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

06/01/2026

Patsy is 64 years old with a history of Bell’s palsy, and today we are doing a full facial rejuvenation for her.

What makes Patsy especially interesting is that she is (almost) a true blank slate. No filler, no Botox, no prior facial surgery, no tightening devices promising to “lift,” just some minor lasers over the years - which means we get to see her anatomy in one of the purest forms possible.

There is one important caveat though, the Bell’s plasy.

Bell’s palsy is a facial nerve paralysis that affects the way the muscles of the face move, rest, and communicate emotion. Patsy was fortunate, and as she describes it, almost all of that paralysis recovered over time. The only real residual change she notices now is drooping around her left eye.

From my surgical standpoint, this is incredibly important.

Quantitatively the face is skin, fat, and their related structure.

Qualitatively the face is movement, tone, expression, asymmetry, compensation, and coordination of how the brain and muscles work together 🧠

When someone has had a facial nerve event, even 53 years ago, I have to incorporate that history in every part of the plan. I am certainly not trying to force symmetry or pursue something artificial that isn’t Patsy. My goal is to understand her baseline, preserve her identity, and restore the areas that have aged while respecting the way her face naturally moves.

Without any prior filler, prior Botox, or prior procedures, we have a very clean look at her true facial anatomy, her true movement patterns, and the subtle residual effects of something that happened more than five decades ago.

A very significant part of my practice is seeking to understand the person in front of me - I do not apply the same procedure to everyone.

For Patsy, the plan is full facial rejuvenation with a very thoughtful process toward her left-sided history, her eyelid position, her facial tone, and the overall harmony of her face.

This is my kind of nuance 🤗

What questions do you have about Bell’s palsy, facial asymmetry, or planning surgery around prior facial nerve changes?

Drop them below 👇🏼

05/31/2026

Karen (54) is so excited (stoked in her words) to see and feel like herself again 🤩 7 months out from a full facial rejuvenation with my EnigmaLift®️, including some very unique details for her.

Her EnigmaLift®️ plan included:
- Brow contouring
- Upper Eyelid Surgery
- Scarless Ptosis Correction
- Stem Cell Rich Fat Transfer
- Laser Cocktail
- Scarless Lower Eyebag Removal
- Preservation style, Minimal Access Deep Plane Facelift
- Deep Plane Neck Lift and Contouring
- My non-implant, Bio-chin restoration*
- My scarless buccal fat pad lift*

Karen’s procedural plan was intricate and complex, including several things that are unique to me:

My Bio-chin implant, using her own structural tissue to function as a chin implant instead of placing something foreign like silicone.

I don’t love placing anything foreign in the human body, even permanent sutures🚨This is very unique to me.

My buccal fat pad lift. Instead of just cutting the buccal fat pad out (as is typical), I lift and reposition it to preserve its structural importance to the face.

Karen traveled in from Colorado, and she is awesome! I have loved getting to know her and her husband through our time together 🙌🏻

Karen was at once both very typical and very complex.

She is healthy, takes care of herself, and puts in the work to be at her best, yet what she sees in the mirror does not match how she feels as a result of all that other effort.

Her complexity comes in some of the anatomy around her eyes, lower face, and neck - as we explained in her pre-op video that we posted previously.

Getting something done with just ‘anybody’ could have been disastrous for her, honestly.

As she was looking for a surgeon, she said it felt like worlds collided when she found me because of the overall focus on health, preparation, recovery, and both looking and moving naturally afterwards. 🤗

She most notices the structural change in her lower face and chin 🤯, and she is incredibly grateful that her eyes maintained her character, this was a big discussion point for us.

05/30/2026

SHOULD YOU FAST BEFORE SURGERY?

Some of my patients have played with fasting - they understand the benefits, yet it’s not a regular part of their practice, and I help them take advantage of this time before surgery to utilize the specific benefits that it provides for surgery!

On the flip side, the majority of my patients already leverage the benefits of fasting for their wellness and longevity (which tells you something special about my patient population 😉🤗) - I LOVE that my patients think this way 🙌🏼

Fasting before surgery can be very helpful, but it’s a bit different than normal - it’s not just about skipping meals.

My six main motivations for fasting around surgery include:

1. Autophagy – cleaning up weak, damaged cells preferentially to prep your tissues for stress resilience after surgery. You might have heard of senescent cells or “zombie” cells that contribute to aging and age related diseases

2. Inflammation control – cytokine modulation to improve healing ❤️‍🩹

3. Insulin sensitivity – better glucose control absolutely means a better recovery (and better maintenance in the long-term)

4. Stem cell regeneration – interestingly, the strongest trigger for this occurs after fasting, during refeeding, which I like to happen in the days right before the surgery

5. Mitochondrial resilience – this is key for energy creation and tissue performance while recovering

6. Neuroprotection – elevated ketones like beta-hydroxybutyrate (BHB) to improve neural stability and reduce brain inflammation, this is wildly important to help prevent postoperative cognitive dysfunction after surgery, protect your brain, limit cognitive fog, and help you feel better faster (I also utilize exogenous ketones to help you with this process)

The key is timing ⏰ and my team will guide you through every step as part of your surgical preparation with me 🙌🏼

What questions do you have about fasting around surgery? Ask me below and I’ll do my best to answer!

🎙️ I recently reported a whole podcast on the subject of metabolic health surrounding surgery with .dagostino.kt on

05/29/2026

Patsy and Kaleigh, mother and daughter, having their EnigmaLifts®️ together (with quite different plans) 🤗

This was such a fun and unique setup. Same week, back to back procedures, recovering together, and getting to take care of each other through the process.

I always love learning the story behind how someone finds me, and in this case Kaleigh was the catalyst, or as we joked, the instigator.

Kaleigh had been interested for a long time - she had tried many of the non-surgical options that failed (especially in her neck) - then she found me, started the conversation, shared it with her mom, and here we are.

There is something very special about a mother and daughter choosing to have this rejuvenation experience together. Neither one is trying to become a different person, both are just ready to feel more connected to what they see in the mirror.

They both cared about doing this the right way, with the right person and with a long-term plan, natural results, and an experience that was thoughtful from beginning to end.

That is exactly the right fit for me and the patient relationship that I love! it is even more meaningful when it becomes something we all get to share together.

I am grateful they found me, grateful for their trust in me, and excited for what is ahead for both of them!

WELCOME TO THE NEXT LEVEL®️

Would you ever do something like this with your mom, daughter, sister, partner or best friend?

Tell me below 👇🏼

05/28/2026

Eyelid surgery revision (fixing prior surgery) for Suzanne (63) using my EnigmaLift®️, 6 months after surgery. *this was eyelid revision only, no surgery was performed on her cheeks, jawline, neck, etc. All improvements there are non-surgical*

You will notice after her prior surgery that she still had very asymmetric, hooded eyelids, with a hollowing out of some of the fat compartments, while others were bulging. 🤦🏻‍♂️

This makes her eyelid plate
(where you would put eyeshadow) very large and asymmetric, which contributes to an aged look in the upper lids. This is something I commonly see after an eye surgery, still today.

With Suzanne, I curated a stealth plan to redistribute and normalize the volume of her upper eyelids while I improved the symmetry, opened the aperture, and gave her a more youthful looking upper eyelid plate.

Her EnigmaLift®️ revision eyelid surgery included:

-Invisible access brow contouring
-Upper eyelid surgery
-Scarless ptosis repair
-Scarless lower eyelid surgery
-Invisible access midface lift
+ Paired with a qualitative combination of my stem cell Rich fat transfer and laser cocktail

For her lower lids, I was very focused on keeping a natural look while smoothing the transition of her lower eyelid bags into her cheek.

Suzanne knew something was off with her original eyelid surgery from the very beginning.

What she was noticing is something I see very commonly - very poorly placed incisions and access that are a result of a poor understanding of the contributors to upper eyelid aging.

The descent and hooding of her eyebrow was also contributing to her upper eyelid aging, but this was not recognized or addressed by her prior surgeon, and this led them to make an incision that was much too high, and much too far out on her eyelid.

This was not the solution, it was flawed logic, and it left her looking “off“ right from the very beginning, even to the point where she noticed🧐

All fixed now!

What do you think?

You can follow Suzanne’s entire revision and correction, from her preoperative assessment through results -

blepharoplasty

05/26/2026

My healing progress after CO2 laser(s). Everybody is a bit different in their recovery, and this is why I want to optimize your metabolic health before you come to see me.

I did one hyperbaric dive in this timeframe, utilized red light and some of the regenerative aspects aspects of my own optimized recovery protocol.

I utilize this protocol much more vigorously for my postoperative patients - I did an attenuated version for myself. 
From a downtime standpoint, I knew I had 5 days before I had to be back not only in the operating room, but shortly after had to be on camera for podcasts.

That meant we had to be very thoughtful with the laser cocktail we chose.

We could have absolutely done something more aggressive, but the decision we made was based off of the needs of where I was at and of course my life and schedule.

Experience matters so much here, especially with ablative laser resurfacing - it is certainly not just about choosing the strongest setting or creating the most dramatic immediate change. Instead we want to match the treatment to the person, their skin, their goals, their recovery window, and the real world life that they have afterward.

In my case, we needed a special laser cocktail that would create meaningful qualitative improvement in the skin while still allowing me to recover quickly. As you can see, by day 5 I was back to functional and largely ready to be in the real world again.

I only do these treatments about once every 7-ish years, so when I do it, I want it done right. I trust Dr. Kelm because of his extensive training, his understanding of lasers and skin, and his similar high-performance mentality around doing things with long-term, qualitative, structural thinking.

What questions do you have about the laser, the recovery, or why we chose this specific approach?

Drop them below 👇🏼

05/24/2026

My first answer to this question is always the FREE things! How do you keep your face looking great when moving forward in your 30s and 40s? How can I avoid surgery?

How does fat transfer fit into this whole paradigm as well?

I explain it all!

If you’re interested and curious, check out the full episode of

Stem cell rich fat transfer, metabolic health, blood glucose, sleep, aging, anti-aging, fat transfer, filler, longevity

05/23/2026

Brows and eyes by .md hesnut.md + Neck and jawline by 9 weeks post- update for Kya (51) who has very unique eyes at baseline (scroll to the end to see photos in her 20s) - after a life in front of the camera, we knew we did not want to change those unique characteristics.

Kya has a couple of specific eye traits that she and I could have fully “fixed,” yet I was concerned that would change the identity that her eyes communicate.

Namely, she had ptosis, or drooping of her upper eyelids, along with scleral show, which is strip of white showing between the pigmented part of her eye (iris) and her eyelid margin.

When you look back to her 20s, you can see these present.

Interestingly, these are most often age related changes that happen - those aging changes also alter somebody’s eye character and identity, yet in Kya these are her baseline eye characteristics that had become slightly more exaggerated as she aged.

This is why I ask everyone for pictures through all the decades leading into our procedure, it really helps give me a deeper understanding to build with.

Kya’s situation is challenging! She illustrates very well that understanding the right amount of correction is key - it should not be all or none. Like my parents taught me, just because you can, doesn’t mean you should.

9 weeks into recovery after my EnigmaLift®️, you can already see the improvement in her eyes with the intricate correction and maintenance of those key eye characteristics that make her uniquely Kya.

Also of note, the improvement in her chin was performed with no chin implant. I used my completely autologous structural rebuild for her chin using all of her own structural fat tissue. This is very unique!

did an absolutely beautiful job with her jawline and neck! He performed that portion of the procedure with a deep plane facelift and necklift, re-stabilizing the deep structure of her neck, while I focused on her brow, upper and lower lids, midface, and stem cell rich fat transfer, including for her chin.

*These after photos were sent from home and are standardized as much as possible.

Chesnut MD Cosmetics

06/01/2026

05/31/2026

05/30/2026

05/29/2026

05/28/2026

05/26/2026

05/24/2026

05/23/2026

Address

Telephone

Website

Alerts

Shortcuts

Share

Category