Just a Bite: Orthognathic Surgery

So, about a month ago, I found that I'd deeply offended the wife of a longtime friend of mine by mentioning that she had an irregular bite. I've been pretty down about it all month... But I've reflected a lot about how I previously felt about my underbite, and I wanted to share some thoughts about the orthognathic surgery I had done. I'd actually wanted to do a real-time record of how I was feeling, but the surgery (and the fact that I went to work at an internship a 1.5 hr each way commute away 2 weeks after D-day while my jaw was still wired shut) took a lot out of me, and I ended up never getting to it.

But this post is supposed to be about my underbite, so I'll focus on that from here on out.

Here are a couple of shots of me, sampled from Facebook. You can see me artfully employing the strategy of having my mouth open, making a weird face, or covering up my chin with my hands in these photos to disguise my unusual bite.

Still, you can tell from many other photos that my chin is protruding slightly too much, and my bottom lip looks like it's out too far for the teeth inside to be standard. Or maybe you can't. Over the years, I've been consistently shocked at how few people actually noticed my underbite.

In any case, to give a closeup of what I really looked like, below are the front and side views of my face, pre-surgery. You can see that my bite is both under and crossed. Unfortunately, I can't find clear pictures of myself pre-braces, but my teeth were not terribly different before them. Slightly crowded on the top, and slightly squareish on the bottom. In these pictures, I am 19 going on 20 years old, still no great beauty, but somewhat less pimply.

Anyways, the process of getting this surgery is like this:

1. up to 3 years of braces to get your teeth aligned properly

• An initial consultation with an orthognathic surgeon. I chose Dr. Aziz, whose reputation in NJ was great (he was honestly fantastic, and I would highly recommend him to anyone. He is super kind, patient, and his team is very familiar with the insurance landscape, so my surgery was nearly free!). He referred us to an orthodontist that he's worked closely with in the past.

• My impression is that the orthodontist I was referred to had a lot of experience in specifically preparing teeth for orthognathic surgery. Sadly I think he is retired now. He was nice, but less sadly, I wouldn't recommend the place I got my braces done, because the staff is kinda mean TBH.

• I think I only had braces for about 9 months. Probably 5 months were spent adjusting my bottom teeth, and then 3 months on the top and bottom simultaneously. A quote from one of my high school friends' college essays rang through my mind a lot during this time "The anti-aging properties of braces can't be denied". And indeed, I felt a tiny bit like a 13 year old, sporting my metalmouth for that time.

2. Surgery

   • Orthognathic surgeon decides on what adjustments to make. (In my case, modifications to both my upper and lower jaws was recommended)

   • Surgery is approved by insurance

   • Surgeon does scans and produces a simulation

   • Surgeon also practices the surgery twice, I think?

   • Surgery: Mine was 3 hours long. One for the top jaw, one for the bottom, and then one to remove my wisdom teeth.

3. Recovery

   • 3 weeks with your jaw wired shut, on only liquid foods

   • 3 weeks with your jaw rubber-banded shut. At this point you have no jaw strength, so you can only eat soft and simple foods.

   • 3 months of observation, then the braces come off.

   • A couple more visits at the half year/year mark with the surgeon to confirm nothing is amiss.

I'll skip the braces. Those were pretty boring.

I was recommended for LeFort I and Bilateral IVRO. The Lefort I means that my whole upper jaw was separated from my face, reshaped, repositioned, and titanium-plated back into place. The Bilateral IVRO means a similar thing was done to my bottom jaw.

Aren't these pictures just amazing? I still love looking at them, even now, 6 years later. I don't think I can say much about the particulars of the surgery. My parents were somewhat against me getting the LeFort I, and thought that I'd do just fine with only the bottom movement. I thought that ether way would probably be ok, but I trusted Dr. Aziz, so I went with his recommendation.

IN RETROSPECT... I somewhat regret getting the Lefort I. My top lip has a permanent nerve irregularity where a segment of my lip is kind of permanently numb. I think that it has affected my speech just a tiny, tiny bit, and it's also just a bit annoying. The other thing is that I seem to have more serious sinus infections now. I'm not sure why that's the case, but I have a feeling it's because of the surgery. There are a few papers published about post-operative sinusitis, but the time range on those studies is pretty short, so I'm not sure whether long-term increases in sinus infections are a documented side effect. The last thing is that my top teeth felt really uncomfortable for about a year. It felt like bubbles were traveling up through the roots of my front teeth and through my skull. My teeth haven't fallen out after 6 years, so I'm probably safe? But I was very anxious for a very long time about this odd feeling.

Now for the exciting part: the surgery and recovery =O

Heh. Look at this adorable sequence of photos. The surgery was cool. They put me under, asked me to count backwards from 10, and I was totally out by 5. I woke up, and I remember being incredibly dazed. When I realized what had happened to me, the first thing I asked was "Did it work?", and I think the nurse or whoever was there reassured me that the surgery had been successful. I think I slept for a very long time. I think I was kept for 24-36 hours post-op, during which I was in a considerable amount of pain. All I had to drink was one apple juice, which I drank quite reluctantly, and threw up as soon as I stood up to go to the bathroom.

A side note is that throwing up when your jaws are wired shut sucks pretty badly.

Afterwards, as you can see, my mouth was quite bloody. I don't have a single scar on the outside of my face, so all of the machinery and shit had to go through my mouth. I think it was probably stretched a bit here and there, so the corners of my mouth are pretty beat up. I also couldn't feel anything in the triangle made by the bridge of my nose and the corners of my mouth.

Here's what I looked like in the two weeks post-op. I continued to swell for 3 days, before it finally started to subside. My parents particularly enjoyed seeing their oldest daughter as a baby again XD. The numb region slowly shrank overtime.

I was very tired and subsisting on a diet of basically 2x400 calorie Ensures per day. I would occasionally choke down a third, but I was pretty miserable. My parents bought a really intense blender so that I could drink chicken noodle soup, but even the best blender couldn't really make the solid stuff into a liquid, so I a lot of the time, I had Ensure and the occasional milkshake.

Luckily, the whole situation was more annoying than painful.

I didn't take as many pics as I probably should have, but by week 3, I'd started my internship in NYC. The commute was brutal, especially on max 1200 calories a day. In just 3 weeks I went from 120 to 110, a weight that I hadn't hit since age 12. My face shape recovered pretty rapidly, but my upper lip has remained numb on the right side to this day. I was somewhat hopeful that the feeling would come back one day, but I abandoned that hope after about a year.

Here's my brand new smile!

This is more or less the final result-my face hasn't changed that much, except it might be a bit rounder from gaining a bit of weight.

I have to admit that I feel much prettier than I did at 17-18, although it's hard to separate that from my skin clearing up. I think I was actually surprised by how nice it was to have a standard smile. And to be totally clear, I'm not saying that beauty doesn't matter. Beauty obviously matters. It is okay for external beauty to be a part of your self-esteem, and there is no doubt that many people in the world will judge you based on your looks. It must sound kind of hypocritical from a girl who got surgery that improved her looks, but take it from me - your happiness and your relationships with others don't (or shouldn't) depend on what you look like on the outside. My then-boyfriend loved me just as much when I had an underbite and cystic acne as he did when I had clear skin and perfect teeth. I did not gain any more friends or admirers, nor was I any luckier in love. But I do look better in a large fraction of the pictures I take (I still have 75% duds), my teeth actually feel as if they have a proper resting position, and I finally ate that apple =).

I'm not really sure anyone will ever read this, but I hope that it was either entertaining, informative, or reassuring. If it was none of these things, I'm sorry for wasting your time. =).

Feel free to contact me with any questions!