# FME 4.5, 10 TAD Full Progression Log

## Personal Info
- 26, Female
- 5'5 and 105 lbs (BMI: 17.5)
- Dense bone as confirmed by Dr. Jaffari due to difficulties during installation.
- Underbite with a steep occlusal plane.
- I have TMJD , no ICR.
- Confirmed to have a bleeding disorder (VWD or Hemophilia A, mild, 30%)
- Possibly EDS, never tested. I am able to bend my thumb about 100° backward on both hands and my right foot (more flexible side) is deformed. Parents said my foot has always been that way.

## Goal
- Resolve UARS and OSA
- Create space to fix crowding in preparation for MMA (To fix underbite)
- Able to breathe through my nose

## FME 4.5, 10 TAD
<img src="https://i.imgur.com/QoEj31c.jpeg" width="40%"> <img src="https://i.imgur.com/r1Zns0y.jpeg" width="40%">

## Cost

- `~18,250` USD for FME 4.5, 10 TAD.
- ` ~8,500` USD for ortho (optional, can opt for local orthodontist)
- ` ~1,500` USD for travel: Most patients travel to Dr. Newaz's office at least `2 times`. Once for FME installation, and then for FME removal. Consultation can be done virtually.

:::info
### :bulb: Discount

Dr. Newaz office offers 10% discount if you pay in full in 1 payment.
:::
:::success
### :warning: As of 06/26/2025
There are reports of price increase of around `3,000` USD after I got mine installed, so the price you see here may not reflect the price you get quoted at Dr. Newaz's office.
:::

## Timeline
`MM/DD/YYYY`
`12/10/2024`: Reached out to Dr. Newaz office for a consultation
`03/01/2025`: In person consultation in NYC
`05/30/2025`: FME 4.5, 10 TAD installed in NYC.
`06/03/2025`: Start turning every morning first thing after waking up.
`07/05/2025`: I split! Diastema present :fire:.

## Why I chose 10 TAD instead of 8 TAD
Dr. Newaz recommended 8 TADs at my consultation, but that didn't end up happening for the following reasons:
- FME 4.5, 8 TADs release date is **unknown** and my installation appointment has been delayed by `32` days once already. Newaz's office said the next opening is in `08/2025`.
- I suspected that my bone is dense, more so than almost all women and a good portion of men due to a medical condition. My suspicion is confirmed when Dr. Jaffari had a lot difficulties with installation due to how dense my bone is (he himself said so).
- I already have an **inpatient** surgery scheduled in `09/2025`. I also was expecting to have my gallbladder taken out in `07/2025` (outpatient). Further delay in FME will potentially wreck all these plans because a lot of planning & aftercare needs to happen for each surgery due to my bleeding disorder.
- My CBCT scan was taken on March 1st, 2025, and it's valid for 3 months. Further delay means I may have to get a new CBCT scan, and I don't know where to get that locally.
## Installation Experience

Installation took around `90 minutes` from the numbing shots to FME installed. Post-op instruction, photo taking, and post-op CBCT scan + discussion took another `60 minutes`. For a total of around `2.5 hours`. Pain is minimal. No pain medication was needed post installation. I flied back 3 hours later and I started water flossing on day 1 post-op with no issue.

I got `2A`, which is capable of about `9-10 mm` of expansion, but I think realistically, about `7mm` of expansion because it takes `1-2` mm to split, and the last `1` mm may not be that stable. I was told to start turning `3 days` post-op.

Since I have a bleeding disorder, IV Infusion for clotting factor is needed for 9 days in total, 1 pre-op, and 8 post-op. It's probably overkilled, but HTC (hemophilia treatment center) would rather err on the side of caution. Dr. Newaz ordered a home nurse to come to my hotel for IV infusion an hour pre-op since my HTC based in California can't order it due to being out-of-state.
<img src="https://i.imgur.com/9Sau7h5.jpeg" width="40%"> <img src="https://i.imgur.com/w8S4fdZ.png" width="40%">

The actual installation took around an hour. Pain was no big deal, but keeping my mouth open wide enough for an hour is beyond challenging due to my TMJD. My maximum mouth opening is 3 fingers wide, and 2.5 fingers is my comfortable mouth opening.

## Starting Point

| What | Distance |
| ------------------- | -------- |
| Nasal Aperture | `20.3x` mm |
| Nasal Base | `14.34` mm |
| Widest Part | `24.94` mm |
| Intermolar Width | `36.66` mm |

Dr. Newaz noted that my nasal base is **absurdly narrow**. I have difficulty breathing through my nose, especially when laying down. Nasal spray never works for me even with proper technique because the liquid would just run out of my nose.

Growing up I am **not** a mouth breather, but I did have grade 4 posterior and grade 4 anterior tongue tie that was never addressed until adulthood. Some part of my bodies are really flexible, but some parts are really not flexible, for whatever reason.

CBCT scan below. It's a bit tilted to the right; hence the lines are tilted as well.

<img src="https://i.imgur.com/R4Kc01C.jpg" width="45%"> <img src="https://i.imgur.com/xcE6ZLZ.jpg" width="45%">

## Hygiene
Get a waterpik.
- Day 1 post-op, low setting
- Day 5 post-op, low-med setting.
- Day 12 post-op, medium setting.
## Dairy
### Turning Protocol
1 turn daily until I split, and then 2 turns every week. Every now and then I would take a photo.

### Day 1 (06/03/25), Turn 1.
- 1 hand to turn.
- I felt slight pressure for around 1 minute and then nothing afterwards.

### Day 2 (06/04/25), Turn 2.

### Day 3 (06/05/25), Turn 3.
- 2 hands to turn (moving forward, it's always 2 hands).

### Day 4 (06/06/25), Turn 4.
- 2 hands to turn.
- I felt nothing at all.
- Slip 2 times and hard to turn. To address this, I made a makeshift handle with tapes. I am worried about slipping too many times would strip the bolt. I think a handle would help with my grip on it. I am planning to hold is like so. Going to test it out tomorrow.

<img src="https://i.imgur.com/x4m4fey.jpeg" width="45%"> <img src="https://i.imgur.com/tsZhlT8.jpeg" width="45%">

Today I also noticed an edge of FME is digging into one side of my tongue whenever I swallow, and it kind of hurts. I am hoping it goes away soon.
<img src="https://i.imgur.com/2bA5eYp.png" width="45%">

### Day 5 (06/07/25), Turn 5.
- 2 hands to turn.
- I felt pressure in my upper front teeth, especially when I bite down, for a few minutes.

### Day 6 (06/08/25), Turn 6.

### [PHOTO] Day 7 (06/09/25), Turn 7.
- 2 hands to turn
- I felt slight pressure in my upper front teeth only for less than 5 seconds.

<img src="https://i.imgur.com/kn1U58F.png" width="45%">

:::info
### **Turn 1-7 Summary**

On turn 7, I felt noticeable tensions throughout the day in my TMJ and upper front teeth. It feels like a huge force is being applied to break my maxilla apart. It felt weird. No split though.
:::

### Day 23 (06/25/25), Turn 8.
- 2 hands to turn.
- I felt pressure in my front teeth and left molars that went away after 1 minute. No split.

:::success
### **Why No Turning from Day 8 to Day 22**

You may have noticed that I haven't turned FME for a while. It's because I ran out of clotting factors and my hemophilia treatment center wants me to stay on it in case there is any internal bleeding when I split & post-split. IV infusion restarted today.
:::

### Day 24 (06/26/25), Turn 9.

### Day 25 (06/26/25), Turn 10.

### (SLIPPED) ~~Day 26 (06/27/25), Turn 11~~.

### (SLIPPED) ~~Day 27 (06/28/25), Turn 12~~.
:::info
### :bulb: How to know it's Slipped

When it is ridiculously easy to turn and there is no pressure present in maxilla at all.
:::

### Day 29 (07/01/25), Turn 11.

### [PHOTO] Day 30 (07/02/25), Turn 12.

I have not splitted yet. No diastema present.

<img src="https://i.imgur.com/Sq8fNZe.png" width="45%">

### Day 31 (07/02/25), Turn 13.

### Day 32 (07/03/25), Turn 14.

### Day 33 (07/04/25), Turn 15.

### (STUCK) ~~Day 34 (07/05/25), Turn 15.~~
- 2 hands to turn.
- ==Impossible to turn.== I broke the makeshift handle trying to turn today. Not sure if I did 0.5 turn or 2 turns because I kept restarting since it won't turn. I need to make another handle.

### [PHOTO] ==SPLIT DAY==: Day 34, EOD, Turn 15
I was drifting into a nap and suddenly got woken up with sharp pain in my upper front teeth. At first, there was no noticeable diastema, but the sharp pain persist throughout when I later ate my dinner which require lots of chewing. After dinner, I noticed a diastema! This is about how much I've turned so far, I think it's about `1.5 mm`.
<img src="https://i.imgur.com/zpK2B4U.png" width="45%"><img src="https://i.imgur.com/qpKVizN.png" width="25%">

### Day 37 (07/08/25), Turn 16.

### (STUCK) ~~Day 40 (07/11/25), Turn 16.~~
- ==I was unable to turn it.==

### Day 43 (07/14/25), Turn 17.

### Day 45 (07/16/25), Turn 18

### Day 48 (07/19/25), Turn 19.
- I think my breathing is a bit better, but not by much.

### Day 50 (07/21/25), Turn 20.

### [PHOTO] Day 53 (07/24/25), Turn 21.
I took those photos right before the video follow-up with Dr. Newaz. We can see that diastema is growing wider!

<img src="https://i.imgur.com/ZOP7Mo4.png" width="45%"><img src="https://i.imgur.com/DSf6wiW.png" width="55%">

### Day 57 (07/28/25), Turn 22.

### Day 60 (07/31/25), Turn 23.

### Day 64 (08/04/25), Turn 24.

### Day 67 (08/07/25), Turn 25.

### Day 71 (08/11/25), Turn 26.

### Day 74 (08/14/25), Turn 27.

### Day 78 (08/18/25), Turn 28.

### [PHOTO] Day 81 (08/21/25), Turn 29.

- I finally reached `3mm` FME device expansion. I think in 3 months, I will reach `6mm` because it looks like `1mm` worth of progression per month. Then I will re-evaluate if that's enough.
- I still have scalloped tongue on both sides, indicating that my maxilla is still too narrow for my tongue.
- I've noticed markedly breathing gain. I can breathe through my nose even when lightly congested.

<img src="https://i.imgur.com/tanSmla.png" width="50%"><img src="https://i.imgur.com/AD4DWGF.png" width="50%">