EP 6: Fixing My Own Surgical Plan | OR DIARIES

In this episode, I break down a real case where a patient took my fully developed surgical plan elsewhere to save money - only to come back needing a complex revision. I explain why execution matters just as much as strategy, how subtle details around symmetry and natural expression can’t simply be “copied,” and why revision surgery is often more invasive, expensive, and limited than getting it right the first time. If you’re considering traveling or price-shopping for surgery, this episode will help you understand the real risks, trade-offs, and long-term consequences before you make that decision.

CONNECT WITH HOST 
Website: https://clinic5c.com/ 
Instagram: https://www.instagram.com/chesnut.md/ 
YouTube: https://www.youtube.com/@chesnutMD 
LinkedIn: https://www.linkedin.com/in/cameron-chesnut-a6910baa/ 

WAYS TO WATCH/LISTEN 
YouTube: https://www.youtube.com/@5CodesPodcast 
Spotify: https://open.spotify.com/show/1FZ7vpmq21iA1noPcFhixb?si=992ef6c8d859463f 
Apple: https://podcasts.apple.com/us/podcast/5-codes-podcast/id1866214238 
Instagram: https://www.instagram.com/5codespodcast/
 
TIMESTAMPS 
00:00 - Intro
00:27 - When a Patient Takes the Surgical Plan Elsewhere
01:40 - Revision Surgery: Best-Case vs Worst-Case Scenarios
03:35- A Real OR Case
04:24 - Managing Expectations in Complex Revisions
06:13 - Outro

ABOUT HOST 
Dr. Cameron Chesnut is the host of the 5 Codes podcast and the founder of Clinic 5C, where he leads a team dedicated to integrative cosmetic surgery, regenerative medicine, and functional health. An internationally recognized facial plastic surgeon, Dr. Chesnut is known for producing natural, refined results that enhance rather than alter one’s appearance. His approach blends surgical precision with biological optimization and disciplined restraint, drawing patients from around the world who value excellence, longevity, and holistic care. On 5 Codes, Dr. Chesnut uncovers the mindsets and evidence-backed strategies he lives by, helping high performers perform better, recover smarter, and feel their best in every area of life. 

DISCLAIMER 
The views shared on this podcast are my own and are not associated with, affiliated with, or representative of my clinical teaching role at the University of Washington School of Medicine. This content is for general educational purposes only and should not be considered individualized medical advice.

Transcript

0:00

Welcome to the Five Codes Podcast, where we discuss evidence-based methods to elevate yourself to the next level through optimizing the way you look, move, perform, feel, and connect. Today's OR Diary is a unique story about revising my own plan. What I mean by that is somebody who had a plan with me took it somewhere else to get it done, and then ended up coming back to me to fix my own plan that had been executed somewhere else. And over the years, I've had this happen a few different places in a few different ways. Sometimes it is taking my plan somewhere overseas. I've had this happen in multiple other countries from Russia, to Turkey, to wherever else where somebody consulted with me. We got deep in the process, went through the entire plan. They took our conversation, what I had put together, and tried to have it go executed somewhere else in another country. Sometimes it's here in the United States. The patient that I was with today, who I was revising, had mine done here in Los Angeles, actually, took my exact plan somewhere else. They tried to execute it. And I think it functions under this idea that you've got in my brain, my plans, things I put together, but the ability to execute that plan is very, very different, as a lot of these folks have learned when they ended up kind of coming back later on. I'm not talking about people who maybe got a preliminary idea from me and then took that somewhere else. I'm talking people where we engage in a deep fashion. We had everything planned out. 95% baked, if you will, is exactly what we're going to do. And then the idea is, well, I'll just have somebody else do this for less money, usually, as why. And that's usually the driver, as why people are going somewhere else. And the revision, afterwards, of those situations, has come in multiple formats. Sometimes, on the best case scenario, it's smaller. I'm fixing the little details that that other person was unable to do that are sort of my signatures, if you will. Things around the eyes, the symmetry, the sort of natural expression, things that lost to natural nature were kind of bringing back, which obviously we don't want to be doing that the second time because your back is against the wall, if you will, a little bit there. Things could never be as good as they would have been that first time. And so that's maybe the best case scenario, honestly. In the worst case scenario, and I've had this happen a few times where the revision situation almost turns into a bigger deal than the original was. And much to people's surprise, sometimes that means it ends up being more expensive than the original procedure would have been. And we can't get to the same place. And so it's these interesting mindsets that I've always tried to grasp around the financial motivation, which I completely understand. It's not lost on me at all. But then the idea of coming back afterwards. And for me, it's something I understand. It's an open arms welcome. I definitely have to take a deep breath and be like, "Okay, we're fine. I understand. We can put this aside. We can move forward together." And it's just an interesting thing to see coming from all over. Thankfully, that's not the norm, obviously. Most people end up, you know, we do the things that we talk about. But in those unique circumstances where somebody quite literally took it to Russia, how to proceed you're done, and they come back and it's worse than where they started. And we have to redo the whole thing. This is a real story. And it's more expensive than the original thing was because it's more time for me and there's more involved. Those are unfortunate circumstances. The actual patient, you know, the most recent, the one I'm talking about from this week was more of the, in the middle of the road. You know, there were some things that we just weren't, that weren't perfect from the previous procedure, but kind of weren't worth redoing. We weren't going to go down that road. There were some things from the other procedure that needed to be redone. And there were some things from our original plan that the subsequent surgeon had convinced to this patient that they didn't actually need done. And so we were, they were left off of their first procedure, which in this case was actually not that long ago. Sometimes, you know, it's a year, 18 months, two years. In this case, it was not even less than a year later. We're back in the operating room, revising some things, doing some things that weren't done the first time, fixing some of the other things. And kind of working with what we have, I usually approach these situations like I would any revision, and that. I want to work with the good parts from before. I want to pick off anything that wasn't done, like, you know, do the things that didn't get done. And then I want to take kind of the low-hanging fruit of things that we can optimize from the previous procedure and make them better. And so you may say, well, my neck isn't exactly where I wanted. It's like, you know, seven or eight out of ten. I wanted a nine or ten out of ten. But to get to that, we have to redo the whole thing, you know, like literally start all over. And it could be more challenging than it was the first time. And so sometimes in those situations we just have to accept that, well, we've got to live with the seven or the eight or whatever it is and know that there's maybe more out there, but it's not juices and worth the squeeze. It's maybe not worth doing it again to get to the outcome that we're after. And so those are their hard conversations. And, you know, I humble myself to, you know, be back in it with that patient. I very much value the relationships that I have with my patients. And so it's hard when somebody sort of like doesn't choose you, goes somewhere else. But I understand at the same time. And so re-engaging is often like both people humbling themselves a little bit to get back to that point. And, you know, there's stories about this and every relationship, you know, where you're like, oh, maybe I did like that better. I probably should have gone that way. So it's like, you know, a little bit of a hug and move on. And here's where we're at now. And let's make the best out of it. And that's certainly where this was. I think that my patients experience through the whole revision was sort of like, yeah, this is what I knew would have happened the first time. And should have done that. But here we are. And in the end, we'll come out the other side, you know, in a good spot and better for it and happy. But they're always hard situations. And I understand them. And they happen often enough. And it can be all over the spectrum in the map. But I definitely thought that this was an interesting story, at least worth sharing. And very sort of middle of the road scenario that we had this week. If you have any questions or topics you would like me to explore further, please leave them in the comments. I read them all and they often help shape the future conversations here. If you would like to learn more about my surgical practice, you can visit clinic5c.com where you will find additional information on my approach to surgery, recovery, and performance focus care. I also want to be clear that the views shared on this podcast are my own and are not associated with or representative of my clinical teaching affiliation with the University of Washington School of Medicine. Nor should this be taken as individual medical advice. Thank you for spending your time with me. I appreciate you being here and I will see you on the next episode.