Facial Rejuvenation

Aging can be a shockingly transformative experience. When you look in the mirror, you may not even recognize the face that looks back at you; the hollowed eyes, the furrowed wrinkles, the drooping cheekbones—a compounding deterioration that causes your confidence to sag along with your skin. What if there was a way to restore the face you love—and restore your confidence with it? At Carmel Valley Facial Plastic Surgery, we believe that the restorative and preventative measures taken through our Facial Rejuvenation programs can genuinely help you maintain the glow of youth—and the spirit that comes with it—far beyond what nature dictates. No one likes to look old—and now you don’t have to.

Our state–of–the–art Facial Rejuvenation program is designed to not only turn back the clock and restore your youthful appearance, but to also slow the clock down so you can truly age gracefully. Helping our patients manage the aging process effectively and restoring their vibrant, youthful look and spirit is our passion and practice mission. Our Comprehensive Facial Rejuvenation Program—which addresses all aspects of the face, rather than a single perceived “problem area”—leaves the face refreshed and natural–appearing. We have successfully treated thousands of patients from all around the world and helped them look as good and young as they feel. The key is our emphasis on a balanced and comprehensive restoration, which returns you to (or helps you maintain) your prime.

facial rejuvenation patient
Comprehensive Facial Rejuvenation: Short incision vertical facelift with extended neck lift, lateral brow lift, lower eyelid skin pinch, upper eyelid blepharoplasty, and full face fat transfer
before and after eye rejuvenation
Comprehensive Facial Rejuvenation: Short incision vertical facelift with extended neck lift, lateral brow lift, lower eyelid skin pinch, upper eyelid blepharoplasty, full face fat transfer and Jessner’s/35%TCA chemical peel.
before and after photo
Comprehensive Facial Rejuvenation: Short incision vertical facelift with extended neck lift, lateral brow lift, lower eyelid skin pinch, upper eyelid blepharoplasty, and full face fat transfer and Contour TRL full face Erbium:Yag laser resurfacing.
before and after eye rejuvenation procedure
Comprehensive Facial Rejuvenation: Short incision vertical facelift with extended neck lift, lateral brow lift, lower eyelid skin pinch, upper eyelid blepharoplasty, full face fat transfer and Jessner’s/35%TCA chemical peel.

Understanding the Emotional Side of the Facial Aging Process

Facial aging is an inevitable process that begins in your mid–30s, progresses through your ‘40s and slides rapidly downhill in your 50s, when significant changes occur to every aspect of your once–youthful face. For many, these changes create a discrepancy between the way a person views themselves in their mind and the way they look. Most people feel younger than their actual age. Often it’s the harsh reality of a photo that brings to light the shocking realization that we no longer look as youthful on the outside as we feel on the inside. With this realization comes a loss of self–confidence as our self–image begins to diminish; we’re brutally forced to reevaluate ourselves based on the seemingly inevitable results of aging. Your face transforms into an unrecognizable visage, one that’s tired and worn and ultimately less healthy. This affects the impressions we make socially, professionally and interpersonally, which further leads to a negative sense of self.

Looking youthful and fresh makes us feel more attractive and, to put it simply, better about ourselves. This is the number one reason why so many people seek Facial Rejuvenation procedures. The principle effect of the procedures is to make you feel better about yourself and boost your confidence and overall happiness. We not only restore your youthfulness—we restore your self–confidence.

Understanding the Physical Side of the Facial Aging Process

One of the most important parts of our Facial Rejuvenation program is the evaluation. Facial aging affects multiple parts of the face simultaneously. Even though everyone ages at different rates and magnitudes, there are patterns and parts of aging that we all have in common. A key part of the consultation process is thoroughly evaluating your face for its unique combinations, leading to personalized treatment recommendations.

We evaluate your face based on three areas of change:

  • Skin The body’s largest and most sensitive organ changes significantly with age: elasticity, thinning, discoloration, lines and wrinkles.
  • Volume As we age, facial fat begins to diminish throughout the face, leaving one looking tired, deflated and hollow.
  • Sagging This is what everyone thinks of when they think of aging. The loose skin around the upper and lower eyelids, the bags under the eyes, the sagging of the outer corner of the eyebrows, jawline and neck.

The combined changes are what we see and recognize as facial aging.

Our Unique Treatment Approach

Comprehensive Facial Rejuvenation

For over 10 years, Dr. Karam has recognized that in order to naturally rejuvenate the appearance of the face, you need to address all the components simultaneously. Otherwise, the face will look unbalanced and lack harmony. Imagine, for example, if you were to restore a 1970s kitchen but all you did was replace the cabinets and countertops—when you walked in, the kitchen would look odd. In order to avoid this, all the elements of the kitchen would have to be fully renovated and updated. This same concept applies to the face. If all the above mentioned areas of the face have aged, it’s necessary to treat all the aged areas together to create a harmonious, seamless and naturally rejuvenated outcome. This means you must treat the skin, replace the volume, lift the sagging muscles and remove the excess skin. With our Facial Rejuvenation programs, we systematically and simultaneously revive each problem area:

  • Skin Patients are treated with skin resurfacing (laser or chemical peel) to remove the damaged, dull and discolored skin in order establish a bright, luminous and healthy layer of new skin. To maintain and further enhance results, patients are started on a medical–grade skin care program. Forever Young BBLs are also used to further boost collagen and maintain clear, pigment–free skin.
  • Volume Depending on many factors, including feasible downtime and degree of loss, volume replacement choices can vary. For mild loss, injectable fillers are used; for more severe or broad volume loss, comprehensive fat transfer is used to replace the lost fat.
  • Sagging For each effected area a specific procedure is used:
  • Upper Eyes Loss and sagging of upper eyelid skin is reduced with an upper eyelid blepharoplasty, in which we remove the excess skin that has accumulated as part of the aging process. The incision is made along the upper eyelid crease and only unnecessary skin is removed so that there is no change to the shape of the eyes.
  • Lower Eyes Excess lower eyelid skin is removed with a skin pinch. If excess fat is present, causing lower eyelid “bags,” a lower eyelid blepharoplasty is used and is typically combined with a skin pinch.
  • Brows Drooping along the corners of the eyebrows leads to hooding of the upper eyelids. In these cases, a lateral brow lift is used to reposition the skin of the outer eyebrow and relieve the upper eyelid of the hooding. This is also combined frequently with our Short Incision Facelift in order to create a balanced and seamless look.
  • Jowls and Neck Laxity Sagging of the lower face is caused by loosening facial fascia (SMAS/muscle) and, as a result, the lax muscles need to be lifted and replaced to their original, pre–aged position. This is performed using our unique approach—the Short Incision Vertical Facelift (SI Lift for short) with a Neck Lift.

These two procedures address the excess fat under the chin and neck by removing the fat pad directly, tightening the neck muscle (platysma) and lifting the jowls. The key here is the natural vector of lift; lifting the face in a vertical direction leads to a naturally refreshed look—not pulled or tight.

When the face and neck are lifted and the facial contours are restored with fat transfer, the face once again takes on the youthful, heart shape that is so important. Fullness in the upper face, tapering down to a soft oval in the lower face, is the structural change we aim to achieve.

The moment you invest in a procedure like a facelift or eyelid lift, you dramatically slow the way that area will age forever. The effects can last for decades, meaning that your procedure is not only restorative, but preventative, as well. We also suggest a specific skincare regiment for our patients, including skincare products and treatment plans with lasers or peels designed to increase collagen and skin thickness and continue to combat skin thinning and aging. When you begin a Facial Rejuvenation program, you’re choosing to change the way your face ages forever.

Many of our patients choose to invest in our Facial Rejuvenation programs as a purely preventative measure. In your 30s and 40s, the signs of aging are minimal—but why not stop them in their tracks? We address each of the subtle changes of aging as they come along, resulting in a face that never ages—the first instances of “forever young.”

The ultimate goal is to reestablish a refreshed, rejuvenated look free of any stigma of plastic surgery. You’ll look revitalized, youthful and confident—and no one will suspect a thing.

Facial Rejuvenation Procedures

Our Facial Rejuvenation Program can include a variety of procedures, including:

Is Facial Rejuvenation Right for Me?

Our comprehensive Facial Rejuvenation program could be right for you if you’re looking to:

  • Eliminate sagging in the entire facial region, especially around the eyes, brows and neck
  • Eradicate dark circles, jowls and under eye bags
  • Remove excess skin
  • Restore facial volume
  • Recover youthful luminousness and tightness
  • Eliminate wrinkles like crow’s feet, age spots and other skin imperfections
  • Feel like your best, most confident self

Advantages of Facial Rejuvenation

  • Natural–looking results
  • Direct treatment of the change resulting from aging
  • No harsh change in appearance, look or identity
  • Short recovery
  • Minimal to no discomfort
  • Long–lasting results (5–10+ years)
  • Large variety of procedures and treatments to choose from
  • Prevents future aging

Procedures and Anesthesia

For non–surgical procedures, patients our treated in the Carmel Valley Facial Plastic Surgery clinics, where our trained and knowledgable staff, including our patient coordinator, medical assistants, nurses and Dr. Karam, deliver the highest level of care. Our surgical patients are treated in our certified and accredited Carmel Valley Surgical Center, which is located conveniently within the same suite. Patients usually perform their procedures under local anesthesia with IV sedation. Although general anesthesia is an option, most patients prefer the safety and convenience of IV sedation.


Recovery varies based on your procedural choices, but is primarily related to swelling. Bruising is not commonly seen in our patients, although it is a possibility. The typical recovery takes between 10–14 days. We recommend planning two weeks off of work or social engagements to allow sufficient time to heal. Although healing is not completely finished by two weeks, most patients are sufficiently healed and can return to work and other occasions. Minor swelling continues to improve steadily for up to one year following the procedures. Exercise is resumed be-tween three to four weeks following surgery, depending on the nature of the activity and the degree of swelling involved.

What to Expect: Results

There are a variety of positive results you can expect from your Facial Rejuvenation, including:

  • Restoration of a youthful and healthy appearance
  • Recovery of your original facial volume
  • Elimination of excess skin, dark spots, bags and sagging
  • Natural–looking results that leave you feeling confident and happy
  • Long–lasting outcomes that help prevent future aging

Why Choose Dr. Karam

Few surgeons in the world have devoted their careers to such a narrow focus of Facial Rejuvenation. Unlike other plastic surgeons, Dr. Karam’s devotion to the face—rather than the entire body—makes him a true expert in his chosen field through both experience and education. His experience is incomparable; he performs over 3500 non-surgical procedures per year; 1500 facial surgical procedures per year, including over 250 facelifts, over 150 rhinoplasty procedures, over 350 eye rejuvenation treatments and over 350 fat transfers, far exceeding other surgeons. He is also in the top 3% of injectable practitioners in the entire US and is one of the nation’s rare experts in fat transfer; very few surgeons have developed the skills necessary to perform comprehensive facial fat transfer.

Throughout his time in practice, Dr. Karam has become an innovative force in the world of facial plastic surgery, pioneering multiple procedures and combinations. His mastery of his art is so great that he wrote the fundamental textbook Rejuvenation of the Aging Face on the subject, along with dozens of book chapters and research articles. He consistently receives awards and accolades for his work, as well as public recognition and laudation in publications and magazines, including winning Best Cosmetic Surgeon in San Diego seven times by public voting.

Double Board Certified by the American Board of Facial Plastic and Reconstructive Surgery and the American Board of Otolaryngology, patients fly in from around the country for advanced techniques. Dr. Karam has successfully treated thousands of patients from around the world using his state–of–the–art approach. Over his years in practice, he has consistently maintained an extremely low complication rate, and the occasions of surgical revisions are incredibly rare. The outcome in every case is the same: natural–looking, youthful results. His artistic eye, excellent technique and inherent amiability make him the best possible choice for your facial plastic surgery and Facial Rejuvenation.

Planning Your Consultation

During the consultation, your expectations will be discussed and a personalized treatment plan will be proposed after careful examination and discussion of your goals. Depending on the extent of facial aging and the patient’s readiness to perform the procedures, the timing of the procedure will be decided. In general, the earlier the better. The advantages of performing the surgery sooner are that the changes are less dramatic and more subtle, and the results last longer. More and more patients are utilizing these procedures as a way to maintain their appearance and prevent aging.

To discuss arranging your own consultation, please call 858–259–3223 or send an email inquiry.

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