Facial Asymmetry (Hemifacial Microsomia) - Maxilliary Osteotomy & Open Rhinoplasty Surgeries

It's now 3 months since I had hoped to have these surgeries done but alas, barely a dollar saved! It's just completely unrealistic that I can save this sort of money while continuing my work in Cambodia, so I'm faced with a few options:

1. Move back to Australia, earn a proper income, and save save save!

2. Move back to Australia, as above, but also invest in private health insurance. I have confirmed that at the very least the double jaw surgery would be covered by insurance as it's correction of a birth defect, however I haven't been able to confirm whether the rhinoplasty would be covered too. I'm pretty sure it would be as it seems to be part of the same condition, but I'm not sure. Plan would be to save up for the rhinoplasty (the much cheaper surgery) and get that done by the same surgeon in Thailand, while waiting out the waiting period to get the double jaw surgery done in Australia and under insurance.

3. Stay in Cambodia and hope for a miracle! I've been trying to build my photography business here and who know, maybe it will take off?!

4. Move back to Australia and get finance to cover the surgeries - easy option. Not very responsible, but I'm desperate, and increasingly impatient.

5. Stay in Cambodia and make some compromises about the procedures I have done. I think that the feature that bothers me most is my crooked/twisted and large nose. I think this is the most obvious part of my condition, unless my head is tilted back and people can see my jaw line from below, and it's bothered me my whole life. This is a significantly cheaper surgery and I think it would still boost my confidence immensely.

In lieu of option #5, I went back to good old Photoshop and edited some images to only correct my nose, not touching my jaw, neck or cheekbones. I also edited the skin between my eyes and on my forehead to remove acne scarring and some moles. Of course, the photos were taken from good angles where my asymmetrical jaw is not that obvious, but I just wanted to give myself an idea of how I might look correcting just one of the issues. I think - just based on these edited photos - that a smaller, straight nose would completely transform my face. It's also a droopy nose that pushes down on my upper lip so I think my upper lip would appear a little bit fuller too. This surgery is estimated at $4000 (at St Louis Hospital, Thailand, with Dr. Nond), then perhaps $500 for skin treatments and $1000 for flights and accommodation to Bangkok (there's a small blessing - it's cheap to fly from Cambodia to Thailand!!) So, conservatively looking at $5500 to be saved, compared to about $17,500 for both surgeries. Still a huge amount for me to save, and I've been desperately scouring the internet for ways to raise this money, or looking for loan providers who would lend to me, but no luck. It's just getting really, really depressing. I'm so ready to just get this stupid face straightened out and get on with my life!

So...! These are the options. I really feel like I'm not ready to leave Cambodia yet, I still love my volunteer work and I've worked so hard to get the photography business going - it feels like it might be just about to break through and start getting busy. So, now that I've written this all out here (and I'm still pretending that this is just a journal and no-one can read it because, gee, embarrasing!) I feel like I can focus on a new, slightly more achievable financial goal. Save $5500 for the rhinoplasty/septoplasty and do the double jaw surgery later in life.

I'd like to finish with one thought - that is that despite the pain (emotional and physical!) that this birth defect has brought me, I am still very fortunate and grateful to have great health. There are so many people with this condition and with others, or who have suffered accidents or illnesses, who are much worse off. I do try to remind myself of that regularly, and be grateful for the things that I do have.

Thank you, random internet strangers, for allowing me to process my thoughts here. I always feel better after a post and a little cry!

Got a little carried away in that last post and forgot a few things :)

* I don't know yet if there will be anything required to fix my teeth after the surgeries. I had braces as a teenager so I have relatively straight teeth, but they don't line up at the front (middle of my two front teeth are not inline from top to bottom) and my bite doesn't close together. Hard to explain in writing, but basically when you close you mouth, your top rows of teeth and bottom rows should touch - especially at the sides, the molars. Mine don't do this now, with the misaligned lower jaw, but they almost do on the left so I subconsciously chew on the left. When I try to pull my lower jaw inline now (I can't do it exactly because it's still twisted and undergrown on one side, and I can pull it from right to left) the top and bottom rows of teeth are no where near each other. If this was the case after the surgery then I wouldn't be able to chew food. I will need to find out more information on this, but I suspect that the doctors wouldn't be able to speculate without me at least getting some x-rays.

* I've been enlightened to some life-long ear problems. It turns out that the good old hemifacial microsomia could be the culprit for my awful earaches that I had as a child, and for a condition that I have now which is commonly known as "glue ear". Basically the fluid that exists naturally in my ear doesn't drain where it's supposed to so my ears feel constantly blocked. It's like that feeling when you go up or down in an aeroplane and your ears pop - except my ears never pop. It's caused hearing loss and causes me to have a semi-conscious twitch of my jaw. The twitching of my jaw equalizes the pressure momentarily but then it's back to blocked, foggy ears. The procedure that could fix it is simple grommit insertion into the ears, but the surgeon said that may actually not fix it in my case, it could be attributed to the wonky jaw (he didn't use the term wonky jaw, exactly...)

* Headaches. I never used to get headaches... unless I hadn't drunk enough water... or I was hungover. In the last couple of years I've been getting frequent tension headaches. The begin in my neck, travel up my jaw, go around my ears and up to my temples. Tension is the best word to describe it. massaging my neck, jaw and temples does wonders, but the tension comes back immediately as soon as I stop! Dr Nond said that surgery could stop these headaches, but that it may not. I don't really understand why not.

Lastly, I'm going to be a bridesmaid! Fills me with joy and dread at the same time. Joy, because my big sister is marrying the man of her dreams and I'm honoured that she asked me to be a bridesmaid. Dread because it means photos. Photos that I would love to look beautiful in, but because they're not going to be taken by me as a selfie on my iphone but rather by a professional photographer with a DSLR camera, I know exactly what I'm going to look like. I'm already trying to prepare myself for it so on the day I can just focus on my sister and ignore the camera. The wedding will be in about 4 months. Even if by some miracle I got the first surgery next week, I'd still have the crooked nose in the photos. It's one of those milestone moments - bridesmaid at my sister's wedding. Photos that will be in our homes forever. Hmm.. I wonder if the photographer will let me photoshop my face ;)
I'll get all this worrying out here, because when the wedding day comes, I am a bridesMAID and nothing else matters!

One more!
* Insurance questions - I have been advised by the Australian Board of Plastic Surgeons... or something along those lines... that the surgeons themselves will be able to advise me as to whether my condition is covered by insurance. I suspect there would be some overheads or a gap to pay, but if it's less than $16,000 that would be alright, eh?! A downside would be that I imagine there would be a waiting period (before claiming, after signing up) of at least a year. But if I'm honest, I doubt I'd be saving $16,000 before that year was out either so the sooner I start, the better. But that means leaving Cambodia. Ohhh, for goodness sake. I'm going to bed! Goodnight, internet land xx

Well, it's been a while, Realself! I haven't updated in a long time, but that doesn't mean that I don't think about surgery every day. I simply haven't had any news until this week. Despite barely having saved anything towards surgery (I'm a volunteer in Cambodia - it's wonderful but not so good financially!!) I made a Skype appointment with Dr Nond in Bangkok. I talked with him earlier this week and it gave me hope that something significant can be done... but it'll cost me! It's more expensive than I had even imagined. I'll start at the beginning:

There are a few names for the condition that I have: Condylar Hyperplasia, Hemifacial Microsomia, or just plain old Facial Asymmetry. I haven't had a firm diagnosis on exactly what's wrong with my face, but everyone agrees there's certainly something! Dr Nond was lovely, friendly and relaxed, didn't rush me, seems to really know his stuff. The only issue was that, thanks to my dodgy Cambodian internet connection, the Skype video wasn't very clear and he had to refer to my photos to see my condition.

Here's the surgical plan: There will be 2 main surgeries, about 6 months apart. The first is the most major surgery, a bimaxillary osteotomy, sometimes called double jaw surgery. Basically my entire lower jaw will be cut and separated from my upper jaw. It will then be rotated into the correct position and screwed/wired in place. It sounds like it's gonna be a painful one! But I'd endure years of pain to fix this condition. The jaw remains wired shut for a period of time (I don't know exactly how long yet) and then it's just up to me to heal for a while until it's time for the second surgery. The second surgery is an open rhinoplasty - this is primarily to correct my deviated septum but will also reduce the slightly bulbous tip of my nose. I do also have slight breathing difficulties through my left nostril - just little things like when exercising I have to breathe with my mouth open. To be honest it doesn't bother me that much, this is really about correcting the facial asymmetry.

During the rhinoplasty surgery Dr Nond will also make any necessary adjustments to my jaw line and cheek bones (my right cheek bone is quite a lot smaller than the left). There could be a need for a small implant or bone graft to be added to my right lower jaw (not only is my lower jaw twisted and offset, but it's also under-grown so even after realignment it will probably still be smaller). The better option, rather than an implant or graft, would be fat transfer to the right lower jaw and the right cheek bone. Dr Nond said this would be his preferred option as it's less risky (higher chance of infection with an implant) and should still provide a natural and balanced look.

So, big question - how much will all this cost? Well, Dr Nond operates at Bumrungrad Hospital (fancy, 5 start hospital) and St Louis Hospital (he calls it "middle class") as St Louis has the same surgical standards as Bumrungrad, you just get less of a hotel experience, I'll be going there. The costs:

* Bimaxillary Osteotomy (double jaw surgery) - 384,000 THB, just over $12,000US. I know, right?!
* Open Rhinoplasty - 122,000 THB, just under $4000US.
I don't have an estimate for any additional procedures like fat transfer during the second surgery, but it will be comparatively minimal.

These prices are inclusive of everything, hospital stay, drugs, etc, but still - we're talking about $16,000, and that's before I've flown to Thailand and paid for accommodation and expenses for however long I'll be there recovering. I've checked out prices in Aus and they vary a lot, but the cheapest I can find is at least double.

So, I earned $250 this month doing photography work, and I'm setting myself the task of somehow saving more than $16,000 for surgery. Ridiculous, huh? And I can't believe I'm posting this on the internet for all to see! I guess I just need to get it out. There's lots of frustration in here.

I had a new little flicker of hope this week while browsing the Realself stories - I came across a young woman who has the same condition as me and who had both surgeries done in Australia. The comment that caught my eye - both her surgeries were completely covered by insurance! Whhaaat?! I've always thought that private health insurance never covers plastic surgery. I frantically began searching the web and emailing surgeons, the Australian Plastic Surgery Board, and the Realself poster. I looked at the fine print of insurance providers. Couldn't find anything answers on this, pro or against. The woman who posted on Realself replied to me today and explained that because this surgery is not considered elective surgery, it's reconstructive surgery on a medical condition, she was 100% covered! This has given me a whole new hope - how did I not know about this a year ago? 5 years ago? Gosh, that makes me so depressed. Could it be possible that I could have actually enjoyed my 20s without being plagued by this face, but rather just had the normal one that's underneath?? If I think about wasted time, wasted youth, too long, it just makes me angry. I don't want to be going through this again at the end of my 30s.

You know, sometimes, it doesn't seem fair. Sometimes I get cross with the people on here who are whinging about wanting more perky boobs, or fuller lips, or liposuction... I KNOW I shouldn't judge, but I do sometimes. I have plenty of things that I could get "fixed" I have pretty awful freckly skin, and I have no boobs at all. I mean, less than an A cup. But a few years ago, I just kind of accepted them. I don't need perfection. I just want to be normal.

Then I remember that I have two arms and legs, 2 good eyes and 2, hmm, goodish ears (they're a little dodgy, that's another story!). I was born in a truly wonderful country, I have a loving family, and man I miss them right now... what right do a I have to complain about being born with this asymmetrical face? I have no right. I have too much to be grateful for to complain. To whinge that it's not fair. Really, it's not fair to have stunning sisters when I go through life looking like I've been in an accident. But life isn't fair, and it's far less fair for many other people than it has been for me.

I have a young Cambodian friend suffering from chronic rheumatoid arthritis. Not only is she in daily agony, she can't drive her motorbike because she can't grip the handlebars; she can't cook dinner for her husband because she can't hold a knife; she can't type and she can't hold a pen properly. She spends $100 out of her $350 a month income to pay for the drugs to treat her, and to receive the awful side-effects of said drugs. I wonder if she'd swap her pain for a bit of facial asymmetry? I don't know. I guess there is more than one kind of pain. I think that her pain is greater than mine, and the hand that she's been dealt is more unfair than mine... but my pain is still my own. It's not diminished because of what someone else is going through. It reminds me to be more grateful for the multitude of blessings that I do have, and when I get these surgeries I'll be grateful for that too.

I don't know how I'm going to do it. I'm trying to work out if health insurance will apply to me. It could mean that I would have to choose between staying in Cambodia or going back to Perth, so I can have health insurance, wait out the waiting period (probably a year) and get the surgery. I just don't know right now. I really wish that I could just let it go, be content with the face I have. Sometimes I think I could, but then I realise that when I feel that way I'm not "accepting and being content", I'm "giving up". And I don't want to give up on myself. I want to live a full life, in all areas of life, why not in the way I look?

I thought I'd feel better if I wrote it out here, and used this as my online journal again. But I don't. I really don't feel better. I feel hopeless.

I hope I can update again with something happier to say. I'll say this: there is hope. And I'm absolutely believing for a miracle of healing for my friend. [RS bleep]