Dear Prospective Patient



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Dear Prospective Patient,

Thank you for your interest in Dr. Spiegel. It is our pleasure discussing your surgical options with you via email, telephone or in person. The following information is enclosed to help better familiarize you with Dr. Spiegel and our practice. Please read through the information thoroughly and if you have any questions please do let me know, I would be happy to review anything with you.


We are honored to be able provide our patients with the highest quality of care at the Boston University Medical Center and take great pride in the specialty services we offer.
Our practice recently moved into the new Moakley Building on the Boston University Medical Center campus. This state-of-the-art building is located in the center of campus and will provide our patients with a convenient and beautiful location for their healthcare. We hope you will visit us in our new location soon!
Thank you again for you interest and we look forward to working with you.
Best regards,

Kelly
Kelly Duchesney

Practice Coordinator


Jeffrey H. Spiegel, MD

Chief of Facial Plastic Surgery, Boston University Medical Center
kelly@drspiegel.com

617-414-5058

www.drspiegel.com

Jeffrey H. Spiegel, MD
Dr. Jeffrey Spiegel is Chief of the Division of Facial Plastic and Reconstructive Surgery at the Boston Medical Center and holds academic appointments in the Departments of Otolaryngology and Head and Neck Surgery and Plastic Surgery at the Boston University School of Medicine.

He received his undergraduate and medical degrees from the University of Michigan, where he served as president of the Alpha Omega Alpha medical honor society, and was selected to present the graduation address at commencement.

Dr. Spiegel completed an internship in General Surgery, followed by a residency in Otolaryngology – Head and Neck Surgery at the University of California, San Francisco. Further advanced training was obtained with fellowship in Facial Plastic and Reconstructive Surgery, and Microsurgery through Harvard Medical School. He currently devotes his practice to facial plastic surgery and head and neck cancer reconstruction. Dr. Spiegel is expert in both the most simple office procedures, and some of the most complex transplant reconstructions done today.

The busiest component of his practice is Facial Feminization Surgery (FFS). Dr. Spiegel has taken the techniques of the pioneer physicians and improved them to the safer and more effective surgical techniques he uses today. These new techniques not only allow patients to heal faster and more comfortably than in the past but in many cases, avoid the use of screws and plates without compromising the result. On average, Dr. Spiegel performs 1-2 feminization surgeries a week is greatly experienced in both full bone reconstruction and soft tissue work.

Dr. Spiegel has published numerous articles and book chapters on head and neck oncology and facial plastic surgery, and speaks nationally on these topics. His research efforts were recognized with the 2000 Sir Harold Delf Gillies research award by the American Academy of Facial Plastic and Reconstructive Surgery. Previous work has resulted in an interview in the science section of the New York Times and a United States patent. The majority of his current research revolves around feminization surgery and gender recognition.

To add to his busy schedule, Dr. Spiegel is one of a select few physicians who write and review facial plastic surgery questions used on the National Boards Exam in Otolaryngology- Head and Neck Surgery.

In addition to research and writing, Dr. Spiegel lectures and facilitates in several courses at the Boston University School of Medicine, and is frequently invited to speak at conferences and medical centers across the United States. He sees head and neck surgery and facial cosmetic surgery patients at Boston Medical Center in Boston’s historic and vibrant South End.


Frequently Asked questions

Q: Will any of Dr. Spiegel’s post-operative patients talk to me about their surgery?

A: Yes. Many of our patients are happy to discuss any questions and concerns you may have. Please let Kelly know if you would like to speak with someone and she can arrange that for you.


Q: Do you have any before and after pictures?

A: Yes. Our photo website is: http://www.drspiegel.com/ffs-facial-feminization-surgery.

The username and password are both: newpatient.

Q: Do you do computer imaging?

A. Our office does not perform virtual imaging for projected results but we highly recommend Alexandra’s work on www.virtualffs.co.uk. She does a wonderful job and her projected results are very accurate to what can be achieved with surgery. These photos are extremely helpful prior to surgery to discuss with Dr. Spiegel what you like (or dislike) about the virtual results and more accurately describe your surgical goals and ideal aesthetics.


Q: When does Dr. Spiegel perform surgery and how far out do you schedule surgery?

A: Dr. Spiegel’s main day in the OR is Thursday; however depending on the size of the surgical case we can often schedule surgery on a Monday, Wednesday or Friday. When booking a surgical date please let Kelly know what works best with your schedule and she will do her best to accommodate your request. We book surgery about 8 weeks in advance; however, we do our best to schedule your surgery as soon as possible.


Q: Are there any medications I should STOP taking prior to surgery?

A: Yes. You should STOP all aspirin, ibuprofen (Advil, Motrin, Naprosyn, Vioxx), vitamin E and Gingko Biloba products seven days prior to surgery. You should quit smoking AS SOON AS POSSIBLE and stop drinking alcohol one week prior to surgery. ALL hormones should be stopped two weeks prior to surgery unless your primary care physician or endocrinologist feels otherwise. Patients typically resume their hormones about four days following surgery—as soon as they are up and walking around frequently. Hormone use can cause blood clots—especially during inactivity (like surgery and recover)—so we ask patients to stop for their safety.


Q: Is there anything else I need to do to prepare for surgery?

A: Once you have decided on a surgical date and confirmed it with a non-refundable 20% deposit Kelly will provide you with a packet of information to help prepare for surgery. This information will detail what you will need to do to prepare for surgery. The hospital requires each patient to have a history and physical within 30 days of surgery and depending on the elected procedures and patient’s health some basic labwork. This can either be done with your local physician or at the hospital.




Q: Where should I stay?

A: There are a number of comfortable hotels near Boston Medical Center-this list is attached for your reference. If you plan on staying with a friend or at a hotel not on our list please supply us with the proper contact information. Boston is a small city so any hotel in Boston proper is about a ten minute cab ride to our office.


Q: How soon prior to surgery should I arrive in Boston?

A: You should plan on arriving in Boston no less than two days prior to surgery to give yourself plenty of time for your visit with Dr. Spiegel and any necessary testing with the hospital.


Q: How long should I stay in Boston?

A: Patients typically stay about one week after surgery. Dr. Spiegel prefers patients to stay 8 days after surgery so we can have some extra time to let the incisions heal before taking out the sutures.



Q: Should I have someone come with me or is there anyone I can hire to stay with me?

A: A travel companion is ideal, however, many patients travel alone and take care of themselves following surgery—and they are just fine. However, if you would feel more comfortable hiring someone to be with you we can arrange a private-duty nurse for you. The cost is $50/hr and a minimum of eight hours. Most patients stay in the hospital one night following surgery and this cost is included in your operating room fee.


Q: What should I pack?

A: Bring lots of comfortable clothing since you will be relaxing and recovery for the majority of your trip. Button down or zip front shirts/sweats are best in order to avoid pulling clothes over your head following surgery. Contact Kelly prior to your surgery to discuss the weather conditions as the weather in Boston varies quite a bit!



Q: When will I begin to look healed?

A: The first week following surgery your face in will be bruised and swollen. Icing the face following surgery is essential to help reduce as much swelling as possible. At your first post-operative appointment with Dr. Spiegel your stitches will be removed and we’ll clean up the incisions so your appearance will improve greatly. However, it will take weeks for the residual swelling to dissipate. Makeup can be used to mask any remaining bruising or redness just one week after surgery. Most patients feel well enough to go back to work 2-3 weeks following surgery. You will see an improvement in your result for many months following your facial feminization surgery.



Boston’s Own Diamond in the Rough
The attached article was written in May 2005 as a class project by a journalism student who interviewed Dr. Spiegel and some of his patients. By, Rachel R. 5/1/05
High above the artsy, pebble-strewn sidewalks of Boston’s famed Newbury Street, Dr. Jeffrey Spiegel tosses his head back in jovial laughter. In three minutes, forty-one seconds, his meter will run out, threatening the accumulation of his fourth parking ticket this month. As Director of the Division of Facial Plastic and Reconstructive Surgery at Boston University Medical Center’s Department of Otolaryngology - Head and Neck Surgery, Spiegel already has enough on his mind before adding another twenty-dollar ticket. Nevertheless, Spiegel leaps into motion, grabbing his overcoat and flying out of his office like a paper airplane. Skipping stairs and careening out the door, Spiegel emerges in pursuit of his cherry red Rav-4. With not a second to spare, he’s there, slipping the meter a handful of silver and pausing to breathe before answering one of his frequent patient telephone calls. Dr. Spiegel, the human equivalent of the energizer bunny, is doing what he always does: taking care of people.
The Art of Medicine

For Dr. Spiegel, taking care of people is more than a job; it’s a lifestyle. In addition to helping cancer patients through reconstructive facial plastic surgery, Spiegel is one of the few professionals in the world who regularly performs facial feminization surgery (FFS). FFS is a cosmetic surgery used to help people with Gender Identity Disorder, commonly referred to as transgendered, from one gender specific lifestyle to another. It is a series of cosmetic surgeries and therefore takes longer and is more complicated than most. The procedure is customized according to the patient’s needs and desires; however, most facial feminization surgeries alter the patient’s entire facial appearance. In fact, FFS is often referred to as the defining surgery of transgender transitions because of the power of facial appearances. As Dr. Douglas K. Ousterhout, M.D. writes in his article Feminization of the Transsexual, “That which is first seen in an initial contact is frequently what defines you. It establishes not only who you are, but often what sex you are as well. As a transsexual, perhaps nothing is more important to you than appearing sexually the same as you feel emotionally.” A successful FFS allows the transgendered patient a greater chance at societal acceptance, as well as an increased level of personal confidence. As one of just a few prominent surgeons in the United States who perform FFS, Dr. Spiegel is helping to pioneer a new wave of medical advancements that focus on what he calls “the art of medicine,” rather than just the “science of medicine.”

Sensitive to patient needs and intent on flawless outcomes, Spiegel uses his surgical talent, inquisitive mind and extraordinary compassion for others for more than just surgery. He is constantly striving to increase medical knowledge on FFS and spends much of his spare time publishing articles in medical journals based on analysis of his own patients’ outcomes.

“There are no textbooks written on this subject,” Dr. Spiegel says. For Spiegel, curiosity leads to knowledge. “I ask questions and I find the answers. It’s an ongoing learning process where the worst thing I can do is make assumptions.”

Spiegel handles personal relationships just as he conducts his research: without making assumptions. Spiegel says. “The people who come to me [for facial feminization surgery] are some of the most intelligent I meet. They are nuclear physicists and engineers, they know what procedures they want and how they can be done, and they’ve already been through the difficulties of gender identity.”
Eager for a Challenge

Dr. Spiegel received his undergraduate and medical degrees from the University of Michigan, where he was president of the Alpha Omega Alpha medical honor society and elected class graduation speaker.

“I had wanted to be a cardiologist,” Dr. Spiegel laughs, but he changed his mind when exposed to head and neck reconstructive surgery at Michigan. Spiegel realized his passion for otolaryngology while witnessing his first head and neck surgery “I [immediately] appreciated the complexity of the anatomy and the difficulty of the procedures,” Spiegel says. “I thought, my God that looks so hard…and I knew then that I wanted that challenge.”

After graduating from Medical School, Spiegel went cross-country for an internship in general surgery and residency in head and neck surgery at the University of California, San Francisco. During internship, Dr. Spiegel was able to work with the pioneering surgeon Dr. Douglas Ousterhout. Dr. Spiegel says, “While I was just one of many surgical interns working with Dr. Ousterhout, I may have been the only one to recognize the importance of what he was doing.”

After five years training in head and neck surgery, voice surgery, and facial plastic surgery, Spiegel relocated to Harvard Medical School where he completed an advanced fellowship in Facial Plastic and Reconstructive Surgery and Microsurgery. While at Harvard, he was awarded the highest facial plastic surgery research award available nationally each year, the Sir Harold Delf Gillies Award.

With his formal education complete, Spiegel joined the Boston University School of Medicine’s Department of Otolaryngology – Head and Neck Surgery. In addition to perfecting common facial plastic surgery procedures, Dr. Spiegel decided to resume performing FFS. Now, several years later, Dr. Spiegel feels right at home. Add to Spiegel’s work surrounding FFS his other medical tasks, a successful teaching gig (teaching head and neck surgery residents from Boston University, Tufts University, and Harvard University), frequent travel as an invited lecturer, and raising a family, and you have one of the most genuine, modest and busy men you will ever meet, as well as one of the smartest.

“Dr. Spiegel is one of the most talented, one of the most caring men I have ever met,” says Peggy, Dr. Spiegel’s past assistant. “He’s just wonderful.”

Spiegel is more humble. “As a medical professional, my job is to provide the utmost professional care,” Spiegel says. “That’s what I do.”


New Beginnings and Wednesday Mornings

It’s ten o’clock on a Wednesday morning and while the average working woman is sitting at her desk, sipping coffee and pecking her keyboard; Charlotte Johnson1 is sitting on a cushy leather chair in Dr. Spiegel’s South Boston office, staring at a whitewashed wall. Yet Charlotte is not average. She glances placidly from the bare wall in front of her, to one speckled with golden plaques at her side, on to the adjacent poster adorned façade where an enlarged picture of a partially dissected nose looms understandingly. She is waiting, has been waiting, but only a minute or so. She wore a white turtleneck sweater today, and now she is barely visible against the ashen walls. She finds that odd, since, in life, she feels she has never blended in. She hears the pitter-pattering of feet, up and down and up and down and her heart pulsates with a mix of excitement and uncertainty. Today, she thinks, today I meet the man who might change my life.

For her whole life, Charlotte always felt as if something in her wasn’t as it should be. “I just felt like, for some reason, I didn’t fit,” Charlotte says. “Underneath everything I was doing there was this huge sadness in myself that I wasn’t being who I was. It wasn’t an always present thing, but I can remember it as far back as I can remember anything else.”

Never knowing what or how or why she felt as she did, Charlotte grew up in a man’s world, became a football star, a loving husband and a doting father.

“I think that I honest to God didn’t know, on any level that I could understand, what was happening,” Charlotte says.

Charlotte’s discomfort peaked in her mid-forties. She felt out of place wherever she went, even in her own home. Depression, fatigue and physical discomfort set in, overpowering her once positive outlook on what had previously been a fulfilling life. Diagnosed as clinically depressed but knowing somehow that she was suffering from more than just depression, Charlotte persevered, visiting countless professionals in search of a definitive answer. A few months later and she discovered, in what she calls her “epiphany,” what it was that she had been coping with for almost fifty years. Charlotte was transgendered.

The popular transgender/transsexual website www.tsroadmap.com defines a transgendered person as “Anyone whose gender identity or expression situates them differently than the traditional gender role they were assigned at birth.” Along with being transgendered, Charlotte had Gender Identity Disorder, a rare birth defect affecting less than one percent of the population. Gender Identity Disorder is caused by hormone irregularities during the first fourteen weeks of pregnancy, but many people don’t realize that they have it until their late teens or mid-forties. It took Charlotte forty-eight years.

“I just knew, like wham, out of the blue, that a weight had been lifted and that I could see clearly now for the first time in my life,” Charlotte says, describing her “epiphany.” “I realized that everything that had happened to me that had felt strange, that I had locked away and compartmentalized growing up, were all signs of my true self; were all signs that I was a woman.”

Further research and consultations faced Charlotte with a life-altering decision: do nothing and risk permanent unhappiness, or undergo a series of hormone therapies and surgeries designed to unify Charlotte’s body with her brain. Charlotte chose the latter, as the only viable option for her, and began her transition, first with hormone therapy, and then by beginning a series of complicated surgeries, starting with FFS.
Looking Like a Woman

Wearing a dress shirt and tie, glasses perched on his nose, Dr. Spiegel enters the consultation room. Brief introductions and biographical tidbits precede Charlotte’s customized planning of her FFS. Dr. Spiegel begins simply, asking Charlotte which features she wants to alter and which she is already pleased with.

“It’s very important that I hear what my patients want done before I give my medical opinion,” Spiegel says later. “Also, it’s important to differentiate between looking like a woman and just having cosmetic surgery,” Spiegel adds. “Looking attractive has to do with attitude and symmetry. What make you feminine are the curves and angles of your facial structure. Plastic surgery can make you look younger, more attractive, and feminine. I want to know each patient’s goals so that we can customize what we do for them. There is no place for a ‘package’ or ‘blue plate special’. Each person must be treated as the individual woman they are.”

Charlotte starts from the top with “a scalp advance, brow bossing, blepharoplasty, and forehead contouring. Then rhinoplasty, upper lip lift, a chin implant…” Charlotte continues listing the various procedures while Dr. Spiegel wheels a charcoal black mesh desk over and angles the flat-screened computer monitor upward so he and Charlotte can both see. The sound of his fingertips on the keyboard harmonizes with Charlotte’s various anatomical desires, filling the room with clicks and jargon.

“I’ve listed the various procedures here and…” Spiegel highlights the various features of his facial feminization software while completing Charlotte’s “wish-list.” “Okay, now here’s what I think we should do.” Dr. Spiegel dissects each desired procedure, explaining how the surgery will change each body part’s appearance, how each specific procedure would be performed and what the overall results would most likely look like. Spiegel is so thorough that he leaves Charlotte speechless.

“All of my questions and concerns were answered,” Charlotte says.

After just over two hours, the consultation is over. Charlotte decides on a scalp advance, brow bossing, blepharoplasty, forehead contouring, rhinoplasty, an upper lip lift, a chin implant, jaw shave, under-jaw liposuction, and a neck lift.

“Going into the consultation I had no reason to be impressed or not to be impressed with him,” Charlotte later reflects. “All that changed in the course of an hour.”


It’s Only Gonna Get Better

Charlotte had considered traveling to Thailand for her FFS, until she met Dr. Spiegel for her consultation. “Dr. Spiegel is not a slick, marketing, self-promoting kind of guy,” Charlotte says, “but he’s a thoughtful person—an academician—a teacher—and a surgeon.”

For all of his achievements, Dr. Spiegel’s lack of advertising kept him relatively unknown among the transgender community. “I know how to operate and I know how to take care of people, but it never occurred to me to send out a memo,” Spiegel jokes. “Seriously though, have you ever had a woman yell at you because she didn’t know you existed?” Spiegel has. “One woman was so upset that she had traveled across the country to have her facial surgery done because she didn’t realize we were doing the same work on the East Coast, in Boston. She was angry that she didn’t know I was here!” He’s been yelled at, hugged by thousands of people, and even cried on. As Charlotte discovered and Dr. Spiegel’s staff has known, “He knows what people need because he takes the time to interact with them and people are very much intrigued by that.”

Marie Guyette2, another transgendered patient of Spiegel’s, agrees, reflecting on her experience with Dr. Spiegel as one of the only times in her life that she has ever felt taken care of. “When Dr. Spiegel came to check on me the day after my surgery, he asked me what, if anything, I needed,” Marie explains. “I said, ‘Ice cream,’ and asked if he could get a nurse to find me some. ‘No,’ he said to my surprise, ‘I’ll get you some ice cream myself.’ He didn’t leave it for the nurses to take care of. When he asked if he could get me anything, he meant that he would actually be getting it.”

Marie, further into her transition and more familiar with the transgender community than Charlotte, describes the transgender community that Dr. Spiegel has come to know as originally “a very beaten down group.” Because it’s difficult for many to understand that being transgendered is not a lifestyle choice, it is common for transgendered people to be categorized along with gays, lesbians and bisexuals. The “T” in the abbreviation GBLT, commonly used in support groups and among ignorant professionals, stands for transsexual; however, many gays, lesbians and bisexuals have the same prejudices against transgendered people, as the rest of society.

Andrea James, author and editor of www.tsroadmap.com, explains on her website, “Many transsexual women face harassment and ridicule, sometimes even since childhood, because of what society considers inappropriate gender behavior.”

“I lost all of my former friends to honesty,” Marie continues. “[Transitioning] isn’t something we choose, there’s no fetish or excitement or fun in it, it’s being who you were at birth. It’s catching up in a very real way. Dr. Spiegel helps us catch up.”

Dr. Spiegel, Marie says, has helped countless people like her find the peace of mind and self-confidence that they have been missing all of their life. “Dr. Spiegel is an extremely sensitive, kind physician who cares a lot about his patients,” Marie says. “We run to people like that because they have the knowledge and compassion to convert our bodies. We need understanding doctors. We need to trust them with our lives. I trusted Dr. Spiegel with my life.”

Trustworthy and ambitious, Dr. Spiegel and his staff are in an ongoing process of expansion and modification directed at further improving patient care. And with the increased demand for Dr. Spiegel’s services, they are confident that they can provide the highest level of service available anywhere. “I’m not in private practice,” Dr. Spiegel says. “I have the freedom of improving patient care without the financial stress. We are always striving to improve the experience.”

Dr. Spiegel’s assistant agrees. “People have seen his surgery, people are pleased, and they know that they have nothing to worry about, so our next step is to strive to keep them happy. What we keep discussing is how we can better meet the needs of our patients. Dr. Spiegel is constantly trying to make sure that every part of the experience here is the best anywhere.”

Meeting their patients’ needs seems effortless for this group, but it’s a never-ending process. Even now, when it seems as though they’ve got everything covered, they’re in the process of developing a patient bed and breakfast, specifically for patients recovering from FFS. “Our patients need to know that they’re our first priority.” To Charlotte, that’s a big comfort.

“I have no doubts that Dr. Spiegel was the right man for my surgery,” Charlotte says. “He’s a highly intelligent man who cares an awful lot about the transgender community.

© 2005, Rachel L. R.

Works Cited

James, Andrea. Transsexual Road Map. World Wide Web: www.tsroadmap.com,

April 28, 2005.
Ousterhout, Dr. Douglas K. Feminization of the Transsexual. World

Wide Web: www.drbecky.com, April 28, 2005.


Works Consulted

“Putting GLBT Issues in Perspective” in Psychology of Gender Identity and



Transgenderism. World Wide Web: www.genderpsychology.org, April

14, 2005.


“Gender Identity Disorder (GID) Case Study: an Autobiography of a Transsexual

Psychology Graduate Student” in Psychology of Gender Identity and



Transgenderism. World Wide Web: www.genderpsychology.org, April

14, 2005.


“What is Transgender?” in The International Journal of Transgenderism. World Wide

Web: www.symposion.com/ijt, April 14, 2005.


Ekins, Richard and King, Dave. “Blending Genders: Contributions to the Emerging Field

of Transgender Studies” in The International Journal of Transgenderism.



World Wide Web: www.symposion.com/ijt, April 14, 2005.

www.gender.org

Area Accommodations

Be sure to ask for the Boston Medical Center rate when booking your reservation!

Courtyard Marriott—South Bay


63 R Boston Street South Boston 02127

617-436-8200


High-speed Internet access in rooms

Shuttle service to airport, BMC and other Boston attractions

Located near shopping center (grocery, Target) and less than two miles from BMC

Offers a fridge and microwave upon request and availability


BMC Patient Rate is $119/night



Best Western—Roundhouse Suites

891 Massachusetts Avenue Boston, MA 02118

617-989-1000
Shuttle to hotel and hospital

Closest to hospital and highway (Rt. 93)

Wireless high-speed Internet access in rooms

Offers a fridge and microwave for your convenience


BMC Patient Rate is $129/night for a suite


TRANSPORTATION


By Air

Boston Medical Center and each of the listed hotels are all located about 15-20 minutes from Boston’s Logan International Airport (BOS). Logan Airport serves most major airlines.


Rhode Island’s TG Green International Airport and Manchester International Airport in Manchester, NH are both about 1 hour from Boston.


By Train/Bus

Boston’s South Station is a major hub for travel by train or bus. The station is a 5-10 minute taxi ride to our office.




More Information

Visit Boston Medical Center’s visitor page at http://www.bmc.org/patients/directions/

for more directions and information.

Your Experience
Our goal is to make your surgical experience as smooth and positive as possible from the moment you first contact us until well after your recovery is finished. If there is anything we can do to help make your personal experience more enjoyable please do let us know.
Consultation (2-24 months before surgery)

Depending on where you are located, your surgical experience with Dr. Spiegel can begin in many different ways; with a visit to our office in Boston, at one of the many conferences Dr. Spiegel attends throughout the year or with a phone consultation. Of course, meeting with Dr. Spiegel in person is ideal in order to determine what surgical options are best for you. However, many of our surgical patients meet Dr. Spiegel for the first time just prior to their surgical date! During a consultation we encourage you to discuss your concerns and questions regarding the surgery and your post-operative goals. Dr. Spiegel will make suggestions about the procedures you can benefit from and what changes you can expect from surgery. Remember, surgery is not “one-size fits all”. Each patient has very different needs and each surgical plan is customized to meet your personal goals. Unless you have had trauma or previous surgery to the forehead or jaw area x-rays and scans are not needed for you consultation, we only need your time and surgical questions! Dr. Spiegel’s assistant, Kelly Duchesney, will meet with you following your time with Dr. Spiegel to review the surgical costs and any of your additional questions you may have regarding payment, scheduling surgery and the recovery process.


Booking Surgery (6-1 month before surgery)

We are able to book surgery once you have had an opportunity to meet with Dr. Spiegel in-person or over the phone. Congratulations! This is an exciting and overwhelming time! However, we will fully prepare you for surgery and walk with you every step of the way. To secure a surgical date, simply contact our office and speak with Kelly. She will work with you to find the date that best suites your needs and schedule. A deposit of 20% (of the total surgical cost) is required to book your surgery and the remaining balances are due two weeks before surgery. You will receive a pre-operative packet of information after booking surgery. This packet includes information regarding how to prepare for surgery, financial report, appointment times, pre-operative medical requirements, procedure-specific recovery information, travel information and maps of the local area. Two weeks prior to surgery, Kelly will check in with you to review this information with you, review any questions you have and remind you about your final payments.


Surgery

The big day has come! We ask you to arrive in Boston one or days prior to surgery in order to meet with Dr. Spiegel once more before surgery and meet with our anesthesia department. This appointment is ideal to review any technique and result oriented questions with Dr. Spiegel. While having someone travel to Boston with you is not required or necessary; it is a comfort many patients prefer to have and one we encourage. On the day of surgery, you will be asked to arrive at the hospital approximately one or two hours prior to surgery and refrain from eating after midnight. You will have an opportunity to meet with Dr. Spiegel once more before entering the operating room so any last questions can be addressed. The actual length of surgery can last from 2-10 hours; however, most surgeries last 4-8 hours in the operating room. Once surgery is finished, you are brought into the “immediate” recovery room before being brought up to your hospital room, where you will stay for the first evening after surgery. The majority of patients feel well enough to return to their homes or hotel the following day. Patients that have had any forehead, mandible or facelift work done will have ace bandages wrapped around their head before leaving the hospital. These bandages are expected to be worn until your first post-operative visit with Dr. Spiegel 5-8 days later.


Recovery

Each patient’s recovery is different based on the procedures performed. However, on average most patients stay in Boston 5-8 days after surgery to visit with Dr. Spiegel and have their sutures removed before returning home. During that time, we encourage you to rest and relax as much as possible. Any bruising or swelling you experience will peak 2-3 days after surgery; icing the surgical areas as much as possible following surgery will help reduce this bruising and swelling. This should dissipate 7-10 days after surgery depending on the extent of your surgery. Most patients return to work their daily activities after 10 days and are able to return to work 2 or 3 weeks after surgery. Remember, your appearance and wellbeing will improve quickly but it is normal to have some minor swelling and improvements to your result even several months after your surgery. Even after you have left Boston and returned home, any questions you have regarding your continued recovery can be addressed via telephone and with the aid of digital photographs. Patients consider themselves “fully recovered” approximately one year after surgery; however, most stay in touch with our office well after that just to keep in touch with us! We hope you will do the same.



Interested in Financing?

Ask about our low-interest rate plans with Capital One and CareCredit!
Facial Feminization Procedures (FFS)
Dr. Spiegel offers full Facial Feminization Surgery. The most popular of FFS procedures are forehead contouring, mandible contouring (jaw and chin reshaping), rhinoplasty, lip lift and trachea shave. Procedures like a facelift and blepharoplasty (eye) can also help achieve a more youthful and feminine appearance.

Each patient’s needs are different based on their anatomy, lifestyle and goals. To find out your best surgical plan, consult with Dr. Spiegel in person or via telephone with photos.


Forehead Contouring
Forehead contouring surgery is one of the most dynamic and advanced surgeries offered by Dr. Spiegel. The technique is very powerful and can completely transform the appearance of the forehead and upper face. Masculine foreheads typically have a heavy bony ridge starting just above the eyes lying beneath the eyebrows, called brow bossing. This ridge can often carry through the middle of the forehead. Forehead contouring surgery involves shaving or reconstructing the forehead bone to remove this ridge, open up the appearance of the eyes and provide the patient with a more feminine, softer appearance.
To access the forehead bone, a fine incision is made along the hairline from temple to temple. The incision is done in front of the hairline to advance the scalp and hairline at the same time. In rare cases, minimal shaving can be done endoscopically (through small incisions in the hair). The forehead skin is pulled forward to reveal the bone and the solid bone, known as the orbital rim, is shaved down. The bone over the frontal sinus is more difficult since it is important not to disrupt the sinus. Dr. Spiegel breaks the bone and removes any excess to provide enough room for the bones to contract and lay flatly over the sinuses.
In severe cases, forehead bossing requires removing the bone from the skull and using small titanium wires or screws to hold the bone in place while it heals. However, in most cases the bone can be reshaped without removing it from the skull, eliminating the need for these bolts or screws. Since the bone is rarely removed from the skull, nerve endings are only slightly disrupted causing short-term nerve loss. Most patients regain full sensitivity on the top of their head by three months after surgery while others have waited 4-6 months.
If shaving or removing the bone is not enough to achieve the desired result (especially if the bones over the sinuses are too thin to be shaven down) a bone-filler may be used to fill in the hollow areas around the forehead. An alternative forehead bossing technique involves shaving the bones over the sinuses thin enough so they become flexible and can be pressed into the correct position.
Once the bone has been adjusted to the desired appearance the tissue around it is positioned to keep the bone in place while it heals. A browlift is often necessary in order to properly align the eyebrows with the new forehead contour and to remove excess skin. The look is subtle and not too pulled but gives patients a beautiful result highlighting their eyes and new, smooth forehead.
Following surgery, a dressing is placed around the forehead and left in place overnight. The dressing is then replaced with an ace bandage for 7-10 days after surgery. The bandage reduces swelling and helps contour the area. Most patients spend one night in the hospital and return to their home or hotel the next day. Pain is common but managed with prescription pain medication. Most patients use the medication for the first week after surgery. After removing the dressing, daily showering and gentle washing of the hair should be done carefully for one week.
Sutures are removed 6-8 days after surgery at a first post-operative visit with Dr. Spiegel. Most patients feel well enough to return to work 8-9 days after surgery; however, if the surgery is combined with multiple procedures then it is advisable to wait two weeks before returning to work. Strenuous activity (causing sweating or rise in blood pressure) like heavy lifting and light exercise should be avoided for two weeks. Heavier exercises like yoga, pilates and running should be avoided for 6 weeks.
Infection after surgery is extremely rare; however, antibiotics are used to avoid any potential infections. Swelling and bruising on the forehead and around the eyes is common. The majority of this swelling and bruising will last about two weeks; however, it is normal to having some minor swelling even after several months. After one week cover-up makeup is allowed to mask any residual bruising. Nerve injury occurs rarely. Forehead numbness is common after surgery and may last several weeks to years.
Feel free to review any questions about this information with our office. We would be happy to answer any questions for you about this exciting procedure.
Mandible Contouring
Having a mandible shave can reduce the appearance and size of the jaw, making it rounder and narrower at the square corners near the back of the jaw and along the chin. The procedure involves reshaping the bone around the corners of the jaw and adjusting the shape of the chin to provide the patient with a narrower, softer, more feminine appearance. In some instances the procedure may even involve cutting the large masseter muscles to further narrow the area.
Incisions inside the mouth are generally used; however, they can also be made externally under the jaw. Patients over 40 may experience loose skin around the jaw or chin after the procedure. A lower or full facelift can help tighten these areas.
During the procedure, incisions are made between the gum and cheek to access the prominent jawbone areas. Marked areas of prominent bone are cut with a surgical drill and micro-saw, curving down from back to front to achieve a well-rounded contour. Small surgical tubes may be inserted in the wound then out through the skin at the level of the previous jaw line, which prevents potential blood collections and also shortens the period of postoperative swelling. Once the proper amount of bone and muscle has been removed the wound is closed with self-dissolving stitches. Chin work typically requires an incision in the front of the mouth along the gum line and is also closed with self-dissolving stitches.
A dressing or ace bandage is placed after surgery to help minimize excessive swelling and help contour the area.
After the surgery the mouth must be cleaned with a prescription mouthwash several times a day. Most patients stay in the hospital for one night after surgery. The face will be moderately swollen immediately following surgery. Swelling and bruising will peak 2-3 days after surgery. The jaw and neck may become very swollen-this is normal and expected. The majority of the swelling will dissipate two weeks after surgery; however, some of the swelling may take several more weeks to disappear. It may take 4-6 weeks for the improved contour to become obvious.
Softer foods like soup, pudding and applesauce are the easiest and most comfortable options for patients for the first 7-10 days after surgery.
Patients can return to their usual daily activities after approximately one week; but exercise and strenuous (causing sweating or rise in blood pressure) activity should be avoided for 4-6 weeks after surgery.
Possible complications from surgery include bleeding and prolonged swelling from the surface of the cut bone—this can create a clot in the wound. Surgical drains and facial pressure garments will significantly reduce this risk. Infections are uncommon but antibiotics are routinely administered during and after surgery. Careful assessment and a complete set of fine surgical instruments can help prevent over cutting of the bone but it is a possible risk. Injury to the sensory nerves (nerves controlling facial muscle) is a risk however these nerves are well protected in the bone and are rarely injured if the cut is not extended to the main nerve. Temporary numbness along the incision line or around the lower lip is common. Temporary or permanent facial paralysis is rare but possible if the nerve that controls the function of the muscle expression around the mouth is injured. Accessing the jawbone from inside the mouth is safe and can significantly reduce the chance of this injury. Temporo-mandibular joint injury or fracture of the joint is possible if the cut line is accidentally extended to the joint—this may limit how the mouth opens or misalign the teeth.
If you have any questions regarding this information please ask Dr. Spiegel or a member or our office to review it with you—it would be our pleasure to do so!

RHINOPLASTY

Noses come in many shapes and sizes, and there is no one perfect nose. What’s important is that your nose fits your face. A nose that is too large, crooked, bent, or rounded can detract from an otherwise beautiful face. As a facial plastic surgeon I strive to help you have the nose that best fits your face; I don’t believe in one nose fits all!

There are many characteristics to the nose that can be changed: the size, the projection (how far the nose sticks out), the size and shape of the tip, the curvature of the nose, the presence or absence of a bump on the nose, the angle that the nose makes with your lip. Our goal is provide you with the nose that will best fit your face.

Depending upon what you would like done, nose shaping usually takes only 1-2 hours. If you have difficulty breathing through your nose the first part of surgery is a septoplasty. The septum is a structure in the middle of the nose that separates the nose into two sides (left and right). If the septum is twisted or “deviated” it can reduce airflow through one or both sides of your nose. Working through your nostrils I can straighten the septum that should allow you to breathe much more easily. By doing the procedure through your nostrils there are no visible scars from septoplasty. You may experience a bloody nose for 48 hours after surgery, and because of swelling inside the nose, many people find it takes a week or more until they notice that they breathe better.

To reshape the nose a small fine incision may be necessary on the bottom of the nose (an area called the columella). Depending upon what you wish to change about your nose, you may or may not have some bruising and swelling around your eyes afterwards. In all cases you can expect to wake up from your surgery with a small “cast” on your nose. This piece of plastic stays on your nose to protect it after surgery and to help hold your nose precisely where we want it during the initial period of healing.

General anesthesia is used during the surgery. Patients over the age of 60, have significant medical conditions, or are having multiple procedures will require a pre-surgical appointment with the anesthesia department. At this time, patients with questions regarding anesthesia can review them with an anesthesiologist and any necessary labwork will be administered.



Immediately after surgery your nose will very tender and often is stuffed so breathing through your nose may be difficult or impossible. This will improve daily by carefully cleaning out the nose and keeping it moist with a nasal spray.

Icing is suggested for the first few days after surgery to reduce as much swelling and bruising as possible. This bruising and swelling usually lasts 7-10 days. Stitches and t he “cast” are removed 6-8 days after surgery. At this time, your nose will look good, but will continue to heal and look better. During the next several weeks you don’t need to wear the cast, but you do need to take extra care not to bump or hit your nose. Patients are usually able to resume their normal daily activities after one week. Exercise, especially ball sports, should be avoided for 6 weeks after surgery.

If you know somebody who had rhinoplasty surgery in the past, or from a surgeon other than Dr. Spiegel, they may have told you about having their nose “packed”. These people had their nose filled with gauze or another material after surgery, and this can be very uncomfortable. Our patients almost never need any packing in their nose, which makes the recovery period from nose surgery easier and much more comfortable.

Most of my patients tell me that recovery from their nose shaping surgery was not very uncomfortable. Rhinoplasty can be an easy way to make a dramatic improvement in your appearance and happiness

If you have any questions regarding this information be sure to discuss them with either Dr. Spiegel or Kelly. We would be happy to review your concerns and ensure you are confident about your surgical plan.

TRACHEA SHAVE

A trachea shave can be an effective, satisfying and long-lasting solution to a large Adam’s apple for men and women. Dr. Spiegel’s specialized technique is able to remove the absolute most cartilage while keeping the vocal cords untouched. A trachea shave can be performed alone or in conjunction with other procedures. The surgery generally takes less than one hour in the operating room.


A small incision is placed on the upper crease of the neck or in a wrinkle in the skin. The incision is placed in one of these locations in order to hide the small scar as much as possible, and this approach works. Using a tiny video camera, Dr. Spiegel locates the vocal cords and marks the location on the neck. He then exposes the thyroid cartilage and removes all of the prominent cartilage and its borders above the vocal cord marking. This way he is able to remove as much as possible while minimizing the risk of voice change. The incision is then closed and cleaned and a small bandage is placed over the incision following surgery.
During the first 24-48 hours after surgery it is common to experience some bruising and swelling as well as a sore throat. Discomfort is typically minor; however, pain medication is given in order to keep the patient as comfortable as possible. Mild voice weakness may occur in the first few days after surgery but should not be long term. Patients are encouraged to rest their voices and apply an ice pack to the treated area for the first couple days following surgery. The incision area may be red and thick for the first few weeks and this will improve with time. Tightness and lumpiness around the neck is common and simply takes time to settle. Once the swelling and bruising has dissipated patients can enjoy their new, smooth neckline!
The most important consideration in addressing the Adam’s apple is voice protection. Using his method, Dr. Spiegel can ensure maximal results with maximal safety.
CHEEK AUGMENTATION
Cheek augmentation is achieved with solid implants or bone-filler paste. Solid implants are available in several shapes and can be placed over and under the cheekbone or closer to the nose. Bone-filler can be molded to its desired shape. The patient is sedated and the implants are placed through a tunnel, into a pocket under soft tissue over the cheekbones. Certain bone cuts and bone segment repositioning is useful for this facial feminization procedure. Pain, swelling, stiffness and temporary numbness may occur. Tenderness in the teeth may also occur and smiling and chewing might be affected after surgery.
LIP LIFT AND AUGMENTATION
To shorten the distance between the nose and top lip, an incision is made just under the nose, a section of skin is removed and the gap is closed, which raises the lip. During a lip lift, the lip can be rolled outwards making it fuller, and an entire section of skin from lip to nose can be angled back slightly if necessary. Natural or synthetic and solid or injected implants can also make the lips fuller. Alternatively, an incision can be made at the Vermilion Border (the edge between the red and white parts of the lip).
RHYTIDECTOMY (FACELIFT)

There’s no way to avoid it. Heredity, years of expressing emotions, facing the world (gravity, sun, wind, and the elements), and the simple passing of time lead to wrinkling and loosening of the skin. You may notice a softer jawline, a looser neck, folds on the neck, or deeper grooves around the nose. Perhaps crow’s feet are appearing by the corners of your eyes, or thin forehead creases are deepening. You could be in your thirties, or in your eighties – you just don’t feel like you like yourself anymore. To some people, these wrinkles and folds are considered signs of character, but you may look older than you feel. And, can’t you have character without the wrinkles?

Facelifts are among the most commonly desired facial plastic surgery procedures, and are not as involved as you might think. However, not everybody who wants a facelift actually needs a facelift. Sometimes, a neck lift, or a mini facelift (sometimes called a weekend face lift) is the right choice. In other situations, liposculpture is all that is needed. And sometimes, a simple filler material is enough.

If a facelift is right for you, we will discuss in detail what to expect before, during, and after the procedure. Of course, each individual person has a different experience as the surgery is customized to fit his or her needs.

After our initial consultation, photographs will be taken and a detailed medical history and examination is done. Bruising history, blood pressure problems, smoking, and any medications you are taking are important considerations to ensure the best results. Patients over the age of 60, those who have significant medical conditions, and those who are having multiple procedures may require a pre-surgery appointment with the anesthesia department.

For a full facelift, an incision is made in a crease just in front of the ear, and the remainder is hidden behind the ear and into the scalp. The skin is raised and underlying muscle and connective tissues are tightened. Excess skin and fat are removed to provide a smooth and natural facial contour, and the incisions are closed with fine sutures. Then, a large fluffy protective dressing is applied for overnight.

You can go home the same day as your facelift, but many patients choose to stay with us overnight. The hospital has comfortable quiet rooms with friendly helpful nurses who can attend to your needs and allow you to rest and relax. Some have remarkably beautiful city views! Cold compresses will be used to keep swelling and bruising to a minimum, and while most patients experience very little pain after surgery, pain medications are of course available. Bruising and swelling around the face and neck is common and will resolve itself over time. The majority of the swelling and bruising will fade after 10-14 days; however some of the swelling may take several months to resolve. Some loss of facial sensation is also common following surgery but will typically return on its own relatively quickly. Dr. Spiegel utilizes many techniques to make sure that you are looking and feeling your best as soon after surgery as possible. In face, many patients have commented on how comfortable and quick the healing process was.

For the next week, a soft compressive dressing (like an ace wrap), is worn as much as possible. This help reduces the swelling and lifts the neck to provide you with the best result possible. Sutures are typically removed after one week, and most patients feel well and ready to get back to their normal routines at this point. Still, patients should wear the soft wrap at night while sleeping for another week and avoid vigorous activity, such as heavy exercise, for 6 weeks.

With time, the incision site scars heal into thin lines that are usually not very noticeable, and these thin lines are hidden in natural skin creases or in the hair. A facelift sets the clock back by restoring your facial skin and underlying tissues to where they once were, but the clock doesn’t stop and relaxation will continue to occur with the passing of time.

BLEPHAROPLASTY (EYELID SURGERY)

If it’s true that the eyes are “windows to the soul”, then sagging, drooping, and puffy swelling around the eyes can give the false impression of being a tired soul. These surrounding changes can hide the bright eyes of a vibrant person. Though you may try highlighting them with eye shadow or dressing them with designer eyewear or colored contact lenses, often it’s your own natural frame that needs attention.

Eyelid surgery can help correct drooping upper eyelids or the puffy skin under the eyes that can make us look older and more tired than we really are. As we age and our skin looses its elasticity or succumbs to external forces (such as sun damage, gravity, air pollutants), so the eyes can look prematurely aged.

The good news is that corrective surgery for this common trouble spot may be simpler than you think. If the main problem is puffiness, we may be able to do “scarless” eye surgery where no visible incisions are used to correct the problem. The puffiness is commonly caused by excess fatty tissue deposited underneath the eyes. This tissue is simply removed and the skin is gently tightened. If your primary concern is fine lines and wrinkles around the eyes (which some begin to see as early as in their 20’s or 30’s) a “mini” eyelift may be all that is needed. This quick procedure provides rapid correction with minimal recovery time. There aren’t even any stitches to remove, and the whole procedure can be done comfortably in under an hour, often times with only local anesthetic if desired. Both types of surgery use incisions that are made inside the eye or along the lash line giving you a “scarless” surgery.

Upper eyelids appear heavy on many people, this is caused by both heredity and aging. We are able to remove some of the excess skin and tissue above the eye using a small incision in the crease of the eyelid. Because the incision is so fine, the scar heals extremely well and after a few months is not visible.

If an eyelift procedure is right for you, we will discuss in detail what to expect before, during, and after the procedure. We customize each procedure to meet the unique needs of the individual, so each patient will have a somewhat different experience. The procedure usually takes between one and two hours. An incision is made along the natural lines of your eyelids and excess fat and tissue causing the bagginess, drooping, wrinkling or sagging around the eyes is trimmed. Fine sutures are used to carefully close the incision. All surgery is performed by Dr. Spiegel, Chief of Facial Plastic and Reconstructive Surgery at Boston University School of Medicine, and a surgeon regularly sought by patients from around the world.

Patients over the age of 60, those having significant medical conditions, and those who are having multiple procedures may require a pre-surgery appointment with the anesthesia department. At this time, patients with questions regarding anesthesia can review them with an anesthesiologist and any necessary medical tests will be ordered.

Your eyelids may be swollen or feel somewhat tight for the first days after the surgery. Pain medication is offered to control any temporary discomfort – but most patients do not need it. Use of cold compresses during the first days are encouraged in order alleviate any excessive swelling or bruising. Stitches are typically absorbable and will dissolve on their own.

While you can go home shortly after the procedure, it’s best to plan on resting for the first few days. Most people feel ready to return to a regular routine in about 6 or 7 days, though in some rare cases swelling or bruising can last longer. All strenuous activity, such as exercise, should be avoided for four weeks following the procedure. Intense exercise like running, yoga, pilates and weightlifting should not be resumed before 6 weeks.

The aim of the procedure is not to make you look different, but to make you look better. My goal is to have people see you and ask “have you lost weight?” or “did you buy new clothes?” because their perception is that you look healthier, happier and fresher. Your eyes will glow, looking as youthful and vibrant as you are!





1 Name changed to protect privacy.

2 Name changed to protect privacy.





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