I had my first appointment with the surgeon and new orthodontist a couple of days ago and I'm a bit concerned about how little was said or done because it feels as if there was no point in me having gone. All of my x-rays and models had already been taken (I saw a private orthodontist about starting cosmetic treatment, only be told that surgery is my best option and to get referred back to the NHS), so I thought this was going to be a chance to talk about possible treatment options and maybe even set a date to start.
It turns out that the surgeon is a really difficult person to get along with (but apparently he's good at the actual surgery, and I don't get a choice of who I see anyway), and although I was warned about this in advance, it didn't prepare me for the reality. Less than 30 seconds after getting into the room, I was sat in the dentist's chair and the surgeon asks me straight off, without so much as a good morning, "what don't you like about your face?". It caught me off guard and I babbled a bit, partly because it's a deeply personal question, but also because I didn't know enough about the surgery to start giving descriptions to the surgeon. He interpreted my reaction to mean that I don't know my own mind and may not be able to make a rational decision on whether to have the surgery, and everything has been put on hold until I've been evaluated by a psychologist. Then he went out into the corridor to talk to his dictaphone.
So I'm absolutely gutted because I've waited months for this referral, but it feels like I'm no further forward and I've had yet another obstacle placed in front of me. I was told that in order to have the surgery done, they need to see that there will be a psychological benefit from it, but that they won't go ahead if I'm too hung up on how I look, because apparently that would mean it's all in my head and there's no point in them operating even though my x-rays show a textbook example of an overdeveloped lower jaw/underdeveloped upper jaw. It feels as if I'm just going round in circles: I know no more than I did last week, except that I might be refused treatment based on not having the right level of unhappiness about how I look.
Has anyone else had an experience like this? I suppose I'm just looking for some reassurance that I haven't thrown away my only chance by getting nervous and not advocating for myself well enough.
NHS Adventures - is this normal?
Moderator: bbsadmin
Hello,
I understand how you must feel - that is so rubbish to have to wait for a psychological assessment! I've not personally had that but I've been kept waiting for what feels like forever now with this whole process.
When I met the surgeon, I was asked the same questions but in front of a bunch of students studying. It was so awkward. Like you, I didn't know what to say and just said how I mainly didn't like my nose or my face shape. The assessment seemed positive but I didn't feel like I was informed much about what was actually going to happen.
This was nearly 2 years ago - I've been in braces since last January and supposedly will have my surgery after August. But we all know the NHS is glacial - my only advice to you would be to stick through it. If you have functional problems and don't like your profile, then the surgery will be a great benefit.
I have days where I'm so fed up and want the braces off and just stuff the surgery but I know it'll be worth it in the longrun. Perhaps you should speak to your ortho again and ask about timings, etc. I know it's difficult to talk to them half the time as you are just another patient but if you're polite and persistent, hopefully they can give you some straight answers about what's going to happen to you.
Have you had braces fixed yet?
I understand how you must feel - that is so rubbish to have to wait for a psychological assessment! I've not personally had that but I've been kept waiting for what feels like forever now with this whole process.
When I met the surgeon, I was asked the same questions but in front of a bunch of students studying. It was so awkward. Like you, I didn't know what to say and just said how I mainly didn't like my nose or my face shape. The assessment seemed positive but I didn't feel like I was informed much about what was actually going to happen.
This was nearly 2 years ago - I've been in braces since last January and supposedly will have my surgery after August. But we all know the NHS is glacial - my only advice to you would be to stick through it. If you have functional problems and don't like your profile, then the surgery will be a great benefit.
I have days where I'm so fed up and want the braces off and just stuff the surgery but I know it'll be worth it in the longrun. Perhaps you should speak to your ortho again and ask about timings, etc. I know it's difficult to talk to them half the time as you are just another patient but if you're polite and persistent, hopefully they can give you some straight answers about what's going to happen to you.
Have you had braces fixed yet?
hi saffie
isnt it a shame when the surgical talent is not matched by bed / chairside manner
... I had the same with a gynae suergeon many years ago when I was trying to get preggers 
ok so
I am assuming from what you said that you are wanting your face changing but dont need the surgery for functional reason...... ie your teeth dont cause any problems , you can eat ok and are doing no damage to teeth, gums or palate that might lead to problems.
For many authorities that it the only criteria they will use when considering jaw surgery.
Cosmetic surgery is usually only offered on NHS for conditions that are recognisable as being visibly removed from the "norm" physically speaking (dont like that word but cant think of better at the mo) and is causing you emotional distress.
if it does not affect your daily life in that way then it might not be seen as necessary surgery.
psychologist report might be part of everyones evaluation to assess suitablility for cosmetic surgery
........ imo it should be 
apart from someone being affected by face shape end eg never wanting to smile, or go out socially etc and other people being able to see that that person is "different" significantly..... there is also a condition called body dysmorphia where people might passionatley hate part of their body that might be considered by most to be physically "normal" . Surgeons might be reluctant to operate putting someone with this at risk when its the persons esteem or psychological state that is faulty not the body.
also there are sometimes concerns that if generally someone is unhappy and fixates on one part of the body as soon as thats fixed the person will move to another part of the body and still be unhappy.
having said aaaaaaaaaaallllll that ... if you were referred by another surgeon, all be it private, who thought surgery was needed then i would imagine he or she had accepted that you were phsychologically stable and aware of what you wanted doing , or more importantly why.
try not to worry about the psychologist ,... and it might help to have things straight in your own mind about exactly why you do want the surgery. and I think you do need to be honest with both of them cause if you try to second guess the criteria they are going to use to decise whether they are willing to operate or not they will suss you out ( you wont succewed in hoodwinking them unless you know for sure what they will and will not "accept".
it might help to make notes and take them with you ........and just explain you feel nervous and dont want to forget stuff.. most docs will understand this cause loads of them reccomend people do that anyway !!!!
isnt it a shame when the surgical talent is not matched by bed / chairside manner
... I had the same with a gynae suergeon many years ago when I was trying to get preggers ok so
I am assuming from what you said that you are wanting your face changing but dont need the surgery for functional reason...... ie your teeth dont cause any problems , you can eat ok and are doing no damage to teeth, gums or palate that might lead to problems.
For many authorities that it the only criteria they will use when considering jaw surgery.
Cosmetic surgery is usually only offered on NHS for conditions that are recognisable as being visibly removed from the "norm" physically speaking (dont like that word but cant think of better at the mo) and is causing you emotional distress.
if it does not affect your daily life in that way then it might not be seen as necessary surgery.
psychologist report might be part of everyones evaluation to assess suitablility for cosmetic surgery
........ imo it should be apart from someone being affected by face shape end eg never wanting to smile, or go out socially etc and other people being able to see that that person is "different" significantly..... there is also a condition called body dysmorphia where people might passionatley hate part of their body that might be considered by most to be physically "normal" . Surgeons might be reluctant to operate putting someone with this at risk when its the persons esteem or psychological state that is faulty not the body.
also there are sometimes concerns that if generally someone is unhappy and fixates on one part of the body as soon as thats fixed the person will move to another part of the body and still be unhappy.
having said aaaaaaaaaaallllll that ... if you were referred by another surgeon, all be it private, who thought surgery was needed then i would imagine he or she had accepted that you were phsychologically stable and aware of what you wanted doing , or more importantly why.
try not to worry about the psychologist ,... and it might help to have things straight in your own mind about exactly why you do want the surgery. and I think you do need to be honest with both of them cause if you try to second guess the criteria they are going to use to decise whether they are willing to operate or not they will suss you out ( you wont succewed in hoodwinking them unless you know for sure what they will and will not "accept".
it might help to make notes and take them with you ........and just explain you feel nervous and dont want to forget stuff.. most docs will understand this cause loads of them reccomend people do that anyway !!!!
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Redfoxjo - Thanks for your comments. The whole process is just so bloody frustrating! I haven't had braces put on yet because they won't start until the psychologist reports back, so every day I'm rushing home to see if there's a letter for me because the waiting is driving me up the wall. Every time I've got an appointment I spend a month or two getting my hopes up that maybe this time they'll start talking about when I can get braces and start actually having my teeth moved, only to have the let down of another referral.
Tazzle - it's not entirely cosmetic (although changing my prominent lower jaw would be fantastic), as I've got some function issues with my back teeth not meeting properly, which means the few which are aligned are getting wrecked, and my front teeth all wobble because they've grown in at 30-something degrees off the normal angle in order to sit in front of the lower teeth (which would make it difficult to have any orthodontic adjustments without surgery). In the past year or so I've started getting some pain in parts of my face, which doesn't bode well for the future because I never had any before. I got referred to an orthodontist because my dentist thought my bite could do with improving, and that some relatively minor adjustments would help that and improve my appearance, which was my main concern at the time since I didn't realise that the other problems were related.
I'm just a bit worried about the psychologist because it is such a big step into the unknown and it's like trying to win at a game where no one will tell you the rules. It's also complicated by the fact that my personal and family history don't include spotless mental health records, which could count against me. I know that I'm up to it, and the surgeon and two orthodontists have agreed the surgery is my best option, but I won't feel completely at ease until this one last person has been convinced...
Tazzle - it's not entirely cosmetic (although changing my prominent lower jaw would be fantastic), as I've got some function issues with my back teeth not meeting properly, which means the few which are aligned are getting wrecked, and my front teeth all wobble because they've grown in at 30-something degrees off the normal angle in order to sit in front of the lower teeth (which would make it difficult to have any orthodontic adjustments without surgery). In the past year or so I've started getting some pain in parts of my face, which doesn't bode well for the future because I never had any before. I got referred to an orthodontist because my dentist thought my bite could do with improving, and that some relatively minor adjustments would help that and improve my appearance, which was my main concern at the time since I didn't realise that the other problems were related.
I'm just a bit worried about the psychologist because it is such a big step into the unknown and it's like trying to win at a game where no one will tell you the rules. It's also complicated by the fact that my personal and family history don't include spotless mental health records, which could count against me. I know that I'm up to it, and the surgeon and two orthodontists have agreed the surgery is my best option, but I won't feel completely at ease until this one last person has been convinced...
Hey,
I just had double jaw surgery on the NHS and it was generally positive... I only saw my surgeon twice before surgery day and he was quite nice but technically very good, and that is the main thing that matters. But you should definitely have questions answered and put forward your concerns. I know it is an emotional time, but don't let that stop you from getting what you need, as this is a HUGE deal and not something to enter into lightly. There are probably registrars that may have more time and are almost as expert as the consultant you could maybe speak to? You won't throw your chance away, but importantly you need to be honest about how you feel and just answer questions honestly, as this will help plan your care better.
My underbite was pretty bad... but to be honest most of why I wanted my surgery was aesthetic. I babbled on about jaw pain and trouble breathing, which although troubled me were not the biggest reasons. However, there was no issue about having it done. I think over a certain measurement will qualify you, and no matter what your reasons they always consent you as having the procedure for both 'functional and aesthetic improvement'.
As for the psych assessment, I know it's frustrating to have to wait, but surgery really will change the way you look and be quite a lot to deal with. I broke down in my initial consult with the ortho as I had to divulge a lot of unhappiness I'd kept buried for years and never said a word to ANYONE about it up until that point. I kinda think there should be more emotional support through the whole process, that's where blogging and forums helped me hugely over the last couple of years. I also went to see a counsellor at college, although I left it quite late (a week before surgery) to talk through some issues, and to continue on after it's been done. I think this will help lots also.
Saying all that, I still have a little bruising and swelling, but I am ecstatic with my results and so pleased I had the surgery done, and cannot fault the NHS in my case. It's important you feel confident in your team and they are not some mystical beings you cannot communicate with, although it may be hard (said as a med student!), make sure you speak to them about worries/concerns- write yourself a list etc so you are prepared next time.
I just had double jaw surgery on the NHS and it was generally positive... I only saw my surgeon twice before surgery day and he was quite nice but technically very good, and that is the main thing that matters. But you should definitely have questions answered and put forward your concerns. I know it is an emotional time, but don't let that stop you from getting what you need, as this is a HUGE deal and not something to enter into lightly. There are probably registrars that may have more time and are almost as expert as the consultant you could maybe speak to? You won't throw your chance away, but importantly you need to be honest about how you feel and just answer questions honestly, as this will help plan your care better.
My underbite was pretty bad... but to be honest most of why I wanted my surgery was aesthetic. I babbled on about jaw pain and trouble breathing, which although troubled me were not the biggest reasons. However, there was no issue about having it done. I think over a certain measurement will qualify you, and no matter what your reasons they always consent you as having the procedure for both 'functional and aesthetic improvement'.
As for the psych assessment, I know it's frustrating to have to wait, but surgery really will change the way you look and be quite a lot to deal with. I broke down in my initial consult with the ortho as I had to divulge a lot of unhappiness I'd kept buried for years and never said a word to ANYONE about it up until that point. I kinda think there should be more emotional support through the whole process, that's where blogging and forums helped me hugely over the last couple of years. I also went to see a counsellor at college, although I left it quite late (a week before surgery) to talk through some issues, and to continue on after it's been done. I think this will help lots also.
Saying all that, I still have a little bruising and swelling, but I am ecstatic with my results and so pleased I had the surgery done, and cannot fault the NHS in my case. It's important you feel confident in your team and they are not some mystical beings you cannot communicate with, although it may be hard (said as a med student!), make sure you speak to them about worries/concerns- write yourself a list etc so you are prepared next time.
well that certainly sounds like a functional requirement to mewhich means the few which are aligned are getting wrecked, and my front teeth all wobble because they've grown in at 30-something degrees off the normal angle in order to sit in front of the lower teeth (which would make it difficult to have any orthodontic adjustments without surgery). In the past year or so I've started getting some pain in parts of my face, which doesn't bode well for the future because I never had any before
I am the same in that function is my main aim ... i will lose what teeth I have if i didn't have any treatment cause my jaw aligntment was putting such strain in my teeth and gums. .. as a byu product I will have a face that will be mor eproportionate ( i have a shallow jaw with the deep bite)
Changing ones face ( or not as the case may be) can have a very profound effect and surgeons do have to be aware of that and take it into account. I too have had mental health issues but that did not put my OS off . I think they would be carefull if the issues were affecting you severely to the extent you could not take on board the commitment to the othrodontic treatment or surgery ....... or if they thought you were not ready for surgery etc.
I agree with vena that there should be a some sort of support avaible ........ I sometimes feel like venting about the cra* dentist I had as a kid that messed my mouth up which is why i lost so many bottom teeth as a child and I feel like explaining that every time i open my mouth for a dentist or surgeon to look in !!!!!!!!!! then I think no as they might think I am knocking the profession instead of one acloholic that got struck off
and sometimes its cause of mouth shape, maybe not wanting to smile, avoiding photos etc .... thing many people on the board chat about.
I dont think saff you are alone in having a wibbly moment in the surgeons clinic
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Hi Saffie
I had to see a psychiatrist - I was told that it was routine. He wrote a report and all was fine. I was going through all sorts of rubbish because I was a witness in a court case about that time (and the case involved a doctor!), and I asked him not to put it into the report, and he scrubbed it all out. I think they're on your side.
I had to see a psychiatrist - I was told that it was routine. He wrote a report and all was fine. I was going through all sorts of rubbish because I was a witness in a court case about that time (and the case involved a doctor!), and I asked him not to put it into the report, and he scrubbed it all out. I think they're on your side.
Curses! Foiled again...
I phoned the orthodontic clinic this afternoon to check that they've referred me to the psychologist because I hadn't heard anything and it's now more than three weeks since my last appointment. Now I wish I had left well enough alone.
The first disappointment was hearing that they haven't sent the letter yet. The receptionist isn't sure whether it got lost somewhere, or whether they're still waiting for someone to type the letter, although it sounds like they've lost/forgotten because they managed to send a letter to my dentist about 1 1/2 weeks after the appointment.
The second - and worse - disappointment is that they've had to move my next appointment back by an entire month. I have to go back to see the orthodontist and surgeon at the same time (the same as last time, when the surgeon spent most of the time out in the corridor and wouldn't answer any questions), but they only hold one of these clinics every month. The orthodontist has now decided to change his schedule and cancel the July clinic, when I was supposed to see them, there aren't any June appointments left, so I've been shifted to a slot in August. The only problem is that I'm supposed to be on holiday - after I waited until I had an appointment to plan my holidays, I now have to either change my plans or wait until mid-September. If I phone up every few days I might be able to take the place of someone else who cancels, but it's hardly guaranteed.
I don't even have braces yet! This is driving me crazy, and I hate the idea of waiting another four months before they start to think about active treatment.
The first disappointment was hearing that they haven't sent the letter yet. The receptionist isn't sure whether it got lost somewhere, or whether they're still waiting for someone to type the letter, although it sounds like they've lost/forgotten because they managed to send a letter to my dentist about 1 1/2 weeks after the appointment.
The second - and worse - disappointment is that they've had to move my next appointment back by an entire month. I have to go back to see the orthodontist and surgeon at the same time (the same as last time, when the surgeon spent most of the time out in the corridor and wouldn't answer any questions), but they only hold one of these clinics every month. The orthodontist has now decided to change his schedule and cancel the July clinic, when I was supposed to see them, there aren't any June appointments left, so I've been shifted to a slot in August. The only problem is that I'm supposed to be on holiday - after I waited until I had an appointment to plan my holidays, I now have to either change my plans or wait until mid-September. If I phone up every few days I might be able to take the place of someone else who cancels, but it's hardly guaranteed.
I don't even have braces yet! This is driving me crazy, and I hate the idea of waiting another four months before they start to think about active treatment.
It isnt unusual for them to ask that sort of question off guard because they need to make sure you know what you are letting yourself in for, its not a walk in the park and you should definitely not feel the need to rush.
There is no rushing in this treatment unfortunetly, i see the surgeon once who agreed i could have treatment but still till now im not actually sure what is going to be done, i dont think they can really decide what surgery is needed untill they have all the teeth into the correct positon.
When i first started my brace treatment i was just being told dribs and draps, they thought i may of needed two jaws done bottom moved forward and top tilted down this then changed and it was thought id only need lower jaw BSSO and since then its been told i will most likely need my lower jaw moving forward and my chin split in half and plated up to widen. ("NEW TYPE OF SURGERY") i wont know properly untill i see the surgeon and get my date for the op on the 11th June
good luck with it all but dont worry too much its a long process and you need to make sure its something you really want to do and can put up with for at least 2 yrs
There is no rushing in this treatment unfortunetly, i see the surgeon once who agreed i could have treatment but still till now im not actually sure what is going to be done, i dont think they can really decide what surgery is needed untill they have all the teeth into the correct positon.
When i first started my brace treatment i was just being told dribs and draps, they thought i may of needed two jaws done bottom moved forward and top tilted down this then changed and it was thought id only need lower jaw BSSO and since then its been told i will most likely need my lower jaw moving forward and my chin split in half and plated up to widen. ("NEW TYPE OF SURGERY") i wont know properly untill i see the surgeon and get my date for the op on the 11th June
good luck with it all but dont worry too much its a long process and you need to make sure its something you really want to do and can put up with for at least 2 yrs
wisdom teeth removed under GA nov07 * Braced 8/2/08 * 2 premolars removed Apr08 * Adjustment 4 rebonding, 4 molar bands & new wire 4/7/08 * 31Jul wire change * 28 Aug last wire fitted and lower powerchain put on. 29th May moulds and x rays. 31st July Surgery date Re: Curses! Foiled again...
RE the holiday issue, my surgeon has always said do not let this surgery/process interfer with your day to day life. Im due for surgery anytime, i get my date on the 11th but istill booked my holiday for july (2 wks) and i will have to arrange surgery around that. Dont let it take hold of your life it will drive u nuts xSaffie wrote:I phoned the orthodontic clinic this afternoon to check that they've referred me to the psychologist because I hadn't heard anything and it's now more than three weeks since my last appointment. Now I wish I had left well enough alone.
The first disappointment was hearing that they haven't sent the letter yet. The receptionist isn't sure whether it got lost somewhere, or whether they're still waiting for someone to type the letter, although it sounds like they've lost/forgotten because they managed to send a letter to my dentist about 1 1/2 weeks after the appointment.
The second - and worse - disappointment is that they've had to move my next appointment back by an entire month. I have to go back to see the orthodontist and surgeon at the same time (the same as last time, when the surgeon spent most of the time out in the corridor and wouldn't answer any questions), but they only hold one of these clinics every month. The orthodontist has now decided to change his schedule and cancel the July clinic, when I was supposed to see them, there aren't any June appointments left, so I've been shifted to a slot in August. The only problem is that I'm supposed to be on holiday - after I waited until I had an appointment to plan my holidays, I now have to either change my plans or wait until mid-September. If I phone up every few days I might be able to take the place of someone else who cancels, but it's hardly guaranteed.
I don't even have braces yet! This is driving me crazy, and I hate the idea of waiting another four months before they start to think about active treatment.
wisdom teeth removed under GA nov07 * Braced 8/2/08 * 2 premolars removed Apr08 * Adjustment 4 rebonding, 4 molar bands & new wire 4/7/08 * 31Jul wire change * 28 Aug last wire fitted and lower powerchain put on. 29th May moulds and x rays. 31st July Surgery date Kerry - at the moment, *not* having the treatment is driving me nuts! I wouldn't mind re-arranging my life around it if it would just let them start moving my teeth.
The surgeon and orthodontist have decided roughly what the surgery should do, and obviously they can't make in-depth plans yet because they haven't started any treatment - but for some reason they won't let things move forward until the surgeon can spend less than a minute measuring my chin again, and I might have to wait four months for that. Why? I don't know, maybe they think it could have changed in the five months since I got the impressions and x-rays done...
The surgeon and orthodontist have decided roughly what the surgery should do, and obviously they can't make in-depth plans yet because they haven't started any treatment - but for some reason they won't let things move forward until the surgeon can spend less than a minute measuring my chin again, and I might have to wait four months for that. Why? I don't know, maybe they think it could have changed in the five months since I got the impressions and x-rays done...
I can understand your frustration, I hate not knowing when things are goign to happen and everything with the NHS is a waiting game. Im ready for surgery now but who knows depending on the waiting list that might not happen till the end of the year 
We are quite lucky to be seen so this quickly sometime people wait years to even . I know a girl on here once mentioned she was waiting 4 yrs just to get an appointment or something
. I was refered to the NHS when i went for an appointment at a private practice, before i could be accepted for treatment the surgeon popped to my practice to tell me if she could help or not this happened in in july 2007 I then had my wisdom teeth out that november 2007 and i was then braced in Feb 08 so thats the kind of time scale i had to wait.
We are quite lucky to be seen so this quickly sometime people wait years to even . I know a girl on here once mentioned she was waiting 4 yrs just to get an appointment or something
. I was refered to the NHS when i went for an appointment at a private practice, before i could be accepted for treatment the surgeon popped to my practice to tell me if she could help or not this happened in in july 2007 I then had my wisdom teeth out that november 2007 and i was then braced in Feb 08 so thats the kind of time scale i had to wait.wisdom teeth removed under GA nov07 * Braced 8/2/08 * 2 premolars removed Apr08 * Adjustment 4 rebonding, 4 molar bands & new wire 4/7/08 * 31Jul wire change * 28 Aug last wire fitted and lower powerchain put on. 29th May moulds and x rays. 31st July Surgery date i also had to see a psychiatrist to see if i was mentally strong enough to go through this process because i was under a lot of work related stress during my first meetings with my ortho/surgeon also because i had some mental health issues when i was younger. i had no need to worry as the psychiatrist was very supportive and seen how dertimined i was to go through with the treatment. i also agree that the nhs time span is a long one but still worth it