They screwed my face back together – The Mirror, 29 June 2000

Reproduced from The Mirror on 29th of June 2000. Article by Jill Palmer.

RHONDA Gibbs stared in the mirror in disbelief. She hardly recognised the rebuilt face that was looking back at her. For the first time in years, she looked “normal”. The bone deformity which had totally disfigured her face had gone. The long and complex operation that involved breaking her jaw and nose and reconstructing them using screws and metal plates had been a success. “I was absolutely delighted and I still am,” says Rhonda, who lives in Croydon, Surrey, with her husband Russell and their two-year-old daughter Molly.

“I had to keep looking at myself for months just to convince myself it was me. “It had been a difficult choice to undergo such major surgery, but when I see myself now I know it was worthwhile.” Thirty-year-old Rhonda’s abnormality developed when she was a teenager. Her lower jaw continued growing much longer on the left than on the right, making her face lopsided and disproportionate and preventing her teeth meeting properly. Her nose was pushed to one side. Her upper jaw and cheekbones had failed to grow and had sunk inwards. By the time Rhonda reached 19, the deformity was making it difficult for her to eat. She suffered extreme pain and there were grating and clicking noises whenever she moved her jaw. Her odd appearance was also emotionally damaging the once-outgoing and confident teenager. In desperation, she went to her dentist for help. He referred her to the maxillo-facial surgery unit at St Bartholomew’s and the Royal London Hospital, which specialises in treating facial, mouth and jaw diseases and deformity.

First, Rhonda had to wear heavy braces on her teeth for a year to move them into the correct position. Then, in an intricate and complex six-hour operation, surgeon Iain Hutchison completely rebuilt her face. He broke her upper and lower jaw and repositioned them. He removed excess bone, broke her nose and rebuilt it in the right place. He used a bone graft and metal plates to wedge her cheekbones out, and screwed her jaws back together. In all, he had to break her skull in seven places.

Rhonda still has six metal plates and 28 screws holding her new face together. They will stay there for the rest of her life. To avoid external scars, Mr Hutchison worked from the inside, making cuts inside her mouth and peeling back her skin to reveal her skull. When she came round from the anaesthetic in intensive care, she was covered in tubes and drains. Her jaw was wired together and her face had swollen to three times its normal size. She needed morphine to relieve the pain and had to be fed through a drip because she couldn’t open her mouth to eat or speak. Her mum later admitted that the first time she saw Rhonda after the surgery, she fled the room and burst into tears. Rhonda was too frightened to look in the mirror until four days after the surgery. She says: “All my friends and relatives were saying how well I looked, but I was too scared to look. “It was a terrible shock when I went to the hospital bathroom and saw myself in the mirror for the first time. “My whole face was horribly swollen and I had these awful wires holding my jaws together.”

Her jaw was still clamped together when she left hospital five days later, but she learnt to make herself understood through gritted teeth. She prepared regular meals which she liquidised and sipped through a straw. “The food tasted OK, but it looked awful,” she says. “I longed for a proper dinner.” After two months, the wires were removed. Over the next five months the swelling gradually went down and she could see her new face properly for the first time. “I could not get used to myself, and kept looking in the bathroom mirror and in shop windows as I walked past,” she says. “People whom I had known for years would walk past me in the street and not recognise me. “As a child, I looked like my brother and sister, but as I grew up my appearance became totally different. “Suddenly, my face has been put back to how it should have been and I look like one of the family again. “When I see old photos now, it seems strange that I looked so different. “I am really pleased with the outcome and my friends all tell me I am much more confident now. “It was certainly worth all the pain and discomfort, although I have to admit that I didn’t think that immediately after the surgery.”

Mr Hutchison explains: “Facial disfigurement can make people introverted and withdrawn during adolescence as well as affecting function. “Rhonda has a very bubbly personality, and surgery enabled her to blossom. “She was not hideously disfigured, but her jaw had grown abnormally and the middle part of her face had not grown at all, so her face was lopsided and hollow. “I had to break and reset several bones in new positions to push out the cheekbones and fit the lower jaw to the top of the face. A computer helps to plan how to set the bones, but the final adjustment can be made only when the patient is on the operating table. “A millimetre movement can make a big difference, and I have to judge whether it looks right or not. “The screws and plates remain in the face permanently. “They can be removed, but unless they are causing pain or problems there is no point in more surgery to take them out.” Two thousand children are born with severe facial defects in the UK every year and another 15,000 develop abnormalities during their childhood and teenage years, as Rhonda did.

Another 4,000 people are diagnosed with mouth cancer, and up to a million more suffer facial injury caused by accidents or assaults. Mr Hutchinson has now set up SAVING FACES – a charity to fund research into the prevention and treatment of oral and facial diseases, injuries and deformity. It was launched yesterday with an innovative art exhibition showing paintings of patients before, during and after surgery. The charity aims to improve the detection and treatment of mouth cancer by co-ordinating data from the 38 UK maxillo-facial surgeons specialising in the disease. It also hopes to run prevention projects to cut the number of mouth cancers and facial injuries and improve surgery for facial deformity. It is also collaborating with the Football Association in looking at the causes and effects of facial injuries in football.