Day 16: The mirror has two faces

I wanted to start this post by saying that I am extremely happy that I had my surgery and am thrilled with the results so far.  However in the interest of writing a completely honest blog about my experiences, I'll admit that sometimes I look in the mirror and do not see any changes at all - or I scrutinise my appearance so much, like I am purposely looking for something to be wrong.  Why am I doing this to myself?

A good friend of mine who used to be overweight, told me that even when she lost her extra weight she still looked in the mirror and saw an overweight person, even though she physically was not.  She explained that I am probably in the same frame of mind.  On the outside I have changed - but on the inside I am still the same person with the same insecurities.  Now that I have changed physically, the next step is to work on the emotional change and learn to love my reflection.

This was a real light bulb moment for me and it really made me think about the way I look at myself.

Throughout this whole journey, people have had different ideas about why I would choose to go through such invasive surgery.  My family and close friends know about my insecurities in terms of how I look, while others presumed my reasons were based solely on vanity.  All of these opinions are absolutely valid, but very few people (even those mentioned) know just how deep and how far back my insecurities go.  I'm not writing this post for sympathy - I'm simply recognising it as a part of who  I am and working on my self perception.

Anyway, it's just a quick update for now.  Feel free to leave me a comment - and if you've had this surgery, how has it affected the way you see yourself?

Days 11-12: Post surgery appointments and I'm feeling fantastic!

Over the last couple of days I have had follow up appointments with both my orthodontist and my maxillofacial surgeon to check on my progress.  My temporary live-in carer (aka Cindi, my amazing friend from California) is still in Australia so it was fun to be able to take her along to my appointments.  I really wanted her to meet the people who have been taking care of me.

First was my orthodontist appointment on the Monday morning.  I absolutely love visiting the office of my orthodontist because the team there are so warm and friendly.  They were all really excited to see me and commented on how good the results looked, which of course made me feel great.  The appointment was a fairly quick one and my elastic bands were changed to a different configuration.  Elastics are really important after jaw surgery as they guide/train your jaw to its new bite.

My beautiful new elastics!

The appointment with my surgeon the following day was a general check-up to see how I am healing and if I was having any discomfort or pain.  I can honestly say that I am feeling pretty wonderful - especially considering my surgery was less than two weeks ago.  Aside from the first few days which were very uncomfortable, I have had no pain or soreness, no major trouble talking, no trouble sleeping, no bleeding and no sickness or nausea.  Even my surgeon commented that I seem to be a couple of weeks ahead of where they would expect me to be.

I'm not writing this to gloat, but hopefully to give some hope to others going through (or about to go through) this process.  It's not all dribbling and pain and my surgeon puts my fast recovery down to my positive attitude.  I absolutely agree with this, because it is amazing what your body can do and how fast it can heal when you feel happy and positive.  I also put it down to having a fairly high pain threshold.

I took the opportunity to ask my surgeon again about what he did during surgery (the last time we discussed this I was in hospital in a drug fuelled state) and I have to say it is nothing short of amazing.  He explained that at my next appointment they would be taking an x-ray so I could see the results, but I already see the results every single day and here are the latest photos.

The most important question I wanted to ask my surgeon - when could I start brushing my teeth?  He said that I could have been doing that already (which I didn't realise) and gave me some tips on how to brush and where to be careful.  So the first thing I did on returning home was brush my teeth for at least ten minutes and I can tell you, it felt great!  Fresh breath ahoy!

Days 8-10: Big journeys start with small steps

It has certainly been a busy weekend and I didn't do too bad at keeping up.  Cindi's niece (also from California) has been studying in Melbourne for the last few months and came to spend a weekend with us in Sydney.  It would have been a shame for them to not see each other,  so we agreed that I would join in for as much as I could and rest as much as needed.

I really got to test myself in terms of how much energy I had and just how much I could (and couldn't) do in three days.  We managed to power through the majority of the iconic sights of Sydney, but while we took the car to most places, it still caught up on me big time.  If I'm honest, I probably pushed myself a little too far.  The swelling on my face has been going down rapidly and I am speaking better than ever, but I need to remember that I am still recovering and only just over a week out of the operating theatre.  So my advice would be to listen to your body and take small steps.  And if you do go out for a full day make sure you take extra smoothies with you for in-between meal snacks.

I'm slowly seeing the changes to my jawline and loving my much shorter face and squarer jaw.  Because my upper jaw was taken upwards, it means that my mouth now naturally sits in the closed position.  Prior to surgery I had to consciously close my mouth.  And even then it looked odd.

Here are a couple of pictures (taken on day 9, 25th October) of my progress so far.

You can see that my jawline and chin have taken on a new shape

My side profile looks a lot more balanced than before my surgery - the overbite is gone!

Day 5: It's all yellow

Today I've noticed a couple of things:

• I'm becoming very bruised on my arms, neck and chest - a good sign that my body is healing.
• My face is starting to tingle in different places and there is an itch I cannot scratch.
• The shape of my face is changing each day and I wonder what the final result will be.
• I absolutely need a shave although I'm also liking this rugged, manly look on me.

       

I'm getting quite used to this whole liquid diet and the weight is dropping off pretty quickly.  If there is one suggestion I can make to anyone about to go through this surgery, it is to bulk up beforehand.  I purposely put on 5kg (11 pounds), but I'm losing it pretty quickly and feel like I should be writing a Bridget Jones style diary: 

OK, maybe not.

Today I participated in a little outdoor exercise as I felt that the swelling had gone down enough to not make children scream.  And by a little bit of exercise I mean walking to the car and back.  This completely exhausted me.  Although Cindi and I are packing lots of nutrients into my smoothies we realised that I need more protein - cue an online order of 1kg of whey protein isolate.  We are by no means nutritionists - although Cindi does know a lot about health, but packing more protein and fibre into my liquid meals will ensure that I feel satisfied for longer while at the same time giving sustained energy release.  Compare that to sugars and carbohydrates that give a quick burst of energy that then decline rather rapidly.

Anyhow here is an updated photo of how I am looking so far.

Day 3: There's no place like home

Sunday - three days after surgery and I was ready to go home.  In fact not only was I ready to go home, but I just had to get out of that hospital.  The food was bland, the bed was uncomfortable and I was completely bored!  I must have seen the same daytime TV shows over and over again and while I had brought my laptop, I had left my hard drive at home with all of my movies.  On a positive note though, I can now tell you everything about personal blenders, carpet cleaners and frying pans made from stone.

Luckily for me, the checkout process is just as fast as the check-in.  The nurse came and removed the valve from my hand and I removed (rather painfully) all of the sticky pads from my chest.  I packed (how did I end up with so much stuff) and waited for some friends to come by and pick me up.  I had time for a couple of selfies before I was collecting my drugs and on my way home.

As you can see my face is still very swollen but I am starting to talk clearer as each day passes.  I still have a lot of numbness all over the lower part of my face and this is to be expected for a number of weeks.

Finally I was back in my own apartment and it felt good!  I made a smoothie before sleeping on and off for the remainder of the day.

Day 2: Oh what a (terrible) night

So I wish I could say that my first night in the ward was uneventful but it was actually quite scary.

Throughout the first day after surgery I had been experiencing reflux - this had made my already swollen and sore throat worse and in turn limited how much I could comfortably breathe.  The weird thing was that I kept feeling as if there was a lump at the back of my mouth that I couldn't swallow.  As my nose and sinuses were also completely blocked, it didn't make a great combination.

Late at night as I was trying to drop off to sleep, I suddenly felt as if the swelling in my throat was too much and I couldn't breathe properly.  I started to work myself into a panic where my heart was racing and I was sweating profusely.  I pressed the call button for the nurse who took all of my stats, but by that point I think I had worked myself up too much.  A doctor also visited and listened to my breathing and assured me there were no obstructions, but again this did not help.  It didn't fill me with a huge amount of confidence that neither the doctor or nurse seemed to know the actual surgical procedures I had been through - they knew I had jaw surgery but did not know that included a septoplasty, which when you are complaining about breathing problems would be very important to know.  And while I don't want to speak badly of the hospital staff - I was in a panic and yet the while all this was going on I felt as if the nurse would disappear for 10-20 minutes at a time while I was feeling as if I would pass out.

Finally at 1am, I asked if they could call my surgeon as I felt I needed his advice.  Around ten minutes later the nurse returned after having spoken to my surgeon who said that this was a normal reaction and that I could use a nose spray to try and relieve the pressure in my sinuses.  After hearing the advice that came from my surgeon I relaxed as I feel very confident in his care.  I finally calmed down and dropped off to sleep a couple of hours later.

In the morning my surgeon came to visit and I of course apologised for having him be woken up - he didnt seem phased at all.  I told him about the lump I could feel at the back of my mouth and he said this was soft tissue that is left hanging because my upper jaw was moved back.  Apparently it will tighten over time.  Knowing what it was instantly made me feel better.  He said that I could leave the hospital that day if I wanted to as they generally want you to leave as soon as you can (less chance of infection at home), but if I felt like I needed to I could also stay another night.  I decided to stay another night as I didn't quite feel ready to go home.

After he left I had the compression bandages taken off my face which relieved a lot of the pressure.  It did give my face a lot more space to swell though and swell it did!

I am not an animal, I am a human being, I am a man!

My drips and lines were also disconnected just leaving a valve in my hand - this added a great level of freedom as it meant I no longer needed to wheel around a whole bunch of equipment.   During the day I had some more visitors and my friends Luke and Sheryn dropped off some lovely flowers and books.  My other friends also returned with balloons.  I'm lucky to have such great people around me.

More updates to come....

Day 1: Let me sleep!

I had slept on and off throughout the night in intensive care and by very early the next morning the place certainly was a hive of activity.  I always seemed to have someone poking or prodding me - either taking my blood pressure and other stats, putting antibiotics or fluids into one of the three lines in my arm or moving me around.  Of course they were only doing their job and making sure that I was well, but it was still really tiring!  To help ease the discomfort though I had my handy self-administered morphine, which I could press every 5 minutes giving me 1ml morphine each time.  Good times!

At some point early in the morning I was moved from my bed to a reclining chair before I was finally able to sleep for a while.

My surgeon came to see me mid-morning and told me that the operation was a great success and that they achieved all they wanted to.  If I remember correctly he said my upper jaw was moved both upwards and backwards 5mm in each direction, my lower jaw was extended forwards 11mm and my chin was repositioned outwards and downwards.  He also said that I had some bone loss in one area of my jaw and he used bovine bone which my body would accept and fuse with my own bone.  His parting words to the team were that they could remove both the gastric tube and the catheter.  While it was not a very pleasant experience having either of them removed, I'll spare you those gory details and just say that I was happy once it was over!

I think one of the most surprising things for me on this morning was that I could talk pretty well and had a good chat with surgeon, albeit with slurred speech and a lot of drooling.  Prior to my surgery I had read blogs where people couldn't speak for weeks, but here I am talking there very next day.  A big reason though will be that here in Australia, they generally do not wire your jaws shut and just use elastics to guide your bite.  While the elastics restrict movement to allow your jaw to heal, they do not completely stop movement.

After lunchtime I was transferred to a ward where I had a private room and I got to have my first liquid meal of fibre milk, clear consommé and water.  I also looked at myself properly in the mirror for the first time - it was not a pretty sight.  Everything was swollen and bruised - my face, cheeks, lips, neck and my arms where the lines were inserted.  On the inside everything was swollen too including my gums and throat - of course this is to be expected after major jaw surgery.

Sing to me, my angel of music!

I was feeling very weak so lots of rest and sleep were in order.  Having to wheel around a drip and grapple with five sets of lines each time I wanted to use the bathroom was tiring in itself.  Later on that afternoon Frankie came to see me in hospital followed by my friends Gerry, John, Jack and Daniel.  They brought me a lovely robe and lots of magazines to keep me occupied.  After another liquid meal I bedded down to try and sleep off the discomfort.

Various pre-op appointments - only days to go!

Over the last month I've had a number of appointments in preparation for my surgery which is now just a couple of days away - so here's a quick update.

On September 17th (one month prior to surgery) I had a pre-op appointment with my maxillofacial surgeon.  It was quite a lengthy appointment which I was glad of as it gave me a chance to ask lots of questions and generally be put at ease.  We discussed the surgical plan and what he hopes to achieve before he took some moulds/impressions (to make the surgical models and splints), 360 degree x-rays and plenty of photographs.  He also took various measurements of my jaw and profile and explained what I should expect during my stay in hospital - which will involve waking up from surgery with a gastric tube and (I'm cringing while writing this) a catheter.  Eek!

A couple of days later I had a telephone call from my anaesthesiologist who introduced himself and had a chat with me about how they would be taking care of me.  He again re-iterated that I will have a gastric tube and a catheter when I wake up from surgery.  The thought of a gastric tube didn't actually bother me until just now as I have realised what it actually is.  I thought it was a tube which goes down the throat to the stomach to deliver food.  Nope.  It is a tube which is inserted through the abdomen and into the stomach.  For some reason that bothers me a lot more than a tube down the throat.  Of course all I need to do to forget the gastric tube is think of the catheter.  Double eek!

Then on October 10th I had a pre-admission appointment at the Prince of Wales Private Hospital where they took my blood pressure, did an ECG, took some blood (in case I need a transfusion) and gave me information about the big day.  On October 16th I will be checking into the hospital at 6am and can expect my surgery to start around 8am.  As it is a 5-6 hour surgery, it will be the only one my surgeon performs that day.  Then after a night in intensive care, I will be transferred to a ward where I will most likely stay for 2-3 days.

Finally today I had a pre-op check with my orthodontist who also placed several surgical hooks into my mouth.  These are small metal hooks which are crimped around the wire of my braces.  They are used during surgery to help my surgeon move my jaw around once the bone has been cut.  In the photo below you can see one of them between my front teeth.

So that's it!  No more appointments now, just a count-down to the main event.  I must admit that I am feeling very excited, scared, positive and apprehensive all at the same time.  While I'm not too concerned about the surgery or the pain, I am nervous about the end result and hope that after all of this time and effort I will finally be happy with what I see in the mirror.

And on that very deep note I shall finish this post and will write another update soon.

I have a date for my double jaw surgery!

I'm very excited to report that I am now booked in for my orthognathic (double jaw) surgery on October 16th.  This surgery will be the most major and invasive part of my treatment plan and involves a number of medical procedures.  It also means that I am nearing the end of my journey, although I will still have to wear braces for up to six months after surgery.  I'm going to throw around some medical terms here, so I will do my best to explain what everything means.

Preparation for surgery
I have a pre-op appointment in mid-September.  At this time my maxillofacial surgeon will take x-rays, moulds and from there make my splints and build the final surgical plan.  It will also give me the chance to ask lots of questions and make sure we agree on the outcomes.

The surgery
Orthognathic surgery is a very general term, the definition of which is 'surgery to correct conditions or abnormalities of the jaw and face'.  More specifically, my orthognathic surgery will involve:

• LeFort I maxillary osteotomy (upper jaw) and Bilateral sagittal split osteotomy or BSSO (lower jaw) - That's literally quite a mouthful, but in layman's terms they will remove sections of bone from my upper jaw (maxillary) and lower jaw (mandibular).  This will take my upper jaw upwards (to remove my gummy smile) and backwards (to finish correcting my overbite) while at the same time correcting the skewed angle at which my upper jaw has grown.  My lower jaw will be split and extended forwards, creating a stronger, more balanced profile.
• Genioplasty - also known as chin augmentation.  A surgical implant will be used to alter the shape of my chin.  This in conjunction with the double jaw surgery assists in creating a balanced profile.
• Turbinectomy - a procedure in which some or all of the turbinate bones attached to mucous membranes in the nasal passage are removed.  This is used to relieve nasal obstruction.
• Septoplasty - a corrective procedure to straighten the nasal septum.

At the moment it is estimated that my surgery will take around six hours to perform and will involve a three day stay in hospital with the first night being in a high-dependancy unit.  Here is a YouTube video (don't worry just an animation) which gives you an idea of what the osteotomy part of the surgery will look like:

Recovery time

I will need to spend the first couple of weeks at home resting and will have several weeks of swelling and bruising.  I'll also be on a liquid and soft food diet for at least six weeks, so hopefully I will lose a bit of weight at the same time!

Results
So what will this mean for my face?  Well I'm not going to come out of the other end looking like Joan Rivers or a contestant from Extreme Makeover that's for sure.  And despite the suggestions of my friends, I've opted not to have a breast enlargement "because you may as well while you're there"!  What I should end up with is a squarer jaw line, no overbite, a stronger chin, a straighter septum, a balanced profile and of course teeth that all meet and a better functioning jaw.   Hopefully I will just look like a normal guy.

I must admit that while I make jokes and say that I'm fine with everything, I'm actually starting to get very nervous.  I'm not so worried about the pain or the healing as I know I can handle that, but I hope that the end results will make this whole journey worth it.  I hope that I will be able to look into the mirror and finally like what I see.

So that's my big news!  Keep posted for more updates in the lead up to my surgery.  I also plan to blog from my hospital bed so you'll be with me every step of the way!

I've finished paying for my braces!

This was a nice surprise for the middle of the week!  I logged on to my internet banking today to check my credit card and wondered why my orthodontic payment had not been debited this month.  After checking my treatment plan I realised that I actually made my final payment last month.  Of course the payments I have made cover my whole treatment plan so I will continue to be seen - it just means that I no longer have the expense each month.

Time for a happy dance!

X-rays, photographs and projected outcomes

I thought I would now share with you some of the x-rays, photographs and projected outcomes in the report from my Maxillofacial Surgeon - Dr Peter Tsakiris.  I've had the report and images for a month or two, but it has taken me a little while to find the courage to upload them because the images really highlight the extent of my jaw abnormalities.  However this blog would not achieve it's purpose if I didn't share them, so here you go.  You can click on any of the images to view a larger version.

In the first x-ray (front view) you can see how my jaw has grown down too far covering my lower teeth.  The x-ray also shows that my upper jaw sits at an angle.  The side x-ray shows the extent of my overbite (upper jaw being further forward than the lower) but also the overjet of my upper teeth (the angle at which they are protruding outwards).

Current view of jaw from front

Current view of jaw from side

My last post talked about my SARME surgery which is the very first stage due to take place in a couple of months.  This surgical procedure will see my palette split in half to allow the expander device to widen my upper jaw.  A few teeth will also be removed during this procedure.  The below images show the expected changes in my jaw after this first stage.  As I stated before, this is actually the least invasive of all the surgical procedures.

First stage projections - SARME

The next set of images show the final expected outcome after stages two and three.  Stage two will involve wearing braces for a period of 8-9 months, and stage three will be the main double jaw surgery which will see me in hospital for a week.

As you can see my jaw will not only be wider, but also more square with the upper jaw being lifted up a further 2mm.  This will be quite a dramatic change as the length (and shape) of my face will completely change.  This is achieved by the removal of different parts of the bone in the upper jaw taking it both up and backwards, while the bottom jaw will be split and extended further forward using implants.  I will also have a genioplasty which involves an osteotomy of a piece of the chin bone, which will then be slid forward or backwards depending on the shape of my face.

Final projected outcomes - front view

While it's quite difficult to see - the final images show the expected changes from the side profile.  Again, click on any of the images to see a larger version.

Final projected outcomes - side view

These images are only projected outcomes and the treatment plan will evolve as I move through this journey, depending on movements made by orthodontics and other factors.

Well that's it for this post - if you have any questions please feel free to send me a message or leave a comment.  Next update soon!