As an academic surgeon, the media occasionally contacts Dr. Spiegel to comment on medical news. He has appeared several times on Boston area news programs, been featured on North Shore Cable Television, and been interviewed in the New York Times.

Glamour Magazine – May 2010

Skin Deep Magazine – October 2008

Download the Beholding Beauty Article to read the whole article.

Additionally, a 2002 cover story of the Phoenix Media Group’s magazine “Stuff @ Night” profiled some of Dr. Spiegel’s cosmetic procedures. Dr. Spiegel has also been asked to write articles pertaining to plastic surgery for “Stuff @ Night” magazine.

BoTox
Stuff@night Magazine – November 7, 2001

Botulinum Toxin – BoTox – sounds familiar, right? ABC’s 20/20 called BoTox a “miracle cure” for crow’s feet and furrowed brows – but isn’t it a poison? How could poison get rid of wrinkles?

BoTox is a poison. In fact, it was discovered in 1895 after an outbreak of food poisoning in Belgium. The bacterium Clostridium botulinum produces a toxin that prevents muscles from receiving the nerve stimulus to contract. This causes the muscle to relax. In 1977 an ophthalmologist started using the purified toxin (BoTox) to weaken hyperactive eye muscles. In 1989 other physicians realized that a very small amount of the toxin could be used to relax muscles of the face. When the facial muscles relaxed, the overlying skin became smoother and many of the wrinkles vanished!

BoTox works best for “dynamic wrinkles” – those that deepen when you squeeze a muscle. Good examples include horizontal forehead wrinkles, vertical wrinkles between your eyebrows, some neck bands, and crow’s feet. Some wrinkles that we’d like to get rid of are caused by muscles that are too important to paralyze, so BoTox can’t erase every facial line. But, in the right situation it is easy and safe. A very small amount of the solution is injected directly into the problem muscles. Over the next 3 – 5 days the muscle weakens, often with a dramatic softening of the overlying wrinkles. A small bruise (from the needle) is typically the worst thing that could happen immediately, and isn’t very common.

If you go to a skilled physician, the most common side effect will be the need for a “touch up” – I’ll tell you why. A novice physician could place the medicine into the wrong muscle, or use the wrong concentration of medicine causing it to spread to a muscle that you don’t want weakened. For example, an eyelid muscle could weaken and a mild droopy eyelid or eyebrow could occur. An experienced doctor places the smallest effective amount of medicine into just the right spots. Of course, some people need a stronger dose than do others so if the minimum amount doesn’t work, you go back for more next week. (It’s better to go back for more than risk getting too much and having a droop.) In order to be certain that the medicine stays in the right spot you may be asked not to rub or massage the injected areas for four hours.

The best and worst thing about BoTox is that it’s temporary. If you don’t like the results, it wears off in around 3 months; if you love it, you need to do it again in around 3 months. Actually, it seems that people who regularly receive BoTox find that the interval between treatments lengthens – even up to 6 months. Because it is expensive to prepare and purify the medication treatments can be expensive. Prices range from $400 – $600 and up depending upon the number of areas treated.

Some of the “side effects” of BoTox wrinkle injections have turned out to be great new uses for the medication. Researchers in California noticed that some of their patients with migraine headaches who received BoTox for forehead wrinkles had a dramatic improvement in their headaches. In one study, nearly 80% of migraine sufferers said that the number or severity of their headaches had been cut in half. In fact, more than 50% of the study participants stopped having any headaches for three months or longer! (Just think, look better AND feel better!) Even excessive sweating can be greatly reduced by BoTox injection directly into the overactive sweat glands. All of this has been very exciting for physicians who are continuing to find new applications for this miracle “poison”.

Many of these uses for the medication, including wrinkle reduction, are considered “off-label” applications; the government hasn’t officially approved of using the medicine in these situations. However, the drug is so effective and safe that many physicians and medical academies are comfortable recommending it for these “off label” uses.

One point to remember is that the medicine works best for “dynamic” wrinkles caused by muscle contraction. Some fine lines in the skin may still be seen even after treatment, although these can be filled in with any of a number of injectable materials (which we’ll talk about another time). BoTox can easily and safely soften wrinkles in the forehead, between the eyebrows, some neck banding, and crow’s feet by the eyes. There’s no age limit and people from their twenties up to their seventies regularly have it done. In many people, it truly is the “miracle wrinkle cure”.

Stylefixx
Dr. Spiegel has also been involved with local beauty events like Boston’s Stylefixx 2005 and 2006 and quarterly beauty workshops associated with Trish McEvoy cosmetics. At these events interested cliental learn more about surgical and non-surgical enhancements and what options will work best for them. If you would like to find out about our next event contact us here.

Endoscopic Surgery
Stuff@night Magazine – May 15, 2002

Children are frequently told of the many ways in which they are wasting their time and “rotting” their brains. The “boob tube” (television, of course) is a prime example. And, since the introduction of PONG around 1971, video games are another. Video games are empty entertainment and a waste of time that could be spent on more educational pursuits. That is, unless you want to be a plastic surgeon!

Cosmetic surgeons want to help you look better. And, we want you to look better as quickly and easily as possible. The problem is that all surgical procedures have risks, leave scars, and may create bruising and swelling that take time to resolve. So, we are constantly seeking new techniques to help people recover from their surgery quickly, and with limited scarring.

One of these new techniques is known as “endoscopic surgery”. An endoscope is a thin telescope (like a drinking straw) which is attached to a powerful flashlight. One end of the scope shines a bright light, and the other end is attached to a video camera displayed on a television screen. So, the deepest and darkest reaches of a person’s body can now be visualized with only a tiny (1/2 inch) incision to allow for introduction of the endoscope! Of course, small incision = small scar = happier patient and doctor!

Once I can see the area of interest, I still need to be able to operate there. So one (or a few) additional very small incisions are made through which specially designed surgical instruments can be passed to the area visualized by the endoscope. Surgery can then proceed, only your surgeon never actually “sees” the area manipulated – it is all watched on TV! Using your hands to manipulate things you see on TV? Sounds like a video game to me.

Endoscopic surgery allows for significantly smaller incisions, decreased swelling and bruising, and may reduce the risk of numbness or other types of nerve damage (you can see all the little nerves bigger than life on the TV). However, endoscopic surgery doesn’t make sense for all procedures; there’s no point using a telescope and camera if you are operating on the skin, for example.

Of course, several procedures are best done with endoscopic techniques. Forehead (brow) lift is one. Many people who look tired or angry (but don’t feel tired or angry) have an aging or sagging forehead. The eyebrows fall and horizontal wrinkles appear. The time-honored correcting procedure involves making a long incision (almost ear-to-ear) across the top of the head and then pulling the forehead up. Using an endoscope the procedure can be done (on TV) through just a few ½ inch incisions! (And you’ll have less swelling, bruising, numbness and can go home faster!) By the way, “just a few incisions” means as few as 2 and up to 6 depending upon each person’s individual needs.

Endoscopic techniques can also be used for breast augmentation, so the whole procedure can be done through a small incision in the underarm or around the navel. Sometimes a tummy tuck can be done with the endoscope to minimize the resulting incision. Remember however, that if you have lots of excess skin the endoscope may not help. And, believe it or not, in some cases a mini-facelift can be done with the endoscope! Recovery from this type of mini-face lift is much faster than from a traditional facelift.

So, technology is helping to make surgery more like playing a complex video game. And, as video games have been around for more than 30 years now there’s a good chance your surgeon has had some experience with them. Now, if we could only find some use for all that Gilligan’s Island trivia…

Lip Enhancement
Stuff@night Magazine – December 5, 2001

Quick, what do Julia Roberts, Angelina Jolie, and Pamela Anderson have in common? Not sure? What if I added Mick Jagger and hometown favorite Steven Tyler to that list?

The answer, of course, is memorable lips.

Now, I can’t be certain that lip appearance is the primary source of their celebrity, but it certainly hasn’t hurt. After all, lips are a prominent facial feature, and a primary means by which we express our emotions. Smiling lips, frowning lips, pursed lips, puckered lips – each tells us something different; we get important nonverbal communication by watching the lips (and that’s just the start of why lips are important to us). Obviously, such an important and expressive body part commands attention.

Unfortunately, not everybody was born with the lips they deserve. You may feel youthful, energetic, and sensual but have thin lips that convey stern, strict, or angry. And, cosmetics can only go so far despite your best efforts with liner pencils and lipstick tricks. So how can you get pouty, kissable, full, soft, gentle, luscious, bee-stung (you get the picture) lips?

The key to lip enhancement is to maintain natural shape and softness, just more sensual, and fuller. There are many available methods, which range from (relatively) inexpensive and quick with minimal recovery (although temporary augmentation), to expensive and requiring a few days off (but possibly with permanent results).

One of the most common approaches is to inject a filler into the lips. Choices are plentiful now, and range from bovine (animal) derived collagen, to human derived collagen, to synthetic materials (polymers, silicone), to fat cells, and new products appear all the time. Most of the synthetic injectable fillers are not approved for use in the United States, and while they usually provide a permanent change, if you don’t like the results it is difficult (or impossible) to undo. For these reasons, most surgeons choose to recommend the temporary collagen injections.

The key with any material is placement into the correct location. Your lips have several different parts. For example with the upper lip there is the red area, the skin colored area rising towards your nose, and the border between the two where red turns to skin color. This border is called the vermilion border and should have a bit of projection and roll to it. Lack of projection of the vermilion border contributes to the appearance of flat, droopy, or thin lips. Thus, one of the first places a cosmetic surgeon will place the injectable material is into this border. Now if you look closely, you’ll notice that the vermilion border changes shape in the middle and the overall appearance of the upper lip vermilion border resembles that of an archer’s bow. In fact, the natural shape of this border is often referred to as having a “cupid’s bow” appearance. An experienced physician will avoid significant injection into the center of the cupid’s bow as it can distort that natural shape and make lips look unnaturally swollen, rather than soft and full. Injections may also be placed into the red of the lip after the border has been augmented in order to further increase the fullness.

Collagen comes in different formulations (as you know, we’ll talk about that some other time), but all of them are temporary. Many people can have results last 4 months, but for some the effect may seem to wear off in as little as 6 weeks. Fat injections involve placing fat cells (taken from your thigh or belly) into your lip and hoping that they develop a new blood supply and stick around forever providing a natural enhancement. For some people this works great with one try, but usually some of the cells “take” and some don’t so you need to repeat the procedure in order to get a long lasting good appearance. With most injections you’ll be swollen for several hours after the procedure, so the size of your lips when you leave the doctor’s office is bigger than what you’ll end up with. And, in most cases the injections hurt (after all, think how sensitive your lips are). You’ll really feel like you have “bee-stung” lips for a while! Fortunately, there are ways to make the procedure much more comfortable and local anesthesia can be given if you want.

If you know you like the look of enhanced lips, but dislike the regular injections, more permanent (or permanent) implants can be placed. These are implanted in the office and are a minor surgical procedure (you get a very small hidden incision, and usually have 2-4 stitches). Lips can be quite swollen afterwards for several days, so don’t plan a big night out for the same day as your surgery. The implants range from strips of your own skin and fat, to scars from other parts of your body, to human derived processed skin, to synthetic materials. The synthetic materials are the most reliably permanent, but require more experience to place correctly.

In some cases other less common procedures may be recommended. These include removing a bit of the skin above your lip to make more of the red lip visible, advancing the lips by incisions within your mouth, and even having a skilled medical tattoo artist add some color to increase the visible red of the lip (the tattoos should only be done after having augmentation of the lip roll). These techniques may sound odd, but for the right person they do work well – and they’re not as strange as some of the lip enhancement products you can buy. If you look, you can find a “pump” which applies a vacuum to your lips and makes them swell for up to six hours. There are even lip balms which contain hot pepper oil or other irritants to make your lips swell. And, some people will vigorously massage their lips before social situations. These last three methods are very short lasting, and could even cause bruising or other problems (not to mention seeming a bit silly).

So, what do Angelina Jolie, Julia Roberts, and the others do? Well, I don’t know (at least, I don’t know for all of them), but a good cosmetic surgeon can tell you how to get where they are – lipwise, anyway…

Jeffrey Spiegel, M.D. is a Facial Plastic and Reconstructive Surgeon at Boston Medical Center and teaches at Boston University School of Medicine. Feel free to contact Dr. Spiegel about this procedure.

Boston University Medical Researchers Find
Expanding Use of Botox® for Facial Wrinkles

Study targets crow’s feet and wrinkling of the lower eyelids

Boston, MA – Researchers from the department of Otolaryngology – Head and Neck Surgery at Boston University School of Medicine (BUSM) have discovered that Botox® might safely be used in the treatment of lower eyelid wrinkles.

The findings were recently presented at the Spring Meeting of the American Academy of Facial Plastic Surgery in Phoenix, AZ.

A purified protein, BotoxCosmetic (Allergan Inc), has enjoyed wide publicity and usage after being approved by the FDA for use to improve the appearance of glabellar rhytids (vertical wrinkles between the eyebrows). To achieve FDA approval, a medication must undergo extensive safety testing. However, some dermatologists and plastic surgeons have been using Botox in an “off-label” fashion to treat wrinkles of the forehead, eyelids, or neck. Botox works by selectively weakening the muscle it is injected into thus allowing the overlying skin to smooth out. If an unintended muscle encounters the medication it too may relax leading to unintended complications such as a droopy upper eyelid or corner of the mouth.

A team led by facial plastic surgeon Jeffrey Spiegel, MD, an assistant professor at BUSM, recently announced the results of a careful laboratory evaluation of the facial muscles producing crow’s feet and wrinkling of the lower eyelids. Spiegel and the research team dissected dozens of faces and measured the specific locations of small muscle groups in and around the eyelids in order to determine if Botox could be safely and effectively used to treat facial wrinkles in this area.

“The result is a set of anatomical guidelines that show fellow plastic surgeons precisely how and where to use Botox in these areas in order to get the best wrinkle reduction without any unintended complications,” said Spiegel.