BIG Problem from Mr. Small - Dublin, Ireland

Hi, this is a relatively long review about Mr....

Hi, this is a relatively long review about Mr. James Small from The Clinic Sandymount Green, Dublin 4, I urge everybody to read it fully and not just flick through. Discover how Mr. James Small claims that my nose is in fact not crooked and that we may call it “an illusion”. I invite you to take a look at the pictures and decide for yourselves if this is an illusion.

They say hindsight is 20/20, well alarm bells should have started ringing when there was a discrepancy over the cost of the surgery. At our initial consultation he quoted me “around €7000”, about 6 weeks later I had a bill come through the door for €8000, this was about 6 weeks prior to the surgery. In my opinion, this is a sign that he is more interested in the money than the patients outcome and wellbeing. I also believe he overcharged me as I had been to see some more expensive surgeons in England (which I told him about). I have seen a similar job (lifting the tip) on here that Mr. Small performed and the girl was only charged €6800. Funnily enough, she is not overly happy with the results either!

I had a rhinoplasty procedure performed in December of 2015. My surgeon had said in a post-op consultation that with time things would sort themselves out, this gave me a false sense of hope.

The reason I am writing this review now is because things have not turned out the way I would have hoped. I feel the need to share my story with you now so that you know my opinion of this surgeon’s skills and limitations with regards to rhinoplasty and take it into account when choosing your surgeon.

I have always had a large nose that I wanted to do something about. I was also involved in a number of accidents when I was younger that caused trauma to my nose, making the nose crooked and bumpy. It took me years to save the money up to finally go and do something about it, I went for roughly 7 or 8 consultations with different surgeons in Ireland and England, I only wanted to go through this procedure once.

After a few consultations with different surgeons, I had originally planned to go with a Mr. Matti in London. During a consultation he used digital imaging to show me how he planned to change my nose. The result looked great from the side but the main thing I was unhappy with was the crookedness and size of my nose from the front view, the imaging was still not showing my nose to be perfectly straight like it used to be before the accidents. I was a little put off by this, so I went seeking more consultations.

My final consultation was with Mr. James Small from The Clinic Sandymount Green, Dublin 4. I had told the secretary when I was arranging the consultation that I had some images I wanted to show Mr. Small. These images would show how I would like the end result, she said there would be no problem with this and to bring them along. Whilst I am fully aware that these are only images and you have to work with the nose you have to achieve the final outcome, I feel that at the very least they should give the surgeon an idea of the changes you want made. In my opinion when the doctor looks at this he should then raise any concerns he has and let you know in clear terms what CAN and what CANNOT be achieved.
I brought along images on a USB device but I also had them on my phone just in case. When i arrived, the secretary was not on the grounds and Mr.Small said that she would usually sort these things out. To my surprise, he did not know how to get the images up on the screen, so i had no other choice but to use my phone. Upon examining the images that Mr.Matti had digitally altered he said "well, we should be able to get it a bit better than that", he repeated this multiple times. Mr. Small now denies ever having said this, this was the main reason I chose Mr.Small over Mr.Matti. I then continued to show him the images that I made in photoshop myself, he looked at these images and just had positive things to say, he never mentioned that he would not or could not do any of these things.

He spent a long time with me in the initial consultation, something that the other surgeons I visited did not do, I would say we chatted for an hour whereas the other surgeons spent 15 minutes with me. This was another key reason why I chose Mr. Small, I thought he was listening to me and that we were on the same page. The initial things I asked Mr. Small to change were :

1.Fix the crookedness
2.Remove the bumps / lumps on the bridge (each bump and lump was discussed)
3.Lift the tip as it was drooping down
4.Reduce the bulbous tip
5.Bring in the nostrils
6.Generally make the nose smaller

The problems that now exist (some of which were not an issue prior to the operation):

1.Nose is still crooked
2.Lump on the left side of my bridge remains
3.Bulbous tip remains and may even be wider
4.My nostrils are completely different and you can see in the right nostril from front profile.
5.The bridge is wider than before
6.The nose is noticeably bigger overall

From looking at the pictures, it appears to me that the only change that was made was to lift the tip of my nose, even when he did this he left the columella drooping down so it now hangs down and is too big from the front view. As you can see from the pictures I have included, the nose is extremely crooked, it actually appears even more crooked than before, this is something that myself and Mr. James Small have talked about post-op, he continues to dismiss claims that my nose is crooked, he says “what you call crooked or deviated, I would call asymmetry”. This is a simple case of six and half a dozen, I agree that there is asymmetry, while this is to be expected with any human face, the sheer amount of asymmetry is the problem.

After my surgery I was allowed to remove the cast myself after about 10 days. As soon as i removed the cast I was unhappy looking at the result. It was crooked, bumps remained where they were before (they had just been shaved down a little), the nostrils were uneven and completely different. I put this down to swelling and tried to convince myself that I liked the result. I avoided people completely for a month afterwards.

I went to see Mr. Small in January so he could have a look at the result. He looked at the nose and said "Well, what do you think?", I said "it looks a lot better from the side, but my nose is still crooked and bumps remain, it's still too big", he replied with "well that's just swelling it will get smaller, I can see the bump on the left still, if that doesn't go down we can remove that, don't worry", I said "remove it? will I have to pay for that" he replied "No, no I will do that for free, how does that sound", I felt a little bit happy as I had a comeback, at least if the bumps did not go down he would re-do the job, I pushed about the nose being crooked again he said "Your nose is not crooked, that nose is dead central", I said "my nose is crooked", he replied "Listen we must wait 6 months to a year to see the final results this could all be swelling".

Once I had done my best to show him my nose is still crooked, he then said “you have one good line there now”, this is in relation to the right deviated side of the nose (left in the pictures). I did not pay a lot of money for one good line, I paid for a straight nose. The one “good” line he refers to is only “good” because it is bump free. The “good” line points off to one side of my face and in my mind is the main reason that my nose is crooked.

He spent about 10 minutes with me in the post op compared to the length he spent pre-op, I would imagine he felt uncomfortable looking at the result and having an unhappy patient, I felt like he had my money now and that was it. He was dismissive of everything I said and passed all the problems off as swelling, he even made mention to “swelling of the bone”, which doesn’t actually exist!

As the weeks went on and my nose became a little bit more refined, the main problems I listed above still persisted, the crookedness, the bumps, the uneven nostrils etc. I arranged another post op consultation with Mr.Small, I wrote a letter to him before I arrived explaining the problems with the operation, the letter was long and extremely detailed. It provided quotes of things he had said such as "This is the kind of thing that you only want to get done once" which he repeated over and over pre-op. The consultation was booked weeks in advance and I sent the letter about a week prior to the appointment, the day before the consultation he tried to cancel the meeting with me and said he would need more time because of the letter I wrote. I refused and said that I would be leaving the country soon. He agreed to meet because of the circumstances. The letter I wrote was sent on February 25th 2016, to which I only just received a reply on June the 16th 2016, I suspect that he was in contact with a lawyer who told him he must reply to the letter to cover himself.

At the second (and most recent) post-op consultation, the secretary was there and she was nice (as usual), she said that Mr. Small would be out soon. This consultation was very disturbing for me. He started off by saying "I received your letter",I could tell he was not happy and he was nervous as he kept stuttering and repeating things. I asked him to go down through the letter (he had printed it and it was in front of him), he refused and raised his voice saying "I do not want to go down through the letter, you need to wait 6 months". There was a lot of disturbing things said in this consultation, I wrote them all down as soon as I came out of the consultation when they were fresh in my mind. I said during this consultation that I felt the ratio was not right with the bridge to the tip, I wanted the bridge reduced, Mr James Small chuckled condescendingly and said “the ratio?” and then chuckled again, he then said “you never mentioned the ratio”, I may have not said the word ratio, but I did say I wanted the bridge to be slimmer, something that wasn’t done. That said, I also told him I wanted the bulbous tip reduced and this was not done either.

During the consultation I asked Mr. Small "are you happy with this job you have done", he replied with "look, this is the thing with surgery, there are always risks". He repeatedly told me that my nose was not crooked. He actually said "your nose is not crooked, you may call it an illusion", I think we can all agree from the pictures that this is no illusion, it is in fact crooked.

In retrospect and after much deliberation with other parties, it seems as though he was treating the symptoms rather than the root cause during this operation. It’s fairly plain to see based on my before picture that the bridge is crooked and twisted and this is actually the cause of both the lumps on the sides.

The fact that he could not see that my nose was crooked after the operation is even more disturbing. I believe that the course of action he recommended to achieve my desired results was simply incorrect. As he was the expert with the qualifications in the field, I trusted him, I believed in him. I now feel as though this trust was massively misplaced.

He stated on numerous occasions that “this is kind of thing that you only want to get done once”. I hope you can all see what his "once" is like and act accordingly.

Given the results of my operation and after care, I’ll leave you all to make up your own minds as to whether or not you’d trust this man to operate on you, if I could have my time back, I certainly wouldn’t.
Dublin Plastic Surgeon

Given the results of my operation and after care, I’ll leave you all to make up your own minds as to whether or not you’d trust this man to operate on you, if I could have my time back, I certainly wouldn’t.

1 out of 5 stars Overall rating
1 out of 5 stars Doctor's bedside manner
1 out of 5 stars Answered my questions
1 out of 5 stars After care follow-up
1 out of 5 stars Time spent with me
1 out of 5 stars Phone or email responsiveness
1 out of 5 stars Staff professionalism & courtesy
1 out of 5 stars Payment process
3 out of 5 stars Wait times
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