Last night I posted my podcast with renowned maxillofacial surgeon Dr. Michael Gunson. So far this interview has the highest average view duration of any video I have ever made.
Here are 14 lessons I learned from Dr. Gunson about double jaw surgery:
- Arnett Cephalometric Analysis
Dr. Gunson credits the beauty of his surgeries to the “Arnett Cephalometric analysis.” This analysis takes a different approach by focusing more on facial features than just cranial references. 0:06:35 - Be Careful with the Term “Normal”
Dr. Gunson cautions against overusing the term “normal” in facial analysis. He believes it can push surgeons to treat patients according to a standard that might not be best suited for their unique anatomy and functional needs. 1:07:25 - Risks of Over-Advancing the Jaw
If the jaws are advanced too much, it can result in lip incompetence. That’s why it’s essential to fully understand the patient’s anatomy and functional needs in order to strike the right balance between esthetics and function. 1:14:30 - Impact of Connective Tissue Disorders
Conditions like Ehlers-Danlos syndrome, which affect connective tissue, can have a big impact on the outcome of jaw surgery. It’s crucial to ensure patients are fully informed and that the surgical approach is carefully customized. 1:52:10 - Waiting on Rhinoplasty
Dr. Gunson prefers not to perform rhinoplasty at the same time as jaw surgery. He believes that the nasal structures can change significantly based on how the jaw and lip positions shift, so it’s often better to address nasal concerns after the jaw surgery is complete. 2:07:10 - Measuring Lip Space for Upper Incisor Placement
Dr. Gunson shares that instead of relying only on cephalometric analysis, he physically measures the space behind the lip to figure out the ideal position for the upper incisor. This way, he can better balance both esthetics and function. 2:25:02 - Don’t Push a Surgeon Out of His Comfort Zone
Dr. Gunson advises patients not to ask surgeons to use techniques they’re not familiar or comfortable with, even if those methods have a reputation for being superior. The surgeon’s expertise and confidence in their approach are more important for achieving successful outcomes. 2:28:00 - Concerns with Custom Plates and DICOM Data
When it comes to custom plates for jaw surgery, Dr. Gunson raises some concerns. He points out that inaccuracies can arise from the DICOM data and the challenge of ensuring the patient’s physiology matches the planned surgical movements. 2:33:59 - Manual Plate Bending for Accuracy
Dr. Gunson prefers to manually bend plates for jaw surgeries. His expertise with the techniques allows him to achieve precise results, which he believes are more reliable than custom plates. 2:41:50 - Preference for Hard Tissue Solutions Over Fillers
Dr. Gunson tends to favor hard tissue solutions to tackle facial aesthetic issues such as cheekbone implants. He believes they offer a more lasting and structural result compared to using soft tissue fillers or fat grafts alone. 2:47:09 - Mandible Issues: Short vs. Narrow
Dr. Gunson suggests that developmental issues with the mandible are more commonly due to it being too short rather than too narrow. He rarely finds situations where multi-piece mandibular surgeries are actually necessary. 2:53:29 - Caution with Multi-Piece Mandibular Surgeries
Dr. Gunson is cautious about performing multi-piece mandibular surgeries. He feels that, in most cases, the mandible grows quite well, so the focus should be on restoring what the anatomy should have been, rather than making drastic changes. 2:56:15 - Maxillary Deficiency and Cheekbone Implants
Dr. Gunson estimates that around 75% of patients with maxillary deficiencies end up needing cheekbone implants or grafts to maintain facial esthetics after jaw surgery. 3:15:49 - Conservative Isn’t Always “Non-Invasive”
Dr. Gunson points out that the most conservative option isn’t necessarily the least invasive one. Sometimes a more comprehensive treatment plan that includes jaw surgery is needed to ensure the best long-term results for the patient. 3:25:56