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Who's that in the Mirror?

unilateral cleft lip and palate patient story and psychology

Whilst being a cleft lip and palate patient has many internal challenges, a large part of being born with a cleft is that there are external differences in facial structure. This is not a ‘bad’ thing, however it is different. Also, it is important to remember that the differences in cleft patient appearances are unique to that person (in the same way everyone looks different to everyone else).

As I grew up, my nose changed shape more noticeably than my lip (after the initial repair), and I started to find my difference harder to cope with. However, as much as I may have struggled with how I looked from day to day, after operations to improve my facial structure and appearance, the change was something I had to get used to as well.

Psychologists are aware of how we link our feelings of identity to who we see in the mirror. Our world is a very visual one so a lot (and often too much) importance is placed on how we look. So, when this changes (even if for the ‘better’), it can still take time to get used to.

I remember being nine years old, having just had my bone graft, and looking in a mirror for the first time. I was a little alarmed due to the bruising and swelling post-op, but after a few days I could see myself properly and there was a small change that I hadn’t expected. When I say small, I mean tiny: maybe a millimetre or two of my top lip was showing more than usual. This did barely anything to change my overall look, and my parents couldn’t even see what I was talking about! Yet I remember crying about it; saying that I suddenly looked very different and thinking ‘that isn’t me in the mirror’. Of course, I gradually accepted it and it became very normal for me, yet it did make me worry about surgery in the future and was a small wake-up call that I was choosing to change the way I looked.

So, when it came to my jaw surgery, I was expecting a big difference in my profile and was aware that the change might take some getting used to. In actual fact, because I’d prepared myself for a massive change, once my swelling had settled down, I didn’t think my appearance had changed much at all. I still felt like ‘me’ and I liked the improvement to my bone structure and the fact my teeth were now the ‘right’ way around.

However, when it came to my septorhinoplasty (reconstructive nose surgery), I remember being a lot more excited and apprehensive about the changes to my appearance. The surgery was something I’d been consciously waiting over a decade for (although it sometimes felt like centuries!). I was so excited that the time had finally come to reflect my inner self externally and show the world the ‘real’ me. However, a few days before the surgery, it hit me that my face was going to look very different to the face I’d grown up with and the face I knew those I cared about loved.

It was an odd conundrum: on one hand, I wanted to look different so I could feel less self-conscious (and raise my internal self-esteem), yet, on the other, I suddenly wondered why I felt the surgery was necessary to have everyone see the person I was inside. I was worried that having the surgery would somehow change the person I’d always been – the sort of person who’d overcome my insecurities to show people who I was inside. The idea that that obstacle may be about to be sorted (although I’d waited years for this), suddenly made me nervous about who the ‘new’ me would be.

After surgery, I looked in the mirror at my ‘new’ nose. I loved it (and still do!). Seeing myself clearly made me realise that all that had happened was that the person I wanted everyone to see (and the people those closest to me saw) was suddenly out in the open. I felt more confident about my appearance than I’d ever done in my life and it raised my self-esteem tenfold. The thing that didn’t change however was myself – my personality. Although this may seem obvious – I wasn’t having brain surgery! – it was a worry that as my appearance changed, some part of my identity would with it.

So, although some cleft surgery can be daunting when considering you won’t know how you’ll look afterwards (due to the complicated nature of clefts, computer generated concepts aren’t created), the change is never as major as you think it will be. It is always a positive step forward and the change will merely be a way of showing the world who you are inside.


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