drchesnut hashtag performance

Collagen is overrated for anti-aging 😳 It’s an unpopular opinion that disrupts everything from the supplement industry (☕️ + 🐄) to the laser and injectable cosmetic industry (Botox, Sculptra, etc 💉) We have all heard the hype about collagen on all of these fronts - how it’s the magic key to youthful, plump skin. That, however, is a very incomplete picture that ignores the more vulnerable and more important aging fiber in the extra cellular matrix = ELASTIN! Collagen gives our skin strength. Elastin gives our skin elastic recoil, helping it snap back like a rubber band (quite literally). When you think of aging skin, do you think of the skin pulling apart and breaking or hanging and losing its resilience and elasticity? 🤔 Yep… exactly! 🎯 Elastin is the key 👑 As an illustration, SCAR tissue is made primarily of collagen (not elastin) so when the body churns out collagen without restoring or protecting elastin, we’re building rigidity rather than true flexibility. This is how many injectable biostimulators work, and how many devices and lasers work. Here’s the issue though: Elastin is more delicate of a flower in the aging process compared to collagen. It is more susceptible to damage from ultraviolet light and from oxidative stress, it breaks down easily, and it does so at a rate that outpaces collagen’s decline. Instead, I have to employ a sophisticated and progressive regenerative medicine protocol in order to help elastin regenerate preferentially to collagen during my surgical procedures and regenerative procedures, such as my laser cocktail. This is truly next level, not thought about by many. *Interestingly: Sculptra (PLLA) is a “biostimulator” that works by inducing a foreign body response, prompting your body to lay down more collagen. While that can create volume, it doesn’t regenerate elastin or restore your skin’s natural elasticity. Relying solely on collagen stimulation—like with Sculptra—may help mask volume loss to a degree, but it doesn’t match the unique biodynamics of our fat pads and skin, and it doesn’t recreate the function of elastin. Send this to a friend!📲 #drchesnut #collagen #thegreatunlearn @Cal Callahan

Hunter eyes vs prey eyes - these are 💯 internet created archetypes. Interestingly, they help illustrate something that I talk about all the time with the male upper eyelid - related to brow positioning and the brow’s interaction with the upper lid positioning and shape. When I assess, I am looking at the brow three dimensionally, not as much the brow hairs, but instead the positioning and projection of the brow fat pad. I’m also looking at the upper eyelid tarsal show (think of the plate area where a woman would put her eyeshadow), or lack there of, that is very common and desirable in a male upper eyelid. Interestingly, this is often distorted (in my opinion destroyed) during male eyelid surgery with improper assessment approach - giving a man excessive tarsal show when he didn’t have it in the first place. This is a key distinction between the “hunter eyes“ and the “prey eyes.” Eyelid shape is key here as well, from assessing the canthal tilt, or the angle and positioning of the inside of the eye in relation to the outside portion of the eye, as well as ptosis (drooping) controlling the actual aperture of the upper eyelid and the symmetry between the two. Neither hunter eyes nor prey eyes are inherently better or more attractive - as you can see from the images of both of these universally attractive men. The key here is that there are anatomical differences inherent in each person’s genetics that need to be understood, paid attention to, and in my opinion preserved to maintain somebody’s natural essence and look. Anything else is transformative. That’s when people’s character changes and what they see in the mirror is not what they are used to - which carries some significant content cognitive dissonance. From an evolutionary psychology standpoint, these subtle differences in eye shape can create or portray different associations of personality and psychological traits. This is why we do not want to change these associations! Do these resonate for you? . . #huntereyesvsprey #huntereyes #drchesnut #cosmeticsurgery #malecosmeticsurgery

Heavy brow + Botox + green screen goofin’ This is the wrong patient for Botox, this is 💯 genetic, yet neuromodulators (Botox, Dysport, Xeomin, Daxxify) are often the first option offered in these “I have lines on my forehead and a heavy brow“ situations, all out of a lack of understanding. We have to elevate our order of thinking - anatomically and three dimensionally! I discuss all the details in this video, using this lovely young woman as a illustration: A challenging forehead, brow, and eyelid situation in this beautiful 33-year-old = corrected with scarless (!), invisible, access EnigmaLift®️ procedures! 🤯 In somebody this young, it’s all about creating a relaxed, appropriately contoured look with everything natural from both a positional and volumetric standpoint. For me, this is about putting fat pads back where they are supposed to go! Scarless upper lids + invisible access brow + stem cell rich fat 🙌🏼 For a video of these results, check out #ameliaschesnutexperience (look on the right under ”reels”) She had tried Botox twice in the past, and it had failed miserably both times, giving her an odd eyebrow shape, making her feel more heavy in some places, and overcompensated in others. The misunderstanding that Botox is going to lift a heavy forehead like this is prevalent, even pervasive, but it’s quite simple logic that weakening the ONLY muscle that lifts our forehead is not going to provide a brow lift - in fact, it will do quite the opposite, instead causing the majority of the brow to drop, except for any portion that is overcompensating (which is usually the outside edge). 🖖🏻 This gives a very oddly peaked brow shape, commonly called “Spocking.“ Being respectful of her baseline and her age, we took a completely scarless approach to her upper eyelids, where I performed my completely scarless upper eyelid blepharoplasty (you will not see this that often, if at all anywhere else) and my scarless approach to a ptosis repair. All of this - quite literally without one visible scar or access! 🤯🙌🏻🪄 What are your thoughts? #drchesnut #foreheadlines #botoxinjections #foreheadwrinkles #enigmalift

Jen (60) from New York has found herself in a very typical situation that is common amongst many of my patients. She had a prior upper eyelid surgery at home, where the assessment and planning was lacked a comprehensive and cohesive foundation. This made her ultimate result very incomplete and dissatisfying. Her very significant brow asymmetry was not addressed, her eyelid apertures were not addressed, and today we are going to fix, revise, redo, and take care of all of the outstanding aspects with my EnigmaLift®️ approach! Let me know if you’d like to see part 2 with a 5 week update from Jen!👇🏼 . . . #drchesnut #endoscopicbrowlift #endoscopicsurgery #naturalresults #enigmalift

Does all filler migrate? The answer(s) may surprise you!💉 To answer this question properly, we need to go to a higher order of thinking about the fillers themselves, their composition, their mechanisms of action, and most importantly: HOW OUR BODY RESPONDS TO THESE PRODUCTS WHEN PLACED IN OUR FACE. The category of “permanent fillers“ includes things like silicone gel and polymethyl methacrylate (PMMA), non-biodegradable microspheres = acrylate beads that are part of Bellafill. These are permanent implants and cause a foreign body response from your body’s immune system - this walling off of the foreign body is often unpredictable and significantly limits their use… Or it should. Bio-stimulating, semi-permanent fillers include things like Sculptra and Radiesse. These create a controlled foreign body reaction from their active ingredients - poly L lactic acid and calcium hydroxylapatite microspheres, respectively. The controlled foreign body response means that after the body recognizes these foreign substances, our immune system is recruited with macrophages and fibroblasts creating a matrix around the foreign substance. This a more controlled response than with the permanent fillers. When I see this surgically, it’s often more of a matted down, concrete type of consistency without a gelatinous center. *I have a series of videos on Sculptra that shows what this looks like interoperatively, if you’re willing to look at some surgical footage. You can find this in my highlights. With both of these permanent and semi-permanent fillers, migration is very difficult after the initial injection phase once the foreign body responses are initiated, as they are relatively entombed and immobilized. That being said, not all filler migrates! When we think about the hyaluronic acid (HA) fillers, these are more typical for migration because they cause less of a foreign body response. Thus, they are not fixated in place and they can move through tissue planes. *I also have several videos of this, which you can find in my highlights as well. What questions do you have about it filler migration? . . #drchesnut #fillermigration #chesnutfiller #filler

Replying to @Dolly How do you improve ELASTIN in your skin?🧐 This is the much anticipated answer to the question that I was asked hundreds of times after my statement that COLLAGEN IS OVERRATED, and it’s actually elastin that is the key fiber to antiaging in our skin👴🏼 The answer used to be: nothing. Prevention and protection were the only solutions then. Elastin is a delicate flower, and it’s very acceptable to oxidative damage (smoking, metabolic) and ultraviolet light from the sun☀️ Interestingly, we now undoubtedly know that regenerative medicine stimulates the production of new elastin and recycling of broken down elastin tissue. A beautiful study showed that the injection of autologous stem cells derived from one’s own fat stimulates this exact creation and recycling of elastic tissue🧬 A various time frames after injection of these autologous stem cells into the skin, that sun skin was removed during a facelift procedure and looked under a microscope, revealing this upregulatuon. Importantly here, the skin treated in this study was not simultaneously injured or damaged, as we may do with a laser or other procedure - that type of combination makes the elastin regeneration even more powerful! Herein lies the magic combination, focused, controlled, and sophisticated injury and stimulation with something like a laser paired with specific growth factors and inflammatory modulation with regenerative medicine. I also received many comments that poly L lactic acid (Sculptra) does not only increase collagen when injected, but also increases elastin - more specifically a soluble elastin precursor called tropoelastin. There’s a caveat to this statement, which holds some truth, but the issue is that the creation is still out of balance to the overall desired benefit for our skin. The foreign body response leading to the inflammation from poly L lactic acid that creates new collagen stimulates all aspects of the extracellular matrix, including the Latin, just to a much smaller degree than it does collagen. This is out of balance, and it is not the same situation as a focused regenerative effort on elastin. What questions do you have? #drchesnut #cosmeticsurgery

Hunter eyes vs prey eyes - these are 💯 internet created archetypes. Interestingly, they help illustrate something that I talk about all the time with the male upper eyelid - related to brow positioning and the brow’s interaction with the upper lid positioning and shape. When I assess, I am looking at the brow three dimensionally, not as much the brow hairs, but instead the positioning and projection of the brow fat pad. I’m also looking at the upper eyelid tarsal show (think of the plate area where a woman would put her eyeshadow), or lack there of, that is very common and desirable in a male upper eyelid. Interestingly, this is often distorted (in my opinion destroyed) during male eyelid surgery with improper assessment approach - giving a man excessive tarsal show when he didn’t have it in the first place. This is a key distinction between the “hunter eyes“ and the “prey eyes.” Eyelid shape is key here as well, from assessing the canthal tilt, or the angle and positioning of the inside of the eye in relation to the outside portion of the eye, as well as ptosis (drooping) controlling the actual aperture of the upper eyelid and the symmetry between the two. Neither hunter eyes nor prey eyes are inherently better or more attractive - as you can see from the images of both of these universally attractive men. The key here is that there are anatomical differences inherent in each person’s genetics that need to be understood, paid attention to, and in my opinion preserved to maintain somebody’s natural essence and look. Anything else is transformative. That’s when people’s character changes and what they see in the mirror is not what they are used to - which carries some significant content cognitive dissonance. From an evolutionary psychology standpoint, these subtle differences in eye shape can create or portray different associations of personality and psychological traits. This is why we do not want to change these associations! Do these resonate for you? . . #huntereyesvsprey #huntereyes #drchesnut #cosmeticsurgery #malecosmeticsurgery

Lower eyelid retraction (pulling down) is a near devastating consequence of old-school, transcutaneous lower eyelid blepharoplasty (lower lid surgery with an incision through the skin and muscle).* Retraction is defined as a pulling down of the lower eyelid margin position. Some of the time, it is subtle, so much so that the patient often does not notice it until it is pointed out to them. In these cases, it is often just a shape change at the outside corner, which we call a lateral bowing. In some situations, retraction is more significant, and the lid margin is pulled down enough that you can see white (scleral show) below the colored portion of the iris. 👁️ This is where things get serious, as it can lead to issues with exposure of the cornea/eyelid surface and very poor aesthetics. Lower lid retraction dramatically changes the look and character of the eye. This character change is the most disturbing aspect for many patients, as they quite literally do not recognize themselves when they look in the mirror anymore. This was the case with our 33 year-old(!) patient who came to see me from a highly populated part of the country after having prior upper and lower eyelid procedures (amongst other procedures) with this devastating consequence. Because of her age and the strong emotional response and identity crisis that she was up against, I took a very complex, intricate, and multifaceted approach to correct or lower eyelid retraction SCARLESSLY! I did not want to add any more incisions to her lower eyelid than she already had, which would have been the easier and more standard approach. The portion you see here is one of the most unique - borrowing extra mucosal lining from the roof of her mouth (hard palate) to utilize on the backside of her eyelid as a spacer to create extra mucosa there, replacing the conjunctiva. *Because of this strong propensity for a transcutaneous lower blepharoplasty approach to lead to this retraction issue, I exponentially prefer a transconjunctival, or scarless approach to the lower lids. #drchesnut #lowerlidretraction #enigmalift

Replying to @AlleiBabe The Bjorn update you’ve ALL been waiting for! 🤩👇🏼 Bjorn (51 years old 🇩🇪) at nearly 2 months after my EnigmaLift®️ Where he’s at is very typical at this point with improvements still happening daily, and starting to see himself coming out of the chrysalis. Bjorn originally said “I’m tired of looking tired!” For any man like Bjorn, we have to work specifically to maintain his inherent identity and masculine look. We do not want perfectly smooth lower eyelids, we do not want to change the character of his upper lids. We nailed that with Bjorn!🙌🏼 As with many of my male patients around his age, Bjorn addressed his upper and lower eyelids with my incredibly minimally invasive male-specific EnigmaLift®️. This male-specific EnigmaLift®️ is mindfully crafted for men to be impactful yet incredibly stealth - focused on enhancing the masculinity that the eyes put out into the world. Before surgery, Bjorn beautifully articulated a key insight, explaining that while he felt incredibly energetic, his eyes and face failed to convey that vitality to the world. This disconnect creates a mismatch, leading to cognitive dissonance - a common phenomenon that many people experience without even realizing it. This is exactly what I fix! Far too often, men get feminized after an eyelid procedure, and much of this has to do with what’s happening in the upper eyelid and its interaction with the brow. This is where my EnigmaLift®️ excels, creating results that look natural and maintain masculine, “hunter eyes,” as Bjorn has. There is no room for error, yet this combination needs to be adequately addressed to achieve optimal results. There’s a razor thin line to walk here, which is why you’ll always see me doing my balance training 😉💪🏼 Follow along Bjorn’s complete journey from pre-op through his final results as we navigate the whole process with Bjorn and create some incredible and natural results! #drchesnut #maleeyelidsurgery #malecosmeticsurgery

Replying to @susanmarie276 Preliminary results *sneak peak* after Morpheus and Ultherapy didn’t give the results promised (stay tuned to the end) for Jen (60) from New York! In another common situation, Jen found herself quite disappointed after having had prior Ultherapy and Morpheus treatments promised to improve her aging neck. There are many of these superficial device treatments out there intended to “tighten,” but almost universally with an aging neck they are doomed to fail from the start, and Jen is a prime example of that. Like most people, Jen‘s real aging changes are deep in the structures of her neck, the musculature of her neck, the glands of her neck, and much less in the fat pads superficially. This takes a very particular type of rejuvenation correct, and even most superficial neck lift procedures fail with this. Through a minimally invasive route, the deep structures of the neck need to be addressed lifted, and shaped back to create a solid deep structure, directly correcting where the actual aging is happening. To boot, these superficial procedures can compromise the vascular and blood flow to the neck with the heat damage that they caused, which can compromise later procedures and increase complication rates. Even these seemingly harmless, yet misguided, attempts to correct an aging face carry consequences in the long-term, as is the case with everything in life. It is certainly better to just get it done properly the first time, especially when the degree of evasiveness can be custom tailored to exactly where you’re at in the aging process. All of that being said, we were able to revise and achieve a beautiful correction for Jen, and you can see those early, early results at the end of this video! This was part 2 for Jen, you can also see the portion related to revising her prior eyelid surgery, posted yesterday. . . . #drchesnut #plasticsurgery #endoscopicbrowlift #naturalresults

Kids don’t want to be distracted—they want to be included. As James Baldwin said, “Children have never been very good at listening to their elders, but they have never failed to imitate them.” Whether we’re skiing together, working out, or just playing around, I want my kids to feel my presence, not just hear my voice. That’s how I approach my entire life—an active, purposeful inclusion of what truly matters. When we lead by example, we create memories that last a lifetime, because they’re not just watching us… they’re becoming us. And yes, that same spirit of inclusion extends to the fellows who come to learn from me: they become part of my life - there’s no better way to master a skill than by being immersed in it, side by side, every step of the way. What are you thoughts? Tell me in the comments! . . . #Family #fitdad #DadLife #LeadByExample #drchesnut

First concert EVER, of any kind, for all of our kids We deliberated over this decision extensively. We wanted to make a core memory💭 We wanted to create an experience they would never forget. We surrounded this adventure with mindfulness and gratitude. Mission accomplished✅ Moments over merchandise. 🙏🏻 @taylorswift 🇨🇦🇯🇵 . . . #erastour #drchesnut #taylorswift #erastourtaylorswift

These are ALL tertiary (3rd time) revisions = fixing TWO prior procedure attempts that Mickey (76) had. That means significantly more complicated surgeries, more hurdles, more problem-solving, and more creativity! I do a lot of revision (fix it) surgeries, including especially complicated ones like this. The beautiful part is - these just make me even better with my primary, first time surgery patients! Mickey is absolutely lovely and traveled to me for this challenging full set of revisions with my full facial EnigmaLift®️ complex for her eyes, face, and neck. We were both very excited to reconnect at the 15 month mark here. Mickey’s eyelid revisions were very complex = requiring correction of size, shape, symmetry, position, aperture, quantity, and quality! What do you think? How did we do? The revision situation also creates significantly more challenge in the execution of each procedure from my end, and it makes the recovery more challenging from her end.
  Revision surgeries are more challenging from an execution standpoint, as the tissue that we are working with is not starting in its native position, and the quality of the tissue has changed from prior scarring and fibrosis.
  Mickey was beautiful to start, I am grateful for her and I have had a great time getting to know her. We both were very up for the challenge of revisions, working together (I love this situation!), and our relationship got stronger through this process!  With much of my work being revisions, I am very upfront about it - Mickey was beautiful to start, and I am grateful for her and have had a great time getting to know her. WELCOME TO THE NEXT LEVEL ®️ . . . #FaceliftExpert #NeckliftRevision #neckliftexpert  #DrChesnut #explorepage

Revising (fixing prior) 👁️ and further rejuvenating for Kim (62). As I review my journal entry from Kim’s procedure 5 months prior - this was a complex overall situation for her forehead, upper eyelids and brow after having had prior surgeries! She was left with significant asymmetry in her eyelids, brows, lips, and even chin. Our objective was to improve her overall brightness, essence, and symmetry to match her internal feelings of energy and bright curiosity, well not changing her overall unique look and facial characteristics. Kim very well illustrates how important the nuances and details are. Her brow and temples were fibrotic and scarred from a prior brow lift with significant a symmetry - I had to do completely separate procedures on each brow to normalize them. The same issue existed in her eyes, where certain fat pads were completely decapitated, scarred, displaced, hollowed, asymmetric and simultaneously herniating. Her lower eyelid positioning was similarly concerning and at a great risk for distortion and malposition after her old school, transcutaneous lower eyelid blepharoplasty that put incisions through the muscle and skin of her lower eyelid. I worked through each and every aspect of her upper and lower lids, step-by-step, piece by piece, in an incredibly minimally invasive and scarless way to replace, rejuvenate, correct, reposition, and strengthen. Very uniquely for her chin, I corrected the volume loss and asymmetry there m using her own, autologous tissue that I fashioned as what I call a bio implant. This procedure is unique to me, this is next level. What are the other aspects that stand out to you? Please let me know below 👇🏻 . . #drchesnut #cosmeticsurgery #endoscopicsurgeries #chinimplant