I had braces fitted to my upper arch in November to start the process of getting ready for orthognathic surgery, but I got some bad news when I went for an adjustment earlier this week - my surgeon is having second thoughts about going ahead with the treatment.
When I first saw the surgeon last year, he said that he wouldn't even discuss treatment until I had spoken to a psychiatrist, so I spent the next three months pestering him into actually writing my referral letter and sending it to the right place. Eventually I saw the psychiatrist, who seemed genuinely okay with the idea of me having the surgery. I got the surgeon's agreement in September, and he told me that, physically, I fall into the category of patients who should be treated because my lower jaw protrudes at least 10mm in front of the upper, although the weird placement of my teeth makes it difficult to take exact measurements now. His final words were that he would see me in about a year to start planning the surgery. Then just after Christmas he wrote to my orthodontist to say that he was concerned that I might not be happy with the final result (because I don't like my appearance now!?) and wants to reconsider the whole thing.
I'm absolutely livid that he decided to wait this long before raising the issue again, especially because I thought that once I got the braces on it would put an end to all of the uncertainty. I've got an appointment in a few weeks where the final decision is going to be taken, and it's pretty much the end of the line if he says no because there aren't any other surgeons doing orthognathic surgery on the NHS in my area. I'm trying to be constructive, looking up papers and guidelines, and collecting whatever evidence I can to make a case for him not to stop my treatment. Does anyone have any suggestions of what I can do, or what my rights are in this situation? I tried complaining once before, but all that happened was the orthodontist called me in for a "chat" where he made a lot of inappropriate comments about my dating prospects.
Yeah, I only seem to post here when I've got something new to whinge about. Sorry about that; I'll try to make some more positive contributions when I've been able to learn something that might be of use to anyone else.
Continued drama with getting surgery
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maloccluser
- Posts: 22
- Joined: Thu Feb 04, 2010 8:04 pm
Hello Saffie.
I think you need to get down to the actual root of the issue of why your surgeon is having second thoughts, especially if he told you that physically you fit into the category of people who would benefit. The fact that he asked you to see a psychiatrist and now is reconsidering because you don't like your appearance seem to suggest that he has questions about whether you could handle the surgery emotionally and for what reasons you're seeking out the surgery in the first place.
It would seem to me that if your bite is off my 10mm, it would be a fairly easy decision. I would make your case based on the physical issues alone, especially if you're having difficulty chewing, apnea, pain, etc., and not mention any type of cosmetic benefits.
Do you have the option of seeing another surgeon in another area of the country?
I think you need to get down to the actual root of the issue of why your surgeon is having second thoughts, especially if he told you that physically you fit into the category of people who would benefit. The fact that he asked you to see a psychiatrist and now is reconsidering because you don't like your appearance seem to suggest that he has questions about whether you could handle the surgery emotionally and for what reasons you're seeking out the surgery in the first place.
It would seem to me that if your bite is off my 10mm, it would be a fairly easy decision. I would make your case based on the physical issues alone, especially if you're having difficulty chewing, apnea, pain, etc., and not mention any type of cosmetic benefits.
Do you have the option of seeing another surgeon in another area of the country?
A major part of the problem is that the surgeon and orthodontist see this type of surgery as primarily, if not entirely, cosmetic. I've tried to talk to the about the functional problems - like the fact that my front teeth are completely unstable because they're tilted at a 30 degree angle from "normal", several teeth don't connect with anything, or that I get muscle cramps and headaches from holding my teeth together for any length of time - they see these as unimportant and won't discuss them. My concerns about function have been classed as "perceived problems", as if they are all in my head, and they tell me that they can't say whether I will still "perceive" the same things after surgery. Concern for my wellbeing is one thing, but treating me like a delusional nutjob for pointing out symptoms that can be externally diagnosed is entirely another. The worst of it is that I'm starting to worry that by disagreeing with them over the existence of the functional problems, I'm making myself look less rational.
The reason that I want surgery is because it is the only way that I'll get a functional improvement, and it will give me a far better cosmetic outcome than orthodontics alone. I have seriously considered what non-surgical treatment could do for me, but to be honest, it isn't much, and the orthodontist is pretty reluctant to try. He actually thinks that I should keep the 3-4mm gap between my front teeth, even though I said this was the thing I liked least about my teeth, not for functional reasons but because "some guys find that quite attractive". That really offended me, and made me reluctant to go back because I don't know if I can trust him to make the right calls when he thinks that I should abandon my own preferences based on what a possible future boyfriend might hypothetically want me to look like.
The reason that I want surgery is because it is the only way that I'll get a functional improvement, and it will give me a far better cosmetic outcome than orthodontics alone. I have seriously considered what non-surgical treatment could do for me, but to be honest, it isn't much, and the orthodontist is pretty reluctant to try. He actually thinks that I should keep the 3-4mm gap between my front teeth, even though I said this was the thing I liked least about my teeth, not for functional reasons but because "some guys find that quite attractive". That really offended me, and made me reluctant to go back because I don't know if I can trust him to make the right calls when he thinks that I should abandon my own preferences based on what a possible future boyfriend might hypothetically want me to look like.
I think they are right for making sure the reasons you want the surgery is to fix functional issues mainly and that they made you see a psychiatrist prior to commencing any long term treatment.
To me this sounds like good practice.
In the UK the surgery is free so imagine everyone who didnt like the way they looked, walking into the NHS for cosmetic reasons. Although you do have a malocclusion which has been identified, what if you didn't like the outcome? Perfectly aligned teeth does not mean a perfect face and then you would want to turn around and say they did not warn you or properly or assess the situation.
I think you should be happy that they are making sure this is the right decision for you as my perception of the NHS is that they offer this surgery out far too lightly.
I was told I MUST HAVE the surgery and it was the only way to fix my 1mm open bite and ended up with 22mm of movement altogether...far too much for my issue, and when I requested my notes from the NHS to see exactly why they carried out my surgery the way they did, it was not to close my bite, it said "for a better facial appearance" something I never came in for or mentioned throughout my time in braces and I am completely unhappy with the results as I do not retain 1 feature from my original face and a 1mm openbite was not a drastic situation to close.
I think they just have your best interests in mind and will prob give you the surgery in the end but I personally think it is good that they are not just throwing it at you, I wish my team did that and gave me other options and identified the fact that I did not have functional or appearance issues and used this in their planning, but they never, they said I had a big problem and have now given me an even bigger 1.
I was sent there by dentist who told my mum it was best to get my bite closed, but I think they took it too far.
To me this sounds like good practice.
In the UK the surgery is free so imagine everyone who didnt like the way they looked, walking into the NHS for cosmetic reasons. Although you do have a malocclusion which has been identified, what if you didn't like the outcome? Perfectly aligned teeth does not mean a perfect face and then you would want to turn around and say they did not warn you or properly or assess the situation.
I think you should be happy that they are making sure this is the right decision for you as my perception of the NHS is that they offer this surgery out far too lightly.
I was told I MUST HAVE the surgery and it was the only way to fix my 1mm open bite and ended up with 22mm of movement altogether...far too much for my issue, and when I requested my notes from the NHS to see exactly why they carried out my surgery the way they did, it was not to close my bite, it said "for a better facial appearance" something I never came in for or mentioned throughout my time in braces and I am completely unhappy with the results as I do not retain 1 feature from my original face and a 1mm openbite was not a drastic situation to close.
I think they just have your best interests in mind and will prob give you the surgery in the end but I personally think it is good that they are not just throwing it at you, I wish my team did that and gave me other options and identified the fact that I did not have functional or appearance issues and used this in their planning, but they never, they said I had a big problem and have now given me an even bigger 1.
I was sent there by dentist who told my mum it was best to get my bite closed, but I think they took it too far.
[quote="ORTHO12"]I think they are right for making sure the reasons you want the surgery is to fix functional issues mainly and that they made you see a psychiatrist prior to commencing any long term treatment.
I think you might have misunderstood what I'm saying - they won't consider the functional issues at all. When I try to discuss anything anything other than the cosmetic implications, they close the discussion, implying that I only *think* the pain and difficulty chewing are problems, and that I should stop complaining about such trivial matters. Also, they've had the report from the psychiatrist for four or five months now, so the fact that the surgeon has doubts now suggests that either he didn't bother to read it until after the treatment started (which is downright unprofessional), or his decision has been influenced by something else, and since I haven't seen him in four months I can't figure out what that would be.
I know you've had a bad experience with NHS treatment, but I don't think it's representative because it falls way outside of the standard guidelines. Usually only those with severe cases are recommended to have surgery, and there are people posting on this board who had to go on two year waiting lists after being approved for treatment, so it is hardly something that NHS doctors are rushing their patients into.
I think you might have misunderstood what I'm saying - they won't consider the functional issues at all. When I try to discuss anything anything other than the cosmetic implications, they close the discussion, implying that I only *think* the pain and difficulty chewing are problems, and that I should stop complaining about such trivial matters. Also, they've had the report from the psychiatrist for four or five months now, so the fact that the surgeon has doubts now suggests that either he didn't bother to read it until after the treatment started (which is downright unprofessional), or his decision has been influenced by something else, and since I haven't seen him in four months I can't figure out what that would be.
I know you've had a bad experience with NHS treatment, but I don't think it's representative because it falls way outside of the standard guidelines. Usually only those with severe cases are recommended to have surgery, and there are people posting on this board who had to go on two year waiting lists after being approved for treatment, so it is hardly something that NHS doctors are rushing their patients into.
Sorry if I misunderstood, but what I am "assuming" and correct me if I'm wrong is that you mentioned some cosmetic concerns before or as well as functional concerns and that is why they are looking at you as a cosmetic case because I think usually they expect you on the NHS to start with function and down the line they themselves address cosmetics.
To try get around it try putting a proposal to them that you would like to continue with braces to at least straighten your teeth and see how bad the situation is and that you will make your choice as to whether to have surgery somewhere down the line. This may sound more rational to them like you are not determined to have surgery but are willing to take it 1 step at a time. Then once you get to the surgery stage in a yr or so and they can prob see the braces won't help they will prob just offer you the surgery and over this time would have had the opportunity to gain a bigger pic of you as a person. They prob want you to focus more on what you would like rather than what you don't like. As in aiming for a nice bite, they can do, aiming for a nice face is in the eye of the beholder.
As for waiting lists I didn't go on a waiting list for my 1st surgery and 4 months after my 1st surgery I was offered a redo surgery by another NHS trust in Jan, no waiting list but I declined because I felt it was too hasty and I do not want surgery on the NHS again.
Good Luck.
To try get around it try putting a proposal to them that you would like to continue with braces to at least straighten your teeth and see how bad the situation is and that you will make your choice as to whether to have surgery somewhere down the line. This may sound more rational to them like you are not determined to have surgery but are willing to take it 1 step at a time. Then once you get to the surgery stage in a yr or so and they can prob see the braces won't help they will prob just offer you the surgery and over this time would have had the opportunity to gain a bigger pic of you as a person. They prob want you to focus more on what you would like rather than what you don't like. As in aiming for a nice bite, they can do, aiming for a nice face is in the eye of the beholder.
As for waiting lists I didn't go on a waiting list for my 1st surgery and 4 months after my 1st surgery I was offered a redo surgery by another NHS trust in Jan, no waiting list but I declined because I felt it was too hasty and I do not want surgery on the NHS again.
Good Luck.
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sauerkraut
- Posts: 573
- Joined: Tue Sep 04, 2007 2:57 pm
- Location: Germany
Saffie, so sorry to hear you're having such a hard time. This orthognathic surgery business is troublesome enough without having all those extra hoops to jump through!
I don't know how practical this is, but as maloccluser has suggested, could you try to find another surgeon in a different area? I know I'd hate the prospect of months or years of treatment (and possibly surgery) from doctors I had such difficulty relating to, and if it were at all possible I'd be looking at going elsewhere.
From a quick google, it looks like you have no (legal) RIGHT to a second opinion http://www.nhs.uk/chq/Pages/910.aspx and if there's only one NHS surgeon in your area then asking for a second opinion probably wouldn't be much use anyway. So that might leave the rather drastic solution of actually moving, or at least finding a connection with another area (studying there/long-term visit to Great Aunt Millie/whatever) and getting treatment there instead. It might be worth looking into, as it's been my experience (outside of orthodontics though) that NHS treatment does vary quite considerably from region to region.
I don't know how practical this is, but as maloccluser has suggested, could you try to find another surgeon in a different area? I know I'd hate the prospect of months or years of treatment (and possibly surgery) from doctors I had such difficulty relating to, and if it were at all possible I'd be looking at going elsewhere.
From a quick google, it looks like you have no (legal) RIGHT to a second opinion http://www.nhs.uk/chq/Pages/910.aspx and if there's only one NHS surgeon in your area then asking for a second opinion probably wouldn't be much use anyway. So that might leave the rather drastic solution of actually moving, or at least finding a connection with another area (studying there/long-term visit to Great Aunt Millie/whatever) and getting treatment there instead. It might be worth looking into, as it's been my experience (outside of orthodontics though) that NHS treatment does vary quite considerably from region to region.
SARPE: Sept 2007
Braced: May 2008
BSSO: Nov 2010
Debraced: March 2011
Braced: May 2008
BSSO: Nov 2010
Debraced: March 2011
ORTHO12 - it's a reasonable suggestion, but the problem is that my first appointment was opened with the surgeon asking what I don't like about the way my face looks, and what did I want him to change. When I couldn't give a concise technical description, he decided it meant that I needed to speak to a psychiatrist. He's known for having no social skills - and after working in a university computer science department, I thought I was used to that kind of thing - but the reality was still a surprise because he seems to have difficulty with holding a reciprocal conversation, and once walked out of the room while I was in the middle of a sentence. Now I'd rather be operated on by an abrupt perfectionist with fantastic surgical skills (which he reputedly has; he gets patients referred to him from other areas to repair surgeries that didn't go as planned) than a mediocre nice guy, but there is just no way of getting a point across to him.
If I thought I could try braces-only treatment and see how it goes, this would have been my preferred option, but trying to make the most of what I've got would involve moving my teeth in exactly the opposite direction from what would be required for surgery, and I would need extractions which could make it impossible to get everything into the best positions for surgery. Basically, I've got one shot at this...
If I thought I could try braces-only treatment and see how it goes, this would have been my preferred option, but trying to make the most of what I've got would involve moving my teeth in exactly the opposite direction from what would be required for surgery, and I would need extractions which could make it impossible to get everything into the best positions for surgery. Basically, I've got one shot at this...