The 5 Codes podcast is hosted by Dr. Cameron Chesnut, a double board–certified physician and practicing facial plastic surgeon with a deep focus on regenerative medicine, functional health, and long-term human performance. Working at the intersection of performance and medicine, Dr. Chesnut brings a unique, practical perspective shaped by years of experience with high performers from around the world.
Despite disciplined lifestyles, advanced health practices, and even cutting-edge biohacks, many driven individuals still feel a disconnect between how they look, how they feel, and how they perform. The 5 Codes exists to bridge that gap.
Each episode explores the principles and tools that help people perform, move, look, feel, and connect as the most optimized version of themselves. Topics include longevity, regenerative medicine, metabolic health, recovery, aesthetics, and personal discipline - approached through a grounded, strategic lens focused on real-world application.
Designed for those who take responsibility for their health and believe their next level can be built intentionally, The 5 Codes is a guide to preserving your prime and optimizing performance in every dimension of life.
EP 29: Same Patient, Two Surgeries, One Wild Coincidence | OR DIARIES
•Cameron Chesnut•Episode 29
Use Left/Right to seek, Home/End to jump to start or end. Hold shift to jump forward or backward.
0:00
|
9:03
In this episode, I take you into the operating room for a revision facelift that turned into one of those "what are the odds" situations you couldn't script if you tried. My patient had a deep plane facelift eighteen months earlier on the other side of the country, and she came to me with a smile block and a visible line down her face that her original surgeon recognized but couldn't explain. The moment I saw her, I knew exactly what had happened.
We get into the technical reality of what a dehiscence is, why her zygomaticus complex had disconnected from its deeper anchoring layers, and how I approached putting it back together. The wild part is that my brand new fellow, on his very first surgery with me, had actually been present at her original procedure on the East Coast, and his old notes ended up guiding how I navigated her scarring and hardware. I also share why not all deep plane facelifts are created equal, how rapidly this surgery has evolved even in the past few years, and why revision cases play so directly to the way my mind works in flow. If you're interested in facial surgery, revision procedures, surgical decision-making, or what separates a good result from a great one, this one is a fun look at what really happens beneath the surface.
TIMESTAMPS 00:00 - Welcome 00:12 - A "What Are the Odds" Day in the OR 00:42 - The Revision Patient and Her Traumatic Experience 01:30 - Diagnosing the Smile Block and Dehiscence 02:24 - The Fellow Who Was There the First Time 03:32 - Notes That Guided the Surgery 04:44 - Not All Deep Plane Facelifts Are Created Equal 06:15 - The Six vs. the Ten Result 07:07 - Why I Love Revision Surgeries 08:13 - The Modern Era of Facelifting 08:58 - Closing Thoughts
ABOUT HOST Dr. Cameron Chesnut is the host of the 5 Codes Podcast and the founder of 5C, where he leads a team dedicated to integrative cosmetic surgery, regenerative medicine, and functional health. An internationally recognized facial plastic surgeon, Dr. Chesnut is known for producing natural, refined results that enhance rather than alter one's appearance. His approach blends surgical precision with biological optimization and disciplined restraint, drawing patients from around the world who value excellence, longevity, and holistic care. On the 5 Codes Podcast, Dr. Chesnut uncovers the mindsets and evidence-backed strategies he lives by, helping high performers perform better, recover smarter, and feel their best in every area of life.
DISCLAIMER The views shared on this podcast are my own and are not associated with, affiliated with, or representative of my clinical teaching role at the University of Washington School of Medicine. This content is for general educational purposes only and should not be considered individualized medical advice.
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.
Today's OR diary is one of those what are the odds type of situations. And it's coming to you from a very fun and unique location. I'm sitting here in one of our retreat homes right next door to a patient that I got to check on, one of my previous patients sitting over there, currently using the retreat home as our podcast studio. So worked out nicely getting to come from the OR, say hi to somebody, and then come over here and do this. But the situation today in the operating room was very, when I say what are the odds,
it was a patient who I was doing a revision surgery on. She had surgery about 18 months ago on the East Coast, way on the other side of the country, directly opposite to me, actually, up here in the Northwest. And I talked to her about six and nine months after her previous procedure, and she had a deep plane facelift, and it was just a traumatic experience for her. Traumatic experience and just the experience that she had after her procedure, ultimately the results that she achieved, which are not great, and how everything went down in that process. So when I first talked to her, she had telling me she had a smile block and these, you know, issues with her facial structure and didn't really know what was happening, her surgeon didn't really know what was happening, offered to try to fix it
for her, but couldn't really tell her what happened in the first place. And the second I saw her, I knew exactly what it was. She had a smile block, she had a dehiscence, which is a medical word for separating or pulling apart of the muscular and the apineurotic part of her SMAS in her face, which we call layer three of her face. They had separated apart based off the way it was dissected and not properly kind of put back together, if you will. And so there was a big line running down her face where that plane had been entered. It was just very obvious, very disturbing. She noticed it but couldn't put her finger on it. Um, and even had the ability to say, oh, well, parts of it were better. But here's the what are the odds part is I have a brand new fellow working with me. Um this is his first, literally first surgery with me. Um zero exaggerating there, first surgery. And he happened to be at her first surgery 18 months ago on the other side of the country, uh, which is very
like serendipitous. What are the odds? He was working with that surgeon and literally happened to be there that day, to the point of pulled up his notes because in the learning stage, he's I love this, taking notes about every single day that he's in the operating room, and pulled up his notes from the exact day that she had surgery and was able to tell me exactly what they did in surgery that day, like better than the OR note, because it was a student's eyes, a white belt mentality, like looking at everything anew. And so I learned that she had a brow procedure with her face that had failed and had bad kind of scarring with hair loss. And he showed me where the endotines, these like absorbable carpet tacks, were put in her scalp, something I don't use, but um, where they had been put in her scalp. And so I knew actually to go around them, if you will, because of his notes from being in the surgery that day. So it was pretty wild um to see that. And you know, it was interesting because as you know, he sort of sees the difference. He, you know, his first deep plane facelift with me is his whole comment was, This is so different than uh what
I saw before. And the surgeon he was working with before also has some great results and and um is you know a very great, you know, plastic surgeon, facial plastic surgeon, board certified in their specialty. Um, but not all of those things mean what we think they mean all the time. And it was very obvious to him. Uh, the seconds having seen a lot of other procedures to what sort of I'm gonna call like the modern era or the the new frontier of a deep plane facelift is, and this idea that not all deep plane facelifts are created equal. Just because someone's calling it a deep plane, is it a deep plane from 10 years ago or from five years ago, or honestly, even from two or three years ago? It's totally different than what's happening now. Um, nothing that I'm doing now is the same as it was when I was in fellowship, let alone 10 or five years ago. I mean, there's probably aspects that have some overlap now, but it's a rapid evolution driven by my obsession with my results and wanting to get better. And that was very apparent. It was interesting to see, just very apparent to um somebody who's been in the field, had a lot of exposure, then kind of coming for their first procedure here, and just like again, what are the odds that it was literally on a patient? It was a direct comparison present for both surgeries to get
to see that. And so, you know, it illustrates some of the changes that uh this person had in their face, some of the static changes that we were working to correct, um, you know, re-elevating things that weren't elevated, taking dehissed areas that had pulled apart and trying to put them back together. So I think the really interesting part for my fellow to see was um the different approaches, even just visualizing and understanding what was going on. For example, this patient with their previous surgeon, that surgeon didn't even know where their results had failed or why their results had failed, recognized that something was off, but didn't exactly uh put together why that failure had happened. And, you know, the second I saw it, I knew exactly, okay, you know, your zygomaticus complex is disconnected from its deep connection, layer three to layer four, um, and what's happening there. And there's you know a septum underneath that muscle that connects it to the deeper, you know, levels underneath or the different layers that we call them. Um and so an immediate recognition on one end versus really not understanding, which I think she very wisely kind of picked up on when she didn't proceed to do the revision offered to her, knowing that it was sort of just kind of like flying blind a little bit, not understanding. Um, but you know, again, for my fellow to sort of see, oh my goodness, like this, it's just a different approach and a different mindset and a different level of understanding uh that goes into this. And again, uh I'll beat this horse to death, but you know, not all D-plane facelifts are created equal. Um, you see a lot of people they get a D-plane facelift
and they get an improvement and they're thrilled with it. You know, it's that six out of ten result. It is what it is. Um, it's better, and that's all that they know. They didn't even know that there was a seven, eight, nine, ten type of result. Um, and that's where the new level lives. That's where the next level is, that's where we're getting better. And it's a it's a pretty progressive evolution. Um, probably something I should talk more about, actually, in and of itself, is like how deep lane facelifting and necklifting have advanced so much, even in the past year, two, three years, uh, even out to four and five years. When before that it just hadn't been changing as much. So a lot going on, a very interesting day in the operating room from a revision standpoint. I love revision surgeries. They're challenging, they're a different, um, a different level. When I'm visualizing through before revision surgery, there are a lot more avenues to go down because I don't exactly know what I'm gonna come across. It's a little bit of choose your old
adventure. I don't know what type of old permanent sutures I'm gonna find or what type of fixation devices, or where there's scarring, or in her case, hair loss and things like that. So uh it was really helpful to have my fellows' previous notes. Um, but you know, it it there's a lot more uh problem solving, which is like honestly my main job when I'm rolling along, is I'm so locked in, hyper-focused, inflow, and I'm problem solving the entire way along. And these are what this is one of my strengths in life, and as an athlete was my ability to do that. And a revision surgery really uh highlights that. It it plays to my strengths very much to be able to do that. When I do a primary surgery, I'm doing the same thing, I'm locked in. Um, but that's a there's a lot less variability in those types of procedures to go through until I come across old filler or an old device or old threads or something that the person had forgotten about. There's a little bit of choose your own adventure there sometimes too. But um, you know, I love these types of revision procedures. It was really great to be able to share that with my fellow and a really interesting, again, what are the odds type of situation to be involved with both of those and get to see the differences directly, same patient, same tissue, same approach, same um,
in this case, sort of like issue afterwards, how to fix it. And um, this is you know just highlighting the modern era of facelifting, which again, something I should talk more about. Maybe I'll do that next. Um thanks for tuning in, and I hope you enjoyed this diary of random things on my mind coming out of the operating room. I thought today was a pretty fun one and a bit of an eye-opener. And again, just what what are the odds? But 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
.png)
