I first learned I might need orthognathic surgery...
My open bite was quite large, and hadn't been fixed with braces as a child; as a result of it, I had a slight lisp, a gummy smile, a long face, and severe lip strain. I also had a weak jawline and chin from the side. Despite that, I was very secure in my looks and usually felt pretty; I'd just always wanted perfect teeth and a healthy bite, so that was my motivation for the surgery.
Not many surgeons in my area took my insurance, so when I finally found one I decided to go with him; I also picked an orthodontist and wore braces for seven months beforehand.
I had never had major surgery before and honestly was a basketcase beforehand; I started having panic attacks about a month before and went on anxiety medication to get me through.
The day of the surgery, I arrived at the hospital super early and things got underway quickly; the surgery took about four hours and they moved my lower jaw back, my upper jaw forward, and my chin out. When I woke up I wasn't scared or in pain; I was mainly confused and drifted in and out for a while. I mainly felt stiff and tired, and I used the little morphine button liberally even though they told me not to because they didn't want me to get nauseated. (I did not get sick at any time though--right after surgery or the days following. I guess I have a strong stomach for medication.)
I was discharged the next night, and I wish I had stayed two nights--I was so weak and tired after, and it is SO hard to get liquids down. Until you get used to the feeding syringe, almost everything spills down your shirt. Since you can't really feel your lips or your face from the neckdown, you also can't really control what stays in your mouth (lots of drool).
The first week was hellish and I was so glad I had my mom and my husband there to help me; even going down the stairs made me shaky, and if I had been on my own it would have been a struggle for me to make myself eat or drink. In the first week and a half, I lost about fourteen pounds.
I also had a splint in (a plastic tray wired to your top teeth that holds your bite in place), and for the first week my teeth were completely banded shut with no mobility. The pain came and went, but was never unbearable--however, all the doctor gave me was codeine and I definitely needed something stronger. There were long periods of time where I just sat in misery (I don't say that to scare anyone, but to be honest.) However, my surgeon was insistent that it didn't hurt and I wasn't in pain, so he wouldn't give me anything stronger.
The second week was a little better, and on the third week I had my splint out and started eating mush like oatmeal, pudding, and mashed potatoes. It was really hard to get my mouth open at first, and I still (at almost four weeks) only can open about a thumb's width. I was also able to go out of the house for short periods of time the second week and longer periods the third week.
At almost four weeks, I'm talking more clearly but still have trouble with some letter sounds, like P and B. My lower lip and tongue (and parts of my mouth) are completely numb, which I think contributes to me being unable to enunciate certain words. I wear one rubber band on each side of my mouth, but it's still a surgical elastic and I can't open my teeth very far against it.
Other things I wish someone had told me...my entire face from the nose down peeled from the swelling, and I also got (and continue to have) very bad acne, I assume as a combination of the steroids and not conscientiously cleaning my face the first week after surgery.
The hardest part of it all though, and a part I think the surgeon didn't address enough, is the emotional component of this surgery. You spend weeks miserable, and feeling ugly and terrible, but my surgeon at least only focused on the physical. He never asked me how I felt, or how I was dealing with the situation. When you look in the mirror, it's still YOU but it's different in a way that's scary, especially with all the swelling. You wonder if you're always going to look this hideous, even if logically you know you won't. Whenever I went out the second week, children had no problem staring (which is fine, kids don't bother me)--but adults at stores consciously avoided eye contact and would offer to help my mother, and not me. It's disheartening and makes you feel terrible!
I think I would have felt more upbeat by picking a more sympathetic surgeon; I trust that he did his job well, but personally I need to feel like my doctor cares about me and listens to me, instead of telling me what I feel/don't feel, and then acting annoyed if I'm scared or emotional.
Also, I took four weeks off of work and I wish I'd taken six--I'm not sure how people handle eating and talking all day at four weeks (though I know everyone is different). I'm still very messy when I eat and need somewhere to clean my teeth, and I don't want to do either in our work bathroom.
So, would I do this again? At this point the answer is no, though I know from this site and many blogs that my opinion will likely change over time. I do feel that my face was prettier before, and I'm worried about how I will look over the next few months. I didn't want a more square jawline, and I also really hope it's the swelling that are making my eyes so asymmetrical.
I will update with more pics and info as the weeks progress! If you have any questions, please ask and I hope I wasn't too negative in this post!
Weeks Four and Five--Recovery Update
*Sleep: In week four, I moved back down my bed and started sleeping just propped up on a few pillows; I would slide down and wake up with fairly sharp pain in whichever side I ended up sleeping on (I am not a back sleeper!). In week five, I can sleep on either side with nothing but stiffness when I wake up.
*Pain: I haven't taken any painkillers other than Tylenol or Aleve since week four.
*Work: I returned to work starting Monday of Week 5, and it turns out full days were too much. By about 2 pm, my jaw was throbbing and I was exhausted, so this week I'm doing half days and then next week will resume full days. My job is desk-based but I do talk quite a bit, and I also don't really have anywhere to eat, leading to the next bullet point...
*Eating: Every meal I take the surgical bands off for an hour, eat, and practice stretching my mouth. I still can only open it a little wider than a thumb, which my surgeon doesn't seem pleased with. I'm eating pretty much anything soft at this point, from baked potatoes to pasta to very soft breads. Chewing is still a struggle--it's more of a few half-hearted chomps and a swallow. I can mostly eat without dropping anything down my shirt, but since I can't feel parts of my mouth I can't tell where food is stuck and it still gets messy.
*Numbness: I still have complete numbness in my chin, lower lip, upper gums, and parts of my cheek. However, if I run my finger over my chin the tingles follow my finger, so I think I'm at least getting directional feeling back.
* My lips still do not close at rest, which is frustrating--maybe they never will, and I can accept that. I can force them close, but with the braces and my residual swelling it looks like I'm sucking on a lemon and very unnatural.
*Speaking: When my bands are in, it's hard to open my teeth and I speak in a very "clenched teeth" way. However, when they are out almost all speech issues have been resolved. Some of my words sound a little too "round," if that makes sense, but I can pronounce all letters and do not have a lisp any longer.
*Appearance: I still look very swollen to myself, and others at work this week remarked on how swollen I am. I'm hoping it's swelling in my jaws, because I'm still very unhappy with my face. The left side is still a different shape and side than the right, which makes my eyes quite asymmetrical (I'm not going to lie, I've had some pretty emotional breakdowns over the past week based on my appearance. I'm trying not to be vain, but honestly going from a self-confident person to one who hates her face is a hard adjustment). But, I know there is still a lot of swelling to go down and settling to do so I'm still trying to be patient. My other dislike is that my chin lacks definition in the front, and looks like it goes right into my neck when I smile. I'm also hoping that resolves when the swelling goes down, which as I constantly remind myself takes six months to a year.
*My blemishes from the steroids and other meds are slowly fading; I started taking biotin daily and using a gentle oil-free face wash in combination with Finacea, which has helped a lot. (You can get Finacea from a dermatologist, but there are a lot of options for clearing up acne...that's just something I had from a previous issue.)
I will update again at the six-week mark (that's a fairly monumental appointment with the surgeon, and at that point I hope the orthodontist gets the go-ahead to resume treatment so we can get these braces off!). After that, I will go month by month.
I hope this is helpful to any patients out there undergoing the same process!
7 Week Update!
*Work: I have returned to work full time with no issues.
*Eating: I still have limited side to side movement, so I can only chomp up and down--I have resumed a normal diet, excluding anything crunchy or nuts, but I do still have a lot of trouble keeping my mouth closed when chewing. When I go out, I make sure to order soft things I can swallow.
*Lips: I have a LOT of lip incompetence when my lips are at rest still; it's actually more than before surgery. I asked my surgeon about this and he said that lips being apart at rest is "natural"--I don't agree at all, at least not to the extent mine are. It's fairly easy to observe that most people at rest have their lips closed. However, I can force mine closed so I guess I can live with that, and I think the incompetence will go down by a few millimeters when the braces come off.
*Speaking: Some of my words still sound a little off--like I have cotton in my mouth--but this is a result of my still-stiff lower jaw and I expect it to resolve. There are times when I'm talking and have no impediment at all, and other times when it's more apparent.
* Numbness: My feeling is coming back everywhere other than the right corner of my mouth. My chin tingles like mad when I touch it, and my lower lip has been itching and burning (and I can also now feel a fingertip on it.) I can live without that tiny patch of feeling on my lip, so I'm very happy that I will eventually regain full feeling based on how things are going right now.
Appearance: Meh. I think from the side, I look pretty good, especially since I can close my lips. The swelling appears to be mostly gone, though I can tell there is some lingering along the jawline and in my cheeks beside my nose. Head-on and unsmiling, I also think I look pretty good, though the surgery has exacerbated my facial asymmetry--one eye now looks a lot higher than the other (I still think this will look better over time, as one side is still more swollen and "tight" than the other.) I can live with that, and I even realize maybe the asymmetry was present before and I didn't notice because I wasn't sitting and staring at myself all the time like a narcissist. I absolutely do not like my smile, though--my cheeks feel too big and round, and there's not a clear distinction between my chin and neck (to me). I realize that all sounds very vain, but I am definitely trying to keep it honest and that's how I feel when I look in the mirror! I do have hope that things will continue to improve and I will like the final result, because I have come SO FAR even in two weeks. The swelling really fell away in week six.
I will post again at week 12!
Week 8 Mini-Update (All About Stretching)
Something I never thought about pre-surgery was stretching! I just assumed that after surgery my jaw would slowly go back to normal and I would regain my range of motion as far as opening.
However, after being banded shut for so long, at first I could only open about 5 mm. At the four week mark, my doctor told me to start working my jaw and stretching open as far as I could. At the six week mark, he told me to use my thumb and forefinger in a "scissoring motion" to stretch it out.
Then he demonstrated that motion, and...it hurt. A lot. (I have a fairly low pain tolerance, so take that with a grain of salt, but it did make me cry. And I might have yelled at him to stop.) He told me to do that multiple times a day because a normal person should have a 40 mm range of motion, and I had a 20 mm range of motion by week 7.
I couldn't make myself do the exercise with my fingers, so instead I used something I saw on Google--rubberband together a stack of popsicle sticks and sit with them in your mouth for five minutes several times a day; every few days, tap another stick into the middle. I supplemented this with frequent stretches just opening and closing my mouth, pushing it to the point where I felt the stress of the stretch on my muscles.
From week 6 to 8, I opened from 20 mm to 27 mm doing this (and to be honest, I only remembered to do the stretches maybe four days out of the fourteen; if I had been more conscientious, I have no doubt it would have opened even farther). At my appointment today, my doctor said that was okay but not great, and he again stretched my jaw for me, getting it to 32 mm (more sobbing...not ashamed).
However, I will continue doing the popsicle sticks stretches until I hit 40 mm, because while that is uncomfortable it's not painful, and I'm fine with moving more slowly than he wants.
By way of explanation for why you need to stretch--though I have seen several accounts on blogs where doctors say it will just open normally--if scar tissue/bone growth occurs around the condyle, then your range of motion will be permanently limited and it could require joint surgery and more rehab.
However, if I only ever open 35 mm, I would never have the joint surgery to correct that. My range of motion is not restricting my diet or life at even 27 mm, so I'm not convinced a limited mouth opening necessitates another surgery, at least in my personal case.
Week 12 Update
*Speaking: I speak completely normally now, unless it's very cold. I don't know why that is--maybe it has to do with lingering numbness--but this weekend I attended a wedding and the temperatures were quite chilly, and I had trouble getting my lower lip to cooperate.
*Eating: I've resumed a normal diet except for very crunchy, hard things (nuts) and lettuce. I just can't chew well enough for lettuce yet, and my jaw isn't strong enough for nuts. I can almost chew with my mouth closed at this point, too...progress! However, I think my front teeth need a little arranging--part of the reason I can't chew correctly is because my front left canine bangs into a bottom front tooth whenever I try a side-to-side motion, and it hurts.
*Braces: Wearing a powerchain to close gaps, currently in triangles to settle bite, and about to move to boxes because I'm still a bit open on the right side.
*Numbness: I still have numbness in parts of my gums, but I don't notice that unless I'm brushing. I almost have feeling back in my entire lower lip--just tiny tingles left--but I do not yet have feeling in my chin. It's very tingly and tight feeling, and I'm still assuming that means I will get full sensation back eventually.
*Jaw range of motion: I can easily move my jaw forward and from side to side; my surgeon seems pleased with that range. He is not pleased with how far I can open; I'm currently at 30 mm and should be around 40 mm when all is said and done. However, I'm still a terrible patient and refuse to do the stretches; it has been opening slowly on its own. My attitude toward that is it will open or it won't, and I'm not too concerned about it. There is no way in h*ll I will ever have mouth surgery again for something that doesn't affect my quality of living, so my doctor's threats of joint surgery are not having much effect on me. From the time I was allowed to start opening, with NOT doing the stretches, I've progressed from 13 to 21 popsicle sticks (which is how I measure). That seems good to me, considering it's still opening a little farther each day. I also read through internet searches that a healthy adult opens from 30 mm to 50 mm, and if you can fit your index finger, middle finger, and ring finger between your teeth vertically you have a healthy, normal opening. I'm a tiny, tiny bit from that so I'm going to self-diagnose and say I'm doing fine.
My main concerns left are my lip incompetence and my appearance. I have asked my surgeon several times about why my lips don't fit together at rest--you can see almost all of my bottom teeth and a bit of my top teeth. He kept telling me it was natural, but I persisted that it is NOT natural to see that much tooth. Part of the reason I had this surgery was to fix that issue. Finally, he said the reason my lower lip could be drooping is scar tissue, and we can do something about it at a later date when I've healed more. I don't see (most) other people walking around with their lips hanging open, and it makes me self-conscious, especially at work when I need to present myself in meetings. I can force my lips together now, but sometimes it looks strained and unnatural--though I think with practice and as my facial muscles get stronger it may look more natural and be easier. I'm so frustrated, though, that my surgeon absolutely will not admit that most people don't have a huge gap between their lips. I feel like when we talk about this, he tries to make me feel silly, and he has even told me I look more ridiculous forcing it closed.
As for my overall appearance, I actually like how it looks at rest, lips closed, and my profile. (Pics of both of those are included in this update.) There's still a little asymmetry left, but I also still feel/see swelling so I'm hopeful by month six I will be very happy with that.
What I am absolutely not pleased with (still) is my smile--it makes my face so and square, with too much flesh around my chin (pics below--one with makeup and a "picture" smile, one with minimal makeup and a genuine smile). My cheeks also look lumpy to me. I also used to have a more narrowed, tapered chin, which I found more feminine and attractive. I do think with swelling and settling this will change a little, but at this point there won't be drastic changes so I need to try to accept it. However, it is very disheartening and emotionally difficult to go through something so painful and challenging and then come out the other side feeling LESS attractive.
I still don't know if this was worth it for me...I think I need to wait and see how my face continues to settle and how I look with the braces off, which is still several months away.
As I said before, I think I personally would have benefitted from a more sympathetic doctor (though my insurance limited me in who I could pick). I do trust in his experience and skill, and I felt very informed of the physical aspect going into the surgery. However, I don't feel like he prepared me for (or took into account) the emotional toll this surgery takes on a person, not only from weeks (or months) or discomfort but also because of the dissonance of looking into the mirror and seeing a changing face that's different from the one you had before. I also feel like my doctor was too rigid in telling me what I should feel--for instance, whether or not I was in pain, and even whether my anxiety was legitimate. (At one point, he told me to "please be logical"...yes, that's very helpful advice! Anxiety all gone, thanks.)