Erin Foster walked into the exam room wearing tall suede boots, jeans and her favorite brown leather jacket.

Faint purple highlights ran through her hair, and her nails sparkled with iridescent polish.

But the biggest and newest change in this petite 18-year-old’s appearance lay hidden beneath the surface of her smile.

Her delicate face contains two titanium steel jaw bones and silicone joints, implanted months earlier in a surgery at Spectrum Health Helen DeVos Children’s Hospital.

The innovative surgery transformed her face and jaw, making it easier to eat, breathe, speak and sleep.

Erin sees and feels the difference every day.

“I can honestly say it has changed my life completely,” she said.

“I can go out somewhere and not be concerned about what I look like. I can smile and not feel like I’m not pretty. It helps with my confidence in myself.”

Erin, who grew up in Cadillac, Michigan, was born with Goldenhar syndrome, a rare congenital condition that affected the development of her ears, eyes and facial features.

She had an undersized lower jaw, which limited her ability to open her mouth.

As an infant and small child, she had a tracheotomy and feeding tube to help her breathe and eat.

Growing up, she underwent multiple surgeries on her eyes, ears, palate and jaw—21 operations by the time she turned 16.

Those surgeries included a rib graft for her jaw. Although the surgery improved the opening for her airway, it also further limited her ability to open her mouth.

At the age of 12, Erin had another surgery to lengthen her jaw, but the effect was temporary.

Even as a child, Erin handled the medical challenges with maturity beyond her years, her mom said.

“She has always been wise for her age,” she said. If Erica became upset about struggles her daughter faced, Erin would say, “It’s OK, mom, God made me this way.”

Erin kept busy with school and activities. She excelled at math. And she loved to read, especially mysteries and thrillers.

Following in the footsteps of her mom, her dad, Craig Foster, and her older brother, Brandon, she took up bowling. She bowled for her high school team. Her high score: 208.

In high school, she worked part-time at the Dairy Queen.

But even a strong network of friends and family could not insulate her from bullying.

The most surprising and painfully cruel comments came from adults. Once while Erin worked at her part-time job, an adult customer made fun of her speech.

Erin stepped back, visibly upset, and a co-worker intervened.

“I was a mess,” Erin said. “I expect it from children, but I don’t expect it from adults. I don’t expect them to be that low to talk to a teenager like that.”

How did she cope?

“I have to block it out. If I don’t, I will overthink everything, and it will break me down slowly,” Erin said. “You hear someone say that, and it plays over and over and over in your head.

“At some point you have to stop and say: ‘You are not that. You are a great person. You are beautiful and you are smart.’ You have to talk yourself into feeling better.”

Support from friends helped. And telling her mom made bad experiences more bearable.

“She is my rock,” Erin said. “She is my best friend. I tell her everything.”

A new approach

Erin did not think there were any options left to improve her airway and jaw until a few years ago.

Erica showed her an article about Peter Dankelson, who underwent a jaw reconstruction surgery pioneered by John Polley, MD, and John Girotto, MD, pediatric craniofacial surgeons at Helen DeVos Children’s Hospital.

Using CT scans and dental impressions, the surgeons design custom jaw implants for young people born with facial differences. TMJ Concepts, a California-based company, fabricates the titanium and silicone jawbones and joints.

Looking at the before and after pictures of Peter, Erin was impressed.

“You can just tell the change,” she said. “It is such a difference.”

She decided to try one more surgery—her 22nd.

Erin was 16 when she and her mom met with the doctors to discuss the surgery.

“I’m really excited about it,” Erin said.

She hoped it would help her breathe more easily. Because of her narrow airway, she had sleep apnea and slept with a CPAP machine.

And she hoped it would make eating easier.

“I love food,” Erin said. And she rattled off a list of some favorites: chicken alfredo, meatballs, lasagna and fruit.

‘A really nice smile’

In December 2019, in her senior year of high school, Erin underwent surgery.

Drs. Polley and Girotto brought her lower jaw forward. They implanted the titanium jawbones and prosthetic joints.

They also brought the upper jaw forward so the teeth would match with the lower jaw.

As she healed after the surgery, Erin’s jaws were wired shut for two weeks. Following a liquid diet was the most difficult part of the experience for her.

A nurse showed her how to use a syringe to deliver pureed food behind the retainer on her mouth, so she consumed as much as she could.

Once the wires came off and Erin recovered, she marveled at the difference the surgery made in her ability to eat, talk, sleep and breathe.

“To be able to have movement on both sides of my face is amazing,” she said.

“She has done really well,” Dr. Polley agreed. “She has a really nice smile.”

Erin said she had numbness on the side of her face, which Dr. Polley said will improve with time.

‘The best end result’

Fifteen months after surgery, Erin arrived for a follow-up appointment with Dr. Polley.

Now 18 and an Aquinas College freshman, she brought along a laptop so she could take a Spanish exam after her appointment.

She happily noticed that she had grown taller, standing at 5-foot-2, and that she had gained 10 to 15 pounds in the past couple of years.

By opening her airway, the surgery made it easier for her to gain weight, Dr. Polley said.

“Before, she had to work so hard to breathe. That takes hundreds of calories a day,” he said. “The calories she was burning just to breathe now can go to other cellular functions, gaining weight and growing.

“She is really blossoming now.”

Dr. Polley discussed plans to do a smaller operation in the future—to bring Erin’s chin forward more. And he will add a fat graft to her left cheek to make her face more symmetrical.

Erin still spoke enthusiastically about the surgery.

“I am really happy with the formation of my face,” she said. “And the airway obviously is way better.

“This is by far the best end result I have ever had out of a surgery.”