Botched results - none of my pre-surgery expectations were met

OPINION
The following is my OPINION based on my PERSONAL INTERACTIONS with Dr. Jason Hamilton and the RESULTS of my rhinoplasty procedure. The review is lengthly, but highly relevant for anyone considering rhinoplasty with Dr. Hamilton. For brevity, the core of this review is contained in the section labeled “THE RESULTS”.
THE RESULTS
My procedure was performed in early October 2017, so I am now approximately 18 months post-op. At the time of my procedure I was a 50 year old African American male (now 52) who presented with fairly standard concerns for an African American seeking a COSMETIC primary rhinoplasty procedure - a low, wide bridge (I was particularly concerned about the width and height of my nose at the radix) and lack of definition in the tip (it was round/bulbous). I had no breathing issues whatsoever, so from a FUNCTIONAL perspective I had no issues with my nose. I am emphasizing COSMETIC vs. FUNCTIONAL now because this relates to a very important observation about Dr. Hamilton.
In short, I consider the results of my procedure not only BOTCHED, but NONE of my pre-surgery expectations were met. Post-op, I still have the low, wide bridge I disliked prior to surgery. Dr. Hamilton’s botched attempt at an osteotomy to address the width of my bridge has resulted in EXTREME asymmetry. I literally have TWO NOSES now - one on the left side of my face and a completely different nose on the right side of my face. During surgery, the nasal bones were shaped DRAMATICALLY different on the left and right sides of my nose, and this is COMPLETELY visible. The results literally look like I had an ACCIDENT; as if, for example, I took a sharp elbow to the nose while playing basketball. The nasal bones on the right side were dramatically OVER-RESECTED in a way that looks COMPLETELY UNNATURAL, is not MASCULINE, and is completely INCONGRUOUS with any other features of my nose.
Regarding the tip, post surgery I still have a tip I would describe as round, bulbous and lacking definition. At the pre-op I showed Dr. Hamilton a photograph of the results I wanted for the tip. I had taken the photograph from the website of Dr. Oleh Slupchynskyj, who is well known for performing African American rhinoplasty. Dr. Hamilton literally looked terrified by this request, and stated I would get “messed up” if I had this tip surgery. Although I didn’t realize it at the time, with this interaction my surgical goals for the tip of my nose were apparently COMPLETELY DISCARDED.
Dr. Hamilton presents himself as an expert on the “black nose job”. In my OPINION, refinement of the BRIDGE and TIP are the cornerstones of COSMETIC rhinoplasty for this population. Based on my RESULTS, I think Dr. Hamilton lacks the fundamental skills necessary to successful perform COSMETIC rhinoplasty on black noses, both in terms of his AESTHETIC (what an attractive black nose looks like) and his TECHNICAL SKILL (the ability to deliver desired results). To be absolutely clear, with my results I’m not lamenting the difference between a good result and a great result, but rather the difference between an ACCEPTABLE result and a COMPLETELY UNACCEPTABLE result. Because of this, if you are Black I would advise extreme caution about using Dr. Hamilton for a cosmetic rhinoplasty procedure. If you are Black and male I would DEFINITELY avoid him altogether.
I have emphasized COSMETIC vs. FUNCTIONAL in this review for a reason. If you do your research on Dr. Hamilton you will find that he has TWO WEBSITES. On one website he emphasizes his capabilities as a ‘FUNCTIONAL NASAL SPECIALIST”. There are lots of BEFORE and AFTER pictures on this website with mostly non-Black patients. On another website Dr. Hamilton presents himself as ‘BLACK NOSE JOB SPECIALIST”. There are far fewer pictures on this website and some have been up for years.
Of course he COULD be both a FUNCTIONAL and COSMETIC specialist, but based on my results, if you are exclusively seeking COSMETIC changes to your nose, and your are Black, I would definitely use someone else.
From a FUNCTIONAL perspective, I had no issues whatsoever with my nose prior to surgery. Now, 20 months post-op, the tip of my nose is STILL NUMB and my nose is SO DRY I require frequent saline spray to improve my comfort. So not only were my cosmetic goals not met, but I am also worse off in terms of the FUNCTION of my nose.
1 WEEK POST-OP
The days after surgery, I noticed that the cast placed OVER my nose was DRAMATICALLY CROOKED. I say “OVER” my nose because the cast was a completely different shape and width than my post-op nose, so it wasn’t really protecting or holding anything in place, it was simply taped on my face OVER my nose. When the cast came off after about a week my nose was very swollen, so the results were not visible. I did notice, however, that after Dr. Hamilton removed the cast and packing from my nose, he took a LONG time before he presented a mirror. I was, quite understandably, extremely anxious to see the results of my procedure, and Dr. Hamilton went on for several minutes engaging in idle small talk. When he finally presented a mirror I observed that my nose didn’t look improved. In other words, I didn’t see the changes I was expecting. Dr. Hamilton produced a nervous chuckle in response to my comment about this. Notably, Dr. Hamilton NEVER asked me what I thought about the results of the procedure..
While I noticed the crooked cast right away, I didn’t begin to understand the underlying issue until about 3 weeks after my procedure, when I finally touched my nose and discovered that the nasal bones were shaped DRAMATICALLY different on the left vs. right sides. My heart literally SANK with this discovery. I wrote an email to Dr. Hamilton to express this concern and he called and advised me to wait and be patient, and of course this was completely reasonable at 3 weeks post-op.
3 MONTH POST-OP
At the 3 months post-op I did a skype call with Dr. Hamilton. Contrary to his assurances at 3 weeks, at 3 months my nose was actually looking WORSE and not better. Over time as the swelling subsided the underlying asymmetry in the shape of the nasal bones was becoming more and more visible. As I expressed my dissatisfaction with my results, Dr. Hamilton became LOUD and very ABRASIVE with me. I was completely shocked by this dramatic change in his disposition. We ended the conversation with additional assurances about the need to be patient, which was completely acceptable at the 3 month mark.
THE CONSULTATION
During the 3 month post-op skype, I re-presented a photograph I had used to express my desired changes during the consultation, which had occurred in July 2017 in Orlando, FL. I had spent several months and countless hours researching the procedure and desired outcome. To facilitate the conversation with Dr. Hamilton I presented pictures of Black men, some who had obviously had a rhinoplasty procedure, to make clear what I DID and DID NOT want. There was one picture of a Black male whose nose I liked, which I discussed and referred to extensively. At the end of an hour plus consultation, referencing the picture, I asked Dr. Hamilton "How close can you get me to this? 50% , 60%, 70%? Dr. Hamilton waved his hand and confidently stated "Oh, I can get you 100% there." Based on this representation, I chose Dr. Hamilton and paid the fee, which was $9,420 in total ($5,400 surgeon fee, $2,750 surgical suite, $770 anesthesia, $500 consultation).
When I re-presented this same photograph at the 3 month post-op, Dr. Hamilton became angry and agitated, asking me “What are you showing me this for?”. At this point, Dr. Hamilton COMPLETELY walked back the assurances he gave me at the consultation. He then freely talked EXTENSIVELY about what he COULDN’T DO, about how Blacks have thick skin and weak cartilage, and about how my nose was asymmetric prior to surgery. Dr. Hamilton discussed NONE of these limitations at the consultation, BEFORE he was paid. It was only AFTER he had been paid, after the procedure, did Dr. Hamilton begin to OPENLY and HONESTLY discuss what he considered to be the limitations of the procedure. With this let me be clear: IF DR. HAMILTON HAD DISCLOSED THE LIMITATIONS OF THE PROCEDURE AT THE CONSULTATION I WOULD NOT HAVE MOVED FORWARD WITH HIM.
Also noteworthy, while Dr. Hamilton charged $500 for the consultation, he performed NO PHYSICAL EXAMINATION of my nose, did not even touch my nose or look inside it, and NO PHOTOGRAPHS were taken. Further, Dr. Hamilton had NO MIRROR present for the consultation. Typically, during the consultation the doctor will present a mirror to the patient and ask him/her to point out areas on the nose where changes are desired. Still, Dr. Hamilton told me he could produce 100% of the changes I was seeking. In hindsight I now realize that this was a strong indication NOT to use him.
6 MONTH POST-OP
The 6 month post-op was in person, in Orlando FL (in the same non-medical office where the consultation took place). This is the first time Dr. Hamilton had seen me in person since the cast was removed 6 months prior in Los Angeles. Again, Dr. Hamilton had NO MIRROR present for the meeting, but this time I had brought my own. Using the mirror, I explained my concerns about the results of my procedure to Dr. Hamilton, again emphasizing the DRAMATIC ASYMMETRY in the bridge. Again, Dr. Hamilton did not TOUCH my nose or perform any PHYSICAL EXAMINATION. He simply assured me that the final results take time and advised me to be patient.
1 YEAR POST-OP
The 1 year post-op took place in Atlanta. Dr. Hamilton happened to be in Atlanta for a medical conference at the 1 year mark so I was able to make an appointment to see him. At the 1 year mark the results of the procedure are pretty much final so the “be patient” advice was less applicable. I met Dr. Hamilton in a hotel lobby for this meeting. Again, using a mirror I brought I discussed my concerns about the results of my procedure, emphasizing the DRAMATIC ASYMMETRY in the bridge. Also, during this meeting I insisted that Dr. Hamilton TOUCH MY NOSE so he could observe the dramatic asymmetry in the shape of the nasal bones.
Dr. Hamilton INITIALLY DENIED he could see the issues I was concerned about. After I got a little loud and agitated (again, we are in the public lobby of a large hotel) Dr. Hamilton relented and admitted he could see my concerns. I then pressed Dr. Hamilton about how this could happen. The DRAMATIC ASYMMETRY was visible when I was ON THE TABLE at the conclusion of the procedure. This is underscored by the fact that the cast placed on my face was DRAMATICALLY CROOKED. As I pressed this issue, Dr. Hamilton finally admitted his mistake and stated: “I WAS WRONG”.
And there you have it, “I WAS WRONG”.
As we concluded the meeting Dr. Hamilton was pressing me about when I could come to Los Angeles for a revision. I was, of course, completely non-committal. With this let me be clear: UNDER NO CIRCUMSTANCES WHATSOEVER WOULD I ALLOW DR. HAMILTON TO OPERATE ON MY NOSE AGAIN AS I ABSOLUTELY DO NOT CONSIDER HIM TO BE A SKILLED OR EXPERIENCED COSMETIC RHINOPLASTY SURGEON, ESPECIALLY FOR BLACK NOSES.
That meeting was 6 months ago. I have not communicated with Dr. Hamilton since, nor do I ever expect to communicate with him again.
THE NOTES
At the 1 week post-op, before I saw Dr. Hamilton, I asked for a copy of the notes. I made this request because I live in Atlanta, and if there were any complications I wanted to be able to present the notes to a local doctor so it would be clear exactly what had been done. Dr. Hamilton’s office did not produce the notes that day, but instead forwarded them to me via email approximately 3 weeks later.
When I read the notes about goals for the surgery I was literally stunned. While I had been very CLEAR and SPECIFIC with Dr. Hamilton regarding my goals for surgery, referencing the bridge extensively, none of this was contained in Dr. Hamilton’s notes. Instead, Dr. Hamilton’s notes described the goals for surgery in language I would describe as extremely VAGUE , GENERAL and CONCEPTUAL language. I literally thought I was reading the notes for another patient that had somehow gotten mixed up with mine. Further, the pronoun “her” appears in my notes (I am male) which leads me to speculate whether Dr. Hamilton is simply cutting and pasting information. My goals for surgery were not at all accurately reflected in Dr. Hamilton’s notes, so naturally none of my goals for surgery were actually met.
Interestingly, while my consultation occurred in late July 2017, and my pre-op occurred on October 3, 2017, the notes indicated they were created on October 15, 2017. If Dr. Hamilton allows this amount of time to pass between an encounter with the patient and capturing the patient’s objectives from that encounter, it’s no wonder his notes are completely inaccurate as far as patient objectives are concerned. Further, if you wait until AFTER the surgery to write the pre-surgery notes, then the notes can be aligned so they are more consistent with the surgical outcome, which is now known.
BLACK DOCTORS PLAYING THE RACE CARD
I have had two cosmetic procedures that are considered more difficult for African Americans: a hair transplant and a cosmetic rhinoplasty. In each case I chose Black surgeons because I (falsely) believed that they would perhaps have more skill, expertise and empathy for me as an African American patient. In each case I was COMPLETELY WRONG and I am TOTALLY DISSATISFIED with the results. With the hair transplant I had 2,000 grafts which completely failed, resulting in me winding up with LESS HAIR after the procedure than before. What I want African American patients considering cosmetic surgery to know is this: DO NOT ATTRIBUTE ANY SKILL, EXPERTISE, CONCERN OR EMPATHY to a surgeon based on race. I have done this twice and been profoundly disappointed. Base your decision on the surgeon’s HISTORY OF RESULTS. Regarding cosmetic rhinoplasty, if a surgeon can’t show you 20 (or even 10) before and after pictures of Black patients AND give you the contact information for a several prior patients you can speak to, DO NOT USE THAT SURGEON. It’s easy to TALK about what you can do, but the proof is in the results.