EP 13: How Stress and Cortisol Accelerate Facial Aging | OR DIARIES

In this episode, I share a powerful case from the operating room that highlights how chronic stress, trauma, and elevated cortisol can rapidly accelerate facial aging. I break down the physiology behind stress hormones, metabolic health, tissue quality, and why your face often reflects what’s happening internally long before labs do. You’ll learn why surgery alone isn’t always the answer, the importance of addressing root causes, and how to think about aging through a more holistic, biology-first lens.

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
01:18 - Stress and Life Events
02:38 - Trauma and Rapid Facial Aging
03:14 - Cortisol and the Physiology of Aging
04:15 - How Do We Address This?
07:12 - 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. So, just came out of the operating room with a really lovely patient who I had a very interesting start to my relationship with. When I was just thinking about this for my OR diaries for this particular week, when I first met this patient, via my preliminary process, when she had sent photos in, and then I kind of went through and we ended up booking a consultation virtually. She lives out of town quite a ways, and when I first saw her photos, I, you know, get a sense of where she's at, and she looked to be in her, like, early 70s. And as I dove into her information, she was actually 60 years old. And so, you know, that just kind of peaked me, and I kind of gave her some ideas of things we might talk about based off what she told me in what her photos. That's my general preliminary process. And when I actually got the talk to her on the phone, like virtually, you know, via a video call, it was on my agenda to seek to understand a little bit of what might be happening here with her. She had also seen some other surgeons and consultation and got some very interesting recommendations that she mentioned in her preliminary plan that I wanted to talk to her about, basically. But one of the things on my agenda was to just understand, okay, why are we looking like we're in our 70s when we're really 60? And, you know, I had some suspicion oftentimes I see this with really stressful circumstances. And so, when I ask this question, I can't be afraid to ask it because I really want to deeply understand, if we're going to work together, we're going to have a really deep relationship. This is something that I value on a really high level. So, I'm not afraid to have an uncomfortable conversation, not uncomfortable in a bad way, but just like a method to grow, grow our relationship, grow my understanding. And so, you know, I asked her in our original conversation, this goes back months now. Hey, you know, I noticed this and, you know, have you had something really stressful in your life? Has there been an issue like this? And I've had this happen a lot of times, and I've seen everything from, you know, cancer treatments and then estrogen blockers like tamoxifen, you know, that makes sense. That's going to change our tissue quality in the way that we age forward in our metabolic health or our face unquestionably reflects our metabolic health, right? But sometimes that's other types of stressors. It could be life stressors. It's losing a child. It's having a really challenging relationship separation or something like that. And so, interestingly as I started, you know, asking her about this, it was tears, you know, instant tears. And I could feel it through the phone and it was heavy. I could feel it through the video call and it was very heavy. And, you know, that's, I asked, I want to sit and understand and know it's going on. And, you know, it kind of went through a story and it was tragic and stressful. And, you know, she said flat out, like coming out the other side of this, I felt like I'd age decades, basically. And she had been very fit and healthy and done all the pulled all the levers before that she could pull. But nothing could prepare her body for this. And this is real physiology. This is gets into a lot of our neuro modulators like, you know, we talk about stress hormones like cortisol, which is the big one. But when we really think about epinephrine and or epinephrine and how all of our adrenal glands are functioning and what they're releasing from a cortisol standpoint, it has an important impact on how our face ages, even in how it affects our sex hormone levels that change how our fat pads respond. But cortisol itself can be really disruptive to our soft tissue quality, our collagen, our elastin, the way that our fat pads age and respond. And, she had that look on her face. She almost, parts of her almost looked like aged in a way of malnutrition and types of things like that. And, you know, there's sleep changes that happen. There's nutritional changes that happen. There's lack of self-care, lack of exercise, plus the cortisol. There's so many things that happen in the stressful situations that lead to premature aging. And I just like instantly resonated and connected with her. And, you know, we sort of talked about what that meant. And the next part is like, well, how do we address that then? How do you change this, you know, probably 15 year discrepancy in soft tissue quality and appearance to a baseline? And she, you know, she had recovered from her tragic event, you know, like still carry that burden, but felt like herself again. And you looked in the mirror and basically just saw this tragic trauma traumatic event every time she looked in the mirror. Very misaligned. And so, you know, I really focus on the regenerative part of it in that setting. Like, yes, there's the objective, you know, placing things back where they go, the, you know, the gravitational components, but there's a big subjective qualitative component to this as well. And it's interesting because when she had seen other surgeons, like for example, she had really hollow upper eyelids, like incredibly hollow upper eyelids, really heavy forehead. And, you know, a lot of things to change. And the surgeon she saw is that we should do an upper eyelid surgeon, upper blood flow pasty. And I'm trying to tell her, like, that is looking only at the downstream effect of a bunch of other upstream things. She needed her whole forehead address and her volume replaced in her eyes. I'm trying to explain to her that, like, that would be like having hollow cheeks and gravitational changes and not liking your nasal labial fold. And the solution being cutting your nasal labial fold out instead of lifting and restructuring with volume or with fat transfer. It's a perfect analogy, actually, for you would never just go cut this tissue out along your face, just like you wouldn't on your eyelid until you had everything appropriately lifted above it. This is a really common eyelid theme, but it was really applicable to her where she needed volume and things a hundred times more than she needed skin cut out of her upper eyelids. But the other surgeons, plural that she had seen, that was like one of their first suggestions for her upper lids. Because she noticed a lot of her aging and stress in her upper lids, which is very typical. That's how we communicate our, how rested we are and how vibrant we are. And so that gets into the whole neurobiology of facial perception. But she just personified a lot of these things. And when you looked at her, she looked sort of not as vital as she was in real life. And you quickly picked up on that. When you talked to her and I knew there was a mismatch and the second I asked about it, she was, you know, gracious enough to, you know, kind of be vulnerable with me. And that led to a great relationship with us. And we did a very comprehensive, qualitatively focused procedure. We're supplementing with some of her own stem cells. We've banked some of her own stem cells. We've got a lot of good things going on for her in the long term. Because, you know, we're viewing this with a long term mindset. We want to get her to a great place now. We want to work to maintain it. And we know that because of her previous stress and aging that, you know, will probably be focused on some qualitative components. We've got the sort of the big, heavy lift out of the way now. But, you know, we're going to have a relationship for a long time. I'm with her. I'm not going anywhere. And, you know, we've set ourselves up for that with some regenerative capacity down the road as well. So, I'm always grateful when people are like, you know, vulnerable enough with me or are willing to share that. And honestly, she would be a prime example of understanding that, having that hard conversation, leading to a completely different plan and a deeper understanding. And ultimately, it's going to be better initial results and better long term results for her down the road. So, I thought that was really, you know, it's moving to me and touching to me. And, and those are the types of relationships and the types of patients that I want to work with. So, yeah, I thought that was worth sharing. 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