Bit of Background & Current Status

Once upon a time...Ok so it truly feels like a century ago, I had braces put on my teeth for the first time, just like every other 11 year old kid, to straighten my teeth and fix my bite. During my almost 4 year orthodontic treatment, I had the palette expander for about 6 months, if I remember correctly, and the dreaded head gear for almost the entire duration- not that I wore it nearly as much as I should have, but who really does? Nevertheless, having my braces finally removed after 4 long years, at 14 years old and a freshman in high school, I was happy as could be about my perfectly straight teeth.

Well, after tossing my retainer to the side, my teeth sadly began to shift, and by junior year, it was noticeable, but I dealt. After all, insurance would not pay for more orthodontic treatment and neither would my parents. So, after graduating high school and getting my first real job, I decided that I would get braces once again to get my perfect, straight teeth back again.
I got a referral from my dentist, who assured me Dr. Holman was one of the best orthodontists in the country, and made my first appointment. After taking models, x-rays and all the necessary items, Dr. Holman diagnosed me with an overbite and open bite. He explained that the reason my teeth shifted was because my bite needed to be corrected, something only jaw surgery could really fix. No way, I thought. I told him I was not interested, I just wanted straight teeth. I was not going to have major surgery-what for? My jaws never bothered me, so I wouldn't bother them. I will just have to wear a retainer for life so my teeth won't shift again. So in September 2006, I had braces put on my top teeth to straighten out what had shifted. So began the all too familiar necessary evils of braces, but I just kept thinking 10 months of these things and welcome back perfect, straight teeth! It'll be no time at all! If I only knew then...

Getting close to what I believe is the finish line, I wake up one morning with an unpleasant discomfort in my jaw.

In the back of my mind is the jaw surgery talk I had with my ortho many months prior. So, I go online to do some research. I'm intrigued now...now THIS could fix everything. I have problems that I never even knew were problems! YES, I DO have trouble closing my mouth without straining. NO, my teeth do NOT touch down in the front. YES, my jaw DOES hurt when I eat hard foods. NO, I CANNOT successfully eat a sandwich 92.8% of the time! YES, I DO have to sleep with my mouth open at all times! YES my jaw DOES click when I open my mouth! And YES, I DO have a receding chin. I had no idea jaw surgery could correct ALL of these problems! Not to mention a major improvement in appearance - that is a major plus!

I explained what I had recently been feeling to my ortho and told him I wanted to give it a go! I had only wished I'd listened and considered surgery before, since the last 10 months were kind of a waste. We would have to start from square 1- pre-surgical orthodontic treatment which meant WAY more time and WAY more money. So add another 2 years in braces (with surgery expected in between) and $9,000 more. Just put it on the tab.

Dr. Holman refers me to a world-renowned surgeon at Stanford that he has worked closely with for over twenty years: Dr. Powell. I meet with Dr. Powell and am even more excited for this whole process. He's great! I am told that I will need to have upper and lower jaw surgery. He tells me it'll be so easy...that he even had patients my age wanting to wakeboard only a couple of weeks post-op. Wow! He also tells me that the whole wiring shut process is a thing of the past and not necessary. Rubber bands will be used instead. YES! What is most comforting to hear is that over the 25+ years he has been performing this surgery, he is glad to report that he has never had a major complication. He even adds that this surgery will "cute-en me up" Awesome! I'm thinking, "I wish I could have this surgery tomorrow!"

So, I carry on, meanwhile even getting a splint to wear for 6 months (was NOT happy about that- I had SUCH a lisp while wearing it; my job was mainly talking on the phone) looking forward to the day when I'll hear "Ok, you're ready for surgery!" That day finally came at the end of December 2008. YAY! Well...not so fast...

I decide to schedule my surgery for mid-march-Spring Break. I can't afford to miss too much school.
So then it's the waiting game... and then I get a call from my surgeon's office, saying that insurance approval will likely take a while, so in the interest of giving ourselves enough time, it is decided that my surgery be re-scheduled for my next break-end of May when school breaks for summer. OK I'll take that-gives me even more time to recover.
I get a call from my surgeon's office again at then end of February 2009 - Guess what? "Your insurance does NOT cover orthognathic surgery." What??? "Can we fight it, petition it, anything?" I say. "Nope, Great West Healthcare has a specific exclusion for orthognathic surgery. Look into switching to a different insurance company like Blue Cross, Blue Shield" etc. So Great West does not cover orthognathic surgery for anyone, anytime, at all?? And you choose to tell me this now??? Any reason you didn't tell me this a YEAR ago???

The problem is that I am insured through my parents - my dad to be exact- and his company offers 1 PPO- Great West Healthcare and 1 HMO- Kaiser. There's no way I could afford to insure myself. Besides by this time, I'm barely working and going to school full-time at San Francisco State University.
Basically, a lot of back and forth ensues in the following months with absolutely nothing accomplished. So much for in and out in 2 years!
I then start to give thought to the only feasible option-switching to Kaiser. My family is not too happy about this. Besides being an HMO (bad rap) Kaiser has not had the best reputation in my family. Apparently they sent my great-grandfather home after he'd had a stroke- and the next day he died. My uncle and aunt (dad's brother) are both lawyers and they tell me they dealt with a case where a mother and father were suing because their daughter died after having jaw surgery at Kaiser. She was apparently unable to breathe. Horrible.

Fast-forward.
Here I am - a new member of Kaiser- I talked my family into it-telling them there have been major improvements and how bad can it be? I say give it a year and we can always switch back; I really need this surgery, I plead. Because Great West is just SO great, you know. So we have to wait till the end of 09 to make the switch. We are approved and become official members in January 2010. My orthodontist's office tell me that Dr. Holman works with a surgeon at Kaiser in Oakland, Dr. O'Ryan, who is also very good. I'm told she has performed this surgery for 20+ years and with excellent results as seen in many of Dr. Holman's patients. I'm so so sad to leave Dr. Powell- after all, I had the best- I saw him about this surgery for over a year! Will I get the same results with someone else? Well, I gotta do what I gotta do, right?

Mid-January 2010
So, I get a referral from a Kaiser physician to see Dr. O'Ryan in Oakland. I have a good feeling about this. I call to schedule a consultation with Dr. O'Ryan. Booked till April. Shit. This is not good. Problem is, insurance (any of them) won't let me stay on with my parents after age 23. I turn 23 in August. If I wait till April and Kaiser makes me wait 6 months before surgery, there's no way this will be able to happen. This whole thing needs to start happening now so I can barely make the cut off. I disappointedly ask to be called if someone cancels and a slot opens up. Dr. O'Ryan is really in demand. The very next day I get a call from the Kaiser Center in Santa Clara saying that Dr. O'Ryan referred me over to Dr. Desai. Who is Dr. Desai? A maxillofacial surgeon apparently. I make an appointment with Dr. Desai. I guess Dr. O'Ryan knew I didn't have much time or was too booked so she passed me along.

February 2010
I met with Dr. Desai on February 5th. It was over an hour long appointment in which I watched a video on orthognathic surgery and then talked things over with Dr. Desai. My orthodontist's office sent my x-rays to him beforehand and I brought my most current molds with me. Dr. Desai took some measurements of my mouth and pictures, and agreed that I am ready for surgery if I wish to proceed. He asked if I wanted to hear him explain the details of my surgery, adding that it makes some people feel queasy so they opt out. I figured if this is going to happen to me, then I should know, right? How bad can it be anyway? Well, it can be pretty bad. He explained the entire surgery in depth and detail, showing me visually on a skeletal model as well as using my own models. In a nutshell, my surgery would consist of upper jaw surgery-cutting or breaking it into 3 pieces and expanding it-impacting it (moving it up) and moving it outward. When it comes to the lower jaw- it would simply be advanced. Exact measurements I do not know. An additional, optional operation (at the same time) would be the advancement of my chin. I had never heard of the chin advancement before. Dr. Powell (my previous surgeon) never mentioned it to me, however, he never did go into detail about my surgery. Dr. Desai said he would push the chin advancement more if I had major sleep apnea (don't think I do). Nonetheless, having that additional operation would much improve aesthetics. So naturally, I would definitely consent to the additional operation.

Here's the kicker: my jaw will be WIRED shut for 2 WEEKS! What?!? I thought this was a thing of the past??? Guess I'll be living in the past for 2 weeks. Lucky, lucky me. WHY? Dr. Desai said he knows many surgeons in private practice use rubber-bands and shun wires as "old school" BUT in the cases he's seen, better results are often achieved with the practice of wiring the jaw shut. In some cases, use of rubber bands only meant relapse and a re-do. Ok, that makes a little sense. BUT HOW do I BREATHE? What if I panic? Because, let's face it, my nose will be completely congested AND my jaw wired shut, I'm practically panicking now! He told me that I will breathe just fine, most patients find that it's not THAT bad, but if I really start to panic, then I can use a set of wire cutters that Dr. Desai sends home with everyone for emergencies and simply cut the wires, then call him immediately so that he can put rubber-bands on in lieu of wires. Ok, that's a little comforting. Dr. Desai also went over the risks of the surgery. I have to say I didn't know about possible permanent nerve damage (luckily I have age on my side) as well as possible tooth loss (yikes) and embolism (double yikes). I also didn't realize the amount of hardware that will be permanently left in my mouth. Oh well, as long as I don't feel it or have to go through a second surgery to remove them (my orthognathic surgery booklet says less than 2% of patients do, but I feel like I've read a lot more about it happening). So at the end of my appointment, Dr. Desai asked what time I'd be looking at to have the surgery. I told him late May/early June would be best given my school schedule. He said it was definitely doable. There we have it!

But after this appointment, I started to get scared. I guess ignorance was bliss when I didn't really know much about the surgery. So many questions popped into my head after the appointment. I guess what my fears boil down to are after surgery. I'm sure the actual surgery will be fine, and I know that pain can be managed to some extent, so I'm not too nervous about that- it's just the state I'll be in- what if I really can't breathe?? Those couple days after surgery are what I am most concerned and worried about.

I know this has been a super long post- tried to cram the last 12 years of my orthodontic life into something short and sweet- so if you made it this far, you deserve a cookie, or at least a few photos of my brace-face. Till then!