In this episode, I take a deep focus on one of the most controversial topics in aesthetics: dermal filler, and specifically the hyaluronic acid gel fillers that have exploded in popularity over the past decade. These products were long sold on a set of assumptions that they were temporary, inert, stable, and easily reversible, but nearly all of those assumptions have turned out to need serious qualification.

I walk through what recent research and my own daily observations have revealed about how long filler actually lasts, how it migrates across anatomic planes years and even decades after placement, and why dissolving it with hyaluronidase is far messier than most people believe. I also get into how filler interacts with the immune system, the inflammatory reactions that can surface long after injection, and why so much of what gets blamed on bad surgery is actually bad filler. I share how this understanding has shaped my own practice, what I wish every future patient knew before their first syringe, and my honest, practical advice for anyone who already has filler and is wondering what to do next. If you're interested in facial aesthetics, longevity, or the real science behind what happens beneath the skin, this episode offers a candid perspective from inside the debate.

CONNECT WITH HOST 
Website: https://5c.co/
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
00:12 - What I Wish Everyone Knew About Filler
00:38 - The Debate That Sparked This
01:39 - Filler's Rise and the Assumptions We Built
03:58 - Assumption One: It's Only Temporary
07:39 - "I've Had Tons and I Look Great"
14:33 - Assumption Two: It Doesn't Move
17:32 - Ultrasound, MRI, and the Limits of Imaging
18:31 - The Next Frontier: Migration Over Time
19:46 - Dissolving and Post-Hyaluronidase Syndrome
25:50 - Why Hyaluronidase Doesn't Fully Work
34:41 - The "Stimulates Collagen" Myth
40:48 - Filler and the Immune System
46:25 - It Is Not Inert, and We Have to Stop Saying It
52:17 - Bad Filler Gets Blamed on Bad Surgery
57:50 - Why I'd Rather Operate Without Filler Present
58:45 - Should You Get Yours Dissolved?
59:47 - Closing Thoughts and Disclaimer

ABOUT HOST 
Dr. Cameron Chesnut is the host of the 5 Codes Podcast and the founder of 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 the 5 Codes Podcast, 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.