Self-esteem - being diagnosed as "aesthetically unappea

[angelcake]

I have an overbite. Basically, it's a long story, but it doesn't actually look as bad as it should because over time my muscles have compensated for it, meaning I automatically hold my jaw forward. My profile isn't perfect, but it appears relatively "normal" (as in, when I explain my "problem", none of my friends can really understand what the "problem" is because it's not that visible).

I was referred to an orthognathic surgeon at the age of 13, but decided against surgery as it scared me. However, in the past year or so I started wondering about it, if I'd been foolish and if it was going to end up causing me health problems. I went back to the same surgeon and he said that really, even if I did nothing it wouldn't be a problem and my health wouldn't suffer. He did say, however, that as I have an overbite, and to have better-aligned jaws is considered more aesthetically appealing, he would still be willing to perform the operation.

Now, I live in the UK, where the NHS exists, and what makes me feel even worse is that he is willing to do all this on the NHS for free. I wouldn't say I was particularly self-conscious about the way I look normally, but how am I supposed to deal with the fact that a doctor considers my face so deformed that he is willing to use tax-payers money to fix it? There are always reports about how the NHS is so underfunded that they can't even provide cancer drugs etc, am I so hideous that I am considered as important as life-saving treatment?

I don't really know how to deal with this. The last thing I want is to have to go through two years of braces and change my face, but I feel like someone has diagnosed me as "ugly". How am I supposed to get over this? I have a boyfriend who says I am beautiful, and my friends and family say they can't understand why I would consider getting it done (of course they're biased ), but every time I'm feeling a bit down or insecure about my appearance, it's like there's a little demon on my shoulder saying "it's not all in your head, you're not being silly. It's true, you ARE deformed, you don't look right, you're not attractive enough as you are".

It's tearing me apart inside, I don't know who to talk to and I really upset everyone when I start crying about it because they don't know what to say. Has anyone else been through this? How can I accept who I am and have any confidence in how I look after this?

[Daveyboy]

Hi Angelcake!

I'm a fellow UK peep on here, and so thought it might help to give my thoughts on this.

I don't believe that the surgeon was implying that the surgery could be paid for on the NHS because of his observation on what you looked like.
I think what he was intending to say was that the facts are that you have an overbite, and that in order to totally fix your bite, then surgery would probably be needed, and that because your bite could not be fixed without surgery, then the NHS would probably cover it.

I too have been told that the NHS would cover my surgery, but I know that they wouldn't cover a genioplasty as they consider this to be for "aesthetic" purposes.

I think the main bit of what i'm trying to say is that the NHS is there to pay for medical conditions, and that your surgeon recognises that your bite, (and not your appearance) is a medical condition.

Remember, that a lot of people who have surgery to fix a bit problem, don't actually see a huge difference in their appearance, thats not what the surgery is for!

Hope this helps. Please feel free to pm me if you need any other advice about my experiences, as so far i've had a lot!

Whereabout in the UK are you?

See ya!
Dave

[angelcake]

Hello,

Thanks very much for the replies, they both helped a lot.

Dave, I suppose you're right in that an overbite is an overbite, and all the surgeon was doing was diagnosing it. Many people on this message board would be thrilled if they could get the surgery for free! I shouldn't really get angry because he was just doing his job.

It's just the fact that he acknowledged that there are unlikely to ever be any functional problems. Orthognathics is also about the way somebody looks, and any changes in appearance are not just a bi-product of the surgery, they are often considered just as important as how the bite works. An overbite is not considered attractive. I keep imagining a whole room of medical students looking at pictures of my profile and being taught how aesthetically unappealing it is (this is the phrase my surgeon likes to use!).

When I'm down I end up searching for information about orthognathics and jaw problems on the internet and that's where I often see my problem described as a "facial deformity". Everyone has flaws and things they don't like about themselves but normally their friends and family can reassure them they're not important. But to have them confirmed by a medical professional is something else!

I would really like to just forget the whole thing, so I will probably go and see a counsellor. I know that if I did have the operation I would find it hard to live with myself knowing that I changed who I am and the way I was born, especially as I'm not sure if it would even have bothered me if it hadn't been pointed out, so I'd just be living up to someone else's idea of perfection. I just can't shake the thought that the way I look isn't "right", and that someone is willing to put me through all that pain just to fix it.

It's true what you said though, that the surgeon actually even said that my appearance wouldn't change that drastically, partly because of where my muscles are. I guess they just don't look at each case individually, it's just the way it is that surgery is the solution for an overbite. To be fair, it's not like anybody is forcing me to have it done, but it's the fact that I'm considered such a worthy cause that I can get it on the NHS that hurts.

Oh and by the way, I'm from East Anglia! And also, what kind of braces do you have? I think the only way I could be persuaded to have the surgery was if I could have lingual braces. Is this even possible with orthognathic surgery, maybe if you're willing to pay? A part of me thinks I should have the surgery done just because the damage has already been done and I don't know how I'll learn to live with knowing something isn't right.

[Clover]

Hi Angelcake,

I'm also from the UK, and currently have full metal braces in preparation for a lower jaw advancement. My treatment is being paid for by the NHS. I really identified with everything on your post, because, in the past, I have had exactly the same feelings as you have.
An orthodontist first told me about my overbite at the age of 25, when I went for a consultation to straighten my crooked front teeth. It was something of a shock, as I had no idea that I had this problem. I thought my profile looked a bit funny, but it didn't really bother me and I didn't know the reason for it.
Like you, I went online to find out more, and was dead against surgery at first. I also got quite upset and cried a fair few times, but I think I just had to come to terms with what I'd been told. It took me about a year to get used to the idea, but then I realised that surgery was really the only way my teeth and bite could be corrected. I have never regretted my decision.
Two friends of mine are nurses, and they have told me that it is extremely difficult to have purely cosmetic surgery on the NHS. For example, one of my friends knows a lady with chronic back pain who needs a breast reduction, but has been refused, because she falls short of NHS guidelines regarding the amount of tissue that would be removed. Orthognathic surgery is performed for many reasons. Yes, aesthetics is one of them, but so is the function of the bite and long term oral health. Remember, your OMS has been trained to consider the aesthetic ideal, but very few people fall into that category.
I used to worry about the whole facial deformity thing too, but then I realised that I am not deformed. I have what the medical profession call a skeletal abnormality, something which other people don't even notice. There are people out there who are coping with far worse things than that.
The decision to have surgery is a personal one, and you have to do what is right for you, and for the right reasons. For me, the benefits of the surgery outweighed everything else, but everyone is different. I agree with KK that you should consider talking to someone about this. Please also be kind to yourself and give yourself time to come to terms with it all. I'm sending you my best wishes x

[angelcake]

To be honest, I have known that I have had this problem for over ten years now, so have had plenty of time to come to terms with it. When I was eleven my orthodontist commented on it and said he would refer me because he was worried I would grow up to have, in addition to other problems relating to an overbite, a "flat profile". It is something that was at the back of my mind all through my adolescence, even if my main reason for going back was because I was worried about the health consequences. I have known what the surgery involves for years now and have gone back to various websites to find out more about it many times.

I appreciate your support, but I was categorically told that not having the surgery would not cause any health issues whatsoever. I may not have the ideal bite, but the surgeon reassured me that I would not have any problems with eating, uneven wearing to the teeth, jaw pain, anything. Believe me, I asked, because that was my main reason for going back. He also said if I didn't want to go through with the surgery, that was absolutely fine and wouldn't cause any problems. So it's pretty hard to take it as anything other than for cosmetic reasons. It genuinely wasn't just a misunderstanding on my part!

Maybe I will go through with it, maybe not. I still have another year on the waiting list to make my decision. This has caused me so much pain and heartache over the years, and never once because a single person I care about has ever commented on it - because I've been told there's something wrong with me by doctors and because I've looked at horrible websites which describe me as deformed. I am a confident person in every other way but I can't even bear to think about this without bursting into tears, and it has been so since I was eleven years old. I know some people say that orthognathic surgery was the best thing they ever did, and I'm pleased for them, but for me all it serves to do is ruin my self-esteem and make me feel ugly. So what if I could be more perfect? So could a lot of people.

[Delag]

the surgeon reassured me that I would not have any problems with eating, uneven wearing to the teeth, jaw pain, anything.

Not to be a wet blanket, but maybe you should get another opinion. I would think that holding your jaw foward would lead you down the road to some painful TMJ problems in the future.

When I first started getting professional opinions about what to do with my 'wonky tooth', I also had a bit of a self esteem crisis. I just wanted to fix one thing and everyone kept pointing out these defects that I had never really noticed. Here I had always considered myself a fairly attractive woman, and now all these doctors were talking about my off center chin, uneven jaw line, crooked nose, deformed cheekbones....... I think it would be almost impossibe for the ego to not take a blow. It took some time for me to stop seeing my 'defects' everytime I looked in the mirror, but I am happy to say that it did pass and I see me again - braces and all.

I have seen tons of people with overbites and overjets and not once have I ever thought someone looked disfigured or even unappealing. I am sure that no one has ever thought that of you either. YOu need to remember that this doctor is speaking from a medical point of view and that none of us is perfect or symetrical. If this doctor recommended you for surgery, I would wonder if he/she wern't really worried about a future functional problem and they didn't want to scare you, or make you feel pressured into having surgery. No one ever died from a bad bite, but surgery does have implicit complications. Before even thinking about going ahead with anything, I would encourage you to get as many opinions as possible. You are doing the right thing now by educating yourself - now the next time you go to the doctor you can ask even more informed questions.

[angelcake]

I feel as though you're all trying to persuade me to have this operation!

As far as moving the jaw muscles forward goes, the surgeon informed me it's perfectly fine seeing as it is what they are now used to and I find it really difficult pushing my jaw back into its old position. He also said they are unlikely to ever move back to where the bones are.

I will not be getting a second opinion, seeing as they will invariably say the same thing - yes, I have an overbite, and yes they will fix it on the NHS if I so wish, but no they will not force me, no it is not ideal, but no it is unlikely to cause any major problems.

I don't think I will be checking this board anymore, seeing as all it seems to do is make me feel worse. Yes, orthognathic surgery does fix a problem, but even though I know you have all read about it and know what it entails, you don't seem to really appreciate how major it actually is. You spend TWO YEARS wearing braces, you have a major operation which leaves your face all swollen like a chipmunk with your jaws tied together (often) and you change your face! Why on earth would I put myself through all that just to fix a "problem" which has never once caused me any pain or discomfort (except the constant inferiority complex which I expect I'll now have to deal with my whole life) and have been told by a surgeon is unlikely to in the future?

[angelcake]

And again, please don't tell me I just need time to come to terms with it, because as I said before it's now been a year since I went back to the surgeon, and I first went when I was thirteen, so I have known for a very very long time what the surgery entails, and that I need it if I ever want to fix my jaw.

Thanks for all your replies, I know you were only trying to help, and good luck with your treatment, I only wish I could be so sure as you guys that going through with it (or not) was the right thing to do.

[Delag]

Please take these words with the kindness and respect with which they are intended. You are right - if you are only considering this surgery for cosmetic reasons it is a lot go go through. The vast majority of us here on this board are going through this because we have to, not because we want to. We don't want to wear braces for years or go though a difficult recovery either - I do believe we know ¨how major it actually is¨.

I also have to say that I don't feel anyone here would ever recommend or push someone to have surgery. We all have had to go though a very real and difficult decision making process in order to get to the points we all are on this journey. Many of us have found multiple opinions helpful to us - those of various medical professionals, and those of the people on this board. Perhaps surgery is not an option for you, perhaps in the future it may be - only you can determine that. Keep doing research and continue to participate on the board if you feel you can get something out of it, if it only serves to upset you - than by all means you should not.

You are indeed a very lucky woman to have a loving boyfriend and family - don´t let the words of one doctor hold more sway than the people who are truely important in your life. I wish you all the best with whatever you choose to do.

[ohmyjaw]

don´t let the words of one doctor hold more sway than the people who are truely important in your life.

I couldn't agree more.

Is it possible that you are taking this doc's opinion just a bit too seriously? As you can read in my last post, a similar thing happened to me, and I just said "NO THANKS!" and that was it.

The issue of self-esteem comes up on this board from time to time. Personally, I believe that if you really, truly, feel that a cosmetic "problem" impacts your life in a negative way, you have every right to want to fix it, whether it is purely cosmetic or partly functional.

But it has to be YOU that wants the change. Don't let someone else make a decision for you - this is a very personal thing.

[Mart]

Hey angelcake, I respect you may not want to return but i hope you read this at some point down the road. This is my story:

Like you i'm from the uk, the midlands, Cheltenham to be precise. Like you i was also diagnosed with a jaw allignment problem (underbite-makes no difference) when i went in for something else-my crooked front two teeth 8 years ago, and they explained it would require surgery.Like you i would get treatment off the NHS, but like you my first reaction was "No chance!". Like you i've spent the time inbetween thinking about it, searching the web, looking through the before and after pics with a fine tooth comb, looking up all the definitions. I'm sure you understand what this means, reminded everyday by myself about it, every time i look in the mirror... and every time i do i feel more inadequate, like i'm not quite the person i could be, and i'm being held back in some way. I completely sympathise with you about the feeling that you have nobody to talk to, i 100% understand, i felt awkward talking to my parents, brothers, girlfriend and if you can't alk to them then who there hell is there left? But I wasn't the only one going through something like this, your in a boat with so many more poeple than you think, all going through this and having exactly the same routine, go there, say no, think about it, go back, think some more... Like you i found it extremely difficult living normally, knowing that there was something wrong and it was the root of a lot of worries, instead of pulling my hair out about the surgery i decided to focus on what would happen if i decided not to do it;

Constant self reminding would in the end consume me, and i'd just be kidding myself that everything was ok, when deep down i know there's a solution. But if i changed my mind after i'd turned 30, theres less chance they'll be so willing to operate, the bones have hardened, and you'll be at more risk from the anesthetic... and i'd wish i could turn the clocks back to when i was younger, like so many other poeple in this situation have. Yes i'll be changing who i am from birth, but for all the right reasons. I would love so so much to have my smile back. the more you talk to the poeple in the same situation the more you'll understand what life will be like with or without the surgey, and thats a very special thing!