Preemptive caveat to all I say/type here: I'm super swollen, sore, and on opiates. Things might get sloppy but I want to share.
So...Updates:
First, for everyone who sent good vibes my way, THANK YOU.
Second, though I'm a doc and researcher, my expertise is certainly (obviously..) not jaw surgery (though I know one or five surgeons, they aren't max fac). I DO have access to all the research articles I want, know what I'm doing when interpreting it, understand the anatomy, and have studied the techniques, have access to fellow physician friends opinions, and feel competent choosing my own providers wisely. I did my best, and I believe my surgeon did his best, and unfortunately, those things don' always beat the odds. Given my professional life, I was very aware of this going in and I took the risk. Most of anything in medicine is a risk/probable-benefit equation.
That said, despite the last month long saga of unfortunate fate, I have some relatively promising news to report.
So I did decide to go through with the partial revision this morning (bum bum bum....).
My surgeon (the same one) shaved my maxilla down about 4-5mm, starting at the most anterior maxillary prominence (right behind the bottom of my nose) and removing bone posteriorly. The amount of bone removed was taperep laterally, limited by the amount of overlap of the boney shelf created by the MMA as well as my incisor roots (which d/t what orthodontists thought was great to do in the 90s, were almost straight up and down!--damn it).
He also revised my alar cinch--tightening that sucker up quite a bit. Although I was still pretty sedated and out of it when he explained things, he added a few extra "cinches" to help lower the tip and further decrease the width of my alar base. I'll need to discuss this with him more in depth at my next visit because I'm not sure I understand how he went about this.
Oh, and I almost forgot, he removed both my lefort plates in order to gain access to the area needed to shave. He was originally going to just cut the bottom part off for fear of further messing with V2, but he said the tissues were easily lifted up and access was not overly difficult, so he did it. He was able to do it without directly interacting with the nerve--this is huge as I still have significant numbness/parasthesia.
Alright--the OUTCOME:
I seriously underestimated the effect that walking around as a monkey-pig-man-beast after my MMA would have on me. I was also very surprised by how such subtle anatomical changes (mm's!) result in quite drastic results in the whole esthetic gestalt of a human face and people's interpretation of it. Obviously, from my posts above, I was very tentative about doing this today and my expectations were neutral at best, and if I'm honest, possibly leaning on the pessimistic side.
Damn, sorry for the suspenseful delay.
My nose looks so much better! As the swelling increases throughout the day, its starting to get a little lost and seems to be reaching for my left ear (its subtle though). I think the crookedness is likely due to asymmetrical swelling. Either way, the pig anatomy has completely been eliminated. I went from showing everything in my barn sized nostrils to anyone in front of me to a close semblance of my old thin, sleek nose. Via his reported measurements, he decreased the width of my nose by 7-8mm!
Those of you more familiar with plastic surgery probably already understand how much the nose effects the whole face. This change alone, has given me hope that I may not scare children away in the near future.
The nose change was complex and was the result of both the maxillary shaving and the actual work on the nose. Though the pig may be gone, the monkey is ever stronger! D/t the swelling, my upper lip is pretty awesome right now--the terrible kind of awesome. Of course, its all swelling but the truth is we don' really know how projected and mesognathic I'll remain after this.
Another huge benefit that my surgeon saw coming but I did not came in the form of my bite improving rapidly! So I'm only 4 weeks out from MMA, my bones are not even through the acute stages of healing. Removing the plates at this time, like we did, is risky and requires me to be very careful and return to stupid tight elastics damn near 24/7. BUT, given that the bone is still quite malleable, my bite on the right side has improved. My surgeon is confident that my bite will be 100% in a few weeks, if we're careful, after the revision and this current plan. I was pretty nervous about the plate thing--again, its always a calculated risk/benefit deal. Despite my further luck, I think I might have won a bit today!
With the change in my nose, however, and the revision of my mentalis in about a month (which will bring my chin forward--where its supposed to be!) I think I'm actually going to end of with an acceptable ante-face look rather than the look of someone who ate lead and BPA plastic sandwiches as a child and now enjoys Fukashima water shakes.
I think the esthetic goal for those seeking MMA for sleep apnea, or any orthognathic movement above 8mm+, should be along the lines of "different but not terrible." Any improvements, no matter how likely, should be considered icing on the cake. I think a lot of suffering, including my own, would have been attenuated to some degree if I could retroactively follow my own advice.
Today, for the first time in a month, I see some esthetic hope--I'll never quite look like myself old self again, but I will gladly accept anything close to normalcy at this point. With any luck, I may return to some degree of attractiveness--which is something I more or less gave up on post op week 2-3 (though early days, I could tell things were not going to pan out well even then).
I will continue to update things as they progress. I hope that my tale of an unexpected esthetic rally, albeit modest, may given hope to some of you out there.
A last point: As overly miserable as I was about things initially, I may be overly optimistic about things now (could also be the oxy talking afterall!). I'm just happy to have some hope at this point. We'll see how I look/feel over the next few days.
