I was excited to see all the 3d scans and how my surgeon would use them, but at the same time I've been dreading seeing them to see the hot mess that is my jaws/face, and also dreading to hear what further damage has been done in the two years since my surgery.  I haven't been sleeping well.  Pretty much not hitting REM sleep at all some nights.  Partially because of the physical discomfort I am in, but also the emotional/mental aspect.  Last week I woke up sleeping talking and mumbling about some kind of mouth guard I needed.  Last night it was nightmares about getting the scans back and finding out my right TMJ was so trashed that I would need to cancel jaw surgery and first to joint replacement on that side to stabilize before doing jaw surgery.  I was a wreck waking up this morning, especially after what is now 5 nights in a row I have slept little, and what little sleep I've gotten has not been peaceful.  I'm pretty glad at this point I am taking off from work early ahead of surgery.  I feel like I am barely hanging on most days now and don't feel like I could function to the fullest for much longer.  Plus running myself in to the ground further is going to risk me not going in to surgery as well and rested as possible.  That is key for me. 

Anywho, I am getting off topic.  Back to the scans.  Most of it, I have no clue what I am looking at, but the things I do understand are depressing.  The report is depressing.  I am definitely in worse shape than I was 2 years ago at my last 3d scan.  No wonder I feel worse and worse.  Good to know it's not in my head.  And the pictures....the pictures are really depressing.  I know my bite is incredibly exaggerated for surgery right now, so that makes it look worse, but it's still a tough pill to swallow for me looking at all of these.  So the report from the radiologist at UCLA Dental:

• My 4 front teeth are trashed.  I've been told this by multiple specialists and my prosthodontist is easing me in to the plan of needing all 4 upper front teeth replaced (7,8, 9, 10-- both main and lateral incisors).  It's noted multiple times that there is severe resorption and blunting with little root left for teeth support and poor root to crown ratio.  Funny note on the report is he mentions that this is probably all caused by orthodontic movement.  Thanks again, Dr. Wadden!
• My TMJ's are breaking down.  This is no bueno.  My biggest fear in all of this is causing TMJ damage when I originally started with none, or going through revision and then causing unstoppable Condyle Resorption.  Two years ago at my last 3d scan with Dr. Gunson, he noted my TMJ's were in great shape.  This was only 2 months post op, so not enough time had gone by yet to see the carnage that my now trashed bite and crooked face would cause.  So, I guess this is what 2 years of clenching down with a wonky bite will do to you. 
• Bone dehisence on one side of my lower jaw.  It was a part of the jaw I didn't quite recognize the name of, and I am still not uber familiar with dehisence except when it comes to open surgical wound stuff.  I have no clue what it means for the bone, but I am guessing the osteotomey on the one side never healed right.  And it's the side I am all bowed out and bulged out on.  Probably not a coincidence.
• My airway is narrow again.  So much so that the radiologist recommended sleep apnea study for me.  I had a class II airway post op, and pre op it was narrow, as it is for most patients with receded lower jaws and an overbite.  But, this is the worst I've ever heard a specialist talk about it.  Hopefully it will open up when my lower jaw comes forward more.  And maybe, this is another reason I have not been sleeping well. 

Here comes the tough part-- the pictures.  I had a hard time looking at all of this today.  After reading the report and looking at everything, I pretty much sobbed uncontrollably for about 10 minutes. Seeing the 3d head on images and just seeing how skewed and asymmetric I am now.  How swung out to my left I am.  It's all incredibly devastating when my original pre op face had zero asymmetry.  To look at it and be reminded that I got butchered by some monster surgeon with no explanation or anything.  I think that would be a tough experience for anybody. 

The pictures especially are really hard to post, but in the same full disclosure I've had for doing this since day 1, I am posting them in all of their glory.  I am really kicking myself for drinking coffee on the way to the appointment.  I had to get the pictures done with stained coffee teeth.  Salt in the wound at that point looking at these...ugh.

Click on a thumbnail for the larger image.

Oh. My. Gawd. ...... I have a surgery date!!  Dr. Karas's office got back to me this morn and asked if I could do Feb 18th.  Why, yes, yes I can!  I double checked to make sure that is enough planning time for him, and they said no worries there.  Only 1 night overnight if all goes well.  Pretty similar to last time.  So, my head is spinning a little bit.  I actually have a date!  And I totally called this happening.  This whole "surprise, you're confirmed!" less than a month out from surgery.  Good thing I bought my mom's ticket out here on a whim that I would in fact end up in Feb.  Oh well, I am happy to have the date finally.  I was able to confirm all of my sick leave with work, book my final teeth cleaning, file my FMLA paperwork with my agency, and start planning my last days up in Tahoe for the season too.  I have a ton more appointments that need to be planned.  I have another set of xrays and ceph with my ortho on Feb 8th, a few more pre op appointments coming with the surgeon, full blood draw, need to get my surgical hooks on, and I think I need to go for final molds and get a splint fabricated right before surgery too.  A lot to do, but I am SO glad to be in the final prep stages for all of this.  Oddly enough I got a shot of excitement today instead of my usual anxiety.  Like, the past month or so I've been having nightmares about waking up from surgery and my mouth is a hot mess.  Like, I am missing tooth 7, my jaws are more crooked than before, and all sorts of bad stuff happened.  But today I was day dreaming of waking up and knowing immediately that it's better.  Being able to look through all of my swelling and tell right away that we got it.  I am finally fixed.  It's dangerous to day dream like that.  While I have faith in my team, I also need not get excited about a result I very well may not get again and then end up in greater depression and disappointment.

In other news, I finally got my CBCT done after the machine breaking the other day and screwing up my appointment.  I guess this is some fancy shmancy machine.  Like a normal MRI looking machine and not your typical stand up pano xray type thing.  The office I got everything done in said this is the only one they own in the Bay Area, and it's only a year old.  Sweet.  So, I am getting the best of the best there.  This should provide my surgeon with super cool 3d imaging that he will be able to mock the surgery off of.  Can't wait to see his plans with it.

The scans were not as long as a traditional MRI, but they sucked a lot more.  You know how hard it is to breathe so calmly that NOTHING moves in your mouth or throat?  I couldn't even swallow for some of them.  That was pretty rough.  Thank god they are not as long as regular MRI scans!  I got through it though.  Hopefully get the images in a few days.  Hopefully I can figure out how to get them and post them.  I know in the past I've had issues with the 3d Dicom images.

For the first time I feel like there is progress.  Well, I have had moments of progress on the ortho side, but on the surgical side I have been mostly just stuck in limbo or in the dark the last year.  And then after last week, more limbo!!

I saw my ortho on Monday.  He consulted with my surgeon earlier that morning and it sounds like the whole discrepancy on my right side is actually like that on purpose.  See, this is the part where I was raising an eye brow about the two of them talking enough.  This is something simple my surgeon should have known BEFORE I went to see him last week.  But, I'm set up that way on purpose to allow for a little extra overjet and some more work with some inter-proximal reduction on some top teeth as well as my implants/vaneers and other restorative work on my upper teeth and it should come together class I after that.  So, surgery on!!  But....when?  I was super hoping to finally have that all tied up in a nice bow by the end of today, but my surgeon didn't send me an email with available surgery dates that they were hoping to get from the hospital today.  So, I am guessing they didn't get them.  Waa waa wwwaaaaaa.

So, ortho checks a few things and sends me on my way to the surgeon (which was not planned, but they wanted to see me and get things rolling). He confirms they're all on the same page and he takes his own molds and does some photos.  Molds.  I am not a fan of doing molds, but this new ortho is a LOT better than my old ortho when it comes to molds, so they haven't been something I dread anymore.  The ones with the surgeon?  Yuck.  Nasty bitter putty, and they way over fill the trays.  I was having flash backs to my first ortho molds in April 2013 where the putty went down my throat and choked me.  No bueno.  But, I toughed through it.  So...think of my disappointment today when I get a call saying the molds didn't turn out and they needed me to come back and redo them.  And not only redo them, but redo TWO sets of them.  Ugh.  So, toughed through that again.  Hopefully second time is a charm.

I've got my 3d scans and CBCT scheduled for tomorrow.  Surgeon also took some measurements and he's going to start doing some 3d modeling to run up a firm surgery plan.  I asked if I could be involved in this, booking a longer appointment to sit down and go through it all with him step by step, and he said that is totally fine.  Phew.  Awesome.  They're also starting the pre-authorization with my insurance.  So, a little anxiety there to see what comes back and how much they'll cover.  They don't seem too worried about it. I guess I am a pretty obvious surgery case that probably won't see much fight from the insurance over, but who knows. I know sometimes they give you a lot of trouble just because.

So that is that.  Hopefully I get that email with available surgery dates to choose from soon.  I see my ortho for new xrays and updated records with him on Feb 8th.  Surgeon will have my scans to start his planning with, so hopefully I'll get an update with them soon and be able to sit down and go through everything.  Things are moving along....finally! 

Finally.... here it is.  After not seeing my surgeon for a year, I finally get an appointment with him.  I guess I went in to this with a lot of heated anticipation....which is maybe why it was a bigger let down than it should have been.  I honestly don't know how to feel about the appointment.  Frustrated.  In limbo.  Confused.  Sad.  Disappointed.  But, lets back up to before the appointment.

As I said in my last post, I started to question a few things going on with all of my planning and the collaboration between my team.  I actually had quite a bit of anxiety going in to this appointment.  Enough that I ate a xanax for breakfast the day of.  I was afraid I was going to walk in and feel rushed, feel like my records got pulled up out of their system for the first time in a year and he would talk vaguely about things like he hadn't even looked at them in the last year and forgot about me.  Thankfully, I didn't get that feeling at all.  He seemed up to snuff on everything; like he had been looking at things and thinking about my case.  Phew.  Good.  He took a look at my molds.  At first it seemed like all was well starting with a look at my left side first, and then when he took a look at the right....he paused.  I wasn't class I on the right when he brought my lower jaw forward with the molds.  Dammit.  So he starts explaining that he needs to talk to my ortho and see what they are going to do.  If it's something they fix prior to surgery, we could be eyeing surgery dates in March/April.  And even with that he didn't sound certain.  On the other hand, we can proceed with surgery sooner rather than later and fine tune my right side post op.  I really get the feeling that in a perfect world, he would advocate for the ortho on the front end, but right away he mentioned that he knows I am looking at taking a new job that is pending my surgery and subsequent healing months after. I also mentioned to him that I already bought plane tickets for my mother to fly from Philly to San Francisco to take care of me through February.  Thankfully it's Southwest Airlines, so I can always put those tickets off.  I told him of course I am ready to go with whatever the team decides is the best thing to do.  I don't want to rush things and risk a worse result for it.  But if we can do the surgery first and still get the same results with doing the ortho after, then I kind of am leaning towards doing it first for a ton of different reasons.  I am getting pretty sick of trying to plan my life around all of this and constantly having to shift it back.

My surgeon opened the floor to me for questions and stuff.  Of course in the heat of the moment I always brain fart and forget what to say.  This is one of the reasons I encourage patients to go in with everything written down before hand.  I didn't do this since I was running short on time before the appointment.  He confirmed that he is definitely doing a 1 piece lefort on the top jaw now that my ortho has expanded me enough.  If all goes well, 1 night in the hospital again... and this time in a private room. YES!!!!  He is sending me for CT/MRI/Xray stuff soon and he'll use that to look at a few more things as well as start some 3D surgical planning. I asked him if it was OK that I can be apart of that.  If he can make a long appointment with me and sit and walk me through everything with the program and modeling. He said he would be happy to.  Phew.  I need that after what happened to me the first time around and I am glad he understands.  He also asked me for a list (in order of biggest issue to smallest issue) of what I would like fixed and my expectations for revision surgery.  I got around to getting that to him today:



Functionality.  I would like to achieve class I skeletal and dental to be able to chew and bite through food properly for the first time in my life.  Also to help in the long term health of my teeth and joints.  I've always experienced face/head strain and headaches due to my bite.  It's been much worse since the first surgery.  I am hoping with a class I result, the face/jaw strain and headaches will improve.  I have always clenched too, but I think part of that is stress which is something the surgery won't help, but an even larger part of it is clenching down to be able to close my lips over my teeth that stuck out.  I know improvement in clenching is not guaranteed, but hoping I can see a bit of improvement there post op.


Upper Jaw Too Far Forward.  I had an overbite/overjet and lip incompetence before the first surgery and it was never in the plan to move my already prominent upper jaw 4mm forward.  I would have never agreed to it, but somehow for whatever reason it was done and done without my knowledge or consent.  It's left me with a really full upper lip and significant strain.  You can't even see an indentation in the philtrum anymore.  That combined with the other issues has caused major lip/cheek/mouth/mentalis strain and sometimes cramping around my mouth.  These muscles are also just constantly tired and sometimes even lock up a bit and make speaking/eating difficult.  Aesthetically I would like better lip competence, but primarily I am looking for better comfort if we can lessen the strain I'm experiencing. I am hoping the upper jaw can be taken back enough (and lower jaw forward a bit more) to help with this. 


Upper Cant.  I understand the lower is canted as well, but the upper seems much worse and definitely less aesthetically pleasing. I am not sure how much I was impacted with the first surgery, but it was very obvious even a week or two post op it was lopsided.   My VME was much worse prior to the first surgery.  My left anterior gum line is probably in a good spot now with the right canted a few mm lower. I feel like in the posterior there is still maxillary excess.  If everything can be evened out where it should be, I will be happy both functionally and aesthetically.  Overall though I would rather be a little under impacted vs. over impacted to keep a little youthful appearance and avoid additional mouth/skin sagging later in life.


Asymmetry.  I completely understand that the asymmetry will be difficult to fix, with some of it even being impossible to fix.  Unfortunately that is the deck of cards I've been dealt with that and I am approaching this one as realistic as possible and will be fine with whatever results we can manage for this, even if it's not perfect.  Aesthetically my biggest issue is the facial asymmetry.  I think I always had more of a square face, but it was pretty  symmetric prior to the first surgery.  Immediately post op I noticed the bulge on my lower left side and saw I was sunken in on my right side.  I was told by Dr. O'Ryan that it was an infection and associated hematoma, citing that I must have ripped a stitch down there to cause it.  We now know that isn't what it is at all, so now the question is, is it fixable?  I think you said in my initial consult that this may require a third surgery down the road to fix the gonial angle on that side.  I may revisit this down the road (but maybe not if it's only for the sake of aesthetics), but I would like to understand more of how this may change in revision if the yaw is corrected and whatever CW/CCW rotation is done may change it.  I actually still don't fully understand how my bones got set to make this asymmetry happen, but I am guessing it has to do with the yaw/rotation that maybe only one proximal side of my mandible saw?  Otherwise functionally, I would like the yaw/rotation/cants leveled out (both upper and lower jaw) as best we can to achieve a good class I skeletal/dental.      


Nose.  This is definitely a last but not least kind of thing.  I know when the maxilla is impacted and moved forward that the nose changes are almost unavoidable.  Some surgeons try to tidy it up a bit with an alar cinch.  My operative report says one was done but I still feel like I saw a significant widening of my nose.  If that is the price I have to pay to have the jaws moved in a functional position, then so be it.  I am willing to pay it, but if there is anything you can do to avoid any further significant widening, it would be much appreciated.  I am hoping that I saw additional widening because my upper jaw was moved too far forward, and maybe it won't get worse (maybe even get a little better?) when it's moved back. Otherwise, my nose came out pretty symmetric after surgery from what I can tell and hope that the second one will be uneventful in that department. 


Paresthesia/Nerve Damage.  Another thing that I understand is almost unavoidable, especially for my age and even more so for revision surgeries.  I understand my nerve has already lost some elasticity in it form the first procedure, and there will be scar tissue around it to battle as well.  I am not expecting miracles and I am willing to pay the price of a little more numbness/tingles if I can get the class I functionality, but if any extra care can be taken to prevent further damage (right now I currently have paresthesia in a strip down my lower lip/chin on my right side as well as through most of the gums on my right), it would be greatly appreciated.

********


So, I feel like what I am asking for is fair.  And I feel like my expectations are fair.  And if they aren't, I hope he knows he can tell me and I will definitely be able to understand and work through whatever we have to.  For the most part I am pretty easy going.... surprisingly even when it comes to something major like relocating bones in my face. 

So.. that is that.  I am kind of just floating in limbo.  The frustration I've had with the limbo thing the last few months just continues on, which is even more frustrating when I was hoping this was the appointment that would end those frustrations.  Kind of funny how life works sometimes.  I don't have another appointment set for the surgeon, I don't have my appointment set (yet) for the CBCT/Xray/Ect, I see my ortho on Mon for I don't even know what.  Just to check in?  Hopefully he talks to my surgeon and can give me an update then.  I need to figure something out because my work already has me on our published February schedule for sick leave, my mom's plane tickets need to be canceled, and I would need to put in for more leave to take weekend days off and go snowboarding some more (I know... sucks, doesn't it? lol  At least there is ONE good thing that can come out of this!). 

Last little bit for this already long post---- The work thing I really need to figure out asap.  We have a big event the first week of February that they would rather me there for.  I am honestly not tripping all over myself to do it because I got royally hosed on the schedule for it and they are bringing in enough temporary forecasters to more than cover me if I am gone.  So, super hosed.  Like, embarrassingly hosed.  I was thinking this would be the last week I would be at work before surgery.  Usually I take that week off since I am a nervous wreck that can barely function, but for the big event I figured I could tough it out.  My office is usually not open overnight, but for this event we are.  I LOVE overnight shifts.  Weird, I know, but I like them vs. working morning shifts.  Plus for me it would be the less stressful shift in a week I don't need the stress before surgery.  A week I am already going to be a walking xanax filled basket case.  A shift that would have less talking.  Less people mingling with less talking.  Less opportunity for me to drool all over myself in front of high level management.  A shift I wouldn't have to go out and drop a wad of cash on new business attire for.  Why?  Because I can't fit in to any of my business clothes right now with the extra 20lbs of pre op weight.  If I work day shifts I would have to go get new business clothes that I am just going to turn around and not fit in a week later because I am going to drop all of my weight being wired shut.  (we don't normally dress business,  but for this event we will)  So, I figured my request to take all of those shifts was fair.  I didn't expect a fight for them since nobody likes working overnight shifts. Turns out.....everybody wanted them!  WTH?!  So, despite what I thought was legit reasoning with my request.... I get none of the shifts.  Nope.  Nada.  One of our guys wanted them, and having the scheduling powers to do so, schedules himself for all of them.  Talk about a kick to the balls.  Sorry, but that is really how I feel about the whole thing after pleading my case, which included the brutally honest embarrassing reasons like how I can't fit in to my business clothes right now.  So, I was kind of thankful I had surgery coming up to just say 'peace out' to all the hassle of it, but now it sounds like I might have to go back on the schedule.  Ugh.  Again, more of the limbo frustration to deal with.  On top of the work frustrations.  On top of all the other frustrations.  I just can't wait for a week where I can finally get some good solid news and stop being frustrated!!!

I saw my orthodontist a few days ago.  A month since I last saw him when he added the c-chain on the top teeth and said he was pretty much done all the ortho on his end.  So,  few little tidbits from this appointment.  1.) The space that opened up on between my left lateral incisor and K9 is there to stay.  He looked more at my molds and then measured my teeth and caught yet another tooth size discrepancy.  My right incisor is bigger than my left, so he's leaving that space to allow vaneer (or in my case implant since the roots are bad on the teeth) placement and correct the tooth size discrepancy there.  Super.  Now I get to walk around with a few mm gap in my front teeth for the next year or so.  2.) I am officially cleared for surgery and was FINALLY allowed to make an appointment with my surgeon to see him.  So, no adjustments and only got a set of surgical molds taken at this appointment.  I have no clue why he couldn't have told me to make an appointment with my surgeon a month ago when he stopped all the adjustments.  I called my surgeon and he's booked out for almost the rest of the month.  Ugh.  I politely mentioned that I really would like to get this show on the road since I am sitting here in a pretty decent amount of pain and discomfort, so they are squeezing me in on the 14th.  Hopefully... just hopefully.... I can finally get a surgery date then.

And then I saw my prosthodontist today.  I don't know what it is about my prosth that makes me spill my guts to him.  Maybe it's because he's super personable and the one out of the 3 to talk to me one on one, like he would be talking to his kid, and makes me feel like he super genuinely cares.  Not that the others don't, but he just goes way out of his way to do what he can for you.  A perfect example is that first appointment I ever had with him where he kept me through his lunch hour.  The guy skipped his lunch so he could talk to me and get all the details on this nightmare I was going through and help me get on a path to fixing it.  He did.  I credit him for putting this whole team together for me.  So, I admit to him today that I've been nervous.  I was nervous a few months ago when my surgeon tells me he's got none of my records and has basically not heard from my ortho at all during the year when I asked him if he had all of my new xrays/scans/etc.  I was nervous back in July/August when I told my ortho that the surgeon wanted me to check in and see him about half way through pre op ortho and he said he wasn't ready to send me yet and then never sent me.  I call the surgeon the other day to finally make a pre op appointment, and first thing they say is "oh, in your treatment notes you were supposed to be here to check in with us half way through ortho."  Yup..... I was.  And I tried.  I didn't want to seem like I was jumping the shark and going over my ortho's head and just making an appointment myself without his approval, but in hindsight, I probably should have done just that.  Now the surgeon's office is confused that they haven't seen me.  Awesome.  So, I admit to my prosth that this all feels a lot like my first surgery.  Like I am worried they are not talking enough and there is a lack of communication and not enough planning being done for my case.  If anything it looked like he wanted to raise an eye brow at the ortho, especially since he doesn't know him and can't really vouch for him, but in terms of my surgeon, he reassured me that he will not let this all go by the seat of his pants.  It was like dejavu for me though because this reminds me of the exact conversation I had with my first orthodontist a month or two before the first surgery.  The appointment where I questioned the weird fact that my surgeon could not provide me with her surgical plan including measurements as well as the positioning of my teeth (which was where my ortho made my bite better instead of worse).  I got smoothed over and he told me it would all be OK.  This is the way they did things.  Just relax and go with it.  Serious dejavu there today.  And I am not saying that my prosth is bull shitting me. I am just saying that because of what happened to me last time, it's completely normal and expected that I be skeptical this time.  I told him all of this and where my feelings were coming from, and he said it's completely understandable and the team understands. 

It's so hard to find a balance between being too worried, involved, concerned and then being the annoying paranoid patient.  Being too trusting vs. not trusting enough. I want to trust my team, but I also want to listen to my gut if it's telling me something isn't right.  And I'm sorry, but I've had a bad feeling for a few months, which isn't really saying much because due to my natural skepticism and distrust after being burned through my first surgery experience, I am pretty much always having a bad feeling to begin with.  But I do worry that my surgeon has basically not even thought of me or seen me for a whole year (since I wasn't scheduled for the half way check up with him), hasn't gotten new records, hasn't done any planning (that I know of after the initial pow wow the team had over a year ago. Maybe it's normal to not do much planning at this point, but again after what happened to me last time, I am just so nervous and want to make sure there is a plan.).  Here we are, about 5-6 weeks out from what I believe will be surgery time, and we're at this point where I'm wondering how much talking is being done. I want to make sure I don't end up like last time.   I don't have a date scheduled and no plans yet at this point, so naturally after last time, I am a little anxious.  I don't know if I am being too paranoid or expecting too much, but that seems off to me.  I feel like we should be at a much firmer place right now.  I just feel like maybe I should have seen my surgeon or at least checked in by now, had a surgery date, and know that people are talking and planning is happening.   No more ortho is going to be done from here until surgery, so now we just wait I guess.  I hope I am wrong. I hope I am starting to freak out over nothing or I am just being paranoid because of whats happened to me before. I hope they've been doing more in the background than what I gather they've been doing or more than what they've mentioned to me.  I started to feel uneasy a few months ago, and I think it's fair to wait as long as I have to finally say enough is enough.  I mean we're 4-5 weeks out from surgery.  I don't think I am being unreasonable now.  I always preach to people to follow their gut if they think something is off.  I probably need to listen to my own advice and just flat out asked my team what is up instead of sitting over here being all worried about everything. 

So, we'll see what happens. I think I am going to be honest with the surgeon when I see him on the 14th and tell him all of my feelings so far on this.  I have to or else I am not going to feel right. I need to get it all out there and be assured they are doing right by me right now and if they are, hopefully put my fears at ease.  And again, it's not that they've really given me a bunch of reason to think they're not doing right by me, but it's just my natural skepticism and distrust after what's happened to me.  I really hope the team understands what I've been through and why I have skepticism and doubts.  It's a whole, "It's not you, it's me," thing, because it's definitely not them.  I know they are doing good work this time, but the sad thing is that no matter how good they do, I don't think I can ever trust anybody again after what I've been through.  I really hope they understand. Really can't wait until the 14th. Hopefully I can lift the elephant that is sitting on my chest...or at least feels like it. 

Normally most people take the new year holiday to reflect on the past year.  I usually follow suit, but thanks to Facebook memories, now I am thinking about 10 years ago!  This picture with a friend from the UK was 10 years ago when he was visiting.  I was 22 and hadn't seen a dentist in probably a decade, so this was even pre basic dental work.

This picture reminds me just how much has changed.  I've definitely aged.  Shift work has not helped me with that at all!  And my teeth have changed so much too.  Despite how whacked out my results are from the first jaw surgery, just the ortho alone plus a few of the changes from upper jaw impaction, has overall made my smile a little better.  Still a TON of issues, especially in the functional areas, but in general it's better on the eyes.  Here is a more recent photo to compare-- taken a little over a year post op just before I got my upper braces back on to start the revision surgery process. 

What a difference 10 years makes!  Since then I've had SO much work done.  The biggest changes probably from the gingivectomy, bonding my front teeth, braces, and the first jaw surgery.  Even though my results aren't right and I am getting everything redone, some changes have at least inched me closer to a better cosmetic improvement.  Can't wait to get the functional improvement with it...as well as even more cosmetic improvement....hopefully.  So, there is a lot to look forward to in 2016.  Hopefully I can finally put this teeth and jaw mess behind me.  Hopefully down the road when facebook reminds me that my more recent picture was 10 years ago, I'll be able to look back on that one and compare it with an even better picture. 

So, happy new year all!  Good luck to anybody with an upcoming 2016 surgery date!