Natalie's new face

1 Natalie pre-surgery.jpg — Seattle Children's Hospital

Meet Natalie Merlo, an 18-year-old college freshman from Seattle, as she is about to embark on a journey she’s been waiting for her whole life.

Natalie was diagnosed with Crouzon syndrome as a child, which is a rare disorder that causes the skull’s bones to fuse prematurely, affecting not only appearance but also vision and breathing as well.

“When people first meet me, I can see that they know there is something off about my appearance, but they can’t place it,” Natalie told CBS News last summer.

Complex craniofacial surgery could help Natalie, but doctors had to wait until she stopped growing. This year, they decided to perform the surgery before Natalie would attend Villanova University in Philadelphia. Here she is the day of the surgery.

With help from Natalie and doctors at Seattle Children’s Hospital, follow along to see Natalie’s long-awaited transformation unfold…

Natalie's "new face"

Here’s Natalie at age 3, when she was first diagnosed with Crouzon syndrome, a genetic disorder that prevents the skull from growing naturally. The National Institutes of Health estimates about 16 in every million children are born with Crouzon.

Common symptoms from the abnormal bone growth include wide-set bulging eyes, shallow eye sockets, vision problems, an undeveloped jaw, beaked nose, dental problems and hearing loss.

Natalie's "new face"

Natalie Age 5.JPG — Seattle Children's Hospital

Natalie’s plastic surgeon, Dr. Richard Alan Hopper, surgical director of the Craniofacial Center at Seattle Children’s Hospital, explained to CBS News that Natalie did not have the telltale genetic mutation seen with Crouzon syndrome, but something in her genetic makeup stopped the middle and upper portion of her face from growing properly.

Many kids with more severe cases get skull surgery between 7 and 9 years old, her doctor pointed out.

Here’s Natalie when she was 5 years old.

Natalie's "new face"

Seattle Children’s Hospital

Natalie’s case was milder than others with Crouzon, but her skull’s shape prevented her from breathing through her nose and her underbite made her have to chew exclusively with her back teeth, what she described as chewing “like a cow.” She did not have sufficient facial bone growth around her eyes and they were frequently dry, and needed extra protection during sports and other activities.

Here’s Natalie pictured at 9 years old.

Natalie's "new face"

Natalieage9 crop photo.jpg — Seattle Children’s Hospital

“I knew I’d get surgery since I was 8,” said Natalie. “I’ve had like 10 years to come to terms to it.”

Here’s Natalie pictured at 9 years old.

Natalie's "new face"

Natalie Age 13.JPG — Seattle Children’s Hospital

Hopper and his team decided to wait until Natalie finished growing, so she’d have more bone protecting her eye. He said there’s a stigma associated with the condition, in which people may misperceive someone with Crouzon to be less intelligent because the eyes are more prominent and upper teeth are behind the lower teeth.

“Whereas Natalie as an incredibly intelligent, vivacious young lady,” Hopper told CBS News the day of the surgery, about 15 minutes before he had to scrub in. “This (procedure) gets her bones where they should have been in the first place.”

Here’s Natalie at age 13.

Natalie's "new face"

Natalie Age 15.JPG — Seattle Children’s Hospital

"I'm excited to not worry about playing a pickup game of softball in college without running for my facemask, or biting into a sandwich and not having to slop the bite around in my mouth, just calmly chewing with my mouth closed,” Natalie said of what she looks forward to most. “They sound like small, trivial things, but it's the stuff I have been so self-conscious about that I can finally let go of. And I know it will feel great.”

Doctors took this image of her at 15 years old.

Natalie's "new face"

Years before the surgery would take place, Natalie got under the care of Seattle-based orthodontist Dr. Hitesh P. Kapadia, whom she considers to be “like an uncle to me.”

She had to see the orthodontist every three weeks to make sure her teeth were sufficiently moved to make enough space in her mouth for the surgery.

“He’s done all sorts of crazy braces magic,” she joked.

Here’s Natalie when she was 16 years old.

Natalie's "new face"

Natalie’s surgery following her high school graduation was nearing.

“All this week I have had a pit in my stomach,” she said. But the day before the surgery, she felt surprisingly calm after meeting with her anesthesiologist and child life specialist.

“There is no stopping what is to come, and the faster it comes the faster it is over,” said Natalie.

Natalie's "new face"

Seattle Children’s Hospital

"I want to see what the intended version of myself would look like, if I had never had a craniofacial condition,” said Natalie. “And I think this surgery will show me that.”

Here is Natalie’s side profile at age 18, right before the surgery takes place.

Natalie's "new face"

7 Dr Hopper.jpg — Seattle Children’s Hospital

The day of the surgery finally arrives. Hopper (right) expects when all is said and done, Natalie’s breathing will improve and she’ll be able to bite into an apple with her front teeth for the first time.

“My personal gratification comes from their enjoyment with the results of the surgery,” Hooper, a father of twin girls, said before the procedure. “She’s excited, so it makes me excited.”

Natalie's "new face"

Distraction 1.jpg — Seattle Children’s Hospital

Today is the first surgery she will require for her transformation – “the big one,” as Hopper calls it.

Doctors will make an ear-to-ear incision and fold Natalie’s forehead over her eyes. Using saws and chisels, they will separate all of her facial bones from the base of her skull. Then the team will attach an external frame (pictured) called a halo to her face that will help get her bones into position.

A family member has to turn a screw one millimeter a day to close the gap in facial bones and maintain healing.

Natalie's "new face"

15 Kapadia and splint.JPG — Seattle Children’s Hospital

The surgery will take place with a full team on hand, including Natalie’s orthodontist, who designed a custom splint that surgeons will wire under her skin to her cheekbones and jaw. This is what doctors will be pulling on to adjust her bones.

Natalie's "new face"

10 Dr Hopper and surgeons.JPG — Seattle Children’s Hospital

Similar surgeries 15 to 20 years ago required using screws and bone grafts from the ribs to hold the face in a better position. Doctors also used to pull directly on the cheekbones, which would leave scarring, Hopper added. The newer techniques will aid in Natalie’s recovery.

Natalie's "new face"

12 Hopper shaves along incision line.JPG — Seattle Children’s Hospital

Hopper says a team of more than 15 medical staffers at Seattle Children’s Hospital -- including a pediatrician, geneticist, pediatric dentist, ear nose and throat doctor, and hearing and speech specialists -- has followed Natalie’s care.

“This surgery could not be done safely or well by a single surgeon,” he said. “You need a whole team.”

In this image, surgeons prep Natalie.

Natalie's "new face"

13 Hopper braids Natalie's hair.JPG — Seattle Children’s Hospital

Hopper says the surgery will be tough for Natalie, noting she will be kept asleep in the intensive care unit for the next three days after it’s completed.

Afterwards, doctors will slowly wake her up and then over the next two weeks, she’ll have the screw on the device turned until her cheek bones are in the right position relative to her eyes.

Natalie's "new face"

20 Scrubbed in before surgery starts.JPG — Seattle Children’s Hospital

The team continues Natalie’s surgery. Hopper said patients like Natalie used to keep the halo device on for three months after the procedure is complete, but he hopes to get it taken off of her within six weeks.

“Her cheek bones will be in the right position, she’ll have a dramatic change of appearance,” he said.

Natalie's "new face"

21 Hopper makes first incision.JPG — Seattle Children’s Hospital

Natalie’s surgery took place on a Friday, and she said she would not remember anything until she was awakened the following Monday.

Natalie's "new face"

Post surgery in bed with Nurse.JPG — Seattle Children’s Hospital

Here is Natalie with a nurse once she awoke from surgery that Monday. She had a breathing tube placed in during the procedure, and was about to be moved from the ICU.

Natalie did not take any pain relievers, and more than anything wanted to leave the hospital, but she’d have to remain another two days.

Natalie's "new face"

post surgery with arms out.JPG — Seattle Children’s Hospital

Next she’ll return to the hospital in about three weeks to get the splint removed.

Natalie's "new face"

post surgery with Dr. Kapadia.JPG — Seattle Children’s Hospital

Here is Natalie with her orthodontist, Dr. Kapadia. She says he is “like an uncle” since they have gotten to know each other well over the years during frequent visits to make sure her teeth were perfectly in place before surgery.

Natalie's "new face"

Leaving Hospital after 1st surgery.JPG — Seattle Children’s Hospital

Natalie leaves the hospital after the first surgery and returns home, but her work is only beginning. The “turning phase” is tough on patients, explains Hopper, because it feels like a surgery that’s extended over two weeks. He anticipated she’d feel weak and down in the dumps, but once the turning phase ends, she’ll perk up.

Natalie's "new face"

Examining Images at Follow Up visit 6.28.JPG — Seattle Children’s Hospital

Here is Natalie with Dr. Hopper at her follow-up appointment, looking over imaging scans of her changing skull.

Natalie's "new face"

Screen Shot 2013-12-27 at 10.14.11 AM.png — Seattle Children's Hospital

This image shows the halo device attached to Natalie's skull. Note the wiring that connects to her splint that helps shift her facial bones when the screw on the halo device is turned.

Natalie's "new face"

Here is Natalie recovering at home with the halo device.

During her recovery, she was cleared by doctors to take in a One Direction concert.

Natalie's "new face"

Before Second Surgery 7.26.JPG — Seattle Children’s Hospital

Natalie awaits her second surgery to remove the splint and halo device. She anticipates it will feel like getting teeth pulled, as doctors split the wires.

“I’m excited to go back out in public and not have people stare at me, or ask me questions or wondering what’s on my face,” she said. “I just want the whole thing to be gone.”

Natalie's "new face"

Seattle Children’s Hospital

Natalie said she has a mental picture of what she’ll look like with her splint gone.

“I think I’m going to be really happy with the results,” she said.

Natalie's "new face"

Seattle Children’s Hospital

This image shows Natalie with the halo removed. The transformation is dramatic.

Natalie's "new face"

Natalie Post-surgery.JPG — Seattle Children’s Hospital

The happy, soon-to-be college freshman is seen here before she departs to Villanova. She still has braces, but expects them to be removed down the road. Next up for Natalie, she may need a more standard upper jaw surgery to bring her upper teeth closer to her lower teeth, then “she should be good to go for the rest of her life,” said Hopper.