Frequently Asked Questions

The following are many of the questions that have been asked of either Dr. Lev or me over the years. Some of the answers I attempt to give are based on my own experience with my own surgery and the surgeries of people I've brought with me on my trips to Costa Rica. All of the technical questions are answered by Dr. Lev.

1. When is the best time to have a facelift?

Some people seem to be under the impression that the longer you wait to have a facelift, the better. This is not necessarily the case, according to Dr. Lev. He says that the older you get the less elasticity in your skin and the thinner your skin gets. This makes surgery a more difficult procedure and the result isn't as good as it would be were the skin more supple, with greater elasticity. I was 48 when I had my facelift and for me, that was the perfect age to have it done. When I asked Dr. Lev how a second facelift would look on me now that I'm almost 57, he said there would be an improvement, but it wouldn't be as good an overall result as I had the first time at age 48.

2. Why should I travel to a foreign ("third world") country to have major surgery, when there are a million and one doctors right here in my own backyard?

Well, firstly, there are no "shoulds" when it comes to where you have your surgery. Going to Costa Rica for plastic surgery or any other procedure, isn't necessarily for everyone.

For some, staying home near their family is of the utmost importance. For others the cost factor is the most important factor in their decision.

Over the last several years, I've been working for Dr. Lev helping coordinate his US patients, forming them into groups so that they won't be alone in their experience in Costa Rica. We have built a wonderful support base down there, between the recovery facilities we use and the state-of-the-art Cima Hospital.

Also, we have a fabulous team of excellent registered nurses who work for Dr. Lev's patients on a private duty basis. They stay with the patients at their side in the hospital overnight for a 12 hour shift beginning at 6 p.m. the night of the surgery and ending 6 a.m. the morning after.

And we've been told that even more than the excellent facilities, nurses and doctors, what really makes the patients feel their experience was so meaningful, memorable and life altering in the most positive sense of the word was the fact that they were with other women going through the same thing at the same time.

3. What's the worst thing that can happen to me if I have a facelift?

Well, when I asked Dr. Lev that question he said that under some extremely rare circumstances a person could die from going under a general anesthesia. Whenever you go under the knife and certainly whenever you have a general anesthesia, you are literally risking your life. There are only two things in this world that can make a person take such a risk...the threat of a terminal disease and Vanity!

More realistically though, it is possible, says Dr. Lev, although still quite rare, for a patient to develop a necrosis of the skin if there is poor circulation. The healing process from this complication can take up to a year leaving an unsightly scar in the end. This happens in extremely rare cases, mostly in smokers and people with poor circulation. Dr. Lev has had two such cases in over 600 surgeries.

More commonly, it is possible to develop a hematoma, which is a collection of blood that occurs when you move your neck around too much right after surgery and the blood is unable to drain freely. This requires the doctor to drain the area daily for about a week after surgery and the bruising takes about a month longer to disappear.

4. What if I die? Does my family have any recourse?

According to Dr. Lev, there is no such thing as "Malpractice Insurance" in Costa Rica. If someone dies in a surgery, the state will automatically investigate to find out if there was a mistake on the part of the doctors or the hospital or if it was no one's fault.

If they decide that there was a mistake by the doctors or hospital, there is a penal trial. If the doctor or hospital is condemned for"non-intentional murder," as they call it in Costa Rica, then the family can ask for a financial indemnization, which generally is not very good compared with the USA.

5. Can Dr. Lev perform two procedures in the same surgery?

Sometimes. Depending on the length of time and the level of difficulty for each procedure. You'll need to consult with him prior to your surgery, usually the day before.

But, Dr. Lev says, the more surgery you have at the same time, the more risky. Dr. Lev will not combine any other surgery with a facelift. But he might, under certain optimum circumstances, perform a tummy tuck and breast enlargement in the same surgery.

Dr. Lev will not put his patients at unnecessary risk by doing too many procedures in one surgery. If you want more than one procedure done, you will have to schedule more than one date for surgery. At the time you book your dates with Didi, she will find you two dates approximately four to six days apart to give your body ample time to recover from the first surgery to the next. You'll need to arrange to stay in Costa Rica at the recovery facility for two weeks after your second surgery.

6. How soon after a facelift can I get dental work done?

No less than 10 days, and of course, depending on how you're feeling. The optimal way to combine dental work with your plastic surgery is to arrange to arrive in Costa Rica one or two days prior to your surgery.

Have Didi make an appointment for you with the dentist for the day you arrive in Costa Rica, and at that time the dentist will do the prep work for your porcelain crowns, inlays or veneers, mouth guard, teeth whitening, etc. Then, 10-13 days after your surgery, you can go back for your final appointment which is usually shorter in duration and less involved.

7. How long do I need to be away if I'm having a full facelift?

We strongly recommend that you plan on being away a total of fifteen days. You need to arrive in San Jose, Costa Rica the morning of the day before your surgery. Then the next day you have your surgery and you count fourteen days from your surgery day and that's when we recommend you return home.

As far as I'm concerned, the longer you can stay after the surgery, the better. The first weeks after surgery are crucial to the healing process. Also, anything that could possibly go wrong, seems to do so within the first week or two after surgery. If you are there, Dr. Lev can treat you and take care of your needs. Besides, when you go back home you will jump right back into your work or your daily life routine and that will definitely impinge upon your healing process.

8. Does Dr. Lev perform the "endoscopic" forehead surgery as opposed to the "open forehead" surgery?

Dr. Lev prefers the "open forehead" surgery. He feels the results are better and longer lasting. The incision is in the scalp and is covered with the hair. See the page on this website entitled "Classic brow lift vs. Endoscopic brow lift" for further details about this.

9. Does Dr. Lev do laser surgery?

No. He stopped using the laser several years ago because he says that the possibility of permanent discoloration of the skin is very high. Dr. Lev will not perform procedures that he doesn't personally believe will bring good results

10. Can I get a TCA Peeling at the same time as the facelift?

No. Dr. Lev says that it's not a good idea. Also, after the peeling, your skin will be very sensitive to sunlight.

11. Do you recommend that I use Arnica before and after the surgery?

No. Dr. Lev says that he has found that Arnica tends to interfere with platelet function. He recommends that people do not use it at all in conjunction with the surgery.

12. Can I have my pre-op tests in Costa Rica prior to surgery? How much would that cost?

Yes, you can have your pre-op blood tests and heart evaluation in Costa Rica and the cost is anywhere from $100-200. However, it is not recommended that you do this because, should there be a problem that presents itself, Dr. Lev will not perform the surgery and you will have wasted a trip to Costa Rica (although you could turn it into a vacation and tour the country in lieu of the surgery.)

It's much better to take your pre-op tests in your home city. These test results need to be faxed to Dr. Lev within one month of your surgery. Dr. Lev wants the tests to be taken no more than one month prior to your surgery so that they are current.

13. What will I look like after a facelift?

You will have a big Ace-type bandage wrapped around your head. It will be uncomfortable and will muffle your hearing because it covers your ears. Also, your ears will be very sensitive even though they are numb. A great deal of the surgery is done around the ears. You will see quite a bit of bruising and swelling and you will barely recognize yourself.

It will be a bit unsettling at first and then it will get worse the next day when the bruising gets a little worse. I like to think of the first three days after surgery as "the storm before the calm." I'll never forget those awful first few days post surgery. I was convinced that I'd never look like "myself" again. That I would be permanently disfigured.

It seems everybody goes through these Post Partum freak outs and everyone always gets over it and heals...completely..eventually. Some people heal faster than others. But almost everybody heals completely within six months to a year. I say "almost" because I suppose it's possible that in some rare instances, there are people who will take longer to heal, but I haven't seen that yet. I've been working with patients of Dr. Lev's for seven years and so far everyone has healed in less than one year.

Just as a side note,I'd like to say that even after eight years after my facelift, I do still have a slightly numb spot under my right ear. So, it is possible to be left with a little "memento" of your Costa Rica experience. But, for me...that is a small price to pay for the excellent result I still enjoy to this day.

14. Do the nurses speak English?

Most of the nurses speak some English. Also, you will have a private duty English speaking nurse at your side for twelve hours overnight when you are at the hospital. And if you are on a trip where I am there too, I will stay with you for the first few hours after your surgery, before the nurse arrives.

15. What happens after I leave the hospital?

The day after your surgery you will be picked up and taken back to your recovery retreat. There, the retreat staff will help you get settled in your room so you can rest. Your meals can be brought to you in your room until you are ready to come out and join the other "campers".

16. When do I get to see the doctor after the surgery?

Dr. Lev will come to the hospital to examine you and then release you the morning after your surgery. Then he will come to see you at the retreat for your post-op care every other day or so until you leave. If you are there without a group, on your own, Dr. Lev will come to the retreat less often. At the retreat he will examine you and remove your stitches.

17. What happens if a complication develops once I'm back home?

Well, it seems that the most common complaints that I have heard over the years from patients I've spoken with after they came home from Costa Rica has been either a stitch popping out after more of the swelling goes down or the possibility of keloiding of scars around the areas that were cut.

When I had a stitch reveal itself after about a month...in front of my left ear, Dr. Lev suggested that my daughter with the good eyes take a small scissors and a tweezer, sterilize the tips of each with alcohol and then carefully grasp the stitch with the tweezers and snip off the stitch.

As for the keloiding, well, I had that as well...that developed behind my right ear. There was a fold of skin behind my ear and it bothered me. I kept playing with it and just could not leave it alone. Finally, the next time I went down to Costa Rica with a group, Dr. Lev repaired the keloided scar right in his office under a local anesthetic.

But if you are back in your own home town, Dr. Lev suggests that you find a doctor in your area who would agree to see you post op. It's good to set this up before you go to Costa Rica, as it may be difficult to find a doctor who is willing to take on another doctor's post op patient.

It happens that I have been fortunate enough to finally find a doctor* in the L.A. area where I live who has agreed to see Dr. Lev's patients postop for stitch removal, tummy tuck drain removal and general postop exams. She is not a surgeon so for surgical repairs, your options are to either find a surgeon locally who will do the repair, or go back to Dr. Lev and he will do the repair for no charge. However, you still will have to pay for the flight, the hospital charge (if he can't fix the problem in his office) and the recovery facility where you'd probably have to stay for a few nights at the least.

*Dr. Caroline Pieszak, located at 960 So. Westlake Blvd. Suite 208 - Westlake Village, CA. 91361 - Ph. (805) 777-7242.

18. What if I'm a "picky" eater?

At the recovery retreat that we use for the patients (the Villa Plenitud,) the food is prepared fresh daily and is nutritious and really delicious. If you like fruit, you will be in fruit Heaven! If you have special dietary needs, make sure you tell Ron at the Villa Plenitud villaplenitud@gmail.com of those needs prior to your arrival.

If your specific dietary needs require special shopping and cooking, there will be an extra $10 a day charge. That's why you must discuss this when you speak with Ron at the Villa Plenitud in advance. Perhaps you could have that discussion at the same time you call to give them your deposit for your room reservation and also to notify them of your flight information so they know when to pick you up at the airport.

But as a "just in case," we do suggest to patients that they bring with them some snack foods that they love. Make sure they're wrapped and sealed tight. You don't want to attract bugs into your room. It's nice to have those snacks when you wake up in the middle of the night feeling like you need a little comfort food. Also, the rooms are equipped with a small fridge to keep your snacks cool and fresh.

19. What will I do all by myself all day at the Villa?

First of all, you won't be alone, especially if you are there with one of Didi's groups. You'll have the company of your fellow "campers". You can sit outside together visiting, reading, listening to music or just enjoying the beauty of the Costa Rican landscape. After a week to ten days, you and your new friends may decide to go into town and enjoy a little outing. In any event, you will never be alone, unless, of course, you want to be.

20. How do I get to Costa Rica and how long is the flight?

There are several airlines that travel to Costa Rica. Personally, for me...the best airline is Taca/Lacsa Airlines. At the present time, they are the only airline that offers a non-stop flight to San Jose, except over the Christmas holidays, when American Airlines offers a non-stop flight to Costa Rica from Los Angeles, where I live.

I much prefer a non-stop flight rather than to have to make a stopover and change planes.

21. How soon after a facelift can I color my hair?

Three to six weeks. If you have a forehead/brow lift you will want to wait closer to six weeks since you will not want to put harsh chemicals on your incisions too soon. Even if you just have a face and neck lift, you will still have incisions in your scalp and all around your ears. So, Dr. Lev recommends waiting the six weeks.

22. How soon can I exercise and do other "strenuous activity"?

Again, Dr. Lev says depending on the type of activity and how you are feeling, from three to six weeks. Listen to your body. It'll tell you when it's time to resume all your previous activities.

Dr. Lev always says to err on the conservative side.

23. What other medical procedures are available to me while I'm there for my plastic surgery?

I have made a great connection with dentists and a gastroenterologist there. The dentists, Dr. Telma Rubinstein and Josef Cordero, are a married couple and they do exceptional work. I've actually had people who did some dental work while they were there for their facelift and then went back again for more dental work later on.

They have a beautiful state of the art lab on the premises so they can charge a lot less. As an example, a full porcelain crown that normally costs around $1000 in the states costs $350 there and the procedure, from start to finish can take as little as five days. If you go down for a facelift, you would go in for your dental prep work the day before your surgery and then a couple of days before you return to the states you would be brought back to the dentists to complete the work (install the finished crown, get your whitening trays, etc.)

My husband and I have both had colonoscopies there with a wonderful gastroenterologist by the name of Dr. Henry Davidovich. The entire cost including doctor, anesthesiologist, hospital and prep meds cost $350-$400. It ended up being cheaper than it would have cost us in the states with insurance! Again, you would arrive in Costa Rica a couple of days before your surgery and have the colonoscopy done at that time.

In April 2002, while I was waiting for a patient to come up to the room from Recovery, I went down to the X-Ray dept and asked if they had a Bone Density machine. They said yes and that I could go right in and have it done and it would only take 20 minutes. Sure enough, twenty minutes later I was done and ten minutes after that they presented me with the re exact machine they used on me in Santa Monica where I paid over $200 out of pocket and had to wait three weeks for an appointment!

It cost me $36 at the Cima Hospital X-Ray Dept (No appt. necessary!!)

24. If I can't go when you go, can I go on my own and still get all the "Didi Perks"?

Absolutely yes. Whether I'm there or not, I will help you through the entire process from beginning to end. And you will get all the same perks you would get if I were there.

Also, you will be scheduled with at least one other person who would be your "buddy" so you wouldn't have to be alone. I have found that being with others who are going through the same thing is extremely beneficial and greatly enhances your experience.