Chesnut MD Cosmetics, 510 S Cowley Street, Spokane, WA (2026)

05/06/2026

Key factors to improve fat transfer success

I see people hesitate about fat transfer to their face when they’ve had it to other parts of their body (or even had it to their face at a different clinic) with results that were not what they expected.

Why?

It’s a fair question, and the answer comes down to understanding what factors going in to determining fat transfer success, and why the face is one of the best possible environments to put it in.

Fat survival is determined by a cascade of variables that just are not thought about enough. It starts with how the fat is harvested and prepared - I use a stem cell-dense fat fraction - because this stem cell concentration is likely the most important predictor of long-term success.

The stem cell density is determined both by where the fat is harvested from and how I prepare it after harvest.

Other regenerative modalities, like platelet rich plasma (PRP), also show evidence backed improvement in fat grafting results.

The key fat transfer success factors include:

🔹 Processing - stem cell-dense fat fraction through a specific, purposeful technique
🔹 PRP timing - placed into the recipient site after fat transfer, not mixed directly into the fat (which is the most common practice, but throws off your assessment of volume when actually performing the transfer)
🔹 Photobiomodulation - red light applied to the fat or recipient site pre-treatment
🔹 Placement - micro-aliquots layered across tissue planes for maximum vascular contact
🔹 Recovery - what you do in the weeks after (and before) directly influences fat transfer success

The face is one of the most vascular-rich regions of the body, thus fat performs very well there compared to areas like the breast or buttocks. When micro-aliquots are layered properly, each deposit has immediate blood vessel contact, and that contact is what allows it to survive and thrive.

Fat transfer success is the sum of every decision made from pre-harvest through the last day of recovery.

Send this to a friend 📲

05/05/2026

handed me his Iron Neck and it looked like a medieval torture device 💪🏼

I chuckled, put it on, got stable, started spinning, and followed Laird’s directions.

I use mine at home often (I think every surgeon should have one) yet this use was a bit different.

The Iron Neck is a resistance harness for your cervical spine that looks absurd strapped to your head (especially when there’s a ball attached to the other end) and feels just as funky the first time you use it, yet the results of producers are hard to argue with.

Most people‘s necks are under trained and injury-prone, especially considering how your neck controls proprioception and sets the entire postural chain below it - when it’s weak, stiff, or deconditioned, you can I have issues in your low back, shoulders, jaw, headache frequency, surgical recovery (my world), and athletic output. Some people stretch their neck, yet almost no one loads it.

The Iron Neck allowed me to load it easily, with rotational resistance, lateral resistance, flexion and extension patterns - it targets the deep cervical stabilizers that traditional training ignores, and I feel that when I train with it!

Interestingly: cervical proprioception directly influences balance, reaction time, and gaze stability, which takes things a step further than simple pain prevention - I consider this a performance variable that most high-performing athletes are just starting to explore.

I’ve been incorporating my Iron Neck for quite some time, but Laird’s adaptation put a different spin on it and elevated my use! When someone who’s survived decades of big wave surfing tells you how he maintains his body, you listen.

If you spend hours at a desk or in an OR or in a cockpit, if you’re a BJJ athlete or a skier or anyone who absorbs impact regularly, or if you just wake up with a stick nexj - this is low-hanging fruit.

Have you ever trained your neck specifically?

05/04/2026

Botox-free forehead wrinkle remodeling after a lifetime of a heavy brows and failed Botox.

This was challenging forehead, brow, and eyelid situation in this beautiful 33 year old = corrected with scarless, invisible access EnigmaLift®️ procedures! 🤯

You can see how her forehead has remodeled.

The harsh forehead lines (especially for a 33 year old) are gone.

These results are 8 months post, and after a lifetime of working hard, her forehead muscle straining is also starting to normalize!

She had my scarless upper lids + invisible access brow + stem cell rich fat 🙌🏼

She had this heavy forehead her entire life, and she noticed that the constant lifting of her forehead to compensate for her hooded lids and her heavy brows was exhausting!

This is common for me to hear.

She had tried Botox twice in the past, and it had failed miserably both times, giving her an odd eyebrow shape, making her feel more heavy in some places, and overcompensated in others.

The misunderstanding that Botox is going to lift a heavy forehead like this is prevalent, even pervasive, but it’s quite simple logic that weakening the ONLY muscle that lifts our forehead is not going to provide a brow lift - in fact, it will do quite the opposite, instead causing the majority of the brow to drop, except for any portion that is overcompensating (which is usually the outside edge).

Being respectful of her baseline and her age, we took a completely scarless approach to her upper eyelids, where I performed my completely scarless upper eyelid blepharoplasty (you will not see this that often, if at all anywhere else) and my scarless approach to a ptosis repair.

All of this - quite literally without one visible scar or access! 🤯🙌🏻🪄

05/03/2026

I don’t want “balance.” Balance is a fallacy. In reality, my life revolves around being at peak performance in all facets - everything is intertwined and integrated.

How I show up for myself affects how I show up as a husband and father, and how I show up for my patients in the operating room.

My overall stress load, whether it’s workouts, work, or family life affects my capacity in the operating room. My recovery is thoughtful and timed around key events, whatever they may be.

The work, the workouts, and the work to do all follow you home - everything is competing for time, attention, and mental space.

Sometimes that looks like the surgery you finish today transitioning immediately into the one scheduled tomorrow, mixed in with the patient you are helping with a recovery question at 9pm - colliding (most would say balancing) with the version of yourself that still needs to train strategically, eat well, sleep like you mean it, and show up in your most important role as a husband and father.

It runs a little bit like and internal navigation that runs quietly, all day, every day. Professional desire and responsibility pulling in one direction, personal recovery pulling in another, with Maslow‘s hierarchy of needs (quality food, rejuvenative rest, genuine connection, etc) mixed somewhere in between.

None of this is wrong, but none of it is balanced.

What I have learned in 12 years of diving very deep in the narrow niche of high-level, face only surgery is that peak performance in the OR is 💯 downstream of how I live outside of - zero question there, and zero compromise.

This is why you won’t see me having a drink anywhere remotely near a surgery, why you’ll see me strategically using Zone 2 🫀 workouts to still get sweaty while not stressing my central nervous system 🧠, or why you’ll see me sleeping, recovering, cognitively preparing, visualizing, and getting into flow state for a surgery like an obsessed zealot (because I am).

Where do you feel this in your life and craft?

I am curious what that looks like for other peak performers and others in this space.

05/02/2026

Scarless lift 🤯 at 3 months for Cory (52) - checking in from home after traveling from the Midwest for her Invisible Access EnigmaLift®️ (including some “filler fixing”).

Zoom in 🔎 she has no incisions in front of her ears, this is very unique.

At two months, the story was about reconnecting her appearance with how she feels inside. She was already seeing a face that matched her energy and presence.

At three months, that initial reconnection has settled nicely into a more permanent type of recognition.

She looks in the mirror and simply sees herself.

That was the goal! 🎯

Our plan for Cory was intentionally minimal when viewed piece by piece, yet comprehensive in the balance it restores. Everything was addressed without anything being overdone, utilizing my invisible access EnigmaLift®️ approach, meaning no incisions in front of the ears like a traditional facelift and no surface-level pulling to chase short-term change.

Her baseline is strong, which matters, because the face always reflects the underlying physiology and the way someone lives.

What she began to notice over time is something many fit women experience: gradual hollowing, subtle descent, and a mismatch between how vital they feel internally and what they see externally.

Looking back at photos, she realized that repeated filler and Sculptra had not solved the problem she was trying to solve. Her face felt puffy. She did not quite feel like herself.

This is often a window into the neuroanatomy of facial recognition and identity, where small distortions in contour and light reflection can disrupt the way we recognize our own baseline. None of her prior treatments were “wrong,” yet none of them addressed the deeper structural changes that occur with time.

My goal is always simple: help patients look the way they feel, especially when they are already doing everything right.

This is why Cory chose me, and this is why I am so intentional with every step of her plan.

More to come on her journey. Follow along here 👉🏻

05/01/2026

LED lights = asbestos?! 🤯 Flickering? Have you noticed the flickering of LED lights on your new phone’s camera?

You will hear more and more about this idea of “the junk food of lighting” relating to poor quality LED lighting with harsh spikes in the blue range and a high degree of flicker.

I think it’s pretty wild that the potential health implications of this poor quality light are being compared to asbestos by those furthest in the no, those studying he photo biology of how light interacts with our entire biology.

What are your solutions to offset this “junk light?”

Red light and near infrared light (I go into great detail about this in ), early morning and late evening long wavelength sunlight, incandescent bulbs, candle light, fires, and the emerging market of circadian friendly LED lighting systems (this is what I used in my own home).

When it comes to bulbs themselves, the entire game has changed. Incandescent bulbs are essentially extinct. The 2014 Nobel Prize in physics was awarded to the three scientists who made these highly energy efficient blue / white LEDs possible.

This makes it so we need to be a bit more thoughtful about how we approach our light, in my opinion, as we sort out the health implications of these spiky white / blue LED lights.

I have a thoughtful and more biology / circadian friendly lighting system in my home and even in my clinic / operating rooms. They vary by time of day and functional goal, meaning sometimes I’m wanting to be activated, alert and focused, so I have a type of light that reacts specifically with the melanopsin receptors in my eye to help accomplish that. Other times I want to start winding down, supporting my natural melatonin production, and I use specific light to help with that. All the while, I’m focused on creating the most natural, biologically friendly light environment that I realistically can in my life and profession!

If this interests you, you’ll love this episode of the 5 Codes Podcast!

04/29/2026

You have never heard this about facelifting before🧐

People think of facelifting as pure elevation, but that misses a key component - we should also be thinking three dimensionally and including the deep structure.

In my opinion, it is what people get wrong when thinking about having this type of facelifting surgery, and Archer demonstrates it well.

Archer’s previous facelift just pulled the superficial sinking tissues tight, but it ignored the laxity that was forming deep.

This gives a signature look that I see often in revision consultations - where the surface envelope is tight but the deep soft tissues are still sinking and bulging.

In full transparency, thinking exactly about it this way is a very new concept in the facelifting world, so it’s not to blame at all.

Facelifting has evolved from skin-focused procedures to SMAS procedures to deep plane procedures to preservation style deep procedure and now to this more comprehensive focus on all layers of depth, above and below.

Archer noticed laxity in a specific zone - the area around her buccal fat pad. Many would just cut out her buccal fat pad, but that wasn’t the right option for her.

Her superficial layer is tight - the problem isn’t on the surface at all - it’s her deep buccal fascia that is lax.

That deep buccal fascia needs to be elevated also, and that’s why Archer illustrates exactly where facelift surgery is heading next.

Her deep soft tissues are bulging against a tight surface because the foundation underneath is loose. That cannot be fixed by pulling harder on the SMAS (the usual solution). Her superficial layer literally couldn’t be any tighter than it already is.

The only way to address this correctly is through a thorough deep plane approach and going through the entire depth unit by unit (much like I do for each fat pad) - and then directly lifting and tightening what is actually lax underneath.

A standard approach risks exacerbating what she is trying to correct.

This is next level facial surgery, illustrating the thought process required to recognize and address where each person’s laxity and sinking occur.

04/27/2026

Wendy (63) is doing beautifully 1 year after a complex EnigmaLift®️ rejuvenation 👁️

Wendy had a complex and dynamic eyelid ptosis, upper lid aging with lacrimal gland ptosis and hollowness.

In addition she had significant lower lid aging changes with eyebags and midface descent.

These was corrected predominantly through scarless and invisible access approaches.

👄 Also take a quick look at her lips, rejuvenated with my LoveLift deep plane lip lift. A minor detail, and make be overlooked with her stunning eyes, but I love the contour from the middle of the lip to the corners.

(She was adamant not to do “too much” and that she still wanted to look like herself)

My stem cell rich fat transfer and laser cocktail were the finishing touches here 🤌🏻

What do you think of her results? Leave me a comment below!

WELCOME TO THE NEXT LEVEL ®

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04/26/2026

Archer is back for a second surgery, 18 months later. Why? We are now in a different chapter, still sharing the same vision.

The first time we worked together, we did a complete eyelid revision (literally everything we did was a revision/fix) 🤯

18 months later we are back to address her lower face and neck, tackling residual laxity from a prior facelift that I was looking unnaturally inflated prior by a meaningful volume of old filler.

I don’t always do it this way, but this was ultimately a planned, intentional, staged surgical approach. I did want to give her some time after her previous revisions to see if that relieved the cognitive dissonance she was feeling, and at largely did, yet she still had this one outstanding area, and the trust that we built with our previous procedure, along with the uncannily good results despite a challenging baseline revision situation led her to make the decision to finish her full facial rejuvenation!

18 lens was also our choice of timeframe - it has allowed her previous results to mature and settle. It sits in a range where the first results have declared itself, healing is complete, and the next chapter can be planned with full information. I find that 6 months is often too soon, yet that is a commonly requested timeframe when it comes for revision surgeries.

What makes this case particularly meaningful is the previous relationship that we have already created. We had a shared vision the first time, we nailed it, and we both are incredibly thrilled with the outcome. That trust does not have to be built from the ground up again - it transfers directly into the second procedure and makes every decision easier.

I do not participate in transactional surgical care - sorry I’m not sorry 😉 That type of a relationship doesn’t fill my bucket for satisfaction.

Her first revisional changes were nuanced, deliberate, and purpose not dramatic. The goal for this facelift revision is the same as it was the first time with her eyes: Archer wants to look like the best, most energized version of herself and have people not be able to put their finger on why.

Let’s go!

04/25/2026

Laura is 56, and she now looks how she feels 🔥

That phrase sounds simple, but in reality it’s quite complex to make happen in the way want.

For most of my patients, there is a gap between the energy, vitality, and identity that they carry internally and what they see in the mirror. Laura felt vibrant, engaged, and full of energy, yet she felt like her face was communicating something different.

That mismatch (cognitive dissonance/friction) is one of the most common things I hear, and it is one of the most meaningful things I get to resolve.

For Laura, we helped her appearance line up with how she feels inside.

She had a facial rejuvenation with my EnigmaLift®️ - her forehead, eyes and upper lids, scarless lower lids, midface, mouth, jawline, and neck. Every detail was addressed with the same goal: a durable anatomical improvement that communicates her inner vitality, and has no signs of surgery 🙌🏼

Laura’s eyes went from communicating disengagement and fatigue to helping us read Laura as awake, alert, present, and vibrant.

I believe this approach helps to differentiate the type of work I do far beyond being cosmetic, shallow, or superficial - this is working WITH your neurobiology. The signal Laura’s face sends to every person she meets has improved, and thus her interface with her entire world has improved. 🧠

Laura’s mouth is the other key axis - and admittedly this one is subtle but powerful. She went from a resting expression that read as frustrated or closed off to one that reads as warm, open, and approachable. People will respond to her differently now without knowing why. That is my goal - looking at her and knowing she looks better, yet not being able to put your finger on exactly what happened. That is one of my goals and standards for every procedure and every patient.

This result is also durable, meaning her anatomy has been structurally repositioned and restored. Laura is going to look this way for a long time. She is thrilled - and so am I.

Without it before photo to compare her to, walking around in the real world, you would never know she had anything done!

Follow her journey here 👉🏻

Chesnut MD Cosmetics

05/06/2026

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