Lemons, I think you've elsewhere seen my take on Spiegel. I had multiple consults with him beforehand (I'm that way) and what he told me varied a bit each time. I haven't ever heard of him saying "I can't help you," and I did feel that his staff (not so much him) does try to sell services. But I also feel ALL plastic surgeons have staff that do this as they are in business.
As I've said before, I think I went into FFS with same concerns you have: that I was a difficult case and that Speigel (and the others I consulted) told me what I wanted to hear. I strongly feel that Spiegel looks at a patient individually and does feel he can help. He sort of says: "what can I do," not "what can't I do." That makes him very optimistic, and he DOES feminize as best he can with what he finds. For these reasons, I don't think he intentionally overpromises and he is being honest with you as best he can. But we all hear what we want to (or never hear what we are actually told), and as I said before, it's important to reassure yourself you and he are talking about the same thing. That said, this doesn't mean that he can't help you and feminize your face. I think the key issue is to be sure you and he are talking about the same results and that your expectations are realistic and flow from what you have.
You are doing the right thing in consulting in person and then reflecting and questioning. All I can say is show him examples of what you want if you can. I also provided him with family photos so he could see how females in my family look. He even had those in the operating theatre when I was rolled in.
I am some two years post op from FFS with him. I had just about everything, and I needed it. I have some friends and family I don't see often, but they saw me at various times during those two years and now say that my face "settled" by about 18 months -- and that they feel it was successful. I still find fault in my face, especially my chin and nose. At times I feel Spiegel was too conservative in what he did there. He did make small revisions to the sculpting of my nose after about a year, in an in office procedure. That helped. However, there really ARE limits to what one can do with a chin before a surgeon compromises the thickness of the bone etc. As for the nose, I had another FFS surgeon look at it and they said they could do no more and only recommended some botox for the area above it. I'm not in a position right now to go back to anyone.
I think it's very true that we see our own faces and bodies far more critically than others see us, and also it takes us a while to not see "old us" in those faces post op FFS. I mention that because if you are very concerned about whether someone can help feminize your face, you may tend to dismiss any results you see for a while. I was that way. This is why I keep saying that he will feminize you as best he can, and that may be more than you realise and may take some time to really see. But at the same time be realistic. I have a strong featured face still, but I am told it is female and striking. I still see old me in there, but in fact, that's probably as it should be. Spiegel's goal is to help you reflect a female you, not someone else.
Think of it in terms of what you want out of the surgery and what your measurement of success will be. Be realistic in that. Explain this to him and then evaluate. No one can tell for sure how a surgery will come out, but at least you already have a decent idea of the parameters and can go in with eyes open.
