I had surgery in Poland. More than one in fact over the years I’ve lived here. I’m in recovery now, and here’s a little bit about my situation leading up to my surgery in Poland. I promise, it’s not gory.

Pre-op

Once upon a time I was a child, which is hard for even me to believe. I am the younger of two children, and I was meant to be boy. I think if my older sister had been a boy, it’s likely I would not have been born. Or maybe I would have been, as my mother recently shared with me that I was in fact “an accident”.*

I came out the spitting image of my father which was as close to having a son as my parents were going to get until their grandson came around 30+ years later. I was given a versatile name, dressed in cousins’ hand-me-downs, played sports (as did my sister), had a crazy at-home haircut, and thus was frequently mistaken for a boy. My resemblance to my father was often commented on. You know, my father was a handsome man. That does not make for an especially attractive girl.

The plot thickens

Anyhow, as a child I developed severe allergies – as far as I can tell the first in the family to have allergies. The medical community at the time was slow to make recommendations for changing things at home, and fast to remove tonsils and prescribe medication. I spent my entire childhood in a home full of my worst allergens, with a perpetually blocked nose, itchy eyes, and asthma attacks. Every year for Christmas when other kids were asking for, I don’t know, Barbies or Atari or whatever, I asked to replace the carpeting in my bedroom with hard flooring. My parents did at least stop using the fireplace, but it was just one contributor to my issues and kind of too little, too late.

Over the years, my face changed dramatically due to these issues (and certainly genetics). With so many breathing problems, I had to constantly keep my mouth open and push my head forward in order to breathe. While my teeth were straight, my bite was severely affected. Honestly, I don’t know how I played sports as a kid, how I ran around. I must have looked like a child drowning on dry land.

Our family dentist did once suggest that I have surgery to correct my bite, but he presented that option with such gruesomeness (and without any explanation of the benefits or drawbacks – other than the gruesomeness) that I was like, no thanks. It was also a different time, medically and technologically. I couldn’t connect with information about the surgery or with other patients who had decided to have the operation (or not) and understand their decision-making process or surgical outcomes.

Life goes on

I just lived my life. Were there unkind comments about my bite? Sure, there certainly were, and I remember each and every one of them, who said them, where we were, everything. It’s not grudge-holding. It’s just that I forever remember them – the last of them being from a complete stranger two days before surgery. What can you respond to something like that? Yes, I have a skeletal defect. What can I do about it?

I had always thought it was a matter of ugliness, of just being some kind of ugly. But as I got older, my traumatic bite (that’s what they call it) caused lots of other problems far beyond my appearance or even my breathing.

Traumatic bites are often accompanied by gum issues. Amazingly, I had healthy teeth and no gum disease, but at the same time, I had severe recession. Well into adulthood, I consulted several specialists here in Poland where I live, and they were all in agreement – You are going to start losing your teeth if you don’t do something about your bite.

Easy peasy, right?

Surgery in Poland, full speed ahead

I set up consultations with a periodontist, orthodontists specializing in surgical patients, and of course surgeons.

While the medical necessity was clear, the surgeon did question me about my intentions and expectations, asking if I was sure I wanted surgery because if not, my only other option was losing my teeth and getting szuflada. I only knew the Polish word szuflada as drawer, and I couldn’t connect that to the conversation we were having, but by the way he said it, I felt that, no, I did not want szuflada whatever that was. It turns out that szuflada is some slang for traditional false teeth, so my answer still stands. No, I do not want szuflada. I also found out that when a patient has a traumatic bite, it is incredibly difficult to fit false teeth, dentures, implants, any kind of intervention really.

They also questioned my motivations. It seems they express concern if a patient is too focused on their appearance, as it can set a person up for extreme disappointment. I did learn the word for vanity in Polish – próżność. Frankly, wanting to keep your own teeth in your head in my opinion is not vanity, but even so, what if it was? The doctors were all in agreement, my health issues had one treatment and one treatment only, surgical intervention. So what? Are you not going to treat my health issues just because I’m vane? And who waits until their 40s for doing such treatment if they are so concerned with their looks?

Let’s say that over the years I was (and am) concerned with my looks. But what can you do when it’s not a matter of make-up or hairstyle, but skeletal defect? I generally just ignored my physicality my entire life. I was clean and groomed, but my looks were not a focus. Honestly, if I could go through life not being perceived somehow, that would be great, not maybe the most healthy approach, but still great. The decision was made, and the doctors assured me that I was not the oldest patient they had operated on. I tried to see the humor in the fact that I was often mistaken for a parent of a younger patient in the waiting area. Sometimes that stranger and I looked more alike than myself and my own children. I felt their pain when they looked at me and realized that, yeah, we do look alike. I know that their traumatic bite was one of it not the biggest problem in their young life.

I must say that the whole process of correcting my bite is much, much more involved than I had imagined at the start. In my case, it involves a minimum of 3 operations, years of other procedures including extractions and gum grafts on 20 teeth. There are braces and other devices for years, ENT visits, physical therapy, myofascial therapy, and the list goes on. And does it ever go on. The original treatment plan was for 5 years, but it turns out that it’s going to be closer to 10.

Under the knife

So where did we start? We started with all kinds of scans of the teeth and skull and probes of the nose and throat. Then extraction of all 4 wisdom teeth. Then 6 gum grafts. At the same time, use of some kind of a splint to help relax the jaw muscles. And then a surgery to widen the top jaw. It’s called SARPE (surgically assisted rapid palatial expansion) and involves cutting through the top jaw, starting the split of the jaw on its center line, and cementing in a device – in my case metal and acrylic, as a kind of jack to allow the patient to turn the device daily with a key to expand the upper jaw. My expansion was 1 cm within a month, meaning I had to go around not only with this huge device in my mouth, but also a 1 cm gap between my two front teeth, looking like SpongeBob. Lovely.

At the end of expansion, the device was blocked, and about 6 months after that it was removed. The next step was braces in order to set the teeth in their post-op position. In my case due to my age and the condition of my gums, this process was done slowly. Slowly, slowly, slowly, you’re not ready, not ready, not ready. And then boom, suddenly you are ready. So suddenly in fact that not everything was prepared for the operation, and it required some rushed work.

A few days before surgery the orthodontist placed some surgical hooks on my braces. They were painful, but they were the least of my problems. That was for my most recent surgery and most difficult – double jaw surgery with genioplasty, septoplasty and turbinate reduction. Those last two are just a bonus option since the surgeons were “already in there”.

In this operation, the upper jaw was separated from the skull, moved a little upward (by removing some of the bone) and forward. The lower jaw was cut, a section on each side was removed, and the jaw was moved back. The chin bone was cut and slid down. All of these bones were secured with metal plates and screws. They also installed exterior screws for aiding in stabilizing the jaws with bands. Oh and the septum was straightened with excess soft tissue removed. The tray of surgical tools I spotted as I entered the operating room made me weak in the knees. Or maybe it was the głupi Jaś (a light pre-surgery sedative called stupid Jonny), they had given me 30 minutes before for nerves, before they put me to sleep for real.

Post-op surgery in Poland

And here’s the real deal. When I woke up from surgery my first thought was that I could not allow anyone I love to go through this operation. I still feel that way. But having said that, if your bite is causing you to have health problems, take care of it sooner, rather than later. Surgery is a young person’s game.

I was also regretting my own decision and basically all my life decisions which led me to this place. The place being the post-op ward in a hospital in Poland with my own post-op nurse who was watching Złotopolscy reruns and pumping me full of fentanyl and telling me to stop talking to her about Dionizy (a character from the TV show she was watching) and to go to sleep. I kept asking her if there was something in my mouth, like a sponge or something, and she had to inform me that no, that was my bottom lip.

Because yes, after surgery you are numb. I was numb from my lower eyelids to the bottom of my chin. The entire inside of the mouth was just stitches and blood. My eyelids did not work in unison. One of them closed independently from the other with a second delay. The vibe was very creepy doll from a haunted house. I could feel my tongue though, which is good. Eating and drinking at that point was done via syringe. Cleaning was practically impossible. Not to bore you with the details, but it was terrible.

So I spent the next 7 weeks with my jaws closed on those screws. The plan was to leave those 4 external screws in for 6 months, but my body decided to attack those screws, and I had something called dzikie mięso (ziarnina) in Polish growing all around the screws. This translates literally to wild meat – new vocabulary which I lowkey love but will probably never get a chance to use again – medically called exuberant granulation in English. Whatever you are imagining, it was worse. It was growing so rapidly it was “escaping” from my mouth, literally hanging out. By the way, they remove those screws with an electric screwdriver thing and the growths with a scalpel.

I spent all of my time caring for my incisions, my teeth, the screws, exercising my jaws, tongue, lips, and feeding myself via syringe. I became a cream soup expert as well as a heavy user of the local pharmacy.

As for every surgery in Poland I have had so far, they sent me home with a prescription for antibiotics and recommendations for recovery, and no narcotics. Thank goodness that Ketonal is available in Poland without a prescription and in sachets. A lifesaver. I went through one bottle of saline nose spray per day. Patients after surgery cannot blow their noses for sometimes up to 10 weeks, so you can only take everything in, not blow out. Eww.

A few months later…

Where am I now in this process? At 4 months post-op, I still have significant numbness and inability to speak and eat normally. My numbness now goes from the tip of my nose to the bottom of my chin. I can feel some altered sensation in my upper lip, but it’s minimal. I can’t feel the roof of my mouth or really any of my teeth. My lower lip is completely numb except for one corner, and my chin is absolutely 100% without any sensation at all. My cheeks have some sensation. So generally, my bones are fused at this stage and my bite is top notch – which was the goal. I can also breathe freely through my nose.

I secure my jaws closed with elastic bands at night on hooks on my braces. Speaking and eating is as you would imagine for someone who cannot feel their mouth. My speaking isn’t clear, and I have to work really hard to produce some particular sounds. As for eating, my bones are fused, so I should technically be able to chew, but I have a real inability to manipulate food in my mouth due to not feeling my lips, teeth, gums, palate, and cheeks. I am able to move some of the areas I cannot feel, but not in a normal way. I can also feel some of the areas I have trouble moving. It’s crazy. So again I am a blended food expert. Anything you want to eat can be liquid if you want it bad enough. Each meal for me resembles a medical procedure, so while I am in no way in danger of starving, I’d really like to just eat a sandwich. I mean I am missing out on all this good Polish bread.

I go to the doctor a lot. At every visit the doctors express worry over my (lack of) progress and I am asked to make dzióbek (puckered lips). While my brain is willing my lips to do it, nothing happens. Because it appears to the observer that I am doing nothing, the doctors repeat the word dzióbek (besides kissy lips, dzióbek mean little bill, as in duck bill), and then they make the dzióbek face at me thinking I don’t understand. I then have to tell them that I in fact do understand the word dzióbek, but this is as dzióbkowate as I can do. It is fun though to see serious medical professionals making dzióbek at me, kind of like how parents do the airplane when they are feeding their baby.

Besides my regular doctor visits, I go to myofascial therapy and have been going for all kinds of PT for a couple of years now. I don’t know if it works, but at least as a patient I feel less alone in my recovery. Thanks to social media, I also feel less alone and have a couple of surgery buddies. It also stresses me out a bit because their progress is much better than mine.

Who’s the fairest? Not me.

Directly after surgery, I wasn’t able to see myself (in the mirror) for more than a day. The nurse was instructed to give me a mirror post-op, but I didn’t ask for it, so why would she? I wasn’t too interested in seeing the results per se because you look crazy afterwards. It’s not the “after” of the classic “before and after” pics. My whole face was swollen and bruised. I had all kinds of medical PT-style tape on my face. I very much wanted to see my bite, the teeth, in proper position. When I got a look at them, I had to ask several times if this was the proper position because I hadn’t seen properly positioned teeth since childhood.

The nurse from the night before said that she would not have recognized me. And I didn’t recognize myself. It is a really freaky feeling to look in the mirror and not recognize yourself at first glance. I mean to not look anything like yourself.

So how do I look? A funny thing happened a few days before my surgery. I was coming out of the periodontist office after my pre-op cleaning and as I checked my face for toothpaste or blood or whatever a stranger, a man, greeted me. Dzień dobry. Ale Pani jest brzydka. (Good morning. How ugly you are, ma’am.) Not untrue, but still, totally unnecessary.

Now I look different. The most positive comments I get are on my profile which wasn’t a big concern for me maybe because I couldn’t see it. Other positive comments are on my bite, so the position of my teeth. One of my surgeons, knowing the anecdote above, agrees that now I am brzydka inaczej. The translation would be differently ugly which can be interpreted in two ways – one interpretation of the phrase in Polish is that it can mean the opposite of ugly, so it could mean nice-looking. Another interpretation is still ugly, but just in a different way. Take your pick I guess. Another surgeon (there are 3), says I look older and should consider plastic surgery options in the near future. And the third surgeon says nothing because he probably thinks I am not right in the head.

I dunno

At some point in my hospital stay, I stopped computing. I don’t know, I reached my limit of Polish language intake and then all language intake at some point. Before sending me home, this doctor was asking me if I had nożyczki at home to cut the elastic bands off in an emergency. I was absolutely sure that he could not have been asking me about regular nożyczki. He had to have been asking me about something else – I thought that maybe this word had another meaning because who doesn’t have scissors at home. So I answered that I didn’t know. And he asked – you don’t know if you have scissors at home. And I doubled-down and indicated that I in fact did not know. It’s not the most embarrassing thing I have ever done or said, but it’s on the list.

So now when I look in the mirror, I see a face that is kind of mine but also not mine. Honestly, though, that’s how I felt about my previous face. I tell you that in confidence because when the surgeon asked me about it, and I said that I felt that neither this face nor my previous face were “mine”, he was like – lady, that’s messed up. My face is super square for me now. Obviously my face muscles don’t function as they should, and it is visible. I sometimes worry that people will think that my surgical recovery and disability is some kind of unsuccessful cosmetic injections, and I guess I don’t want to be perceived in that way.

Early days, I guess

I do look more like my childhood self from before my jaw issues were visible, and I do look more like my father. It’s not nice to look like someone you don’t want to look like, I have to say. And the surgeon isn’t wrong, I do look older. I have no problem with the aging process and looking older, but in this case, it’s like overnight aging. I didn’t sign up for that. Overall, 4 months from surgery, it is still early days which is hard for some people to understand. They think I should be tip top by this point. Sometime within the next 6+ months I will return to the hospital to remove all the plates and screws inside my face, and re-start the recovery process. When I think about it, I feel sick.

Surgery in Poland

Now about Poland – I have been asked before why I chose to have surgery in Poland. The answer is simple – I live and work in Poland. I wouldn’t say Poland is a mecca of medical tourism on a scale such as Türkiye or Korea for example, but people do come to Poland for medical procedures. My unscientific research shows that (within Europe) Poland is a destination for dental treatment, cosmetic procedures, and bariatric surgery and maybe more.

Poland has publicly funded national healthcare called Narodowy Fundusz Zdrowia – NFZ. A person is covered by the NFZ if they pay the contribution or their employer pays the contribution for them. Spouses and children of the covered person are covered as well. Young children, people with disabilities, pregnant women, and the elderly are all covered. If I understand correctly, unemployed people who previously paid into the system for a certain length of time and who are registered in the employment office are covered as are current students and graduates entering the employment market (right?). I am a contributor to the system and thus have access to the care provided. The system is far from perfect, and most people use some kind of mix of public and private services.

While I went almost entirely private for my surgeries due to my needs and my age, it is possible to get jaw surgery in Poland on NFZ. Even when a patient chooses to go through the public healthcare system for jaw surgery (also called orthognathic surgery), most of the preparatory procedures for surgery are not covered. In my case, scans and x-rays were not available via NFZ. I did get my wisdom teeth extracted on NFZ though a payment for the numbing was charged. The periodontist visits, periodontal cleanings, and gum grafts were also not available via NFZ. Orthodontist treatments are only available via NFZ under the age of 12. Surgical planning was also paid out of pocket. But again jaw surgeries and even hardware removal are available via NFZ (again with all the prep being covered by the patient).

If a patient chooses the public option, it is up to the patient to get referrals for surgical visits and then for surgery. After that, the patient needs to get themselves on the waiting list for surgery and hope for the best. There’s no guarantee that you will have the surgeon you want or even the procedure exactly as you agreed, and the timeframe is completely out of your control. I know from my patient groups that recently some patients were left high and dry when their chosen hospital discontinued performing jaw surgeries, and now they are at the back of the line at a new hospital. Having said that, private is not necessarily better. I went private because I wanted the surgeons of my choice, in my city, performing exactly the operation we had agreed on. As for my first surgery, I needed to have an alternative method performed in order to preserve the tissue of my palate for future gum grafts and that option was not available via NFZ.

What more can I say? You definitely can rock up to the hospital and pay for your surgery in cash. They just whip out the cash-counting machine, and you’re golden. I was treated in a Polish hospital in Poland so I had zero expectation that anyone would or should speak English. Technically though you could probably arrange surgery in Poland in English in a private hospital, although my main surgeon doesn’t speak English at all. Some of the nurses and staff said they could speak English, but since I can speak Polish (more or less), they didn’t have to. We communicated just fine, and I got a lot of compliments on my Polish, but even so, the stay was stressful.

No-brainer

Recovery is long and difficult, and I’m at a place now where I cannot envision a future for myself in which I can speak and eat normally, work and travel, not think about my jaw every second of the day and night. I’d like to wrap up my experience with some clever conclusion, but I’m all out. Sometimes I think I should have just had a lobotomy and called it a day. I guess get back to me in a year, and we’ll see if I am more clever then 😉

*Parents, if you became a parent in a less-than-planned way and feel the need to share this information with your child, please consider using terminology such as “surprise” over phrases such as “accident” or even worse “mistake”. Additionally, if you are telling your child this in their 40s, you might want to consider just not telling them at all. It’s ok to take things to your grave.