Plastic Surgery

Plastic Surgery

paul

paulMr Paul Johnson was educated in Yorkshire and attended Leeds University Dental School qualifying in 1979 with honours. After working in junior dental jobs at Leeds Dental Hospital, he returned to Medical School at the University of Cambridge in 1980 graduating Bachelor of Medicine and Bachelor of Surgery in 1984. He was House Surgeon to Professor Sir Roy Calne at Addenbrookes Hospital, Cambridge and trained in Surgery in General at the The North Staffordshire Royal Infirmary, Stoke-on-Trent. Higher training in Oral and Maxillofacial Surgery was in Stoke-on-Trent, the Queen Victoria Hospital, East Grinstead and King’s College Hospital in London.

Overseas experience includes training in Salzburg, Austria and Seattle. As a senior trainee he also took part in a ‘Medicine du Monde’ surgical team which treated war casualties in Addis Abbaba at the end of the Ethiopian civil war.

He was appointed as Consultant in Oral & Maxillofacial Surgery at the Royal Surrey County and Frimley Park Hospitals in 1992 and is now the Senior Consultant in the Maxillofacial Department at the Royal Surrey County Hospital.

His clinical interests are wide ranging and he has published on several areas of maxillofacial surgery. Current areas of special interest are in the treatment of facial deformity, facial cosmetic and reconstructive surgery and the treatment of skin cancer. He is a core member of the Multidisciplinary Tumour Group for skin cancer at the Royal Surrey County Hospital.

He lectures and conducts surgical masterclasses nationally and internationally and is closely involved in training surgeons in his speciality and related specialities in the UK. Teaching interests extend to facial cosmetic and orthognathic surgery. He runs a Royal College of Surgeons approved cosmetic fellowship based in Guildford and London to train junior Surgeons in facial aesthetic procedures.

He currently chairs the Training Interface Group of the Royal College of Surgeons for reconstructive cosmetic surgery, laser surgery, soft tissue trauma and skin cancer. He is active in the British Association of Oral & Maxillofacial Surgeons (BAOMS) and represents them on several national and international Committees. He is the BAOMS lead for Orthognathic and Facial Cosmetic Surgery. He is also an interspecialty member of the British Association of Aesthetic Plastic Surgeons (BAAPS). He is currently secretary of the Academy of British Cosmetic Practice.

In the private sector Mr Johnson is based at the Nuffield Health Guildford Hospital and Shades Clinic where he pursues a busy general Oral & Maxillofacial practice and Facial Aesthetic practice.

He is chairman of the Medical Advisory Committee at the Nuffield Health Guildford Hospital.

Key areas of specialist expertise

  • Common and surgical conditions, such as impacted wisdom teeth, are treated under general or local anaesthetic.
  • Skin cancer, which is primarily caused by exposure to the sun, is increasing. Changing lesions and moles should be checked to exclude skin cancer.
  • Mr Johnson is a world leader in the treatment of dental malocclusions and the correction of jaw anomalies and works closely with orthodontist practitioners.
  • A wide range of facial cosmetic procedures are provided, from reducing the signs of ageing to transforming unwanted or unattractive facial features.

Surgical Procedures

Oral Surgery & Oral Medicine
Oral surgery and Oral Medicine deal with conditions affecting the mouth and related structures, for example, salivary glands.

This includes both soft tissue conditions affecting the oral mucosa, or lining of the mouth, and conditions of the teeth and jaws. Soft tissue lesions may be removed for microscopic examination. Oral ulcers may need to be examined to exclude pre-malignancy or malignant conditions of the mouth.

The most commonly dealt with dental problems from the surgical prospective are impacted wisdom teeth. Wisdom teeth commonly cause problems, typically in young adults, but also in older patients. Removal may be complicated and can be carried out under local or general anaesthesia. Typically patients are admitted for a general anaesthesia on the day of surgery. Removal takes approximately 30 minutes and patients are discharged home later the same day. Dissolving stitches are often in place, which take about ten days to dissolve and patients can expect to be swollen and even bruised for approximately five days.

Dental Implants
Dental Implants have revolutionised the replacement of missing teeth

Alternatives to dental implants include dentures and bridges. Implant, however, can be used either to replace individual teeth or provide the support for bridges or dentures within the mouth.

Mr Johnson places dental implants and works in conjunction with restorative dental colleagues who provide the restorative phase of care i.e. the provision of bridges, dentures etc. He also works with local Dental Practitioners in their practices to place dental implants. In some cases patients may require bone grafts to facilitate placement of implants when there is insufficient bone in the jaw to permit placement of implants.

Dental implant treatment can be carried out under local or general anaesthesia.

Orthognathic (Jaw & Chin) Surgery
Dental maloclusions and facial deformities can be corrected by means of surgery to the jaw and chin

These procedures, which are known as osteotomies include surgery to either the maxilla (upper jaw) or mandible (lower jaw) or both (bimaxillary osteotomy) and is usually combined with orthodontic treatment carried out by an Orthodontist.

Typically the Orthodontist prepares the patient for surgery by placing the teeth in a position so that when the jaws are moved the teeth will fit together. After appropriate preparation by the Orthodontist surgery can then be carried out to move the jaw(s). It is possible to move both upper and lower jaws to the appropriate position in one surgical procedure. Single jaw surgery typically takes about an hour to perform.

Following single jaw surgery patients can expect to be swollen post operatively for approximately two weeks. In lower jaw surgery the most commonly encountered complication can be numbness or tingling of the lower lip due to interference with the inferior dental nerve, which runs through the lower jaw. This generally recovers fully, though patients must be aware that the lip may be numb for weeks or even months following surgery.

Two jaw or bimaxillary surgery usually results in a three-week recovery period. The emphasis in the treatment of dento-facial deformity is on obtaining the correct dental occlusion i.e. the teeth must meet correctly. However, movement of jaws may change a patient’s appearance and a great emphasis is placed by Mr Johnson on obtaining the best aesthetic result. Mr Johnson has unrivalled experience in this form of surgery in the UK and receives referrals from throughout the UK and also from abroad. He lectures widely nationally and internationally on this subject and has an international reputation in this area.

Chin retrusion or prominence can also be corrected by means of a procedure called a genioplasty.

Jaw Joint
Disorders of the jaw joint or temporomandibular joint are common.

These can present as a clicking joint or locking of the joint. This is due to displacement of the cartilage within the joint. A displaced cartilage can cause a clicking joint and this is termed reducible displacement of the joint meniscus. Occasionally, the cartilage can become completely displaced and not reduce into position when the mouth is open. There is then no click in the joint but the patient presents with extreme limitation of opening of the mouth and pain. Investigation of jaw joint problems involves x-rays and occasionally MRI scans. Treatment consists of the use of appliances in order to decrease pain, injections into inflamed joints and occasionally surgery to reposition displaced cartilages and anchor them into position.

The temporomandibular joint can also be affected by arthritis. The muscles, which act on the jaw, can also become painful due to habits such as tooth grinding at night. These conditions can generally be treated with analgesia or suitable dental appliances.

Occasionally other conditions causing facial pain may masquerade as temporomandibular joint pain. Neurological conditions such as atypical facial pain, trigeminal neuralgia or cluster headaches affect the face and can cause severe pain. The commonest cause of facial pain, however, is toothache. Comprehensive investigation of facial pain therefore involves thorough clinical and radioligical dental examination and examination of the teeth, jaws and temporomandibular joints.

Skin Lesions
A variety of skin lesions can present on the face.

These can be benign lesions, such a seborrheic keratoses, which although not worrying from a medical view, are disfiguring and are easily removed usually using a laser.

A variety of other skin swellings and lesions can also be removed. The emphasis is always on obtaining the best cosmetic result, leaving inconspicuous scars. Most skin lesions can be removed under a local anaesthetic.

Skin Cancer
Skin cancer is increasingly common in the United Kingdom and is the result usually of sun exposure in fair skinned individuals.

Three types of skin cancer are commonly encountered:

Basal cell carcinomas, or rodent ulcers, are very common and occur usually on the face. They are treated by excision. Once removed they are cured and these tumours do not spread to other parts of the body.

Squamous cell carcinomas usually present as ulcers or nodules on the skin. Again the treatment is surgical and follow up is usually required because it is possible for them to spread.

The most worrying type of skin cancer is melanoma. These present as pigmented lesions usually and can spread widely. Treatment is again by excision. Auxiliary treatment may be required. In an aesthetically sensitive area such as the face obtaining the best aesthetic result from any form of treatment is clearly a priority.

Mr Johnson is a core member of the Surrey Multidisciplinary Tumour Group for Skin Cancer.

Facial Cosmetic Surgery
All aspects of facial cosmetic surgery are undertaken by Mr Johnson including:

  • Jaw and Chin reshaping (genioplasty)
  • Eyelid surgery (blepharoplasty)
  • Nose reshaping (rhinoplasty)
  • Face lift
  • Neck lift
  • Correction of prominent ears (pinnaplasty)
  • Revision of unsightly scars
  • Botox and fillers

Call us today to arrange an appointment to see Mr Johnson.