"Ideation of a perfect world" - Living with a facial difference in South Africa.

MY FACIAL RECONSTRUCTION JOURNEY IN JOHANNESBURG, SOUTH AFRICA: 2004 – 2013

In 2004, I had a major car accident in Johannesburg, South Africa. I did serious damage to my internal abdominal area and hit my face on the dashboard which caused complex disfigurement. This is the list of injuries: https://vanessacartersa.wordpress.com/medical-history/

I had a broken nose, an orbital blowout, smashed zygoma (cheek bone), lost my right eye, broke my jaw and had massive facial lacerations which went through the cheek tissue. I also had neck and back injuries and a fractured pelvic bone.

I was resuscitated on scene and taken to the Johannesburg Academic hospital on life support. What an amazing group of nurses, paramedics, interns, professors and doctors that saved my life. Doctors say today that I am a walking miracle and I believe I owe it to these individuals that worked together to save me.

I had a facial reconstruction at the Johannesburg hospital at the time which included a silicone implant and a zygoma re-positioning in my face. I also had abdominal laparotomies for my internal damage. I went on for a few months to recover which took about a year. I had lost the eye and the adjustment of that alone was incredible. I had to learn to drive again and had to adjust to the new 2D vision. I was pretty petrified for a long time to drive like that, especially after being in such a big accident, but over time I slowly adjusted and got the confidence to drive a little again.

2 years later, because of the asymmetry from the orbital blowout, I had to have an orbital floor reconstruction, which was done in Pretoria. It made a huge difference. It basically just pushed the eye socket up so that it aligned to the left side.

I had worn tinted glasses for 2 years which hid the dropped eye and I could finally take them off and move forward with life. I built up my business and had a baby and did the usual stuff. 3 years later, the cheek bone seemed as though it was shifting inward. I went to see to having it repositioned forward and had an implant inserted. This was hoped would strengthen a gap which was present between the cheek and the nose and causing a weakness. At the time of the accident, a lot of bone was shattered, and some parts weren’t salvagable. The pain was incredible after this implant operation with the drilling into the face bones, but I made it through. It was a cold winter when they did this and I will never forget how painful my face was because it wasn’t a part of me I could cover for warmth. What worsened it was that my tear duct kept tearing and made the cheek wet.  The freezing wind didn’t help me much. That went on for a few months as the swelling subsided.

As time went by, the eyelid begin to pull down onto the implant, which meant more corrective surgery, which I did. A few months later I developed an infection.  Everyday, I watched the infection eat the skin away on my face. I have never experienced anything more frightening than that. I felt incredibly helpless, like there was nothing I could do except pray I still had the skin the next day and that they could fix it. I kept waiting to see the implant show through as the skin thinned out. There were times I was really scared to wipe the skin in case I wiped it away. I spent many months on the internet trying to figure out what to do, it was a very difficult time which went on in the end for about 3 years.

After a few ops to try save the implant and treat the infection, it had to be removed in an emergency procedure. The implant had a local pocket with MRSA. This is a bacteria which has mutated. The “M”stands for methycillin “R” resistant – i.e; Penicillin type antibiotics can’t treat it. After removal I took a course of new generation antibiotics which had to be specially ordered as a precaution.

The lower eyelid area had been badly damaged by infection. They couldn’t operate again for 6 months to a year because it may have aggrevated the infection again. So, I put on an eyepad and started to drive around Johannesburg to get the right advice. I think I wrote overseas to about 10 different doctors too. Only to get refered back to South Africa to some pretty amazing doctors in the end. I spent months researching until midnight on my phone in bed. Figuring out terms and figuring out what was successful on other patients. I have never read so much like I did then. It did me some good, because today I understand terms like Free flap, craniofacial, mustarde flap, tripier flap, microsurgery. Okay, I went through a few of those though myself.

In 2012, finally, the maxillofacial professor did a Zygomatic osteotomy. (Cheek bone realignment) which got the framework back into the right place. He did this in theatre with a plastic surgeon who did some lower eyelid work at the same time. Wow, this was the best I had been in 8 years. He did an unbelievable job for me. i felt like I finally saw the light at the end of the tunnel. I mean, you just lose so much time in your life when you are in hospital and figuring out how to fix your condition.

2 weeks after this op, I broke out with what seemed like a full face infection and landed me back in hospital for a week. We did tests and concluded at the time, it was some sort of viscious allergy, but as a precaution, I took antibiotics for a month. My worst fear, an infection in the bone, I think it was then that I hit the lowest point of my life. I felt as if all the work I had done to get the operation done right had just left me with a more severe infection and I was going to lose my whole face. When it was done eating my face, it would move to the brain. it’s weird what things go through your head when you don’t understand what is happening to you. Luckily, it cleared up and it seemed as more of an allergy. A really, really bad one.

4 months after the osteotomy, I was admitted back to hospital with an abdominal bowel obstruction. This was from adhesions where I healed from the internal damage, but they believed my stomach had also had a lot of strain from all the antibiotics I had used. They performed major abdominal surgery and I recovered over a 6 week period. I might add, not a pretty picture with 2 kids, a business & a house to run. I was pretty finished then. I always say, this was my second death scare. I couldn’t eat for 10 days, I had all sorts of pipes everywhere. What a bad year 2012 ws for me.

In January 2013, I finally went for my eyelid reconstruction. The last thing before I could remove the eyepad. By then I had been wearing the eye pad for 3 years. the plastic surgeon did a fantastic job and one can’t see the scars too badly. I am able to wear a pair of spectacles now and it isn’t as easily noticeable. My ocularist is busy working on the artificial eye.  I think after so many years of trying to get the job right, we decided to mess around with a blue eye. I always wanted blue eyes. The Blue also just looked softer for some reason as opposed to the brown. I still have some more operations to finish the reconstruction,, I need a rhinoplasty and some touch up plastic surgery, but I am so relieved that the worst seems to be done.

I have 4 prosthetics which make up my face. The orbital floor, a titanium implant at the zygoma (cheek) arch, a silicone ocular implant and an artificial eye. I was fortunate we removed the infected cheek implant as infection can spread to other implants quite easily. That means I would have had to start over again. so we did the right thing. My plastic surgeon who I still thank to this day, because in the end he had to make the decision.

I have a successful small advertising business in Johannesburg which I started in 1997. I don’t know sometimes how I kept it afloat through everything but I guess I just decided my medical obstacles wouldn’t be something that stopped me from accomplishing my dreams. I kept looking at my heroes, guys like Stephen Hawking amazed me, there is no reason why we cannot achieve great things in adversity. Our greatest achievement in advertisty is to get control over the thoughts in our minds.

Sometimes in life there are outer circumstances you can’t control, but inner circumstances you can. Sure, it doesn’t just happen to some of us, it takes practice and work, but it can be done.

I actually get incredibly upset with people’s comments about my face, which happens, but it makes you stronger inside. What someone says isn’t anything but an opinion and it is only one opinion of many. It shouldn’t dictate your outcome. The world is a strange place, there are loads of negatives, knowing this is very important. Accepting that our world is not perfect and that neither are any of us. What we focus on in life, like positivity, is  the key.

Anyway, I hope that by creating awareness, it opens the doors for another.