Realfoodology Podcast Summary

Episode: Botox, Fat Transfers & Microplastics: The Future of Clean Plastic Surgery
Host: Courtney Swan
Guest: Dr. Cameron Chesnut
Air Date: November 4, 2025

Overview

This episode explores the future of “clean” plastic surgery with Dr. Cameron Chesnut, a facial plastic surgeon who integrates principles from functional medicine and metabolic health into his practice. The discussion dives into the hidden toxins in the cosmetic industry—such as the problematic use of fillers, plastics, and phthalates—and the innovative strategies Dr. Chesnut employs to optimize patient outcomes and healing. The episode emphasizes a root-cause, health-first approach to aging, beauty, and surgical recovery.

Key Discussion Points & Insights

Dr. Chesnut’s Background & Philosophy

• Nutritional Roots: Raised by a nutritionist mother who was critical of industrial oils and margarine, forming the basis for his “countercultural” approach to medicine and surgery.
  • “My mom was a nutritionist… she said, ‘These [margarine and industrial oils] will not be in our household.’ That really shaped how I viewed nutrition and food.” [04:40]
• Patient Focus: He prioritizes high-quality, personalized care and invests heavily in pre- and post-operative protocols to ensure optimal outcomes, often pulling overlooked levers in recovery (e.g., environment, nutrition).

Fillers vs. Botox: The “Seed Oils of Beauty” (08:38–14:10)

• Filler Critique: Dr. Chesnut likens fillers to seed oils — widely used, poorly understood, and with more hidden risks than benefits.
  • “I think fillers are the seed oil of the beauty industry.” [09:09]
  • Fillers often accumulate and last decades, not months as patients are told. They can migrate, cause chronic inflammation, and are hard to dissolve completely.
• Botox Nuance: Somewhat less critical of Botox; though it is a toxin, it is broken down and does not accumulate. However, he cautions about its subtle neurological implications (blood-brain barrier concerns).
  • “I’m a little bit more neutral about Botox as opposed to something like fillers.” [09:09]
• Facial Movement Matters: Overuse of Botox or filler can diminish non-verbal communication and result in an unnatural look.
  • “We have whole areas of our brain dedicated to recognizing [facial animation]. If we’re taking that away, something looks off.” [11:06]

The Science and Practice of Regeneration (17:08–22:07)

• Strengthening Skin: Instead of weakening facial muscles or adding volume artificially, Dr. Chesnut recommends supporting the skin’s collagen and especially elastin through nutrition, sun protection, and “workouts for your skin” (e.g., microneedling, lasers, growth factors).
  • “Elastin is the elasticity, the recoil of the skin… we want to focus on things that rebuild elastin.” [12:56]
• Tools & Treatments: Microneedling, lasers, and topical growth factors (like PRP and exosomes) prompt the skin to regenerate naturally. However, he warns against overdoing these procedures, which can damage tissue and complicate future outcomes.

Alternatives to Fillers: Fat Transfer & PRP (25:38–41:28)

• Fat Transfer: Uses patient’s own processed fat (high in stem cells) to restore volume and regenerate facial structure, rather than merely “filling” space.
  • “Fat transfer comes in lots of different shapes... but when you really focus on fat as not just volumetric but also as regenerative... now you’re addressing the honeycomb structure and the volume all together.” [37:41]
• Source Matters: Quality and stem cell density of fat are prioritized over quantity, often harvesting fat from areas with highest stem cell content (near abdomen).
  • “A single-digit body fat person… will have really, really healthy stem cells in their fat.” [38:48]
• PRP and Regenerative Aids: Platelet-rich plasma (PRP) and other growth factors are helpful in certain contexts, especially for superficial textural improvements or early volume loss.

Surgical Outcomes: Philosophy and Technique (44:56–53:01)

• Patient Selection: Puts emphasis on introspection, realistic expectations, and matching intervention with individual needs. He often turns patients away for whom surgery is not truly beneficial.
• Natural Results: Minimally invasive approaches focus on rejuvenation, not transformation. Most impactful results often come from subtle work around the eyes and mouth to support natural vitality.
  • “Anything you do around your eyes or mouth is going to have a much greater impact on… perception to the world.” [48:31]

Toxins and Plastics in Surgery (53:01–78:40)

• Implants and Sutures: Avoids permanent implants, permanent sutures, and synthetic materials, favoring dissolvable sutures and using the patient’s own tissues when possible.
  • “I don’t use permanent sutures in the face, which is very atypical.” [53:33]
• Threads: Gives a “gigantic thumbs down” to thread lifts for lack of effectiveness and risk of complications.
• Operating Room Revolution: Actively removed plastics and phthalates (including Europe-banned DEHP) from his OR, seeking non-toxic alternatives for gloves, IV bags, gloves, and drapes.
  • “I went on this deep dive into what I could do to get these [phthalates, plastics] out of my operating room.” [73:24]
• Microplastics: Concerned about recent studies showing IV bags leach thousands of microplastic particles into the body.
  • “I just saw that IV bags and tubing are putting thousands of microplastics in your body.” [76:01]

The Recovery Protocol: Pre- and Post-Surgery Preparation (59:55–88:25)

• Patient Optimization:
  • Nutrition (anti-inflammatory diet, fermented foods, no alcohol, precision supplements).
  • Peptides and specific supplements (e.g., creatine, melatonin).
  • Sleep and circadian optimization.
  • Functional medicine testing for a personalized plan.
• Anesthesia Innovation: Avoids general anesthesia; instead uses targeted local anesthesia with light IV sedation (no benzodiazepines or opioids), preserving cognitive function and reducing inflammation.
  • “People are asleep, comfortable, wake up quickly or clear. And then the pain afterwards is reduced because… signal never gets sent in the first place.” [66:16 – 70:22]
• Healing Modalities:
  • Red light therapy, pulsed EMF, hyperbaric oxygen therapy (pre/post op), IV nutrition (using safe materials).
  • “Red light’s a huge part of my post-operative recovery protocol… there’s just the systemic effect on mitochondrial health and function.” [23:54]
  • “Hyperbaric oxygen chamber… accelerates healing, reduces inflammation… makes you feel better faster, and you get better results after your procedure because of it.” [86:23]
• Athlete Mindset: Dr. Chesnut prepares for surgery like an elite athlete—fasting, ketosis, sleep, visualization, mindful journaling, and post-operative recovery routines.
  • “I prepare for surgeries like my surgery tomorrow… I’ve been getting ready for weeks… Cognitively, physically, nutritionally.” [81:21]

Notable Quotes & Memorable Moments

• On the Filler Obsession Cycle:
  “The pendulum is swinging... there’s this ‘filler fear’ happening.” [33:10]

• On Surgery vs. Filler:
  “If you buy into ‘get it frequently, it doesn’t last that long, you can just get rid of it,’ ... that is 99.9% of what’s being told to patients—and it’s not true.” [26:00]

• On Clean Surgical Practice:
  “Do I want plastic tubing with these phthalates in it that I know are not good for me and that are accumulating? I’m not getting rid of these — or not quickly at least.” [73:24]

• On Healing and Environment:
  “When my patients come in, they stay with us… it’s beautiful, on the water, plants and mountains everywhere… and an extensive recovery protocol.” [23:54]

Timestamps for Key Segments

• 04:40 — Dr. Chesnut’s nutrition upbringing and its influence
• 08:38 — Thoughts on Botox, fillers, and the “seed oil” analogy
• 12:56 — Skin regeneration: collagen vs. elastin & UV impact
• 17:08 — How to support skin elastin production
• 23:54 — Red light and recovery protocols in practice
• 26:00 — The real risks and misconceptions about fillers
• 33:10 — The “filler fear” and perception drift phenomenon
• 37:41 — Alternatives to filler: fat transfer and its regenerative benefits
• 44:56 — Philosophies on surgery vs. non-surgical and turning away candidates
• 48:31 — The most impactful, least invasive rejuvenation procedures
• 53:33 — Rejecting permanent implants and sutures; the problem with facial threads
• 59:55 — Pre- and post-surgery optimization: nutrition, environment, supplements
• 66:16–70:22 — Innovative, less-toxic anesthesia methods
• 73:24 — Removing plastics and phthalates from the surgical suite
• 86:23 — The role of hyperbaric oxygen in healing

Final Takeaways

• Root-cause, regenerative approaches to beauty and aging are available and effective—integrating the best of surgery, nutrition, and functional medicine.
• Minimize chemical, plastic, and toxin exposure at every step for both patients and surgical teams.
• Preparation and recovery are as important as the surgery itself; optimize metabolism, sleep, and healing environment.
• Redefining the standards: Seek practitioners who work with the body, not against it, and ask questions about materials used and holistic outcomes.

Where to Find Dr. Chesnut

• Instagram: See @drchesnut for educational content and to begin the consult process.

This summary covers the essential content for listeners interested in clean aesthetic medicine, surgical innovation, and health-optimizing strategies for anti-aging and recovery.