Bill Klaproth: This is OMS Voices, an AAOMS podcast. I’m Bill Klaproth, and with me is Dr. Paul Ciuci, a private practice oral and maxillofacial surgeon at Milford and Derby Oral and Maxillofacial Surgery in Milford, Conn. And we also have Dr. Brian Farrell, a practicing OMS in Charlotte, N.C., as we talk about genioplasty versus corrective jaw surgery, choosing the right path for facial harmony, Dr. Ciuci and Dr. Farrell, welcome.

Paul Ciuci: Good morning, Bill.

Brian Farrell: Thanks for having me.

Bill Klaproth: You bet this is going to be fun. So, Dr. Ciuci, let me start with you. Can you explain the main differences between genioplasty and corrective jaw surgery in terms of procedure and goals?

Paul Ciuci: Sure, so a genioplasty is just an isolated surgical procedure basically of the chin and it’s the goal is to kind of restore facial harmony of the lower chin area. Corrective jaw surgery can be a little bit more involved, where you’re kind of restoring the function of the patient’s bite, so you want to get their upper jaw and their lower jaw to come together better.

So, it’s a little bit of a bigger procedure and that’s to help them not only with facial harmony and look better, but also to function better.

Bill Klaproth: So, people can choose to do this if they want it just for the esthetic, if they don’t like how their chin looks?

Paul Ciuci: So, a genioplasty is primarily esthetic and it kind of goes hand in hand sometimes with corrective jaw surgery to make everything look symmetric or kind of more in balance.

Bill Klaproth: All right. And Dr. Farrell, so then what are the typical indications for genioplasty and when might corrective jaw surgery be recommended instead?

Brian Farrell: The difference between the two, obviously many individuals choose to do a genioplasty when they’re attempting to camouflage the fact that they are deficient in the chin.

So an isolated chin procedure essentially is trying to provide projection oftentimes or correction of asymmetry. Truly to provide sort of a camouflage for the fact that they have deficiency in the lower part of their face. Corrective jaw surgery oftentimes is focused not only on the esthetic side, but maybe more importantly on the functional side, as Dr. Ciuci mentioned about bringing those teeth together. If an individual has a discrepancy between the top and the bottom jaw, where it throws their bite off or askew, then orthognathic surgery or corrective jaw surgery is focused on providing improvement of their bite, their functionality, and to provide facial balance, proportion, symmetry.

Bill Klaproth: And Dr. Farrell, I would imagine then for someone you’re trying to correct their bite, I would imagine this really helps their quality of life as well?

Brian Farrell: Yeah, I think that’s the true focus is to make sure that, you know, we’re oftentimes talking to individuals who anticipate chewing for another 80 years of their life.

If they’re a teenager or if they’re middle-aged, of course, they’ve got a lot of chewing in front of them. So, I always bring it back to something very simple like chewing their favorite food. And if an individual has a skew in their bite and only 50 percent of those teeth touch or maybe their lower jaw hasn’t developed enough, and they have to continually or repetitively posture their jaw forward to chew.

Every time they sit down and have a meal, they’re going to chew more than an individual that has a bite that comes together ideally and efficiently. And if you think about our focus, our focus is to give them something that’s going to be stable, reproducible, obviously an esthetic occlusion, but something that’s functional where all those teeth come together to chew, to speak, to breathe.

Bill Klaproth: So not only facial harmony, so looking better, but chewing better, too.

That’s got to be stressful for somebody to be worried about, I’m going to go out to dinner. I’m going to have to look weird while I’m chewing. Is that right, Dr. Ciuci? Is that?

Paul Ciuci: Well, I’m sure Dr. Farrell would agree that sometimes patients come in for psychosocial reasons because they don’t like the way that they look and they might say, my chin is off to one side and it’s not necessarily the chin may be a problem, but it’s actually a result of the jaws being, not in the correct position.

So they come in and they say, I want my chin over here but then when we do a proper evaluation, then it’s like, well, it’s not just your chin, it’s actually your bite that’s off and then when we say do you have difficulty chewing your food, they’re like, yeah, you know, I can’t use this side or I can’t snip things off and then once we do a proper workup or an evaluation of the patient, we can make that proper diagnosis and recommend the correct treatment.

Bill Klaproth: Yeah, you can fix two things at once, right? You correct the bite and the look at the same time.

So Dr. Ciuci, what are the potential risks then and complications associated with each procedure and how can patients mitigate these risks?

Paul Ciuci: Genioplasty might not be as involved as corrective jaw surgery, so they would have less pain or swelling, less discomfort. The recovery is quicker with an isolated genioplasty procedure. Corrective jaw surgery can involve the upper jaw or the lower jaw. It could involve the upper jaw, the lower jaw and the chin. So the recovery tends to be a little bit longer. Patients do very well postoperatively with pain, control or discomfort.

They don’t have a lot of discomfort with these procedures, which is a blessing. But with both procedures, I would expect a significant amount of swelling. So they might not be in the public eye for a week or two after the procedure. I tell them, don’t have a big life event. Prom can’t be within two weeks, their wedding can’t be within two weeks, things like that.

Some of the procedures can end up with some numbness or tingling of the nerves of the face and that typically resolves over time.

Bill Klaproth: So, Dr. Farrell, Dr. Ciuci just said corrective jaw surgery, the recovery is longer. So, can you give us a little more indication of the recovery times and overall patient experiences and how they compare between genioplasty and corrective jaw surgery?

Brian Farrell: Well just to kind of piggyback on what Paul just mentioned, remember if you’re a student or we’re talking to students, the window in those individual’s calendar is going to either be the winter break or the summer break because of the fact that people need a minimum of a couple weeks to lay low and recover from what we do.

And so, ultimately, we have the window to do this in the winter break. Listen, I think we most often label the first week slow, dark, the second week’s got a lot of progress, but truly once an individual gets past a couple weeks, they’re generally moving, you know, at least three quarters of themselves, if not 80 or 90 percent of themselves, young, healthy, they generally bounce back fairly quickly.

As Paul mentioned uh, individuals that have something done with their chin, it’s going to give some fullness, but oftentimes it doesn’t hold them down as long, and the reason is, we’re not sort of disrupting the bite, and so diet moves forward faster. The major difference is, when we are truly making cuts that allow us to reposition the bone that supports the teeth, holding it back together with plates and screws, that of course is going to make the diet admittedly become liquidy for a bit, but it can transition to softer foods.

But I think it’s using the analogy of a car or gas, listen, when they don’t have food and the calories for a bit, that, that keeps them slow. But many individuals most of the individuals bounce back quite quickly whether it’s a genioplasty or jaw surgery.

Paul Ciuci: Brian, I counsel a lot of my patients on the exact same things that you’re saying and I tell them to kind of avoid the internet and social media because that might be an experience of one.

When they go to see Dr. Farrell for a consultation, he’s going to tell them what to expect and what he’s seen over a lifetime of doing orthognathic surgery. And what you see online is just not reality. And so I counsel my patients about avoiding that and trusting the surgeon that you’re seeing.

Brian Farrell: Yeah, listen, I’m nodding as Paul’s mentioning that I’m nodding because it is amazing to me, all the individuals that come in and they’re doing a ton of research these days, but when you tell them that they’re not wired together I don’t know why that myth hasn’t been debunked.

We generally do not wire individuals teeth together anymore. Yeah, we may limit their function with elastics and such, but it’s just that misnomer that’s on the internet and it’s amazing.

Paul Ciuci: Have you wired anyone shut in 20 years?

Brian Farrell: No, I’m knocking on wood right now.

Paul Ciuci: It’s just the technology and the procedure has advanced that they just see things that don’t apply and then they raise their anxiety levels instead of just trusting their surgeon that they’re sitting in front of and really taking their advice.

Brian Farrell: Listen, I was fortunate to experience jaw surgery when I was a freshman in college. My roommate had jaw surgery. And it was done by my father, in fact. But back then, I spent time with that individual as he recovered from jaw surgery in the second semester of our freshman year. And he was wired together for six or seven weeks. And what I remember about the recovery was the blender. Pureeing food and no telling what was growing on the inside of his mouth.

Well, now we have made tremendous advances in technology in terms of we now can appreciate it digitally. We can measure a bunch in the digital world, go accurately, do it clinically, once. Anesthesia is better, the plates and screws that hold it together are better.

We’re able to deliver this and not spend two or three days in the hospital. So, the advances in the orthognathic surgery world, the genioplasty world are incredible. The ability to see it first and then accurately deliver it to an individual.

Bill Klaproth: So, you both have mentioned wiring. Can you explain that for someone listening? Is that wiring the mouth shut?

Paul Ciuci: So, yes, it is wiring the teeth together in order for the jaws to heal. It’s kind of like if you broke your arm, they put you in a cast so the bones don’t move. And then over, six to eight weeks, the bones fuse and they’re good as new. You can’t put a cast on the upper jaw or the lower jaw. So, in order to stabilize the bite, in the past, they would actually wire their teeth together for six to eight weeks. With advances in technology and basically what we call fixation or plating, we put these tiny little plates and screws, I refer to them as an erector set, and only the three of us know what an erector set is, but tiny little plates and screws that substitute for the cast, and they also substitute for the wiring shut.

So patients can open their jaw, they can talk, they can eat their ice cream or their mashed potatoes. And they’re so much more comfortable.

Bill Klaproth: Okay. Well, thank you for explaining that. I appreciate it. And Dr. Farrell, you mentioned students. Is this procedure generally performed on younger people? They have this surgery younger generally?

Brian Farrell: I think most individuals are generally younger and the reason why is it is oftentimes done in combination with orthodontics. And obviously most individuals are coming through the ranks, they have braces and that’s oftentimes when we initially see those individuals. At the same time, there’s quite a subset of individuals that come to see us in their college life, or they come to see us in their professional life.

And then the oral and maxillofacial surgeon also has a large seat at the table for correcting those individuals that have obstructive sleep apnea. And those individuals may be all over the gamut between 40, 50, 60, etc. And so most individuals in my practice generally are on the younger side. At the same time, it’s a full gamut of individuals.

Paul Ciuci: When it comes to genioplasty, sometimes it’s more on the adult side of it, where they’re like, I don’t like my chin. I need a stronger chin. I don’t like the position of my chin. So those patients might be a little bit older. They might’ve had orthodontics as a kid, but their facial harmony and symmetry just isn’t right. So those patients might be just for an isolated genioplasty, a little bit older and not require full corrective jaw surgery.

Bill Klaproth: So, let me ask you this, in our social media selfie world, does this fuel a lot of that, too?

Brian Farrell: Huge. Huge.

Paul Ciuci: I mean, the selfies and the pictures and the videos and they see themselves in these videos and they’re like, I don’t like the way that my chin looks or that my bite comes together. And that can get them to an orthodontist or an oral and maxillofacial surgeon.

Bill Klaproth: So, can you both share some success stories or examples of where patients have benefited from genioplasty or corrective jaw surgery? Dr. Ciuci, let me start with you.

Paul Ciuci: I think for me, the most happy patients are ones that have a very weak chin.

Their jaw is set back very far.

Bill Klaproth: Is that what you, so when you refer to a weak chin, that’s?

Paul Ciuci: That’s kind of set back, like they, they don’t have very good chin projection and they’re very self-conscious about that. And when you can move either their jaw forward and then in conjunction with the genioplasty and their confidence just soars. It’s routine that they get their confidence back. And they put themselves out there more, and they’re just a happier patient. When you see them back at two weeks they’re beaming because they just feel better about themselves.

Bill Klaproth: Yeah.

Brian Farrell: I want to second that. Yeah, obviously, the oral surgeon sits in the four spot.

And what I simply tell people is, obviously, the focus is on taking care of that individual.

And there’s nothing better than taking an individual who has a challenge, whether it’s functional, whether they have concerns esthetically, getting them in the win column by providing balance, proportion, symmetry of their face. But obviously, we want to make sure that the patient’s happy. We love it when mom and dad is happy. We love it when an orthodontist is happy. And when one, two and three are happy, we sit in the fourth spot and feel very good about what we’ve done. But, yeah, to concur with what Dr. Ciuci said, there’s nothing better than taking an individual who has maybe reserved on the quiet side and truly given them an opportunity to feel great about themselves. And we like it when they take selfies after jaw surgery, because they’ve been afraid to take them before, there’s nothing better than an individual who loves to take selfies afterwards because we know we’ve hit the mark.

Bill Klaproth: That’s excellent. And before we wrap up, if I could just get a couple thoughts from each of you. Anything else you want to add, Dr. Ciuci, when we talk about genioplasty versus corrective jaw surgery?

Paul Ciuci: I think that the deciding between the two is in the expert hands of an oral and maxillofacial surgeon. You know, go in for that consultation, allow the oral surgeon to make the diagnosis explain the procedures and what’s needed to really give them what they need. So, it’s really just relying on your oral surgeon. Avoid the internet and rely on your surgeon.

Bill Klaproth: Dr. Farrell, final thoughts from you?

Brian Farrell: I second that. Yeah, listen many individuals... we’re here to understand where you are and truly give you options. No one’s going to drive or push you into something, but remember in this world everyone’s coming in very educated. They’ve done a lot of research. At the same time, the ability to come in and allow an oral surgeon the ability to identify where we are and where we might go, and here are the options, here are the choices. Remember, we mentioned earlier that a genioplasty may be camouflaged, that there may be a bigger deal behind it in terms of the occlusion, and we’re going to present: Okay, this is one path, this is a second path, this is a third path, and obviously give expert opinion on which way we think may be best, but ultimately it’s going to be their decision, but nothing better than making sure that they have the knowledge and the resources to make sure that they’re making the best decision for themselves.

Bill Klaproth: Absolutely. Well, this has been great, Dr. Ciuci and Dr. Farrell, Thank you so much. Once again, it is Dr. Paul Ciuci and Dr. Brian Farrell. And for more information, please visit MyOMS.org. And if you found this show to be interesting, please share it on your social media. And don’t forget to subscribe. Thanks for listening.