Overview of The Model Health Show episode — The Dark Side of Fillers, Botox, and Anesthesia (with Dr. Cameron Chesnut)
This episode features Dr. Cameron Chesnut, a facial plastic surgeon who reviews clinical and biological concerns around common aesthetic practices (hyaluronic acid fillers, neuromodulators/Botox), anesthetic approaches and their cognitive effects, and how beauty perception is wired in the brain. He also outlines perioperative strategies and regenerative tools (hyperbaric oxygen, PEMF, red/near‑IR light, IV nutrition, etc.) to improve recovery, outcomes and long‑term health. The conversation blends practical patient guidance, surgical philosophy, and neuroanatomy of facial perception.
Key takeaways
- Fillers (cross‑linked hyaluronic acid gels) are not the simple, short‑term, “physiologic” materials many assume — they can persist for years to decades, migrate or change layer, cause local inflammation and encapsulation, and cumulative re‑treatment can produce unnatural “volumetric” or uncanny results.
- Botox (botulinum toxin) is a neuromodulator that weakens/paralyzes facial muscle contraction. It reduces wrinkles by lessening muscular pull, but it also affects nonverbal communication; consider trade‑offs vs. strategies that strengthen skin/structure instead of weakening muscle.
- “Perception drift”: repeated, gradual cosmetic changes shift a person’s internal “true north” so large changes accumulate before they (or friends) notice.
- General anesthesia is a major metabolic and neurologic stressor. Repeated or prolonged exposure is linked to post‑operative cognitive dysfunction (POCD), delirium in vulnerable populations, and possibly long‑term cognitive consequences for some.
- There are gentler, neuroprotective anesthetic strategies (opioid‑free, benzodiazepine‑free twilight approaches + precise local/nerve blocks) that preserve sleep architecture, reduce neuroinflammation, and shorten recovery for elective procedures.
- Perioperative regenerative medicine (prehab + targeted post‑op protocols) — hyperbaric oxygen, PEMF, red/near‑IR photobiomodulation, tailored IV nutrition and peptides — can accelerate healing, improve tissue quality and enhance final outcomes.
- Microplastics and plasticizers (e.g., phthalates) are an underrecognized issue in surgical settings; they can contribute to inflammatory and mitochondrial burden and are worth minimizing when possible.
- The neuroanatomy of facial perception: eyes, mouth, symmetry, averageness and micro‑features (e.g., scleral show) drive instant emotional judgments (likability, trustworthiness) via reward and amygdala circuits — small facial changes can change social signaling substantially.
- Foundational advice to look and feel better: optimize metabolic health (glucose control, inflammation), sleep, movement, airway/orthodontic care for kids, and protect mitochondrial health.
Topics discussed (high level)
- How fillers work: composition, cross‑linking, persistence, migration, inflammatory response, outcomes over time
- Botox vs filler: mechanisms, aesthetic and social/communication trade‑offs
- Perception drift and societal trends in appearance
- Anesthesia types: general vs twilight/hybrid approaches; benzodiazepine and opioid risks; POCD and sleep architecture
- Perioperative optimization: prehab, intra‑op choices, post‑op protocols
- Regenerative/supportive modalities: hyperbaric oxygen, pulsed electromagnetic field (PEMF) therapy, red/near‑IR light (photobiomodulation), IV nutrition, peptides
- Microplastics in the OR and downstream health implications
- Surgeon/team performance, sleep, flow‑state preparation and post‑op review practices
- Neuroanatomy and the biology of facial attractiveness, recognition and social signaling
- Practical preventive advice for patients and families
Notable quotes & conceptual highlights
- “Push you to the bottom of the ocean” — analogy for general anesthesia and its depth of unconsciousness.
- “Fillers last decades, not years.” — warns against assuming short duration and unlimited repeatability.
- Botox: “weaken one end of the tug‑of‑war” — describes how reducing muscle pull affects skin aging and expression.
- “Perception drift” — the slow normalization of incremental cosmetic change.
- Plasticos (Greek): “to be molded” — origin of “plastic” in plastic surgery.
- Surgery as a mitochondrial stress test — healing/regeneration demand large energy reserves; perioperative interventions should support mitochondria.
Practical recommendations & action items
For people considering cosmetic procedures
- Pause and reflect before repeat treatments: review old photos, evaluate cumulative change to avoid perception drift and unnatural results.
- Ask your provider about the product/material (type of filler), how long it actually persists, and the risks/management of complications.
- Consider autologous fat grafting (your own fat) as an alternative to repeated gel filler in some cases — it can be regenerative (contains mesenchymal stem cells) and may integrate more biologically than cross‑linked gels.
Regarding anesthesia and elective procedures
- Ask your surgeon/anesthesiologist well before the day of surgery about anesthetic plan: is general anesthesia necessary? Are opioid/benzodiazepine‑free or neuroprotective twilight options available?
- If elective, prefer approaches that minimize exposure to deep general anesthesia when clinically appropriate.
- Prepare with prehab: optimize metabolic health, sleep, exercise and mitochondrial resilience. Consider targeted fasting/ketosis, creatine, and building aerobic/CO2 tolerance if recommended by your clinician.
Perioperative recovery strategies to discuss with providers
- Hyperbaric oxygen therapy can accelerate healing and quality of tissue repair (used proactively by some surgeons).
- PEMF and red/near‑IR photobiomodulation have evidence for improved tissue healing and mitochondrial support.
- Tailored IV micronutrition and peptide protocols can aid recovery in selected settings.
- Minimize unnecessary exposure to opioids and benzodiazepines in perioperative period where safe alternatives exist.
Everyday health & appearance (preventive)
- Metabolic optimization: control blood glucose (measure — CGM or labs such as A1c), reduce chronic inflammation, exercise and sleep well — these reduce glycation and aging of skin and vessels.
- Early attention to pediatric airway/orthodontics influences skeletal growth and long‑term facial form.
- Use photobiomodulation (validated red/near‑IR devices) and sensible skin care to support tissue health.
Questions to ask your surgeon or clinic before a procedure
- What anesthesia will be used and why? Is an opioid‑free/benzodiazepine‑free protocol an option?
- Do you perform precise local/nerve blocks to limit systemic sedation?
- What materials (IV bags, tubing, disposables) do you use — any efforts to reduce harmful plasticizers?
- What is your prehab/post‑op recovery protocol (nutrition, sleep, hyperbarics, PEMF, light therapy)?
- Can I review long‑term before/after results for similar cases and see documented complication management?
Risks / concerns summarized
- Fillers: long persistence, migration, inflammatory capsules, cumulative volumetric distortion, difficult reversibility in some contexts.
- Botox: loss of expressive nuance and potential social/communication consequences if overused.
- Anesthesia: POCD and post‑op sleep disruption; benzodiazepines and opioids have known cognitive and addiction risks; repeated/prolonged exposure more concerning, especially in vulnerable populations.
- Microplastics/plasticizers: accumulate in tissues (blood vessels, testes, brain demonstrated in studies); associated with inflammatory and mitochondrial burden and with some disease correlations.
- Systemic effects: aesthetic interventions interact with metabolic, inflammatory and mitochondrial biology — affecting broad health beyond appearance.
Where to learn more / follow Dr. Chesnut
- Dr. Chesnut is most active on Instagram and posts education about facial anatomy, perioperative protocols and aesthetic guidance. Search for his name (Dr. Cameron Chesnut / Chesnut) on Instagram to find his official account and clinic links.
- For patients: discuss anesthesia preferences and perioperative optimization options with your surgeon well ahead of your procedure day.
Bottom line
Aesthetic interventions are more biologically and neurologically consequential than many people realize. Smart, informed choices — including asking about anesthetic strategy, limiting repeated filler cycles, prioritizing metabolic and mitochondrial health, and using regenerative perioperative tools when appropriate — can improve outcomes, shorten recovery and lower long‑term risks. Dr. Chesnut emphasizes education, modesty in treatment, and a performance‑and‑health oriented approach for both patients and surgical teams.