Costa Rica was among the first well-known destinations for modern medical travel, dating back to the 1970s and early 1980s when some pioneering plastic surgeons and dentists first began serving international clients. Among them was Dr. Miguel Alfaro, who, like many Costa Rican surgeons, came to medical school in the United States and was trained in general and plastic surgery at the University of Colorado; the University of Missouri and the University of Michigan. He returned to Costa Rica in 1976 and worked for years for the country’s public health care system, while building his private practice in plastic surgery on the side. Most recently, Alfaro has been chairman of the Department of Surgery at Hospital San Juan de Dios in San José, Costa Rica.

Among other professional associations, Dr. Alfaro belongs to the International College of Surgeons; the Costa Rican Plastic Surgery Association; and the Plastic Surgery Association for Iberoamerica. He is a Fellow of the International College of Surgeons, a member of the American College of Surgeons and a Founding partner of the Costa Rican Association of Mastology.

Alfaro prides himself on being a conservative plastic surgeon and has built his international reputation in plastic surgery on excellent results as well as a safety record that is second to none.

“I have very good results,” he said in a recent interview with The Bridge. “I have done thousands of operations and I am very conservative … I mean, if I see a change in technique going on, I will wait a few years, frankly. I want to be sure it is safe, see what complications are encountered by others.”

Q: How has, say, the Internet changed your practice? How are people finding out about you?

Dr. Alfaro: “Well, we have a lot better communication with the patients.  I have 30 years of bringing patients from overseas … I can tell you,  at the beginning it was just telephone calls, that was what we had.  I have performed a lot of operations on people that work here at the American Embassy; or they are just people who used to live here; or they had come for vacation. They would tell their friends and then I would get a call. Now we communicate through the Internet. It is a lot easier, definitely.

“Now you get much more extensive communications from the U.S., with all the questions, all the doubts that they have, and they sometimes ask you for photographs of results. Which we can do, but, well, I think of what my boss in the States used to say –  I remember we were in Denver, 30 35 years ago, and a patient asked him, “Can you show me photographs?” And he said, “You want to see my excellent results, my medium results, or my poor results?”

“Everybody shows the best results, of course. It doesn’t mean so much, what you did for others – it is what you can do for the patient who is in front of you now. So the important thing is that now the patient sends their photograph through email so that you can start analyzing the patient’s anatomy and see what kind of a promise you can make.”

Q: In the last few years, is more and more countries, more doctors, are taking international patients. How do you see the competition working out for Costa Rica? Is Costa Rica going to stay competitive? What are the strengths?

Dr. Alfaro: “I think we will remain a leader.  Among our strengths is that we have  a nice peaceful country, stable, and it is a paradise. A lot of people like to come here.

“It is just a short trip. You can go to India, to Europe, or Asia, but then you have to be in the airplane 22 hours. You will have excellent, excellent surgical skills in India and excellent medical care here, too. But then it is a matter of closeness. Here you are close. Besides that, the price here is very competitive.”

Q: I have heard that besides being a surgeon, you are quite a singer as well?

Dr. Alfaro: “Yes, I sing with the opera. I’ve got to give a concert the 22nd of October at Dom Pasquale International Theater. There is a baritone coming from the Metropolitan. I am a bass and we are going to sing a lot of duets.”

Q: I think patients like to know a little bit about the personal side of their surgeon, also …

Dr. Alfaro: “It’s very important, yes, and one of the pleasures of the work is getting to know the patients. I Have been 40 years singing all around the country … I have sung in Guatemala. And a lot of my patients, they know I sing, and sometimes they invite me to go to sing in weddings …  they invite me to New York, to Miami, to Denver, and I go over. It’s a pleasure for me just to fly there and sing there. It’s beautiful.”

Q: So you get to visit the U.S. often?

Dr. Alfaro: Yes. I go for meetings and also my son is a physician there. He’s a general surgeon. He lives in Denver, so I like to go to visit my son and his children and his wife.

Q: Here’s another more general question: I’m sure you know the economic conditions in the United States have gotten worse over the last year…

Dr. Alfaro:  Yes, difficult.

Q:  … Has that affected your patients?

Dr. Alfaro:  “Well, you know, I’ve talked with several plastic surgeons here, and they have noticed a little decrease in the number of people coming from the states. Like, let’s say, 15 to 20 percent.  Of course, people are expecting now the election to see what is going to happen, what is going to happen in the next administration, whoever wins. We don’t know. And it’s something that you have to be prepared for.

“It could be – well, if there’s a crisis, the first thing you take off your table is the dessert, right? And I see plastic surgery, sometimes, as a dessert. People will say, well, I’m not going to have this because this is not an emergency situation, and they are uncertain of the economy and their jobs. People are afraid of what is going to happen.

“Life has to continue and you have to do whatever you want to do, and a lot of people realize that and I’m sure they will keep coming.”

Q: This is maybe too hard, but how many Americans would you say you had as patients over all the years?

Dr. Alfaro:  Well, 50 percent of my clients are from the United States.

Q:  OK …

Dr. Alfaro:  In the past I used to do … about 12 to 15 major surgeries a week. Now there is more competition and I have other responsibilities, I do not do so many … I’m doing three or four a week, plus the Costa Ricans, so I do eight operations a week, big operations.

Q:   Big operations?

Dr. Alfaro:  Yes, the big operations; tummy tuck with a breast lift at the same time, for example. Or a face lift with the rhinoplasty and blepharoplasty. Yes, I do usually two big cases a day.

Q: Well, I hope I can hear you sing sometime, but I won’t ask you to do that on the phone. I am sure patients will have questions for you, would it be all right if I forward them along?

Dr. Alfaro: Of course. I will be happy to answer, or my daughter Monica, who manages our email correspondence, can do that. I look forward to hearing from your readers.

Editor’s Note: Questions for Dr. Alfaro can be left as comments, below, or addressed to: info@BridgeHealthInternational.com. We also welcome general discussion and questions about Costa Rican plastic surgery, dentistry and medical travel for other surgery, procedures and healthcare. Dr. Alfaro’s own web site is here.