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A new paradigm in facial rejuvenation

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.

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.


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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 through the use of our Vertical Restore ™ technique and remove the excess skin.

Pure Renewal, Dr. Karam

Before Surgery

Pure Renewal, Dr. Karam

After upper/lower eyelid surgery

Pure Renewal, Dr. Karam

After Vertical Restore & Fat Transfer

The full magical restoration of facial rejuvenation only comes about through a combined approach with eye rejuvenation and Vertical Restore.

With our Facial Rejuvenation programs, we systematically and simultaneously revive each problem area:


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.


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.

Discover Our Latest Innovative Procedure in Facial Rejuvenation:

Vertical Restore

While most surgeons will discuss options for a traditional Facelift and Necklift, Dr. Karam's unique approach to addressing the signs of aging and turning back the clock has resulted in a new paradigm for facial rejuvenation called the Vertical Restore™

One simple look at the results from Vertical Restore indicates the advancement this procedure has made over the traditional Facelift and Necklift.

Learn More

A Patients Journey



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For each effected area a specific procedure is used:

Upper eyes

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.


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 of a Vertical Restore™ which address the upper face, midface, cheeks and neck.

The neck lift procedure removes fat from under the skin as well as tightens the neck muscle. This procedure also removes any fat along other bulky structures in the neck region that may cause the neck to look heavy or unshapely.

Once the tissue under the muscle has been removed, we then trim and fold the excess muscle that has gotten longer with age. This is done through suturing/folding it together at the midline, which creates a durable and stable neck. This is further improved by the vertical lifting from above: the loose excess skin is removed both behind the ear and from above, leaving the neck significantly smoother.

Dr. Karam applies a deep plane approach to address the jawlines and midface, which releases the various facial ligaments holding the face in its aged position. The release procedure is important, without it, you are limited by how much repositioning can be achieved as well as durability.

The other benefit is the healing occurs quite a bit faster as it is not interfering or disrupting the relationship between the fascia (a think sheath of fibrous tissue enclosing a muscle or other organ) or the skin.

The Vertical Restore™ is one of those difficult and advanced procedures, but after 10 years, this procedure has been a hugely beneficial addition to the world of cosmetic surgery. The results not only last longer, but it also restores the position of the midface, lifts the neck, helps the nasolabial folds and smoothens the jawline.

The outer brow is addressed simultaneously. The approach that Dr. Karam has been using is not a brow lift – he doesn’t believe patients need browlifts. Aside from 1/3rd of the brow, the rest of the brow doesn’t sag. So, knowing this, why get a brow lift procedure that lifts the entire brow? Dr. Karam’s answer is you shouldn’t get a brow lift because, when you do, your face ends up having a surprised or entirely different look.. Having that restored and refreshed look is the goal. Dr. Karam applies a very minimally invasive approach to reposition just the tail of the brow back to its original spot. For woman, this is just above the orbital rim. In men, it is at the orbital rim. This procedure never has an extreme outcome and always looks natural, which is what patients are looking for.

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:

  • Vertical Restore
  • Vertical Prevent
  • Fat transfer
  • Upper blepharoplasty
  • Lower eyelid blepharoplasty
  • Lower eyelid skin pinch
  • Skin Resurfacing (laser or chemical peel)

The new paradigm in facial rejuvenation

This field has advanced tremendously in the last 20 years. Until recently, when a patient walked into a plastic surgeon’s office, they were offered surgery and nothing else. The surgical approaches were deeply invasive and the recovery took months.

Often as a result of overly aggressive surgical approaches to rejuvenate the eyes, forehead, cheeks and neck, patients ended up looking distorted, pulled and unnatural.

Unfortunately, many prospective patients today still have a vivid memory of these faces and they think twice about having facial surgery to refresh and rejuvenate their look. Who can blame them?

Today, things have changed dramatically. In the hands of a modern and well-trained facial plastic surgeon, dramatic yet natural-appearing results can be achieved using a variety of advanced, minimally-invasive approaches, such as micro fat transfer, short-scar vertical facelifts, or skin resurfacing. In our practice, patients are offered a choice of local anesthesia or general anesthesia.

With the availability of these tools, the artistry of the field has improved. Patients are offered a range of procedures that can produce subtle to substantial changes in their facial appearance. The net result of the new paradigm is less downside but a much higher upside with respect to a natural rejuvenation and restoration of facial youth.

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 changes 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


For non-surgical procedures, patients are treated in the Carmel Valley Facial Plastic Surgery clinics, where our trained and knowledgeable 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. Our San Diego patients usually undergo 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 and 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 between three to four weeks following surgery, depending on the nature of the activity and the degree of swelling involved.


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 authority in his chosen field through both experience and education.

His experience is incomparable; he performs over 1,500 facial surgical procedures per year, including over 250 facelifts, 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 leaders in fat transfer; very few surgeons have developed the skills necessary to perform comprehensive facial fat transfer.

Throughout his time in practice in San Diego, 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, the doctor has patients fly in from around the country for his 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.

The consultation – Your gateway to well-being

A major part of the consultation process is to first elucidate what your concerns are, then formulate a unique and comprehensive treatment plan, followed with a thorough understanding of the rationale, pros/cons, and expected outcome.

Patients leave the consultation feeling very well-informed and comfortable with the treatment plan. The goal is to make the process understandable, simple, and ultimately successful. My general approach has always been based on getting the best results in the safest, most effective, and most natural-looking way.

To achieve this, each patient is evaluated based on skin quality, facial volume status, and facial contour. In order to truly rejuvenate the face, often a combination of non-surgical and surgical approaches are designed to give you control of the aging process and once again leave you looking as young as you feel!

Dr. Karam, who is board certified by the American Board of Facial Plastic and Reconstructive Surgery and American Board of Otolaryngology, offers services in San Diego County including San Diego, Del Mar, Carlsbad, Carmel Valley, Encinitas, Rancho Bernardo and La Jolla in Southern California.

If you are ready to schedule an appointment with Dr. Karam, contact us today.

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