Chrissy Steltz, who lost her face to a shotgun blast, to undergo second surgery

Surgeons plan to drill eight titanium dental implants into Chrissy Steltz's disfigured face next month – none of them in her mouth. 

They will be sunk half an inch into her eye sockets and cheekbones as "footings" for a prosthesis that Steltz hopes will allow her to face the world again without a black nylon mask. 

It's the second major step in a year-long effort to rebuild Steltz's face, much of which was destroyed by an accidental shotgun blast nearly 11 years ago. She was 16 at the time, partying with other unsupervised teenagers at her boyfriend's apartment in Southeast Portland. 

View full sizeRandy L. Rasmussen/The OregonianDentist Larry Over marks where the dental implants will be placed on Chrissy Steltz's face.The blast blinded her and blew away her nose and cheeks from her forehead to her upper jaw. "Most of face gone," is the short answer under "reason for admission" on her voluminous medical chart, starting when she was rushed toLegacy Emanuel Hospital & Medical Center on March 21, 1999. 

Step 1 in the new effort to restore Steltz's face was a three-and-a-half hour surgery on Sept. 30. A team led by Dr. Eric Dierks, a Portland head-and-neck surgeon, cut a large nasal opening in the "paddle" of grafted skin covering the middle of her face. 

Step 2, scheduled Feb. 9 at Legacy Emanuel, involves setting the eight screw-like implants, two around each eye socket and two along each cheekbone. Eventually, a silicone  prosthesis designed to match Steltz's original face and skin tone, with hand-painted plastic eyeballs and an artificial nose, will snap onto the implants, held in place by magnets. 

That final step won't happen until summer. The implants take four to six months to fuse solidly with the bone. 

"What we want is like rebar and concrete," said Larry Over, a Eugene dentist and maxillofacial prosthodontist who will design and build the new face mask. 

He saw Steltz first in 1999, months after the shooting, but she was not medically or emotionally ready for such an elaborate reconstruction. A decade later, Over says she has grown up impressively. 

"I saw a big change," he said. "She's much more mature, much more responsible." 

Steltz lives in Milwaukie with her boyfriend of seven years, Geoffrey Dilger, who also is blind, and their 6-month-old son, Geoffrey Jr. 

Dierks and Over have collaborated on other complex facial reconstructions – usually in cases of trauma or cancer of the mouth, jaw or eye. But Steltz's is their biggest. The sideways shotgun blast entered just below her right eye and exited her left temple – only grazing her brain even as it ruined her eyes and mid-face. 

Her prosthesis must cover both eyes, as well as the nose and both cheeks. 

"The size is what makes it a huge challenge," Over said. "So much of her face is missing. 

"We can't give Chrissy her sight back," he said. "But we can help get enough of her face back so that she can go out in public without people, you know, staring at her." 

Designing and sculpting a facial prosthesis is dicey. It must be lightweight (about 4 ounces), snug and aesthetic, matching the original as closely as possible. It has to be sturdy enough to last for years. It must be easy to take off and clean – and yet secure enough to stay on even if, say, Steltz sneezes violently or stumbles. 

To help make the prosthesis as realistic as possible, Over will study photos of Steltz taken before the accident. 

Breathing improves

 
It is not clear how much of the cost will be covered by insurance. Most insurers, including the Oregon Health Plan, cover reconstructive surgery for functional purposes, but not cosmetic. In a case such as Steltz's, the distinction blurs. Her doctors say they will absorb the cost of what is not covered by insurance, and the manufacturer is donating the dental implants, which cost about $2,100 each. 

During the September surgery, before cutting a new nasal opening where Steltz's nose used to be, Dierks removed the remains of her right eye and trimmed scar tissue and bone. He also took out some "hardware," metal plates and bits of wire left over from her original trauma operations. Surgeons had used a section of fibula, the slender shin bone, and metal plates to replace her shattered cheekbones and upper jaw. 

Steltz still lacks a nose and sense of smell, but she can breathe nasally for the first time in more than 10 years. She also sleeps more soundly and speaks without a nasal tone. 

"We're just exactly where I hoped we would be," Dierks said after examining Steltz last month. "I'm very pleased. The next big thing will be to go in and place the dental implants." 

But to do that, he needs to know exactly where they should go. 

Time for a fitting 

In the center of a brightly lit examining room with three Norman Rockwell paintings on the walls, Steltz sits in a gray dental recliner, her cane folded on her lap. Her boyfriend sits by the window. 

They've come to Eugene so that Over can check Steltz's facial scars and contours and make a plaster impression of her face. The "map" will guide Dierks in targeting the implants, and Over in sculpting her prosthesis. 

Over repositions Steltz so that she is seated directly across from him at a small table. She removes her black sleep shade, revealing her scarred face, with its vacant eye sockets and the surgically cut nose hole. He asks her to lean forward into the light she can't see. 

"Let's take a look here," Over says, holding her face in his hands, a thumb on each cheekbone. "Smile for me real big." 

She smiles, her intact mouth and lips doing most of the work. 

"Relax. Smile again." 

He marvels at the improved symmetry of her face since her September surgery. 

"OK, give me a big squint." 

Because she can't see the wooden stylus tipped in indelible ink in his hand, he warns Steltz that he is about to draw dotted lines in ink on her cheeks, outlining where the edge of the prosthesis will meet her own skin, from just above the eyes to her upper lip. 

He studies her again, then marks eight spots, in purple, on her eye sockets and cheeks. The ink will stain the plaster impression. 

As Steltz leans back in the recliner, Over dabs wet gauze into her eye sockets and nose hole and fits a wall of red tape around her face to contain the impression. Twelve scoops of goopy plaster cover her face like a scuba mask. It hardens in a few minutes, and Over taps it and gently wiggles it off. 

The plaster mold shows eight purple marks for the implants –a surgical map for Dierks. 

Steltz puts her black sleep shade back on and rejoins her family in the waiting room, where baby Geoffrey is asleep in Dilger's father's arms. Everyone is upbeat. 

"One more step," she says, "toward all this being done." 

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