There is no reason one must have all procedures at once, in fact there is a good argument for seeing how each procedure or combinations of them affect your face. Many plastic surgeons suggest that approach to women. Sometimes less is more when it comes to plastic surgery. In addition, if you are just having a rhinoplasty or other widely performed procedure, Spiegel and others may not be the best or only candidate to perform it. Each surgeon has his or her area of expertise, skill, or gift.
I think that if you need a great deal of work done to feminize your face, Spiegel and others are an excellent choice. They understand how the elements of a face harmonize and how each element affects the outcome. If you need just "adjustments" to your nose or whatever, there are more cost-affordable and perhaps even better surgeons, which is only logical. I've known women who have gone to different surgeons for different aspects of what they want done. I happen to have used Spiegel and I feel he is better at some aspects than others, but if taking a "whole face" approach (which I needed), he is a very good choice. Similarly, when I had my GRS I was faced with a choice of whether to do my BA at the same time. BA is a common procedure and there was no particular reason to have it when I had GRS other than convenience. I ended up deciding NOT to have it at the same time, but to choose a surgeon later who specializes in BA and could accomplish the results I really wanted.
I'd also caution that it is the nature of plastic surgery "need to/want to" lists to grow as a surgeon explains what he can do and what he thinks you need. You'll soon see costs rise as you add this or that tuck, cut, or pull. This is especially true as you get older and are already sagging here or there -- in which case it's tempting and warranted to add to that list I suppose. If you are young, you need less and you also have time to digest procedures and see how they work. It's too easy to add unnecessary work, or at least not yet necessary work to the list. And for a surgeon/sculptor, who looks at your face in terms of "what can I do if I had the chance," they may go further than you need or want. In the end, you have to step back and really think it through. The "front" office patient coordinators or liaison are not your friends in this area either. Their job is not only to answer your questions but to help sell procedures. Rarely are you offered a "deal."
As to cost, of course having several procedures done at once can be less expensive. One saves in travel, hospital costs, and you only need the anesthesiologist once (they are not cheap). But on the other hand "phasing" your sculpting is like paying on an installment plan: you can digest the financial burden even if it costs more in the end. I'd also add, be realistic about what quality plastic surgery costs. I'd suggest researching what the procedures you want cost if done by a wide range of surgeons, not just those specializing in FFS -- though there is a reasonable premium for surgeons who understand that area. There are plenty of plastic surgeon go-to sites that offer up what a procedure costs on average and you can find examples of how much was done for that price.
