Eva Sheie (00:03):
The purpose of this podcast is simple. We want you to get to know your doctor before meeting them in person because you're making a life-changing decision, and time is scarce. The more you can learn about who your doctor is before you meet them, the better that first meeting will be. There's no substitute for an in-person appointment, but we hope this comes close. I'm your host, Eva Sheie, and you're listening to Meet the Doctor. Welcome back to Meet the Doctor. Today I'm really excited to have Dr. Cameron Chesnut back with me on this podcast, and he is a dermatologic surgeon in the Spokane, Washington area. Welcome to you, Dr. Chesnut. Can you tell us about yourself? 

Dr. Chesnut (00:48):
Yeah, thanks for having me. It's good to see you again. And like you said, I'm a practicing dermatologic surgeon whom I'm fellowship trained in facial plastic surgery, reconstructive surgery. I practice up in the beautiful Pacific Northwest in Spokane, Washington. I grew up in Coeur d'Alene, Idaho, which is right across the border. That's where I live. And my practice is, uh, a hundred percent cosmetic at this point, very travel based. Most of my patients are coming to me nationally or internationally, kind of via social media, finding me that way. But, uh, really love that aspect of my practice. It really allows me to choose the procedures that I really wanna do, choose my patients very carefully so that we have this wonderful, beautiful relationship and get to innovate and be creative in that space, which is a little bit of what I'm known for. 

Eva Sheie (01:33):
Your practice is called Clinic 5C. Can you tell us kind of what's behind the name? 

Dr. Chesnut (01:37):
Ooh, that's like the super secret name. The, uh, Clinic 5C. A patient from Austin actually asked me this yesterday. And to be fully honest, the real truth of the story is when I was trying to find a name, I wanted something really random clinic, something. I was thinking of a number or some noun or adjective. And I was like, well, I'll mix a number and a letter together. And I was like, well, my favorite number's always been five and I like the letter C. So I kind of put 'em together and then it turns out, well, there's five members of my family, myself, my wife, and my three little kids. And our practice had created this sort of five core values. So that's usually what I say it is, is the five core values of our practice. But in reality, it's probably the five Chesnuts. And I later learned that my dad, when he was a kid, his family had a business called the Seven C's, but they called it Cees and there was five brothers and two parents. So that was a total, I learned that like six or nine months later looking through an old photo album with my son. So I thought it was serendipitous and kind of fit. Perfect. So there's the long story between 5 C and it's really about our five core values. 

Eva Sheie (02:43):
It was back there in your memory somewhere. 

Dr. Chesnut (02:45):
Yeah, exactly. 

Eva Sheie (02:46):
What are the five core values? Can you tell us?

Dr. Chesnut (02:48):
Yeah, so I kind of actually love this. Our practice created these and I just had, we have about 40 some staff members. And so I kind of just had everybody throw in like, what do you think our values are as a practice? And when that happened, we kind of got to these five that really stood out, people worded a little bit different, but we kind of, uh, create them as like a heart of service, a spirit of innovation mindset of the next level goals of growth. And and all of those, like I said, came out of just what we had put together as things that we really liked. And you know, some of them like spirit of innovation that was like almost universal throughout our thing. And so it was really great. And the goals of growth, for example, that is more about like our interpersonal staff growth more than like a practice growth because you know, as I think many physicians will say, and anybody who's in a intense work environment is just like, well, these are your family, right? So we want everybody to flourish and be the best they can be. And sometimes that happens at work and sometimes that happens outside of work, but we want everybody to be their best. 

Eva Sheie (03:49):
It's nice when you can be the same person all day, whether you're at work or not at work. 

Dr. Chesnut (03:54):
Absolutely. 

Eva Sheie (03:56):
I'm starting to see a pattern among derm surgeons being truly innovative. And I wonder if you see that among your colleagues. Is that something that is happening in that space? 

Dr. Chesnut (04:08):
Absolutely, yeah. And uh, there's a little bit of like, uh, a history to that and every specialty has sort of its boundary pushers and people who have, you know, felt strongly and worked really hard for something that expanded. And uh, that's been really, really prevalent in dermatologic surgery and in facial plastic surgery, even just becoming a distinct specialty from plastic surgery, which was a really difficult task. And, uh, dermatologic surgery became a distinct specialty from dermatology, which is a really difficult task. So in my world, there's just lots of that room for growth and again, that, you know, spirit of innovation and I definitely have just always sort of had that mindset and I'm fortunate to have found a specialty where I can use it. It wasn't necessarily on purpose and some level it's probably what gravitated me towards these specialties, but I really, really love that and I love the ability to think creatively, apply those things, use my right and my left brain. And uh, it's a constant discussion with my fellows. I have two fellows every year who come train with me for a year and how do we innovate and progress in a responsible and safe way? So I've had a lot of people in front of me who've sort of laid that groundwork. 

Eva Sheie (05:17):
Well, you're setting me up nicely to ask you next. What are you innovating on now? What are you working on? 

Dr. Chesnut (05:23):
Most of the innovations that I work with are ways to make more traditional facial plastic surgical procedures, uh, a bit more minimally invasive while still achieving sort of the key outcomes and key end results. I found that when I was watching and training and learning about these procedures, I was very fortunate to train in LA at UCLA and, you know, I saw 30 some different surgeons and different ways that people thought. And I noticed that with time and with kind of becoming stagnant, people would just kind of cookie cut the same procedure over and over, whether the person needed more or less. They were kind of always performing the same thing. And I thought, well, that's sort of not where my brain lies. That's not how I like to work and think. And so I've kind of gone for this low hanging fruit, pareto principle, like the 80/20 rule where we can get 80% of our results with 20% of the input. 

(06:14)
That's a really great value proposition. And so that's really led me down different ways to achieve great outcomes. And you know, anybody who's sort of looked at my, uh, before and after results on social media or anything like that tends to see that. And a lot of it is just sort of understanding what those specific low-hanging fruits are to go after and how to get that minimal input to get to 'em. So, you know, a lot of facelifts without traditional incisions, with completely invisible hidden things, lower eyelid procedures with no scars whatsoever. So that's definitely the space that I am innovating and thinking about most. 

Eva Sheie (06:49):
Are you combining any unusual technologies together? 

Dr. Chesnut (06:53):
Yeah, absolutely. And this is, I would say if you were to like define me as a difference or what my brand or my shtick is, is very regenerative medicine based. And that comes from honestly just my personal interest as I'm talking to you from inside of a sauna right now. Um, I love this wellness and biohacking world. I'll get in an ice bath right after this and you know, I, I utilize all kinds of recovery modalities with my patients from hyperbaric oxygen to targeted IV nutrition to pulse electromagnetic frequencies, things to get them better faster. And that's just post-operatively, intraoperatively, I'm using a lot of stem cell-based modalities and growth factor-based modalities to try to help my patients get number one, better results. Number two, faster recovery and number three aspects of results that we wouldn't otherwise be able to get. Because if you're not pushing the regeneration, it's not often gonna happen organically. And so it's a whole aspect of aging that a facelift, for example, is not gonna address a facelift, can a address the amount of tissue and the positioning, but it's not gonna affect the qualitative, the quality of that tissue. And that's where I use a lot of regenerative medicine to help those other aspects. And it really fits into that minimally invasive thought paradigm that I mentioned earlier. 

Eva Sheie (08:03):
If you're adding all these extra things that most doctors aren't doing, it sounds like that also adds more value to the procedure? Is that a, an accurate way of describing what you're trying to do? 

Dr. Chesnut (08:15):
Yeah, absolutely. Like I said, I think that it really is targeting some of those aspects that go untouched. Whether that is just the recovery being faster, which for a lot of people is an important metric of success for me, I'm looking more at what the long-term results are, what that value add is, and these regenerative modalities add things that otherwise just go completely untouched. And so it really again, fits into that minimally invasive aspect. It does not add a lot of risk while it adds a touch of complexity and time to those particular procedures, that value proposition that you just mentioned is really high. Uh, when you look at the investment for the output.

Eva Sheie (08:56):
When you post about these things on social media, are you usually describing all of the things that went into somebody's before and after results? I'm just looking at some of these incredible photos here.

Dr. Chesnut (09:07):
Yeah, thank you. And I try to be as full transparency as possible with those procedures and let people know because the connection that happens on social media, sometimes it's just, "Wow, that's an incredible before and after photo", and that's great. But most often it's kind of recognizing aspects of what you're noticing and those patients that are on there. And so it's really helpful for people to know going in, well, here's some aspects and avenues. And I get a lot of people who have maybe already talked to other surgeons and in their consult with me, they're saying, you're noticing all these little subtle nuances that weren't even mentioned in my other conversations. And I think a lot of those are really what set those results apart from being a a minus to an a plus or something like that. It's those final little details, uh, which shall also add longevity. 

(09:55)
And so back to that value proposition, knowing that the important pieces of low hanging fruit are being picked, nothing is being left, but at the same time we're not reaching for anything that's sort of not worth the, the value or, you know, as people say that juice isn't worth the squeeze. So, you know, it's, it's really understanding those. And so I am very, very, very open with what procedures somebody had and what nuances. I don't know that I've ever done the exact same procedure twice. There's always some, you know, my fellows and I talk about these little 1% changes with every procedure and part of our pre-procedural timeout is, okay, well what are the nuances that we're doing a little bit different here so that everybody's aware of them from a safety standpoint and from a creative fund standpoint, I love what I do and that's one of the things that fuels me. 

Eva Sheie (10:41):
Where do the fellows come from? Like how are they finding you? 

Dr. Chesnut (10:45):
Yeah, so fellows are in their postgraduate training. They're already board certified. Oftentimes, they've already done a previous reconstructive surgical fellowship and then they're coming to me for a year just for cosmetics and just to kind of learn the nuances of these, you know, relatively intricate procedures and honestly more than operating, they're learning how to think and how to approach, which is great because these are very high level physicians and they are all smarter than me and they all make me think and discuss. And you know, to teach is to learn again. And it's a constant challenge. I can't do something without explaining it. And so there's, you know, those 1% changes have to have a lot of thought that goes into them, but they're finding me usually. And you know, we have a six month long interview process and it's very, very intimate. Any of my patients who have met me know my fellows by name also because they're just so involved. They're not physically performing the procedures, but they're again very involved with the thought processes and the care afterwards. And so it's a really intimate setting and it takes a lot of work, but it's sort of one of my loves is kind of passing on that higher level.  

Eva Sheie (11:59):
Thinking back to that value question I asked you earlier, I would think that having three of you, three minds looking at you and talking about how they're going to help you adds a tremendous amount of value to what you're doing. 

Dr. Chesnut (12:14):
Yeah, absolutely. It's multiple opinions and you know, you're getting their individual opinions, they're getting aspects of previous experience that they've had with me that they'll bring up, how is this different than, you know, the last thing? And so there's just, it creates a lot more of those moments of innovation and growth and, and all of those value propositions basically are all those core values of my practice that really highlights a lot of them and it definitely improves patient care. There's just absolutely no question about it. 

Eva Sheie (12:43):
Spokane is not a place that, uh, uh, people would describe as a destination or <laugh>. 

Dr. Chesnut (12:50):
Yes, 

Eva Sheie (12:52):
It is beautiful. Coeur d'Alene may be a little more of a destination than Spokane, but what does your team do to make it comfortable for people to come from out of town? 

Dr. Chesnut (13:03):
Such a great question, and it's something that we talk about all the time. When I trained in Los Angeles, my wife and I had our first child there. He was very young and we just, we discussed at least staying in Los Angeles just for the nature of what I was gonna do. And we both are from this area. And again, sort of fitting our core values and happiness and what we knew we'd want with our long-term life, we decided, okay, we're gonna move back to Idaho. It's beautiful, it's rugged, it fits our outdoor lifestyle and we're gonna build it and if we build that, they will come. We sort of knew that things were special and different and we knew what we were capable of. And so we came back and we did that. We build it and people come. And the more that happens, the more it snowballs because again, that value proposition is very high. 

(13:50)
People know what they're getting, they see the results, people are happy. And it's a lot of word of mouth now. So, you know, again, it's that old adage, if you build it, they'll come. We did that and it's interesting cuz a lot of people haven't been to this part of the country. It is so rugged, beautiful. My patient who is in town last week from the south spent, you know, the first part of her trip here, skiing at our beautiful ski mountain, kind of in a mountain environment, in a skiing, ski out situation. A lot of people that come in the summer have sort of a lake vacation. And so, you know, we have a lot of options for what that recovery period looks like because, you know, as you travel, you mentioned like, well, what does our staff do? Well, number one, everybody cares deeply. 

(14:31)
We have the whole logistics of the travel very frictionless, which is great for our patients. But then when they get here, it is truly like a deep relationship that we create and there's a lot of people involved and we know what expectations are. We are the next level. We know that we try to live that, we try to push what the next level is. Our patients definitely feel that. And so it's a bit of a different experience and you know, we try to deliver and make it a really, really special experience. And there's some logistic challenges that go in, but we have those very, very worked out and it's been a really great thing. It lets me meet a lot of different people, so I I love it. 

Eva Sheie (15:09):
I heard that Mark Wahlberg has a house in Coeur d'Alene. Have you been there? 

Dr. Chesnut (15:13):
Yes. Mark is, uh, 

Eva Sheie (15:14):
What? 

Dr. Chesnut (15:14):
Mark's a neighbor, <laugh>. He lives on the water in, in this little lake community, and we see Mark often out boating. He loves to boat. 

Eva Sheie (15:24):
<laugh>. I wasn't expecting you to say yes. 

Dr. Chesnut (15:27):
We have a lot of, oh yeah, yeah. We have a lot of celebrities in Coeur d'Alene in the summer especially. We have a a really, again, it's beautiful. There's no question why. And a few years ago it got discovered and you know, it's the Kardashians and Kanye and sports stars and all. It's a wonderful place. 

Eva Sheie (15:46):
If somebody wants to come see you, what's the best way to reach out? How can we find more information about you? 

Dr. Chesnut (15:53):
The best way is generally on social media, honestly, which sounds a little silly to say, but I only mentioned that because on social media, you'll find more before and after pictures than you'd ever wanna look at, which, you know, let's be honest, that's where the proofs in the pudding a little bit and that's what people are coming for. But there's also just a lot more on there about logistics of travel or my philosophy about aesthetics or myself, my family, whatever, whatever you wanna know, it's out there. And so it's a really great way to kind of get to know me and what you're gonna expect and how I think. And on there are sort of links to everything you need to know about actually getting a consultation because of the traveling situation. I screen everybody beforehand, in a good way screen with a photo screening, so they can get a pretty good idea of what we're gonna talk about, what the costs for those procedures. 

(16:44)
I'm very open with my costs, they're available on my website. You can go look, there's no secrecy behind that, but you can get an idea of what we might specifically be talking about based off of your individual concerns. That's totally free. And so you get a, a good idea and if you're like, okay, I like this, this is good, we can set up a time to chat. And that chat's usually like an hour very intimate at that point where at least, you know, trying to just kind of find out if it's a fit. And I tell people no sometimes and their screenings or in rarely in person at that point I've usually kind of worked out if I just don't think I'm the right fit or that sometimes they're just not a good candidate for what they want and I'll have to kind of, you know, educate them a little bit in that setting of like, well here might be a better set of procedures for you in my hands. And so it's a really great way to like kind of noncommittally get a feel for what's happening. And it's really a great way for us to know that if we are sort of both investing that hour of time to sit down and talk that we're on the same page removing in the same direction. And so that's all set up virtually. It's very, again, frictionless as that goes. And it's a really great way to introduce. But social media, again, that's that main way. Most of that's on Instagram, it's a way to look. 

Eva Sheie (17:54):
And that's at chesnut.md 

Dr. Chesnut (17:56):
Chesnut. Yeah. With no t in the middle of Chesnut. 

Eva Sheie (18:00):
Well thank you very much for sharing your story with us today and um, hopefully we can have you on again. 

Dr. Chesnut (18:06):
Absolutely. Yeah. 

Eva Sheie (18:07):
We can talk about fat some more and I see that you have some interesting ideas about what's happening with fat. 

Dr. Chesnut (18:13):
Yeah, fat is, uh, a passion of mine. I'm a fat aficionado and definitely, I mean that fat gets really into that regenerative aspect and I get a lot of questions based off my social media about if I'm anti filler, which is such a hot topic and I'm not anti filler at all. Uh, I just think that it's getting used often for as a sole strategy for aging and trying to cover a lot of aspects for which it is not suited to do. Like lifting, adding mass to something is not going to lift it up generally, it's going to weigh it down and we're not adding real mass adding gel-based mass. And so if we are thinking about little minor aspects of volume loss, filler can be really great on a larger scale with full facial volume loss. We'd wanna be replacing that loss Fat with fat and fat is highly regenerative, especially when done thoughtfully or properly. 

(19:04)
And so it really fits into that regenerative medicine paradigm for me. It really fits into that minimally invasive long-term results. And I use it a lot. And just based off my sort of tertiary referral part of my practice, I end up dealing with a lot of filler issues. I don't know that I do a surgery now, it's rare that I do a surgery or not managing some filler issue from prior where somebody kind of got down the filler road and they're 65 and they've been getting filler for 10 years and it's just way past what it should have been doing. So anyway, uh, side note of yeah, I love fat and I think it's a really great volume restoration option, usually as an adjunct or usually as a, uh, complimentary procedure to what else is happening. 

Eva Sheie (19:46):
Yeah, I I recently learned that some surgeons are helping people change the way that they eat or take care of their body ahead of surgery so that their fat can be in the correct condition to be able to be used or moved or preserved. 

Dr. Chesnut (20:00):
Absolutely. Yeah. It's sort of a natural selection process to make sure that that fat is as strong as it can be. And there's ways to do that sort of after harvest as well to kind of select for the stem cell dense portions of the fat, which is, in my opinion, the, the key to fat transfer success is what the stem cell density is. Now, thankfully, on the face, we can be really selected with the fat that we take. If I harvest a hundred ccs of fat, which is very minor in comparison to like a liposuction case where they're harvesting thousands of ccs, if I can take a hundred and I may throw half of it away or more and just sort of select for the quote, good fat quote, the, you know, kind of that high quality stem cell dense fat allows me to be really selective and that improves our outcomes. 

(20:46)
That makes it more, which is always one of the criticisms. It's unpredictable. Well, that's not true if it's, again, done thoughtfully, but when you're doing a body case flipping over from a facial case, you're trying to do a, a breast reconstruction or breast augmentation or a Brazilian butt lift, you don't have that luxury. You gotta take every bit of fat you take out and put it back in so they're not comparable. The blood flow and the recipient of our face is so different than it is on our butt. And, um, anyway, so it gets again, a little bit in the weeds, but fat is a wonderful regenerative volumizing long-term option for the face. 

Eva Sheie (21:22):
There are a lot of people who don't want to put foreign substances into their body at all, right? No matter what it is, be it filler or be it an implant, but are completely open to moving their own fat around. It's gonna be interesting to see how this changes over time and, and I, it sounds like you're at the front of figuring it out and making it work well. 

Dr. Chesnut (21:43):
Absolutely, yeah. And that's just part of that, you know, again, back to the values of, I see better results with it. So that's the main driver. But in that spirit of innovation, it's something that I talk about, lecture about, teach, and I'm trying to, you know, just educate my peers on what my experience is based off of, again, others' discoveries and how to apply it. You know, I, I really like the on the ground level thinking and most of my research, uh, and publications are about technical procedures and about ways to think about procedures more so than the basic science behind them. I like to take that basic science and, you know, put it in the operating room. So that's just where my passion lies. So I've learned that and I, uh, I nurture it. 

Eva Sheie (22:23):
I can't wait to see what you do next. 

Dr. Chesnut (22:25):
<laugh>, Thank you. 

Eva Sheie (22:30):
If you are considering making an appointment or are on your way to meet this doctor, be sure to let them know you heard them on the Meet the Doctor podcast. Check the show notes for links, including the doctor's website and Instagram to learn more. Are you a doctor or do you know a doctor who'd like to be on the Meet the Doctor podcast? Book your free recording session at Meet the Doctor podcast.com. Meet the Doctor is Made with Love in Austin, Texas and is a production of The Axis, t h e a x i s.io.