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

03/21/2026

Collagen is overrated for anti-aging 😳 It’s an unpopular opinion that disrupts everything from the supplement industry (☕️ + 🐄) to the laser and injectable cosmetic industry (Botox, Sculptra, etc 💉)

We have all heard the hype about collagen on all of these fronts - how it’s the magic key to youthful skin.

That, however, is a very incomplete picture that ignores the more vulnerable and more important aging fiber (IMO) in the extra cellular matrix = ELASTIN!

Collagen gives our skin strength.

Elastin gives our skin elastic recoil, helping it snap back like a rubber band (quite literally).

As an illustration, scar tissue is made primarily of collagen (not elastin) so when the body lays down collagen without restoring or protecting elastin, it builds structure that is rigid rather than elastic.

This is how many injectable biostimulators work, and how many devices and lasers work, “collagen stimulation.”

Here’s the issue though:

Elastin is more delicate of a flower in the aging process compared to collagen. It is more susceptible to damage from ultraviolet light and from oxidative stress, it breaks down easily, and it does so at a rate that outpaces collagen’s decline.

Instead, I have to employ a sophisticated and progressive regenerative medicine protocol in order to help elastin regenerate preferentially to collagen during my surgical procedures and regenerative procedures, such as my laser cocktail.

*Interestingly:
Sculptra (PLLA) is a “biostimulator” that works by inducing a foreign body response, prompting your body to lay down more collagen. While that can create volume, it doesn’t regenerate or restore your skin’s natural elasticity. Relying solely on collagen stimulation (like with Sculptra) may help mask volume loss to a degree, but it doesn’t match the unique biodynamics of our fat pads and skin, and it doesn’t recreate the function of elastin.

Send this to a friend!📲

03/20/2026

If I had 3 months to prepare you for a facelift (or any surgery), here’s exactly what I would focus on.

This is a different mindset that most people never hear - the best surgical results start long before you or your surgeon are in the operating room. The window to optimize starts months before you ever get there and opportunities exist in the daily decisions you make leading in to your procedure.

Your surgeon, the surgical technique, and the procedure itself matter enormously to your results, yet there’s a bit more to it that you can control. Your physiology, your metabolism, your immune system, and your overall biology is doing all of the work once that procedure is done.

Your baseline tissue quality, metabolic fitness and flexibility, your baseline systemic inflammation your baseline tissue quality, collagen and elastin structure, vascular tone, immune response, and even your muscle mass all contribute to both your recovery and your long-term results.

Your condition going in helps to shape everything that comes out.

A skilled surgeon matters. Primed metabolic health and a strong baseline physiology matter just as much.

When patients do this work before their procedure, they heal with higher quality, recover faster, and their results are better and last longer.

This is the standard I hold for myself and my patients, we are a team, and it’s a part of why our outcomes look the way they do. 🚀

What questions do you have? Ask me in the comments!

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03/19/2026

Everybody is removing buccal fat… but should it actually be removed? 🤔

One of my overarching surgical philosophies centers on replacing and restoring structural anatomy instead of cutting it out and removing it.

The buccal fat pad is no exception, and it actually illustrates this reasoning very well and illustrates how my mindset contrasts a bit with what typically happens = removal.

This small fat pad plays an important structural role - it functions like a buttress.

Simply cutting it out can disrupt the natural architecture of the face.

Restoring and redistributing volume to recreate the face’s natural structure is a MUCH better alternative in my thought process, which is thinking ahead in decades about the outcomes I’m achieving and their durability.

🎧 Curious about the science behind facial fat and structure?

Comment “FAT” and I’ll send you the full episode!

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03/18/2026

4+ YEAR follow up after my signature EnigmaLift®️ eyelid rejuvenation 👀

Approaching this from a neuroanatomy standpoint, we wanted to create what is now a perfect, crisp, even and symmetrical upper lid crease with her youthful volume maintained and evened. It is very difficult to achieve without addressing all of the moving parts.

This communicates vibrance in her eyes. These subtleties make all the difference!

For her lower lids, I took a completely scarless approach to reposition her eyebag (periocular) fat pads and correct her tear trough. Scarless 🤯

We finished her treatments with my gentle Laser Cocktai.

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

*There IS make up in this after photo, yes. This is the nature of long-term follow ups, especially when we’re talking years later like this (4+ years here).

I am just so thrilled to see these wonderful and important people in my life back at any of these time points! I’m not hounding them to take their makeup off in these situations 😉

It may take a little “vision“ to see past it - if you’re attributing these results to make up… I’ve done my job perfectly. If you can’t see past it, my apologies.

Ready to start your journey? Click the link in my bio 🔗

WELCOME TO THE NEXT LEVEL®️

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03/17/2026

THIS OR THAT: FACIAL PLASTICS EDITION💉

Agree or disagree? Tell me below 👇🏻

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03/16/2026

Laura (56) is looking as vibrant as she feels, 9 months after our refresh - here is a focus on her eyes.

Laura now looks in the mirror and sees something she loves, something that is cohesive with her values, and there are no signs that anything was done.

Laura and I achieved this goal - to look how she feels (which means she looks incredible and vibrant) - and she got there quickly, efficiently, and reliably through my fully customized plan for her.

This is why we are focusing on her eyes here. They are undoubtedly the most important area for our interface with the outside world, how we affect our environment, and how we ultimately perform and are perceived.

This is the most common thing I hear from my patients: they look in the mirror and it doesn’t match their expectations, it doesn’t match what they feel inside, and sometimes it even seems to have happened quickly.

This is frustrating, and on a very core neurobiological level it creates cognitive dissonance and mental friction. We want to remove that dissonance and friction.

Our entire project together sends you skyrocketing forward with that friction removed, and it does so with an experience that is incredible, completely next level in every single step of the process, and with results that will be durable for your decades ahead.

From preparing you for your procedure and my
neurocognitively 🧠 protective anesthesia protocol through your optimized recovery and your incredible long-term results - there’s nothing else that can make you feel this way and give you these types of results.

You will feel like the most elite professional athlete.

It certainly isn’t for everyone, you have to value these types of results and this type of process.

For those that understand, there’s nothing else quite like it.

If you’d like to see her pre-op and post- op videos, comment “LAURA” and I’ll send you her full journey!

What do you think about her results at 9 months? Let me know in the comments!

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03/15/2026

An entry from my Operating Room Diaries 🔪
This one has a weird twist 🌪️

I removed filler from a patient’s neck today.
This wasn’t filler that was placed there. It was filler that had migrated there from her lower face and chin. It moved through the connections that the muscles of the lower face and chin (depressor anguli oris and mentalis) have to the muscle of the neck (platysma), and then traveled further down the muscles of her neck. 🤯

Migration (now being called “movement” because filler isn’t alive) is an issue the injection community has transitioned on. For years it was a hard, vehement “no” - filler did not migrate! Then as evidence of migration collected, the conversation swung to “only poorly placed filler migrates.”

This one I can get behind a bit more, because of reflects reality a bit, but is it good? 🤔 Do you want filler to migrate into your neck? I get the overall challenge in embracing the migration, because it’s a hard thing to accept when filler is your bread and butter, the highest level of intervention you have to offer.

We will hear: “It was placed there intentionally.” “You’re seeing it wrong.” “It was put in the wrong plane.”

Yet when you’re standing in the OR and you see it with your own eyes, there is simply no other explanation, and we definitely don’t want it there!

Filler moves, full stop.

She had recently had liposuction on her neck because it looked “heavy” and something felt off. That decision was made through a common cognitive bias - when something looks wrong the instinct is almost always to add or subtract rather than to ask WHY it looks wrong in the first place. First order thinking.

The twist emerges because the problem in her neck was never fat. It was migrated filler sitting on top of lax deep tissue that needed to be lifted, with the floor of the mouth tightened and the structures that had actually descended properly elevated.

Instead, valuable fat contour was removed and the real issue remained completely untouched. 🤦🏻‍♂️

The full OR Diary episode is out now, comment “NECK” and I’ll DM you the link!

03/14/2026

Can devices “lift” and “tighten” 🤔 Let’s look at this 🍆 for our answer.

The key points are =

Devices deform and dehydrate (in their attempt to lift and tighten), but what we really want is a qualitative rejuvenation of the skin envelope.

As you see here, the same device can do both. One option is wildly damaging in an attempt to chase empty promises of lifting, the other one gives beautiful, long-term qualitative results.

“Devices” can mean radiofrequency (RF), RF microneedling, focused ultrasound (HIFU), plasma, sound waves, lasers, magnetic stimulation, hole pouching, light sources, the list goes on and on.

DEVICES WORK BEAUTIFULLY when their intent is to regenerate and rejuvenate the qualitative structure of our skin - I love lasers specifically for this. This means building what everybody thinks of, collagen - but if you have been follow along with me at all, you know ELASTIN is paramount here.

If you are on the fortunate end, these treatments just deliver little to no results - which is the most common situation, and one to be thankful for when you understand what can happen.

*For anyone who claims they have or deliver exceptional results with these devices, please let us all see the standardized photos. The industry overall is waiting for them, and they are yet to be reproduced. I also often hear providers told me that their patients are “really happy“ with some of these treatments. That is great, but that is actually not well linked to delivering reliable and quality results, as we all know.

On the less fortunate end, these devices used with the intent to lift and tighten can permanently damage the wildly important deeper structures of our face. It’s something I see every week. 🫣

Again, devices can ABSOLUTELY deliver beautiful results when used with the right intent.
Like many things in life… Intent is everything.

*Only one 🍆 was harmed in the filming of this video.

What questions do you have?

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03/13/2026

Pores + Aging 🕳️ Everything you need to know about these structures in your skin, how they change overtime, and what you can do about it.

In all likelihood, this is MORE than you ever wanted to know about these integral skin structures 🤗

There’s more to them than just puberty. Your pores change with age and contribute to the aging appearance of your skin.

Strategies to address these aging pores are varied and range from tropical treatments to lasers and even surgical lifting procedures, which help pre-distribute crowded for density as skin structures fall with the underlying structural changes.

Any questions I didn’t answer in here? Please let me know in the comments!

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03/12/2026

Tricia absolutely loves what she sees when she looks in the mirror now. She sees herself again.

She said when she looked in the mirror for the past several years, all she could see was her eye bags and her hooded upper eyelids. These were throwing her off, she didn’t feel right, and she didn’t know exactly what to do with it.

Tricia is 50 years old, and her initial suggestions from providers when she started to look into what she should do were all based off of short-term mindsets, myopic views, and flawed logic. Suggestions ranged from filler (of course) to surgical options that included cutting her fat pads out.

These would have very likely changed her entire essence, and made her look even less like herself.

Luckily, she found me and we took a whole different approach with my EnigmaLift®️ that included SCARLESS repositioning of her eyebags (as opposed to cutting them out), an invisible improvements of her forehead and upper eyelids that give her the appearance of being vibrant and well rested, with zero evidence that we were there.

We have been moving smoothly through the recovery phase, and now 3 months out she is red carpet ready, and we will still see significant improvements from here!

We rejuvenated her entire upper face and eyelids in an invisible fashion. Forehead, temple, upper lid, lower lid, midface - You won’t see an incision, scar, or access point anywhere.

Uniquely in our field, I did NOT to remove any of her fat pads. Removing them often creates hollowing and leads to an odd look with lack of support for the eyeball, in my opinion.

I instead of repositioned all of her fat pads, which I think intuitively makes sense. Those fat pads are valuable structural tissue that can be moved into a more youthful position to smooth the contour between the lower eyelid and cheek while maintaining volume, eyeball support, and ultimately identity.

Follow along here

What questions do you have about eyelid bags, filler, or fat repositioning around the eyes?

Chesnut MD Cosmetics

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