jawsurgeryforums.com
User Blogs => Standard & Video Blogs => Topic started by: znewton on October 01, 2012, 11:51:35 AM
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Hey Everyone,
I wasn't sure whether I wanted to make a post or even continue with my blog (I started a blog the first week or so that I got my braces and only posted two or three times). I'm realizing that I'm going to have plenty of down time to document my experience and putting it on a blog will serve as a means to hopefully help somebody else who's curious or on the fence about orthognathic surgery.
That's it for now. I'm @ Dr. Arnett's awaiting my second appointment of the day. This morning my surgical assistant took impressions, two wax bites, and another x-ray for treatment planning. Upon finishing the scan Dr. Arnett spent the next 45 minutes or so taking all sorts of measurements of my face and bite. He pointed out that I have a fair amount of asymmetry and joked that I looked like a "banana head" -- whatever that means! I'm looking forward to having a healthy bite and the facial balance/harmony that is coming my way.
I will post the link to my actual blog later and will start making regular updates there!
Zach
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Thanks for sharing. Good luck. I wish I were in your shoes. I'm two months behind you.
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Thanks for sharing. Good luck. I wish I were in your shoes. I'm two months behind you.
And im a month and a half behind you! Good luck znewton!
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Good luck playa.
Also, quick question. Is a 3-piece Lefort how surgeons typically handle an off-center midline?
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I was told by a couple surgeons that I had a "banana head"
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Good Luck
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45 minutes? geez that's a long time. was he very explicit about the facial harmony/asymmetry? Did you have to go through signing all those papers yet.
damn that is specific. i was the same as you, certain procedures gunson wasn't 100% on the day before. the genio is probably common, because they run your facial scan through the VSP and it shows where your chin should be. if it goes beyond a redline then genio is it. But your genio was like .02 on the original ceph right? second one is always different though.
good luck! stash up on ginger ale lol.
He was fairly specific regarding the asymmetry. Apparently my right jaw line is "bigger" than the left side. He's going to use the HA grafts to even things out. Also, my cheekbones are more prominent on the right side of my face which he will also even out.
In regards to the genio you are correct that my original ceph showed something like .2 but I believe that was because there was no plan to do a genio. I'm not sure if the software just had to compute a value or what but it would make zero sense to do a .02 genio! I asked him about it today and as I said he just won't know until he's done with everything else. I assured him I did not want to end up looking like Jay Leno and have left the decision up to him.
I did fill out the questionnaire which addresses what I would like to see changed etc (which I've seen you discuss on your thread) but he did not go over it with me whatsoever. I really didn't put anything down though except for wanting to "Move chin forward" and "Show more teeth when smiling". All of the other options were things I really wasn't concerned about.
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Also - the link to my blog is http://zachsjaw.wordpress.com/ (http://zachsjaw.wordpress.com/) :)
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i think because arnett already went over your issues (aesthetically) directly and relatively explicitly, the TMS didn't really matter as far as he was concerned. did arnett brief you on the questionnaire or did he just hand it to you?
It was just handed to me by the assistant. I was going to mention that - it wasn't an issue because we discussed everything in detail. I'm pretty sure I got the general briefing he goes over with every patient but he had no problem answering any specific questions I had for him. I do still find it funny he called me a banana head ;D
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Haha right? He was just commenting on the fact that I have a LOT of asymmetry and was probably trying to make me laugh. Here's the surgical plan as of now:
3-Piece Lefort I - I believe he said he would be advancing the maxilla around 2-3mm. My midline is also off and he will be moving it around 1mm to the left.
BSSO - My lower jaw will be advanced 16.3mm. By most surgeons standards this would probably be their largest advancement ever, but Dr. Arnett routinely sees this amount of movement. Lower jaw also needs to be leveled.
Genio - Right now it's up in the air. He said there is about a 50% chance that he will do the chin but he won't know until he gets everything else done.
Hydroxyapatite Grafting - He will be doing a fairly extensive amount of grafting to my cheekbones and lower jaw.
Have a pre-op appointment at the hospital tomorrow and a full physical in the afternoon. Wednesday is free and surgery is Thursday!
Are you getting a lot of counterclockwise rotation? If not, the 16.3mm movement of the lower will be linear, and that strikes me as extreme, even by A/G's standards.
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Arnett told me I have a "cow bite" cause my teeth dont intercuspate and just sit on top of eachother...I chew the cud so to speak lol. I thought it was funny. Arnett is actually a kind, funny guy; his humor is just dry though. Youd have to hear the way he says things to know not to take it personally.
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Are you getting a lot of counterclockwise rotation? If not, the 16.3mm movement of the lower will be linear, and that strikes me as extreme, even by A/G's standards.
I'm really not sure about the CCW. I'm really not too concerned.
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Good luck Znewton!! Think positive! ;D
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As long as he knows his audience, I think the joking is ok. It wouldn't bother me at all, might even put me more at ease since we can have a laid back, personal relationship.
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so i read through your blog a bit, just to reiterate - Arnett devoted 45 minutes simply evaluating your face clinically - like, aesthetically did that time include other issues?
and when it came to question time, did you initiative it or was it more of an open invitation?
how explicit was arnett when he referred to asymmetry, and did he say he would address it with x, y and z? or just "everything will be good" sort of deal?
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I'd say between 30-45 minutes taking various measurements and what not. That time included him taking measurements and simply expressing his thoughts and findings out loud to me as he worked.
In terms of asking questions - after he did his 3rd check of all the measurements he sat down next to me to go over all the procedures and risks. We did that verbally than went over a checklist of what we had just discussed so I was sure he had covered all his bases. I took this as an opportunity to ask questions which he politely answered without hesitation. I don't think I really had that much to ask though compared to other patients.
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In terms of asking questions - after he did his 3rd check of all the measurements he sat down next to me to go over all the procedures and risks. We did that verbally than went over a checklist of what we had just discussed so I was sure he had covered all his bases. I took this as an opportunity to ask questions which he politely answered without hesitation. I don't think I really had that much to ask though compared to other patients.
that's good. verbal checklist, smart. seems like you are well-informed and have a good handle on the surgery.
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Here's my initial CPT that was done 14 months ago verus the final treatment plan Dr. Arnett came up with yesterday. I saw him today briefly while stoppin by to meet with one of the assistants. He said he's probably going forward with the genio. So that's a 16mm advancement of the lower jaw in addition to a 2mm genio. He said overall the total movement of "Pog" (which I believe is right under your bottom lip) would be 20mm. (Yes, TWENTY!) I told him that number seemed large and I was a bit concerned, and he reassured me I will look great. I know that has to be what he tells all his patients, but after thinking about it a bit more I'm not worried. I'm not the doctor and am solely anxious based off of other numbers I've read on random blogs. I'll be sure to post pictures for you all!
(http://i71.photobucket.com/albums/i123/znewton1/ScreenShot2012-08-28at93005PM.png)
(http://i71.photobucket.com/albums/i123/znewton1/photo7.jpg)
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Here's my initial CPT that was done 14 months ago verus the final treatment plan Dr. Arnett came up with yesterday. I saw him today briefly while stoppin by to meet with one of the assistants. He said he's probably going forward with the genio. So that's a 16mm advancement of the lower jaw in addition to a 2mm genio. He said overall the total movement of "Pog" (which I believe is right under your bottom lip) would be 20mm. (Yes, TWENTY!) I told him that number seemed large and I was a bit concerned, and he reassured me I will look great. I know that has to be what he tells all his patients, but after thinking about it a bit more I'm not worried. I'm not the doctor and am solely anxious based off of other numbers I've read on random blogs. I'll be sure to post pictures for you all!
(http://i71.photobucket.com/albums/i123/znewton1/ScreenShot2012-08-28at93005PM.png)
(http://i71.photobucket.com/albums/i123/znewton1/photo7.jpg)
Interesting that your head tilt changed. The TVL was originally 10mm from glabella now its 6mm. Def a sign that you werent tilting your head upwards as much this time around. Also interesting that hes not advancing the TVL afterall. Its amazing how much decompensating the upper incisors orthodontically will change the treatment plan.
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Interesting that your head tilt changed. The TVL was originally 10mm from glabella now its 6mm. Def a sign that you werent tilting your head upwards as much this time around. Also interesting that hes not advancing the TVL afterall. Its amazing how much decompensating the upper incisors orthodontically will change the treatment plan.
What do you mean by TVL? He took the measurement for my head posture two separate times and initially I was closer to the first ceph, but ended up at -6 by the end of it.
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TVL is the "true vertical line" in your ceph tracing that runs through subnasal.
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true vertical line.
for your genio, like i said, he'll run it through the virtual surgical planner, sort of like this:
http://www.dolphinimaging.com/3dsurgery.html (http://www.dolphinimaging.com/3dsurgery.html)
first image, but profile of your skull - right side i believe - and no soft tissue.
it basically guarantees the hard tissue will be aligned (your bite), and is a strong aid in designing soft tissue/aesthetic treatment, but imo it's more beta-like for soft tissue because i dont think dolphin - yet - can control for different types of soft tissue for individual patients, or even recognize a range. so the genio looks strong bone-wise, from a computer, but it may look different in RL depending on how your skin is. though the chin area tends to be the most bony at least from what i've seen so it isn't usually a problem. the sliding genio doesn't alter the symmetry of your chin, it just lengthens it in whichever direction the surgeon determines. i dont know what version of dolphin they use, or if it used to this kind of extent:
http://www.dolphinimaging.com/3dimages/digitize_big.jpg (http://www.dolphinimaging.com/3dimages/digitize_big.jpg)
the riskier variables imo lie in the mid-upper face, and really boils down to the clinical analysis of the surgeon.
Thanks for the clarification! I almost forgot - one thing that really surprised me is that I will not have a split despite the fact that he is segmenting my upper jaw. Are your skeletal screw and hook still in CK? I'm curious what it will be like to see a phillips head exposed right above my teeth!
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Thanks for the clarification! I almost forgot - one thing that really surprised me is that I will not have a split despite the fact that he is segmenting my upper jaw. Are your skeletal screw and hook still in CK? I'm curious what it will be like to see a phillips head exposed right above my teeth!
you mean a splint? you'll have a splint, but it is taken out after the operation. if you request your VSP records, there should be a page that shows pre-op, mid-op (with splint), and final bite.
all my screws/hooks/latches/plates are still in. i cant see it or really even feel it. only way i know is when looking at an xray. i read some former patient said she could feel the screws getting cold if it was really chilly, but i havent had that problem.
it isn't that big of a deal. did arnett go over the HA and its vulnerability - i.e, dont sleep on the side of your face? or sleep on your face at all basically...because if the HA does flatten i was told they can't do much about it.
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you mean a splint? you'll have a splint, but it is taken out after the operation. if you request your VSP records, there should be a page that shows pre-op, mid-op (with splint), and final bite.
all my screws/hooks/latches/plates are still in. i cant see it or really even feel it. only way i know is when looking at an xray. i read some former patient said she could feel the screws getting cold if it was really chilly, but i havent had that problem.
it isn't that big of a deal. did arnett go over the HA and its vulnerability - i.e, dont sleep on the side of your face? or sleep on your face at all basically...because if the HA does flatten i was told they can't do much about it.
Yes, I meant splint. When referring to the skeletal screws I was referring to the ones that are exposed which are used to secure the front elastic. Did he not use those with you? I'm not worried about all the other hardware/plates/etc and feeling those. I'm just curious what the front hook and elastic (which are exposed) feel like.
He did go over the HA grafts with me as did the assistant. He explained how critical it is to stay upright and on my back when the time comes. The assistant mentioned if I did end up flattening one side that he would simply have to do the same to the other side. Essentially, they can even it out but I'd lose the effect he was originally going for. I just plan on being hyper-aware and doing my best to not mess things up :-\
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Yes, I meant splint. When referring to the skeletal screws I was referring to the ones that are exposed which are used to secure the front elastic. Did he not use those with you? I'm not worried about all the other hardware/plates/etc and feeling those. I'm just curious what the front hook and elastic (which are exposed) feel like.
oh, you mean the hooks? yes, you have to have hooks to loop the bands. it all depends on the patient. you may not even use the front hook, just the sides. it all depends, you'll wake up after surgery and know where your bands are. they dont feel like anything, you'll be so numb it will be the last thing on you mind.
He did go over the HA grafts with me as did the assistant. He explained how critical it is to stay upright and on my back when the time comes. The assistant mentioned if I did end up flattening one side that he would simply have to do the same to the other side. Essentially, they can even it out but I'd lose the effect he was originally going for. I just plan on being hyper-aware and doing my best to not mess things up :-\
yeah, that's what sucks. plus, even if they do even if it out, im not sure if you can have it re-do without scrapping off the original HA. it can really influence the aesthetic result so i would be very mindful of how you sleep. i slept at a 40-50* angle for two months. let us know if arnett molds your cheek grafts afterwards.
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Yeah, someone answer this please. Sounds like a very stressful thing to try and not roll in your sleep or something stupid to screw it all up.
8 weeks.
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Whoa, its creepy how your profile in the recent CTP looks a lot like my profile (especially with how the lower lips hang, along with how far apart the lips are from each other when relaxed, and the chin) LOL. Also, even creepier, I checked out your most updated post on your blog where you included a picture with the various photographs of you on the board; I, seriously, felt like I was looking at myself from afar - is this what it feels like to be looking at a doppelganger? I find this eerie, fascinating, and humorous all at once haha.
Man, I better brace myself for when I start orthodontics and my bite and profile begins to change (for the "worse") in preparation for surgery - I can barely handle the look of my current profile. Although, I won't be starting braces for another year or two.
Anyways, 1 more day til the big day for you; best of wishes to you, znewton.
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Thank you to everyone for all the encouragement! I've gotta say I was a bit surprised at how many people have chimed in here. In addition to posting on here I've received a few e-mails as well wishing me luck for surgery. At this point I'm just about 24 hours from surgery. I'm going to the Zoo in Santa Barbara since I don't have much left to do today. I have to check out of my hotel at 10 and the rental property I reserved isn't available until 3:00PM. I think the last time I was at a a zoo was 10-15 years ago in San Francisco (my hometown). Than again, I did summit Mt. Kilimanjaro seven years ago which included plenty of animal sighting that obviously trumps a zoo!
Ok, that's enough ranting for now - probably stemming from pre-surgery nerves! Also wanted to say I'm looking forward to sharing my surgery and recovery with all of you. I will be sure to post and take pictures as often as I can. I've gotta figure out the logistics about that though. My stepmom (who will be my primary caretaker along with my father for these first five days in SB) who is the sweetest woman ever, might be taken back if I asked her to tae pictures of me in all my glory right out of surgery. We'll see.
I"ll post later on today.
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definitely take some photos, gunson didnt seem to mind. especially when you first wake up, it's cool to look at them months later.
arnett is probably the same.
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Just to clarify, znewton means the hook (not in braces) and the Phillips-head screw that are embedded in the gums above and below the teeth. This girl who had surgery with Gunson had them:
http://ashleysjawsurgery.wordpress.com/ (http://ashleysjawsurgery.wordpress.com/)
I think I'm having them too. (I'm Arnett's next surgery after znewton next week).
CK did you have these and if so did you have them removed yet?
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Just to clarify, znewton means the hook (not in braces) and the Phillips-head screw that are embedded in the gums above and below the teeth. This girl who had surgery with Gunson had them:
http://ashleysjawsurgery.wordpress.com/ (http://ashleysjawsurgery.wordpress.com/)
I think I'm having them too. (I'm Arnett's next surgery after znewton next week).
CK did you have these and if so did you have them removed yet?
yeah i believe i had the hooks that are trapped in the gums lol. definitely did not like them at all. i had them removed awhile ago.
congrats on your surgery antbee!
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It's 06:10AM here in Santa Barbara! Heading out the door in about twenty minutes for the hospital. Wish me luck everyone :)
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Good luck man!
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I can't get over how long jaw surgery takes.
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I can't get over how long jaw surgery takes.
i think the limit is like 8 i would say. i was told the average was 4-6.
z is probably trying to figure out how to use the suction device right about now lol.
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i think the limit is like 8 i would say. i was told the average was 4-6.
z is probably trying to figure out how to use the suction device right about now lol.
what are the immediate moments after jaw surgery like? are you very disorientated? are you in a lot of pain or is it somewhat okay?
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I hope your surgery went well Zach, we look forward to hearing from you friend!
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what are the immediate moments after jaw surgery like? are you very disorientated? are you in a lot of pain or is it somewhat okay?
depends on the patient. all patients react differently. some people say you don't remember when you go under or when you wake up, but i remembered all of it lol. the nurses were trying to wake me up from the recovery room and beaming lights into my eyes. they wanted to move me to my room and i wanted to as well but my eyes kept closing. at the same time one of the nurses was trying to use my hand to suction blood/saliva, and holding a mirror to my face which then i did NOT want to see. nurses were pretty pushy then.
definitely did not expect that lol. i just thought i would wake up in my room. i was in a lot of pain and really wanted the morphine, but said i couldnt have the button until was i fully awake.
i bet some people are reactive immediately in the recovery room, and are good to go to their room very quickly. i think it just depends on your chemistry and how much long you were under.
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I heard surgery went well! Looking forward to hearing from you Zach:)
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Facebook friends
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It makes me nervous to think that it takes days before one is able to muster up enough energy to make a blog/forum update.
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Antbee.... Have you heard anything on Zack?
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Yes. I don't want to speak too much on his behalf and I'm sure he'll be on here soon, but just to let everybody know I heard from him and he's doing well. I've seen a pic and he already looks great.
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Awesome news, so happy for him!
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I am
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I am
Yes, totally forgot marisama. dont see you as much on the forum anymore.
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I'm always around. I posted in this thread. Anyway, this is Znewton's thread. Looking forward to hearing from him.
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Ck, how long until you felt up to texting/using a pc after surgery? A few hours? Days?
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Also - just quick as this is Zach's thread but heard from Trossi too. She made it and from what I can tell seems ok if nauseous. I'm sure she'll be back here soon too. Just always nice to hear people made it without any obvious upfront complications. Thinking good healing thoughts for them.
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trossi?
dont really want to hijack zach's thread lol. do u want me to move that or re-post it in my thread?
Lol no one is hijacking his thread. Im just asking a question about recovery to get a better idea of when we might hear back from zach.
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Zach looks like he's doing okay and TRossi is doing well for being a few hours post op !
Im slowly learning, post op expect everything and then some.
Im no where near surgery ready and Im supposed to go w/ Gunson but Im starting to get a pinch worried.
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Trossi posts on the other forums - thought she had been on here too...
Frankly I'm nervous as hell - mine's in five days and hearing how bad everyone feels right after is giving me the willies
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well, i was in the recovery room longer than average i think, and it also depends on how long you were under. i wasnt really ready to use the computer until maybe a week after my surgery. but i was till in SB, and the laptop wasn't mine. i was able to skype on the 10th day but i think the frustration of not being able to talk was a huge turn off.
i definitely wasnt in a state of mind to discuss my surgery online in a meaningful way until much later (early August). zach should be able to use a computer rather quickly, but he may not have the motivation/desire because the post-operative reality is so traumatic physically. or maybe he is 100%, everyone is different and not all surgeries go as anticipated.
Hey eveyone - this pretty much sums it up. So tired, extremely swollen, and was not expecting it to be THIS bad. Lips are HUGE and I'm overall just extremely uncomfortable. It's hard to breathe and anytime I drink something half of it just pools up in my mouth. Don't really have much else to say at this point. Surgery was six hours, was in the hospital one night, and was discharged yesterday at noon.
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Congrats on making it to the other side. How does the new bite feel? Or can you even tell since you are most likely numb?
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Good to see you here Zach. Was wondering about the pooling liquid. Sounds like you have feeling and not completely numb (also from what you said before) - that's good. I never thought about that problem of liquid before though. I guess tipping your head forward to drool it out is too painful? Or doesn't that work? I'm seeing that the first few days are just a really rough road... All the best
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Zach! Glad to see your okay (minus lots of the swelling).
This is TRossi or Terra http://openbiteblog.blogspot.com/ (http://openbiteblog.blogspot.com/) she had her surgery on Friday for an open bite!
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Hey everyone! Finally getting around to updating on here. I'm hanging in there and am doing alright. As of now I'm just over 120 hours post-op and saw Dr. Arnett for my first follow-up appointment today. I'm extremely swollen due to all of the BMP (bone morphogenetic protein) that was used for grafting on my upper jaw. Apparently this causes prolonged and more intense swelling which wasn't really mentioned to me until after surgery. Lena even mentioned today that they need to update their post-surgical care packet to educate patients about this so they know what they're in for. Whereas most patients swelling will peak around Day 3-4 mine should peak around Day 5-7. It's rough but I'm just hoping I'll wake up tomorrow with a little less swelling. My lips are also very swollen which I've been treating with blistex 24/7. In regards to numbness - can't feel much around both my cheekbones, right nostril, roof of my mouth, lower lip, and chin. I'm more than willing to answer any questions some of you might have. Can't really think of much else to update. Just trying to stay positive that the swelling will subside soon!
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Hey zach! Glad to hear youre doing ok. How difficult has it been to sleep upright/not disturb your cheekbone augmentations?
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Sleep in general has been hit or miss but I haven't found it too difficult. I guess I don't seem to move much in my sleep because I've yet to fall asleep in an upright position and wake up on my side :o Just have to be careful!
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Congrats on making it to the other side. How does the new bite feel? Or can you even tell since you are most likely numb?
The bite feels good but is also very foreign to me. I can't remember the last time I had a bite that actually closed. That being said, it's pretty amazing to be able to feel the closed bite with my tongue whereas last week I could fit my tongue through the same spot.
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The bite feels good but is also very foreign to me. I can't remember the last time I had a bite that actually closed. That being said, it's pretty amazing to be able to feel the closed bite with my tongue whereas last week I could fit my tongue through the same spot.
Cant wait for that feeling
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It seems crazy to me that they discharge patients so soon. Can you drink anything?
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It seems crazy to me that they discharge patients so soon. Can you drink anything?
Yes, I've been drinking things since I got out of recovery in the hospital and into my own room. They wouldn't discharge me unless I could urinate on my own (after the catheter was removed), drink fluids and keep them down, and take a short walk around the ward. I was in surgery from 08:30AM - 2:30PM on Thursday and was discharged Friday around noon. If anything it was great getting to leave the hospital so quickly. I was stable and so far I haven't had any major complications.
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Was your upper jaw segmented? Can you notice a difference in space for you tongue with the added width and advancement?
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Was your upper jaw segmented? Can you notice a difference is space for you tongue with the added width and advancement?
Yes, he did a 3-piece LeFort. It's hard to say because it's all numb, but I'd definitely say it feels bigger.
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Have you had any difficulty breathing? In preparation for post-op breathing issues, I will clench my teeth and plug my nose and try to breath through my mouth. It is NOT a good feeling. This is one of my biggest worries about surgery.
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Have you had any difficulty breathing? In preparation for post-op breathing issues, I will clench my teeth and plug my nose and try to breath through my mouth. It is NOT a good feeling. This is one of my biggest worries about surgery.
Just tried doing that.... Scary...your right not a good feeling at all.
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Just tried doing that.... Scary...your right not a good feeling at all.
You will both get used to it. It was a shock at first but the human body adapts rather quickly. Some times I'll find my nose completely clear and will breathe through it and the next hour it's all stopped up and I'll breathe through my mouth. The really frustrating thing about breathing through my mouth is that it ends up drying out my lips that much more than they already are. I've been putting blistex on them 24/7 to try and help with the cracking/dryness.
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Did arnett do any work on your septum? I know he often does if theres an issue since hes already in there...
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How's the liquid diet going for you? Is it as bad as I'm imagining it to be?
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How's the liquid diet going for you? Is it as bad as I'm imagining it to be?
I've taken it easy so far because I haven't really had much energy nor much appetite. Thus far I've been surviving off Boost, chocolate milk, apple juice, gatorade, and water. The first two weeks are liquid only & particle free (strained) so I'm just taking it easy. Next Tuesday I should be cleared to start blending stuff up.
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I've taken it easy so far because I haven't really had much energy nor much appetite. Thus far I've been surviving off Boost, chocolate milk, apple juice, gatorade, and water. The first two weeks are liquid only & particle free (strained) so I'm just taking it easy. Next Tuesday I should be cleared to start blending stuff up.
basically lived off chocolate milk during my recovery. sounds like you're doing pretty good. i wouldnt stress on the nose thing. only allowed three shots of affrin i think but in your two week check up gunson has a tool that will suck out anything left in your nose.
i think you're on particles after ~2 weeks of surgery, plus or minus a few days i guess. i tried blending everything and i couldnt stand the taste lol. assistants told me i would get so hungry that i would start blending pizza LOL! actually tried it, tasted AWFUL.
just ate tomato soup and milkshakes every day lol.
question if you can answer: how many bands do you have? did arnett make use of the archwires?
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Thanks for the input guys - I'm just trying to get in what I can for now until I'm cleared to start blending next week.
Right now my main concern is the swelling - apparently Dr. Arnett used a lot of BMP (bone morphogenetic protein) which causes massive swelling of the soft tissue. Without BMP people generally peak anywhere from Day 3-5 (and six in some cases). Their office said it's completely normal that my swelling seems to have peaked as of a day or two ago but has NOT started to subside yet. I'm trying to stay positive - just hoping I won't look like this forever! My face is HUGE. They estimated my swelling at a 7/10 (ten being someone whose eyes are swollen shut).
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you cant use a straw for several weeks because of the incisions. i think at least 8 weeks. the constant rinsing helps control and prevent cavities.
trust me, z is going to want carbs. a few weeks of chocolate milk isn't going to kill him. the real issue is flossing. i can only floss maybe 2 or 3 of my bottom teeth, and i still cant floss any of my upper teeth because it hurts so much. i was told i could floss a month ago. flossing with braces is hard enough, jaw surgery makes it 1,000,000 times more challenging.
i do the straw thing now, but you can still get cavities in your back teeth my dentist told me.
Can you use interproximal brushes to clean between teeth?
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Thanks for the input guys - I'm just trying to get in what I can for now until I'm cleared to start blending next week.
Right now my main concern is the swelling - apparently Dr. Arnett used a lot of BMP (bone morphogenetic protein) which causes massive swelling of the soft tissue. Without BMP people generally peak anywhere from Day 3-5 (and six in some cases). Their office said it's completely normal that my swelling seems to have peaked as of a day or two ago but has NOT started to subside yet. I'm trying to stay positive - just hoping I won't look like this forever! My face is HUGE. They estimated my swelling at a 7/10 (ten being someone whose eyes are swollen shut).
yea i didnt have any BMP and peaked around day 5. the visible swelling eventually goes away but your face still feels very hard? at least for me, pressure in my eyes, cheeks, muscles...always something new each day. maybe avoid the mirror for a bit when you can.
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yea i didnt have any BMP and peaked around day 5. the visible swelling eventually goes away but your face still feels very hard? at least for me, pressure in my eyes, cheeks, muscles...always something new each day. maybe avoid the mirror for a bit when you can.
Yeah it's hard to do though! I resemble something like a potato head at this point. Hopefully tomorrow is the day!
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you're arent supposed to brush your teeth for a few weeks or more depending on the incisions. they dont want you messing up the incisions because everything is so vulnerable. you'll go through the power point presentation (unless they have upgraded their tech) the day before surgery or whenever your pre-op is about the 8 rinses a day saltwater/peroxide etc..
also cant balloon your cheeks during the rinses, you have to move your head side to side slowly which is hard to get used to.
but this is gunson, maybe arnett has his own philosophy i don't know.
Ok thanks for the info! Hows the swelling been btw?
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Ok thanks for the info! Hows the swelling been btw?
no more visible swelling as far as i know.
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no more visible swelling as far as i know.
Good to hear!
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Good to hear!
i guess.
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Are you a natural pessimist or is it just regarding jaw surgery?
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Yeah it's hard to do though! I resemble something like a potato head at this point. Hopefully tomorrow is the day!
Oh my God.....I am half laughing and half crying at that statement.
What is BMP.? And what is it used for?
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Oh my God.....I am half laughing and half crying at that statement.
What is BMP.? And what is it used for?
It's a protein that Dr. Arnett uses to help induce bone growth amongst other synthetic bone materials.
http://en.wikipedia.org/wiki/Bone_morphogenetic_protein (http://en.wikipedia.org/wiki/Bone_morphogenetic_protein)
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I was told DR A was lowering my nasal floor and would use that bone to graft the CCW, but he mixes it with BMP to make a mush and then mixes in blood plasma as the 'glue'.
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He used a combination of my own bone, cadaver bone, platelet rich plasma, and the BMP. Yikes!
cadaver bone...wtf?
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Here's some pictures for all of you -
Just before I was rolled into the OR
(http://i71.photobucket.com/albums/i123/znewton1/IMG_0304.jpg)
This was taken after getting out of recovery and into my own room on surgery day.
(http://i71.photobucket.com/albums/i123/znewton1/IMG_0313-1.jpg)
Day 1 @ Cottage Hospital
(http://i71.photobucket.com/albums/i123/znewton1/IMG_0323.jpg)
Day 5 (I believe) - I had really extreme swelling.
(http://i71.photobucket.com/albums/i123/znewton1/IMG_0358.jpg)
Peak swelling on Day 6.
(http://i71.photobucket.com/albums/i123/znewton1/IMG_0366.jpg)
Day 7
(http://i71.photobucket.com/albums/i123/znewton1/IMG_0416.jpg)
Day 8
(http://i71.photobucket.com/albums/i123/znewton1/IMG_0424.jpg)
Day 9/10
(http://i71.photobucket.com/albums/i123/znewton1/IMG_0468-1.jpg)
Yesterday - Day 13- on the way back from Dr. Arnett's :)
(http://i71.photobucket.com/albums/i123/znewton1/IMG_0539-1.jpg)
Today - Day 14
(http://i71.photobucket.com/albums/i123/znewton1/IMG_0548.jpg)
Left Side (swelling is WAY down)
(http://i71.photobucket.com/albums/i123/znewton1/IMG_0549.jpg)
Right Side (cheeks are still very puffy!)
(http://i71.photobucket.com/albums/i123/znewton1/IMG_0552.jpg)
Comparison - I know I'm not comparing the same sides but my right is to swollen to really use as a comparison at this point. Left picture is from final records @ Dr. Arnett's.
(http://i71.photobucket.com/albums/i123/znewton1/IMG_0553.jpg)
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Thanks for posting these Zach!! Gives me hope that its normal to still look very swollen and not like your end result on day 7. You look awesome!!! Congrats!!
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Wow, you are going to look great! The swelling has really come down a lot already. You have me more hopeful about my surgery with Arnett in January :)
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Thanks for sharing! Things are looking good. That swelling has me so nervous!
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Thanks for sharing! Things are looking good. That swelling has me so nervous!
not everyone swells up like, all depends on what is done. more manipulation with the upper jaw+HA (Z had a lot) can affect swelling. I had the same thing taped to my head, except I was still dead asleep. Why do you have that thing around your heard? Because of the hair?
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What thing around his head? I had the same head wrap and plastic drool-catcher and natty blue hat too! Plus I've swollen almost as much I'd say. I had all that HA though too- probably why.
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What thing around his head? I had the same head wrap and plastic drool-catcher and natty blue hat too! Plus I've swollen almost as much I'd say. I had all that HA though too- probably why.
natty blue hat, never had that. maybe because my hair was shorter? i like high his hair manages to stay spiked each day LOL.
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Haha I noticed that too, u might be swollen like hell but your hair looks good z lol
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not everyone swells up like, all depends on what is done. more manipulation with the upper jaw+HA (Z had a lot) can affect swelling. I had the same thing taped to my head, except I was still dead asleep. Why do you have that thing around your heard? Because of the hair?
The compression bandage in the first picture? That stayed on overnight until Dr. A came to do his rounds around 8AM the next day to check in and remove it.
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The compression bandage in the first picture? That stayed on overnight until Dr. A came to do his rounds around 8AM the next day to check in and remove it.
yeah everyone has the compression bandage, i just meant the thing on your head.
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natty blue hat, never had that. maybe because my hair was shorter? i like high his hair manages to stay spiked each day LOL.
It's a combover, not spiked. Haha. After about Day 5 I decided after I showered as part of attempting to feel more human I'd at least comb/gel my hair since I couldn't shave or brush my teeth. Helped me to feel a little better than again I generally keep my hair looking pretty good :) Haha.
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yeah everyone has the compression bandage, i just meant the thing on your head.
What thing?
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He means the green surgery cap. I thought everyone had to have those.
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He means the green surgery cap. I thought everyone had to have those.
Gotcha. That's what I thought as well.
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Oh my God......that is some crazy swelling......they(A/G) really have to figure out a way to control the swelling . I can tell your gonna look great once the swelling comes down. Hang in there!
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Zach, thanks for sharing photos. I think you are going to have great aesthetic results.
Forgive me if this is a silly question, but does it hurt to be puffed up like that? All I can think is - where are the anti-inflamatories? Poor Zach! Tough week for those facial tissues!
I never paid much attention until now, but my estimate from consultation shows 14 grafts in the top jaw; 14 in the bottom jaw; and 8 bone harvests. Is that similar to what you had?
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Zach, thanks for sharing photos. I think you are going to have great aesthetic results.
Forgive me if this is a silly question, but does it hurt to be puffed up like that? All I can think is - where are the anti-inflamatories? Poor Zach! Tough week for those facial tissues!
I never paid much attention until now, but my estimate from consultation shows 14 grafts in the top jaw; 14 in the bottom jaw; and 8 bone harvests. Is that similar to what you had?
Zach, thanks for sharing photos. I think you are going to have great aesthetic results.
Forgive me if this is a silly question, but does it hurt to be puffed up like that? All I can think is - where are the anti-inflamatories? Poor Zach! Tough week for those facial tissues!
I never paid much attention until now, but my estimate from consultation shows 14 grafts in the top jaw; 14 in the bottom jaw; and 8 bone harvests. Is that similar to what you had?
Funnybones (would rather refer to you by your name but obviously don't know it yet!) -
1) Swelling - The first week I was obviously extremely uncomfortable with the extreme amount of swelling that I had. It didn't hurt (I've had little to no pain through this entire process) as much as it was just uncomfortable. As I've heard others describe it almost feels like you're wearing a mask. It's a hard sensation to describe because in addition everything else is very tight, so to speak, so it's a combination of everything which makes for an odd feeling.
2) Surgical estimate - My final treatment plan included "10 graft placement" for the upper jaw, "8 graft placement" for the lower jaw, and "18 local punch harvests". Dr. Arnett used a mix of my own bone, cadaver bone, and the BMP for the extensive grafting of my upper jaw. It looks like you're going to have even more than I did!
If you have any concerns or questions feel free to ask and I will do my best to answer or resolve them for you :) Don't get me wrong, this is a tough process, but so worth it!
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weird question maybe, but how long was your surgery? it should say on your OP record (will also include blood loss, drugs used, first time of incision, etc...very meticulous.)
and do you remember entering the OR and seeing arnett or whoever was in the room, and what they were saying? i remember everything, but it seems a lot people totally forget even entering the operating room.
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weird question maybe, but how long was your surgery? it should say on your OP record (will also include blood loss, drugs used, first time of incision, etc...very meticulous.)
and do you remember entering the OR and seeing arnett or whoever was in the room, and what they were saying? i remember everything, but it seems a lot people totally forget even entering the operating room.
My surgery was six hours from start to finish. As for my experience about entering the OR, I have ZERO memory whatsoever. I obviously remember Dr. Funk coming to my room to start my IV and later getting wheeled down the hallway to the OR doors. I remember Dr. Funk meeting me there and pushing the Versed into my IV - and my memory stops there. I have no memory of the OR itself or even seeing Dr. Arnett. I believe the first thing I really remember is waking up in my own room.
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I wonder if I can take a "pre-versed" right when I wake up that morning. I want that morning to be a complete blur.
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I wonder if I can take a "pre-versed" right when I wake up that morning. I want that morning to be a complete blur.
Lol
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I'm not sure about those #'s. You're welcome to see my ceph though to try and figure it out :)
(http://i71.photobucket.com/albums/i123/znewton1/photo7.jpg)
Doesn't look like you had any impaction.
Znewton, did you have any extractions or shaving? I ask because your lower jaw is 3mm smaller than mine and I'm faced with the need for either lower bicuspid extractions or a lot of narrowing.
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I wonder if I can take a "pre-versed" right when I wake up that morning. I want that morning to be a complete blur.
It's not bad at all. I was fairly calm as I knew the day had finally come I had been waiting so long for. The versed will do it's job for you, trust me.
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Doesn't look like you had any impaction.
Znewton, did you have any extractions or shaving? I ask because your lower jaw is 3mm smaller than mine and I'm faced with the need for either lower bicuspid extractions or a lot of narrowing.
I thought he impacted my upper jaw by at least a few mm because I needed a ton of grafting to fill in the space. I could be mistaken though. In regards to my lower jaw, I was lucky enough to have not had any extractions. Apparently I had a ton of asymmetry (overall - not just in lower jaw) in my lower jaw and he used a bunch of hydroxyapatite to even out my jawline.
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I thought he impacted my upper jaw by at least a few mm because I needed a ton of grafting to fill in the space. I could be mistaken though. In regards to my lower jaw, I was lucky enough to have not had any extractions. Apparently I had a ton of asymmetry (overall - not just in lower jaw) in my lower jaw and he used a bunch of hydroxyapatite to even out my jawline.
I have a considerable amount of asymmetry as well. Our cases are quite similar. So Arnett added HA along the contour of your shorter side to even things out? Can you see the grafting on your post-op x-ray. I'd be interested to see that if you don't mind.
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I have a considerable amount of asymmetry as well. Our cases are quite similar. So Arnett added HA along the contour of your shorter side to even things out? Can you see the grafting on your post-op x-ray. I'd be interested to see that if you don't mind.
I'd like to see it as well! They took new x-rays at my visit on Wednesday and I will be able to see them all on Monday. I will be sure to get copies/take pics of everything and will definitely post them up.
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Hey zach, did arnett do any work on your septum/did you have a deviated septum or nasal breathing issues before surgery?
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I'm a bit concerned about my opening, which by my own measurement has to be somewhere between 6-8mm right now. I've only been doing the jaw exercises for two days now but I'm just worried I'll be the exception who has a slipped disc in their joint or some major issue that prevents real opening. He did advance my lower jaw 16.5mm so I'm sure it's going to take awhile. Does anybody have any insight here?
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I'm a bit concerned about my opening, which by my own measurement has to be somewhere between 6-8mm right now. I've only been doing the jaw exercises for two days now but I'm just worried I'll be the exception who has a slipped disc in their joint or some major issue that prevents real opening. He did advance my lower jaw 16.5mm so I'm sure it's going to take awhile. Does anybody have any insight here?
that's normal. typical is 1-2mm a week.
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Not the best quality but here's a quick before/after of my bite. The before picture is the only recent one I have of how open it was. I apologize for the terrible camera angle but that's really how my teeth came together if I actually bit down "correctly". I'm going to try and get some of my pictures from Dr. A at my next visit.
(http://i71.photobucket.com/albums/i123/znewton1/IMG_0584-1.jpg)
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Not the best quality but here's a quick before/after of my bite. The before picture is the only recent one I have of how open it was. I apologize for the terrible camera angle but that's really how my teeth came together if I actually bit down "correctly". I'm going to try and get some of my pictures from Dr. A at my next visit.
(http://i71.photobucket.com/albums/i123/znewton1/IMG_0584-1.jpg)
Damn! That bite is solid! I can't wait for that.
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Hey Everyone!
It's Day 18 and here's my attempt at smiling. The swelling in my cheeks comes up into my eyes when I try to smile making them look small and hollow. It's quite odd.
(http://i71.photobucket.com/albums/i123/znewton1/IMG_0648.jpg)
The swelling continues to come down albeit very slowly. I'm headed up to Santa Barbara for my 3rd follow up appointment in a few hours. Blended diet is going well so far and I'm removing my elastics 3x/day to eat and to perform my jaw exercises. My opening is still very small and I'm hopeful it will start to open up over the next month or two. Can't really complain about much at this point :)
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Your swelling has come down a ton! You must be feeling a lot better.
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Just wanted to give you all a quick update. Today is Day 19 and I seem to be doing really well. I had my 3rd post-op appointment yesterday and met with Dr. Gunson because Dr. Arnett was busy teaching at the annual course he holds in Santa Barbara.
Two of the "doors" on my ceramic brackets had broke during surgery which caused the archwire to come loose. Two of my lower incisors were starting to crowd and had moved significantly within the last two weeks. He took some time to fix this by bonding the wire to the actual bracket to prevent any further movement of the teeth.
In addition, my bite is still a tiny bit open on the right. The assistant that was helping me with Lena (didn't catch her name - I think she's new) mentioned it was probably due to my swollen right joint and said not to worry. Dr. Gunson was a bit concerned as my overjet had increased from '0' to '2' since my last appointment. He mentioned that next week when I see Dr. Arnett he will have to remove the bonding from my upper archwire (it was cut prior to surgery and he bonds the brackets together after performing the 3-piece Lefort) and make some adjustments to "pull those teeth down". He didn't seem overly concerned in the slightest and said that I look great.
I was also able to snap some pictures of my x-rays which I've attached for your viewing pleasure below. So far the blended diet is actually going quite well. I just blended up a mexican "bowl" of sorts (rice, sour cream, corn, chicken, refried beans, salsa) and it was AMAZING. I guess I'm getting used to this whole concept of not chewing and just swallowing my food.
Also one huge plus -I noticed that my opening increased today! This was a huge relief as I was convinced I'd be in the small % of patients who end up with major problems getting their opening back. It wasn't a huge increase but large enough to notice that getting the toothbrush in between my upper and lower teeth was much easier today than it's ever been.
It truly amazes me to look at the before and after x-ray. This explains my perfect bite and feeling that I have an entirely new mouth.....because I do! Anyway, here are the pictures.
(http://i71.photobucket.com/albums/i123/znewton1/IMG_0664_zps6854a179.jpg)
(http://i71.photobucket.com/albums/i123/znewton1/IMG_0663_zps27774ff6.jpg)
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The grafting on the contour of your jawline looks great.
CK, slide the photo if you're on an iPhone.
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The grafting on the contour of your jawline looks great.
CK, slide the photo if you're on an iPhone.
I feel like a complete idiot asking this - but where is it?
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did Arnett still do a sliding genio? i don't see any latch near the chin or bone cutting. the xray cuts off near the ramus. you should see a more complete xray on the wall during check ups.
No genio. Part of me wishes he did but I really can't judge my profile as I'm still really swollen. Even without it I can see a great result under all the swelling. After all, he did advance my lower jaw 16.5mm. I'm amazed at how my giant lower lip no longer folds over and seems to sit how it should. I just hope the chin comes out as the swelling comes down :)
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The grafting on the contour of your jawline looks great.
CK, slide the photo if you're on an iPhone.
im not, my xray shows the entire skull all the way to the spine. z's xray doesn't show all of the ramus.
No genio. Part of me wishes he did but I really can't judge my profile as I'm still really swollen. Even without it I can see a great result under all the swelling. After all, he did advance my lower jaw 16.5mm. I'm amazed at how my giant lower lip no longer folds over and seems to sit how it should. I just hope the chin comes out as the swelling comes down
from the front i think it was the right call. your chin is strong, though you are smiling (right?) so that can push it out. i had more lower jaw movement than you and my chin isn't as vertical as yours post-op. sometimes the bone doesn't always line up with the soft tissue so the surgeon has a lot of latitude when it comes to dealing with the chin during surgery.
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im not, my xray shows the entire skull all the way to the spine. z's xray doesn't show all of the ramus.
from the front i think it was the right call. your chin is strong, though you are smiling (right?) so that can push it out. i had more lower jaw movement than you and my chin isn't as vertical as yours post-op. sometimes the bone doesn't always line up with the soft tissue so the surgeon has a lot of latitude when it comes to dealing with the chin during surgery.
Thanks, CK. I read in my operative report that at the end Dr. Arnett went over my chin and noticed that it had a "waist on it". He than made a chin incision and did some HA grafting in the area along with my jawline to fix the asymmetry I had. I have to trust that he would have done it had he thought I needed it. It's probably just still too early to tell. Also started letting the goatee (or lack thereof - was never blessed with the full beard genes) go for a bit since I was getting annoyed with shaving my numb chin. I think that makes it harder for me to tell in pictures now. Will probably shave it soon and take new pictures.
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Three weeks post op today! Still have plenty of swelling (right still more than left) but here's the most recent before/after pic for you guys. I'm quite pleased with the results and can't wait to see how I look in a few more weeks. Hoping my lips come together at some point!
(http://i71.photobucket.com/albums/i123/znewton1/IMG_0733.jpg)
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I cant believe how much the swelling came down! Youre looking great man!
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I second that! Your cheekbones look great too.
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yea second on the cheek bones, no puffiness at all. pretty jealous lol. although a right profile pic would be nice when you're up to it, since that is your pre-op arnett photo that goes through the software, while the left is evaluated clinically.
really good on the cheeks tho.
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Thanks for the comments guys. It's funny because I didn't even really notice the cheekbones until it was pointed out. Either I'm just that oblivious or don't care. Haha. Anyway, here's a pic of right to right. You can see why I've been reluctant to post it. I'm still swollen around the cheeks but the right MUCH moreso than the left. My left side is the most accurate portrait of what my result has been so far.
(http://i71.photobucket.com/albums/i123/znewton1/IMG_0739.jpg)
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Dr. A has you do an exercise where you bob your head up and down multiple times (in front of the mirror) and than stop while looking straight ahead. While doing this he's standing next to you with a frame of sorts that measures where your normally posture your head. That's how he comes up with the TVL.
Gunson doesn't do that. looking good Z. just dont fall asleep on your sides.
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In all honesty, you're actually looking really, really good. Impressive result. And really glad to hear you're in good spirits and not in pain.
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Z ....looking good..... R u making a blog?
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I created one but prefer just posting updates on this thread. That's my plan for the rest of my recovery at least.
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I created one but prefer just posting updates on this thread. That's my plan for the rest of my recovery at least.
hey z ive been reading through your blog, very detailed and open. not a lot of blogs show so much detail (usually it's just before/after.)
a few questions, im just quoting what you wrote on your blog, i can remove it if you prefer:
At this point Dr. Arnett came in and took two wax bite impressions. It was extremely uncomfortable biting into the wax because I’m not used to having my back molars touch other than when I’m eating. It just felt very foreign to me and put a lot of stress on my joints. I kept the wax bite in while they took an x-ray and MRI of my face and joints. We took new profile and bite pictures after the x-ray. Dr. Arnett than proceeded to measure my face for the next 45 minutes or so. This wasn’t bad at all except for the fact that he kept pointing out all my asymmetry. Than again, that is his job though.
We took a break for lunch and I came back about an hour later to go over all the post-surgical instructions with Kim. We finished this after about 45 minutes and Dr. Arnett came back to go over the final treatment plan, risks, and to answer any questions I stil had at that point.
how exactly did he point out the asymmetry? how specific was he? was it more casual, or you have x, and it will be corrected by y. and did you spend a lot of time with the assistants during the pre-op, like more than with arnett? did the assistants provide further info on what will occur during the surgery, or define potential results? if that makes sense.
did arnett go into detail on what procedures would be done - specifically - and what effect they would have? or did you have to ask first?
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hey z ive been reading through your blog, very detailed and open. not a lot of blogs show so much detail (usually it's just before/after.)
a few questions, im just quoting what you wrote on your blog, i can remove it if you prefer:
how exactly did he point out the asymmetry? how specific was he? was it more casual, or you have x, and it will be corrected by y. and did you spend a lot of time with the assistants during the pre-op, like more than with arnett? did the assistants provide further info on what will occur during the surgery, or define potential results? if that makes sense.
did arnett go into detail on what procedures would be done - specifically - and what effect they would have? or did you have to ask first?
CK - It's really quite hard to say and I'm sure this varies patient to patient. I can imagine some want to know more than others and have different expectations of the doctor. By the time I went in for my final records I had scoured the internet and read at least 20+ blogs from start to finish (majority being bi-max), posted on the forums, looked at before and after pictures, researched the risks, and so on. You get the point.
That being said let me answer your first question regarding how he pointed out the asymmetry - It went something like "You look like a banana head!". Sorry, I'm only kidding here but had to say it. He started examining my face and made a generalized statement that I had a lot of asymmetry. He than would mention things as he saw them - "One eye seems to be a tiny bit lower than the other (I never noticed this and dont think anybody else could but him). Some more asymmetry exists between your cheekbones. Your left is larger than the right." He than explained how the HA would even that out. That was it until he got to my lower jaw and than explained how my jaw lines were asymmetrical (right larger than left and not even) and that he would even out with the HA. He was very thorough through the entire record taking process and at making me aware of what issues existed (not solely the cosmetic ones - explained all the tilts/cants I had going on with both jaws etc.)
I'm hoping that answers your question. I prefaced this reply with that initial statement because I feel as though I walked into the office knowing what to expect. I knew that my nose could change from advancing or widening the maxilla. I was aware of potential numbness and whatnot. Hell, I had even watched YouTube videos of both a Lefort I and a BSSO. That being said, Arnett did an amazing job going over everything with me as did the assistants. Being just a little over 3-weeks post-op now I have no qualms or complaints. I didn't have exceedingly high expectations in terms of what my final result would be. My bite is now how it should have been my entire life and my facial profile is so much more balanced than it was before. I'm extremely pleased and just want the swelling on my right side to come down!
-Z-
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CK - It's really quite hard to say and I'm sure this varies patient to patient. I can imagine some want to know more than others and have different expectations of the doctor. By the time I went in for my final records I had scoured the internet and read at least 20+ blogs from start to finish (majority being bi-max), posted on the forums, looked at before and after pictures, researched the risks, and so on. You get the point.
That being said let me answer your first question regarding how he pointed out the asymmetry - It went something like "You look like a banana head!". Sorry, I'm only kidding here but had to say it. He started examining my face and made a generalized statement that I had a lot of asymmetry. He than would mention things as he saw them - "One eye seems to be a tiny bit lower than the other (I never noticed this and dont think anybody else could but him). Some more asymmetry exists between your cheekbones. Your left is larger than the right." He than explained how the HA would even that out. That was it until he got to my lower jaw and than explained how my jaw lines were asymmetrical (right larger than left and not even) and that he would even out with the HA. He was very thorough through the entire record taking process and at making me aware of what issues existed (not solely the cosmetic ones - explained all the tilts/cants I had going on with both jaws etc.)
I'm hoping that answers your question. I prefaced this reply with that initial statement because I feel as though I walked into the office knowing what to expect. I knew that my nose could change from advancing or widening the maxilla. I was aware of potential numbness and whatnot. Hell, I had even watched YouTube videos of both a Lefort I and a BSSO. That being said, Arnett did an amazing job going over everything with me as did the assistants. Being just a little over 3-weeks post-op now I have no qualms or complaints. I didn't have exceedingly high expectations in terms of what my final result would be. My bite is now how it should have been my entire life and my facial profile is so much more balanced than it was before. I'm extremely pleased and just want the swelling on my right side to come down!
-Z-
thanks for the response. i definitely entered the surgery with far less info and explanation on what would happen, and my surgery was similar to yours. maybe gunson is just quieter? i don't know. he briefly explained a CCW (after I asked), but spent most of the face time was going over the risks. in fact, most of the talking was about risks. I might move this to my own thread later, a lot more to explore but I need to look over my notes and make sure I'm not forgetting anything. It's good to know Arnett is very thorough in explaining how things will go down during the surgery.
I haven't looked to closely at your pre-op and post-op photos, but in areas where Arnett specifically pointed out where the cheek grafts were placed and HA designed to even everything out (to the best he can), can you see it yourself? Like he said your left is larger than your right, and then provides a treatment plan in addressing that. And you think so far, based on what you're seeing, the asymmetry is fixed compared to pre-op? I mean areas above the jaw, for example.
This questions may sound redundant, feel free to ignore them if you want. It is your thread after all. ;D This really helps me a lot.
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thanks for the response. i definitely entered the surgery with far less info and explanation on what would happen, and my surgery was similar to yours. maybe gunson is just quieter? i don't know. he briefly explained a CCW (after I asked), but spent most of the face time was going over the risks. in fact, most of the talking was about risks. I might move this to my own thread later, a lot more to explore but I need to look over my notes and make sure I'm not forgetting anything. It's good to know Arnett is very thorough in explaining how things will go down during the surgery.
I haven't looked to closely at your pre-op and post-op photos, but in areas where Arnett specifically pointed out where the cheek grafts were placed and HA designed to even everything out (to the best he can), can you see it yourself? Like he said your left is larger than your right, and then provides a treatment plan in addressing that. And you think so far, based on what you're seeing, the asymmetry is fixed compared to pre-op? I mean areas above the jaw, for example.
This questions may sound redundant, feel free to ignore them if you want. It is your thread after all. ;D This really helps me a lot.
I really can't tell due to the uneven swelling. To be honest, I was unaware of much of the asymmetry that he pointed out in the first place. Although the cosmetic improvement is one aspect of this surgery it was not something I was hyper focused on (not implying that you are/were). I just still have a lot of swelling on the right side but looking at my left profile I'm very happy.
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I really can't tell due to the uneven swelling. To be honest, I was unaware of much of the asymmetry that he pointed out in the first place. Although the cosmetic improvement is one aspect of this surgery it was not something I was hyper focused on (not implying that you are/were). I just still have a lot of swelling on the right side but looking at my left profile I'm very happy.
yeah, i had the same, more swelling on the right than the left. question, again lol - was your right side smaller or larger than the left pre-operatively? or you don't really remember? edit: i mean the sides of your face in general, the curve i guess, not only the jawline, although it is can be beneficial if the cheeks and rims of your face follow the jawline evenly.
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it might seem tough but it is helpful to take pics one a day or so for the first two weeks, then once a week after. try to get profile, 3/4s and front. it can be a pain i know, but months from now you'll be glad you did. makes it much easier to keep track of your progress or just keep the memories when you're all done a year or so from now. the photos arnett/gunson take are sort of low resolution on paper. plus i think they only do three sets - pre op before surgery (day before), 8 week, and then after braces. but im not 100% sure.
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Zach, glad to see your swelling going down !!!! HURRAY!!! When do you see Dr.Arnett next?
I know this is slightly premature but how does your face post op look compared to your morph? Would you mind posting a side by side if possible?
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Zach, glad to see your swelling going down !!!! HURRAY!!! When do you see Dr.Arnett next?
I know this is slightly premature but how does your face post op look compared to your morph? Would you mind posting a side by side if possible?
Just got back from a 2.5HR drive back to my place in LA from seeing Dr. Arnett this afternoon. Things went well with a big surprise at the end of the appointment that I wasn't necessarily expecting.
Last week I saw Dr. Gunson because Dr. A was busy teaching his annual course in SB. He mentioned that next week (this week) that Dr. A might have to grind down some of the acrylic he used to bond the segments of my upper jaw together and "pull" some of the teeth down. I wasn't quite sure what he meant. Well, I found out at the end of the appointment.
My right molars still aren't touching but they were when Dr. Arnett finished surgery. That being said, he's not worried in the slightest. Bite looks good but as I said he wanted to bring the upper teeth down a bit to tighten up the bite and eliminate the 1.5-2mm overbite/overjet that I currently have. So, at the end of the appt with the assistance of Lena he proceeded to slice the acrylic (on each side) as to "open" each segment back up. I'm not sure how to explain it. Since my upper archwires were cut prior to surgery he had to bond them after surgery to keep it all in line. It's now opened back up and with the grand finale....FOUR rubber bands from my screw to hook (in the middle) and THREE bands on each side of my mouth. The pressure is extremely uncomfortable and I'm not used to it. The good news is that I go back on Thursday for him to re-bond it all together and I can go back to my regular one band at each location. Apparently at 4 weeks out the bone can still be moved a bit so that's what he's trying to do (according to Lena). I didn't really have much time to ask many questions to Dr. A (nor did I really have many) as I was the last patient of the day. He stayed late and I definitely wasn't rushed.
I don't mean to make this seem like some giant deal - because it's simply not. It's just uncomfortable and wasn't what I was expecting. Everything's looking good though so I'm very pleased.
In response to the question about posting my morph vs current profile - that's probably not going to happen. I believe I posted my morph somewhere on this thread at some point. The only reason I say that is because I lost around 25lbs in the year between my initial consult and actual surgery day (on purpose...adopted a very healthy lifestyle along with regular exercise) See picture below:
(http://i71.photobucket.com/albums/i123/znewton1/IMG_0556.jpg)
My face changed a fair amount with the weight loss. That being said, I have no problems posting pictures so people can follow my progress. I'm still pretty swollen in the cheeks and am just waiting for it to all come down. Here's two shots I just took. I'm showing the left profile instead of the right because there's much less swelling.
(http://i71.photobucket.com/albums/i123/znewton1/IMG_0820.jpg)
Day 9 Swelling
(http://i71.photobucket.com/albums/i123/znewton1/IMG_0468-1.jpg)
Day 26 Swelling
(http://i71.photobucket.com/albums/i123/znewton1/IMG_0821.jpg)
I was not planning on creating this long of a post! I'm exhausted from the long drive home tonight and the intense pressure I feel in my jaws. I can't complain about anything at this point. I'm very pleased with my bite along with the aesthetic improvement I've seen thus far. Every day that goes by is another day of healing :)
-Z-
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Great news, you look good. Can you speak normally now? I.e. maintain a conversation for any length of time? Let's say you had to give like a 30 minute speech to a group of people, do you think you could do it? Just asking with regards to my own concerns about getting back to work... Thanks.
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Great news, you look good. Can you speak normally now? I.e. maintain a conversation for any length of time? Let's say you had to give like a 30 minute speech to a group of people, do you think you could do it? Just asking with regards to my own concerns about getting back to work... Thanks.
It's hard to speak with the elastics in which you're required to wear 24/7 outside of doing the prescribed jaw exercises. You're essentially required to speak through your teeth. The office is very firm in making sure patients do not try to move their jaws against the elastics. I can hold a conversation just fine but it can prove difficult at times. I believe around the eight week mark the bands only need to be worn at night which will be a huge relief for me.
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It's hard to speak with the elastics in which you're required to wear 24/7 outside of doing the prescribed jaw exercises. You're essentially required to speak through your teeth. The office is very firm in making sure patients do not try to move their jaws against the elastics. I can hold a conversation just fine but it can prove difficult at times. I believe around the eight week mark the bands only need to be worn at night which will be a huge relief for me.
i had my bands out a lot sooner. i was told they hate the bands ("it isn't natural") because you can't exercise the jaw muscles. i think they start to taper you off the bands around the 8th week. but i imagine everyone is different.
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Just wanted to post a quick update for you all. Today is Day 31 post-op and I'm doing really well. My energy is coming back slowly but surely (slowly being the key word). I went back to work last Monday which requires me to do a fair amont of speaking and the week proved to be fairly rough. I was just beat by the end of the day and would come home, eat dinner, and be in bed by 8 at the latest. My swelling is still hanging on but is slowly coming down. I'm still waking up in the morning with pain in my left joint but that's from the slight clenching I'm doing while asleep. Dr. Arnett has me on some mediation to try and alleviate the clenching but it doesn't 100% stop it. I thought it would stop once my bite was corrected but so far that's not the case. Hopefully it will improve with time. I'm not really sure what else to say here. I'm seeing Dr. Gunson this week since Dr. Arnett will not be in the office. Here's some pictures. The first is Day 24 vs Today and the other is a pre vs post-op.
SLOWLY...but surely it's coming down.
(http://i71.photobucket.com/albums/i123/znewton1/IMG_0878.jpg)
Although not a dramatic transformation I'm quite pleased. I feel as though aesthetically my profile is just an improved version of my former self. I'm anxious to see what's under all the swelling I still have!
(http://i71.photobucket.com/albums/i123/znewton1/IMG_0877.jpg)
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Actually zach, I would def consider your transformation to be dramatic. Your midface, chin, and throat have all improved tremendously but as you said, you still look like you :)
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Actually zach, I would def consider your transformation to be dramatic. Your midface, chin, and throat have all improved tremendously but as you said, you still look like you :)
Thanks :) That actually means a lot. I guess in my own eyes it's just hard to see. I can't wait to take pics in another few weeks and really compare then.
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Do you have any frontal photos to post. You said you had some asymmetry so it would be interesting to the the improvement there.
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I know this is about the worst before/after frontal possible but it's all I've got at the moment. I need to get copies of all the before pictures that were taken by Dr. Arnett the week of surgery. I'm also attempting to smile here which is still difficult at the moment. I was hesitant to really post a picture because my swelling is still very uneven (right side much more swollen than the left). Anyway, here it is:
(http://i71.photobucket.com/albums/i123/znewton1/photo17-2.jpg)
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Zach, you look great and so happy ! ;D
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Just wanted to make a brief update! I'm thirty-eight days post op and doing really well. Obviously still on the blended diet and it's looking like it wil be ten or eleven weeks in total before I'm released to the soft food diet. I'm considered a "high risk" patient according to Dr. Arnett I believe due to the severity of my open bite along with the 16.5mm advancement of the lower jaw. So far my recovery has been complication free and I've just had to become accustomed to the nuances that come along with recovering from this surgery. This includes but is in no way limited to : friends not understanding you, having to repeat yourself on a regular basis, getting odd looks from strangers upon beginning a conversation and than attempting to explain why you sound/look the way you look, etc etc. :) I'm headed to see Dr. Arnett on Tuesday for my six week appointment. Here's an updated pre versus post op picture. I'm very pleased with the results and know that I'm nowhere near my final result. Still waiting on my upper lip to come down a bit along with the swelling in my cheeks and whatnot. That's it for now folks!
(http://i71.photobucket.com/albums/i123/znewton1/picstitch.jpg)
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Phenomenal results Z. I bet it feels great.
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excellent profile. are you afraid to shave because of the cheek grafts? ;D
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Keep the scruff. Looks better in my opinion.
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Just wanted to post a quick update with some new x-rays and pictures. My lack of involvement on the thread lately has stemmed from life resuming as normal but also from allowing myself to move on from the "jaw surgery is all I can think about" phase ;)
I'm 10 weeks post op today and am feeling quite good! Most of my numbness has subsided and I'm now left with hypersensitivity on the right side of my chin and lip area. Whenever I touch my lip or chin it's as if I can feel it in my teeth. It's all just very sensitive if that makes sense to you. I get little "zings" whenever I attempt to get rid of the phantom itches I feel there and especially when shaving every morning. I'm only wearing bands at night and my teeth seem to be fitting together quite nicely. My bite is currently a class II but that's all orthodontic at this point according to Dr. A. I find that at the end of the day my jaw is still sore at times but other than that I really can't complain.
I was just released to the soft chew diet on Tuesday which was great. I can't believe I've been blending ALL my food for the last 2.5 months. I've attached the pics/xrays below. That's about it for now. I'll update again at some point - can't really say when though! Hope this thread is of help to some of you. I'm more than pleased with my results. At one point I found myself regretting the fact that Dr. A opted not to perform the genio but I'm really happy with my chin. I'm most pleased with the bite I have now which still feels very foreign to me. I'm simply not used to having a closed bite that fits like this - it's really amazing!
Pre-Op vs Week 10 Post op
(http://i71.photobucket.com/albums/i123/znewton1/photo23.jpg)
Week 1 vs Week 10 Post op swelling comparison
(http://i71.photobucket.com/albums/i123/znewton1/ScreenShot2012-12-12at82601AM.png)
(http://i71.photobucket.com/albums/i123/znewton1/ScreenShot2012-12-12at81558AM.png)
(http://i71.photobucket.com/albums/i123/znewton1/ScreenShot2012-12-12at81449AM.png)
(http://i71.photobucket.com/albums/i123/znewton1/ScreenShot2012-12-12at81530AM.png)
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Phenomenal results z. Great jawline definition and bite stability. You've made me feel so much better about my upcoming surgery. Glad you're feeling well too!
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For everyone else - just found my pre-braces pano and wanted to post the comparison as it's pretty dramatic. I nearly forgot how "wonky" my bite was before the braces! It's truly amazing what this surgery accomplishes :)
(http://i71.photobucket.com/albums/i123/znewton1/ScreenShot2012-12-28at71130PM_zpsc8eb7466.png)
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Quick update for you guys - I'm 5.5 months post-op and everything is going great. 95% of my numbness has gone away and I have a small patch on the right quadrant of my chin that's hypersensitive and is hard to touch or shave. The range of motion of my jaw is still limited and I'm doing exercises daily to hopefully increase it. I guess most patients regain the full range by six months but I may require some physical therapy I'm about 60% of the way there compared to my pre surgery range (54mm) but my surgeon said as long as I can get into the high 30s or low 40s that I'll be just fine. I don't think I'm swollen anymore but for all I know I could be. Here's an updated before / after as well a tease I got of the final product. I moved from LA to San Francisco and upon seeing my new orthodontist was made aware I would have to have my braces removed and replaced with the type he uses. I was able to enjoy my braceless teeth for about 5 minutes at which point I was asked to return to the chair for the new brackets to go on! It was such a tease :o. That's it for now!
(http://i71.photobucket.com/albums/i123/znewton1/photo29_zpsef25bbbc.jpg)
(http://i71.photobucket.com/albums/i123/znewton1/photo30_zpsb3dfe5ea.jpg)