It's been too long - here's an update to my journey

A blog is a big commitment and sometimes it can be really easy to think 'I'll update it next week'.  I've been super busy with work, travelling quite a lot for both work and pleasure and I also moved to a new apartment.  Then I realised that almost a year has passed by since my last post.  I am still very much on my journey and the biggest step is yet to come, so I thought I would finally give an update and will commit to keeping this blog up to date.

So what has happened in the last year?  

To start with the expansion device had to stay in my mouth for a good 3-4 months after the braces were on so my jaw could stabilise.  It was a bit awkward having both in my mouth so you can imagine my joy when it was finally removed - I could touch the top of my mouth with my tongue again!

Since then it has been braces all the way - and my face has changed a lot.  I knew that it would take a while to close the huge gap that was between my front teeth - I just didn't realise it would take so long, but now I am really happy to say that the gap has almost closed.  In fact, there is only a 0.25mm gap right now thanks to orthodontic power chains.  You can see the result for yourself in the photo below - needless to say I am extremely happy with the result.  When I used to smile wide, there used to be huge gaps at each side of my upper jaw due to how extremely narrow it was.  Now my teeth are as wide as my smile.

When you look at yourself in the mirror every day you do not always notice the changes.  Looking at my upper jaw here though - it's amazing to see the changes.  And yes, it's another stupid pose!

I mentioned power chains - but what are they?

Well they are definitely not as scary as they sound.  At first when I heard about power chains I expected metal chains to be placed in my mouth and across the braces.  In reality, a power chain is just a plastic set of links similar to the o-rings that hold the brackets closed on your braces.  They go over the top of your regular o-rings and are quite tight, and that tension pulls the teeth together which in turn closes any gaps you may have.  There are different types of power chains and as the gaps get smaller, so do the links between each o-ring on the power chain.  In the image below, you would start with the power chains at the bottom of the image and slowly move to the ones at the top. 

Other results of the braces

Aside from the closing of the gap, the braces have also greatly reduced the over-jet of my front teeth. I didn't expect the result to be so dramatic because reducing the over-jet has in turn reduced the appearance of the overbite.  I still need double jaw surgery to fully correct everything, but I am well on my way to having a functional jaw.

This side profile shows the reduction of the over-jet

Of course the main function of braces is to straighten teeth and while my upper teeth were always nice and straight, my lower teeth were a mess.  I had a fang on each side of my lower jaw and these were not in line with the other teeth - but the braces soon worked their magic and straightened these teeth out.  In fact this only took a couple of months before there was a big change.

And that's it for now!  I will be posting a couple more updates soon on how to live with braces and the next steps in my treatment leading up to surgery.  Until then, thanks to everyone who has taken the time to read and comment - your support means a lot and your questions are always welcome. 

Before and after jaw widening

Throughout my whole SARME experience I have of course noticed my jaw getting wider.  This is mainly because of the gap that has formed between my front teeth.  However because I look at myself every day, I don't think I realised just how much wider my jaw actually is.  Last night I took a photograph of the roof of my mouth and compared this to the same photograph I took before the surgery/widening and I am truly amazed at the difference.  So here are the photographs side by side, so you can see the difference too!  When I look at these, I have no doubt that I am doing the right thing.

Enjoy the lovely nostril shots...

Pass that paper bag

It's been a strange few days.  Last weekend I suddenly became extremely self-conscious and aware of the stares I get in public due to the gap in between my front teeth, and a Facebook post where I vented my frustration prompted an interesting conversation with a very good friend.

Why am I worried about people staring at me, when I have this blog which is showing my jaw (and journey) for all to see?

I thought that was a very good question because my blog if anything, is quite explicit in the descriptions I give and the photographs I share.  To me, it comes down to control and context.  When I post an update to my blog I am putting my face right out there for all to see.  And while I have no control in who reads the blog, the reactions of people who read it are not displayed to me right away.  If someone is reading my blog, they know I am going through surgery and so for my readers, things are put into context.  This is quite different to what happens in public.

When I am out and about in public, people stare.  They can't help it but they just do.  I have had people stare so much that I turn around and they are still looking.  On one occasion the stares have led to all out laughing which was very obviously directed at me.  The issue is this - they do not know I am having jaw surgery, they do not know this is all part of a larger plan and they do not know that I haven't been in a fight and had my teeth knocked out (because after all, I am quite butch).  Of course I don't blame people for looking because unlike my blog there is no context, however after a while the stares make me uncomfortable.  Of course the laughing to me is another matter and just plain rude, and prompted my Facebook frustration.

So there is a bit of an insight into how I am feeling and why stares in public are very different to someone reading my blog!  It has definitely highlighted my coping (or lack of) mechanisms and this is something I will be working on.  On a more positive note, this situation has prompted me to contact my orthodontist who has said they can put some temporary composite (the same material fillings are made from) across my front teeth which will disguise the gap.  It won't look like a tooth, but I won't have a huge gaping hole either so in the short term I can get back to looking fairly normal.

Now all I need to do is wait until the upper braces are fitted and the gap starts to close...

SARME surgery post-op day seven - Look at my gap!

It has now been seven days since my SARME surgery and I'm glad to say that everything is going pretty well.

I went to see my Maxillofacial Surgeon for the first time since the procedure and he has commented that my gums are nice and pink and that I look like I am healing fast.  I still have no feeling in my upper teeth and my gums are completely numb, but he has said it can take months for the feeling to come back!  I mentioned to him my concern over one side of my jaw sitting slightly lower than the other, but he assures me this is normal and that it will be fixed up during both orthodontics and my bi-maxillary surgery next year.

I'm really surprised with how quick my upper jaw is widening.  I know I said before that it would widen by 0.25mm with each turn and yes I know it's called a 'rapid' maxillary expansion, but I didn't realise how quickly it would become a large gap.  After four days of turning the gap is extremely noticeable and I am able to do all sorts of tricks with my gap such as whistle or direct a stream of water through it.

Anyway that's all for now - enjoy the photos below and check out my sexy (not) gap!

I'm sexy and I know it

I can almost fit a straw through the middle

SARME surgery post-op day three - I've started turning!

Three days after my SARME surgery and I am still feeling no pain, however I have been extremely exhausted and sleeping loads.

Today I went for an appointment with my orthodontist to start the adjustments/turns on my expansion device.  I freaked out a little inside when he put the mini spanner into my mouth and shook (quite visibly) as he made the very first turn.  I was so convinced that it was going to hurt, but to my surprise it didn't.  My orthodontist gave me instructions on adjusting my expander and within five minutes I was finished.

The SARME surgery on Monday split the jaw bone which allows the upper jaw to move and now by turning the device I am making my upper jaw wider.  This is not a slow process (theres a reason they call it 'rapid' maxillary expansion) as my jaw is widening by 0.25mm with each turn.  After the first turn by the orthodontist I could already notice a gap (however this did not come out in the photo below) so it's reasonable to say that I will be looking like Cletus from The Simpsons in no time.  

That's all for now - just a quick post.  I will update more in the days to come.

SARME surgery and post-op day one

The big day has come and gone so I thought I would give you an update on the surgery and my recovery since then.

I had to report at the hospital at 1.30pm on Monday 11th March, which meant that I couldn't eat after 7am that morning.  I couldn't sleep well anyway as I was nervous so I was awake and having breakfast at 6am.  I pottered around as much as I could Monday morning (including making the last video) and then set off to the day surgery in Randwick.

I still felt nervous on arrival but the team of nurses and my anaesthetist came to chat to me at different times to go through various questionnaires and I felt confident in their hands.  They advised me that I wouldn't be having the four teeth removed at the same time as my surgeon and orthodontist had decided they would come out later.  

The day unit was a little different than a hospital ward, and I had to wait in reception until they were ready for me.  As soon as they called me through it was time to gown up and go straight through to theatre - no sitting around in a hospital bed for me.

Giving away my age again

In theatre I saw my surgeon Dr Tsakiris who came to assure me that I would be ok everything would run smoothly.  I feel so confident with him that any nerves or worry I had started to disappear instantly.  I also saw Andrew again (the anaesthetist who came to originally talk to me) and while all the team were busy with their jobs their focus was on me - asking if I was ok, keeping me chatting about what I did for work etc.  The drip went into my hand and before I knew it I was breathing oxygen through a mask.  I remember the coldness of the anaesthetic going into my hand and remember saying 'that feels good' before drifting off to sleep.

This was only my second experience of general anaesthesia and it felt like I woke up as soon as I had fallen asleep.  The surgery actually took around 1 hour and 40 minutes.  I was a little groggy when I came around and kept drifting in and out losing track of time, although I did feel quite relaxed.  I remember the nurses calling my escort to come and pick me up, and it felt like only seconds later until he arrived, even though it was 30 minutes.  My surgeon came and spoke to me and said that everything had gone well.  After a short while longer in recovery I was on my way home and soon enough was resting up in bed.

On my way home from the hospital

Resting up in bed

And so here I am one day after my SARME surgery.  I have been quite surprised with the pain levels in the fact that they have been low to non-existent!  I guess I must be very lucky as I have read from other blogs that people have been in tremendous amounts of pain after this procedure.  I am religiously taking the antibiotics and the panadeine forte (very strong painkillers) they prescribed me so the pain does not creep up on me.

While there has been no pain there is a lot of pressure and numbness on my upper jaw and the swelling is very, no extremely noticeable - think Joan Rivers meets Alvin and the Chipmunks.  

I am not allowed to spit or blow my nose for two weeks and this is because the sinus walls are damaged during this kind of surgery and need to repair.  I'm not even allowed to sniff which is frustrating as my nose is clogged, but I have been prescribed some nose drops for this.  Sometimes I have sniffed without realising which has caused some blood to come through to my mouth, but not tremendous amounts.

So what else can I say?  Well apparently a lot because I have not lost my ability to talk!  I thought it would be too painful but if you watch the video below you'll realise I'm the same old me!

The day of my SARME surgery

It's the day of my jaw widening surgery (SARME) so I thought I'd let you hear it from the horses mouth!

Maxillary expander update and three days until surgery!

My expander has been in for three days and I must say I'm getting used to it quicker than expected.  My speech is not half as bad as it was on Tuesday (I no longer sound like Joseph Merrick) and it's now only certain words and sounds that I have difficulty with.  Eating is still a challenge as food constantly gets stuck between the device and the roof of my mouth, but nothing that gargling water after every meal doesn't cure.

The strange thing is that since having my expander in my sense of smell seems to have heightened.  I did not expect this to happen and haven't read it in other peoples experiences so it came as a surprise, but I must say it's a rather pleasant surprise.  I seem to be picking up smells that transport me back in time to a place with fond memories - spices in an Indian market, the smell of damp English soil when camping as a child, the smell of the sea breeze on San Francisco Bay.  Call me crazy, but they do say that if certain senses are limited, the others compensate for them.

Aside from this it is only three days until my surgery and I am starting to get a little nervous.  However, I am in the care of an absolutely fantastic team who make me feel comfortable and I have every confidence in them.  Dr. Peter Tsakiris is my Oral and Maxillofacial Surgeon and will be performing the SARME surgery on Monday, Dr. Steve Stromotas is my Orthodontist (who also has an amazing, friendly and professional team of staff) and will be assisting me with the expansion device and later my braces, and my dentist Dr Kenneth Wong is keeping my dental health at top notch condition.  That's enough love for one thread!

So what am I doing this weekend?  Well apart from stocking up on mashed potato, soup, protein drinks and other soft meals I am going to make the most of my oral freedom <insert naughty pun here>.  I have some friends coming for dinner on Saturday evening (I love to entertain) and will be chilling out on Sunday and catching up with as many people as I can on the phone while I can still talk.

I'll be updating this blog pre and post surgery so watch this space!

The expander is in!

I finally got my expansion device in today in preparation for my SARME next week on Monday and for the first time I have started feeling nervous!  The expander only took 15-20 minutes to be installed and glued into place, and after a quick check by the orthodontist I'm ready to go.

Learning to speak with the expander in is a lot of fun as I suddenly have a very prominent lisp.  Add to that the constant swallowing from the excess saliva and it all adds up to a rather attractive package!  I haven't tried to eat anything yet but have been warned to stay away from any sticky foods - so goodbye chewing gum, sweets and caramel :(

While I'm feeling nervous I am also excited as it means things are now moving along.  I can't wait for my SARME surgery next Monday and will keep this blog updated of my progress.

For now here are some photos showing the expander in my mouth as well as some side pictures which show the metal rings of the expander attached to my teeth.  Not very attractive camera angles but what can you do?

When my palette is split in half this device will widen my jaw

The metal rings surround two teeth on each side of the upper jaw and are glued into place

Another attractive shot

How much will it all cost?

When I started enquiring about 'fixing' my jaw I first did a lot of research on pricing.  While the costs have worked out to a little more than I originally expected (well OK around 40% more), I still had a fair idea of what I was letting myself in for.

So for those of you out there who are looking into SARME/SARPE, orthodontics and bi-max surgery - here is the cost for each stage along with a breakdown of what fees make up the total.  All prices are in Australian dollars before any rebates from my private health fund or Medicare.

Stage 1 SARME = $6,250

Surgical fee = $3,000

Teeth removed x 5 = $550 (total)

Day surgery fees = $1,800

Anaesthetist fees = $900

Stage 2 Orthodontics = $10,800

Braces, adjustments and all appointment fees = $10,800 ($3750 initial deposit then $470 per month for 15 months).

While the orthodontics sound expensive this also includes consultations for two years after orthodontic work is completed.

Stage 3 Bi-maxillary (double jaw) surgery = $23,000 (approx.)

Pre-op surgical appointment = $1,500 (approx)
Surgical fees = $17,000

Hospital and anaesthetist fees including 1 night high dependency unit and five night stay total = $4,000 (approx.)

Other fees for x-rays, consults, veneers, cleaning and general dental = $3,000 (approx.)

Grand total for entire treatment = $40,000 (before any rebates)

Expensive?  Well yes it is - but remember these fees are before any health fund or Medicare rebates.  I can expect to receive about $8,000 in total from these rebates.  Then there are the tax refunds on top of that - the Australian government will give 20% back on all medical expenses over $2,200 in any tax year (after rebates from health funds and Medicare).  The cost of these procedures will be spread over two years, but I can still expect to receive another $5,000 or so back, which brings the grand total out of pocket to around $27,000 which is much more manageable.

If you are still reading but unsure of the prices I think its a matter of putting things into perspective.  Some people would not think twice about spending this much money on a brand new car.  Some people will easily spend $10K on an overseas holiday.  This is something that will last me for the rest of my life, so I definitely think it is a wise investment.

Well that's all for now - it's late here in Sydney and time for bed.  If you have any questions feel free to drop me a line or leave a comment.

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!

So what is a SARME?

For those of you wondering exactly how the first stage of surgery works (mentioned in my last post), here is a YouTube video showing an example of the SARME (Surgically Assisted Rapid Maxillary Expansion).  My teeth are not crowded like the example in the video, but you still get to see how the jaw is expanded.

Disclaimer: I am not the female in the video...