Papers by Jeffrey Spiegel
Aesthetic Plastic Surgery, May 16, 2019
Background The objective is to evaluate the safety of performing multiple combined facial plastic... more Background The objective is to evaluate the safety of performing multiple combined facial plastic surgical procedures affecting various planes of the face including rhytidectomy, forehead contouring with browlift, cheek implants, rhinoplasty, and mandible contouring in a single setting. Methods This is a retrospective study of patients undergoing facial plastic surgery with the senior author at Boston Medical Center from 2005 to 2017. Patients were included if they underwent all of the above procedures in one setting and had not had previous facial surgery. The primary outcome measure was local postoperative complications of tissue necrosis and wound dehiscence. The secondary outcome measures were general postoperative complications of venous thromboembolism and prolonged intubation. Results A total of 25 patients met inclusion criteria. Four patients experienced an infection-two patients had cheek implant infections delayed by months, one had a facelift hematoma that became infected, and one had an intraoral incision infection. One patient suffered from pulmonary embolism 2 months after surgery in the setting of hormone replacement therapy. All patients were extubated at the end of the case and none required reintubation. All patients had good cosmetic results. Conclusion Despite elevating multiple planes of the face at the same time, there were no complications related to vascular supply in any of the patients. Complications were limited to those known to occur with the individual procedures. This study demonstrates that concurrent procedures that elevate multiple planes in the face in a single setting may be performed safely and with good cosmetic outcomes.
Facial Plastic Surgery Clinics of North America, Aug 1, 2023
Facial plastic surgery & aesthetic medicine, Sep 24, 2021
Background: Forehead feminization cranioplasty (FFC) risks entering the frontal sinus to achieve ... more Background: Forehead feminization cranioplasty (FFC) risks entering the frontal sinus to achieve the desired contour. To date, no study has investigated long-term FFC complications. Objective: Determine if long-term sinus and headache symptoms worsen secondary to frontal sinus mucosal violation, measured by patient-reported outcomes. Methods: Single database retrospective chart review of patients who underwent forehead contouring between August 2012 and August 2019 was conducted. Two cohorts-frontal sinus mucosal violation versus mucosal preservation-were surveyed postprocedurely for postprocedure SNOT (Sinonasal Outcome Test)-22 scores and pre- and postprocedure sinus and headache symptoms. Results: Frontal sinus violation, mean time between surgery and response was 4.16 ± 1.88 years (range: 1-8). Without violation, mean time between surgery and response was 2.5 ± 1.10 years (range: 1-5). Postoperative SNOT-22 severity scores were not different (12.55 vs. 8.6, p = 0.20). Postoperative SNOT-22 scores were equivalent to a control nonrhinosinusitis population. No difference was found between violation of the frontal sinus with worse postoperative sinus (22 vs. 5, p = 0.60) or headache symptoms. Conclusion: Our data did not detect a difference in sinus or headache outcomes in patients who experienced violation of the anterior frontal table compared with a similar population with preservation of the frontal sinus, over an 8-year follow-up.
Facial plastic surgery & aesthetic medicine, Dec 1, 2022
Advances in Cosmetic Surgery, May 1, 2023
Plastic and Reconstructive Surgery, Oct 25, 2022
Oral Health and Dental Management, Aug 1, 2015
Archives of Otolaryngology-head & Neck Surgery, 2002
Journal of Craniofacial Surgery, 2019
This article provides an overview of the key concepts and techniques of facial feminization surge... more This article provides an overview of the key concepts and techniques of facial feminization surgery. The author reviews 20 years of experience with thousands of patients.
Facial Plastic Surgery, 2021
Elective rhinoplasty surgeons' fees vary considerably and are influenced by geographic surgeo... more Elective rhinoplasty surgeons' fees vary considerably and are influenced by geographic surgeon density, surgeon's experience, local economic factors, patient demand, and other factors. The American Board of Facial Plastic and Reconstructive Surgery, the American Society of Plastic Surgery, and other organizations certify physicians who profess expertise in rhinoplasty. We sought to determine if specific board certification or experience correlates with higher rhinoplasty fee. An internet search was conducted of seven U.S. metropolitan areas using the search terms “rhinoplasty and “city name.” Top search results were surveyed for rhinoplasty fee, years of experience, annual volume of rhinoplasties, board certification, and other demographic data. Using both univariate and multivariate comparisons, the data were analyzed for forces having significant correlation with rhinoplasty fee. Sixty-seven surgeons were included in the study. The average price for ABFPRS certified surgeo...
Facial Plastic Surgery & Aesthetic Medicine, 2021
American Journal of Otolaryngology, 2021
BACKGROUND Nasal obstruction is a common patient complaint and has a variety of etiologies, and a... more BACKGROUND Nasal obstruction is a common patient complaint and has a variety of etiologies, and a specific anatomical abnormality can often be found within the nasal cavity on physical examination. In practice, this observed pathology does not always correlate with the laterality, severity, and exact intranasal site of the patients' perceived obstruction. OBJECTIVES We seek to answer the following questions: 1) Does a physician's evaluation of nasal obstruction correlate with subjective patient complaints? 2) Is there reasonable correlation between physicians of similar training in the routine evaluation of nasal obstruction? METHODS First, we asked patients presenting to the otolaryngology clinic with a primary complaint of nasal obstruction to fill out a modified NOSE survey. Nasal endoscopy was performed on all subjects to assess all potential sites of obstruction. We then determined whether there is an association between patient complaints and findings on physical examination. Second, we determined if there is correlation between similarly trained physicians in their interpretation of a basic nasal examination. Otolaryngologists were shown a series of standardized videos of an endoscopic nasal examination that were recorded with a primary complaint of nasal obstruction. Findings were reported in an anonymous online survey focusing on laterality, severity, and specific site of perceived obstruction. RESULTS A total of 38 patients were included in the first part of the study. The Cohen's kappa coefficient was used to determine the interrater agreement between the patient and physician in the degree of nasal obstruction. The kappa coefficient was 0.03 (p value 0.372) for the comparison of the left-sided scores (fair agreement), and 0.16 (p value 0.014) for the right-sided scores (slight agreement). A comparison was also done between the side of the nose the patient felt was most obstructed to the most obstructed side found on physical exam by the otolaryngologist. Thirteen of the 38 patients (34%) had perceived nasal obstruction on the opposite side of that noted to be most obstructed on physical exam. Despite this, the kappa coefficient in this comparison was 0.43 (p value <0.001) revealing moderate agreement between the two groups. Seventeen otolaryngologists participated in the second part of the study. Data extrapolated revealed very little agreement among the physicians in reporting which side of the nose was most obstructed, what anatomical structure contributed to the obstruction the most, and what percentage obstruction was present. DISCUSSION Based on our findings, patients can reasonably determine based on their symptoms which side is most obstructed, but symptoms do not correlate with severity of obstruction when compared to physical exam. There is also very little consistency between otolaryngologists in their assessment of the degree of nasal obstruction on exam. The results of this study may have far-reaching implications for patient management, surgical intervention, and medicolegal documentation as it relates to the current surgical treatment of nasal obstruction.
The Laryngoscope, 2019
Objectives/HypothesisHairline advancement is a powerful procedure to shorten the forehead and eli... more Objectives/HypothesisHairline advancement is a powerful procedure to shorten the forehead and eliminate areas of hair loss, especially along the temporal recesses. This study was undertaken to report the typical hairline advancement possible with the senior author's method for scalp advancement at the time of forehead feminization.Study DesignRetrospective chart review.MethodsA review was conducted of 29 consecutive cases that met inclusion criteria from January to March 2018 at an academic medical center. Sex, gender, age, whether galeatomy was performed, and additional variables were recorded. The distance of hairline advancement was measured in the midline and at the left and right midpupillary line. Galeatomies and rapid intraoperative tissue expansion were performed as per standard surgical protocol.ResultsFor the group of 29 individuals who underwent the specified method for scalp advancement, the average differences for the glabella to the trichion, the right midpupillary...
American journal of otolaryngology
Otolaryngology - Head and Neck Surgery, 2005
documentation in specific patient care areas to facilitate evaluation of outcomes for purposes of... more documentation in specific patient care areas to facilitate evaluation of outcomes for purposes of determining reimbursement. Since these areas are yet to be defined within Otolaryngology-Head and Neck Surgery, otolaryngologists must be involved to ensure the adoption of reasonable goals and development of reasonable systems for documentation. Conclusion: "Pay-for-performance" reimbursement is increasingly common in the current era of outcomes-based medicine. It will assume an even greater role over the next three years and will directly affect most otolaryngologists. There are things we can and must do to influence implementation and to achieve the goals of optimal quality, compliance, and reimbursement.
Otolaryngology - Head and Neck Surgery, 2005
Conclusion: Invasive fungal infection should be considered in the diabetic or immunocompromised p... more Conclusion: Invasive fungal infection should be considered in the diabetic or immunocompromised patient presenting with acute upper airway obstruction. Early diagnosis followed by aggressive surgical debridement of devitalized tissue and systemic liposomal amphotericin B may offer an alternative to extensive tracheal resection. Hyperbaric oxygen therapy may play a role in the early management tracheal mucormycosis.
Facial Plastic Surgery & Aesthetic Medicine
Facial Plastic Surgery & Aesthetic Medicine
Background: Facial feminization surgery can include forehead feminizing cranioplasty (FFC). The r... more Background: Facial feminization surgery can include forehead feminizing cranioplasty (FFC). The reshaped bones are fixated together with titanium plates and screws. Objective: To define the authors' preferred plating patterns and measure complications of bony nonunion when less hardware is applied. Methods: A 7-year retrospective review of patients who underwent FFC was conducted. Data collection included cranioplasty technique, fixation patterns, and complications. Traditional fixation (‡2 screws on each side of the osteotomy) was compared with conservative fixation (<2 screws). Results: A total of 483 patients were identified with a median of 241 days of follow-up (interquartile range: 8-528 days). Most patients (77.8%) had frontal bone fixation with microplates and screws. The most common combination was placement of two plates with four screws in total, comprising two screws on each plate, with one screw on each side of the fracture line (305/483, 63.1%). No signs or symptoms of bone flap mobility were noted on examination. Conclusion: Conservative fixation of the anterior table does not appear to increase signs of nonunion in forehead reshaping gender-affirming surgery.
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Papers by Jeffrey Spiegel