Christian Constantine of the UK has undergone as many as 36 operations to set right the facial deformities he was born with. And he looks much better now.
He had a cleft that ran from his upper lip to his forehead, as if the two halves of his face hadn't fused properly. He had hypertelorism, which meant his eyes were abnormally far apart and his brows and hairline were far too high.
AdvertisementFrom his lower lip down he was normal, but where his upper lip should have been, the roof of his mouth was visible. His nose was barely formed. And that was without his other assorted difficulties, including kidney reflux, where urine backflows to the kidney and causes infection, and damaged hearing.
It was a genetic quirk that had produced such a terrifying combination of deformities. It is also so rare that there has only been three other cases recorded in the world.
But his loving parents wont give up, at any cost. At 12 weeks he underwent his first operation to close the gap in the roof of his mouth, and he's since endured nearly 35 more - some of which sound so harrowing that one cannot imagine how anyone, let alone a little boy, could survive the pain and trauma.
In 1993, when he was nine, Christian's parents took him to Paris to see craniofacial surgeon Paul Tessier. He agreed to perform a major operation to lower Christian's eyebrows and bring his eyes closer together.
Tessier had never carried out an operation of such complexity before and there was a risk of brain damage from the surgery. The night before the operation, Tessier said: 'We're entering a patch of fog without a compass.'
The operation took 14 hours. 'I woke up and couldn't see a thing because my eyelids were stitched down. But a few days later, when the stitches had gone, I could see I looked different, better.
'And I can still remember the huge smile on my uncle's face when he saw me. I knew then that things had gone well,' Christian told Isla Whitcroft of the Daily Mail.
By 1995, Christian had undergone at least 15 operations, including an operation to improve his upper lip, and grommets to correct the hearing defects caused by the malformation of the facial and head bones.
There was then a three-year break as doctors waited for Christian to stop growing. At 17, it was time to start again.
Because his palate had not developed properly, Christian had no top teeth and had worn dentures. In October 2000, the long process of building the foundations for dental implants began.
Bone was removed from his right hip to form a platform inside the top of his mouth. It took two years for this to be strong enough to take implants.
In his early teens, Christian had struggled to come to terms with the effect his face was having on his life.
'I went through a period when I could hardly bear to look at myself,' he says. 'At school, I recall two boys saying I had no hope of ever getting a girlfriend.
'The Christian of today would have fought back - but then I still hadn't had many of my corrective operations and had no way of knowing how things would turn out, so was easily crushed.
'My lowest point came at 16 when I lost my best friend George to leukaemia. I started drinking heavily and it took until I was nearly 18 to pull myself together.'
Christian didn't consider counselling and rarely confided in his family. It is a mark of his incredible strength of character that he sorted the problem out for himself.
'Simply growing up helped a lot; but I also realised my face would only be a problem if I let it be.'
In August 2002, Christian felt ready to start afresh with a new set of operations. The first step was a new nose. UK surgeons wouldn't do it because the job was so complex, so the family flew to Chicago to see the man reputed to be the best nasal reconstruction surgeon in the world.
He explained Christian's upper lip had been constructed too high up. To make room for a nose, they'd have to lower the lip. This would leave a large hole where his lip had been which could only be filled with a skin graft. If the graft didn't take, they'd be back at square one.
It was a risk, but one that Christian was prepared to take.
In all, between August 2002 and June 2004, Christian endured ten operations in his quest to get a new nose. It was formed using bone from a rib and a skin graft from his forehead. This, in turn, was covered by a graft from his abdomen. Again, there was no guarantee it would work.
'Most people struggle with the aftereffects of one operation. For me, the surgery was mentally and physically gruelling, and I had no time for anything else in my life.
'I finally got back to England in time for a New Year's Eve party. Some of my friends and relatives cried when they saw how much better I looked.'
The last major reconstruction was carried out three years ago. 'My eyebrows and hairline were still abnormally high,' Christian explains. 'But we couldn't find anyone to lower them until we saw a TV documentary about an LA-based facial surgeon called Henry Kawamoto.'
Even he, one of the best surgeons in the world, was stumped for ideas. The problem was finding enough skin to cover the gap in the forehead once the eyebrows had been moved down.
Usually, when such surgery is carried out, little balloons known as skin expanders are placed just under the skin on the forehead and slowly inflated over weeks to stretch the skin. In Christian's case, the skin of his forehead was grafted, making it unnaturally tight and inflexible. Expanders would simply rupture his skin.
Initially, the pain of the expanding process 'wasn't too bad', says Christian. 'But as the weeks went by and the pressure was increased, it became more and more painful.'
Six weeks later, with the skin stretched sufficiently to accommodate the new eyebrows, Christian was back in the operating theatre.
'As soon as I woke up, I could see the difference. I really felt like it was a new beginning.'
Christian is done with operations for now, concentrating instead on his degree. He hopes to go into insurance and is looking for a publisher to print his life story.
'I want people to know you can go through terrible difficulties and still pick yourself up and carry on.
'I will never say never again when it comes to more operations, because you don't know what medical advances are around the corner.
'I am now happy with my looks and I'm not a bad-looking guy, either. Now it's time to get on with life and pursue my ambitions.'
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