Consultant Facial Surgeon Kent, UK
MAXILLOFACIAL & RECONSTRUCTIVE SPECIALIST:
Treating disorders of the face, mouth, jaws, jaw joint, salivary glands and neck
Care and Skill in practice, Clear and Honest in tone, When and Where it matters, to you
David's commitment to your care
Facial cosmetics; facelift After trauma / cancer deformity
Facial Cosmetics
Surgical management of deformity after treatment for head and neck cancer or trauma is my subspeciality interest.
This could be total nose reconstruction.
This could be resurfacing of scarred or retracted tissue heavily damaged by surgery and / radiotherapy.
I perform deep plane face lifts for untreated hemi-faces to harmonise facial aesthetics and improve balance.
Lower lip weakness can be managed by muscle plication. An upper lip lift is straightforward.
I manage lower eyelid deformity by various canthopexy procedures to treat epiphoria and cosmetic appearance.
I will guide you when non surgical treatments are to be preferred.
Pre-prosthetics; zygomatic implants, ridge augmentation and
Pre-prosthetic surgery
Surgical management of bone deficit is a core of the pre-prosthetic surgical concern.
I perform bone grafting with bone subsitutes, as ridge augmentation or sinus floor lift.
I perform onlay grafting.
If bone deficiency after treatment for head and neck cancer or trauma the need, zygomatic implants or dnetal implants maybe offered. I have performed free flap surgery with composite flaps for pre-prosthetic purposes. This can be complemented with;
Single unit implants
Zygomatic implants
Full mouth dental restoration with Appletree Dentists
I will guide you when non surgical treatments are to be preferred.
Facial Onlays for Aesthetics
Prosthetics: 3D customised implants
I can consult for bespoke implants (chin or cheek) which can be planned and fabricated to your requirements. This will require high resolution pre-operative CT scanning and virtual planning.
The implant is inserted under the soft tissues of the face and permanently fixed to the underlying bone structure.
I co-wrote the chapter section 12.11 Modification of the Facial Skeleton in Aesthetic Facial Surgery
in the following text:
Kay, Simon, David McCombe, and Daniel Wilks (Eds)
Oxford Textbook of Plastic and Reconstructive Surgery, Oxford Textbooks in Surgery
ISBN : 9780199682874
Aesthetics
I can treat facial cosmetic form and facial function. I am familiar with adapting cosmetic techniques when required after injury or disease.
Surgical procedures I offer to address facial aesthetics;
- Upper lip augmentation (Cupid's bow lift)
- Buccal fat pad excision / reduction
- Fat grafting to address volume deficit.
- Brow lift and eyelid procedures to address permanent upper face asymmetry.
- Face lifts (mini, deep plane) and neck procedures to address asymmetry after stroke, injury or surgery.
- Tendon slings and plastic surgical correction to address permanent lower face asymmetry.
Facial Trauma
I can offer prompt assessment & treatment planning of hard and soft tissue trauma
I can manage the following as day surgery admissions at the Spencer Unit, William Harvey Hospital, Kent
Broken nose
Broken Jaw
Broken Cheekbone or Orbit (with double vision)
Lacerations of the face and neck
Face, Mouth and Jaw Cancer
Mouth cancer including lip and jaws
I have 10 years experience as a Head & Neck and Reconstructive Surgeon working in Kent.
Our team has treated around 350 patients requiring major Head and Neck resections and immediate (free flap) reconstruction.
I have published clinical outcome data of this complex discipline of surgery. The key metrics of my unit compare favourably with national data on complication rates, margin resection rates and free flap success rates.
I have co-led the Quality Outcomes in Oral and Maxillofacial National Audit. In it's inaugural report I was the lead author of the Oncology and Reconstruction chapters. I developed the Risk Adjustment Methodology embedded in the programme.
My interests in surgical management of the Head and Neck include palliative surgery and treatment of late effects with surgery aimed at improving quality of life.
My academic collaborations with the University of Kent are now focused on benchmarking 5 year survival after surgical management.
I have published a paper in collaboration with Quantum Analytica (Surrey) and the Integrated Care Board of Kent; a study investigating Health Equity issues affecting the treatment of Head & Neck Cancer in Kent. The paper was supported with a Kent & Medway Cancer Alliance grant.
Skin Cancer and Facial Plastic surgery
Skin Cancer
Surgical management of skin cancer is a core part of my NHS commitment. I have performed thousands of excisions and plastic surgical reconstructions
I follow British Dermatology guidelines and discuss skin cancer patients on our weekly regional specialist skin multidisciplinary board meeting.
Successful treatment is a combination of achieving complete excision with safe clearance margins and optimal cosmetic surgical reconstruction. I have audited and researched extensively on this topic and developed risk adjusted models which serve as national benchmarks against which performance is reported.
I will guide you when alternative treatments such as creams or radiotherapy are to be preferred.
Cosmetic lesions; sun spots, tags, warts etc.
These lesions, though of no medical consequence, can be a cosmetic problem. I will assess and offer surgical excision in any area of the face if indicated.
Mouth Ulcers and sore mouth
Inflammatory disorders of the mouth lining
Oral apthous ulceration
Oral lichen planus
Pemphigoid or pemphigus
Nutritional deficiency states
Salivary gland disease
Benign or malignant disease of the salivary glands
Obstructive problems secondary to stones or strictures
Over or under production of saliva
Botulinum Toxin injections to treat Frey's syndrome OR excess saliva in context of neuro-degenerative disease
Sjorgen's syndrome assessment including testing with minor salivary gland biopsy and blood tests
I co-wrote Chapter 41 Major Salivary Gland Cancer
in the following text
R. Bryan Bell, Peter A (Eds)
Oral, Head and Neck Oncology and Reconstructive Surgery -
ISBN : 9780323265690
Facial Pain Including Botox
Temporomandibular joint dysfunction
Arthrocentesis
Masseteric and temporalis injection with Botulinum Toxin (Botox A)
Electromyographic guidance of needle for infiltration of lateral pterygoid with Botulinum Toxin
Open TMJ surgery; As the indication and evidence base for these procedures is limited, there will be strictly limited provision of the following open TMJ procedures :
- Meniscopexy
- Menisectomy
Update 2024; TMJ arthroscopy (Level 2)
Trigeminal neuralgia and other facial pains
Trigeminal neuralgia; medical and surgical management of acute exacerbations and poorly controlled neuralgic pain
Facial migraine and cephalgia's; medical management and appropriate onward referral to neurology and pain specialist colleagues.
Atypical facial pain; a holistic approach that includes maxillofacial assessment of possible causes, medical management, psychosocial enquiry and complementary medicine approaches.
Complex dental extractions
Difficult teeth OR Difficult (High risk) patients
Dental extractions that merit hospital care with sedation or general anaesthesia
Dental cysts and benign jaw pathology that merits oral surgical interventions
Scar Revision
C02 laser
Dermabrasion
Refashioning of traumatic or surgical unsightly scars
Keloid and hypertrophic scar management
Acne and pitted scars
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I welcome patients with private insurance from most UK Health Insurance companies.
Self paying patients are offered;
Initial consultation £250
Follow up consultation £200
Operation / procedure fees on request.