Introduction

Dr. Cameron Chesnut 0:00

Welcome to the Five Codes Podcast, where we discuss evidence-based methods to elevate yourself to the next level through optimizing the way you look, move, perform, feel, and connect.

Things That Age Us Faster

Dr. Cameron Chesnut 0:12

Welcome to today's OR Diary. Today I want to talk about things that age us faster. And I'm going to get very specific in here because there are some interesting topics about. I really want to talk about the things that age us faster that we do expecting to be anti-aging, which I think is a very important concept. And it also ties into a little bit of younger patients having procedures done, which is a very hot topic that's changed through time, with people seeking procedures younger. And the question being, why? Because most of the time I'm telling people, no, you're probably not ready. But occasionally, like the patient that I'm talking about from this week, who was in her early 40s having a procedure done, it was very objectively, yes, you are a good candidate to have these done, where other people in her age group might not

A Patient's Story

Dr. Cameron Chesnut 0:57

be. And the interesting part for her is that part of that reason was because of some of these things that she had done trying to be anti-aging or address these little changes that she had had aging-wise that ended up exacerbating and leading her into an earlier procedure. Just there's no way around it. That's sort of what happened. And so I thought it was a really interesting thought exercise to go through why for her did she seek things in the first place? What did they do? Why'd they lead her to surgery in her early 40s? And it got gets into this topic of things that we can do to that I see aging us faster, things we can do to anti-age, then this unfortunate overlap of things that are sold to be anti-aging that actually I see age us faster all the time.

The Real Drivers of Aging

Dr. Cameron Chesnut 1:40

My real answer to the things that age people faster, you know, everybody's going to expect this to be like genetics, the sun, time. Those are all true. Those all do things. We can't control time. Uh we can't control our genetics, but we can certainly control like our, you know, exposures, right? Smoking, sunshine. Those are, they get down to a level of like physiology, metabolism, inflammation, which is the boring place that I actually love that my real answer goes about our best ways to be anti-aging. When I see somebody who's had, I've talked about this many times, major stressors in their life, major metabolic insults or inflammatory insults. They age faster. There's no way around it. Sometimes they're exogenous via the hormones they're giving themselves. Sometimes it's life experiences and traumas. Um, sometimes it's diet. But if I could really bunch all that up and you could be perfect in your anti-aging there, it would be, you know, be calm, be

The Anti-Aging Checklist

Dr. Cameron Chesnut 2:36

zen, um, have a great emotional and spiritual health, and, you know, keep your cortisol levels low, those your stress hormone levels low, keep your inflammation low. Eat real whole anti-inflammatory foods, not processed highly or highly processed, palatable, packaged things. Um, sleep as best you can. Get your exercise, um, keep your blood glucose and insulin levels down so that you're not getting glycated, you know, these we call them advanced glycation end products, AGEs, ages. Um, we want to keep all those things low. Those that's the boring answer, honestly. Um, but I see that all the time. Those things undoubtedly age us faster when you don't do them well. Just look around. You'll see that everywhere, right? All of those things tie up from somebody's traumas to their diet to their personal habits and decisions that they make. We become a reflection of all those decisions.

Seeking Surgery Young

Dr. Cameron Chesnut 3:31

But I want to talk more about my particular patient in her early 40s and the things that lead someone in their early 40s to have surgery. This is, you know, comes out all the time like, oh, the industry is like, why can't we just let people age gracefully? And I agree, let's let people age gracefully. Unfortunately, these things that become accepted as like early, oh, early little interventions that you can do often change the aging course. So yeah, if I have somebody in their early 40s come to me most of the time, I'm gonna tell them, you're not ready. We don't, you're, we don't need to do anything yet, or you know, the juice isn't worth the squeeze, things don't quite line up. But when it does, oftentimes there was something going on

What's Going On Underneath

Dr. Cameron Chesnut 4:08

underneath. Um, sometimes it's GLP1s, sometimes it's filler, sometimes it's a device that they had that they thought was going to be tightening for them. And all sometimes it was liposuction or chibella to take, you know, things out of their neck that they thought were were in excess. And these lead to earlier aging changes. Those last two are especially pertinent with the patient that I'm talking about, as is um uh massive amount of weight loss, you know, via a peptide. And so when we really look at what's happening here, these are important things to understand from an anti-aging standpoint actually causing aging. And these are some of these are really well marked out, some of these are more controversial. Um, filler would be one of those that I see. When someone's had

Filler and Aging

Dr. Cameron Chesnut 4:54

a lot of filler in their lips or under their eyes, um it they're more likely to have accelerated aging in those areas over time. Sometimes it's seven years down the road, and it's just from the filler properties apparently changing. There's no evidence to support that that's actually what's happening, but it's a very repeatable pattern that sometime down the road things change. They aren't the way that they used to be with the filler itself. It appears to be have more water attracted to it than it used to before. It appears to be in a different location than it was before. It just makes sense that it's changing over time. So we can argue the injectors will argue there's no evidence to show that, but we see clinical evidence that would highly support that. And I see it inside of tissue all the time. But in addition to those properties changing, which creates a physical, we call it a tissue expander effect. This is very well laid out in the literature. What happens when there's an expansion effect on soft tissue? It changes it. It changes the elastin structure, the collagen structure, the vascular structure of all these things. In addition to, and this is another hot topic, any little bits of inflammation that that filler might cause. Tons of screaming about filler doesn't cause inflammation, et cetera, et cetera. But when we really think about a lot of the things that we know about filler, especially those of us that are around it a lot, you know that if somebody has their teeth cleaned, their filler can get inflamed. If they have a vaccination, their filler can get inflamed. If their son gets strep throat and they're exposed to the strep throat, their filler can get inflamed. If they have allergic rhinitis, hay fever to pollen, their filler can get inflamed. We know that there's an inflammatory process happening around the filler. It's tender, it's red. A lot of people don't even notice that it's happening. They don't even understand what's there. But those inflammatory changes, those mechanical changes from the tissue expander effect can certainly cause tissue changes that we don't want happening in that area that could be interpreted as more rapid aging. Let's just leave that at that for what it is. Um when

Tightening Devices

Dr. Cameron Chesnut 6:52

we talk about this idea that like a youthful face is tight. And a youthful face is elastic, not shriveled and tight. That's the wrong thing. We don't want to be doing that. And unfortunately, a lot of these devices that are aiming at tightening are very significantly damaging the deeper tissues that are supposed to be structurally and supportive. We're going to come back to that later. Structurally supportive in their process of trying to tighten this envelope. So these could be ultrasound-based devices, these could be radio frequency-based devices. Generally, not our best ways to cause an anti-aging. And I often see the opposite, where there's a lot of like, oh shoot, now this area, the neck is quite messed up, or we've lost volume, or we've damaged subcutaneous fat that's so wildly important to our aging process, and the idea of trying to shrink and tighten. So we've got filler, we've got tightening devices. These are things that, and I've seen age people faster. I'm not saying they do it every time. I'm not demonizing these as bad treatments, but when they're overdone or they're used and they're misunderstood, or when they're used for the wrong reason, they're not great at uh anti-aging, let alone maybe making things worse.

Lipo, Kybella, and GLP-1s

Dr. Cameron Chesnut 8:04

My patient that I'm talking about from this week had always had some genetic fullness in her neck. And this had nothing to do with excess adipose tissue in her neck, excess fat in her neck. That was not what was happening in her neck. She had a genetic predisposition to have a little bit of more sinking of the contents of the floor of her mouth. She had a smaller jawbone. If you feel it, you immediately feel that it's firm. It's not squishy fat, it's like solid structure. So she had had liposuction, she had had kybella, and she had been on weight loss peptides, GLP1s, you would say. And with that combination of things that happened to her, her facial structure changed. Um, her neck looked super aged in comparison to the rest of her. And it had taken a lot of insults metabolically, physically, uh, that had been happening there. And so, you know, I will say this that this demonstrates

The Subtractive Effect

Dr. Cameron Chesnut 9:01

the subtractive effect of what anti-aging treatments can do on our face when things are taken away. Um, liposuction or surgery. Surgery can prematurely age us as well. That's really important to talk about that. Any surgery that has a subtractive mindset as far as taking things out, taking fat pads out around the eyes, above the eyes, under the eyes, we have to be really careful about those things because it's not that we're getting extra or excess, it's that things are out of place. This is why my entire philosophy revolves around instead

Repositioning vs. Removing

Dr. Cameron Chesnut 9:34

of removing it's repositioning, replacing, putting things back where they used to be, because we know that those fat pads didn't get bigger, it's that they changed position, lost structure. And we do we actually want to rejuvenate their structure, their size, and put them back in the wrong position, which is often some combination of a, you know, minimally invasive surgical option with some fat transfer, say to add volume and structure back. That's the magic recipe of my results, basically. But when it's the opposite, like let's go access this and take it out, we get problems. And I see people, especially around their eyes, who get aged prematurely. I'm not talking about looking funny or looking, I'm just talking about straight things that would be more of like an aged appearance, not an unnatural necessarily, but that make you look like you're 90 years old and are malnourished, right? That take fat out of your eyes and you'll see that real quick. Well, these other items of liposuction, removing things and causing inflammation with something like kybella or belkyra and in some other countries, um, or significant weight loss can mimic those structural effects in those key tissues. And that's what had

The Neck Lipo Problem

Dr. Cameron Chesnut 10:39

happened with my patient. Now, I think it's really important when I see liposuction in the neck, so rarely, so rarely is that person a good candidate for it. It's often situations like this. Um, it's it's it's exceedingly rare that somebody's like a great liposuction or kybella or belkyra candidate to just like, oh, you just have actually the only thing that's happened in your neck is extra fat. Let's just get rid of that. And you'll see that in the satisfaction rates around these procedures. It's like ultimately the skin on top of the areas just looks extra wrinkly and damaged and it's lost, it's lost its structural support underneath. Doing revision surgeries in those situations is exceedingly challenging because the connection of the skin and the fat is so wildly important and insulating. And when it's been separated or the fat's been removed or damaged, things get stuck together. The deep musculature that's not supposed to be touching the skin is stuck to the skin. These are regular occurrences. These things happen all the time, and it explains the superficial looks that you see where the skin looks quite different and the neck looks quite different, it does not look better after those types of treatments. I think the most fascinating of these is what's happening with our

Peptides and Facial Fat

Dr. Cameron Chesnut 11:45

weight loss peptides, right? Because if we look at the epigenetics of them and we look at the metabolic health, some of the signatures of epigenetic aging are actually reversed with this. If you look at patients with HIV lipodystrophy and their epigenetic markers before and after these particular peptides, they actually get better. So there's elements of these that are significant anti-aging, right? And you can't argue with the metabolic health that they're providing that is back to that at first thing I talked about, is helping control blood glucose and insulin levels. So there's that whole aspect of it that's incredible. But what they really point to is the importance of the structural fat in our face. The reason we don't want to remove it, whether it's with a drug, unfortunately, or with surgery. We don't want to remove it. That structural fat is so important. Everybody's heard of ozempic face or these things that are that are just describing this process happening. The face appears more aged with rapid loss of the structural subcutaneous fat that exists above and below the muscles of our face. Things look different. There's some new emerging evidence that gets into actual like skin health and potential aging-related changes to the skin health from these drugs, but that's very early on. This is just talking about what we see, these structural changes from these significant changes of facial structure, weight loss, and leading to sort of earlier needs for surgery, earlier seeking surgery. And this has been a pattern, not just related to these particular weight loss peptides, but that has just been happening anyway. Younger patients seeking surgery. And I guess, oh, you shouldn't do that. That's everybody's just seeking, you know what? It's not surgeons driving that

Younger Patients, Bigger Pattern

Dr. Cameron Chesnut 13:28

demand. It's the world exposing, you know, maybe for me, it's more minimally invasive options that make it like, well, maybe it's not as much of an initiation hurdle to get to that. And so, yeah, maybe it is appropriate to do this little procedure when you're a little bit younger to address this thing that is real and there, especially if it's been accelerated in a

Fixing It the Right Way

Dr. Cameron Chesnut 13:46

position like this. And that's exactly where my patient was in her early 40s. She had significant changes in these areas that were well beyond what an early 40-year-old would have. These were driven by these other elements in her life, whether it was inflammation, metabolic health, genetics for her was strong. Um, and then the things that she had done to try to address those other things. She had a genetic predisposition, she tried some things that had failed, and that put her further down the line. And so now here we are in her early 40s, doing a procedure that is essentially fixing what needed to be done in the first place, addressing the aging changes she's accumulated along the way, which are a little bit accelerated because of her genetics. And we're back to a new baseline that is like super minimally invasive to get there. It is a checkbox of all of these things. This is what she really wanted the whole time. Um, but it finally got to the point of like realizing that the other options were making things worse, right? And so finally eliminating the hamster wheel that was actually driving her backwards of getting on trying all these things that weren't working and getting her to a place where, okay, we have a definitive

A Definitive Answer

Dr. Cameron Chesnut 14:58

answer. We've decided it's worth doing it, the changes are real, you know, we're all on the same page, we're gonna keep it as minimally invasive as we can. And we get to this place where nobody will ever know that she had anything done, but she's getting that ultimate goal of hers taken care of. She's gonna look in the mirror and she will have that,

Mirror vs. How You Feel

Dr. Cameron Chesnut 15:14

you know, look in line with how she feels on the inside. This is her back again. What she was seeing was not quite literally not reflecting her internal feeling and matching her appearance. And that's a it's a frustrating, hard to describe place of cognitive dissonance, cognitive friction that almost all of my patients experience in some capacity, whether it's just normal, untouched aging, or in her case, a bit of accelerated aging from these other things. It's very disconcerting to look in the mirror and not recognize that person looking back at you. So it's kind of my job, at least how I view my job, is really trying to restore um what you're seeing in the mirror with how you feel. And most of my patients feel incredible. This particular um young 40-year-old had changed her life with these peptides and with her dietary changes, but then she had this like, you know, this almost like traumatic scar, if you will, on the whole process from these things that she had tried that didn't work. And I was part of that journey of undoing those, getting her to a new place and letting her move on with her life in her early 40s. So a very interesting tie-in of things that things that age us, things that age us faster, things that we expect to be anti-aging or make us look better that actually age us.

The Future of Peptides

Dr. Cameron Chesnut 16:31

So then getting into, I think, with a future with many peptides beyond just our you know FDA approved weight loss-based peptides, what are those going to do in the long run? We're learning so much about them. Um, and overall, we see big benefits with metabolic health. But we see these changes that are happening structurally, and um we need good ways to address them. And for me, that is often these micro or minimally invasive procedures and some good solid stem cell-rich structural fat transfer. And we're gonna we're gonna learn more about that. I'm constantly, I'm super curious about this and paying attention to it because we know that the facial fat, um, including the stem cells of the facial fat, uh, do change with these particular peptides. And that's a whole nother discussion beyond this, but I'm paying really close attention to that and the best ways to address this. And I think we're gonna learn a lot more about this in the future. And I think we're gonna see a lot younger people seeking surgery, especially because of these earlier things that they're seeking with results that either make things worse or don't accomplish what they're after.

Closing Thoughts

Dr. Cameron Chesnut 17:30

Thanks for staying with me. I hope you learned something from that and got some actionable items. If you have any questions or topics you would like me to explore further, please leave them in the comments. I read them all and they often help shape the future conversations here. I also want to be clear that the views shared on this podcast are my own and are not associated with or representative of my clinical teaching affiliation with the University of Washington School of Medicine, nor should this be taken as individual medical advice. Thank you for spending your time with me. I appreciate you being here, and I will see you on the next episode.