@galaxygrrl I followed the expertise for DS, at the time Ungson which became Esquerra by the time of my surgery. I did contemplate Costa Rica for PS. But I did not want to spend 2 weeks there recuperating in a motel/recup center and then fly all the way back and be totally on my own. (My family was not on board with me spending 2 weeks so far away.) Here, I can spend the night in the hospital and fully recuperate in my home with a private duty nurse. Next if there was a complication during the two weeks i was still in CR, they would fix it but once I returned to USA I was on my own. I have complication insurance here for my PS, and if a month or two from now I discover one butt cheek higher than the other, he will fix it. Furthermore, I did not want to do all my surgeries at once -- too long being unconscious for someone my age (and many docs would argue for someone of any age -- <5 hours is recommended). So that would mean at least two and possibly three trips to Costa Rica. Finally, there are aesthetics in PS unlike DS, and I was not sure I could communicate my aesthetic to someone who was not a native English speaker. Going local just made more sense and actually the price was not all that bad. My LBL will be $14k - which includes overnight hospital stay, pre-op testing, anesthesiologist, surgeon's fee.