Cross Bite Causing Chronic Pain, Interrupted Sleep and Issues with Self Confidence. Jaw Reconstruction - Santa Monica, CA

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When I was 20 years old I found out I needed to...

When I was 20 years old I found out I needed to have jaw reconstruction. I walked into an Oral surgeon's office at UCLA expecting to be consulted, and scheduled for surgery within a few months to fix all my problems. Of course, this is not at all what happened and my journey to relief was only just beginning. To do this I first had to straighten my teeth, I had the lingual braces or Incognito Braces applied by Dr. Mascola in his office in Long Beach, California in 2012. Incognito braces, which go on the insides of your teeth, they are roughly 10% visible when you smile, and 40% when you talk. They do not come in clear, only silver, or atleast that was the only option when I got them on. They are produced in Germany by 3M, an innovating company whose claim is bringing science into everyday life.
I've now had braces on for four years (since July 11, 2012) and at 24 years old I was told by my orthodontist I'm ready for the surgery I have been waiting for. I have a love/hate relationship with these damn these things. My smile has improved quite a lot already as far as cosmetics go, but sadly my bite is still the same crooked mess and the pain has not subsided much. I'm sure if you've gone through or are in a similar situation, we keep our fingers crossed that our braces are going to move the mountain that is our bite, but if you are just beginning I advise you to come to the realization the major movements are for the surgeon, not the orthodontist. FYI Since I did not have dental insurance, I got a cash discount from 13k down to $8,310.00. I'm not sure if dental insurance would've covered them anyway.
My goals since the beginning were to:
Straighten my teeth
Widen my smile
Pull my front teeth back so they do not stick out (minor)
Replace the unattractive crown I have on my right lateral incisor
Even out my lips
Adjust my lower mandible to align with the rest of my face
Have my top bite fit comfortably over my lower bite
Stop the muscle spasms and extreme pain/bouts of lock jaw I have due to strain on my TM joint on the right side of my face
Stop using muscle relaxers or pain killers to help with pain in worst case scenario
Stop needing cortisone/botox shots in my face to numb/freeze muscles

My first consultation with a potential surgeon with Mark M Urata was around April 1st, 2015. I was referred to him by a friend of mine who is also a plastic surgeon and studied under Dr. Urata. He said if his wife was going to have the surgery I was going to have this is who he would take her too.
I gave the staff the panorama X-rays from my orthodontist and I was told I needed a Bilateral Sagittal Split of the Mandible which I understood was breaking my lower jaw into pieces and putting it back together like a morbid puzzle. I was ready for this news. I was told it was going to cost around $21k including anesthesia and a one night hospital stay at St. John's in Santa Monica. I felt like I was going to faint, but knew my supportive family would help me come up with the money as my parents feel great guilt for not getting braces put on my malleable, preteen face. I really liked Dr Urata and although insurance was not going to pick up the tab on this one, I had made my decision to stick with him.

My second consultation with my surgeon Dr. Mark M. Urata was last week, June 23rd 2015, at his office in Santa Monica, CA.
This was some news I was not ready for. I gave Dr. Urata the molds of my jaw from my orthodontist, and after going back and forth between looking at my face, asking me questions about my orthodontic treatment, and studying the molds up and down, open and closed, Dr. Urata told me I needed to have a Lefort I which meant my top jaw would have to be broken as well. I was very sad and scared when he told me what this meant. I had also just received a denial in the mail from my insurance and now knowing the cost was going to very possibly double, I was also stressed on top of it. My wonderful parents, my boyfriend and I all agreed I should still go forward with it. I got an estimate from Dr. Urata's assistant, and it said:
Dr. Urata's surgical fee is $36,000.00 for your surgery. This represents the following procedures:
1. Lefort I (3 piece) $18,000.00
2. Bilateral Sagittal Split of the Mandible $16,000.00
3. Surgical Splints needed for surgery (Not billable to the insurance) $2,000.00

At this point I am waiting for an open slot from the hospital and trying to deal with insurance to help with the costs. I will update this account after my next appointment. I hope this can be of some help to even one person because I had a lot of questions and still do.

Before Braces/After surgery

Update of Orthognathic surgery, Bilateral Split of Mandible, Lefort 3 piece and Genioplasty

Hello Real Self!
So as you know going through anything medical is an emotional roller coaster and although I meant to keep up I was so stressed mentally and physically after the operation I chose to wait so I could write a helpful and (hopefully) unbiased update.

I went through with the operation having a Lower Split of Mandible, Lefort 3 Piece and Genioplasty. All in one she-bang. A team of talented surgeons did everything possible to straighten my bite and face aesthetically. Cutting edge technology was used to scan my face and complete a virtual surgery before gate time. Writing this is difficult because it closed many doors but opened some new ones. I wonder throughout my recovery, during the weight loss and hunger, the claustrophobia, the moodiness and pain, what I did to myself? How could I have volunteered for this?
Real Selfers, if I am standing on a cosmetic side, I think my decision was a wonderful one. My face is much more symmetrical, my teeth and smile have a shot at actually being beautiful. Did I feel beautiful before? Yes. Did it come for a price? Yes, doesn't everything. Both financially and physically. On the other hand, my teeth fit together beautifully more and more each day and I know this will help my overall comfort with daily activity, but a surgery I was told could be intended to alleviate pain in my severe TMJ was a flat out lie. This sped up erosion of my joint, I am 25 and my left joint now looks like an 80 year old with arthritis. It hurts. It was almost unbearable for about 6 months after surgery. I was told this is very uncommon but who knows? I must say I thought this was what the computers were used for. Doctors: can't you see if bone is going to collide? I hope one day there is a drop down menu to add X amount of wear and tear years left in lifespan to a joint to see what could possibly occur. On the bright side... I have had great relief with Botox into my masseter, pteragoid, and temporal muscles and !!acupuncture!! (I was a skeptic, not anymore!)
During recovery I lost 24 lbs taking me from 125 at 5 ft 7 in to 101 lbs, which after 9 months I am at 116 lbs and comfortable with that. I was difficult to deal with and stubborn with food I think it would be possible to stay at a healthier weight. Also some people will shed 24 lbs easier if there is any extra weight.
I want to go on record saying that I would still have done surgery. I wish we could have been more aware of the pain I would endure and ways to avoid it. Maybe we wouldn't have moved my jaw quite so far. Maybe I had a bit too much work for one session.
My advice is to ask way too many questions even if you feel you are annoying. Get a second, third or forth opinion. Trust your gut. Tell yourself you are beautiful every damn day and don't go under the knife for a very traumatic surgery for only cosmetic reasons because with the price tag I could've had full veneers and just the genioplasty. I had pain half my life and getting worse, I was brave and chose to make a change and my only regret was not exploring EVERY SINGLE OPTION.

I will post more pics or updates if this is helpful to anyone! I have lots to share but my fingers are sore.
Cheers and God bless!


An update!

I finally got my braces off a few weeks ago after 4 years almost to the day. Looking back on this journey it did make a huge difference in my appearance and I am 80% happy. Now I just have some dental work to complete, a few veneers and a replacement of one that I hate from many years ago (2004). Also the Genioplasty that was added onto the jaw operation kind of last minute, I'm not sure if I'm fully happy with that. My chin does still look a bit crooked, like maybe not much was done there. I am getting a few more opinions and going to see the surgeon to ask him about it in Oct. Just wanted to add more photos for anyone who is interested. These are all but one after my surgery(the one with fully blonde hair is prior). Let me know what you think. Also considering getting fillers in cheeks because I feel like they sunk in a tiny bit after surgery.
Hollywood Dentist

I feel very comfortable and extremely confident in Dr. Mark Urata. He is beyond qualified. Mark M. Urata is head of the Division of Plastic Surgery at Children's Hospital Los Angeles. Dr. Urata had been associated with Children's Hospital Los Angeles as director of Craniofacial Surgery and medical director in the Division of Plastic Surgery. He is currently director of Craniofacial and Pediatric Plastic Surgery at Cedars-Sinai Medical Center and co-director of the Cleft Team at Shriner's Hospital in Los Angeles. Dr. Urata is certified by both the American Board of Plastic Surgery (2005-present) and the American Board of Oral and Maxillofacial Surgery (2007-present). He specializes in complex craniofacial anomalies, including craniosynostosis, syndromic (Apert, Crouzon, Treacher-Collins, etc.) reconstruction and jaw deformities. Dr. Urata is an assistant professor of plastic surgery at the Keck School of Medicine of University of Southern California and a research assistant professor in the Center for Craniofacial Molecular Biology at the USC School of Dentistry. Dr. Urata is a member of the: American Society of Maxillofacial Surgeons (2006-present) Plastic Surgery Research Council (2006-present) American Cleft Palate/Craniofacial Association (2003-present) California Society of Plastic Surgeons (1999-present) Los Angeles Society of Plastic Surgeons (1999-present) American Society of Plastic Surgeons (1999-present) American Board of Oral and Maxillofacial Surgeons (1994-present) American Association of Oral and Maxillofacial Surgeons (1989-present) Southern California Society of Oral and Maxillofacial Surgeons (1989-present) Marsh Robinson Academy (1989-present) American Dental Association (1994-present) California Dental Association (1994-present) San Gabriel Valley Dental Association (1994-present) Southern California Japanese-American Dental Society (1994-present) Southern California Society of Dental Anesthesia (1989-present) LAC/USC Medical Center Health Research Association (1993-present) He is a Fellow of the Southern California Academy of Oral Pathology. Dr. Urata received a bachelor's degree from the University of Southern California in 1985. He received a D.D.S. degree from the USC School of Dentistry in 1989 and completed a residency (1989-93) in oral and maxillofacial surgery at Los Angeles County-University of Southern California (LAC/USC)Medical Center. Dr. Urata received an M.D. from the Keck School of Medicine of University of Southern California in 1996. He completed an internship (1996-97) and a residency (1997-99) in general surgery at LAC/USC Medical Center. Dr. Urata completed a residency (1999-02) in plastic and reconstructive surgery at the University of Southern California and a fellowship (2002-03) in craniofacial surgery at the University of California, Los Angeles. 100% the right surgeon for me!

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