Anesthesia and Pain Management

Most procedures are performed under general anesthesia, with a licensed anesthesiologist at your side through the whole process: before, during and after your surgery. Minor procedures can be performed under local anesthesia, but must be determined by Dr. Alfaro.

Pain management starts before you even feel the pain. You will receive as much pain medication as needed, although many people do not even need it. Hospital staff will be informed of any specific needs, allergies, etc.

Face lift

Rhytidectomy or face lift is a surgery that is designed to remove wrinkles. It can be performed alone or with an eyelid lift, neck lift or brow lift. A face lift places facial skin and muscles in a way that gives the face a more youthful shape that age, environment or weight loss have changed. Excess skin is lifted and then removed; inner support sutures are placed to maintain the results. Fat tissue can also be removed to sculpt and detail the face.

Incisions are placed on front of and behind the ears towards the hairline; and from the ear up towards the head, also behind the hairline. In some cases this last incision can be continued to the top of the head to lift the forehead, too. They are hardly visible after healing. The results of a face lift can last seven to ten years, in some cases less time. Results also depend on how much patient takes care of their skin with proper skin care products for home use and professional treatments as follow up. Sun block as well as proper nutrition is very important.

Blepharoplasty or eyelid lift

An eyelid lift or blepharoplasty corrects upper and lower droopy eyelids, bags under the eyes and deep crow’s feet. This plastic surgery procedure removes excess skin and fat pads that protrudes. Incisions on upper eyelids are placed on the fold, and are not visible after healing. On the lower lids, incision in placed directly under the eyelashes; it can also be performed through the inside of eyelid. Recovery from eyelid lift is a week to ten days. Exercise can be initiated after a month, and sun needs to be avoided for two more weeks.

Brow lift

The brow lift or lifting of the forehead, reduces lines in the area above the eye brow and raises them, too. Swelling can be present for about a week to ten days after the procedure. Some patients can experience loss of hair and/or sensation near the incision. Avoid the sun for two to three months.

Facial Implants

Several types of facial implants may be placed to enhance different features of the face. They can be solid or porous. The procedure can be performed with general or local anesthesia, as needed. 
 Recovery usually takes a week.

Facial irregularities

To complement your plastic surgery in Costa Rica, you can have minimally invasive procedures. Facial irregularities can be treated with different kinds of procedures, chemicalpeels, dermabrasion, dermal fillers, fat injections or fatgrafting. These and other procedures can improve skin tone, acne scarring, fine wrinkles, make skin smoother, minimize scars; all performed at our medical spa Med Spa Delicate

These procedures do not substitute a face lift, but complement it. A face lift cannot eliminate fine lines near the upper and lower lids or crow’s feet around the outer edges of the eyes; nor can these minimally invasive procedures eliminate loose, sagging or excess skin.

Neck sculpting

Chin liposuction or neck sculpting involves the removal of fat from under the chin area. Neck sculpting can also be performed with the platysmal tightening (tightening of the neck muscle).


Minimally invasive rejuvenation by relaxation of the muscles of the face that will in turn minimize expression lines: frown lines, crow`s feet, forehead lines, smokers lips, neck, chin, and many more. The product starts working after 4 to 5 days, and full effect is established after 21 days. Results are temporary, lasting anywhere from 4 to 6 months. Treatment is about ten minutes, through tiny injections applied on the selected area. Not recommended for women who are pregnant or breastfeeding.

Lip Augmentation with dermal fillers

The lip augmentation can be performed with local anesthesia if the patient prefers. It increases the size of the lips and can be done on men or women. This lipaugmentation is performed with fillers made of natural materials, which ate temporary, lasting about 9 months to a year, in some people a little longer.

Rhinoplasty or nose job

The rhinoplasty or more commonly referred to as nose jobis the procedure performed to improve or reshape the nose. It can be performed to correct deformities after a trauma, to correct obstruction and help the patient breathe better; or simply to improve appearance. This does not mean that the patient will have a short, upturned nose, the objective is a pleasing natural look. The surgery may require removing or adding cartilage or other materials either from the body or synthetic implants. There is no visible external incision. There is a splint to be worn on the nose for a few days; sometimes the nose is packed with gauze for a few days, too. Swelling and bruising can take a week to ten days to disappear. This is not a very painful procedure. It is performed as an outpatient, and sutures are inner and absorbable.


Otoplasty or pinning of the ears is a procedure that is performed to place the ears close to the head. Most commonly performed in children, but can be performed in adults, too. It can be done under local or general anesthesia. Incisions are placed in back of the ears and disappear with time. Sports or activities where the ear can be forced forward should be avoided.

Abdominoplasty or Tummy Tuck

Tummy tuck is a procedure that removes unwanted excess skin and fat from the lower abdomen, remodels your flanks and in some degree your upper abdomen. It can also surgically tighten the underlying muscles of the abdominal wall, when indicated. The resection of the skin from the abdomen eliminates any previous scars or stretch marks caused by pregnancy or changes in weight. Performed on both men and women, after childbearing is complete.

Abdominoplasty is not designed for weight loss; patients should be at normal or near normal weight before surgery. Abdominoplasty procedures may vary according to individual patient´s needs. In younger patients, at normal weight, with excellent skin tone, the incision is placed above the pubic hair, some times called miniabdominoplasty or minitummy tuck. In other patients, who need correction, a full tummy tuck is performed. The incision is also low, near pubic hair, the incision might be longer, and the work performed on the abdominal tissue is much more extense. An incision is placed around the belly button, but is hardly visible after the healing process is complete. Another version is the circumferential tummy tuck, also known as lower body lift. This procedure involves an incision all around the body, low like the regular tummy tuck, which removes skin and fat from all the circumference of the body at that level.

The sooner the patients start moving after surgery, the quicker and better they will heal; so getting out of bed, to sit or go to the bathroom is encouraged. The first couple of days a lighter diet is recommended. Some discomfort can be felt at the incision site, which gets better when patients start walking. You will be provided all the pain medication needed. Patient must shower daily after the third day post procedure. Drains are kept in for a few days. Most stitches are internal and absorbable, outer skin stitches will be removed five days after surgery. Patients should wear a compression garment day and night for a month after surgery, and another month only during the day. Some patients may have altered sensibility on parts of the abdomen. This disappears slowly over several months.

Do not have a tummy tuck if you are planning to become pregnant in the future.

Tummy tuck and liposuction can be combined when the patient needs a little extra help on other areas of the body like back, hips, thighs to complete the contouring of the body.

Liposuction – liposcuplture

Liposuction is the removal or fat through suctioning from the body. This is not a weight loss procedure, rather a contouring of the body. Dr. Miguel Alfaro has been performing liposuction in Costa Rica since 1976. Different techniques have different results, even high definitionliposuction is available. General anesthesia is used to remove the fat from the abdomen, thighs, buttocks, flanks, waist, arms, bra line, even under the chin. Patients must wear a compression garment day and night for a month, then one more month during the day only. Avoid the sun for three months after surgery, since hemoglobin or hematomas with the sun can give you dark spots on the skin.

Liposuction is a safe and predictable procedure. The patient may experience swelling, pain and bleeding that last for a couple of days. Results can be seen immediately after the procedure, but more detailed and definite results can be seen after four to six months, when all swelling has disappeared.

Fat grafting or injections

Fat grafting or injections are performed after fat is suctioned out of the body to be injected into another area. Fat is injected into the areas of the body that need reshaping like the lips, face, cheeks, nasolabial folds, buttocks or any area that has a deformity that needs attention. Not recommended for injection into the breasts because of a risk of calcification of the fat and transformation into cancer.


Gynecomastia or male breast reduction is the removal of breast tissue in men, which can be performed by liposuction if the predominant tissue is fat; or by resection if it is mainly glandular tissue. A compression garment is to be worn for a month. Exercise can be started after a month, too.

Inner thigh lift

The inner thigh lift removes the extra amount of skin and fat that accumulates between the legs. This stops the uncomfortable rubbing and irritation. The incision is placed in the groin area and down from the groin towards the knee about 5 cms. It heals well, but is visible, so this must be considered when deciding on the procedure.

Arm lift or brachioplasty

The arm lift is designed to remove excess fat, but especially loose skin located in the upper arm. This can be performed alone or in combination with liposuction of the area.

 An incision is placed on the inside of the arm towards the back and the axilla.

Breast augmentation

Breast augmentation surgery consists of the enlargement of the breasts with the placement of implants, to increase the cup size. Silicone implants are the most common, but saline implants are also used. There are several techniques to place the implants that will be discussed by patient and surgeon. The most common is placing the incision under the breast at the fold, where it is hardly visible. Placing the implant under the muscle is best in patients that have practically no glandular tissue of their own, who are very thin and have very little body fat. Breastimplants are usually placed under the gland for a more natural appearance, and to avoid the double droopy breast “snoopy like” breast that results from implants under the muscle in patients with enough glandular tissue. The procedure can be performed on women of any age. Regular activity can be initiated after a week. Exercise can be started after two to three weeks. Swimming in a pool or the ocean only after a month. Sun exposure on this or any scar can make it more visible, so avoid direct sunlight for at least two months. You will be provided a special bra to wear for at least a month.

Breast lift

Breast lift, also known as mastopexy, is performed alone or with implants to reshape sagging breasts that have been affected by pregnancy, weight loss and age. A breast liftcan also reduce the size of the areola or darker skin around the nipple. Incisions are placed around the areola and down in a diagonal line to the outer side of the body, making them easy to hide inside a bra or bathing suit. This technique preserves erectibility and sensibility of the nipple, even the ability to breast-feed. Temporary altered sensibility in the breasts or nipples is not uncommon. You will be provided a special bra to wear for at least a month.

Breast reduction

Breast reduction is performed with a similar technique as the breast lift; placing the incision around the areola and in a diagonal downward line to the outer side of the body. A breast reduction can help relieve back pain that results from the weight of large breasts. You will be provided a special bra to wear for at least a month.