It really depends on what you need, and what you are starting with. Not everybody needs the same surgical techniques, to achieve the desired result, especially I have in mind upper facial area. I dont know everything about all US surgeons... honestly, some are not really at their best at achieving natural feminine results. Dr. Ousterhout and Deschamps-Braly who work together, would be my first suggestion for natural looking results (even though dr. Ousterhout wasnt really known for natural looking noses nor chins in the past..). Second would be Spiegel. I know this isnt of any help, because those two are even more expensive than Spiegel.
Other than that I would suggest you to look outside US.. I personally dont see an alternative in US, unless if you need only subtle change in forehead&orbital area, in which case there are others doctors you should look at. Dr. Mayer comes to mind, and dr. Bensimon from Montreal. Some other might be in the little different direction, not necessarily ideal for those who seek naturally-feminine look.
If you are willing to look outside... I personally believe that dr. Di Maggio has the most natural looking results of all FFS surgeons. Often very subtle and delicate despite very aggressive bone transformation where its needed. There is dr. Van der Dussen in Europe, and Facial team more or less aims for natural results... even though they tend to be a little less aggressive with bone work (sometimes for the better, sometimes not..). All these have a little more affordable price than dr. Spiegel.
If not for anything else you should look outside of US for a better comparison between surgeons, and different result.
