comparing smiles before & after

I'm still working on a better before & after compare. Here is a quick version for the curious...

1) In braces for 5 months, May 2008

2) In braces for 11 months, 6 weeks post op, Dec 2008

I think you can see how the braces straightened my teeth, widening my smile even before surgery. As my teeth straightened, my overbite (and over jet, too) appeared larger. My teeth should lighten up again after my next scheduled cleaning. The surgery shortened my face, especially noticeable (to me, at least!) across my cheekbones. My cheeks are fuller. My jawline is now more square. I knew one eye was larger, now I can see the very subtle difference in cheek fullnesses prior to braces. Also, now that my lower jaw is in place, my laugh lines have softened. That's good! I still expect to see face #1 in the mirror...when I see face #2 instead it seems strange. Bit by bit this sense improves. My smile is slowly relaxing and broadening as the muscles in my face come back. My lower lip and chin improve daily. The constant buzzing & twitching nerves lead me to believe this feeling will return, too. :)

Yes

As I approach the six week mark, my attitude is shifting. Finally!

• Am I feeling better? Yes.


• Can I eat more food? Yes.


• Do I like my new smile? Yes.


• Is my energy returning? Yes.


• Is the mild depression lifting? Yes, mostly.

Isn’t that good news?
Yes!

...here I tried to recreate a shot from last Christmas.

gastronomic bliss

Our family visited my in-laws today. My sweet MIL pick up some smoothie mixers for me. Also, we dined at a local pizza spot where I experienced a moment of culinary bliss...ravioli in pesto sauce. Hmmm hmm good!

4 weeks pics...it's getting better

...I actually put on foundation and my favorite top for this...:)

I poured over other's before & afters for hours. It totally helped calm my nerves. Then again, nothing prepares you for looking into your own face in the mirror. Bizarre, really. I've lost 10 pounds now, but since my cheeks are fuller, I actually feel like I've gained weight. Is there such thing as a post-surgery eating disorder?!

Perhaps it is the permanence of the experience that feels so strange.

The fourth week marked the end of my pain, per se, though I still describe my general state as uncomfortable. Something is always achy, twitchy, sore, etc. I am truly a joyful person - don't let the pessimistic sound of my posts fool ya. :) Also, I can now swallow tiny motrin pills, woohooo, so no more liquid motrin cocktails for me! My energy wanes after lunch big time. Most days I try to sneak in a nap...how do you working folk do it?

The best sign of recovery this week is that I cooked an entire meal for my family. We were all thrilled.

So, for any other orthognathic-obessessed folk out there, here is what I think 4 weeks out. I'm uncertain whether one side is more swollen or if my face is that lop-sided. Everything feels swollen, and my husband say I look better in person that in these photos, but I do continue asking myself,"What if this is my final look?" The tip of my nose has come down a bit; it's likely in it's final spot. I love where my upper lip falls against my upper teeth when I smile, though the uneven muscle tone creates a very crooked smile.

At an ornament swap this morning, I totally covered my smile when laughing because a) it hurt to laugh and b) I was aware of how weird I looked. O confident self, where art thou?

Lastly, and I admit to being apprehensive about writing this, but I wish my lower jaw had been moved further or my chin moved out. My new lip compentance is fabulous - truly - doesn't the profile need some balancing? Right now, I'm trying to trust the surgeons who do this sugery all the time, on lots of different bones, and be thankful for the lack of complications I've experienced.

3 weeks pics

....premiering fresh from the shower, sans maquillage...

It feels so strange to post these. I don't completely like the results yet and feel very self-conscious about my new look. Sometimes, I think there's no difference at all and wonder if it is all worth it...I guess this is where the conviction that one's long-term health is more important than a short-term aesthetic change.

Here is how I felt at 3 weeks post op, written the night I snapped these photos:

Christmas music? Check. Haagan Daas? Check. Feeling better? Hmmm, can I get back to you on that?
When friends ask me how I'm doing I don't know what to say. Yes, I can talk, but it aches. Yes, I'm sleeping better but I wake up swollen like Humpty Dumpty. I am constantly frustrated eating. I miss kissing my husband. Most of all, I miss my optimistic self.

I admit, it has been really difficult to stay positive. I'll be minding my own business, and BOOM, a gigantic zap of pain attacks my chin. Each zap means another nerve is waking up. Thankfully, this stage, too, shall pass. Isn't there some improvement around the 6 week mark? Feeling under my eyes, around the corners of my mouth and around my upper lip has returned. Every couple of days another part of my mouth regains feeling. Swallowing remains strange.

Of course, having any surgery during the holidays is challenging. I miss the aromas of good & good-for-you-food filling the house. I'm at home again tonight instead of celebrating with friends. I miss arriving places with lipstick applied correctly....my lips are still kinda wonky. As the swelling under my nose improves, my upper lips are slowly unfolding. My moods are settling down. The mild depression seems to be lifting more each day.

My father kindly asked me today if I was pleased with my new look. I think so...

Honestly, I’m still growing into this softer face. I liked how Million Dollar Smile phrased it, "getting used to new angles". My fuller cheeks make me look younger – that’s a plus, I guess. They also hide what little cheek bone I do have! I don’t yet like my nose angles. It’s funny how looking at other’s photos I can see the little difference is just that, little, but when I examine my own face in the mirror the difference seems E-normous.

Running holiday errands this week, I ran into several neighbors, each of whom asked me if I had had my surgery yet. This was weird. It‘s good still look like myself, right? Is it good that they don’t see the improvement. Or maybe they see a difference, it registers as "not an improvement" and so they ask? I’m not sure.

OS follow up 23 days post op

My Monday check up with the surgeons went well. The entire visit was over in 10 minutes. In short, they were both very pleased with my results, smiled at me a lot, and told me to come back when my braces were off, for a final x-ray and photo. OS even said with a warm grin, "Lady, you're healed." ( he said lady in a pleasant tone, not that middle school slang tone)

I was rather surprised.

When I mentioned that my OD thought there was condoyle sag, my attending OS laughed slightly, and asked the chief resident who assisted the surgery to come check out my bite. Right on. Midline? Right on. Next, they reviewed all my x-rays. Again, right on. I was delighted! I reminded myself how far my jaws & teeth have moved thus far, and even if every tooth wasn't perfect, my current smile is a huge improvement.

There's still some tweaking to do for sure.

A funny moment occurred while looking at the x-rays. The attending reminded me how much tooth I used to show when my lips were at rest. He said the normal range is between 2-3 mm or something. I interrupted him to show off I knew my own measurements, that I had shown 7 mm. Well, he laughed and said more like 157 mm! Humor seem much more appropriate now that the surgery is behind me.

At the end of my extraordinarily brief appointment, I wanted to hug both men (and find the other 2 lady surgeons who cared for me in the hospital). Alas, the clinic was busy. I settled for a handshake. All the appointments, and the fretting, and the blood work, and the drug effects, and late night calls to the dr...all of it seemed over too soon.

This is a huge generalization, okay, but since both of my performing surgeons are men, and both are well, surgeons, they weren't too big on the whole touchy feely aspect of me processing the experience. :) Oh, I wanted to tell them all about it, but I could tell they didn't really want to hear. They've likely heard it before.

The attending did tell me I was too critical of myself (I already know that sir!) and reiterated how pleased he was with the surgery. The resident didn't say much - he leaned in close to measure my new upper lip angle, checked out my jawline scarring, told me that would go away in a bout 3 months, and smiled at me really big! With their combined positive energy, I left the hospital on cloud nine.

Of course, once I was in my car driving the 100 miles home, I thought of all the questions I had intended to ask. The only advice given was to be sure not to chew until I was 6 weeks out. I am to call if I have any concerns, but otherwise, the attending surgeon didn't think seeing me biweekly would do much good. Who knew I could feel so relaxed in the hospital again? Just walking down the hallways at previous appointments had shaken my confidence.

I've been pondering how best to say thank you. How does sending a large box of citrus to the office sound?

First OD visit, post-op

I went to the OD twice this week. I initiated the appointment, and am so glad I did. I wanted to remove the surgical lugs. Yippee!

Bad news? My OD is concerned my condoyles have sagged. Uh huh. NOT what you want hear after surviving two weeks of what I’m coining as “the darkness”. His concerns worried me for several days. Really, though, what can I do except wear my elastics and wait for the swelling to go down? I think this is pretty common. I’ll speak to my surgeons about it on Monday. My assessment is that the OS was very pleased with my bite while the OD preferred my teeth to be set end-to-end to compensate for the settling in process.

My left side looks great. My right side is slightly class II, so that side has stronger elastics. The plan is to correct my bite while the mouth is still settling. Then, around the six week mark, we’ll start tweaking rotations, mid lines and such.So, new flexible wires are in as well as a lower power chain. My little persistent gap finally seems to be closing. Prescription is to wear the Fox elastics on the left & Ram elastics on the right 24-7 for the next three weeks. I feel more pressure than pain from these, though my cheeks are still puffy and catch on the elastics whenever I speak.

Since I cannot chew any food, the additional pain hasn’t slowed me down. Well, perhaps it’s made me grumpier than usual. I am definitely more focused on comforts than I used to be: warm socks, smooth puddings, hot showers, fresh sheets. As long as I don’t have to chat much, excursions help me distract myself from the discomforts.

Last night, my husband and I taught an NFP class. Oooh, I paid for all that talking today. Every muscle in my jaw aches, even under my chin. My face also swelled back up. Grrr.

Oh, I cannot for these babies to come off!

Brrr...

I've been surprised by just how sensitive my face is, to well, just about everything. So many friends have loved on my family with frozen meals that most nights, I'm pulling supper right out of the oven. It's a real treat, for sure! Strangely, that initial gust of hot air really stings my face. It's the same when I step outside into colder air. It's like someone turned on a giant internal vibration device on...any shift beyond about 10 degrees F feels really uncomfortable.


Sunday, I tried joining my little ones at the park. Weather was a cool, 50 degrees F. I lasted 3, maybe 4 minutes before jumping back into the car, turning up the heat, and placing the warm rice pack I'd brought along, on my cheeks. Husband-of-the-year took over thankfully.


Been reading about similar experiences on Archwired and Yahoo....


The best explanation I've found is this: the metal expands/contracts at a different rate than bone & tissue, therefore, the sudden shock of temperature change "feels" noticeably different. At this point, that difference registers as pain. Hopefully, once the nerves are back in place, the sensation will just be "different".


I guess it's good I'm here in Carolina. :)

how my young children are reacting...

Hi Katherine, you asked about my children. Overall, they are taking it in stride. It took my youngest (18 mos) about 4 days to come around. She is a sensitive, quiet child. We bonded one afternoon when we spent about 5 hours together, just us two, and said very little. For my old chatty self, this was different and beautiful. I need to remember this when she grows older! My older daughter (3yrs) spells love with time and activity. She doesn't mind my new look but is impatient with my lack of energy, apathy and sometime tears. Since my return from the hospital, she's grown concerned I'll disappear again anytime I have a doctor's appointment. She's not yet aware that this is just a stage. My take is, like potty training, she'll figure it out eventually....my challenge is to remain calm & steady for her.

My physical pain ebbs and flows unpredictably as have my emotions. Sweetpea is the first to say, "Mama, don't cry, it's okay...just go take your medicine." While I am touched by her sympathy, I am concerned she's acting like a parent. I reassure her that I am "not feeling well" and soon I'll be back to my old self. This comforts her. Also, I try to warn her when I am in pain. When I feel good, I make an extra effort to engage her. My other tactic has been to follow our general routines. Mentally, I know they're too young to remember this experience well. I guess my fear was that we'd all find ourselves in a new pattern and then let that become normal. Thankfully, my husband is pretty grounded. He (plus the many dear friends who have "remembered me") are keeping me from straying too far.

Thanks for asking about my little ones. :)

quick pics - a side view at 14 days out

I don't quite have the energy to post proper before & after pictures. Here is a quick comparison of my profile about 1 month prior to surgery and about 2 weeks after surgery.

In my after shot, you can tell my nose still turns up from the residual swelling. Also, my surgical lugs are on, as well as, lots of dental wax. I am not completely used to my new look, but I do like the placement of my chin foreward.

Upper jaw: impacted 3.5 mm

Lower jaw: moved forward 5mm

coming out of the dark

Each day continues to feel a bit better!

I'm still experiencing some pain and mild depression - though there are moments where I feel the old me has returned. Since my OS encouraged me to talk at Monday's appointment, I've been trying to talk more, to stretch out my waxy-feeling facial muscles, but of course, it increases swelling and sucks all my energy.

Thank you to my friends for emailing, calling and loving on me. It makes a difference. :)

The Darker Side Effects of Dilaudid

Today, I finally investigated the side effects of the pain reliever I was taking. Since I couldn't swallow very well, and vomited several other pain meds in the hospital, Dilaudid's 2-4 mL doses worked well for me. I am grateful for the pain relief the drug provided, but goodness, it seems I was sensitive to the drug in almost every category! I'm so glad that I am not still taking this powerful drug every 3 hours.

For anyone researching jaw surgery and such, here is a copy/paste of the side effects. I've italicized the ones that effected me. Also, I checked out withdrawal symptoms, and BAM - there were other symptoms I'm experiencing.

I am glad I am not really going crazy!

"The major hazards of DILAUDID-HP include respiratory depression and apnea. To a lesser degree, circulatory depression, respiratory arrest, shock and cardiac arrest have occurred.

Dilaudid is an analgesic narcotic with an addiction liability similar to that of morphine. It is apparent within 15 minutes and remains in effect for more than 5 hours. Dilaudid is approximately 8 times more potent on a milligram basis than morphine. Often called "drug store heroin" on the streets. Dilaudid inhibits ascending pain pathways in Central Nervous System. It also increases the pain threshold and alters pain perception....of course, the pain alteration is why this was so helpful during those early days. :)

The most frequently observed adverse effects are lightheadedness, dizziness, sedation, nausea, vomiting, sweating, flushing, dysphoria, euphoria, dry mouth, and pruritus. These effects seem to be more prominent in ambulatory patients and in those not experiencing severe pain.

Less Frequently Observed Adverse Reactions:
General and CNS:, Weakness, headache, agitation, tremor, uncoordinated muscle movements, alterations of mood (nervousness, apprehension, depression, floating feelings, dreams), muscle rigidity, paresthesia, muscle tremor, blurred vision, nystagmus, diplopia and miosis, transient hallucinations and disorientation, visual disturbances, insomnia, increased intracranial pressure

Cardiovascular: Flushing of the face, chills, tachycardia, bradycardia, palpitation, faintness, syncope, hypotension, hypertension

Respiratory: Bronchospasm and laryngospasm

Gastrointestinal: Constipation, biliary tract spasm, ileus, anorexia, diarrhea, cramps taste alterations

Genitourinary: Urinary retention or hesitancy, antidiuretic effects

Dermatologic: Urticaria, other skin rashes, wheal and flare over the vein with intravenous injection, diaphoresis"
--from web.md

Here are the possible withdrawal symptoms:

Withdrawal symptoms from Dilaudid can occur four to five hours after the last dose. dilaudid withdrawal symptoms usually last 7 to 10 days. Ah ha! Users may respond to the pain of dilaudid withdrawal by taking another dose without realizing they have become addicted. Dilaudid Withdrawal symptoms include but are not limited to:
severe anxiety , insomnia, profuse sweating, muscle spasms, chills, shivering, tremors, restlessness, yawning, gooseflesh, restless sleep, irritability, anxiety, weakness, twitching and spasms of muscles, kicking movements
severe backache, abdominal and leg pains, abdominal and muscle cramps, hot and cold flashes, nausea
anorexia , vomiting, intestinal spasm, diarrhea, repetitive sneezing, increase in body temperature, blood pressure, respiratory rate, and heart rate