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 35: Chin Lipo, Kybella, and GLP-1s: A Perfect Storm | OR DIARIES
•Cameron Chesnut•Episode 35
In this episode, I share an OR Diary from a surgery on a 40 year old patient, which is very young for my operating room. She arrived as a perfect storm of factors, some she could control and some she couldn’t. Those factors included a genetic predisposition in her jaw and neck, weight loss and tissue changes from a GLP 1 agonist, and a history of Kybella and submental liposuction aimed at a problem that was never caused by fat in the first place.
We dive into how jaw size and the deep structures of the neck shape the lower face. I explain why energy based devices, fat dissolving injectables, and chin liposuction so often fail to address these structural changes. I also talk about how removing the protective layer of fat beneath the skin can leave the neck looking harsh and aged. Then I walk through the deep neck procedure we performed, the scarring and damage we had to work through, and the regenerative medicine we used to restore the area. If you’re considering neck treatments, wondering whether a quick fix is right for you, or curious about how GLP 1 medications can affect the face, this episode offers an honest look at what I see in the operating room when the wrong treatments come first.
TIMESTAMPS 00:00 - Intro 00:12 - A 40 Year Old in the OR 00:52 - Kybella, Chin Lipo, and a GLP-1 01:26 - How Jaw Size Shapes Your Neck 02:27 - Why Devices and Injectables Miss the Target 03:07 - The Problem With Submental Liposuction 04:34 - The Deep Neck Procedure 05:17 - Cleaning Up the Aftermath 06:35 - Why Catching It Early Matters 07:40 - GLP-1s and Accelerated Facial Aging 08:19 - Regenerative Medicine and Lasting Results 08:45 - 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.
All right, for my OR diary today, just coming out of the operating room with a 40-year-old patient, which is very young for me. And I think my biggest takeaway from her that I wanted to share with you guys was this mix of things you can control and things you can't control. She was a bit of a perfect storm to end up in my operating room at 40 years old. Admittedly, that's again very young for me. But she had a mix of genetics and aging and things that that got put on top of that. One of those was a GLP1 agonist that had some weight loss, and that led to structural changes, qualitative changes, all these things that we're defining.
That's a whole another fun podcast topic that's coming up. Also, some things that she had done very much in her control, as far as having tried kybella, and which is a fat-dissolving substance that people would inject under their skin that caused a bunch of inflammation and fibrosis and things like that. Then submental liposuction. This is what people call like chin liposuction, which just is makes this really bad procedure sound so gentle. Oh, it's just I had some chin liposuction. This is like sucking the fat out of your neck that you don't want sucked
out of your neck. And she's a prime example of this because when I say she has a genetic predisposition to sort of aging in her lower face and neck, a lot of that actually has to do with the structural contents of your neck. Very little to do with extra fatty tissue. And for her, that meant she had a little bit of a smaller mandible, little bit, nothing crazy. But our mandible, our jawbone, is like a horseshoe. And the bigger it is, the more it can fit inside of it. The smaller it is, the less fits. And so the contents of the floor of our mouth and our neck, which is sometimes like the base of your tongue, your glands, all the musculature that creates this trampoline-like floor, if it has a smaller volume to fit in, like you have a little bit of a smaller jaw, then it tends to sink down, drop down, and give like a fullness and a firmness underneath your neck. Pretty straightforward. Laws of volume and, you know, basically the necessary contents for the floor of our mouth.
But far too often, I see somebody with that genetic predisposition who has early aging changes, things are falling down a little bit. Um, they go seek these treatments sometimes. It's energy-based devices. Oh, I'm going to tighten that. You know, you're not going to tighten your way out of your genetic anatomy. Um, I'm going to use radio frequency microneedling or high-intensity focused ultrasound or injectables like kybella to try to dissolve the fat. Well, guys, this is not excess subcutaneous fat that's causing this. Uh, this these are structural changes in the neck. This is muscle and glands and the base of our tongue and things like that. Um,
or liposuction. This is the the worst one. Um, because liposuction takes the layer, the very important, I will say, layer of fat, just like Hybella does, between our skin and the superficial animation musculature of our neck. Yes, we have a muscle in our neck that helps us animate, helps us pull the corner of our mouth down. The fat between those two is so valuable. It gives a youthful softness to our neck. It's like a duvet cover, the blanket that kind of keeps everything underneath going on. When there's deep structural changes, yeah, sometimes those need to be addressed, even when you're young. Um, but the idea of trying to suck the fat out of that superficial layer when there just isn't any there in the first place is just flawed logic from the get-go. And that was very much the case for my patient today, who'd been through a lot of different things going on. Um, even her GLP1 agonist that she was on was slightly aimed, or at least in part aimed at the changes that she had in her jawline and neck that she attributed to being overweight. Um in reality, she is very much of a normal weight and just has some fullness there. And so, you know, ultimately we did the definitive treatment that she would have needed originally before she'd done all these other things. And we were dealing with some changes in some laxity and some tissue quality on top of that because of, you know, year or years of GLP use
on top of that. And so that procedure is a simple deep neck procedure where we actually go underneath those superficial animation muscles that I was talking about to the deep structure. And we lift, sculpt, and elevate the things. We basically like, I always say there's like a floor of a trampoline in there, it gets laxed with time or lax when there's extra contents on it. And so I'm basically trying to like lift and tighten the floor of that trampoline again so that we have everything elevated back up into our neck where it's supposed to be in the first place. That's the definitive treatment for this. It's not a device, it's not an injectable, and it's not submental liposuction. Um, so in that process, we definitively took care of what she needed done,
but then we're left dealing with all the aftermath of these other superficial treatments that were never, ever, ever, ever going to work in the first place. So now she doesn't have any subcutaneous fat between her skin and that very important muscle. And so it looks harsh, it looks skeletonized, it looks aged. Almost everybody who has submental liposuction tells me this at some point. Like, my neck aged so drastically from it. And it's like, well, it kind of literally did because that fat, you know, gets lost as we get older. When I have an older patient who I'm doing just a normal facial rejuvenation or neck rejuvenation on, I'm usually adding fat to that layer to give them that nice light reflection and softness and gentleness to that area as we lift all the substructural things underneath. So we want that duvet cover to be nice and soft and fluffy to hide kind of what's happening underneath. You know, it's we're not supposed to see all the substructural little striations and contents and um, and it's really challenging to deal with, especially when somebody's done multiple things like multiple rounds of liposuction or kybella and liposuction or a tightening device like a RF microneedling that just crushes the subcutaneous fat and the tissue under there and dehydrates it and and tries to contract it. And it's that's the wrong place to be working in the first
place. So anyway, a 40 years old is very young to need anything done in the first place. There can be a genetic predisposition if you, if I very fortunately find somebody who is early on in the process, like has literally legitimately has those genetic predispositions, hasn't done anything yet, it's a very straightforward and relatively simple process to correct what needs to be done before all these other issues come about with submental liposuction, cybella, energy-based devices, radio frequency, micro needling, high intensity, focus, ultrasound. Um, there's things that we can do beforehand. But what happened today is more commonly the case, um, which is that somebody tries all these other things first, they fail. Um, I've never seen them work. They don't work. They're just that's the flawed logic, it's the wrong choice in the first place, should have never been done. Um, but you know, you go to the spot on the corner where they have this device and do these injections, and they're like, oh yeah, that's fat. We'll just get rid of it for it's so easy. Everybody wants hopes that they're the, you know, unique unicorn, the one-off case where it
works. Um, but this is what usually happens afterwards. And I think very uniquely thrown in with her is this these other like accelerated aging changes in her face that came from GLP1 agonist use, which was partially aimed at that substructural change, that genetic change in the first place. She thought that she was overweight more because she had this fullness in her neck. Um, and so that's just a whole nother wrinkle thrown into this and a whole nother topic that we need to go into more. Uh, what happens to our face when we're on a GLP1 agonist? Um, but all in all, this there's a lot of take-home lessons from the operating room today. And um wish her the best, did some beautiful substructural work,
did as much regenerative medicine as we could to restore some of those uh damaged changes, flat out, damaged. It was so scarred, so stuck together. Um, it's just a mess, honestly, uh, when you're working through spaces that have been damaged like that. And so did a bunch of regenerative medicine to try to restore that area and get her back on a track that will last decades, literally thinking ahead decades and decades and decades for her with the procedure that we did today.
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.
