Chesnut MD Cosmetics, 510 S Cowley Street, Spokane, WA (2025)

09/22/2025

🚨Controversial Topic🚨 Hyaluronidase damage treated with regenerative medicine for Daniela (22)

All the way from Peru 🇵🇪 6 months after treatment.

📷 Daniela sent these photos from home

What actually happens when hyaluronidase causes damage? 😳

This is an important point to to understand for all - many injectors and doctors don’t believe this happens.

Daniela had qualitative changes in the skin: sebaceous glands more prominent, blood vessel showing through, shelving of the subcutaneous fat… atrophy, darkness, shadows.

She had a genetic predisposition to lower eyelid bags, which is very, very common. This is the reason that she got filler the first place,

Daniela’s story is one that many can relate to: multiple cycles of under-eye filler placement, filler dissolution (hyaluronidase), re-injecting filler, and dissolving again.

Tissue damage like this is a hot and controversial topic, with many injectors vehemently denying that this can happen.

When I say Hot, I mean Hot. 🗣️😳

Read some of the comments that will come with this post.

In these situations, we have to look at Daniela‘s photos.

I undoubtedly see this in some - absolutely NOT with every use of hyaluronidase for dissolution.

This is NOT the norm, but it CAN happen. I have talked about this extensively, much to the chagrin and disagreement of many of my injector colleagues.

We used my SCARLESS EnigmaLift®️ eye bag removal and regenerative medicine protocol to do what filler cannot!

We addressed the underlying changes directly, stealthy, and durably.

We also used her own stem cell rich fat and laser to regenerate her tissue quality. 🙌🏼

I’m so grateful to Daniela for trusting me and sharing with you her journey! Follow along at to see more!

What do you think of her results?

09/20/2025

FULL REVISION 👀 long term follow up - fixes and improvement on the overall results of a prior eyelid surgery using my EnigmaLift®️ upper and lower eyelid revision surgery for David (58), from New York.

We are looking at the durability he is still enjoying nearly 2.5 years after surgery. *These photos were taken in New York*

In David’s case, it was the details that I highlight in these drawings.

Specifically for David, about 25 years ago he had an upper and lower eyelid surgery that “never looked quite right.” In fact, about one week after his initial eyelid surgery, he went back in for a small revision to his right upper lid, and even after that it was not right.

His prior upper lid surgery also removed much of the fat in his upper eyelids, contributing to this hollowness, or A frame, that he has now in his upper eyelids - along with the significant contour irregularity of his upper lid crease. We want a nice, smooth contour there, as in the after photo.

In addition to upper lids, the lower lid portion of that prior surgery skeletonized the inside portion of his lower eyelids, but left some bulging fat pads on the outside edge.

For our revision, we took a very minimally invasive approach to fix his upper eyelid ptosis, scarlessly. We also rearranged the fat pads of his upper eyelid, restored the volume and contour of his upper lids, improved his upper lid symmetry, reshaped the bulging lateral fat pad on the lower eyelids scarlessly, removed his filler, and replaced that filler with stem cell rich fat to optimize the volume of all of the areas around his eyes. We finished with my laser cocktail to strengthen his skin while also removing some dilated blood vessels on his skin surface!

What questions do you have? Drop them in the comments!

Male eyelid surgery, male plastic surgery, eyelid surgery, bleph, Dr. Chesnut

09/18/2025

Julie (53) 5 month follow up after an absolute *full facial* rejuvenation with my EnigmaLift®️ 🤩

Here we see before photos taken from home by her + before photos taken by me + versions in repose (resting) + dynamic, animated versions (smiling)

Her left brow… yes, this is more typical when I get a single photo from home, and it is part of the process in evolution. We have seen it stabilize nicely over time 🔬🔍

It’s also notable that she still has swelling under her chin - this is very expected and something that I talk about often when I talk about the different types of tissue and the pace of inflammation reduction. This is very specifically myositis, the muscles under her chin healing from lifting and tightening them, and it certainly hangs on the longest. The skin usually loses its inflammation first, followed by the fat pads, and muscle always lags a bit behind, which is what we are seeing here.

The healing process is approaching a more stable state around this timeframe, where things start to really improve, redness continues to fade, and swelling continues to go down.

Julie’s full facial EnigmaLift®️ rejuvenation =
-Invisible access brow support
-Upper lids *revision from previous surgery*
-Ptosis repair
-Scarless lower eyelids
-Face and neck lift - deep plane preservation style (you can already see the elevation of the deep structures of her neck: muscles, glands, etc)
-Stem cell rich fat transfer done my special way 😉
-My optimized laser cocktail
-Manual filler removal

As is typical, if you look closely you can still see swelling in key areas, namely in the muscular structures of her neck. (Myositis)

What do you think of her results so far?

Follow along her entire journey

Scarless surgery, neck lift, jawline contouring, facelift, browlift

09/16/2025

Every week, I see the long-term impact of filler in the operating room - and it’s not the simple, harmless, short story that most people are told.

1️⃣ Hyaluronic acid filler doesn’t just fade in 6–12 months. I find it in tissue decades later. (20+ years of use in the USA, longer overseas)

2️⃣ Filler migrates. It moves more than most people (and injectors) realize.

3️⃣ Those “tiny tweaks” add up… until you look in the mirror and don’t quite recognize yourself. This is called perception drift and has a strong neuroscientific foundation.

4️⃣ Dissolving filler is not a perfect, complete science. You do not get a clean slate or get out of jail free card - I truly believe some injectors don’t understand this. Filler type, placement details, and time all matter - a lot of the filler sticks around even after dissolution.

5️⃣ The more filler you’ve had, the harder it is for your lymphatics to drain. This is why swelling lasts longer in areas of filler, and this becomes especially important during a surgical recovery.

6️⃣ Filler pulls in water. Over time, as it breaks down, the extra volume it attracts is real, we’ve all seen the facial texture that creates.

7️⃣ Filler IS recognized by your immune system while it’s present, it does cause inflammation. I see it all the time with people who have a common cold, who go to the dentist, or who have a local allergic reaction. The filler pops up as well. Your body knows it’s there.

None of this means filler is always wrong. It just means we need to stop pretending it’s harmless and temporary.

That’s why I’ve built my practice around stealth, anatomy-driven solutions:
+ Stem cell-rich fat transfer
+ Minimally invasive lifts
+ Regenerative strategies for collagen + elastin

These work with your biology -for results that age gracefully and stay true to you.

Curious what might be right for you? Drop your questions below ⬇️

WELCOME TO THE NEXT LEVEL®️

09/14/2025

EnigmaLift®️ completely SCARLESS lower eyebag removal paired with my LoveLift deep plane lip lift with corner lift to revise and correct what she called a “filler mustache” that was distorting and weighing her upper lip down for 🙌🏼

The major challenge with her lower eyelid surgery was the prominence of her lateral (outside of her lower lid - see drawing) fat pad, which I always call the step child of the lower lid fat pads, as it is often neglected, under treated, or completely left alone by most surgeons.

It’s logistically challenging and technically difficult to treat.

When most surgeons address it, they tend to just cut it out, resect it, or cauterize it down, which I find leaves a suboptimal and under treated lack of volume at that outside portion of the eye.

I instead like to reposition that fat pad, helping to fix the hollow areas below, which introduces a significant amount of extra difficulty in the procedure, but also yields exceptional results!

That lateral fat pad alone is significantly responsible for the development of my proprietary triple fat pad fixation technique for those repositioned fat pads - all without any external access or scarring!

Her upper lip posed another challenge as it had had filler on multiple occasions that had migrated (which even very well placed filler is bound to do in this muscular area), and it felt like her upper lip was heavy, as though she was wearing a mustache.

Aesthetically, it also weighed down her upper lip and flattened out her Cupid‘s bow and vermillion border, distorting her anatomy.

A deep plane liplift and corner lift significantly improved that baseline anatomy and functional movement.

What do you think of her results? Tell me below!

WELCOME TO THE NEXT LEVEL®️

09/14/2025

Movement snacks? The actual purpose of these may surprise you 🤔

At specific points in surgery, you’ll see me step back and take what I call a movement snack.

Visitors to the OR are always surprised by it - but my team and fellows know it well. For me, it’s usually just a few bodyweight squats.

Why? It’s not about the exercise itself. It’s about the physiology and downstream neurochemistry.

This is all about peak performance! (The positive effects on surgical outcomes have even been studied)

Engaging my largest muscles releases a small burst of adrenaline. That adrenaline then binds to the vagus nerve - one of the most powerful conduits between body and brain.

From there:
⚡️ Glutamate release is triggered.
⚡️ Glutamate activates the locus coeruleus in the brainstem.
⚡️ This beautiful cascade sharpens focus, boosts adaptability, and primes neuroplasticity.

Here’s the key: I don’t need extra focus in surgery.

What I want is neuroplasticity - the ability to stay curious, nimble, and tuned in - so I can make the best decisions in real time, case by case.

This is one of my simplest strategies to level up every procedure I do.

A reminder that even in the most technical environments, the body and brain are inseparable and can be leverage to elevate one another. 💪🏼🧠

Have you tried anything similar to this before? Tell me below!

WELCOME TO THE NEXT LEVEL®️

09/12/2025

A scarless facelift? This is my Invisible Access EnigmaLift®️ - just 1 month after a my incredibly minimally invasive EnigmaLift®️ - browlift, deep mid face lift, and jawline lift 🙌🏼

Background: This beautiful, 40 year-old mother of 4 wanted to address her early aging changes in a natural and permanent way. A lot of people are turning to fillers and thread lifts at this point, both of which are short term and sub-optimal answers, at best.

I love what this minimally invasive, essentially scarless procedure did for her.

She has no scars in front of her ears, no scar under her chin (no midline neck work was performed), and no scars on her upper lids (see below).

She said, “My lower face and jawline are better than I could have ever imagined!”

I really love the brightness in her eyes, which was accomplished without any incisions on her upper lids.

Commonly, I will see young people have an upper eyelid surgery with incisions on their upper eyelids - and there’s a better way to do it!

That approach can unfortunately remove skin that didn’t need to go and ironically often leaves the root cause of the upper lid hooding untouched and uncorrected.

Here you see results achieved with an approach based on an understanding of that root cause, leaving no scars on the upper lids.

Follow her whole process through pre-op, the first week of recovery, all the way to final results at .

We were able to address all of her major areas of concern in a permanent, long-term fashion, while leaving no visible signs that we were there! No visible scars, no scars in front of her ears, a true EnigmaLift®️.

We also utilized my stem cell rich fat transfer for long-term volume restoration and she is utilizing my optimized recovery protocol to get her back on her feet in no time!

Truly: WELCOME TO THE NEXT LEVEL ®️

Scarless surgery Plastic surgeon Dr. Chesnut Filler alternative Threads EnigmaLift ®️ Endoscopic facelift

09/11/2025

NOTHING restores elasticity like fat-based stem cells. Period.

I’ve seen time and time again, and we have strong and beautiful scientific evidence to support it and show the mechanism of recycling broken down elastin and creating new elastin precursors. (PMID: 32459770)

Fat-derived stem cells injected into and under the skin don’t just volumize, they regenerate.

Here’s why I use them, and why stem cell banking excites me for the future:

🔹 Fat pads - regenerating existing fat, turning “on” and optimizing what’s already there, and restoring natural volume.

🔹 Structure + function - improving muscular support, not just surface changes - this means more natural facial movements and better communication.

🔹 Skin - the holy grail. True elastin turnover and recycling of broken-down elastin. This is what gives us strength, durability, and resilience over decades.
md and I team up in the OR to take regenerative medicine to the next level.

While I’m rejuvenating facial structures with stem cell–rich fat transfer, he’s also able to target joints with stem cell injections - helping patients heal, recover, and perform better inside and out.

What we can do today with stem cell-rich fat transfer is already unmatched.

What we’ll be able to do in the future with stem cell banking? That’s where it gets really exciting. 🚀

This is regenerative medicine in action - and it’s all part of my mission and obsession with not just staying ahead of the curve, but defining the front of the curve for my patients.

Welcome to the next level.

09/10/2025

1 month 👀 into recovery for Randi (45), who traveled from Colorado to see me 🧠

Randi’s surgery 👇🏻
We performed a very minimally invasive EnigmaLift®️
1️⃣ Scarless lower eyelid rejuvenation
2️⃣ Upper eyelid symmetry correction
3️⃣ Invisible access focal brow contouring
4️⃣ Scarless eyelid ptosis repair

I’m always grateful when patients are willing to share their journey in this vulnerable time, that is not lost on me! One month is challenging, you’re doing well and back to real life, yet you are undoubtedly still healing.

Randi saw significant benefits and is healing beautifully with help from my optimized recovery protocol:
Hyperbaric oxygen, pulsed electromagnetic field therapy, biocharger, NanoVi, targeted IV nutrition, red light therapy, the list goes on and on.

There’s nothing else like it.

Randi’s back story:
She long had been concerned about dark circles under her eyes - they have been there for as long as she can remember. Her story highlights why it’s so important to identify and understand underlying anatomy and the root causes of dark under eye circles.

Randi had tried filler and even placental matrix injected under her eyes, which actually left her with inflammation, bruising, and a kind of “iron tattoo” effect (hemosiderin deposition) from the breakdown of her red blood cells under her skin.

When we get granular with the causes of her dark under eye circles - her concern actually came from multiple sources:

🧬 genetic under eye coloration
🫀blood vessels showing through
☀️sun damage and pigmentation on her skin
💉purple discoloration from filler - this is common
🖤 post inflammatory discoloration from the injection of the placental matrix

This gave us lots to do!

This is where precision matters. My plan with Randi was not just to camouflage or cover up, but to directly RESTORE and REGENERATE her anatomy and tissue quality with invisible access techniques.

I am excited she is sharing her updates and outcomes 🙌🏼

What questions do you have?

Under eye circles, eye bags, scarless surgery, Dr. Chesnut, EnigmaLift®️, endoscopic surgery

09/08/2025

Why do some facelifts look funny? What leads people to consult with me for revision facelifts?

You have 💯 seen these, yet you may not have noticed… now you will!

I just had three back-to-back consultations with the same theme: “lower facelifts” that only grab and pull at the jawline to chase jowls.

This leads the some of the most dreaded, telltale signs of a bad facelift - things you have definitely seen:

👉🏼 A lateral sweep deformity, where tissue sinks over a tight “chin strap” below with a band pulled from the corner of the mouth, along the jaw line, to the ear. Often referred to as a “Nike swoosh.”

👉🏼 A pixie ear deformity, where that tightness on the skin and SMAS pulls your earlobe down and fuses it into the jawline. This one you have definitely seen, it’s all over politics and screens.

These are not rare. I see them all the time.

The result from the baseline thinking and approach. That approach is a SMAS lift - a myopic way of thinking about lifting the lower face with problematic outcomes.

The jowls and lower face do not live in isolation. They are the end of the road, and they are dependent on and tied to everything above them - from the brow and the temple through the midface and the buccal fat pad.

This is why my EnigmaLift®️ is designed to reposition everything in harmony. Quite literally fat pad by fat pad from their deep positional
surfaces.

Invisible or minimal access, yes - all still deep, structural, and comprehensive approaches.

Natural, durable, beautiful and long-term results come from restoring and repositioning structural anatomy, NOT PULLING on the surface.

What questions do you have about jowls and lifting the lower face? Ask me in the comments and I’ll answer as many as I can!

Plastic surgery, jowls, jawline contour, lower facelift, scarless surgery, endoscopic surgery

09/07/2025

Regenerative medicine at its finest!🧬

This is (primarily) a qualitative improvement using my regenerative focused, non-surgical approach to achieve her goals!

This can include a multitude of options, but most often entails my stem cell rich fat transfer and a version of my optimized laser cocktail.

This athletic mother and grandmother wanted to utilize non-surgical options to look as fresh and as spunky as she lives her life!

Our main targets were her skin pigmentation, skin ELASTICITY and strength, along with the static and dynamic wrinkles around her lips.

Her results are beautiful with minimal input.

I utilized my regenerative medicine protocol (which enhanced a subtle touch of upper eyelid volume) along with of my optimized laser cocktail.

This was paired with my LoveLift, deep plane lip lift to subtly enhance her lips shape and position.

WELCOME TO THE NEXT LEVEL ®

What do you think of her results? Tell me below 👇🏼

Lip lift, facelift, Dr. Chesnut, scarless surgery

Chesnut MD Cosmetics

09/22/2025

09/20/2025

09/18/2025

09/16/2025

09/14/2025

09/14/2025

09/12/2025

09/11/2025

09/10/2025

09/08/2025

09/07/2025

Address

Telephone

Website

Alerts

Shortcuts

Featured

Share

Category