In yesterday’s interview with Dr. Miguel Alfaro of Costa Rica, he candidly noted that the number of plastic surgery patients coming to Costa Rica from outside the country is down by perhaps 15-20 percent in 2008. This should surprise no one, given the state of the economy in the United States. In fact, Costa Rican plastic and cosmetic surgeons are probably weathering the economic slowdown better than are their higher priced counterparts in the U.S. The American Society of Plastic Surgeons estimates that business is down more than 50 percent, according to CNN, as reported by the Business and Media Institute.