earlier.

Yeah, absolutely.

I'm going to define this through the lens

of what I do a little bit where you have

transformative things, right?

That is taking a 20 year old who does not

like his or her nose

and changing it, right?

Nothing physiologically happening there,

just straight transforming it into

something that didn't exist, which is

really common and is fine.

No judgment.

It just is what it is.

And then we have my world,

which is more anti-aging.

When I think of regenerative, I like to

look at this again through my lens

because you and I right now immediately

could do something regenerative with

little to no input, right?

That could be a peptide

that we take or put on.

That could be a small

treatment that we'd like.

Very simple things can be regenerative

and that is trying to harness our

internal ability to repair and restore.

I'm going to go with soft tissue.

This could also be bone and things like

that, but soft tissue

being skin muscle fat.

That's what's really

important to me in our face.

So just turning on mechanisms,

epigenetics, regulating inflammation,

vascularity, whatever we need to do to

make the tissues that we

already have better, right?

So that is just

regenerative medicine in and of itself.

And then in my world, when I am

physically moving or replacing or adding

a little bit of a mechanical force to

gravity, say that would be a really

common situation, now I can take that

regenerative medicine and get the

baseline improvement out of it and

improve our healing and long-term results

from these little minor

procedures that we're doing.

So I'm really trying to

mix those things together.

And that's where my world of facial

plastic surgery intersects and interacts

and benefits from regenerative medicine.

That's perfect.

And to be honest, that lines up with my

next question perfectly.

Now, as any long-time listener of our

audience knows and something I've already

sort of alluded to, my background is in

biochem and I've since gone down the

integrative rabbit hole myself.

And all I can say is that I see things,

again, through this lens of a chemist for

better or worse, having worked with

people for a while now.

I think I've come to the conclusion that

maybe outside of infections, genetic

issues and a high toxic load,

one of the main drivers of any sort of

systemic dysfunction

within the body is stress,

especially psychological stress.

It sounds pedestrian.

I know we hear it all the time, how

stress is a killer

and it's making us sick.

But the more I look at stress and stress

physiology, the more I feel it needs to

be central to any

sort of health protocol.

Now bring that full circle again.

I do know, among other things, you sort

of also operate in this functional space,

as you've alluded to.

Have you ever noticed that by improving

an individual's appearance, you can

modulate or lower the stress that they

are under and by as a result, see

improvements in other

aspects of their health?

I know I'm bolting

together mechanisms here.

But the way I see it, I think that if

somebody is experiencing feelings of

inadequacy as a result of the way that

they look, that's going to, by default,

impact their health.

And if you can remove that dysregulation

of the central nervous system and make

them feel better about themselves, I

assume that there's then going to be a

carryover to the rest of their health in

general, how they operate, feel, et

cetera, if there is some sort of

underlying condition, perhaps.

Absolutely.

There's so much in there, Robert.

And that's such a good question.

I don't know that anybody's

asked me this in that way before.

And I love this because I talk about

stress often and the way

that it leads to aging, right?

And I'm going to be being specific with,

I'm going to just reword what you said

with the cognitive dissonance that comes

with not looking the way that you want to

or looking the way that you feel, right?

And we know that basic stress from all of

the other things in our life, kids, jobs,

work, entrepreneurial, things like you

and I were talking about offline a little

bit, definitely contribute, right?

Via tons of mechanisms, epinephrine or

epinephrine cortisol, right?

But this, I'm going to skip that because

we talk, you can talk about that a lot.

I think the unique part here is this

like, does changing the way you look

relieve some of that stress?

And the answer is yes.

But it's not the sole

aspect of this, right?

And what I mean by that is so, and I

don't think it's as insightfully front

and center with what people think.

The most common thing that I hear from a

patient when I first talk to them and I

actually, you know, secret, secret story,

love to hear this from somebody is I just

don't look the way that I feel inside.

I feel so good.

I feel vibrant and vital and then I look

and it just doesn't

quite match up, right?

And so that's a great win for me because

I know what I can do objectively, right?

And I want the subjective to line up that

if somebody doesn't feel good, no matter

how good I make them look, I don't think

I can actually turn that around.

And so what I'm really doing is trying to

line up their already internal identity

and vision with what they kind of see in

the mirror, making the objective match

the subjective a little bit there.

And when I do that unquestionably

relieving that cognitive dissonance takes

away some of that psychological stress

that's there, right?

And we know that all the ways that that

lines up with, you know, inflammatory

cells and IL-6 and changing steroid or

cortisol receptors and their sensitivity

and downregulating,

all these things add up.

And I think what really happens there,

and this is why I like to talk about

baseline stress so much, is that without

the baseline stress downregulating the

cortisol receptor

sensitivity in numbers, right?

I don't think that that little

psychological stress of, you know, not

matching how you look and feel would be

as impactful, right?

It's when that, you know, piggybacks on

top of the baseline

stress that things add up.

And so part of my long-term mission,

again, this is where that overlap that

you're talking about with the integrative

or functional medicine comes is trying to

not only relieve the cognitive dissonance

of how you look and how you feel, but

then also like changing the baseline,

which you know, we could argue is

probably one of the most beneficial

things we could do for them long-term and

also preserving the

results that we're getting them.

And so there is a super complex interplay

of chickens and eggs and what's happening

where and, but it all

ties together unquestionably.

And, you know, this gets into, I think

something we'll talk about later too,

with even how we're regulating our sex

hormones and, you know, back in,

everything coming back to the, maybe even

the mitochondria in some capacity.

Yeah.

I mean, ultimately, I suppose

mitochondria help with the production of

hormones and all of that.

That will definitely be a discussion

we'll have in a minute.

Dr.

Chestnut, do you,

maybe a bit of an odd question, but are

there any sorts of clients that you work

with specifically that are coming to you

with sort of a broad spectrum of issues

that they have their aesthetic concerns,

but they're then also coming to you with

maybe a greater health complaint.

Do you sort of work with people like that

in tandem or is it very sort of binary in

the way that you do end up working with

patients with clients?

No, I like the situation where we get a

more comprehensive or holistic

integrative component to it, right?

Because that's where we can make the

most, again, this gets to my personal

goals, missions, values, and that I value

that part of my life and career.

I'm a very like high

quality, low quantity surgeon.

I'm not doing five surgeries a day.

I'm doing like one a day with one person

that I have a deep relationship with, and

I want them to sort of live their best

life afterwards, right?

And that's where, you know, I have my

little moment in the operating room, say,

but then after that is where we can

really have a lot of impact too.

And so the most common and ideal

situation for me is that we meet with

somebody, they often have a baseline

knowledge, like let's say, pretend,

Robert, you're going to be a patient or

some point, you have a crazy, crazy

strong baseline knowledge, right?

And so great, let's take whatever you're

at, I'll meet you where you're at and

plug you in into this sort of like

forever turning wheel of like, what's

your, you know, get your genetic profile,

get your metabolic profile, get your

genetic and epigenetic aging and get just

get all the information that we can.

Then we have that for the long term span,

which is, you know, wonderful and

something you talk about on here a lot.

But then the unique part for me is that I

can also use that information to make

your surgical procedure better, make your

recovery stronger, make

the results last longer.

So I get to kind of use the baseline

knowledge that we're going to have for

this like little moment in time to make

it better and make it go smoother.

But then we also have the longitudinal,

you know, ability to impact your overall

metabolic health, longevity, health span,

however we want to word it.

And that is the most, like I said, the

most common and my most ideal situation

because it continues the relationship, we

get long term benefit, or get to like,

you know, cliche change

lives a little bit in that way.

In a way that's really positive.

Yeah, I have so much I want to ask you

this especially with regards to all the

testing because you just sort of, you've

just lit a fire under me and I just want

to go there, but we will get there.

Okay,

so I'd like to transition into talk about

aging skin next to that's okay.

Now, the way I see it, which grants is

fairly rudimentary skin health or or

youthfulness or maybe a combination of is

a combination of multiple factors,

including hormonal health

and function thereof, and then it's, and

its effect on collagen production, all

the way through to how did it how

effectively

mitochondria are of course working.

Of course, there's a

lot of overlap there.

But fundamentally, the way I view it,

it's a deterioration in these various

cell types and metabolic processes in the

body that then drive this sort of

deterioration in skin appearance.

Could you elaborate on maybe what's going

on in here and I suppose why skin quality

and tone deteriorate with age?

Yeah, absolutely.

So skin and this is a great place to

start because I mentioned a little bit

for like the soft tissues of skin fat

muscle being the most important parts of

facial aging, but it doesn't stop there.

We talk about facial aging so much

because it just as I'm sitting here, the

rest of me is covered and

you can see my face right.

If I didn't have a shirt on or I was

naked, you get to see

aging everywhere how it looks.

And so face becomes especially important

here, but face is also because of what I

just mentioned exposed to things that the

rest of our body isn't the skin there is

exposed to more UV radiation,

environmental

exposures, things like that.

So all of these add up

into what this skin aging is.

It is truly the window to our internal

health, no question about it.

But then it also kind of has this

double-edged sword because it's what it's

really affected by what's happening

internally, but also has this massive

external effect more than any other organ

system does really maybe

our gut you could argue.

But because we have UV

and environmental exposures.

And so you hit on it.

And I think that the most important cells

to talk about the actual cells of our

skin are called keratinocytes, right?

They make this protein called keratin,

which is our hair and our nails and the

barrier of our skin.

But then we also really need to focus on

a cell called the fibroblasts.

And fibroblasts become really important

because we know that their mitochondrial

health is wildly important to creating

the things you hinted at.

Let's talk about collagen and elastin.

Collagen is the hot one.

Everybody talks about that.

Collagen is the

structural strength of our skin.

It is important, but in my opinion is

less important when we talk about aging

changes or things we recognize than

something like elastin, which is a much

more delicate flower when we get into

these little skin fibros that kind of

hold things together.

Elastin is elastic as

the name would suggest.

It controls how our skin recoils after a

force is applied to it.

And it's wildly sensitive to damage from

external exposures, UV radiation.

It breaks down easily and

it's hard to rebuild, right?

This is where regenerative medicine

really comes in hinting ahead because we

want to rebuild that elastin tissue and

there's good ways to do that.

But then these fibroblasts also make

things in our extracellular matrix like

we've probably heard of hyaluronic acid,

which attracts water

and things like that.

So when we get into our skin aging, it

reflects what's happening externally,

which I've talked about a lot, but it

also reflects a lot of what's happening

internally with our internal metabolic

health, which meets in the mitochondria,

goes to those fibroblasts.

How well can they make collagen and

elastin and hyaluronic

acid in these very high demand

to turn on the DNA to make those happen

takes a lot of energy.

And so fibroblast is a very high energy

cell and it needs this

mitochondria to function well.

So when we have any dysfunction there

metabolically, our skin

is going to reflect that.

And this comes with metabolic health.

This comes with hormonal health.

This comes with external exposures and

our skin is that window basically.

Yeah.

I'd love to take a deeper dive into the

hormonal side of it in a second, but just

a question just jumps in mind.

What do you think about collagen

supplementation in general?

I mean, there's a lot of

back and forth on that.

I mean, a lot of people will just point

to the fact that it's you just ingesting

your amino acids, your hydroxyproline,

proline, et cetera, and that those are

then forming the base

amino acid profile of the skin.

Whereas other people and granted more not

people, but companies and studies will

often point to the fact that collagen

peptides have an immunomodulatory effect,

excuse me, and in doing so can actually

alter the way things like

fibroblasts are going to function.

Do you think collagen peptides are

effective or is it really just a

glorified amino acid supplement that's

helping to provide the role building

blocks for the skin in general?

Such a deep, good question.

In a nutshell, to answer this in one

sentence is I would say

it's a neutral to a positive.

There's the one extreme that is when you

digest any protein, you're breaking it

down to its amino acids, essentially

individual amino acids.

There may be some differences to that,

but they're transporting across the gut

barrier and they're getting reassembled.

From that end, collagen is a protein.

It's missing tryptophan.

It's not a complete

protein, but it's still a protein.

You have some nice

essential amino acids in there.

That would be the one school of thought

that is you eat it, you break it down,

and then you got to reassemble it.

Then I think that the other extreme that

a lot of people think and want to believe

is that you eat collagen, it crosses

across your gut intact and just goes to

your skin and all of a

sudden, "Wow, am I call it?"

Yes, exactly, which we

know that's not true either.

Like many things in life, there's

something more complex

happening in the middle.

Whenever there's two extremes, usually we

look in the middle for the actual truth.

We've been trying to figure this out

because you can't argue with those data

too much that are showing that taking

collagen improves your skin health.

There is evidence to show that.

Nothing is negative.

There's some unequivocal neutral studies

and there's some

positive studies to show it.

This is what the companies

want to hang their hat on.

You touched on this little

immunomodulatory part of

it within the fibroblasts.

That may be what this

missing link has been.

Well, we know that we probably are

breaking it down to some degree, but then

something's happening with the

fibroblasts themselves.

Again, I subscribe to this idea that

definitely isn't going to hurt.

Don't spend your life savings on it

because it's not something worth hanging

your hat on, but you're at least getting

a high quality protein minus one amino

acid that's essential.

You're likely having some small benefit

to your skin overall, especially when

you're pairing it with other things that

would increase collagen production.

If you're increasing collagen production,

you need the amino

acids to make that happen.

That could be getting into red light

therapy or anything

like that later on too.

Again, neutral to a positive.

I'll break the bank, in my opinion, but

it's likely to either do nothing worst

case or have some small benefit.

Yeah, no, I agree.

I think the only caveat to that would be

anyone who's taken

collagen to support muscle growth.

I think that's really probably pushing

the boundaries of

what's sort of acceptable.

I mean, just the losing content there

being so low and you're not going to

trigger mTOR and actually support muscle

growth in any way,

shape, or form, I think.

There are definitely companies out there

that are promoting specific collagen

products as being supportive of muscle

growth, but outside of that, I agree with

everything that you've just said.

I'd love to come back to talk about the

hormonal side of it for a minute.

Now, this is obviously going to affect

any aging individual,

but specifically women,

individuals who start to go through

menopause where they get the

sharp drop off in estrogen.

And now estrogen is obviously very

closely linked to the

production of collagen.

So I suppose this is very much in the

sort of regenerative wheelhouse.

But are you sort of looking at sort of

when you're sort of working with the

clients, specifically a woman, but I

suppose to an extent an aging male as

well when you're going to get this drop

off in testosterone because obviously

testosterone converts

into estrogen to some extent.

Does the HRT sort of conversation come up

regularly when you're working with

somebody to help them sort of maintain

the health of their skin?

Absolutely.

And so absolutely, yes, it does.

And I'm also going to use this at the end

of segue into a small conversation on

topical or like products to put on, which

is a conversation I actually don't love

having because most things

are snake oil and not helpful.

But I think this whole thing illustrates

some important points and our hormonal

levels and specifically our sex hormone,

like our sterile levels are wildly

important, estrogen being the main one,

but testosterone,

progesterone also play into it.

Estrogen is the wildly important one for

skin functioning as a true hormone,

crossing into the nucleus of these

fibroblasts and changing the DNA

regulation to make

more collagen and elastin.

And that absolutely happens.

And when levels decline and menopause

coincidentally is right around the not

coincidentally, but is right around the

average age that I see somebody for the

first time, usually kind of like as

though change, which makes sense, right?

There's aging is nonlinear for sure.

And this is probably the steepest decline

that we have is right around this time

for a female specifically in menopause.

Like you're saying, it

happens with men as well.

And so as we have a decrease in our sex

hormone levels, specifically estrogen in

our fibroblasts are and in our adipocytes

in our fat cells, we change drastically

change the skin everywhere.

And in our face, the fat pads of our face

change quite

dramatically around this time.

And doing something like HRT is a

conversation that I have that is I'm not

advocating to do HRT solely

for a facial aging standpoint.

But this is just a reflection of our

internal health, right?

So this is not just happening here.

And so I am generally

encouraging somebody.

Again, I have a team of for functional

medicine within my practice and whether

they're doing it with us

or with wherever they live.

It's a conversation worth having going

into a procedure and most importantly,

long term afterwards for keeping and

maintaining it if it fits in with their

overall health goals, longevity goals and

sort of their

lifespan and health spangles.

It is important.

And the best illustration of this, I

think, is this is my little switch over

to talking about topicals, right?

Which is, again, I don't love topicals.

I don't talk about them a lot.

I'm not a big fan of most of them, but

something like our retinoid,

a vitamin A derivative, right?

Vitamin A is a fat soluble vitamin.

And in the sense of our skin aging, we've

all heard of retinols,

I think, for skin aging.

It functions as a hormone.

And so it hits this star protein, this

stereogenic, yeah,

acute regulator protein.

That's kind of what the star protein.

But it's an excellent example of when

that little stereogenic, like, you know,

again, sex hormone mimic her when the

vitamin A goes into the nucleus, because

it's fast soluble, it can go in the

nucleus, it can upregulate, it sort of

replaces what estrogen

is doing in aging skin.

Right.

So it's a nice little hack, if you will,

to get around decreasing estrogen levels,

which happens anyway, to turn on some of

those genes that

upregulate collagen and elastin.

And so when I get the question all the

time, what are your favorite topicals?

Like kind of the main one I would point

out is a retinol, cheap, available, easy,

low risk and beneficial for being near

everybody who's having any

sort of skin aging happening.

And so it fits into that really well.

But it just illustrates what's happening

in our skin as those sex hormone levels

decline a little bit, does a really good

job of replacing or, you

know, working around that.

Yeah.

And Mark Ricton is saying that it's

increasing the turnover of the skin cells

within the fibroblasts.

Is that sort of

mechanistically how it's working?

Is that baby correct or not?

Yeah, so there's two aspects to how

hormones change what's

happening in our skin aging.

And turnover is one thing.

Turnover is a really big conversation as

we talk about thyroid

hormone, interestingly.

Next question.

Okay.

Yeah.

So that segues along to that.

So there's the turnover question.

And then there is the creation of these

skin fibrils or these glycosaminoglycans,

the extracellular things

that support our skin as well.

And the sex hormones

drive more of that production.

Collagen, elastin,

hyaluronic acids, things like that.

And they regulate those to make our skin

strong and elastic or to make our, even

our, like I said, I kind of hinted at the

fat cells of our face to make those

strong, structural, and volumous, right?

You can imagine the fat pads of our face

are meant to create shape and structure.

And if they get weak, we lose shape,

structure, and volume, right?

But then we get into cellular turnover.

And that is where something like thyroid

hormones, specifically our skin cells

have a receptor for T3.

And that is a wild

regulator of the cellular turnover.

And so it does a great job of

illustrating how important that is

because even in normal normalish ranges,

lower T3 levels that would be considered

normal can have impacts on our skin aging

by changing the turnover.

And that isn't just our skin.

It's our hair, it can be our nails.

We people that have truly low thyroid

hormone levels know that everything loses

luster a little bit over time.

Right.

Because the turnover time for, you know,

kind of going through all the layers of

our skin changes from a month or

something to two or three months.

It goes doubles or triples.

And so that turnover rate

is really, really important.

So thyroid hormone really,

really drives the turnover rate.

It also controls the creation of some of

the extracellular matrix, like, for

example, really low thyroid hormone over

time, we overcreate highly uronic acid in

our skin, which looks really bad.

It's called myxodema.

And it kind of it creates this sort of

like overly puffed skin look a little

bit, which sounds like it might be good,

but looks really unnatural.

And there's a little hint over to these

ideas of dermal fillers that people use

and kind of overuse to anti age early on

creates kind of a funny look over time,

they start to get puffy and inflated.

Well, that gets mimicked with thyroid

hormone levels when they're low.

And it's related to that turnover.

On the flip side, the retinols can again

help increase the

cellular turnover rate, too.

So we have double benefit there.

Not only are they just improving the

creation of fibroles, but they like

collagen elastin, but they're also

changing the cellular turnover rate.

So there is this interlap or this overlap

or interplay of what's happening between

the sex hormones and

something like thyroid hormone.

Okay, that's perfect.

Again, probably a bit of script.

Have you ever looked at the use of

topical thyroid creams at all?

I know they exist, but

they exist and they've been looked at and

they do have some effect

on skin health for sure.

And I think that they've been under

talked about or we don't talk about them

as much in overall health, because if

you're needing them topically on your

skin, there's probably again, thinking of

that all tissues have the same exposure

that there's probably

more of a systemic issue.

The same thing goes for estrogen creams,

actually, which we know can work as a

systemic absorption, but looking at those

specifically, it's going to help.

They have similar benefits.

But then we get into what's happening

with our overall systemic health and

those sex hormone or thyroid hormone

levels from an

overall systemic standpoint.

So yes, there certainly are topical

versions of them, but they generally get

more applied to an overall use.

Fair enough.

I suppose I'd love to start talking about

your specific process and the testing and

everything that you do up front.

But before we get there,

the longevity side of the equation,

specifically with regarding how you start

to look at an individual's mitochondrial

health from a sort of a generative

standpoint, what are your sort of go to

therapies or how do you sort of educate

people with regards to this sort of

health span longevity

side of the equation?

Are you a fan?

Do you sort of take people through a sort

of a dietary education side of things or

do you just are you a proponent of NAD

supplementation products like that to

support mitochondrial health in general?

Again, coming back from

this regenerative standpoint.

Yeah, so I try to tailor this with my

patients to where their interest levels

are going to lie and where what they can

like, I would say commit to or kind of

what you know what they know they'll

actually do because we could go crazy

with this and then if there's no

adherence, it doesn't matter.

And so again, a lot of people that I'm

seeing for the first time have a baseline

that they're doing really well with.

And so rarely are we

starting at ground zero.

It would be honestly kind of really fun

to have that situation where it's just

like educating from the ground up, but

everybody comes in pretty strong with

where their baseline is.

And so, you know, again, focusing on the

surgical portions of my practice, I am

often working with them from a

nutritional standpoint on like a fasting

protocol, doing more like

anti-inflammatory types of things, which

could be anything from looking at the

types of fats they're eating to, you

know, what their gut health is, right?

And so this is where it gets very

individualized into like, you know, as

any, I think, integrative or functional

medicine practitioner would do.

And again, I'm not

physically actually doing this myself.

It's like this connection.

And then it's like, I would, you know,

with that information, I'm like, okay,

great, let's chat with our team because

sometimes people are doing this at home.

They're not doing it with us necessarily.

But I'm, you know, just kind of guiding

whether it's their functional medicine

provider home or somebody in our

practice, like what we want to be looking

at going and what kind of information I

want and sort of what types of things.

So I love it when I

have patients on like it.

Let's call it a month

before their procedure.

We start, you know, lowering their

systemic inflammation very purposefully.

We start to go on some fasting protocols

or fast mimicking even types of protocols

to get them in a position coming into

surgery where they're already in sort of

a regenerative state.

They're mobilizing their stem cells,

their sort of metabolic health or their

mitochondrial health is

optimized as it can be.

And again, this is like going back to

this mindset of an athlete, right?

If Ronaldo was going to have a knee

injury on a set date,

we know it's coming.

It's going to be like Thanksgiving or,

you know, Christmas day or so.

I don't know, whatever.

We know that this injury is coming

leading into that known injury for this

athlete would be a whole bunch of prep,

you know, getting them ready, knowing

like, okay, before this injury happens,

let's make sure that

you're ready to recover before.

Yep.

And so I'm doing the same thing less

physically from like, you know, we're not

talking about an injury here, but from a

physiologic metabolic profile, I'm just

trying to get as much

time with them going into it.

And again, it can be some people are

really willing to dive deep

and have these big changes.

And that's the best case scenario

long-term, not just for our procedure,

but then, you know, others, it's more

just like, okay, let's educate you about

an anti-inflammatory diet and fasting

and, and kind of getting things set just

in that like little month or few weeks

leading into their procedure with me.

That's perfect.

And what I what sort of information do

you ideally like to see beforehand?

We mentioned this a bit earlier, sort of

the genetic testing specifically, but are

you taking, are you looking at any more

sort of detailed blood work or specific

or anything in that respect, or you've

already mentioned gut health, are you

doing any sort of organic amino acids

testing, GI map, stuff like that, to sort

of get this with your team, of course, to

get this baseline assessment up front?

What I suppose what I'm asking is what

sort of data do you really want to see in

a patient before they I

suppose go into the knife?

Yeah, so I might if we have their genetic

profile, that's great, because we could

open up a whole world of things that

we'll find within their genetic profile.

So I love having that information.

And that's great, again, from another

long term, definitely

systemic blood work.

That is the universal sort of layover

that comes everybody has their blood work

before surgery and that's the sort of

easiest thing for them to do at home,

we'll sort of dictate what we want.

And I'm looking at again

comprehensively at that.

But, you know, let's go back to our

discussion before about stress, you know,

I'm not getting direct cortisol levels,

but I can even see things like their CRP,

you know, like what's happening with

their inflammaging, they're just like

baseline inflammation.

And that's wildly important information

for me going into the procedure itself,

because that would be like a, you know, a

red flag, you know, glaring at us as

something that we need

to be able to go after.

And then when we start pairing, of

course, their lab work with their

metabolic profile, it even helps me

design things like their post-operative

IV therapy as to, you know, oh, great,

let's let's, you know, talk about any

nutritional deficiencies they might have

if we have that information or have a

methylate or all, you know, all the like

kind of catchy things that

that we see often, actually.

And so I can, again, they can take it

home with them afterwards as far as like

knowing it long term, but I can also make

that recovery better.

The fun thing to also get is if I can get

somebody's metabolic and genetic aging,

again, looking at their epigenetics,

that's a really cool, insightful piece of

information for somebody to look at

coming in, because like many things, it's

like you weighed yourself for the first

time and you have this baseline like, oh,

great, what, how, how is

this going to change over time?

And what can we do?

And I think, Robert, going a little bit

full circle, we can circle that back to

your one of your original questions is,

can the procedure itself change what's

happening with say, maybe their

epigenetics afterwards?

Yeah.

And so still to be determined there as we

get, you know, kind of collect more

information with that.

But that's something I'm super curious

about and paying really close attention

to, especially as we can get subsequent,

you know, follow up

epigenetics on people.

Yeah, you obviously, you obviously are a

fan of epigenetic testing.

And I've had a couple of chats with Dr.

Matt Dawson from True Edge Diagnostic.

I'm still back and forth regarding the

validity of the testing, I must admit.

I've seen more than one provider do the

old trick where they've sent in the same

sample on the same day, they've just

submitted two samples, and they've got

completely different test results back.

I've had that happen.

It's very, very similar.

Yeah, absolutely a brand outliers.

And, and, and I totally agree.

And I, you know, and that's why I even, I

view that as more of almost like a fun

part of this, you know, more than like

this essential aspect and, and it, again,

going back to like weighing yourself at

the first time is weighing yourself

actually important as a

truly reflect your health.

No, not necessarily.

But it's a piece of information that we

can like talk about, work at and in

there, you know, again, different parts

of it have different

validity, no question about it.

I completely agree with that.

But it gives us at least some metric to

follow based on I've experienced this

personally, where I've had, you know,

close together tests that were

drastically different from one another.

And like, well,

nothing changed that much.

But as we sort of get back on track, we

can kind of follow a

little bit of a baseline.

And, and it's interesting, though,

because I do agree with that completely.

Yeah, I think it's interesting data.

And I think that it just needs to evolve.

I think they have to be bigger

populations that need to be to be

assessed and the data then cross

referenced against against to sort of get

a true representation of what these

values actually mean.

And then can they actually at the same

time be sort of cross referenced against

more traditional lab that is potentially

where there is already that large sort of

depth of population data that sort of

speaks to their specific

specificity and

yeah, validity.

But yeah, I think it is, as

you said, interesting data.

And I think all data fundamentally helps

at the end of the day.

Dr.

Chesler, I'd love to talk about your

post-operative process, if that's OK,

something you've

already alluded to yourself.

Now, I suppose fundamentally, it's

probably one of your main USPs, one might

say, and that is what separates you from

the rest of the industry.

Now, I believe you use lots of H-BOD and

red light, but I'd be curious to find out

what other sorts of biohacks, and I hate

that word, or technologies that you're

using to help speed

up the healing process.

Fundamentally, what does your

post-operative process look like?

Yeah, so it's interesting because I break

this up, you know, if I'm being like full

transparency, I have an entire protocol I

go through, and I even think of it

through like levels of

evidence for myself, right?

What are the like slam dunk,

unquestionable, massive benefits?

What things are we doing that maybe have

like some data, but it's not as strong,

those data aren't as strong as, you know,

what other things would be.

And the anchor of that

protocol for me is H-BOD.

And hyperbaric oxygen therapy has

approvals from the US FDA for specific

types of wound healing and basically

helping tissue repair itself.

We know that that works well.

And it's interesting because that's not

readily adopted across

every specialty in medicine.

And to me, it's, it is the most powerful

anecdotally from what I see in my

patients every single day and has the

strongest evidence behind it.

But in a specialty, like say orthopedics,

they're not utilizing it as much, which

is very interesting because they could

wildly benefit from it.

And so that is the anchor, the mainstay.

If I could only choose one, that would be

the one I'm seeing the, you know,

frequency of that increase so

dramatically from when I started my

protocol and as it's developed over the

years, you know, went from, you know,

being a complete unicorn type of a

situation to especially with hopefully me

helping influence and educate.

Like a lot of, a lot of my colleagues are

now sort of like at least doing that one

thing, which is great.

And it's improving patient care and

outcomes and recovery time and long-term

results, which is really cool because

patients want to get better faster.

That's their main driver afterwards,

which is great because

it achieves that for them.

It helps their inflammation swelling

pretty dramatically in the first week or

two after the procedure.

I'm a bit obsessive and interested in the

long-term results of my work, right?

I want my

masterpieces to be great forever.

And so it's a great benefit there too,

because very uniquely it improves the

long-term results that we're achieving.

Let's say something like fat transfer,

which we haven't really talked about

much, but in almost every procedure that

I'm doing with the little procedures or

surgeries, I'm borrowing some of the

patient's adipocytes or their fat-based

stem cells or, you know, fat-derived

mesenchymal stem cells.

And I'm using them in their facial

tissues and the fat pads and the skin and