Wednesday, 15 April 2015

FAQ Orthognathic Surgery

After spending hour upon hour and day upon day searching the internet, sometimes all you need is a quick FAQ section to put your mind at rest. Here is list of questions my readers frequently ask.

How long ago was your surgery?

I had my first surgery in August 2011 and my plate removal surgery in December 2012. So 3.5 and 2 years ago.

Did you feel unhappy with the way you looked before surgery?

Yes I felt unhappy with the way I looked. Growing up for a girl in modern society is not the easiest thing to go through. I know, I know, first world problems. But when you are a 13 year old school girl being bullied for the way you look and seeing your friend’s receive attention from boys, you do not really see the bigger picture. I would not say I had it too bad. Looking back, I had some great friends, both boys and girls and was able to get through school with ease. Of course there would be the odd incident or name calling. The worse was being spat on.  But by and large I had it good compared to others. I thank my friends and the school for that.

For many years I felt uncomfortable with the way I looked. So I would hold my head to the side and sit on a certain side of the bus, as to not offend anyone with the “worst side” of my face. Although both sides were pretty odd looking. At the age of 17 I was attacked on a bus and this really knocked my confidence. So much so, that for many years I would not even leave the house alone. When I passed my driving test, things became a little easier. But you would never find me walking along the street alone or going to the shops.

After the trauma of my first operation, I became a total recluse. I did not want to go out. I became scared of the world. I often had flashbacks from the attack and would worry about somebody smashing my face in or falling and breaking my face. I could not go through that pain again, so I retreated into myself. The only time I would leave the house would be to go to my hospital appointments.  I finally started to receive some help for my agoraphobia and anxiety after my first operation. This has helped me a lot. I still have the odd panic attack and I am still anxious and on high alert when I leave the house. But anything is an improvement on what I used to be like.
Before the operations I used to notice people staring at me. Some people would whisper and the old ladies would often say “oh you poor love”.  Since the operations I feel like I am not so much of an easy target. I sort of blend into the background now.

I would not say I am 100% happy with the way I look. But who can be in a society that popularises perfection and cloning. I will never look like the symmetrical tanned models in the magazine. But I do not need to. I am unique. It has taken a long time for me to accept this but, I do not want to be somebody else. For once in my life, I want to be me! Flaws and all.

Did you have any problems before surgery?

Other than the psychological issues experienced before surgery, I had a terrible underbite. My back teeth did not meet at all. I had to chew on my front teeth only. I also found it hard to smile and talk at times.  On top of this the asymmetry was putting quite a lot of pressure on my TMJ and 2 years before surgery I started to develop crippling left sided facial pain. I was diagnosed with Atypical Trigeminal Neuralgia and TMJ dysfunction. I was put on muscle relaxants, powerful pain medications and antidepressants. I went from being a fit young woman who loved to dance, swim and cycle, who had 3 jobs and was studying for her BA Hons, to a weak heap on so much medication I could not even string a sentence together.

I did feel like the operation was the only option I had. My surgeon had warned me that the operation may make my pain 100x worse, but I was desperate. I did not care. I could not live another day with the pain I was in. I had to try something, anything! At the time of the operation, my brace work had placed my teeth to one side of my jaw. I could only chew on one side of my mouth. So realistically I did not have much of a choice in the matter.

To find out more, click here. 

How do people react to you now, compared to before surgery?

Before surgery some people would make comments. There were a few incidents where 2 different boys spat on me on the way home from school. I feel a lot of my esteem issues came after visiting the hospital in Sidcup. I used to dread going to my appointments. They made me feel like a freak. I remember one of the surgeons coming in briefly and saying “don’t worry we will sort that out”, like my face was something to be ashamed of. It felt like I did not have a choice in the matter. When I transferred to Mr Matthews’ team at Guy’s Hospital things changed. Although, I tried so hard to find a way of not having the brace work before surgery they told me that it would be the best option for me. They also said the decision about my treatment was down to me. If I was not ready to have the treatment now, they would wait for me.

Immediately after surgery there was a mixture of reactions. Some of my friends and family noticed the change straight away. As others, could not really see the change. I was swollen for a very long time after surgery and the sinus infections did not help the situation. Now I feel like people are more positive about the way I look. I receive the odd nasty comment. But I believe most people will experience that. Out of habit I still show my “best side” in photos or when I conduct myself in daily life. My surgeon and orthodontist are both pleased with my final bite result. Other medical professionals have all been impressed with my surgeon’s work.

To read more about people's reaction soon after surgery, click here. 

Did the surgery stop you from grinding your teeth?

Because of my asymmetrical bite I never did grind my teeth. I would find myself clenching quite a bit after surgery. But I suppose that was down to my bite being in a completely new position. I have spoken to a lot of patients who have found they grind and clench a lot less since their surgery.

Did the surgery stop your jaw joints from clicking?

My jaw joints still click and I still have a slipped piece of cartilage in my right joint. So this sometimes causes my joint to click. When I first started opening my jaw after surgery I found that my jaw would click a lot. Almost every time I opened my jaw. Rest assured this is very common after surgery. Even now, if i find my joint is clicking a lot I will use a heat pad to soothe the area. I also carry on with my jaw opening and strengthening exercises.

Does your bite feel stable now?

Yes! Now I am 3 years post orthognathic surgery my bite feels a lot more stable. I do have times were I feel like my muscles are trying to pull on my jaw and force it back into its original position. When this happens I tend to wear my retainers more often and use heat pads to soothe the muscles. Sometimes my teeth will cross one another and get stuck. This was quite frightening the first time it happened. I spoke to my surgeon straight away and he put my mind at ease. I went to have an examination and he also took some x-rays. He was happy with the stability of the bite.

I feel like it is important to write here that although relapse is rare, it can happen. I have spoken to 2 women who were 3 years and 8 years post op and experienced relapse. If you feel as if you are experiencing more pain than normal, or if your bite is unstable please contact your dentist or doctor. 9 times out of 10 it will be nothing, but it is so important to get checked out. 

Do you still get sinus infections?

Yes, unfortunately I still experience sinus infections. Since my surgery, I started to develop reoccurring sinus infections. I had never had a sinus infection in my life before this point. It was hoped by removing the upper jaw titanium plates that this would resolve the issue. But it has not. I still suffer from sinus infections but I do not experience them as often now.

To read my blog about sinus infections, click here.

Why did you have your plates removed after jaw surgery?
I had my plates removed following reoccurring sinus infections and lower jaw pain. The screws in my top jaw were poking through into my nasal cavity. It was assumed by the ENT doctor that these were causing irritation to my sinuses, thus causing the infections. The lower plates would really hurt in cold weather. Because I do not have a lot of flesh around my lower jaw, the plates were sometimes visible. I have a very slender jaw line so the muscles would clench and pull around the plate sites causing pain and discomfort. Since having the plates removed the frequency of sinus infections has decreased and my lower jaw pain has decreased. The muscles still spasm around the jaw, but it is not as painful now the plates have been removed.

To read my blog about plate removal surgery and recovery, click here.

How long did you have to wear braces?

I wore my braces for a total of 3 years and only had them on 4 months after surgery.

To read my blog about coping with braces, click here

What is the pain like after surgery?

It is important to note that everybody is unique. Everybody has a different pain threshold, some people have pain and issues before surgery and some people have relatively quick and easy procedures. Predicting how this surgery will affect you is impossible.

I know some patients who have no pain at all when they wake up. They go on to have a quick and easy recovery and do not have any lasting issues. Realistically, I was never going to be one of those people. I have gone through life and created a challenge no matter where I went. After the first surgery I experienced the worst pain of my life. I would not have wished this pain on my worst enemy.

To read my blog about coping with long term pain, click here.

What is the pain like now?

Pain Level in 2011: 10
Pain Level 2013: 5/6
Pain Level 2014: 5/6 sometimes 7

Pain levels are stable and mostly controllable. However, I have been experiencing a lot of migraines and optical nerve pain this year. Muscle spasms and muscle strength has not improved. Current pain medications include: co-codamol 30/500mg, ibuprofen 400mg, Amitriptyline 20mg, Sumatriptan Nasal Sprays 20mg and Diazepam 5mg. I am still taking raspberry ketones, green tea extract, multivitamins and fish oil supplements. It really is not ideal and I do worry about the effects these medications are having on my body. I have tried to cut the medications down, but these attempts have been unsuccessful. I have recently started using Sumatriptan and Diazepam because my migraines and muscle pain was becoming relentless. I had a crazy migraine on the whole of the right side of my head for 5 days straight. The pain would start at the top of my head; travel down my face and also through my eye to the back of my head. When this happens, the nerve that runs down my right arm fires off and I cannot grip with my right hand. These episodes started to become a weekly occurrence and it was stopping me from functioning at all. I could not read or drive, so I decided to try some new pain medications. I am quite sensitive to many medications, so I was very reluctant to try anything new. I have tried muscle relaxants in the past and they had a very negative effect on me.

Find out more, click here. 

Do you need to have more surgery?

After seeing my surgeon in September I made the decision not to undergo anymore surgery. My joints are reasonably healthy and my bite is good. I could undergo a genioplasty to straighten my chin, but this will not impact on my bite or pain levels. If anything, replacing my face with more metal work may make my pain worse. After weighing up the pros and cons, I decided against having anymore surgery.

What did you use to ease the pain?

Immediately after surgery I was in so much pain. Unimaginable pain! Nothing could have prepared me for what happened. In the beginning I used ice packs continuously. I also took high strength pain killers and rested as much as I could. It was impossible to sleep, so I spent my days highly drugged up, in agony, listening to Disney movies. I positioned myself in an upright position and used 4-6 pillows to support my head, neck and back.  Knowing what I know now I would have drank a lot more green tea and pineapple juice. Both of these can act as natural anti-inflammatories. I would have also tried listening to sleep hypnosis and guided meditation.

To read my bog about how to sleep after surgery, click here.

Were you worried or scared before surgery?

I was petrified before surgery. Even up until I went into the aesthetic room I was crying and I genuinely thought I was going to die. The thought of never seeing my mum and brother again really upset me. The anaesthetist was really cold and heartless. She even said “Well you don’t have to go through with it, we can cancel”. After waiting my whole life and after experiencing so much pain I hardly had a choice to just walk away from the operation. I was in such a state leading up to my operation, but I managed to keep a lot of my fears to myself.

To read my blog "The Night before Surgery", click here. 

What are your 5 top tips for a speedy recovery?

1. Make sure you are prepared. Have 4 bags of frozen peas at home; make sure you have a blender, plenty of pillows, DVDs, books and someone there to help for the first few weeks.
2. Book a reasonable amount of time off of work/ college. It is so important not to rush your recovery. 
3. Don’t panic or stress. Realise that this is a huge operation and you should be compassionate with yourself. Don’t be too hard on yourself. Some people experience little or no pain and are back to normal within a few weeks. As others have a longer and more complex recovery. No one person is the same.
4. Eat/ Drink well. Make sure you eat and drink well. 2 litres of fresh still water a day and lots of high vitamin rich soups and food. I know it is tempting to overload your body with sugar and salt, but this really isn’t healthy. In order to speed up recovery you should maintain a balanced and healthy diet. If you can, use supplements and take multivitamins that are high in vitamin B12, C and D.
5.  Maintain good oral hygiene by using antiseptic mouthwash and follow your surgeon’s instructions. Ensure that you attend all of your follow up appointments and listen to your team’s advice.

I am worried about infection, what should I do?

On leaving hospital you may be given a mouthwash to rinse with to stop infection. You will be encouraged to start brushing your teeth as soon as possible. In the beginning, I found using a soft baby brush was beneficial and Corsodyl mouth wash to ease the ulcers and to stop bacteria. However, it took me several weeks to get to this stage. With the combination of scarring, swelling, bleeding and bands/wires it was nearly impossible to brush my teeth. I was in a huge amount of pain and found opening my mouth wide enough for a syringe was very challenging. To ensure that my internal wounds did not get infected and my mouth was hygienic, I rinsed with medication mouthwash and salt water every 2 hours.

Anytime I drank or ate I would rinse my mouth with water after every mouthful. I was also on a course of antibiotics for 2 weeks after surgery. This was a precaution. With any health issue, please consult your doctor or surgeon if you experience any symptoms or discomfort.

To find out more about brushing your teeth post-surgery, click here. 

Did they remove your wisdom teeth before or during surgery?

Yes I had one of my exposed wisdom teeth removed before surgery. My surgeon made the decision to leave the remaining 3 wisdom teeth in after surgery. Some surgeon’s like to remove all wisdom teeth during surgery to avoid future complications.

To read more about wisdom teeth extraction, please click here.

At what age did you start your corrective treatment?

At the age of 11 I was told I would need corrective jaw surgery. At the age of 12 I started orthodontic treatment on my lower teeth and had 7 teeth removed. It wasn’t until many years later that the main bulk of my treatment began.

To read my story from the beginning, click here.

How long do I have to wait before the swelling goes down?

After surgery it is not uncommon to have swelling on your face and neck area. The swelling should peak by day 3 and then start to slowly decrease as you recover. You may find the swelling and pain is worse in the morning, but should improve throughout the day as you become more mobile and sit upright.

Sometimes you will wake up after surgery with a pressure bandage on your face. The bandage will feel very tight and uncomfortable. However, you will normally only be expected to wear the bandage for the first 24 hours after surgery. It has been found that the pressure bandage is very effective in preventing excessive swelling and bruising.

It would be expected that the worst of the swelling should disappear within 2 weeks. However, it can take up to 6-8 months before your tissue fluid levels return to a stable condition. In my case I had issues with the titanium plates so my swelling lasted a lot longer than most patients. Finally, it is not uncommon to experience “puffy days” after undertaking jaw surgery. Some patients, even 5 years after jaw surgery, still experience the odd “puffy day”. It does not last and you should have nothing to worry about.

To find out more why not check out my “Patient’s Guide to Reducing Swelling”, by clicking here.

Can you feel your face now?

No not fully. A lot of my feeling has come back, but I am still completely numb from my lower lip and teeth down to under my chin. This is on both sides. I do sometimes dribble and I feel very conscious when I go out to eat or drink. Kissing is not the same as before. I am lucky though that the muscles have not been affected and it is purely the numbness. After a few months of training, I was able to eat and drink without the use of a mirror.

After lower jaw surgery it is expected that patients will feel numbness or pins and needles around the chin, lower jaw and lip area. This is completely normal and should only be temporary. In most cases the lower numbness starts to wear off within a couple of weeks. However, sometimes it can take up to 12-18 months for full sensation to return to the area. In a few cases the numbness may become permanent. As the muscles will be unaffected, the numbness should not restrict you from speaking properly or using your lip or lower jaw in the future.

If you are undertaking upper jaw surgery the area of numbness may be larger. With upper jaw surgery it would be expected for the patient to feel numb from the eye area downwards. The numb area can spread down the face and cause numbness in the upper lip, gum and teeth. As with the lower jaw surgery the upper numbness should start to fade between 8-12 weeks and full sensation would be expected within 12-18 months.

To find out more about numbness after surgery , click here. 

How long after surgery did you have to wait before you could talk and eat normally?

For the first 4 days after surgery I could not eat anything. I was having water through a syringe. After day 4 I started to have soup and watered down fruit juice through the syringe. Because of the pain and numbness my mother had to help me. I moved to small plastic cups after 3 weeks.

I had 3-4 weeks of liquid diet and my surgeon gave me the go ahead to move to a soft food diet. All in all it took around 5 months before I was eating a normal diet again.

Download my “Jaw Surgery Survival Kit” to find out more.

Did you go clubbing with your braces? Did you find it harder to talk to guys or feel pretty?

As most of you would have guessed by now I am quite a private person. I rarely open up about my love life or past pursuits. But after speaking with some young ladies recently, I have decided to add their question into my FAQ.

Current society puts a lot of pressure on young people to fit in. If you aren’t pretty enough, skinny enough, muscular enough, or popular enough, you are an outsider, a freak! Yes I know this all too well. Like most children and teenagers growing up I was bullied. My self-image suffered immensely and I still look in the mirror and see the freak staring back at me. Yes, even after all of the operations and being brace free I still don’t like my reflection.

In answer to the first part of the question; Yes I did still go clubbing. I feel like I was probably a little more self-conscious after having my braces and I would be conscious to hide my braces as much as possible. I wore my hair down and ensured that I did not wear big or bright make up or high-necked tops. I wanted to draw attention away from my face as much as possible. Nowadays, even in the short 3 years since my braces, we are seeing a bigger cultural shift. More adults are getting corrective surgery and many more people are investing in braces. More adults than ever are having braces. If you can’t have Invisalign, do not worry. Embrace your brace. You will only have them on for a couple of short years and then you will have perfect teeth forever. It is more than worth it.

In answer to the second part of the question; did I find it harder to talk to guys or feel pretty? Well when I finally got my braces at the age of 19 I already had a boyfriend. He knew I was going to have surgery and also knew that I would need to wear braces for a couple of years. He was ok about the whole thing and never once complained or mentioned them. I was very worried before I had the braces and tried to figure out a way not to have them. Unfortunately, due to the severity of my case there was no other way. I often felt like ugly Betty, but other than a few immature comments, I mostly forgot I had braces. The way I looked did not impact on my ability to study or to complete my job.

To read more about braces click on the links below:

Cleaning your Braces: 
Adult Braces: 
Eating and Drinking with Braces: 
Problems with Braces:
Teeth Whitening Post- Surgery:

After surgery did you have to wear a splint?

After jaw surgery many patients will be fitted with a splint. This is a plastic wafer that sits between the upper and lower teeth. The wafer has small indents which allow for your teeth to sit inside them. The splint helps to stabilise your bite and train your muscles to function with your new jaw position after surgery. After my orthognathic surgery I had to have my splint removed as it was causing excess saliva build up and making me gag. Due to my slight overbite post-surgery I was unable to use the splint and it was removed the next day.

Are you happy you had surgery?

I get asked this question a lot! I am 100% happy I went through with the surgery. Although it has been a tough few years, I am more content now than I have ever been. By going through what I did and by experiencing the setbacks and the pain, I am now able to share my story with you all. Although I still suffer from pain daily, I am in a lot less pain than I was before surgery.

Before surgery I was suicidal. I could not function at all. Life was a living nightmare. Now I am in less pain and have access to the support I need. I have an amazing group of people around me and life has finally started to get back on track. I take strength and courage in the fact I have helped others and will continue to share my journey with you all. Every single follower and reader is so unique and you have all touched and inspired me with your courage and honesty. I hope we can all continue to build on this and help others through these difficult times.

“Owning our story can be hard but not nearly as difficult as spending our lives running from it. Embracing our vulnerabilities is risky but not nearly as dangerous as giving up on love and belonging and joy—the experiences that make us the most vulnerable. Only when we are brave enough to explore the darkness will we discover the infinite power of our light.” – Brene Brown

Other blogs you may find useful:

You can now continue the chat and speak with other patients on my new closed Facebook group:

Looking forward to connecting with you soon!

Lots of love always,



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