I've chronicled a bunch of things through my blog, but I'm doing a little before/during/after summary here for people quickly looking for before/after in their surgery research and don't want to read through mine or a bunch of others' blogs. So, this section will cut to the chase.
I started my treatment with an almost 9mm overjet/3mm overbite class II with super narrow arches, gummy smile, and pretty bad crowding. My chin was receded and similar to most cases like mine, I had a smaller airway. Since my bite was open in the front, most of my chewing was done on my back molars, which were wearing to the point that my doctor said they would soon need restoration. I had a lot of facial tension, muscle tiredness, headaches, constant clenching and strain to battle my lip incompetence, I was a mouth breather, and I snored. My TMJ's never gave me severe issues. No popping, locking, or pain, but they were starting to get tender and tired feeling with the rest of the muscles in my face and neck and most of the doctors I saw said this was going to get worse for me from here on out if I didn't jump in and fix my dental/skeletal discrepancy. Some of my pre treatment films/pictures:
I started my treatment with an almost 9mm overjet/3mm overbite class II with super narrow arches, gummy smile, and pretty bad crowding. My chin was receded and similar to most cases like mine, I had a smaller airway. Since my bite was open in the front, most of my chewing was done on my back molars, which were wearing to the point that my doctor said they would soon need restoration. I had a lot of facial tension, muscle tiredness, headaches, constant clenching and strain to battle my lip incompetence, I was a mouth breather, and I snored. My TMJ's never gave me severe issues. No popping, locking, or pain, but they were starting to get tender and tired feeling with the rest of the muscles in my face and neck and most of the doctors I saw said this was going to get worse for me from here on out if I didn't jump in and fix my dental/skeletal discrepancy. Some of my pre treatment films/pictures:
I got braces put on May 2013 and was scheduled for double jaw surgery April 2014. My 2 week preop pictures/films after 11 months of braces:
If you've read parts of my blog then you already know how that surgery went. And if you haven't read up on anything else on my website, then long story short is the surgery was pretty messed up and my surgeon abandoned me 4 weeks post op after it became evident my results were that bad. She wouldn't see me, wouldn't book an appointment to examine me let alone bring me in to revise the mistakes. I was left asymmetric class II skeletal and dental with a 3mm cant down in my top jaw, biting edge to edge on my left side but still had about 2-3mm overjet on my right side. My lower jaw was also canted. My midlines were a good 2-3mm off. Both jaws were yawed significantly, causing a lot of strain/torque in my face and TMJ's. My lower jaw was swung out and yawed so badly that my face visibly bulged out to my left. My face was pretty much skewed all to the left and my chin was twisted/rotated in that direction too. My upper jaw was over advanced and brought forward a whopping 4mm without my consent or knowledge either pre op or post op. My postop pictures/films:
I required immediate revision and didn't get it since my surgeon wouldn't even see me to tell me I needed it, let alone actually do it. My orthodontist took me in the completely wrong direction and only worked to cover up and mask the surgical errors. I put a whole new team together to revise everything from the first round of treatment. My pictures/films for records with my new orthodontist in Oct 2014 (6 months post op from my original surgery):
I got my braces taken off Dec 2014 while my new team of doctors worked up a plan for my revision treatment. Jan 2015 I got a lower incisor extracted and lower braces put back on. They worked to close the extraction space and in June 2015 I was fitted with upper braces again.
Part of the plan for my pre op set up was to get my overjet as big as possible and remove all ortho compensations my first ortho did to cover up all of the problems I had out of surgery. By the end of 2015 I was rocking an 8mm overjet, my cant was back to its full extent, and my bite was open in the front and laterally on my left side. Only my back molars touched. With the exaggeration of the malocclusion I was left with out of my first surgery, I was in a ton of pain at this point. Headaches were 24/7, I could barely close my lips even when I was forcing them, and I had pretty bad muscle cramps/spasms around my mouth and face. I was also drooling and lisping a lot. The few months leading up to surgery weren't pretty, both to the eye and most importantly, how I was feeling physically. My films/pictures leading up to revision surgery:
I had revision surgery Feb 2016. I could tell as soon as I woke up from anesthesia, even through all of my swelling, that things felt better and less torqued. Even through all of the blood and gore going on in my mouth, I could tell things were level and where they were supposed to be. I didn't even need to see it because I could feel it. When I got my first pano taken 5 days post op, I cried happy tears because I couldn't believe how straight it all was. As of writing this, I'm about to hit 6 months post op and I'm freshly debanded. My results speak for themselves. The post op films speak for themselves. I honestly don't think my team could have done any better because they have basically fixed everything 100% the best it could be given the absolute mess they got to start with. I have an amazing team of doctors and I am incredibly fortunate to have them through this process. I 100% do not believe a better job could have been done on my case. What a difference the revision flims/pictures are vs. my initial post op films/pictures above:
Top: Just before braces got put on in May 2013. Middle: 22 months post first surgery, 1 week before revision. Bottom: Final records 9 months post op revision. Right click and hit "view image" to see larger image.
Intraorals. Top: pre treatment 2013. Bottom a few days after debanding, Aug 2016.
Patients doing research on all of this always ask, "was it worth it?" That's the million dollar question. I always tell patients you'll get the full spectrum of answers here. You'll have some people say it was the best decision of their life, and others tell you it really was not worth it. If I had received the same kind of care during my first surgery that my second surgery experience gave me, I think I'd say it was worth it. But given what I had to go through and the irreversible damage it's caused (the typical nerve damage and numbness in the lower lip/chin/gums, the asymmetry left on the left side of my lower jaw, the wider nose, decreased range of motion and cracking of my joints, deviated septum, and losing all 4 front upper teeth and at least 1-2 lower front teeth due to root resorption), I am not so sure it was worth all of that. Especially losing the 4 upper front teeth. That is really devastating and has forced me to do implants/bridge work that will require me to spend money and time to upkeep the rest of my life. I've also had to spend way too much money to fix my first team of doctors mistakes. When all is said and done after implants, restoration, ortho, revision surgery, etc, I am probably going to be out about $25,000+ for everything. Some people pay that (and much more) for jaw surgery to begin with and that's fine, but because I had to pay it to fix my first team of doctor's mistakes ....well, that is a little irritating to say the least, but like I've said so many times now, it is what it is!
Don't get me wrong. I do appreciate what I have now with improvements after revision. I'm chewing with all of my teeth now, biting clean through foods that I was never able to bite through before (pizza, sandwich, corn on the cob, an apple, etc), my headaches are MUCH better (and almost gone completely), I no longer snore, and overall I would say aesthetically things look better now (even though there are a few changes I am not a fan of, like the much wider/bigger nose, but that is just the cost of doing business if you have your upper jaw impacted and/or moved forward). The fixes for what I was left with after the first surgery were huge and greatly appreciated. Those were totally worth it. Even little things like my hearing in my right ear that was left muffled after my first surgery due to the placement of my jaw/tmj near my ear canal, I now have that back and I can clear the ear without pain. And the nasal spine cartilage that was loose in my nose and clicking/flopping around any time I opened my mouth wide or touched my nostrils, that is now fixed and back to normal. And like I said, had I gotten this the first time I do think the typical issues (IE: numbness) would have been worth it for sure 100%. But with everything having to be redone, losing so many teeth, and having to spend so much money, unfortunately all of that wasn't worth it in the end and I have to say over all I do regret the surgery. So, revision to fix what I was left with was for sure worth it, but overall if I could go back and just not do the first surgery, I would do that for sure. For patients reading this, do not let my story of regret scare you off. My case is not typical. Not only is it not typical, but I am not sure what happened to me has happened to anybody else. I bet it has, but I have yet to find a story like mine in the online community where the patient was just completely abandoned when it went wrong. My point is, what happened to me is rare and chances are you will have a normal experience with normal risks/complications. Regardless, it's great to do the research and hear stories like mine to be as informed as possible about this process.
Here are a few shots of the casualties of my journey:
Don't get me wrong. I do appreciate what I have now with improvements after revision. I'm chewing with all of my teeth now, biting clean through foods that I was never able to bite through before (pizza, sandwich, corn on the cob, an apple, etc), my headaches are MUCH better (and almost gone completely), I no longer snore, and overall I would say aesthetically things look better now (even though there are a few changes I am not a fan of, like the much wider/bigger nose, but that is just the cost of doing business if you have your upper jaw impacted and/or moved forward). The fixes for what I was left with after the first surgery were huge and greatly appreciated. Those were totally worth it. Even little things like my hearing in my right ear that was left muffled after my first surgery due to the placement of my jaw/tmj near my ear canal, I now have that back and I can clear the ear without pain. And the nasal spine cartilage that was loose in my nose and clicking/flopping around any time I opened my mouth wide or touched my nostrils, that is now fixed and back to normal. And like I said, had I gotten this the first time I do think the typical issues (IE: numbness) would have been worth it for sure 100%. But with everything having to be redone, losing so many teeth, and having to spend so much money, unfortunately all of that wasn't worth it in the end and I have to say over all I do regret the surgery. So, revision to fix what I was left with was for sure worth it, but overall if I could go back and just not do the first surgery, I would do that for sure. For patients reading this, do not let my story of regret scare you off. My case is not typical. Not only is it not typical, but I am not sure what happened to me has happened to anybody else. I bet it has, but I have yet to find a story like mine in the online community where the patient was just completely abandoned when it went wrong. My point is, what happened to me is rare and chances are you will have a normal experience with normal risks/complications. Regardless, it's great to do the research and hear stories like mine to be as informed as possible about this process.
Here are a few shots of the casualties of my journey:
I just got debanded and don't have final records yet, so I will drop back and update with final films/pictures down the road. I will drop back on this page at 12 months and probably 1.5 years post op to update revision recovery. By 12 months everything should almost be fully settled and final results more evident.
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Final records update, 9.5 months post op, 3 months post debanding: My swelling is pretty much gone finally. I thought majority of it was gone in the 6 month records pictures I had done in my surgeons office, but looking back on it now compared to my final records, it most definitely was not gone then! Amazing how long this all takes, so for those patients reading this going, "are we there yet???!!!!" No.... you probably aren't! When they say give it the full year, it means give it the full year. My bite is still solid. My surgeon was smiling ear to ear when he saw me for a check up the other day, saying I look really good and my bite looks great. For the first time in this whole process, I've had some good feelings. For the most part overall it's been regret, but after feeling my bite settle more, seeing swelling drop more, and also now finding out I am keeping my front teeth for the near term (but not long term), it's giving me a little more optimism with all of this. And for the first time, I am happy with the way things are looking and I do feel like aesthetically (and functionally despite the bum front teeth that will eventually go) there is a HUGE improvement from what I started with as seen in the photos above. I'll be back in to see my surgeon for a 1 year post op follow up in February, and will be back to check in with my ortho in March.
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Final records update, 9.5 months post op, 3 months post debanding: My swelling is pretty much gone finally. I thought majority of it was gone in the 6 month records pictures I had done in my surgeons office, but looking back on it now compared to my final records, it most definitely was not gone then! Amazing how long this all takes, so for those patients reading this going, "are we there yet???!!!!" No.... you probably aren't! When they say give it the full year, it means give it the full year. My bite is still solid. My surgeon was smiling ear to ear when he saw me for a check up the other day, saying I look really good and my bite looks great. For the first time in this whole process, I've had some good feelings. For the most part overall it's been regret, but after feeling my bite settle more, seeing swelling drop more, and also now finding out I am keeping my front teeth for the near term (but not long term), it's giving me a little more optimism with all of this. And for the first time, I am happy with the way things are looking and I do feel like aesthetically (and functionally despite the bum front teeth that will eventually go) there is a HUGE improvement from what I started with as seen in the photos above. I'll be back in to see my surgeon for a 1 year post op follow up in February, and will be back to check in with my ortho in March.
Final ortho records. 9.5 months post op, 3 months debanded. (right click "view image" for a larger image)
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1 Year Post Op Update: I just had my 1 year post op follow up with my surgeon, which was also coincidentally a week post op plate removal follow up since I got some plates/screws removed from around my nose in the upper jaw the week before. My surgeon is still super happy. He got a peek at my upper osteotomy while he was in getting my hardware and said it's healed beautifully, especially for a revision where there are usually a few gaps, but I don't even have a single one. This is really fantastic news for me since as of just a few xrays ago they weren't sure if I was full union yet. Phew! Usually my surgeon takes new records at the year follow up, but since I was bruised and swollen from hardware removal he is bringing me back in May (15 months post op) to do them, so I will update with those in a few months. For now here are a few shots from my 1 year blog post I put together the week before plate removal so you can see what a year looks like before I was all beat up from having the hardware removed.
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15 months post op check up and records: I saw my surgeon for the records I mentioned a few months ago in the 1 year update, so I wanted to come back and drop a note and update a few images from the records. All is well still. I healed nicely from the plate removal. I still feel like my right side around my nose is tender, but that side always felt a little weird, even after the first surgery. I am still slightly desensitized up under my eye and a little through my cheek and down around that spot around my right nostril corner. I think there is something more nerve related (or maybe just scar tissue that hurts in certain places?) going on there and not necessarily anything to do with the bones or infection because 1.) bones are healed beautifully and 2.) no more plates there, so nothing to get infected as far as I know. Only other minor complaint is my scar tissue is still pretty lumpy. Again, nothing I am surprised at. My surgeon saw it during my check up and said he can free some of that up down the road when I want to address it. I think I am going to allow another 6 months and wait until the end of the year to see where things settle with that before letting him have a go at it. My surgeon is still really happy and said I am past the point of bone relapse from surgery (Waahhooooo!!), and now we're just monitoring for the slow changes that can happen if you start to get ICR/relapse. So, like always, I'll watch for that like a hawk! All in all though still doing really well at this point! The veneers just got done on my 4 upper fronts for these records too, so perfect timing.....although I still hate records pictures with my surgeon. Unlike the ortho, they are ALL up in your grill and super close with the camera. Great for records, not great for scrutinizing every little imperfection in the picture for me.
15 months post op check up and records: I saw my surgeon for the records I mentioned a few months ago in the 1 year update, so I wanted to come back and drop a note and update a few images from the records. All is well still. I healed nicely from the plate removal. I still feel like my right side around my nose is tender, but that side always felt a little weird, even after the first surgery. I am still slightly desensitized up under my eye and a little through my cheek and down around that spot around my right nostril corner. I think there is something more nerve related (or maybe just scar tissue that hurts in certain places?) going on there and not necessarily anything to do with the bones or infection because 1.) bones are healed beautifully and 2.) no more plates there, so nothing to get infected as far as I know. Only other minor complaint is my scar tissue is still pretty lumpy. Again, nothing I am surprised at. My surgeon saw it during my check up and said he can free some of that up down the road when I want to address it. I think I am going to allow another 6 months and wait until the end of the year to see where things settle with that before letting him have a go at it. My surgeon is still really happy and said I am past the point of bone relapse from surgery (Waahhooooo!!), and now we're just monitoring for the slow changes that can happen if you start to get ICR/relapse. So, like always, I'll watch for that like a hawk! All in all though still doing really well at this point! The veneers just got done on my 4 upper fronts for these records too, so perfect timing.....although I still hate records pictures with my surgeon. Unlike the ortho, they are ALL up in your grill and super close with the camera. Great for records, not great for scrutinizing every little imperfection in the picture for me.
These were taken as a "final" final at my ortho after my veneers and implant work was all done. Records July 2017. Still can't believe these are my teeth now!
